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Bodard S, Guinebert S, Dimopoulos PM, Tacher V, Cornelis FH. Contribution and advances of robotics in percutaneous oncological interventional radiology. Bull Cancer 2024; 111:967-979. [PMID: 39198085 DOI: 10.1016/j.bulcan.2024.06.004] [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] [Received: 02/02/2024] [Revised: 05/13/2024] [Accepted: 06/03/2024] [Indexed: 09/01/2024]
Abstract
The advent of robotic systems in interventional radiology marks a significant evolution in minimally invasive medical procedures, offering enhanced precision, safety, and efficiency. This review comprehensively analyzes the current state and applications of robotic system usage in interventional radiology, which can be particularly helpful for complex procedures and in challenging anatomical regions. Robotic systems can improve the accuracy of interventions like microwave ablation, radiofrequency ablation, and irreversible electroporation. Indeed, studies have shown a notable decrease of an average 30% in the mean deviation of probes, and a 40% lesser need for adjustments during interventions carried out with robotic assistance. Moreover, this review highlights a 35% reduction in radiation dose and a stable-to-30% reduction in operating time associated with robot-assisted procedures compared to manual methods. Additionally, the potential of robotic systems to standardize procedures and minimize complications is discussed, along with the challenges they pose, such as setup duration, organ movement, and a lack of tactile feedback. Despite these advancements, the field still grapples with a dearth of randomized controlled trials, which underscores the need for more robust evidence to validate the efficacy and safety of robotic system usage in interventional radiology.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Necker Hospital, University of Paris-Cité, 149 rue de Sèvres, 75015 Paris, France; CNRS UMR 7371, Inserm U 1146, laboratoire d'imagerie biomédicale, Sorbonne University, 75006 Paris, France.
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Platon M Dimopoulos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Interventional Radiodolgy Dpt, University Hospital of Patras with memorial, 26504 Rio, Greece
| | - Vania Tacher
- Unité Inserm U955 n(o) 18, service d'imagerie médicale, hôpital Henri-Mondor, université Paris-Est, AP-HP, Créteil, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Tenon Hospital, Sorbonne University, 4, rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Butano VW, Phillips MC, Wells AB, Strand MS, McKillop IH, Baker EH, Martinie JB, Iannitti DA. Analysis of technical failure after 1,613 surgical microwave ablations: A propensity score-matched analysis. Surgery 2024; 176:775-784. [PMID: 38971698 DOI: 10.1016/j.surg.2024.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 05/19/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Microwave ablation is becoming increasingly common for the treatment of liver tumors. Despite numerous studies aimed at identifying risk factors for local recurrence after microwave ablation, a consensus on modifiable risk factors for failure remains elusive, partly because of the limited statistical power of these studies. This study investigated the incidence of technical failure after microwave ablation, encompassing both incomplete ablation and local recurrence, and aimed to identify modifiable factors that reduce technical failure. METHODS This retrospective review included patients who underwent surgical microwave ablation at a high-volume institution between October 2006 and March 2023. Univariate analysis, multivariate analysis, and propensity score matching were performed to identify risk factors for technical failure. RESULTS A total of 1,613 surgical microwave ablations were performed on 3,035 tumors, with 226 instances (14% per procedure, 7.4% per tumor) of technical failure. Incomplete ablation occurred at a rate of 1.7% per tumor, whereas local recurrence was identified in 6.5% of ablations in per-tumor analysis. Body mass index >25 was significant for failure (odds ratio, 1.50; 95% confidence interval, 1.07-2.11; P < .05), suggesting that more difficult targeting may lead to increased technical failure rates. African American race (odds ratio, 1.62; 95% confidence interval, 1.16-2.27; P < .05), pre-microwave ablation transarterial chemoembolization (odds ratio, 1.54; 95% confidence interval, 1.08-2.21; P < .05), and previous ablation (odds ratio, 1.58; 95% confidence interval, 1.09-2.29; P < .05) were found to be statistically significant. CONCLUSION On the basis of the largest microwave ablation database available to date, this study identified novel modifiable and nonmodifiable risk factors of microwave ablation failure. These results can lead to decreasing technical failure rates after microwave ablation.
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Affiliation(s)
- Vincent W Butano
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Michael C Phillips
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Alexandra B Wells
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Matthew S Strand
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Iain H McKillop
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - Erin H Baker
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC
| | - David A Iannitti
- Division of HPB Surgery, Department of Surgery, Atrium Health Carolinas Medical Center, Charlotte, NC.
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Della Corte A, Mori M, Calabrese F, Palumbo D, Ratti F, Palazzo G, Pellegrini A, Santangelo D, Ronzoni M, Spezi E, Del Vecchio A, Fiorino C, Aldrighetti L, De Cobelli F. Preoperative MRI radiomic analysis for predicting local tumor progression in colorectal liver metastases before microwave ablation. Int J Hyperthermia 2024; 41:2349059. [PMID: 38754994 DOI: 10.1080/02656736.2024.2349059] [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] [Received: 12/19/2023] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE Radiomics may aid in predicting prognosis in patients with colorectal liver metastases (CLM). Consistent data is available on CT, yet limited data is available on MRI. This study assesses the capability of MRI-derived radiomic features (RFs) to predict local tumor progression-free survival (LTPFS) in patients with CLMs treated with microwave ablation (MWA). METHODS All CLM patients with pre-operative Gadoxetic acid-MRI treated with MWA in a single institution between September 2015 and February 2022 were evaluated. Pre-procedural information was retrieved retrospectively. Two observers manually segmented CLMs on T2 and T1-Hepatobiliary phase (T1-HBP) scans. After inter-observer variability testing, 148/182 RFs showed robustness on T1-HBP, and 141/182 on T2 (ICC > 0.7).Cox multivariate analysis was run to establish clinical (CLIN-mod), radiomic (RAD-T1, RAD-T2), and combined (COMB-T1, COMB-T2) models for LTPFS prediction. RESULTS Seventy-six CLMs (43 patients) were assessed. Median follow-up was 14 months. LTP occurred in 19 lesions (25%).CLIN-mod was composed of minimal ablation margins (MAMs), intra-segment progression and primary tumor grade and exhibited moderately high discriminatory power in predicting LTPFS (AUC = 0.89, p = 0.0001). Both RAD-T1 and RAD-T2 were able to predict LTPFS: (RAD-T1: AUC = 0.83, p = 0.0003; RAD-T2: AUC = 0.79, p = 0.001). Combined models yielded the strongest performance (COMB-T1: AUC = 0.98, p = 0.0001; COMB-T2: AUC = 0.95, p = 0.0003). Both combined models included MAMs and tumor regression grade; COMB-T1 also featured 10th percentile of signal intensity, while tumor flatness was present in COMB-T2. CONCLUSION MRI-based radiomic evaluation of CLMs is feasible and potentially useful for LTP prediction. Combined models outperformed clinical or radiomic models alone for LTPFS prediction.
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Affiliation(s)
- Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Martina Mori
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Palazzo
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Monica Ronzoni
- Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emiliano Spezi
- School of Engineering, Cardiff University, Cardiff, UK
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | | | - Claudio Fiorino
- Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- University Vita-Salute San Raffaele, Milan, Italy
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Ahmadzade M, Rouientan H, Golzarian J, Akhlaghpoor S. An Evaluation of Ultrasound-Guided Percutaneous Microwave Ablation for the Treatment of Symptomatic Uterine Fibroids. J Vasc Interv Radiol 2024; 35:45-50. [PMID: 37748576 DOI: 10.1016/j.jvir.2023.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/12/2023] [Accepted: 09/17/2023] [Indexed: 09/27/2023] Open
Abstract
PURPOSE To evaluate the feasibility and effectiveness of ultrasound-guided percutaneous microwave ablation (MWA) for the treatment of symptomatic uterine fibroids. MATERIALS AND METHODS A single-center retrospective study was conducted on 17 patients, mean age 37.5 years (SD ± 7.3; range 19-47 years) with symptomatic uterine fibroid who underwent MWA between September 2018 and December 2022. Outcomes included volume reduction of uterine fibroids, hemoglobin levels, uterine fibroid symptoms, and health-related quality-of-life questionnaire scores before and 12 months after ablation. RESULTS Preoperative fibroid diameter was a mean of 6.7 cm (SD ± 1.1; range 5-9 cm), and volume was a mean of 101.9 cm3 (SD ± 63.3; range 16.9-264.1 cm3). The mean ablation time was 12.2 minutes (SD ± 3.1; range, 8-20 minutes). The mean reduction of volume at 12 months after treatment was 70.9% (SD ± 23.8). The hemoglobin level increased significantly from 9.96 g/dL ± 2.33 before treatment to 12.14 g/dL ± 1.34 at 12 months after treatment (P = .002). The symptom severity score and health-related quality-of-life scores were significantly improved at follow-up (P < .001). CONCLUSIONS The application of MWA as a standalone treatment method might provide an effective, minimally invasive option for Federation of Gynecology and Obstetrics Types 1-6 symptomatic uterine fibroids with the potential to enhance patients' quality of life.
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Affiliation(s)
- Mohadese Ahmadzade
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran
| | - Jafar Golzarian
- Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Shahram Akhlaghpoor
- Department of Interventional Radiology, Pardis Noor Medical Imaging Center, Tehran, Iran.
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Muglia R, Marra P, Pinelli D, Dulcetta L, Carbone FS, Barbaro A, Celestino A, Colledan M, Sironi S. Technical and Clinical Outcomes of Laparoscopic-Laparotomic Hepatocellular Carcinoma Thermal Ablation with Microwave Technology: Case Series and Review of Literature. Cancers (Basel) 2023; 16:92. [PMID: 38201536 PMCID: PMC10778313 DOI: 10.3390/cancers16010092] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC. MATERIALS AND METHODS This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule's suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls. RESULTS A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6-50 mm) were treated for 7 min (2-30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1-51 days), and patients were followed up on average for 238 days (13-1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge. CONCLUSIONS Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Domenico Pinelli
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Ludovico Dulcetta
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Francesco Saverio Carbone
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Alessandro Barbaro
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Antonio Celestino
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Michele Colledan
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
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Nakamura S, Tada T, Sue M, Matsuo Y, Murakami S, Muramatsu T, Morii K, Okada H. Clinical Outcomes of Next-Generation Microwave Thermosphere Ablation for Hepatocellular Carcinoma with Primarily Hepatitis-Related Etiology. J Clin Med 2023; 12:7577. [PMID: 38137645 PMCID: PMC10743866 DOI: 10.3390/jcm12247577] [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: 10/24/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND AND AIM We investigated the clinical outcomes of patients with hepatocellular carcinoma (HCC) who underwent next-generation microwave thermosphere ablation (MTA). METHODS A total of 429 patients with 607 HCCs (maximum tumor diameter ≤40 mm) were included. We defined the following areas of the liver as those where MTA therapy is difficult to perform: caudate lobe and areas near the primary and secondary branches of the intrahepatic portal vein, inferior vena cava, gallbladder, heart, duodenum, abdominal esophagus, collateral veins around the liver, and spleen. Factors which predisposed patients to local tumor recurrence in the context of tumor location and complications were examined. RESULTS The primary etiologies of HCC were hepatitis-related: 259 (60.4%) cases of HCV, 31 (7.3%) cases of HBV, and two instances of both. Median maximum tumor diameter was 15.0 (interquartile range, 10.0-21.0) mm. There were 86 tumors in areas of the liver where MTA is difficult. The most common area was near the primary and secondary branches of the intrahepatic portal vein (26 nodules). The cumulative local tumor recurrence rates at 1, 2, and 3 years were 4.4%, 8.0%, and 8.5%, respectively. The cumulative local tumor recurrence rate differed significantly by tumor size group: 6.6%, 13.8%, and 29.4% at three years in the ≤20 mm group (n = 483), 20-30 mm group (n = 107), and ≥30 mm group (n = 17), respectively (p < 0.001). The cumulative local tumor recurrence rate was similar despite difficult-to-treat status (p = 0.169). In the multivariable analysis, tumor size (>15 mm) (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.11-4.16; p = 0.023) and ablative margin (<3 mm) (HR, 2.94; 95% CI, 1.52-5.71; p = 0.001) were significantly associated with local tumor recurrence. Only tumor size (>15 mm) (odds ratio, 3.41 95% CI, 1.53-7.84; p = 0.026) was significantly associated with complications. CONCLUSIONS MTA is a safe and effective local ablation therapy for HCC, even for tumors located in areas of the liver where local ablation therapy is difficult.
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Affiliation(s)
- Shinichiro Nakamura
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji 670-8540, Japan; (T.T.); (M.S.); (K.M.); (H.O.)
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Cafarchio A, Iasiello M, Brunese MC, Francica G, Rocca A, Andreozzi A. Emprint Microwave Thermoablation System: Bridging Thermal Ablation Efficacy between Human Patients and Porcine Models through Mathematical Correlation. Bioengineering (Basel) 2023; 10:1057. [PMID: 37760159 PMCID: PMC10525213 DOI: 10.3390/bioengineering10091057] [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: 07/31/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
To investigate the in vivo ablation characteristics of a microwave ablation antenna in the livers of humans with tumors, a retrospective analysis of the ablation zones was conducted after applying Emprint microwave ablation systems for treatment. Percutaneous microwave ablations performed between January 2022 and September 2022 were included in this study. Subsequently, immediate post-ablation echography images were subjected to retrospective evaluation to state the long ablated diameter, short ablated diameter, and volume. The calculated ablation lengths and volume indices were then compared between in vivo and ex vivo results obtained from laboratory experiments conducted on porcine liver. The ex vivo data showed a good correlation between energy delivered and both increasing ablated dimensions (both p < 0.001) and volume (p < 0.001). The in vivo data showed a good correlation for dimensions (p = 0.037 and p = 0.019) and a worse correlation for volume (p = 0.142). When comparing ex vivo and in vivo data for higher energies, the ablated volumes grew much more rapidly in ex vivo cases compared to in vivo ones. Finally, a set of correlations to scale ex vivo results with in vivo ones is presented. This phenomenon was likely due to the absence of perfusion, which acts as a cooling system.
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Affiliation(s)
- Andrea Cafarchio
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Marcello Iasiello
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
| | - Maria Chiara Brunese
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy;
| | - Aldo Rocca
- Dipartimento di Medicina e Scienze della Salute DIMES, Università degli Studi del Molise, 86100 Campobasso, Italy; (M.C.B.); (A.R.)
| | - Assunta Andreozzi
- Dipartimento di Ingegneria Industriale DII, Università degli Studi di Napoli “Federico II”, 80125 Napoli, Italy; (M.I.); (A.A.)
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Hui TCH, How GY, Chim MSM, Pua U. Comparative Study of Ablation Zone of EMPRINT HP Microwave Device with Contemporary 2.4 GHz Microwave Devices in an Ex Vivo Porcine Liver Model. Diagnostics (Basel) 2023; 13:2702. [PMID: 37627962 PMCID: PMC10453042 DOI: 10.3390/diagnostics13162702] [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: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Percutaneous microwave ablation (MWA) is an accepted treatment of non-operative liver cancer. This study compares the ablation zones of four commercially available 2.45 GHz MWA systems (Emprint, Eco, Neuwave, and Solero) in an ex vivo porcine liver model. (2) Methods: Ex vivo porcine livers (n = 85) were obtained. Two ablation time setting protocols were evaluated, the manufacturer's recommended maximum time and a 3 min time, performed at the manufacturer-recommended maximum power setting. A total of 236 ablation samples were created with 32 (13.6%) samples rejected. A total of 204 samples were included in the statistical analysis. (3) Results: For single-probe protocols, Emprint achieved ablation zones with the largest SAD. Significant differences were found in all comparisons for the 3 min time setting and for all comparisons at the 10 min time setting except versus Neuwave LK15 and Eco. Emprint produced ablation zones that were also significantly more spherical (highest SI) than the single-probe ablations from all other manufacturers. No statistical differences were found for ablation shape or SAD between the single-probe protocols for Emprint and the three-probe protocols for Neuwave. (4) Conclusions: The new Emprint HP system achieved large and spherical ablation zones relative to other 2.45 GHz MWA systems.
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Affiliation(s)
- Terrence C. H. Hui
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Guo Yuan How
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Michelle S. M. Chim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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Kratzke IM, Goss RS, Razzaque S, Shih A, Steele PL, Nurczyk KM, Gerber DA. Navigation Improves Tumor Ablation Performance: Results From a Novel Liver Tumor Simulator Study. Am Surg 2023; 89:1693-1700. [PMID: 35098720 DOI: 10.1177/00031348221075748] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The efficacy of microwave ablation in treating hepatic tumors requires advanced ultrasound skills. Failure of proper technique has the potential for either under- or over-treatment and possible harm to the patient. Emprint SX™ navigation provides surgeons with intra-operative, real-time navigation through augmented reality localization of the ablation antenna and the expected ablation zone. We hypothesize that incorporating this technology leads to improved targeting and optimizes ablation coverage. This study utilizes a simulated model to evaluate ablation outcomes using Emprint SX™ navigation vs standard ultrasound. METHODS Surgical residents and faculty were recruited from a single institution. Using a novel tumor ablation simulator, participants performed ablations via 2 modes: standard ultrasound guidance (STD) and Emprint SX™ navigation (NAV). Primary outcome was the percentage of under-ablation. Secondary outcomes included percentage of over-ablation, time to complete trial, and number of attempts to position antenna. RESULTS 281 trials were performed by fifteen participants, with 47% female and 60% novice ablationists. Under-ablation volume decreased by a mean of 16.3% (SEM ±12.9, P < .001) with NAV compared to STD. Over-ablation volume decreased by a mean of 14.0% (±8.2, P < .001). NAV time was faster by a mean of 32 seconds (±24.9, P < .001) and involved fewer antenna placement attempts by a mean of 1.3 (±1.0, P < .001). For novice ablationists, all outcomes were improved with NAV and novices saw larger improvements compared to experienced ablationists (P = .018). DISCUSSION In a simulated model, NAV improves ablation efficacy and efficiency, with novices gaining the greatest benefit over standard ultrasound.
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Affiliation(s)
- Ian M Kratzke
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan S Goss
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Sharif Razzaque
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Alex Shih
- Gastrointestinal and Hepatology Division, Medtronic, Boulder, CO, USA
| | - Paula L Steele
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kamil M Nurczyk
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David A Gerber
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Vandeputte M, Saveyn T, Lutin B, De Meyere C, Parmentier I, D'Hondt M. Combined Ablation and Resection for Colorectal Liver Metastases in the Minimally Invasive Surgical Era. Surg Laparosc Endosc Percutan Tech 2023; 33:121-128. [PMID: 36821654 DOI: 10.1097/sle.0000000000001153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND Thermal ablation is an accepted treatment modality for small and central liver tumors. In extensive colorectal liver metastatic disease (CRLM), hepatectomy can be combined with ablation, resulting in a parenchymal-sparing strategy. This may increase salvageability rates in case of recurrence. METHODS All patients with advanced CRLM that underwent combined ablation and resection between April 2012 and April 2021, were retrospectively analyzed from a prospectively maintained database. Primary endpoints include postoperative 30-day morbidity and ablation-site recurrence (ASR). The surgical approaches were compared. Ablated lesions were screened for ASR on postoperative follow-up imaging. RESULTS Of 54 patients that underwent combined ablation and resection, 32 (59.3%) were performed through a minimally invasive approach. Eleven (20.4%) were minor resections, 32 (59.3%) were technically major and 11 (20.4%) were anatomically major resections. Twelve complications occurred (22.2%), among which 2 (3.8%) major complications (Clavien-Dindo ≥IIIa). Ninety-day mortality rate was 1.9%. Out of 82 ablated lesions, 6 ASRs (11.1%) occurred. Median blood loss was significantly lower in the minimally invasive group, compared with open [90 mL (32.5 to 200) vs. 200 mL (100 to 400), P =0.005]. Pringle maneuver was significantly performed less in the minimally invasive group [8 (25.0%) vs. 16 (72.7%), P =0.001], but took more time [36.1 min (±15.6) vs. 21.6 (±9.9); P =0.011]. Short-term (1 y) overall and disease-free survival were respectively 81.4% and 50.0%. CONCLUSION Combining microwave ablation and liver resection is a feasible and safe parenchymal-sparing technique, through both minimally invasive and open approach for treating extended CRLM disease. It has a low ablation-related complication rate and acceptable ablation-site recurrence rate.
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Affiliation(s)
| | | | | | | | | | - Mathieu D'Hondt
- Departments of Digestive and Hepatobiliary/Pancreatic Surgery
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11
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Retrospective Evaluation and Significance of Neutrophil-to-Lymphocyte Ratio Prior to and 1 month Following Microwave Ablation of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2023; 46:49-59. [PMID: 36180599 DOI: 10.1007/s00270-022-03288-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/19/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Neutrophil-to-lymphocyte ratio (NLR) recently demonstrated predictive value for hepatocellular carcinoma (HCC) recurrence after thermal ablation. Microwave ablation (MWA) has been shown to induce changes in the immune landscape after HCC treatment. This study aims at identifying predictors of local tumor progression (LTP) and post-treatment NLR kinetics after MWA. MATERIALS AND METHODS Data from 108 consecutive patients who underwent percutaneous MWA of 119 HCCs with a 2450 Hz/100 W generator in two institutions from October 2014 to September 2021 were retrospectively reviewed. Forty-five HCCs (42 patients) met inclusion criteria for analysis (technique efficacy, pre- and post-treatment NLR availability, follow-up > 6 months, absence of complications). NLR was analyzed prior to therapy and at 1-month follow-up; difference between the two time points was defined as ΔNLR1stFU. RESULTS After a median follow-up of 25 months, LTP occurred in 18 HCCs (40%) and 18 patients (42.9%). Multivariate competing risk regression comprising ΔNLR1stFU > 0, cirrhosis etiology and subcapsular location showed that the only independent predictor of LTP was ΔNLR1stFU > 0, on both a per-patient (HR = 2.7, p = 0.049) and per-tumor (HR = 2.8, p = 0.047) analysis. ΔNLR1stFU > 0 occurred in 24/42 patients (57.1%). In this subgroup, higher rates of female patients (p = 0.026), higher mean baseline NLR (p < 0.0001) and lower mean energy/size (p = 0.006) were observed. Upon ROC curve analysis, energy/size < 1414 J/mm predicted ΔNLR1stFU > 0 with 76% sensitivity and 70% specificity (AUC = 0.74). CONCLUSION NLR increase after ablation was the only independent predictor of LTP, supporting the role of balance between systemic inflammation and immunity in recurrence after MWA. Ablation energy/tumor size predicted NLR increase, reinforcing the concept of immune ablation. LEVEL OF EVIDENCE III.
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12
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Microwave Ablation of Liver, Kidney and Lung Lesions: One-Month Response and Manufacturer’s Charts’ Reliability in Clinical Practice. SENSORS 2022; 22:s22113973. [PMID: 35684594 PMCID: PMC9182645 DOI: 10.3390/s22113973] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/20/2023]
Abstract
Microwave ablation systems allow for performing tumoral destruction in oncology. The objective of this study was to assess the early response and reliability of the microwave ablation zone size at one month for liver, kidney and lung lesions, as compared to the manufacturer’s charts. Patients who underwent microwave ablation with the EmprintTM ablation system for liver, kidney and lung lesions between June 2016 and June 2018 were retrospectively reviewed. Local response and ablation zone size (major, L, and minor, l, axes) were evaluated on the one-month follow-up imaging. Results were compared to the manufacturers’ charts using the Bland–Altman analysis. Fifty-five patients (mean age 68 ± 11 years; 95 lesions) were included. The one-month complete response was 94%. Liver ablations showed a good agreement with subtle, smaller ablation zones (L: −2 ± 5.7 mm; l: −5.2 ± 5.6 mm). Kidney ablations showed a moderate agreement with larger ablations for L (L: 8.69 ± 7.94 mm; l: 0.36 ± 4.77 mm). Lung ablations showed a moderate agreement, with smaller ablations for l (L: −5.45 ± 4.5 mm; l: −9.32 ± 4.72 mm). With 94% of early complete responses, the system showed reliable ablations for liver lesions, but larger ablations for kidney lesions, and smaller for lung lesions.
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13
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Improved Outcomes of Thermal Ablation for Colorectal Liver Metastases: A 10-Year Analysis from the Prospective Amsterdam CORE Registry (AmCORE). Cardiovasc Intervent Radiol 2022; 45:1074-1089. [PMID: 35585138 PMCID: PMC9307533 DOI: 10.1007/s00270-022-03152-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023]
Abstract
Background To analyze long-term oncological outcomes of open and percutaneous thermal ablation in the treatment of patients with colorectal liver metastases (CRLM). Methods This assessment from a prospective, longitudinal tumor registry included 329 patients who underwent 541 procedures for 1350 CRLM from January 2010 to February 2021. Three cohorts were formed: 2010–2013 (129 procedures [53 percutaneous]), 2014–2017 (206 procedures [121 percutaneous]) and 2018–2021 (206 procedures [135 percutaneous]). Local tumor progression-free survival (LTPFS) and overall survival (OS) data were estimated using the Kaplan–Meier method. Potential confounding factors were analyzed with uni- and multivariable Cox regression analyses. Results LTPFS improved significantly over time for percutaneous ablations (2-year LTPFS 37.7% vs. 69.0% vs. 86.3%, respectively, P < .0001), while LTPFS for open ablations remained reasonably stable (2-year LTPFS 87.1% [2010–2013], vs. 92.7% [2014–2017] vs. 90.2% [2018–2021], P = .12). In the latter cohort (2018–2021), the open approach was no longer superior regarding LTPFS (P = .125). No differences between the three cohorts were found regarding OS (P = .088), length of hospital stay (open approach, P = .065; percutaneous approach, P = .054), and rate and severity of complications (P = .404). The rate and severity of complications favored the percutaneous approach in all three cohorts (P = .002). Conclusion Over the last 10 years efficacy of percutaneous ablations has improved remarkably for the treatment of CRLM. Oncological outcomes seem to have reached results following open ablation. Given its minimal invasive character and shorter length of hospital stay, whenever feasible, percutaneous procedures may be favored over an open approach. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03152-9.
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Pfannenstiel A, Iannuccilli J, Cornelis FH, Dupuy DE, Beard WL, Prakash P. Shaping the future of microwave tumor ablation: a new direction in precision and control of device performance. Int J Hyperthermia 2022; 39:664-674. [DOI: 10.1080/02656736.2021.1991012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Austin Pfannenstiel
- Precision Microwave Inc, Manhattan, KS, USA
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
| | - Jason Iannuccilli
- Department of Diagnostic Imaging, Division of Interventional Oncology, Rhode Island Hospital, Providence, RI, USA
| | - Francois H. Cornelis
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Damian E. Dupuy
- Diagnostic Imaging, Brown University, Radiology, Cape Cod Hospital, MA, USA
| | - Warren L. Beard
- Department of Clinical Sciences, Kansas State University, Manhattan, KS, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS, USA
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Kanaya M, Miyamoto N, Fujii T, Kudo K, Kinota N, Kato H. Combination Therapy by Transarterial Injection of Miriplatin-Iodized Oil Suspension with Microwave Ablation for Medium-Sized Hepatocellular Carcinoma: the Preliminary Experience. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:1-8. [PMID: 35911877 PMCID: PMC9327324 DOI: 10.22575/interventionalradiology.2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/16/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the feasibility and safety of transarterial injection of a miriplatin-iodized oil suspension combined with Emprint miriplatin-iodized oil suspension-microwave ablation in patients with medium-sized (3-5 cm) hepatocellular carcinomas. MATERIALS AND METHODS This retrospective study included a total of 11 patients with 12 hepatocellular carcinomas (mean size, 3.6 ± 0.6 cm) underwent miriplatin-iodized oil suspension-microwave ablation. Microwave ablation was performed under the guidance of computed tomography fluoroscopy following transarterial miriplatin-iodized oil suspension injection on the same day. Technical success, complications, and local tumor progression were assessed. RESULTS The primary and secondary technical success rates were 75.0% and 100%, respectively. The number of treatment sessions per nodule was 1.25 ± 0.45. A total 15 sessions were required to achieve technical success (one session in nine lesions, two sessions in three lesions). Two major complications (pneumothorax [n = 1] and hemorrhage [n = 1]) occurred (2/15, 13.3%). No local tumor progression was observed during the follow-up period (mean 12.0 ± 2.0 months, range 2.7-23.9 months). CONCLUSIONS Miriplatin-iodized oil suspension-microwave ablation for medium-sized hepatocellular carcinomas can be safely performed with good local control.
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Affiliation(s)
- Motoma Kanaya
- Department of Radiology, Obihiro Kosei Hospital, Japan
| | | | - Takaaki Fujii
- Department of Radiology, Obihiro Kosei Hospital, Japan
| | - Kyohei Kudo
- Department of Radiology, Obihiro Kosei Hospital, Japan
| | - Naoya Kinota
- Department of Radiology, Hyogo College of Medicine, Japan
| | - Hirotaka Kato
- Department of Radiology, Hakodate Municipal Hospital, Japan
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Raissi D, Sanampudi S, Yu Q, Winkler M. CT-guided microwave ablation of hepatic malignancies via transpulmonary approach without ancillary techniques. J Clin Imaging Sci 2022; 12:2. [PMID: 35127245 PMCID: PMC8813600 DOI: 10.25259/jcis_152_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The objectives of the study were to determine the safety and efficacy of computed tomography (CT)-guided transpulmonary percutaneous microwave ablation (MWA) for hepatic malignancies without the use of ancillary techniques. Material and Methods: A retrospective review was performed on patients who underwent MWA for hepatic malignancy between January 2014 and February 2020 at a single tertiary center. Imaging was reviewed for each procedure to identify MWA showing transpleural transgression on CT scans. For these patients, demographics, ablation data, pulmonary complication rate, and predictors of pneumothorax were analyzed. Results: A total of 71 consecutive sessions (62.1 ± 11.3 years, 79% of males) of MWA were performed to treat 71 tumors (1.90 ± 0.96 cm) via transpulmonary approach under CT guidance. Technical success was achieved in all cases immediately after the procedure. At 1-month follow-up, 65/69 (94.2%) patients had no residual disease (two patients were lost to follow-up). Pulmonary complications occurred in 26/71 (36.6%) sessions, and 15/26 (57.7%) were minor requiring no intervention. Pneumothorax occurred in 14/71 (19.7%) sessions, and the rate of major pneumothorax requiring chest tube was 8/71 (11.3%). Lesions on the left side of the liver (segments I–IV) and intraprocedural probe adjustment were found to be independent predictors of developing major pneumothorax (P = 0.007 and 0.028, respectively). There were no reported pulmonary complications at the 1-month follow-up. Conclusion: CT-guided transpulmonary MWA is safe and effective in treating hepatic malignancies. Although it is associated with the risk of developing pulmonary complications, patients underwent successful ablation of their hepatic malignancies without life-threatening complications and mortality.
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Affiliation(s)
- Driss Raissi
- Department of Radiology Surgery, Medicine, and Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky, United States,
| | - Sreeja Sanampudi
- Department of Radiology, University of Kentucky, Lexington, Kentucky, United States,
| | - Qian Yu
- Department of Radiology, University of Kentucky, Lexington, Kentucky, United States,
| | - Michael Winkler
- Department of Radiology, University of Kentucky, Lexington, Kentucky, United States,
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17
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Lee J, Rhim H, Lee MW, Kang TW, Song KD, Lee JK. Direction of Tissue Contraction after Microwave Ablation: A Comparative Experimental Study in Ex Vivo Bovine Liver. Korean J Radiol 2022; 23:42-51. [PMID: 34983092 PMCID: PMC8743151 DOI: 10.3348/kjr.2021.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/11/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate the direction of tissue contraction after microwave ablation in ex vivo bovine liver models. Materials and Methods Ablation procedures were conducted in a total of 90 sites in ex vivo bovine liver models, including the surface (n = 60) and parenchyma (n = 30), to examine the direction of contraction of the tissue in the peripheral and central regions from the microwave antenna. Three commercially available 2.45-GHz microwave systems (Emprint, Neuwave, and Surblate) were used. For surface ablation, the lengths of two overlapped square markers were measured after 2.5- and 5-minutes ablations (n = 10 ablations for each system for each ablation time). For parenchyma ablation, seven predetermined distances between the markers were measured on the cutting plane after 5- and 10-minutes ablations (n = 5 ablations for each system for each ablation time). The contraction in the radial and longitudinal directions and the sphericity index (SI) of the ablation zones were compared between the three systems using analysis of variance. Results In the surface ablation experiment, the mean longitudinal contraction ratio and SI from a 5-minutes ablation using the Emprint, Neuwave, and Surblate systems were 28.92% and 1.04, 20.10% and 0.53, and 24.90% and 0.45, respectively (p < 0.001). A positive correlation between longitudinal contraction and SI was noted, and a similar radial contraction was observed. In the parenchyma ablation experiment, the mean longitudinal contraction ratio and SI from a 10-minutes ablation using the three pieces of equipment were 38.60% and 1.06, 32.45% and 0.61, and 28.50% and 0.50, respectively (p < 0.001). There was a significant difference in the longitudinal contraction properties, whereas there was no significant difference in the radial contraction properties. Conclusion The degree of longitudinal contraction showed significant differences depending on the microwave ablation equipment, which may affect the SI of the ablation zone.
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Affiliation(s)
- Junhyok Lee
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Hyunchul Rhim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.,Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, Mokdong Hospital, Ewha Womans University, School of Medicine, Seoul, Korea
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De Cobelli F, Calandri M, Della Corte A, Sirovich R, Gazzera C, Della Vigna P, Bonomo G, Varano GM, Maiettini D, Mauri G, Camisassi N, Steidler S, Ratti F, Gusmini S, Ronzoni M, Aldrighetti L, Odisio BC, Racca P, Fonio P, Veltri A, Orsi F. Multi-institutional analysis of outcomes for thermosphere microwave ablation treatment of colorectal liver metastases: the SMAC study. Eur Radiol 2022; 32:4147-4159. [PMID: 35092474 PMCID: PMC9123066 DOI: 10.1007/s00330-021-08497-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/29/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Oligometastatic colorectal cancer benefits of locoregional treatments but data concerning microwave ablation (MWA) are limited and interactions with systemic therapy are still debated. The aim of this study is to evaluate safety and effectiveness of Thermosphere™ MWA (T-MWA) of colorectal liver metastases (CLM) and factors affecting local tumor progression-free survival (LTPFS). METHODS In this multi-institutional retrospective study (January 2015-September 2019), patients who underwent T-MWA for CLM were enrolled. Complications according to SIR classification were collected, primary efficacy and LTP were calculated. Analyzed variables included CLM size at diagnosis and at ablation, CLM number, ablation margins, intra-segment progression, chemotherapy before ablation (CBA), variations in size (ΔSDIA-ABL), and velocity of size variation (VDIA-ABL) between CLM diagnosis and ablation. Uni/multivariate analyses were performed using mixed effects Cox model to account for the hierarchical structure of data, patient/lesions. RESULTS One hundred thirty-two patients with 213 CLM were evaluated. Complications were reported in 6/150 procedures (4%); no biliary complications occurred. Primary efficacy was achieved in 204/213 CLM (95.7%). LTP occurred in 58/204 CLM (28.4%). Six-, twelve-, and eighteen-month LTPFS were 88.2%, 75.8%, and 69.9%, respectively. At multivariate analysis, CLM size at ablation (p = 0.00045), CLM number (p = 0.046), ablation margin < 5 mm (p = 0.0035), and intra-segment progression (p < 0.0001) were statistically significant for LTPFS. ΔSDIA-ABL (p = 0.63) and VDIA-ABL (p = 0.38) did not affect LTPFS. Ablation margins in the chemo-naïve group were larger than those in the CBA group (p < 0.0001). CONCLUSION T-MWA is a safe and effective technology with adequate LTPFS rates. Intra-segment progression is significantly linked to LTPFS. CBA does not affect LTPFS. Anticipating ablation before chemotherapy may take the advantages of adequate tumor size with correct ablation margin planning. KEY POINTS • Thermosphere™-Microwave ablation is a safe and effective treatment for colorectal liver metastases with no registered biliary complications in more than 200 ablations. • Metastases size at time of ablation, intra-segment progression, and minimal ablation margin < 5 mm were found statistically significant for local tumor progression-free survival. • Chemotherapy before ablation modifies kinetics growth of the lesions but deteriorates ablation margins and does not significantly impact local tumor progression-free survival.
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Affiliation(s)
- Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy ,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy ,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Calandri
- Department of Oncology, University of Torino, Turin, Italy ,Interventional Radiology Unit, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Angelo Della Corte
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy ,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy ,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Sirovich
- Department of Mathematics “Giuseppe Peano”, University of Torino, Turin, Italy
| | - Carlo Gazzera
- Radiology Unit, AOU Città Della Salute E Della Scienza, Turin, Italy
| | - Paolo Della Vigna
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Guido Bonomo
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Gianluca Maria Varano
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Maiettini
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Giovanni Mauri
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy ,Dipartimento Di Oncologia Ed Emato-Oncologia, Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Camisassi
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Stephanie Steidler
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy ,Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Gusmini
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Monica Ronzoni
- Unit of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy ,Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy
| | - Bruno C. Odisio
- The University of Texas, Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX USA
| | - Patrizia Racca
- ColoRectal Cancer Unit, Department of Oncology, AOU Città Della Salute E Della Scienza, Turin, Italy
| | - Paolo Fonio
- Radiology Unit, AOU Città Della Salute E Della Scienza, Turin, Italy ,Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Andrea Veltri
- Department of Oncology, University of Torino, Turin, Italy ,Interventional Radiology Unit, AOU San Luigi Gonzaga, Orbassano, Turin, Italy
| | - Franco Orsi
- Divisione Di Radiologia Interventistica, Istituto Europeo Di Oncologia, Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS), Milan, Italy
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On Efficacy of Microwave Ablation in the Thermal Treatment of an Early-Stage Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13225784. [PMID: 34830937 PMCID: PMC8616542 DOI: 10.3390/cancers13225784] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/08/2021] [Accepted: 11/16/2021] [Indexed: 02/08/2023] Open
Abstract
Microwave ablation at 2.45 GHz is gaining popularity as an alternative therapy to hepatic resection with a higher overall survival rate than external beam radiation therapy and proton beam therapy. It also offers better long-term recurrence-free overall survival when compared with radiofrequency ablation. To improve the design and optimization of microwave ablation procedures, numerical models can provide crucial information. A three-dimensional model of the antenna and targeted tissue without homogeneity assumptions are the most realistic representation of the physical problem. Due to complexity and computational resources consumption, most of the existing numerical studies are based on using two-dimensional axisymmetric models to emulate actual three-dimensional cancers and surrounding tissue, which is often far from reality. The main goal of this study is to develop a fully three-dimensional model of a multislot microwave antenna immersed into liver tissue affected by early-stage hepatocellular carcinoma. The geometry of the tumor is taken from the 3D-IRCADb-01 liver tumors database. Simulations were performed involving the temperature dependence of the blood perfusion, dielectric and thermal properties of both healthy and tumoral liver tissues. The water content changes during the ablation process are also included. The optimal values of the input power and the ablation time are determined to ensure complete treatment of the tumor with minimal damage to the healthy tissue. It was found that a multislot antenna is designed to create predictable, large, spherical zones of the ablation that are not influenced by varying tissue environments. The obtained results may be useful for determining optimal conditions necessary for microwave ablation to be as effective as possible for treating early-stage hepatocellular carcinoma, with minimized invasiveness and collateral damages.
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Feng H, Yang C, Xu F, Zhao Y, Jin T, Wei Z, Wang D, Dai C. Therapeutic efficacy of microwave coagulation versus liver resection for hepatocellular carcinoma within the Milan criteria: A propensity score matching analysis. Eur J Surg Oncol 2021; 48:418-424. [PMID: 34509336 DOI: 10.1016/j.ejso.2021.08.035] [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] [Received: 06/03/2021] [Revised: 08/26/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION This study aimed to compare the therapeutic efficacy of resection (RES) and microwave ablation (MWA) for hepatocellular carcinoma (HCC) within the Milan criteria. MATERIALS AND METHODS Between 2011 and 2019, 426 HCC patients within the Milan criteria were treated at our institution (RES: n = 291; MWA: n = 135). We compared overall survival (OS), disease-free survival (DFS), complications, and hospital stay in these patients using propensity score matching (PSM) and determined the prognostic factors using multivariate Cox analysis. RESULTS Following 1:1 matching using PSM, 121 patients were matched in each group. The 1-, 3-, and 5-year OS rates were 98.3%, 84.7%, and 69.6% for the MWA group and 96.5%, 81.8%, and 78.1% for the RES group (p = 0.667). The corresponding DFS rates for the MWA and RES groups were 81.8%, 54.4%, and 42.3% and 85.4%, 67.8%, and 57.9%, respectively (p = 0.174). The MWA group had less blood loss and shorter hospital stays (both p < 0.001) than the RES group. CONCLUSION MWA resulted in survival outcomes that were similar to those of RES for HCC within the Milan criteria. However, it had more favorable hospital stay and blood loss outcomes than RES.
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Affiliation(s)
- Hanxin Feng
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Chunbo Yang
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Feng Xu
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Yang Zhao
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Tianqiang Jin
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Zeyuan Wei
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Dexin Wang
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China
| | - Chaoliu Dai
- Department of Hepatobiliary and Splenic Surgery, Department of General Surgery, Shengjing Hospital of China Medical University, China.
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Tamai H, Okamura J. New next-generation microwave thermosphere ablation for small hepatocellular carcinoma. Clin Mol Hepatol 2021; 27:564-574. [PMID: 34333957 PMCID: PMC8524063 DOI: 10.3350/cmh.2021.0136] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background/Aims In July 2017, the EmprintTM next-generation microwave ablation system using thermosphere technology (Covidien, Boulder, CO, USA) was approved for use in Japan. This system can produce a predictable spherical ablation zone at higher temperatures than radiofrequency ablation (RFA). The aim of the present study was to elucidate whether this new microwave thermosphere ablation (MTA) could safely improve outcome compared to RFA, which is the standard of care for small hepatocellular carcinoma (HCC). Methods This retrospective study analyzed 513 patients with 630 HCCs (≤3 cm) who were performed by percutaneous RFA (174 patients, 214 HCCs) or MTA (339 patients, 416 HCCs) between January 2016 and March 2020. Results Median ablation time was significantly shorter for MTA (240 s) than for RFA (721 s; p<0.001). A significant difference in 3-year local tumor progression rate was evident between the RFA group (22%) and MTA group (8%; p<0.001) Multivariate analysis revealed ablation procedure and tumor diameter as independent factors contributing to local tumor progression (MTA, p<0.001, hazard ratio 0.565, 95% confidence interval 0.437-0.731). In patients with primary HCC, a significant difference in overall survival was evident (RFA vs MTA, 3-year, 77% vs 95%, p=0.029). Ablation procedure and Child-Pugh score were independent factors contributing to survival. The total complication rate was significantly lower for MTA (8%) than for RFA (14%, p<0.05), particularly for bile duct injury (3% vs 9%, respectively; p<0.05). Conclusions Next-generation MTA for small HCC could provide safer, more curative treatment in a shorter ablation time than RFA.
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Affiliation(s)
- Hideyuki Tamai
- Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan
| | - Jumpei Okamura
- Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan
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Suwa K, Seki T, Aoi K, Yamashina M, Murata M, Yamashiki N, Nishio A, Shimatani M, Naganuma M. Efficacy of microwave ablation versus radiofrequency ablation for hepatocellular carcinoma: a propensity score analysis. Abdom Radiol (NY) 2021; 46:3790-3797. [PMID: 33675382 PMCID: PMC8286931 DOI: 10.1007/s00261-021-03008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/14/2021] [Accepted: 02/20/2021] [Indexed: 12/15/2022]
Abstract
Purpose To evaluate the efficacy and safety of radiofrequency ablation (RFA) and new-generation microwave ablation (MWA) for the treatment of hepatocellular carcinoma (HCC). Methods The propensity score matching method was applied to patients with HCC treated with MWA (93 patients) or RFA (156 patients) at a single institution from January 2014 to April 2020. The local tumor progression (LTP), intrahepatic distant recurrence (IDR), and recurrence-free survival (RFS) of the two matched therapies were analyzed using the Kaplan–Meier method. Cox proportional hazard models were used to identify risk factors for LTP and RFS. The therapeutic effects and complications of the two treatments were also compared. Results The LTP, IDR, and RFS of MWA and RFA were equivalent (LTP: hazard ratio [HR] = 0.87; 95% confidence interval [95% CI] 0.36- 2.07; P = 0.746, IDR: HR = 1.03; 95% CI 0.61–1.73; P = 0.890, RFS: HR = 1.15; 95% CI 0.69–1.91; P = 0.566). Para-vessel lesions was the only risk factor for LTP, whereas age, previous treatment, Albumin-Bilirubin score, and tumor diameter were risk factors for RFS. On the other hand, the ablation time per nodule (6.79 ± 2.73 and 9.21 ± 4.90 min; P = 0.008) and number of sessions per nodule required to achieve technical success (1.16 ± 0.39 and 1.34 ± 0.57; P = 0.009) were significantly lower in MWA than in RFA. The major complication rate of MWA and RFA was also equivalent. Conclusion MWA and RFA have similar therapeutic effects and safety, although MWA has advantages over RFA regarding efficacy, including shorter ablation time and fewer sessions required.
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Khan MS, Hawlitzki M, Taheri SM, Rose G, Schweizer B, Brensing A. Investigation of Microwave Ablation Process in Sweet Potatoes as Substitute Liver. SENSORS 2021; 21:s21113894. [PMID: 34200011 PMCID: PMC8200201 DOI: 10.3390/s21113894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/24/2022]
Abstract
The microwave ablation technique to destroy cancer tissues in liver is practiced clinically and is the subject of ongoing research, e.g., ablation monitoring. For studies, liver tissue from cattle or pigs is often used as a substitute material. In this work, sweet potato is presented as an alternative material for microwave ablation experiments in liver due to similar material properties. Sweet potatoes as a substitute for liver have the advantages of better handling, easy procurement and stable material properties over time for microwave ablation experiments. The dielectric constant and electrical conductivity of sweet potato are characterized for temperature variation with the help of high-temperature dielectric probe. Furthermore, a test setup is presented for microwave ablation experiments in which a bowtie slot antenna matched to sweet potato is placed on its surface to directly receive the microwave power from a self-developed microwave applicator inserted into a sweet potato 4 cm below the surface antenna. A high-power source was used to excite the microwave powers up to 80 W and a spectrum analyzer was used to measure the signal received by the surface antenna. The experiments were performed in an anechoic chamber for safety reasons. Power at 50 W and 80 W was stimulated for a maximum of 600 s at the 2.45 GHz ISM band in different sweet potato experiments. A correlation is found between the power received by the surface antenna and rise of temperature inside sweet potato; relative received power drops from 1 at 76 ∘C to 0.6 at 88 ∘C (max. temperature) represents a 40% relative change in a 50 W microwave ablation experiment. The received power envelope at the surface antenna is between 10 mW and 32 mW during 50 W microwave ablation. Other important results for 10 min, 80 W microwave ablation include: a maximum ablation zone short axis diameter of 4.5 cm and a maximum ablation temperature reached at 99 ∘C, 3 mm away from the applicator’s slot. The results are compared with the state of the art in microwave ablation in animal liver. The dielectric constant and electrical conductivity evolution of sweet potato with rising temperature is comparable to animal liver in 50–60 ∘C range. The reflection loss of self-developed applicator in sweet potato is below 15 dB which is equal to reflection loss in liver experiments for 600 s. The temperature rise for the first 90 s in sweet potato is 76 ∘C as compared to 73 ∘C in liver with 50 W microwave ablation. Similarly, with 80–75 W microwave ablation, for the first 60 s, the temperature is 98 ∘C in sweet potato as compared to 100 ∘C in liver. The ablation zone short-axis diameter after 600 s is 3.3 cm for 50 W microwave ablation in sweet potato as compared to 3.5 cm for 30 W microwave ablation in liver. The reasons for difference in microwave ablation results in sweet potato and animal liver are discussed. This is the first study to directly receive a signal from microwave applicator during a microwave ablation process with the help of a surface antenna. The work can be extended to multiple array antennas for microwave ablation monitoring.
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Affiliation(s)
- Muhammad Saad Khan
- Department of Engineering, RheinMain University of Applied Sciences, 65428 Ruesselsheim, Germany; (M.H.); (S.M.T.); (B.S.); (A.B.)
- Correspondence:
| | - Michael Hawlitzki
- Department of Engineering, RheinMain University of Applied Sciences, 65428 Ruesselsheim, Germany; (M.H.); (S.M.T.); (B.S.); (A.B.)
| | - Shadan Mofrad Taheri
- Department of Engineering, RheinMain University of Applied Sciences, 65428 Ruesselsheim, Germany; (M.H.); (S.M.T.); (B.S.); (A.B.)
| | - Georg Rose
- Institute of Medical Engineering and Research Campus STIMULATE, Otto Von Guericke University, 39106 Magdeburg, Germany;
| | - Bernd Schweizer
- Department of Engineering, RheinMain University of Applied Sciences, 65428 Ruesselsheim, Germany; (M.H.); (S.M.T.); (B.S.); (A.B.)
| | - Andreas Brensing
- Department of Engineering, RheinMain University of Applied Sciences, 65428 Ruesselsheim, Germany; (M.H.); (S.M.T.); (B.S.); (A.B.)
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Kuroda H, Nagasawa T, Fujiwara Y, Sato H, Abe T, Kooka Y, Endo K, Oikawa T, Sawara K, Takikawa Y. Comparing the Safety and Efficacy of Microwave Ablation Using Thermosphere TM Technology versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Cancers (Basel) 2021; 13:cancers13061295. [PMID: 33803926 PMCID: PMC7998443 DOI: 10.3390/cancers13061295] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Microwave ablation using ThermosphereTM technology is a novel locoregional treatment for hepatocellular carcinoma. This study compared the safety and efficacy outcomes of this microwave ablation strategy versus radiofrequency ablation using propensity score-matched analysis. Microwave ablation led to a high rate of curative ablation (94.7%) and a low rate of local recurrence (3.3%), with an overall survival rate of 99.3% at 1 year (recurrence-free survival: 81.1%) and 88.4% at 2 years (recurrence-free survival: 60.5%). There were no significant differences in survival outcomes after microwave and radiofrequency ablation. However, microwave ablation required significantly fewer insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). Based on the similar survival outcomes, we recommend microwave ablation using ThermosphereTM technology for hepatocellular carcinoma with a diameter of >2 cm because of the lower number of insertions. Abstract There is limited information regarding the oncological benefits of microwave ablation using ThermosphereTM technology for hepatocellular carcinoma. This study compared the overall survival and recurrence-free survival outcomes among patients with hepatocellular carcinoma after microwave ablation using ThermosphereTM technology and after radiofrequency ablation. Between December 2017 and August 2020, 410 patients with hepatocellular carcinoma (a single lesion that was ≤5 cm or ≤3 lesions that were ≤3 cm) underwent ablation at our institution. Propensity score matching identified 150 matched pairs of patients with well-balanced characteristics. The microwave ablation and radiofrequency ablation groups had similar overall survival rates at 1 year (99.3% vs. 98.2%) and at 2 years (88.4% vs. 87.5%) (p = 0.728), as well as similar recurrence-free survival rates at 1 year (81.1% vs. 76.2%) and at 2 years (60.5% vs. 62.1%) (p = 0.492). However, the microwave ablation group had a significantly lower mean number of total insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). This retrospective study revealed no significant differences in the overall survival and recurrence-free survival outcomes after microwave ablation or radiofrequency ablation. However, we recommend microwave ablation for hepatocellular carcinoma tumors with a diameter of >2 cm based on the lower number of insertions.
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Performance of the Emprint and Amica Microwave Ablation Systems in ex vivo Porcine Livers: Sphericity and Reproducibility Versus Size. Cardiovasc Intervent Radiol 2021; 44:952-958. [PMID: 33462682 PMCID: PMC8172387 DOI: 10.1007/s00270-020-02742-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/04/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the performance of two microwave ablation (MWA) systems regarding ablation volume, ablation shape and variability. MATERIALS AND METHODS In this ex vivo study, the Emprint and Amica MWA systems were used to ablate porcine livers at 4 different settings of time and power (3 and 5 minutes at 60 and 80 Watt). In total, 48 ablations were analysed for ablation size and shape using Vitrea Advanced Visualization software after acquisition of a 7T MRI scan. RESULTS Emprint ablations were smaller (11,1 vs. 21,1 mL p < 0.001), more spherical (sphericity index of 0.89 vs. 0.59 p < 0.001) and showed less variability than Amica ablations. In both systems, longer ablation time and higher power resulted in significantly larger ablation volumes. CONCLUSION Emprint ablations were more spherical, and the results showed a lower variability than those of Amica ablations. This comes at the price of smaller ablation volumes.
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Filippiadis D, Mazioti A, Velonakis G, Tsochantzis A, Tosoratti N, Kelekis A, Kelekis N. Continuous versus pulsed microwave ablation in the liver: any difference in intraoperative pain scores? Ann Gastroenterol 2021; 34:80-84. [PMID: 33414626 PMCID: PMC7774668 DOI: 10.20524/aog.2020.0557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background This study prospectively compared intraoperative pain scores during percutaneous microwave ablation of the liver in patients randomized between continuous and pulsed energy delivery algorithms. Methods During a 12-month period, 20 patients who underwent microwave liver ablation were prospectively randomized between 2 different energy delivery modes: “continuous mode” (CM, n=10) and “pulsed mode” (PM, n=10). All ablation sessions were performed using the same microwave ablation platform under computed tomographic guidance and intravenous analgesia. Within 30 min post ablation, all patients completed a questionnaire assigning a numeric pain intensity score from 0 (no pain) to 10. Results Mean pain scores were 8.17±1.850 in the CM group and 4.50±1.567 in the PM group, with a statistically significant difference of 3.667±2.807 pain units (P=0.001). The mean procedure time was 53.5±20.90 min in the PM group vs. 58.5±17.44 min in the CM group (P=0.279). The mean size of the lesions was 2.81±0.95 cm in the PM group and 2.81±0.85 cm in the CM group (P=0.984). On a per-lesion basis, technical success was achieved in all evaluable tumors in both groups. No difference was noted in the local tumor control on the 6-month imaging evaluation. No complications were observed in the CM arm, while small perihepatic hemorrhagic fluid collections were reported in the PM group. Conclusions Both algorithms for microwave energy delivery have comparable treatment effects in terms of 6-month local tumor control for liver lesions <3 cm in diameter. PM treatments compared to CM appear to induce significantly less pain in patients undergoing percutaneous liver ablation under intravenous analgesia.
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Affiliation(s)
- Dimitrios Filippiadis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Argyro Mazioti
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - George Velonakis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Athanasios Tsochantzis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nevio Tosoratti
- R&D Manager, HS Hospital Service SpA, Aprilia (LT), Italy (Nevio Tosoratti)
| | - Alexis Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nikolaos Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
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Miyamoto N, Kanaya M, Fujii T, Kato H, Kudo K, Kinota N. Combination therapy by transarterial injection of miriplatin-iodized oil suspension with radiofrequency ablation (RFA) versus microwave ablation (MWA) for small hepatocellular carcinoma: a comparison of therapeutic efficacy. Jpn J Radiol 2020; 39:376-386. [PMID: 33150469 DOI: 10.1007/s11604-020-01064-7] [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: 07/06/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the technical efficacy and complications of the transarterial injection of a miriplatin-iodized oil suspension combined with radiofrequency ablation (RFA) or microwave ablation (MWA) in the treatment of small hepatocellular carcinomas (HCCs). MATERIALS AND METHODS This retrospective study included 123 HCCs in 101 patients treated with the transarterial injection of a miriplatin-iodized oil suspension and RFA (MPT-RFA) (maximum diameter: 1.5 [Formula: see text] 0.5 cm, range: 0.6-3.0 cm) and 68 HCCs in 49 patients treated with the transarterial injection of a miriplatin-iodized oil suspension and MWA (MPT-MWA) (maximum diameter: 1.6 [Formula: see text] 0.7 cm, range: 0.5-3.0 cm). Technical success was defined as the achievement of an ablative margin of at least 5 mm for each tumor. Technical success, complications, and local tumor progression were compared between the two groups. RESULTS The initial technical success rate was significantly higher with MPT-MWA (94.1%) than with MPT-RFA (76.4%; P = 0.003). The number of treatment sessions per nodule was significantly lower with MPT-MWA (1.1) than with MPT-RFA (1.3) (P = 0.004). The major complication rates were similar with MPT-RFA (5.8%) and MPT-MWA (2.7%) (P = 0.391). The one-year local tumor progression rate was similar between MPT-RFA (0%) and MPT-MWA (0%) (P = 0.73). CONCLUSION MPT-MWA may have improved therapeutic efficiency in the treatment of small HCCs.
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Affiliation(s)
- Noriyuki Miyamoto
- Department of Radiology, Obihiro Kosei Hospital, 1, W14, S10, Obihiro, Hokkaido, 0800024, Japan.
| | - Motoma Kanaya
- Department of Radiology, Obihiro Kosei Hospital, 1, W14, S10, Obihiro, Hokkaido, 0800024, Japan
| | - Takaaki Fujii
- Department of Radiology, Obihiro Kosei Hospital, 1, W14, S10, Obihiro, Hokkaido, 0800024, Japan
| | - Hirotaka Kato
- Department of Radiology, Obihiro Kosei Hospital, 1, W14, S10, Obihiro, Hokkaido, 0800024, Japan
| | - Kyohei Kudo
- Department of Radiology, Obihiro Kosei Hospital, 1, W14, S10, Obihiro, Hokkaido, 0800024, Japan
| | - Naoya Kinota
- Department of Radiology, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo, Japan
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Matsuki Y, Matono T, Koda M, Miyoshi K, Sugihara T, Okano JI, Isomoto H. Preablation three-dimensional ultrasonography can predict therapeutic effect and local tumor progression after radiofrequency ablation for hepatocellular carcinoma. Eur J Radiol 2020; 133:109358. [PMID: 33126170 DOI: 10.1016/j.ejrad.2020.109358] [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] [Received: 04/25/2020] [Revised: 09/03/2020] [Accepted: 10/13/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the agreement between ablative margin (AM) predicted by preablation three-dimensional ultrasonography (3D-US) and AM measured on postablation computed tomography (CT)/magnetic resonance (MR) images. METHODS Sixty patients with 73 hepatocellular carcinoma nodules were enrolled. 3D-US data were collected immediately after puncture by the electrode before ablation. The maximum distance from the electrode to the edge of the tumor in the plane perpendicular to the electrode (C-plane) was defined as "a" and the diameter of the ablation zone as "b". We classified predicted AM into "0.5b - a" ≥0 mm as AM(+) or <0 mm as AM(-), and "0.5b - a" ≥3 mm or <3 mm. RESULTS Forty-eight nodules (66 %) were visualized in the C-plane. There was an agreement between the predicted and measured AMs for 39 (81 %) of the 48 nodules. Local tumor progression was observed in 3 (7%) of 43 nodules with predicted AM(+) and in 2 (40 %) of 5 nodules with predicted AM(-) but was not observed in any of 21 nodules with predicted AM ≥ 3 mm. The local tumor progression rate was significantly lower for nodules with predicted AM(+) compared with predicted AM(-)(p = 0.03), and for nodules with predicted AM ≥ 3 mm compared with predicted AM < 3 mm (p = 0.04). Local progression was detected in 2 (4.7 %) of 42 nodules with a sufficient AM (≥0 mm) on postablation CT/MR images and in 5 (83.3 %) of 6 nodules with an insufficient AM (<0 mm); the difference in progression rate was significant (p = 0.0008). CONCLUSION 3D-US allows prediction of the AM before radiofrequency ablation.
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Affiliation(s)
- Yukako Matsuki
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomomitsu Matono
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Masahiko Koda
- Department of Internal Medicine, Hino Hospital, Tottori 683-4504, Japan.
| | - Kenichi Miyoshi
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Takaaki Sugihara
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Jun-Ichi Okano
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hajime Isomoto
- Division of Medicine and Clinical Science, Department of Multidisciplinary Internal Medicine, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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Han J, Fan YC, Wang K. Radiofrequency ablation versus microwave ablation for early stage hepatocellular carcinoma: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22703. [PMID: 33120763 PMCID: PMC7581069 DOI: 10.1097/md.0000000000022703] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several randomized control trials (RCTs) were conducted to compare microwave ablation (MWA) and radiofrequency ablation (RFA) in the treatment of hepatocellular carcinoma (HCC) over the years. The purpose of this study was to compare the efficacy of RFA and MWA for early stage HCC. METHODS Studies were systematically searched on Emabse, Ovid Medline, PubMed, and Cochrane Library until March 20, 2020. Continuous variables and dichotomous variables were compared using weighted mean difference (WMD) and odds ratio (OR), respectively. For the comparison of overall survival (OS) and disease-free survival (DFS), the hazard ratio (HR) and 95% confidence interval (CI) were extracted from univariate analysis or survival plots. RESULTS A total of 26 studies (5 RCTs and 21 cohorts) with 4396 patients (2393 patients in RFA and 2003 patients in MWA) were included in our study. Of these patients, 47% received treatment under general anesthesia in the MWA group and 84% in the RFA group (OR = 0.529, P < .001). The median ablation time was reduced in the MWA group (12 minutes) compared with RFA group (29 minutes) (WMD = -15.674, P < .001). In total, 17.6% patients exhibited progression during follow-up in the MWA group compared with 19.5% in the RFA group (OR = 0.877, P = .225). No statistically significant differences were observed between MWA and RFA groups in terms of OS and DFS (HR = 0.891 and 1.014, P = .222 and .852, respectively). CONCLUSIONS MWA exhibited similar therapeutic effects as RFA in the treatment of early stage HCC. Given the shorter ablation time, MWA can be performed under local anesthesia.
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Etoz S, Brace CL. Computed Tomography-Based Modeling of Water Vapor-Induced Changes in Permittivity During Microwave Ablation. IEEE Trans Biomed Eng 2020; 67:2427-2433. [DOI: 10.1109/tbme.2019.2962363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Dornbusch JA, Wavreille VA, Dent B, Fuerst JA, Green EM, Selmic LE. Percutaneous microwave ablation of solitary presumptive pulmonary metastases in two dogs with appendicular osteosarcoma. Vet Surg 2020; 49:1174-1182. [PMID: 32521058 DOI: 10.1111/vsu.13469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/08/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe percutaneous microwave ablation (MWA) of presumptive pulmonary metastases and the outcome of two dogs. ANIMALS Two dogs with pulmonary lesions after treatment of spontaneously occurring appendicular osteosarcoma. STUDY DESIGN Preliminary prospective clinical study. METHODS Two large-breed dogs were referred from tertiary veterinary hospitals 146 and 217 days after limb amputation to pursue MWA as an alternative therapy to metastasectomy. Both dogs had been receiving chemotherapy protocols at their respective referral centers. RESULTS A novel percutaneous approach for MWA with ultrasonographic or computed tomographic (CT) guidance was successfully performed. The only complications consisted of pneumothoraxes, requiring treatment in one dog. In the weeks after their procedures, both dogs were reported to do well at home. Dog 1 died and dog 2 was euthanized 82 and 19 days, respectively, after their MWA of confirmed (dog 1) or presumed (dog 2) metastatic disease. CONCLUSION Percutaneous MWA of pulmonary nodules was technically feasible in two dogs without major complications. CLINICAL SIGNIFICANCE Percutaneous MWA may provide a minimally invasive option for treatment of osteosarcoma pulmonary metastases. Additional studies are required to evaluate the benefits of MWA on survival and confirm histologic cell death within pulmonary neoplastic lesions.
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Affiliation(s)
- Josephine A Dornbusch
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Brian Dent
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Jason A Fuerst
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Eric M Green
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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Electro-Thermal Therapy Algorithms and Active Internal Electrode Cooling Reduce Thermal Injury in High Frequency Pulsed Electric Field Cancer Therapies. Ann Biomed Eng 2020; 49:191-202. [PMID: 32415482 DOI: 10.1007/s10439-020-02524-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Thermal tissue injury is an unintended consequence in current irreversible electroporation treatments due to the induction of Joule heating during the delivery of high voltage pulsed electric fields. In this study active temperature control measures including internal electrode cooling and dynamic energy delivery were investigated as a process for mitigating thermal injury during treatment. Ex vivo liver was used to examine the extent of thermal injury induced by 5000 V treatments with delivery rates up to five times faster than current clinical practice. Active internal cooling of the electrode resulted in a 36% decrease in peak temperature vs. non-cooled control treatments. A temperature based feedback algorithm (electro-thermal therapy) was demonstrated as capable of maintaining steady state tissue temperatures between 30 and 80 °C with and without internal electrode cooling. Thermal injury volumes of 2.6 cm3 were observed for protocols with 60 °C temperature set points and electrode cooling. This volume reduced to 1.5 and 0.1 cm3 for equivalent treatments with 50 °C and 40 °C set points. Finally, it was demonstrated that the addition of internal electrode cooling and active temperature control algorithms reduced ETT treatment times by 84% (from 343 to 54 s) vs. non-cooled temperature control strategies with equivalent thermal injury volumes.
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Locoregional Therapies in the Treatment of 3- to 5-cm Hepatocellular Carcinoma: Critical Review of the Literature. AJR Am J Roentgenol 2020; 215:223-234. [PMID: 32255691 DOI: 10.2214/ajr.19.22098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE. Treatment options for hepatocellular carcinoma (HCC) continue to expand. However, given the complexity of the patients including factors such as codominant cirrhosis or portal hypertension and transplant status, it can be difficult to know which treatment is most advantageous. The choice of HCC treatment is perhaps most complex in the setting of HCCs that are 3-5 cm. This article reviews the evidence for locoregional therapies in treating 3- to 5-cm HCCs. CONCLUSION. Combination therapy with transarterial chemoembolization (TACE) and ablation has the most robust and highest level of evidence to support its efficacy and therefore should be considered first-line therapy for nonresectable HCCs that measure 3-5 cm. The studies support that TACE followed by ablation is superior to either TACE alone or ablation alone. Data for transarterial radioembolization (TARE) to treat HCCs in this specific size range are very limited. Additional data are needed about the comparative effectiveness of TACE-ablation combination and TARE and how the TACE-ablation combination compares with surgical resection.
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Young S, Rivard M, Kimyon R, Sanghvi T. Accuracy of liver ablation zone prediction in a single 2450 MHz 100 Watt generator model microwave ablation system: An in human study. Diagn Interv Imaging 2020; 101:225-233. [DOI: 10.1016/j.diii.2019.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022]
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Kapoor H, Nisiewicz MJ, Jayavarapu R, Gedaly R, Raissi D. Early Outcomes with Single-antenna High-powered Percutaneous Microwave Ablation for Primary and Secondary Hepatic Malignancies: Safety, Effectiveness, and Predictors of Ablative Failure. J Clin Imaging Sci 2020; 10:10. [PMID: 32257586 PMCID: PMC7110402 DOI: 10.25259/jcis_173_2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/29/2020] [Indexed: 02/07/2023] Open
Abstract
Objective: Microwave ablation (MWA) of liver malignancies has gained much traction over the past 5 years. However, MWA carries relatively higher rates of residual disease compared to resection. Likelihood of MWA success is multifactorial and newer devices with more reliable ablation zones are being developed to overcome these drawbacks. This manuscript is a review of our first 100 liver ablations with the newer single antenna high powered MWA system. Materials and Methods: Retrospective chart review of patients that underwent MWA for either primary or secondary hepatic malignancies between March 2015 and July 2016 was conducted. The complete ablation rates, rate of new lesions, complications, and short-term survival were analyzed. Multiple statistical tests, including multivariate regression, were used to assess risk factors for local residual and recurrent disease. Results: Fifty-three patients (median age 61 ± 9 years, 39 males) underwent 100 MWAs. Of the 100 lesions ablated, 76 were hepatocellular cancers (HCCs) and 24 were metastases. Median lesion size was 16 ± 9 mm. Seventy- five of these patients had multifocal disease targeted in the same session. Seventy patients had cirrhosis (median model for end-stage liver disease score 9 ± 3; Child-Pugh B and C in 42%). An 83% complete lesion ablation rate was seen on follow-up imaging with liver protocol magnetic resonance imaging/computed tomography (median follow-up of 1 year). The minor complication rate was 9.4% with no major complications or 30-day mortality. Despite this, evidence of new foci of hepatic disease was found in 47% of patients, the majority (80%) of which were in HCC patients (P < 0.01) and most of these new lesions were in a different hepatic segment (64%). Degree of cirrhosis (P < 0.01), presence of non-alcoholic steatohepatitis (NASH) (P = 0.01) and lesion’s subcapsular location (P = 0.03) was significant predictors of residual disease. With the subset analysis of only HCC lesions larger than 1 cm, only the presence of NASH remained significant. Conclusion: The single probe high power MWA of malignant hepatic lesions is safe and effective with minimal morbidity. Degree of cirrhosis, NASH, and subcapsular location was associated with an increased rate of residual disease on short-term follow-up.
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Affiliation(s)
- Harit Kapoor
- Departments of Radiology, University of Kentucky, Lexington, Kentucky
| | | | - Ravi Jayavarapu
- Departments of Radiology, University of Kentucky, Lexington, Kentucky
| | - Roberto Gedaly
- Departments of Surgery, University of Kentucky, Lexington, Kentucky
| | - Driss Raissi
- Departments of Radiology, University of Kentucky, Lexington, Kentucky
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Abstract
With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (I) unresectable liver lesions; (II) in combination with hepatectomy; (III) in patients with significant medical comorbidities or poor performance status (PS); (IV) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection; and (V) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC).
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Affiliation(s)
- Hideo Takahashi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
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Suwa K, Seki T, Tsuda R, Yamashina M, Murata M, Yamaguchi T, Nishio A, Okazaki K. Short term treatment results of local ablation with water-cooled microwave antenna for liver cancer: Comparison with radiofrequency ablation. Mol Clin Oncol 2020; 12:230-236. [PMID: 32064099 PMCID: PMC7016568 DOI: 10.3892/mco.2020.1983] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to evaluate the efficacy and safety of the new-generation percutaneous microwave ablation (MWA) compared with the radiofrequency ablation (RFA) system for the treatment of hepatocellular carcinoma (HCC). A retrospective study was conducted from January 2014 to February 2019. A total of 44 patients and 52 nodules (mean tumor size, 17.2±4.9 mm) were treated with MWA, and 55 patients and 70 nodules (mean tumor size, 17.7±6.4 mm) were treated with RFA. After 4 days of treatment, the direct effects of ablation were assessed using dynamic CT, and after discharge, a follow-up dynamic CT scan was performed every 3-4 months. Treatment efficacy, complications and local recurrence were recorded. For MWA and RFA, the average number of CT sessions were 1.05±0.23 and 1.28±0.54, respectively, and the mean ablation times were 5.0±2.0 and 8.1±4.8 min. Following MWA and RFA, the ablation ranges that were evaluated with the axial images were 31.9±5.5 and 33.3±9.0 mm, respectively, in the long-axis diameter and 27.6±5.3 and 23.4±6.8 mm, respectively, in the short-axis diameter. The flatness ratios of the ablation regions were 0.13±0.09 and 0.29±0.14 (axial image) and 0.11±0.07 and 0.28±0.14 (coronal image), respectively. The rates of complete tumor necrosis were comparable. The complication rates were 13.6% (MWA) and 14.5% (RFA), which were not significantly different. The cumulative local recurrence rates were not significantly different between the two methods (one-year recurrence rate, MWA: 6.91%, RFA: 5.17%). MWA was therefore indicated to be an effective treatment for HCC in respect to session number, treatment time and spherical ablation.
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Affiliation(s)
- Kanehiko Suwa
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Toshihito Seki
- Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Rinako Tsuda
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Masao Yamashina
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Miki Murata
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan.,Kansai Medical University Medical Center, Liver Disease Center, Moriguchi, Osaka 570-8507, Japan
| | - Takashi Yamaguchi
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Akiyoshi Nishio
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
| | - Kazuichi Okazaki
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Osaka 573-1101, Japan
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Imajo K, Ogawa Y, Yoneda M, Saito S, Nakajima A. A review of conventional and newer generation microwave ablation systems for hepatocellular carcinoma. J Med Ultrason (2001) 2020; 47:265-277. [PMID: 31960190 DOI: 10.1007/s10396-019-00997-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/21/2019] [Indexed: 12/15/2022]
Abstract
Although microwave ablation (MWA) exhibits a high thermal efficiency, the major limitation of conventional MWA systems is the lack of predictability of the ablation zone size and shape. Therefore, a specific newer generation MWA system, The Emprint™ Ablation System with Thermosphere™ Technology, was designed to create predictable large spherical zones of ablation that are not impacted by varying tissue environments. The time required for ablation with MWA systems is short, and the shape of the necrosis is elliptical with the older systems and spherical with the new system. In addition, because MWA has no heat-sink effect, it can be used to ablate tumors adjacent to major vessels. Although these factors yield a large ablation volume and result in good local control, excessive ablation of liver tissue and unexpected ablation of surrounding organs are possible. Therefore, MWA should be carefully performed. This review highlights the efficacy and complications of MWA performed with conventional systems and the newer generation system in patients with hepatocellular carcinoma (HCC). MWA with the newer generation system seems to be a promising treatment option for large HCCs and secondary hepatic malignancies, with several advantages over other available ablation techniques, including conventional MWA. However, further randomized controlled trials are necessary to fully clarify the benefits and pitfalls of this new system.
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Affiliation(s)
- Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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Do TD, Melzig C, Vollherbst DF, Pereira PL, Kauczor HU, Kachelrieß M, Sommer CM. The value of iterative metal artifact reduction algorithms during antenna positioning for CT-guided microwave ablation. Int J Hyperthermia 2019; 36:1223-1232. [PMID: 31814464 DOI: 10.1080/02656736.2019.1690168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objectives: To compare image quality between filtered back projection (FBP) and iterative reconstruction algorithm and dedicated metal artifact reduction (iMAR) algorithms during antenna positioning for computed tomography-guided microwave ablation (MWA).Materials and methods: An MWA antenna was positioned in the liver of five pigs under CT guidance. Different exposure settings (120kVp/200mAs-120kVp/50mAs) and image reconstruction techniques (FBP, iterative reconstruction with and without iMAR) were applied. Quantitative image analysis included density measurements in six positions (e.g., liver in extension of the antenna [ANTENNA] and liver >3 cm away from the antenna [LIVER-1]). Qualitative image analysis included assessment of overall quality, image noise, artifacts at the antenna tip, artifacts in liver parenchyma bordering antenna tip and newly generated artifacts. Two independent observers performed the analyses twice and interreader agreement was compared with Bland-Altman analysis.Results: For all exposure and reconstruction settings, density measurements for ANTENNA were significantly higher for the I30-1 iMAR compared with FBP and I30-1 (e.g., 8.3-17.2HU vs. -104.5 to 155.1HU; p ≤ 0.01, respectively). In contrast, for all exposure settings, density measurements for LIVER-1 were comparable between FBP and I30-1 iMAR (e.g., 49.4-50.4HU vs. 50.1-52.5U, respectively). For all exposure and reconstruction settings, subjective image quality for LIVER-1 was better for the I30-1 iMAR algorithm compared with FBP and I30-1. Bland-Altman interobserver agreement was from -0.2 to 0.2 for FBP and iMAR, and Cohen's kappa was 0.74.Conclusion: Iterative algorithms I30-1 with iMAR algorithm improves image quality during antenna positioning and placement for CT-guided MWA and is applicable over a range of exposure settings.
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Affiliation(s)
- Thuy Duong Do
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudius Melzig
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Philippe L Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken Heilbronn GmbH, Heilbronn, Germany
| | - Hans-Ulrich Kauczor
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (Dkfz), Heidelberg, Germany
| | - Christof M Sommer
- Clinic for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Diagnostic and Interventional Radiology, Klinikum Stuttgart, Stuttgart, Germany
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40
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Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA. AJR Am J Roentgenol 2019; 213:1388-1396. [PMID: 31593520 DOI: 10.2214/ajr.18.19856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).
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Percutaneous Microwave Ablation Versus Cryoablation in the Treatment of T1a Renal Tumors. Cardiovasc Intervent Radiol 2019; 43:76-83. [DOI: 10.1007/s00270-019-02313-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 02/07/2023]
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Temporal evaluation of the microwave ablation zone and comparison of CT and gross sizes during the first month post-ablation in swine lung. Diagn Interv Imaging 2019; 100:279-285. [DOI: 10.1016/j.diii.2018.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 12/22/2022]
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43
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Nonresectional regional therapies for metastatic colorectal cancer to the liver. J Surg Oncol 2019; 119:636-641. [DOI: 10.1002/jso.25423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 02/09/2019] [Indexed: 01/20/2023]
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Hübner F, Schreiner R, Reimann C, Bazrafshan B, Kaltenbach B, Schüßler M, Jakoby R, Vogl TJ. Ex vivo validation of microwave thermal ablation simulation using different flow coefficients in the porcine liver. Med Eng Phys 2019; 66:56-64. [PMID: 30826254 DOI: 10.1016/j.medengphy.2019.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
Abstract
The purpose of the study was to validate the simulation model for a microwave thermal ablation in ex vivo liver tissue. The study aims to show that heat transfer due to the flow of tissue water during ablation in ex vivo tissue is not negligible. Ablation experiments were performed in ex vivo porcine liver with microwave powers of 60 W to 100 W. During the procedure, the temperature was recorded in the liver sample at different distances to the applicator using a fiber-optic thermometer. The position of the probes was identified by CT imaging and transferred to the simulation. The simulation of the heat distribution in the liver tissue was carried out with the software CST Studio Suite. The results of the simulation with different flow coefficients were compared with the results of the ablation experiments using the Bland-Altman analysis. The analysis showed that the flow coefficient of 90,000 W/(K*m3) can be considered as the most suitable value for clinically used powers. The presented simulation model can be used to calculate the temperature distribution for microwave ablation in ex vivo liver tissue.
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Affiliation(s)
- Frank Hübner
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | - Roland Schreiner
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Carolin Reimann
- Institute for Microwave Engineering and Photonics, Technische Universität Darmstadt, Merckstrasse 25, 64283 Darmstadt, Germany
| | - Babak Bazrafshan
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Benjamin Kaltenbach
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Martin Schüßler
- Institute for Microwave Engineering and Photonics, Technische Universität Darmstadt, Merckstrasse 25, 64283 Darmstadt, Germany
| | - Rolf Jakoby
- Institute for Microwave Engineering and Photonics, Technische Universität Darmstadt, Merckstrasse 25, 64283 Darmstadt, Germany
| | - Thomas Josef Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe - University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Imajo K, Tomeno W, Kanezaki M, Honda Y, Kessoku T, Ogawa Y, Yoshida K, Yoneda M, Kirikoshi H, Ono M, Kaneta T, Inoue T, Teratani T, Saito S, Nakajima A. New microwave ablation system for unresectable liver tumors that forms large, spherical ablation zones. J Gastroenterol Hepatol 2018; 33:2007-2014. [PMID: 29851164 DOI: 10.1111/jgh.14294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM The aim of this study was to assess the efficacy of a new microwave ablation (MWA) system, the Emprint Ablation System, for the ablation of unresectable large liver tumors (≥ 30 mm). METHODS Twenty-one hepatic tumors (mean diameter, 34.7 mm) from 21 patients who underwent percutaneous MWA were included in this cross-sectional study. A volume analyzer based on computed tomography imaging was used for all patients within the month before and month after the procedure to evaluate the shape and volume of ablation zones. In addition, computed tomography imaging was performed again 3 months after the procedure to evaluate the presence of residual tumors and local recurrence. RESULTS Mean ablation time was 11.3 min, and mean overall procedure time was 33.4 min. An ablated adrenal gland-induced Takotsubo (stress) cardiomyopathy occurred immediately after MWA as a major complication in one patient. Roundness index A, B, and C presented a mean value of 0.94, 0.94, and 1.01, respectively (all values near 1 is a perfect sphere), indicating that a spherical ablation zone was achieved. The mean ablation volume was larger than the volume of tumors (24.5 vs 41.7 cm3 ). Residual tumors were confirmed in only 4.8% of tumors after a single ablation session. There was no local recurrence. CONCLUSIONS In our experience, the new MWA system provides an effective treatment option for unresectable large liver tumors. However, to ablate the liver tumors safely, it is necessary to consider the surrounding organs, such as the adrenal glands.
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Affiliation(s)
- Kento Imajo
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Wataru Tomeno
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mineo Kanezaki
- Department of Gastroenterology, Kanto Medical Center Tokyo, Tokyo, Japan
| | - Yasushi Honda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takaomi Kessoku
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuji Ogawa
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Keisuke Yoshida
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masato Yoneda
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroyuki Kirikoshi
- Department of Clinical Laboratory, Yokohama City University Hospital, Yokohama, Japan
| | - Masafumi Ono
- Department of Gastroenterology and Hepatology, Kochi Medical School, Nankoku, Kochi, Japan
| | - Tomohiro Kaneta
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tomio Inoue
- Department of Radiology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takuma Teratani
- Department of Gastroenterology, Kanto Medical Center Tokyo, Tokyo, Japan
| | - Satoru Saito
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsushi Nakajima
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Vogl TJ, Roman A, Nour-Eldin NEA, Hohenforst-Schmidt W, Bednarova I, Kaltenbach B. A comparison between 915 MHz and 2450 MHz microwave ablation systems for the treatment of small diameter lung metastases. Diagn Interv Radiol 2018; 24:31-37. [PMID: 29317376 DOI: 10.5152/dir.2018.17017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE We aimed to retrospectively compare the local tumor control rates between low frequency (LF) and high frequency (HF) microwave ablation devices in the treatment of <3 cm lung metastases. METHODS A total of 36 patients (55 tumors) were treated with the LF system (915 MHz) and 30 patients (39 tumors) were treated with the HF system (2450 MHz) between January 2011 and March 2016. Computed tomography (CT) scans performed prior to and 24 hours after the ablation were used to measure the size of the ablation zone and to calculate the ablation margin. The subsequent CTs were used to detect local tumor progression. Possible predictive factors for local progression were analyzed. All patients had a minimum follow-up of 3 months with a median of 13.8 months for the LF group and 11.7 months for the HF group. RESULTS The ablation margin (P = 0.015), blood vessel proximity (P = 0.006), and colorectal origin (P = 0.029) were significantly associated with the local progression rate. The local progression rates were 36.3% for LF ablations and 12.8% for HF ablations. The 6, 12, and 18 months local progression-free survival rates were 79%, 65.2% and 53% for the LF group and 97.1%, 93.7%, and 58.4% for the HF group, with a significant difference between the survival curves (P = 0.048). CONCLUSION HF ablations resulted in larger ablation margins with fewer local progression compared with LF ablations.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Andrei Roman
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
| | | | - Iliana Bednarova
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany; Institute of Diagnostic Radiology, Department of Biological and Medical Sciences, University of Udine, Udine, Italy
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
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Kodama H, Ueshima E, Gao S, Monette S, Paluch LR, Howk K, Erinjeri JP, Solomon SB, Srimathveeravalli G. High power microwave ablation of normal swine lung: impact of duration of energy delivery on adverse event and heat sink effects. Int J Hyperthermia 2018; 34:1186-1193. [PMID: 29490524 DOI: 10.1080/02656736.2018.1447149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The purpose of this study is to assess the impact of duration of energy delivery on adverse events (AEs) and heat sink effects during high power microwave ablation (MWA) of normal swine lung. MATERIALS AND METHODS High power (100 W) MWA was performed with short (2 min, 18 ablations) or long (10 min, nine ablations) duration of energy delivery in unilateral lung of swine (n = 10). CT imaging was done prior to sacrifice at 2 or 28 d post-treatment, with additional imaging at 7 and 14 d for the latter cohort. Ablation zones were assessed with CT imaging and histopathology analysis. Differences in AEs and ablation characteristics between groups were compared with Fisher's exact test and Student's t-test, respectively. RESULTS There were no significant differences in formation of air-filled needle tract, cavitation, and pneumonia (p > 0.5) between the treatment groups. Intra-procedural pneumothorax requiring chest tube placement occurred in three animals. Substantial (>20%, p = 0.01) intra-procedural ablation zone distortion was observed in both groups. The presence of large airways or blood vessels did not result in heat sink effect within the ablation zones and was not indicative of reduced ablation size. Increased energy delivery yielded larger (8.9 ± 3.1 cm3 vs. 3.4 ± 1.7 cm3, p < 0.001) spherical ablations (sphericity: 0.70 ± 0.10 vs. 0.56 ± 0.13, p = 0.01). CONCLUSIONS High power MWA of normal lung with longer duration of energy delivery can create larger spherical ablations, without significant differences in post-procedure AEs when compared with shorter energy delivery time.
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Affiliation(s)
- Hiroshi Kodama
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Eisuke Ueshima
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Song Gao
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Sebastien Monette
- b Laboratory of Comparative Pathology , Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine , New York , NY , USA
| | - Lee-Ronn Paluch
- c Center of Comparative Medicine and Pathology , Memorial Sloan Kettering Cancer Center, Weill Cornell Medicine, Hospital for Special Surgery , New York , NY , USA
| | - Kreg Howk
- d Medtronic Inc , Massachusetts , MA , USA
| | - Joseph P Erinjeri
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA.,e Department of Radiology , Weill Cornell Medical College , New York , NY , USA
| | - Stephen B Solomon
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA.,e Department of Radiology , Weill Cornell Medical College , New York , NY , USA
| | - Govindarajan Srimathveeravalli
- a Department of Radiology , Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center , New York , NY , USA.,d Medtronic Inc , Massachusetts , MA , USA
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Vogl TJ, Panahi B, Albrecht MH, Naguib NNN, Nour-Eldin NEA, Gruber-Rouh T, Thompson ZM, Basten LM. Microwave ablation of pancreatic tumors. MINIM INVASIV THER 2017; 27:33-40. [PMID: 29278340 DOI: 10.1080/13645706.2017.1420664] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the clinical performance of percutaneous microwave ablation (MWA) for treatment of locally-advanced-pancreatic-cancer (LAPC). MATERIAL AND METHODS Twenty-two MWA sessions (August 2015-March 2017) in 20 patients with primary pancreatic cancer (13 men, 7 women, mean-age: 59.9 ± 8.6 years, range: 46-73 years), who had given informed consent, were retrospectively evaluated. All procedures were performed percutaneously under CT-guidance using the same high-frequency (2.45-GHz) MWA device. Tumor location and diameter, ablation diameter and volume, roundness, duration, technical success and efficacy, output energy, complications, and local tumor progression defined as a tumor focus connected to the edge of a previously technically efficient ablation zone were collected. RESULTS Seventeen pancreatic malignant tumors (77.3%) were located in the pancreatic head and five (22.7%) in the pancreatic tail. Initial Mean Tumor Diameter was 30 ± 6 mm. Technical success and efficacy were idem (100%). No major complications occurred. Two patients (9.1%) showed minor complications of severe local pain related to MWA. Post-ablation diameter was on average 34.4 ± 5.8 mm. Mean ablation volume was 7.8 ± 3.8 cm³. The mean transverse roundness index was 0.74 ± 0.14. Mean ablation time was 2.6 ± 0.96 min. The mean applied energy per treatment was 9627 ± 3953 J. Local tumor progression was documented in one case (10%) of the 10/22 available three-month follow-up imaging studies. CONCLUSION High-frequency (2.45 GHz) microwave ablation (MWA) for treatment of unresectable and non-metastatic locally-advanced-pancreatic-cancer (LAPC) shows promising results regarding feasibility and safety of percutaneous approach after short-term follow-up and should be further evaluated.
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Affiliation(s)
- Thomas J Vogl
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Bita Panahi
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Moritz H Albrecht
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Nagy Naguib Naeem Naguib
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Nour-Eldin A Nour-Eldin
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Tatjana Gruber-Rouh
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
| | - Zachary M Thompson
- b Department of Radiology and Radiological Science , Medical University of South Carolina , Charleston , SC , USA
| | - Lajos M Basten
- a Department of Diagnostic and Interventional Radiology , Frankfurt-University Hospital , Frankfurt am Main , Germany
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Wang J, Zhang ZG, Zhang WG. A modified surgical approach of hepatopancreatoduodenectomy for advanced gallbladder cancer: Report of two cases and literature review. Curr Med Sci 2017; 37:855-860. [PMID: 29270743 DOI: 10.1007/s11596-017-1817-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 05/12/2017] [Indexed: 02/07/2023]
Abstract
Gallbladder cancer (GBC) is the most common cancer of the biliary tract, constituting 80%-95% of malignant biliary tract tumors. Surgical resection is currently regarded as the sole curative treatment for GBC. Hepatopancreatoduodenectomy (HPD) has been adopted to remove the advanced gallbladder tumor together with the infiltrated parts within the liver, lower biliary tract and the peripancreatic region of GBC patients. However, patients who underwent HPD were reported to have a distinctly higher postoperative morbidity (71.4%, ranging from 30.8% to 100%) and mortality (13.2%, ranging from 2.4% to 46.9%) than those given pancreatoduodenectomy (PD) alone. We present two patients with advanced GBC who underwent a modified surgical approach of HPD: PD with microwave ablation (MWA) of adjacent liver tissues and the technique of intraductal cooling of major bile ducts. No serious complications like bile leakage, pancreatic fistula, hemorrhage and organ dysfunction, etc. occurred in the two patients. They had a rapid recovery with postoperative hospital stay being 14 days. Application of this approach effectively eliminated tumor-infiltrated adjacent tissues, and maximally reduced the postoperative morbidity and mortality. This modified surgical method is secure and efficacious for the treatment of locally advanced GBC.
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Affiliation(s)
- Jian Wang
- Department of Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Hepatopancreatobiliary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China
| | - Zhan-Guo Zhang
- Department of Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wan-Guang Zhang
- Department of Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Takahashi H, Kahramangil B, Berber E. Local recurrence after microwave thermosphere ablation of malignant liver tumors: results of a surgical series. Surgery 2017; 163:709-713. [PMID: 29273176 DOI: 10.1016/j.surg.2017.10.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 10/01/2017] [Accepted: 10/18/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Microwave thermosphere ablation is a new treatment modality that creates spherical ablation zones using a single antenna. This study aims to analyze local recurrence associated with this new treatment modality in patients with malignant liver tumors. METHODS This is a prospective clinical study of patients who underwent microwave thermosphere ablation of malignant liver tumors between September 2014 and March 2017. Clinical, operative, and oncologic parameters were analyzed using Kaplan-Meier survival and Cox proportional hazards model. RESULTS One hundred patients underwent 301 ablations. Ablations were performed laparoscopically in 87 and open in 13 patients. Pathology included neuroendocrine liver metastasis (n = 115), colorectal liver metastasis (n = 100), hepatocellular cancer (n = 21), and other tumor types (n = 65). Ninety-day morbidity was 7% with one not procedure-related mortality. Median follow-up was 16 months with 65% of patients completing at least 12 months of follow-up. The rate of local tumor recurrence rate per lesion was 6.6% (20/301). Local tumor, new hepatic, and extrahepatic recurrences were detected in 15%, 40%, and 40% of patients, respectively. Local recurrence rate per pathology was 12% for both colorectal liver metastasis (12/100) and other metastatic tumors (8/65). No local recurrence was observed to date in the neuroendocrine liver metastasis and in the limited number of patients with hepatocellular cancers. Tumor size >3 cm and tumor type were independent predictors of local recurrence. CONCLUSION This is the first study to analyze local recurrence after microwave thermosphere ablation of malignant liver tumors. Short-term local tumor control rate compares favorably with that reported for radiofrequency and other microwave technologies in the literature.
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Affiliation(s)
- Hideo Takahashi
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Bora Kahramangil
- Department of Endocrine Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Eren Berber
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH; Department of Endocrine Surgery, Cleveland Clinic Foundation, Cleveland, OH.
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