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Basseri S, Perlis N, Ghai S. Focal therapy for prostate cancer. Abdom Radiol (NY) 2024:10.1007/s00261-024-04482-7. [PMID: 39162800 DOI: 10.1007/s00261-024-04482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 08/21/2024]
Abstract
Traditional treatments for localized prostate cancer include radical prostatectomy or radiation therapy but pose challenges due to treatment related side effects, namely erectile dysfunction and urinary incontinence. In recent years, focal therapy has emerged as a viable treatment option for localized low-intermediate risk prostate cancer in carefully selected patients. Short and medium-term studies show acceptable cancer control outcomes and reduced morbidity when comparing focal therapy to whole gland treatment for prostate cancer, however there is paucity of long-term studies. Here we review focal ablative therapies commonly used, discuss the role of imaging in monitoring treatment, and summarize oncologic outcomes based on studies to date.
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Affiliation(s)
- Sana Basseri
- Division of Abdominal Radiology, Joint Department of Medical Imaging, University Health Network - Mt Sinai Hospital - Women's College Hospital - University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Division of Abdominal Radiology, Joint Department of Medical Imaging, University Health Network - Mt Sinai Hospital - Women's College Hospital - University of Toronto, Toronto, ON, Canada.
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Chen M, Liu W, Liu B. Cryoablation with KCl Solution Enhances Necrosis and Apoptosis of HepG2 Liver Cancer Cells. Ann Biomed Eng 2024; 52:2118-2133. [PMID: 38615077 DOI: 10.1007/s10439-024-03512-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
Cryoablation has become a valuable treatment modality for the management of liver cancer. However, one of the major challenges in cryosurgery is the incomplete cryodestruction near the edge of the iceball. This issue can be addressed by optimizing cryoablation parameters and administering thermotropic drugs prior to the procedure. These drugs help enhance tumor response, thereby strengthening the destruction of the incomplete frozen zone in liver cance. In the present study, the feasibility and effectiveness of a thermophysical agent, KCl solution, were investigated to enhance the cryodestruction of HepG2 human liver cancer cells. All cryoablation parameters were simultaneously optimized in order to significantly improve the effect of cryoablation, resulting in an increase in the lethal temperature from - 25 °C to - 17 °C. Subsequently, it was found that the application of KCl solution prior to freezing significantly decreased cell viability post-thaw compared to cryoablation treatment alone. This effect was attributed to the eutectic effect of KCl solution. Importantly, it was found that the combination of KCl solution and freezing was less effective when applied to LO2 human liver normal cells. The data revealed that the ratio of mRNA levels of Bcl-2 and bax decreased significantly more in HepG2 cells than in LO2 cells when cryoablation was used with KCl solution. In conclusion, the results of this study demonstrate the effectiveness of KCl solution in promoting cryoablation and describe a novel therapeutic model for the treatment of liver cancer that may distinguish between cancer and normal cells.
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Affiliation(s)
- Mu Chen
- Institute of Biothermal Science and Technology, University of Shanghai for Science and Technology, Shanghai, 200093, China
- Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai, 200093, China
- Shanghai Collaborative Innovation Center for Tumor Treatment with Energy, Shanghai, 200093, China
| | - Wei Liu
- Institute of Biothermal Science and Technology, University of Shanghai for Science and Technology, Shanghai, 200093, China
- Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai, 200093, China
- Shanghai Collaborative Innovation Center for Tumor Treatment with Energy, Shanghai, 200093, China
| | - Baolin Liu
- Institute of Biothermal Science and Technology, University of Shanghai for Science and Technology, Shanghai, 200093, China.
- Shanghai Technical Service Platform for Cryopreservation of Biological Resources, Shanghai, 200093, China.
- Shanghai Collaborative Innovation Center for Tumor Treatment with Energy, Shanghai, 200093, China.
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Moussa M, Alswang JM, Degerstedt SG, Honhart J, Abiola GO, Ramalingam V, Ahmed M. Utility of Intraoperative Neuromonitoring to Protect against Adjacent Nerve Injury in Musculoskeletal and Lymph Nodal Cryoablation. J Vasc Interv Radiol 2024:S1051-0443(24)00442-1. [PMID: 38964631 DOI: 10.1016/j.jvir.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
PURPOSE To demonstrate the utility of intraoperative neuromonitoring (IONM) as an effective method of passive thermoprotection against cryogenic injury to neural structures during musculoskeletal and lymph node cryoablation. MATERIAL AND METHODS Twenty-nine patients (16 men; mean age among men, 68.6 years [range, 45-90 years]; mean age among women, 62.6 years [range, 28-88 years]) underwent 33 cryoablations of musculoskeletal and lymph node lesions. Transcranial electrical motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) of target nerves were recorded throughout the ablations. Significant change was defined as waveform amplitude reduction greater than 30% (MEP) and 50% (SSEP). The primary outcomes of this study were immediate postprocedural neurologic deficits and frequency of significant MEP and SSEP amplitude reductions. RESULTS Significant amplitude reductions were detected in 54.5% (18/33) of MEP tracings and 0% (0/33) of SSEP tracings. Following each occurrence of significant amplitude reductions, freeze cycles were promptly terminated. Intraprocedurally, 13 patients had full recovery of amplitudes to baseline, 11 of whom had additional freeze cycles completed. In 5 of 33 (15.2%) cryoablations, there were immediate postprocedural neurologic deficits (moderate adverse events). Unrecovered MEPs conferred a relative risk for neurologic sequela of 23.2 (95% CI, 3.22-167.21; P < .001) versus those with recovered MEPs. All 5 patients had complete neurologic recovery by 12 months. CONCLUSIONS IONM (with MEP but not SSEP) is a reliable and safe method of passive thermoprotection of neurologic structures during cryoablation. It provides early detection of changes in nerve conduction, which when addressed quickly, may result in complete restoration of MEP signals within the procedure and minimize risk of cryogenic neural injury.
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Affiliation(s)
- Marwan Moussa
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | | | - Spencer G Degerstedt
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - John Honhart
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Godwin O Abiola
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Vijay Ramalingam
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
| | - Muneeb Ahmed
- Division of Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Santucci KL, Snyder KK, Van Buskirk RG, Baust JG, Baust JM. Investigation of Lung Cancer Cell Response to Cryoablation and Adjunctive Gemcitabine-Based Cryo-Chemotherapy Using the A549 Cell Line. Biomedicines 2024; 12:1239. [PMID: 38927445 PMCID: PMC11200978 DOI: 10.3390/biomedicines12061239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Due to the rising annual incidence of lung cancer (LC), new treatment strategies are needed. While various options exist, many, if not all, remain suboptimal. Several studies have shown cryoablation to be a promising approach. Yet, a lack of basic information pertaining to LC response to freezing and requirement for percutaneous access has limited clinical use. In this study, we investigated the A549 lung carcinoma cell line response to freezing. The data show that a single 5 min freeze to -15 °C did not affect cell viability, whereas -20 °C and -25 °C result in a significant reduction in viability 1 day post freeze to <10%. These populations, however, were able to recover in culture. Application of a repeat (double) freeze resulted in complete cell death at -25 °C. Studies investigating the impact of adjunctive gemcitabine (75 nM) pretreatment in combination with freezing were then conducted. Exposure to gemcitabine alone resulted in minimal cell death. The combination of gemcitabine pretreatment and a -20 °C single freeze as well as combination treatment with a -15 °C repeat freeze both resulted in complete cell death. This suggests that gemcitabine pretreatment may be synergistically effective when combined with freezing. Studies into the modes of cell death associated with the increased cell death revealed the increased involvement of necroptosis in combination treatment. In summary, these results suggest that repeat freezing to -20 °C to -25 °C results in a high degree of LC destruction. Further, the data suggest that the combination of gemcitabine pretreatment and freezing resulted in a shift of the minimum lethal temperature for LC from -25 °C to -15 °C. These findings, in combination with previous reports, suggest that cryoablation alone or in combination with chemotherapy may provide an improved path for the treatment of LC.
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Affiliation(s)
| | - Kristi K. Snyder
- CPSI Biotech, Owego, NY 13827, USA
- Phase Therapeutics, Inc., Owego, NY 13827, USA
| | - Robert G. Van Buskirk
- CPSI Biotech, Owego, NY 13827, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY 13902, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY 13902, USA
| | - John G. Baust
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY 13902, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY 13902, USA
| | - John M. Baust
- CPSI Biotech, Owego, NY 13827, USA
- Phase Therapeutics, Inc., Owego, NY 13827, USA
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Jiang W, Lee S, Caruana D, Zhuang KD, Cazzato R, Latich I. Recent Advances in Minimally Invasive Management of Osteolytic Periacetabular Skeletal Metastases. Semin Intervent Radiol 2024; 41:154-169. [PMID: 38993598 PMCID: PMC11236455 DOI: 10.1055/s-0044-1787165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Sangmin Lee
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
| | - Dennis Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Roberto Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
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Al-Assam H, Botchu R, Azzopardi C, Stevenson JD, James SL, Patel A. Measurement Analysis of Ice Ball Size during CT-Guided Cryoablation Procedures for Better Prediction of Final Ice Ball Size and Avoidance of Complications. Indian J Radiol Imaging 2023. [DOI: 10.1055/s-0043-1764466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Abstract
Introduction Cryoablation is the destruction of living tissue by the application of extreme freezing temperature. There has been an increase in the use of cryoablation in the management of musculoskeletal lesions, in particular fibromatosis.
Aim This study aimed to measure the average and relative increase in size of the cryoablation ice ball after the first (10 minutes) and second freeze cycles (20 minutes) to accurately predict the size of the ice ball between first and second freezes to help prevent any unwanted damage of the nearby skin and neurovascular structures. This is especially important when ablating in relatively small body parts such as in the appendicular skeleton.
Material and Methods Eight patients treated with cryoablation over a 12-month period for fibromatosis were, included in the study. The size and volume of the ice ball were measured during the first and second cycle of cryoablation.
Results The average patient age of the cohort was 35.6 years old (min 28 and max 43). There was female predominance in the study (3:2, F:M). There was a significant increase (26%) in the linear dimensions and almost doubling in the volume of the ice ball between freeze cycles (p-value = 0.0037 for dimensions and p-value = 0.0002 for volumes).
Conclusion This pilot study is a preliminary attempt to predict the eventual size of the ice ball during cryoablation procedures when treating cases of fibromatosis. This should help in planning cryoablation to ensure decrease morbidity by preventing injury to adjacent critical structures (neurovascular bundle and skin).
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Affiliation(s)
- Hayder Al-Assam
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Rajesh Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Christine Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | | | - Steven L. James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
| | - Anish Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, United Kingdom
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Computed Tomography Evaluation of In Vivo Pulmonary Cryoablation Zone Sizes. J Vasc Interv Radiol 2022; 33:1391-1398. [PMID: 35940364 DOI: 10.1016/j.jvir.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate ablation zone sizes in patients undergoing pulmonary tumor cryoablation with 14-gauge cryoablation probes. MATERIALS AND METHODS A single-center retrospective analysis of all consecutive patients who underwent cryoablation of pulmonary tumors with 1 or more 14-gauge probes (August 2017 to June 2020) was performed. Intraprocedural and 1-2-month postprocedural chest computed tomography (CT) scans were evaluated to characterize pulmonary lesions, ice balls, and ablation zones. Single-probe 14-gauge ablation zone volumes were compared with manufacturer reference isotherms and single- and 2-probe ablation zones from a prior investigation of 17-gauge probes. Overall survival and local recurrence-free survival were calculated to 3 years. RESULTS Forty-seven pulmonary malignancies in 42 patients (women, 50%; mean age, 75.2 years ± 11.5) underwent cryoablation with 1 (n = 35), 2 (n = 10), or 3 (n = 2) cryoablation probes. One- to 2-month follow-up CT images were available for 30 of the 42 patients. The mean cryoablation zone volumes at 1-2 months when 1 (n = 21), 2 (n = 8), and 3 (n = 1) probes were used were 5.0 cm3 ± 2.3, 37.5 cm3 ± 20.5, and 28.4 cm3, respectively. The mean single-probe follow-up ablation zone volume was larger than that previously reported for 17-gauge probes (3.0 cm3 ± 0.3) (P < .001) but smaller than manufacturer-reported isotherms (11.6 cm3 for -40 °C isotherm) and the 2-probe ablation zone volume with 17-gauge devices (12.9 cm3 ± 2.4) (for all, P < 001). The 3-year overall survival and local recurrence-free survival were 69% (95% confidence interval [CI], 53%-89%) and 87% (95% CI, 74%-100%), respectively. CONCLUSIONS Fourteen-gauge probes generate larger ablation volumes than those generated by 17-gauge probes. Manufacturer-reported isotherms are significantly larger than actual cryoablation zones. Cryoablation can attain low rates of local recurrence.
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An In Vitro Investigation into Cryoablation and Adjunctive Cryoablation/Chemotherapy Combination Therapy for the Treatment of Pancreatic Cancer Using the PANC-1 Cell Line. Biomedicines 2022; 10:biomedicines10020450. [PMID: 35203660 PMCID: PMC8962332 DOI: 10.3390/biomedicines10020450] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023] Open
Abstract
As the incidence of pancreatic ductal adenocarcinoma (PDAC) continues to grow, so does the need for new strategies for treatment. One such area being evaluated is cryoablation. While promising, studies remain limited and questions surrounding basic dosing (minimal lethal temperature) coupled with technological issues associated with accessing PDAC tumors and tumor proximity to vasculature and bile ducts, among others, have limited the use of cryoablation. Additionally, as chemotherapy remains the first-line of attack for PDAC, there is limited information on the impact of combining freezing with chemotherapy. As such, this study investigated the in vitro response of a PDAC cell line to freezing, chemotherapy, and the combination of chemotherapy pre-treatment and freezing. PANC-1 cells and PANC-1 tumor models were exposed to cryoablation (freezing insult) and compared to non-frozen controls. Additionally, PANC-1 cells were exposed to varying sub-clinical doses of gemcitabine or oxaliplatin alone and in combination with freezing. The results show that freezing to −10 °C did not affect viability, whereas −15 °C and −20 °C resulted in a reduction in 1 day post-freeze viability to 85% and 20%, respectively, though both recovered to controls by day 7. A complete cell loss was found following a single freeze below −25 °C. The combination of 100 nM gemcitabine (1.1 mg/m2) pre-treatment and a single freeze at −15 °C resulted in near-complete cell death (<5% survival) over the 7-day assessment interval. The combination of 8.8 µM oxaliplatin (130 mg/m2) pre-treatment and a single −15 °C freeze resulted in a similar trend of increased PANC-1 cell death. In summary, these in vitro results suggest that freezing alone to temperatures in the range of −25 °C results in a high degree of PDAC destruction. Further, the data support a potential combinatorial chemo/cryo-therapeutic strategy for the treatment of PDAC. These results suggest that a reduction in chemotherapeutic dose may be possible when offered in combination with freezing for the treatment of PDAC.
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Condino S, Cutolo F, Cattari N, Colangeli S, Parchi PD, Piazza R, Ruinato AD, Capanna R, Ferrari V. Hybrid Simulation and Planning Platform for Cryosurgery with Microsoft HoloLens. SENSORS 2021; 21:s21134450. [PMID: 34209748 PMCID: PMC8272062 DOI: 10.3390/s21134450] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/16/2022]
Abstract
Cryosurgery is a technique of growing popularity involving tissue ablation under controlled freezing. Technological advancement of devices along with surgical technique improvements have turned cryosurgery from an experimental to an established option for treating several diseases. However, cryosurgery is still limited by inaccurate planning based primarily on 2D visualization of the patient’s preoperative images. Several works have been aimed at modelling cryoablation through heat transfer simulations; however, most software applications do not meet some key requirements for clinical routine use, such as high computational speed and user-friendliness. This work aims to develop an intuitive platform for anatomical understanding and pre-operative planning by integrating the information content of radiological images and cryoprobe specifications either in a 3D virtual environment (desktop application) or in a hybrid simulator, which exploits the potential of the 3D printing and augmented reality functionalities of Microsoft HoloLens. The proposed platform was preliminarily validated for the retrospective planning/simulation of two surgical cases. Results suggest that the platform is easy and quick to learn and could be used in clinical practice to improve anatomical understanding, to make surgical planning easier than the traditional method, and to strengthen the memorization of surgical planning.
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Affiliation(s)
- Sara Condino
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
- Correspondence:
| | - Fabrizio Cutolo
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
| | - Nadia Cattari
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Simone Colangeli
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Paolo Domenico Parchi
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Roberta Piazza
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Alfio Damiano Ruinato
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (N.C.); (R.P.); (A.D.R.)
| | - Rodolfo Capanna
- Orthopaedic and Traumatology Division, Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, 56124 Pisa, Italy; (S.C.); (P.D.P.); (R.C.)
| | - Vincenzo Ferrari
- Information Engineering Department, University of Pisa, 56126 Pisa, Italy; (F.C.); (V.F.)
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Rieder C, Schwenke M, Pätz T, Georgii J, Ballhausen H, Schwen LO, Haase S, Preusser T. Evaluation of a numerical simulation for cryoablation - comparison with bench data, clinical kidney and lung cases. Int J Hyperthermia 2021; 37:1268-1278. [PMID: 33198534 DOI: 10.1080/02656736.2020.1845402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The accuracy of a numerical simulation of cryoablation ice balls was evaluated in gel phantom data as well as clinical kidney and lung cases. MATERIALS AND METHODS To evaluate the accuracy, 64 experimental single-needle cryoablations and 12 multi-needle cryoablations in gel phantoms were re-simulated with the corresponding freeze-thaw-freeze cycles. The simulated temperatures were compared over time with the measurements of thermocouples. For single needles, temperature values were compared at each thermocouple location. For multiple needles, Euclidean distances between simulated and measured isotherms (10 °C, 0 °C, -20 °C, -40 °C) were computed. Furthermore, surface and volume of simulated 0 °C isotherms were compared to cryoablation-induced ice balls in 14 kidney and 13 lung patients. For this purpose, needle positions and relevant anatomical structures defining material parameters (kidney/lung, tumor) were reconstructed from pre-ablation CT images and fused with postablation CT images (from which ice balls were extracted by manual delineation). RESULTS The single-needle gel phantom cases showed less than 5 °C prediction error on average. Over all multiple needle experiments in gel, the mean and maximum isotherm distance were less than 2.3 mm and 4.1 mm, respectively. Average Dice coefficients of 0.82/0.63 (kidney/lung) and mean surface distances of 2.59/3.12 mm quantify the prediction performance of the numerical simulation. However, maximum surface distances of 10.57/10.8 mm indicate that locally larger errors have to be expected. CONCLUSION A very good agreement of the numerical simulations for gel experiments was measured and a satisfactory agreement of the numerical simulations with measured ice balls in patient data was shown.
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Affiliation(s)
- Christian Rieder
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Michael Schwenke
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Joachim Georgii
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Hanne Ballhausen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Lars Ole Schwen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Sabrina Haase
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Tobias Preusser
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
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Moreira P, Tuncali K, Tempany CM, Tokuda J. The Impact of Placement Errors on the Tumor Coverage in MRI-Guided Focal Cryoablation of Prostate Cancer. Acad Radiol 2021; 28:841-848. [PMID: 32863151 PMCID: PMC7910318 DOI: 10.1016/j.acra.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES There have been multiple investigations defining and reporting the effectiveness of focal cryoablation as a treatment option for organ-confined prostate cancer. However, the impact of cryo-needle/probe placement accuracy within the tumor and gland has not been extensively studied. We analyzed how variations in the placement of the cryo-needles, specifically errors leading to incomplete ablation, may affect prostate cancer's resulting cryoablation. MATERIALS AND METHODS We performed a study based on isothermal models using Monte Carlo simulations to analyze the impact of needle placement errors on tumor coverage and the probability of positive ablation margin. We modeled the placement error as a Gaussian noise on the cryo-needle position. The analysis used retrospective MRI data of 15 patients with biopsy-proven, unifocal, and MRI visible prostate cancer to calculate the impact of placement error on the volume of the tumor encompassed by the -40°C and -20°C isotherms using one to four cryo-needles. RESULTS When the standard deviation of the placement error reached 3 mm, the tumor coverage was still above 97% with the -20°C isotherm, and above 81% with the -40°C isotherm using two cryo-needles or more. The probability of positive margin was significantly lower considering the -20°C isotherm (0.04 for three needles) than using the -40°C isotherm (0.66 for three needles). CONCLUSION The results indicated that accurate cryo-needle placement is essential for the success of focal cryoablation of prostate cancer. The analysis shows that an admissible targeting error depends on the lethal temperature considered and the number of cryo-needles used.
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Affiliation(s)
- Pedro Moreira
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA.
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA
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Kim DK, Han K, Won JY, Kim GM, Kwon JH, Kim MD. Percutaneous cryoablation in early stage hepatocellular carcinoma: analysis of local tumor progression factors. ACTA ACUST UNITED AC 2020; 26:111-117. [PMID: 32071029 DOI: 10.5152/dir.2019.19246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness and safety of percutaneous cryoablation (PC) for early or very early stage hepatocellular carcinoma (HCC) and assess the risk factors for local tumor progression (LTP) after PC. METHODS A total of 45 treatment-naïve patients treated with PC for early or very early stage HCCs were included in this retrospective study. The safety of PC was assessed by evaluating procedure-related complications and comparing hepatic function before and after the procedure. The effectiveness was assessed by evaluating technical success, LTP rates, and disease progression (DP) rates. Prognostic factors associated with LTP after PC were also analyzed. RESULTS Technical success and complete response were achieved in all patients (100%) by 1 month after PC. During a mean of 28.1±15.6 months of follow-up, the incidences of LTP and DP were 11.1% and 37.8%, respectively. The LTP-free and DP-free survival rates were 93.3% and 84.4% at 1 year and 88.9% and 62.2% at 2 years, respectively. Hepatic function was normalized within 3 months after PC. There were no major complications and only one minor complication of small hematoma. On univariate and multivariate analysis, minimal ablative margin <5 mm was the only significant risk factor associated with LTP. CONCLUSION PC is a safe and effective therapy for patients with early or very early stage HCC. Minimal ablative margin <5 mm was a significant prognostic factor for LTP.
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Affiliation(s)
- Dong Kyu Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
| | - Kichang Han
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
| | - Jong Yun Won
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
| | - Gyoung Min Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
| | - Joon Ho Kwon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
| | - Man Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University School of Medicine, Seoul, Korea
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Snyder KK, Van Buskirk RG, Baust JG, Baust JM. Breast Cancer Cryoablation: Assessment of the Impact of Fundamental Procedural Variables in an In Vitro Human Breast Cancer Model. Breast Cancer (Auckl) 2020; 14:1178223420972363. [PMID: 33239880 PMCID: PMC7672727 DOI: 10.1177/1178223420972363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prominent form of cancer and the second leading cause of death in women behind lung cancer. The primary modes of treatment today include surgical excision (lumpectomy, mastectomy), radiation, chemoablation, anti-HER2/neu therapy, and/or hormone therapy. The severe side effects associated with these therapies suggest a minimally invasive therapy with fewer quality of life issues would be advantageous for treatment of this pervasive disease. Cryoablation has been used in the treatment of other cancers, including prostate, skin, and cervical, for decades and has been shown to be a successful minimally invasive therapeutic option. To this end, the use of cryotherapy for the treatment of breast cancer has increased over the last several years. Although successful, one of the challenges in cryoablation is management of cancer destruction in the periphery of the ice ball as the tissue within this outer margin may not experience ablative temperatures. In breast cancer, this is of concern due to the lobular nature of the tumors. As such, in this study, we investigated the level of cell death at various temperatures associated with the margin of a cryogenic lesion as well as the impact of repetitive freezing and thawing methods on overall efficacy. METHODS Human breast cancer cells, MCF-7, were exposed to temperatures of -5°C, -10°C, -15°C, -20°C, or -25°C for 5-minute freeze intervals in a single or repeat freeze-thaw cycle. Samples were thawed with either passive or active warming for 5 or 10 minutes. Samples were assessed at 1, 2, and 3 days post-freeze to assess cell survival and recovery. In addition, the modes of cell death associated with freezing were assessed over the initial 24-hour post-thaw recovery period. RESULTS Exposure of MCF-7 cells to -5°C and -10°C resulted in minimal cell death regardless of the freeze/thaw conditions. Freezing to a temperature of -25°C resulted in complete cell death 1 day post-thaw with no cell recovery in all freeze/thaw scenarios evaluated. Exposure to a single freeze event resulted in a gradual increase in cell death at -15°C and -20°C. Application of a repeat freeze-thaw cycle (dual 5-minute freeze) resulted in an increase in cell death with complete destruction at -20°C and near complete death at -15°C (day 1 survival: single -15°C freeze/thaw = 20%; repeated -15°C freeze/thaw = 4%). Analysis of thaw interval time (5 vs 10 minute) demonstrated that the shorter 5-minute thaw interval between freezes resulted in increased cell destruction. Furthermore, investigation of thaw rate (active vs passive thawing) demonstrated that active thawing resulted in increased cell survival thereby less effective ablation compared with passive thawing (eg, -15°C 5/10/5 procedure survival, passive thaw: 4% vs active thaw: 29%). CONCLUSIONS In summary, these in vitro findings suggest that freezing to temperatures of 25°C results in a high degree of breast cancer cell destruction. Furthermore, the data demonstrate that the application of a repeat freeze procedure with a passive 5-minute or 10-minute thaw interval between freeze cycles increases the minimal lethal temperature to the -15°C to -20°C range. The data also demonstrate that the use of an active thawing procedure between freezes reduces ablation efficacy at temperatures associated with the iceball periphery. These findings may be important to improving future clinical applications of cryoablation for the treatment of breast cancer.
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Affiliation(s)
| | - Robert G Van Buskirk
- CPSI Biotech, Owego, NY, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - John G Baust
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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14
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Seager M, Kumar S, Lim E, Munneke G, Bandula S, Walkden M. Renal cryoablation - a practical guide for interventional radiologists. Br J Radiol 2020; 94:20200854. [PMID: 32960674 DOI: 10.1259/bjr.20200854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Renal cryoablation is a treatment option for early stage renal cell carcinomas with excellent oncological outcomes and low morbidity. This review outlines the technique of renal cryoablation and provides a guide for interventional radiologists on setting up an integrated service within a renal cancer network multidisciplinary setting. Patient selection and preparation, together with the technical aspects which ensure optimal oncological outcomes and avoid collateral damage to adjacent organs are highlighted.
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Affiliation(s)
- Matthew Seager
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Shankar Kumar
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Emma Lim
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Graham Munneke
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
| | - Steve Bandula
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom.,Centre for Medical Imaging, University College London, London, UK
| | - Miles Walkden
- Interventional Oncology Service, University College Hospital, 235 Euston Road, NW1 2BU, London, United Kingdom
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15
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Baust JM, Robilotto A, Santucci KL, Snyder KK, Van Buskirk RG, Katz A, Corcoran A, Baust JG. Evaluation of a Novel Cystoscopic Compatible Cryocatheter for the Treatment of Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND: As the acceptance of cryoablative therapies for the treatment of non-metastatic cancers continues to grow, avenues for novel cryosurgical technologies and approaches have opened. Within the field of genitourinary tumors, cryosurgical treatments of bladder cancers remain largely investigational. Current modalities employ percutaneous needles or transurethral cryoballoons or sprays, and while results have been promising, each technology is limited to specific types and stages of cancers. OBJECTIVE: This study evaluated a new, self-contained transurethral cryocatheter, FrostBite-BC, for its potential to treat bladder cancer. METHODS: Thermal characteristics and ablative capacity were assessed using calorimetry, isothermal analyses, in vitro 3-dimensional tissue engineered models (TEMs), and a pilot in vivo porcine study. RESULTS: Isotherm assessment revealed surface temperatures below – 20°C within 9 sec. In vitro TEMs studies demonstrated attainment of ≤– 20°C at 6.1 mm and 8.2 mm in diameter following single and double 2 min freezes, respectively. Fluorescent imaging 24 hr post-thaw revealed uniform, ablative volumes of 326.2 mm3 and 397.9 mm3 following a single or double 2 min freeze. In vivo results demonstrated the consistent generation of ablative areas. Lesion depth was found to correlate with freeze time wherein 15 sec freezes resulted in ablation confined to the sub-mucosa and ≥30 sec full thickness ablation of the bladder wall. CONCLUSIONS: These studies demonstrate the potential of the FrostBite-BC cryocatheter as a treatment option for bladder cancer. Although preliminary, the outcomes of these studies were encouraging, and support the continued investigation into the potential of the FrostBite-BC cryocatheter as a next generation, minimally invasive cryoablative technology.
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Affiliation(s)
| | | | | | | | - Robert G. Van Buskirk
- CPSI Biotech, Owego, NY, USA
- Center for Translational Stem Cell and Tissue Engineering Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - Aaron Katz
- Department of Urology, NYU Winthrop Hospital, Mineola, NY, USA
| | | | - John G. Baust
- Center for Translational Stem Cell and Tissue Engineering Binghamton University, Binghamton, NY, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
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16
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Santucci KL, Baust JM, Snyder KK, Van Buskirk RG, Katz A, Corcoran A, Baust JG. Investigation of Bladder Cancer Cell Response to Cryoablation and Adjunctive Cisplatin Based Cryo/Chemotherapy. CLINICAL RESEARCH (MILPITAS, CALIF.) 2020; 6. [PMID: 35128225 PMCID: PMC8813088 DOI: 10.16966/2469-6714.154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Due to a rising annual incidence of bladder cancer, there is a growing need for development of new strategies for treatment. In 2018, the World Cancer Research Fund and other groups reported that there were ~550,000 new cases worldwide of bladder cancer. It has been further estimated that >200,000 individuals die annually from bladder cancer worldwide. Various treatment options exist. However, many if not all remain suboptimal. While the preferred chemotherapeutic options have changed in the past few years there have been few advances in the bladder cancer medical device field. Cryoablation is now being evaluated as a new option for the treatment of bladder cancer. While several studies have shown cryoablation to be promising for the treatment of bladder cancer, a lack of basic information pertaining to dosing (minimal lethal temperature) necessary to destroy bladder cancer has limited its use as a primary therapeutic option. Concerns with bladder wall perforation and other side effects have also slowed adoption. In an effort to detail the effects of freezing on bladder cancer, two human bladder cancer cell lines, SCaBER and UMUC3, were evaluated in vitro. SCaBER, a basal subtype of muscle invasive bladder cancer, and UMUC3, an intermediate transitional cell carcinoma, are both difficult to treat but are reportedly responsive to most conventional treatments. SCaBER and UMUC3 cells were exposed to a range of freezing temperatures from −10 to −25°C and compared to non-frozen controls. The data show that a single 5 minute freeze to −10°C did not affect cell viability, whereas −15°C and −20°C results in a significant reduction in viability 1 day post freeze to <20%. These populations, however, were able to recover in culture. A complete loss of cell viability was found following a single freeze at −25°C. Application of a repeat (double) freeze resulted in complete cell death at −20°C. In addition to freezing alone, studies investigating the impact of adjunctive low dose (1 μM) cisplatin pre-treatment (30 minutes and 24 hours) in combination with freezing were conducted. The combination of 30 minute cisplatin pre-treatment and mild (−15°C) freezing resulted in complete cell death. This suggests that subclinical doses of cisplatin may be synergistically effective when combined with freezing. In summary, these in vitro results suggest that freezing to temperatures in the range of −20 to 25°C results in a high degree of bladder cancer cell destruction. Further, the data describe a potential combinatorial chemo/cryo therapeutic strategy for the treatment of bladder cancer.
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Affiliation(s)
| | | | | | - Robert G Van Buskirk
- CPSI Biotech, Owego, USA.,Center for Translational Stem Cell and Tissue Engineering Binghamton University, USA.,Department of Biological Sciences, Binghamton University, USA
| | - Aaron Katz
- Department of Urology, NYU Winthrop Hospital, US
| | | | - John G Baust
- Center for Translational Stem Cell and Tissue Engineering Binghamton University, USA.,Department of Biological Sciences, Binghamton University, USA
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Tsoumakidou G, Mandralis K, Hocquelet A, Duran R, Denys A. Salvage Lymph-Node Percutaneous Cryoablation: Safety Profile and Oncologic Outcomes. Cardiovasc Intervent Radiol 2019; 43:264-272. [DOI: 10.1007/s00270-019-02341-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/06/2019] [Indexed: 12/14/2022]
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18
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Shah TT, Peters M, Miah S, Eldred-Evans D, Yap T, Hosking-Jervis F, Dudderidge T, Hindley RG, McCracken S, Greene D, Nigam R, Valerio M, Winkler M, Virdi J, Arya M, Ahmed HU, Minhas S. Assessment of Return to Baseline Urinary and Sexual Function Following Primary Focal Cryotherapy for Nonmetastatic Prostate Cancer. Eur Urol Focus 2019; 7:301-308. [PMID: 31590961 DOI: 10.1016/j.euf.2019.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/11/2019] [Accepted: 09/04/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The oncological outcomes in men with clinically significant prostate cancer following focal cryotherapy are promising, although functional outcomes are under-reported. OBJECTIVE To determine the impact of focal cryotherapy on urinary and sexual function, specifically assessing return to baseline function. DESIGN, SETTING, AND PARTICIPANTS Between October 2013 and November 2016, 58 of 122 men who underwent focal cryotherapy for predominantly anterior clinically significant localised prostate cancer within a prospective registry returned patient-reported outcome measure questionnaires, which included International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF-15) questionnaires. INTERVENTION Standard cryotherapy procedure using either the SeedNet or the Visual-ICE cryotherapy system. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was return to baseline function of IPSS score and IIEF erectile function (EF) subdomain. Cumulative incidence and Cox-regression analyses were performed. RESULTS AND LIMITATIONS Probability of returning to baseline IPSS function was 78% at 12 mo and 87% at both 18 and 24 mo, with recovery seen up to 18 mo. For IIEF (EF domain), the probability of returning to baseline function was 85% at 12 mo and 89% at both 18 and 24 mo, with recovery seen up to 18 mo. Only the preoperative IIEF-EF score was associated with a poor outcome (hazard ratio 0.96, 95% confidence interval 0.93-0.999, p = 0.04). The main limitation was that only half of the patients returned their questionnaires. CONCLUSIONS In men undergoing primary focal cryotherapy, there is a high degree of preservation of urinary and erectile function with return to baseline function occurring from 3 mo and continuing up to 18 mo after focal cryotherapy. PATIENT SUMMARY In men who underwent focal cryotherapy for prostate cancer, approximately nine in 10 returned to their baseline urinary and sexual function. Keeping in mind that level 1 evidence and long-term data are still needed, in men who wish to preserve urinary and sexual function, focal cryotherapy may be considered an alternative treatment option to radical therapy.
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Affiliation(s)
- Taimur T Shah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK.
| | - Max Peters
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Saiful Miah
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK
| | - David Eldred-Evans
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tet Yap
- Department of Urology, Guy's Hospital, Great Maze Pond, London, UK
| | - Feargus Hosking-Jervis
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Richard G Hindley
- Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, Basingstoke and North Hampshire Hospital, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
| | - Stuart McCracken
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Damian Greene
- Department of Urology, Sunderland Royal Hospital, Sunderland, UK
| | - Raj Nigam
- Department of Urology, Royal Surrey County Hospital NHS Trust, UK
| | - Massimo Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Mathias Winkler
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jaspal Virdi
- Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Manit Arya
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK; Division of Surgery and Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital (UCLH), UK; Department of Urology, The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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19
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Golkar E, Rao PP, Joskowicz L, Gangi A, Essert C. GPU-based 3D iceball modeling for fast cryoablation simulation and planning. Int J Comput Assist Radiol Surg 2019; 14:1577-1588. [PMID: 31407156 DOI: 10.1007/s11548-019-02051-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/05/2019] [Indexed: 02/01/2023]
Abstract
PURPOSE The elimination of abdominal tumors by percutaneous cryoablation has been shown to be an effective and less invasive alternative to open surgery. Cryoablation destroys malignant cells by freezing them with one or more cryoprobes inserted into the tumor through the skin. Alternating cycles of freezing and thawing produce an enveloping iceball that causes the tumor necrosis. Planning such a procedure is difficult and time-consuming, as it is necessary to plan the number and cryoprobe locations and predict the iceball shape which is also influenced by the presence of heating sources, e.g., major blood vessels and warm saline solution, injected to protect surrounding structures from the cold. METHODS This paper describes a method for fast GPU-based iceball modeling based on the simulation of thermal propagation in the tissue. Our algorithm solves the heat equation within a cube around the cryoprobes tips and accounts for the presence of heating sources around the iceball. RESULTS Experimental results of two studies have been obtained: an ex vivo warm gel setup and simulation on five retrospective patient cases of kidney tumors cryoablation with various levels of complexity of the vascular structure and warm saline solution around the tumor tissue. The experiments have been conducted in various conditions of cube size and algorithm implementations. Results show that it is possible to obtain an accurate result within seconds. CONCLUSION The promising results indicate that our method yields accurate iceball shape predictions in a short time and is suitable for surgical planning.
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Affiliation(s)
- Ehsan Golkar
- ICube, Université de Strasbourg, Strasbourg, France
- Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pramod P Rao
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Afshin Gangi
- Department of Radiology, University Hospital of Strasbourg, Strasbourg, France
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20
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Shah TT, Peters M, Eldred-Evans D, Miah S, Yap T, Faure-Walker NA, Hosking-Jervis F, Thomas B, Dudderidge T, Hindley RG, McCracken S, Greene D, Nigam R, Valerio M, Minhas S, Winkler M, Arya M, Ahmed HU. Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. Eur Urol 2019; 76:98-105. [DOI: 10.1016/j.eururo.2018.12.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 12/18/2018] [Indexed: 01/23/2023]
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21
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Reply to Zhipeng Mai's Letter to the Editor re: Taimur T. Shah, Max Peters, David Eldred-Evans, et al. Early-Medium-Term Outcomes of Primary Focal Cryotherapy to Treat Nonmetastatic Clinically Significant Prostate Cancer from a Prospective Multicentre Registry. Eur Urol 2019;76:98-105. Eur Urol 2019; 76:e63-e64. [PMID: 31153649 DOI: 10.1016/j.eururo.2019.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 11/22/2022]
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22
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de Marini P, Cazzato RL, Garnon J, Shaygi B, Koch G, Auloge P, Tricard T, Lang H, Gangi A. Percutaneous MR-guided prostate cancer cryoablation technical updates and literature review. BJR Open 2019; 1:20180043. [PMID: 33178928 PMCID: PMC7592492 DOI: 10.1259/bjro.20180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed.
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Affiliation(s)
- Pierre de Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Behnam Shaygi
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
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Zhou SR, Simopoulos DN, Jayadevan R, Felker ER, Delfin MK, Barsa DE, Kwan L, Marks LS. Use of MRI-Guided Biopsy for Selection and Follow-up of Men Undergoing Hemi-gland Cryoablation of Prostate Cancer. Urology 2019; 126:158-164. [PMID: 30659903 PMCID: PMC6698362 DOI: 10.1016/j.urology.2018.11.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate safety, efficacy, and quality of life impact of hemi-gland cryotherapy for clinically-significant prostate cancer (CaP), when patient selection and follow-up includes MRI-guided biopsy. METHODS Twenty-nine men with unilateral CaP (all clinically significant with prostate volume <60 cc) were enrolled in a prospective observational trial of hemi-gland cryotherapy. Mean patient age was 68.7 years. Median prostate-specific antigen (PSA) was 6.6 ng/mL. MRI-guided biopsy (3T-MRI, Artemis US fusion) was used for diagnosis and repeated at 6-month follow-up in all men. Treatment was under general anesthesia using the BTG/Galil system. Validated questionnaires were used to determine effects of treatment on urinary and sexual function and quality of life. RESULTS Cryotherapy was completed satisfactorily in all 29 cases in <60 minutes with no intraoperative complications. Significant decreases in PSA (median decrease 5.6 ng/mL) and PSA density (median decrease 0.14 ng/mL/cc) were observed (P < .01). At 6 months, 23 patients (79%) demonstrated no residual cancer on follow-up MRI-guided biopsy of the treated side. Three patients (10%) revealed micro-residual disease. Three patients (10%) had residual cancer and underwent further treatment. Ipsilateral MRI lesions were present before treatment in 26 patients and after treatment in only 2, reflecting the gross ablative effect; however, MRI showed disappearance of lesions in 4 patients with residual tumor on biopsy. The single complication was 1 case of transient urinary retention; 85% of men who were sexually active continued without change after treatment. Voiding function was unchanged. CONCLUSION Hemi-gland cryoablation for clinically-significant CaP is well-tolerated, and when patients are selected and followed by MRI/US fusion biopsy, cancer control appears promising at 6 months.
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Affiliation(s)
- Steve R Zhou
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Demetrios N Simopoulos
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Rajiv Jayadevan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Ely R Felker
- Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Merdie K Delfin
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Danielle E Barsa
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA.
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Pulmonary Cryoablation Zones: More Aggressive Ablation Is Warranted In Vivo. AJR Am J Roentgenol 2019; 212:195-200. [DOI: 10.2214/ajr.18.19527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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25
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Kim DK, Kwon JH, Won JY, Han K, Kim GM, Kim MD, Lee DY. Ablation Volume Measurement After Percutaneous Cryoablation Using a Two-cryo-probe Technique for Small Hepatocellular Carcinomas. Cardiovasc Intervent Radiol 2018; 42:220-229. [DOI: 10.1007/s00270-018-2084-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/19/2018] [Indexed: 12/25/2022]
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26
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Santucci KL, Baust JM, Snyder KK, Van Buskirk RG, Baust JG. Dose Escalation of Vitamin D 3 Yields Similar Cryosurgical Outcome to Single Dose Exposure in a Prostate Cancer Model. Cancer Control 2018; 25:1073274818757418. [PMID: 29480024 PMCID: PMC5933822 DOI: 10.1177/1073274818757418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Vitamin D3 (VD3) is an effective adjunctive agent, enhancing the destructive effects of freezing in prostate cancer cryoablation studies. We investigated whether dose escalation of VD3 over several weeks, to model the increase in physiological VD3 levels if an oral supplement were prescribed, would be as or more effective than a single treatment 1 to 2 days prior to freezing. PC-3 cells in log phase growth to model aggressive, highly metabolically active prostate cancer were exposed to a gradually increasing dose of VD3 to a final dose of 80 nM over a 4-week period, maintained for 2 weeks at 80 nM, and then exposed to mild sublethal freezing temperatures. Results demonstrate that both acute 24-hour exposure to 80 nM VD3 and dose escalation resulted in enhanced cell death following freezing at −15°C or colder, with no significant differences between the 2 exposure regimes. Apoptotic analysis within the initial 24-hour period postfreeze revealed that VD3 treatment induced both caspase 8- and 9-mediated cell death, most notably in caspase 8 at 8-hour postfreeze. These results indicate that both the intrinsic and extrinsic apoptotic pathways are involved in VD3 sensitization prior to freezing. Additionally, both acute and gradual dose escalation regimes of VD3 exposure increase prostate cancer cell sensitivity to mild freezing. Importantly, this study expands upon previous reports and suggests that the combination of VD3 and freezing may offer an effective treatment for both slow growth and highly aggressive prostate cancers.
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Affiliation(s)
- Kimberly L Santucci
- 1 Department of Biological Sciences, State University of New York at Binghamton, Binghamton, NY, USA.,2 Institute for Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,3 CPSI Biotech, Owego, NY, USA
| | - John M Baust
- 2 Institute for Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,3 CPSI Biotech, Owego, NY, USA
| | - Kristi K Snyder
- 2 Institute for Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,3 CPSI Biotech, Owego, NY, USA
| | - Robert G Van Buskirk
- 1 Department of Biological Sciences, State University of New York at Binghamton, Binghamton, NY, USA.,2 Institute for Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA.,3 CPSI Biotech, Owego, NY, USA
| | - John G Baust
- 1 Department of Biological Sciences, State University of New York at Binghamton, Binghamton, NY, USA.,2 Institute for Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA
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Focal Ablation of Early-Stage Prostate Cancer: Candidate Selection, Treatment Guidance, and Assessment of Outcome. Urol Clin North Am 2017; 44:575-585. [PMID: 29107274 DOI: 10.1016/j.ucl.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer lesions smaller than 0.5 m3, or Gleason pattern 3, are likely clinically insignificant. Clinically significant disease is often limited to a single index lesion. Focal ablation targets this index lesion, maintains oncological control, and minimizes complications by preserving healthy prostate tissue. Template mapping biopsy or multiparametric MRI-targeted biopsies are used to identify appropriate index lesions. Multiple energy modalities have been tested, including high-intensity frequency ultrasound, cryoablation, laser ablation, photodynamic therapy, focal brachytherapy, radiofrequency ablation, irreversible electroporation. Outcome is assessed by biopsy of the target area, triggered by prostate-specific antigen measurements or MRI imaging, or performed per protocol at 12 months.
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Joshi P, Sehrawat A, Rabin Y. Computerized Planning of Prostate Cryosurgery and Shape Considerations. Technol Cancer Res Treat 2017; 16:1272-1283. [PMID: 28731368 PMCID: PMC5762061 DOI: 10.1177/1533034617716041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The current study aims to explore possible relationships between various prostate shapes and the difficulty in creating a computer-based plan for cryosurgery. This research effort is a part of an ongoing study to develop computational means in order to improve cryosurgery training and education. This study uses a computerized planner-a key building block of a recently developed prototype for cryosurgery training. The quality of planning is measured by the overall defect volume, a proprietary concept which refers to undercooled areas internal to the target region and overcooled areas external to it. Results of this study numerically confirm that the overall defect volume decreases with an increasing number of cryoprobes, regardless of the geometry of the prostate. However, the number of cryoprobes required to achieve the smallest possible defect may be unrealistically high (<30). Results of this study also demonstrate that the optimal cryoprobe layout is associated with a smaller defect for symmetric prostate geometries and, independently, for prostate models that better resemble a sphere. Furthermore, a smaller defect is typically achieved when the urethra passes through the center of the prostate model. This study proposes to create a cryoprobe convex hull for the purpose of initial planning, which is a subdomain similar in shape to the prostate but at a reduced size. Parametric studies indicate that a cryoprobe convex hull contracted by 7 to 9 mm in all directions from the prostate capsule serves as a quasi-optimal initial condition for planning, that is, a preselected number of cryoprobes placed in the cryoprobe convex hull yields favorable results for optimization. The cryoprobe convex hull could accelerate computer-based planning, while also being adopted as a concept for traditional cryosurgery training, when computerized means are absent.
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Affiliation(s)
- Purva Joshi
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Anjali Sehrawat
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Yoed Rabin
- Department of Mechanical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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Boas FE, Srimathveeravalli G, Durack JC, Kaye EA, Erinjeri JP, Ziv E, Maybody M, Yarmohammadi H, Solomon SB. Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning. Cardiovasc Intervent Radiol 2017; 40:761-768. [PMID: 28050658 DOI: 10.1007/s00270-016-1562-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/26/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE To create and validate a planning tool for multiple-probe cryoablation, using simulations of ice ball size and shape for various ablation probe configurations, ablation times, and types of tissue ablated. MATERIALS AND METHODS Ice ball size and shape was simulated using the Pennes bioheat equation. Five thousand six hundred and seventy different cryoablation procedures were simulated, using 1-6 cryoablation probes and 1-2 cm spacing between probes. The resulting ice ball was measured along three perpendicular axes and recorded in a database. Simulated ice ball sizes were compared to gel experiments (26 measurements) and clinical cryoablation cases (42 measurements). The clinical cryoablation measurements were obtained from a HIPAA-compliant retrospective review of kidney and liver cryoablation procedures between January 2015 and February 2016. Finally, we created a web-based cryoablation planning tool, which uses the cryoablation simulation database to look up the probe spacing and ablation time that produces the desired ice ball shape and dimensions. RESULTS Average absolute error between the simulated and experimentally measured ice balls was 1 mm in gel experiments and 4 mm in clinical cryoablation cases. The simulations accurately predicted the degree of synergy in multiple-probe ablations. The cryoablation simulation database covers a wide range of ice ball sizes and shapes up to 9.8 cm. CONCLUSION Cryoablation simulations accurately predict the ice ball size in multiple-probe ablations. The cryoablation database can be used to plan ablation procedures: given the desired ice ball size and shape, it will find the number and type of probes, probe configuration and spacing, and ablation time required.
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Affiliation(s)
- F Edward Boas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA.
| | | | - Jeremy C Durack
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Elena A Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave., New York, NY, 10065, USA
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