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Bitton RR, Shao W, Chodakeiwitz Y, Brunsing RL, Sonn G, Rusu M, Ghanouni P. Intraprocedural Diffusion-weighted Imaging for Predicting Ablation Zone during MRI-guided Focused Ultrasound of Prostate Cancer. Radiol Imaging Cancer 2024; 6:e240009. [PMID: 39212524 DOI: 10.1148/rycan.240009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Purpose To compare diffusion-weighted imaging (DWI) with thermal dosimetry as a noncontrast method to predict ablation margins in individuals with prostate cancer treated with MRI-guided focused ultrasound (MRgFUS) ablation. Materials and Methods This secondary analysis of a prospective trial (ClinicalTrials.gov no. NCT01657942) included 17 participants (mean age, 64 years ± 6 [SD]; all male) who were treated for prostate cancer using MRgFUS in whom DWI was performed immediately after treatment. Ablation contours from computed thermal dosimetry and DWI as drawn by two blinded radiologists were compared against the reference standard of ablation assessment, posttreatment contrast-enhanced nonperfused volume (NPV) contours. The ability of each method to predict the ablation zone was analyzed quantitively using Dice similarity coefficients (DSCs) and mean Hausdorff distances (mHDs). Results DWI revealed a hyperintense rim at the margin of the ablation zone. While DWI accurately helped predict treatment margins, thermal dose contours underestimated the extent of the ablation zone compared with the T1-weighted NPV imaging reference standard. Quantitatively, contour assessment between methods showed that DWI-drawn contours matched postcontrast NPV contours (mean DSC = 0.84 ± 0.05 for DWI, mHD = 0.27 mm ± 0.13) better than the thermal dose contours did (mean DSC = 0.64 ± 0.12, mHD = 1.53 mm ± 1.20) (P < .001). Conclusion This study demonstrates that DWI, which can visualize the ablation zone directly, is a promising noncontrast method that is robust to treatment-related bulk motion compared with thermal dosimetry and correlates better than thermal dosimetry with the reference standard T1-weighted NPV. Keywords: Interventional-Body, Ultrasound-High-Intensity Focused (HIFU), Genital/Reproductive, Prostate, Oncology, Imaging Sequences, MRI-guided Focused Ultrasound, MR Thermometry, Diffusionweighted Imaging, Prostate Cancer ClinicalTrials.gov Identifier no. NCT01657942 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Rachel R Bitton
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Wei Shao
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Yosef Chodakeiwitz
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Ryan L Brunsing
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Geoffery Sonn
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Mirabela Rusu
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
| | - Pejman Ghanouni
- From the Departments of Radiology (R.R.B., Y.C., R.L.B., M.R., P.G.) and Urology (G.S.), Stanford University School of Medicine, 1024 Welch Rd, MC 5488, Stanford, CA 94305; and Department of Medical Quantitative Health, University of Florida, Gainesville, Fla (W.S.)
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Faiella E, Santucci D, Vertulli D, Vergantino E, Vaccarino F, Perillo G, Beomonte Zobel B, Grasso RF. Irreversible Electroporation (IRE) for Prostate Cancer (PCa) Treatment: The State of the Art. J Pers Med 2024; 14:137. [PMID: 38392571 PMCID: PMC10890194 DOI: 10.3390/jpm14020137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/24/2024] Open
Abstract
We evaluated the most recent research from 2000 to 2023 in order to deeply investigate the applications of PCa IRE, first exploring its usage with primary intent and then salvage intent. Finally, we discuss the differences with other focal PCa treatments. In the case of primary-intent IRE, the in-field recurrence is quite low (ranges from 0% to 33%). Urinary continence after the treatment remains high (>86%). Due to several different patients in the studies, the preserved potency varied quite a lot (59-100%). Regarding complications, the highest occurrence rates are for those of Grades I and II (20-77% and 0-29%, respectively). Grade III complications represent less than 7%. Regarding the specific oncological outcomes, both PCa-specific survival and overall survival are 100%. Metastasis-free survival is 99.6%. In a long-term study, the Kaplan-Meier FFS rates reported are 91% at 3 years, 84% at 5 years, and 69% at 8 years. In the single study with salvage-intent IRE, the in-field recurrence was 7%. Urinary continence was still high (93%), but preserved potency was significantly lower than primary-intent IRE patients (23%). In addition, Grade III complications were slightly higher (10.8%). In conclusion, in males with localized low-intermediate-risk prostate cancer, IRE had an excellent safety profile and might have positive results for sexual and urinary function.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Domiziana Santucci
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Daniele Vertulli
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Elva Vergantino
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Federica Vaccarino
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Gloria Perillo
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Bruno Beomonte Zobel
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
| | - Rosario Francesco Grasso
- Department of Radiology, Policlinico "Campus Bio-medico", Via Alvaro del Portillo, 200-00128 Rome, Italy
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Campana LG, Daud A, Lancellotti F, Arroyo JP, Davalos RV, Di Prata C, Gehl J. Pulsed Electric Fields in Oncology: A Snapshot of Current Clinical Practices and Research Directions from the 4th World Congress of Electroporation. Cancers (Basel) 2023; 15:3340. [PMID: 37444450 PMCID: PMC10340685 DOI: 10.3390/cancers15133340] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The 4th World Congress of Electroporation (Copenhagen, 9-13 October 2022) provided a unique opportunity to convene leading experts in pulsed electric fields (PEF). PEF-based therapies harness electric fields to produce therapeutically useful effects on cancers and represent a valuable option for a variety of patients. As such, irreversible electroporation (IRE), gene electrotransfer (GET), electrochemotherapy (ECT), calcium electroporation (Ca-EP), and tumour-treating fields (TTF) are on the rise. Still, their full therapeutic potential remains underappreciated, and the field faces fragmentation, as shown by parallel maturation and differences in the stages of development and regulatory approval worldwide. This narrative review provides a glimpse of PEF-based techniques, including key mechanisms, clinical indications, and advances in therapy; finally, it offers insights into current research directions. By highlighting a common ground, the authors aim to break silos, strengthen cross-functional collaboration, and pave the way to novel possibilities for intervention. Intriguingly, beyond their peculiar mechanism of action, PEF-based therapies share technical interconnections and multifaceted biological effects (e.g., vascular, immunological) worth exploiting in combinatorial strategies.
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Affiliation(s)
- Luca G. Campana
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Adil Daud
- Department of Medicine, University of California, 550 16 Street, San Francisco, CA 94158, USA;
| | - Francesco Lancellotti
- Department of Surgery, Manchester University NHS Foundation Trust, Oxford Rd., Manchester M13 9WL, UK;
| | - Julio P. Arroyo
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
| | - Rafael V. Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA 24061, USA; (J.P.A.); (R.V.D.)
- Institute for Critical Technology and Applied Sciences, Virginia Tech, Blacksburg, VA 24061, USA
| | - Claudia Di Prata
- Department of Surgery, San Martino Hospital, 32100 Belluno, Italy;
| | - Julie Gehl
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, 4000 Roskilde, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
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