Radiofrequency hyperthermia in the palliative treatment of mucinous carcinomatosis of appendiceal origin: optimizing and monitoring heat delivery in western patients

Thermal Protection Strategies and Neuromonitoring during Ablation

Advanced interventional pain management approaches seek to lesion neural targets to achieve desirable analgesia; however, equally important is preservation of motor and sensory function for regional bystander nerves. The topic of neuroprotection is also relevant for thermal ablation of metastatic bone tumors in the vicinity of neural structures. This report aims to provide an IR-directed framework of thermoprotective techniques available during thermal ablation.

The use of hyperthermia to overcome tumour hypoxia in the treatment of advanced breast cancer

Purpose:The purpose of this review was to explore the literature on the use of hyperthermia (HT) in advanced breast cancer.

Methods:A literature search was conducted to obtain information from recent trials of HT and/or chemotherapy (CH) and radiotherapy (RT) for patients with locally recurrent breast carcinoma. Issues concerned with patient compliance and side effects have also been reviewed and future recommendations for research made.

Results:Results of recent trials have demonstrated promising outcomes for HT and RT in combination, particularly for recurrent disease to improve local control (LC). There is no evidence, however, to support a positive effect on overall survival.

Conclusions:Despite positive results HT has not been widely embraced, due to financial and logistical limitations. Future recommendations include larger, randomised, controlled studies and the development of temperature mapping to avoid potentially limiting HT blisters.

Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy

OBJECTIVE

The aim of this study was to analyze the survival of patients with peritoneal dissemination of appendiceal malignancy having incomplete cytoreductive surgery.

SUMMARY BACKGROUND DATA

Cytoreductive surgery plus perioperative intraperitoneal chemotherapy has emerged as a new and potentially curative treatment option for patients with peritoneal dissemination of appendiceal mucinous tumors. The goal of surgery is to remove all visible disease. Nevertheless, in some patients, complete cytoreduction is not possible.

METHODS

Over a 30-year period, 645 patients with epithelial peritoneal surface malignancy of appendiceal origin were treated with cytoreductive surgery and intraperitoneal chemotherapy by a single surgeon. One hundred seventy-four (27.1%) of these patients had an incomplete cytoreduction. A critical statistical analysis of the impact of selected clinical features on survival was performed from a prospective database.

RESULTS

Mortality and morbidity rates were 0% and 33.3%, respectively. Median survival of these 174 patients was 20.5 months and their 1-year, 3-year, and 5-year survival rates were 71%, 34%, and 15%, respectively. By multivariate analysis, the presence of signet ring cells and lymph node involvement were independent prognostic indicators of poor survival (P = 0.047 and P < 0.001, respectively). Patients who underwent more than 1 cytoreduction or repeat intraperitoneal chemohyperthermia showed significant improvement in survival (P = 0.018 and P < 0.001, respectively)

CONCLUSION

Incomplete cytoreduction plus perioperative intraperitoneal chemotherapy of peritoneal dissemination from appendiceal malignancy results in limited long-term survival. Patients with signet ring histology or lymph node involvement have an especially poor outcome. Repeat cytoreduction and intraperitoneal chemohyperthermia may improve outcome.

Remote thermometry to avoid complications in radiofrequency ablation

Percutaneous image-guided radiofrequency ablation (RFA) of tumors has the potential risk for thermal damage to nearby normal collateral tissues. Thus, the goal of creating a sufficient area of tumor necrosis must be weighed against the risk for injury to collateral tissues. In this study, remote thermistors were used to monitor temperatures near collateral structures during tumor RFA. Four unique cases are described. When temperature-sensitive structures are near the target lesion, remote thermometry could further increase the safety of this evolving minimally invasive procedure.