1
|
Sparks H, Rink JS, Ramakrishnan A, Sung K, Ni J, Lu DSK, Raman SS, Lee EW, Chiang J. Characterization of Microwave Generator Energy and Ablation Volumes following Transarterial Embolization in an In Vivo Porcine Liver Model. J Vasc Interv Radiol 2024; 35:1227-1233. [PMID: 38754759 DOI: 10.1016/j.jvir.2024.05.005] [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: 10/26/2023] [Revised: 03/24/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To characterize the relationship between ablation zone volume (AZV) and microwave ablation (MWA) energy in an in vivo porcine liver model following arterial embolization. MATERIALS AND METHODS With Institutional Animal Care and Use Committee (IACUC) approval, 11 female swine underwent either right (n = 5) or left (n = 6) hepatic artery embolization under fluoroscopic guidance. Subsequently, ultrasound (US)-guided MWA was performed in each liver segment (left lateral, left medial, right medial, and right lateral) at either 30 W (n = 4 lobes), 60 W (n = 4), 65 W (n = 20), 90 W (n = 8), 120 W (n = 4), or 140 W (n = 4) continuously for 5 minutes. Postprocedural volumetric segmentation was performed on standardized multiphase T1 magnetic resonance (MR) imaging sequences. RESULTS Mean AZVs in embolized lobes (15.8 mL ± SD 10.6) were significantly larger than those in nonembolized lobes (11.2 mL ± SD 6.5, P < .01). MWA energy demonstrated significant positive linear correlation with both embolized (R2 = 0.66, P < .01) and nonembolized (R2 = 0.64, P < .01) lobes. The slope of the linear models corresponded to a 0.95 mL/kJ (SD ± 0.16) and 0.54 mL/kJ (SD ± 0.09) increase in ablation volume per applied kilojoule of energy (E) in embolized and nonembolized lobes, respectively. In the multivariate model, embolization status significantly modified the relationship between E and AZV as described by the following interaction term: 0.42∗E∗(embolization status) (P = .031). CONCLUSIONS Linear models demonstrated a near 1.8-fold increase in ratio of AZV per unit E, R(AZV:E), when applied to embolized lobes relative to nonembolized lobes. Absolute AZV differences between embolized and nonembolized lobes were greater at higher-power MWA.
Collapse
Affiliation(s)
- Hiro Sparks
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California.
| | - Johann S Rink
- Department for Radiology and Nuclear Medicine, Mannheim University Medical Centre, Mannheim, Germany
| | - Abinaya Ramakrishnan
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Kyunghun Sung
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Ni
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - David S K Lu
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Steven S Raman
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Edward W Lee
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| | - Jason Chiang
- Department of Radiology, Ronald Reagan University of California, Los Angeles Medical Center, Los Angeles, California
| |
Collapse
|
2
|
Vogl TJ, Martin SS, Gruber-Rouh T, Booz C, Koch V, Nour-Eldin NEA, Hussainy Said MN. Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial. ROFO-FORTSCHR RONTG 2024; 196:482-490. [PMID: 38065541 DOI: 10.1055/a-2203-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
PURPOSE To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. MATERIALS AND METHODS In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. RESULTS The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5 months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). CONCLUSION The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. KEY POINTS · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..
Collapse
Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - M N Hussainy Said
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| |
Collapse
|
3
|
Ji X, Zhu L, Hsu JC, Wang H, Zhou J, Wang Q, Li Y, Cai W, Ni D, Wu Z. Tungsten-based nanoparticles as contrast agents for liver tumor detection using dual-energy computed tomography. Biomater Sci 2023; 11:7817-7825. [PMID: 37873585 PMCID: PMC10873050 DOI: 10.1039/d3bm01068f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Dual-energy computed tomography (DECT) is a commonly used imaging technique for detecting and diagnosing liver cancer. Currently, it is performed using clinically approved iodinated small molecule contrast agents (CAs). However, these iodinated CAs have several drawbacks, including sub-optimal contrast generation and contra-indication in patients with renal insufficiency. Herein, we synthesized tungsten-based CAs (i.e., WO3-x NPs) with excellent biocompatibility and investigated their effectiveness in DECT imaging. WO3-x NPs significantly enhanced the contrast between liver tumors and normal liver tissues as indicated by in vivo DECT imaging. Furthermore, WO3-x NPs exhibited excellent biocompatibility and minimal systemic toxicity. This study introduces a novel class of CAs for DECT and presents a promising method for accurate early diagnosis of liver tumors.
Collapse
Affiliation(s)
- Xiuru Ji
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, P. R. China.
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China.
| | - Jessica C Hsu
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Wisconsin 53705, USA.
| | - Han Wang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, P. R. China.
| | - Jingwei Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizaoju Rd., Huangpu District, Shanghai 200011, People's Republic of China
| | - Qingbing Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China.
| | - Yuhan Li
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, P. R. China.
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Wisconsin 53705, USA.
| | - Dalong Ni
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Rd, Shanghai 200025, P. R. China.
| | - Zhiyuan Wu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China.
| |
Collapse
|
4
|
Ren E, Wang Y, Liang T, Zheng H, Shi J, Cheng Z, Li H, Gu Z. Local Drug Delivery Techniques for Triggering Immunogenic Cell Death. SMALL METHODS 2023; 7:e2300347. [PMID: 37259275 DOI: 10.1002/smtd.202300347] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/10/2023] [Indexed: 06/02/2023]
Abstract
Immunogenic cell death (ICD), a dying state of the cells, encompasses the changes in the conformations of cell surface and the release of damage-associated molecular patterns, which could initiate an adaptive immune response by stimulating the dendritic cells to present antigens to T cells. Advancements in biomaterials, nanomedicine, and micro- and nano-technologies have facilitated the development of effective ICD inducers, but the potential toxicity of these vesicles encountered in drug delivery via intravenous administration hampers their further application. As alternatives, the local drug delivery systems have gained emerging attention due to their ability to prolong the retention of high payloads at the lesions, sequester drugs from harsh environments, overcome biological barriers to exert optimal efficacy, and minimize potential side effects to guarantee bio-safety. Herein, a brief overview of the local drug delivery techniques used for ICD inducers is provided, explaining how these techniques broaden, alter, and enhance the therapeutic capability while circumventing systemic toxicity at the same time. The historical context and prominent examples of the local administration of ICD inducers are introduced. The complexities, potential pitfalls, and opportunities for local drug delivery techniques in cancer immunotherapy are also discussed.
Collapse
Affiliation(s)
- En Ren
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Yanfang Wang
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Tingxizi Liang
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Hanqi Zheng
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Jiaqi Shi
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Zesheng Cheng
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Hongjun Li
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
- Department of Hepatobiliary and Pancreatic Surgery the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, P. R. China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, P. R. China
- Jinhua Institute of Zhejiang University, Zhejiang University, Jinhua, 321299, P. R. China
| | - Zhen Gu
- Key Laboratory of Advanced Drug Delivery Systems of Zhejiang Province, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, P. R. China
- Jinhua Institute of Zhejiang University, Zhejiang University, Jinhua, 321299, P. R. China
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, P. R. China
- The National Laboratory of Advanced Drug Delivery and Release Systems, Hangzhou, 310058, P. R. China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Zhu Y, Li Q, Wang C, Hao Y, Yang N, Chen M, Ji J, Feng L, Liu Z. Rational Design of Biomaterials to Potentiate Cancer Thermal Therapy. Chem Rev 2023. [PMID: 36912061 DOI: 10.1021/acs.chemrev.2c00822] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Cancer thermal therapy, also known as hyperthermia therapy, has long been exploited to eradicate mass lesions that are now defined as cancer. With the development of corresponding technologies and equipment, local hyperthermia therapies such as radiofrequency ablation, microwave ablation, and high-intensity focused ultrasound, have has been validated to effectively ablate tumors in modern clinical practice. However, they still face many shortcomings, including nonspecific damages to adjacent normal tissues and incomplete ablation particularly for large tumors, restricting their wide clinical usage. Attributed to their versatile physiochemical properties, biomaterials have been specially designed to potentiate local hyperthermia treatments according to their unique working principles. Meanwhile, biomaterial-based delivery systems are able to bridge hyperthermia therapies with other types of treatment strategies such as chemotherapy, radiotherapy and immunotherapy. Therefore, in this review, we discuss recent progress in the development of functional biomaterials to reinforce local hyperthermia by functioning as thermal sensitizers to endow more efficient tumor-localized thermal ablation and/or as delivery vehicles to synergize with other therapeutic modalities for combined cancer treatments. Thereafter, we provide a critical perspective on the further development of biomaterial-assisted local hyperthermia toward clinical applications.
Collapse
Affiliation(s)
- Yujie Zhu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Quguang Li
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Chunjie Wang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Yu Hao
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Nailin Yang
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Minjiang Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang, P.R. China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang, P.R. China
| | - Liangzhu Feng
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| | - Zhuang Liu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, 199 Ren'ai Road, Suzhou 215123, Jiangsu, P.R. China
| |
Collapse
|
8
|
Liu Q, Huang W, Liang W, Ye Q. Current Strategies for Modulating Tumor-Associated Macrophages with Biomaterials in Hepatocellular Carcinoma. Molecules 2023; 28:molecules28052211. [PMID: 36903458 PMCID: PMC10004660 DOI: 10.3390/molecules28052211] [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: 01/31/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fourth most common cause of cancer-related deaths in the world. However, there are currently few clinical diagnosis and treatment options available, and there is an urgent need for novel effective approaches. More research is being undertaken on immune-associated cells in the microenvironment because they play a critical role in the initiation and development of HCC. Macrophages are specialized phagocytes and antigen-presenting cells (APCs) that not only directly phagocytose and eliminate tumor cells, but also present tumor-specific antigens to T cells and initiate anticancer adaptive immunity. However, the more abundant M2-phenotype tumor-associated macrophages (TAMs) at tumor sites promote tumor evasion of immune surveillance, accelerate tumor progression, and suppress tumor-specific T-cell immune responses. Despite the great success in modulating macrophages, there are still many challenges and obstacles. Biomaterials not only target macrophages, but also modulate macrophages to enhance tumor treatment. This review systematically summarizes the regulation of tumor-associated macrophages by biomaterials, which has implications for the immunotherapy of HCC.
Collapse
Affiliation(s)
- Qiaoyun Liu
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan 430071, China
| | - Wei Huang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan 430071, China
| | - Wenjin Liang
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan 430071, China
| | - Qifa Ye
- Zhongnan Hospital of Wuhan University, Institute of Hepatobiliary Diseases of Wuhan University, Transplant Center of Wuhan University, National Quality Control Center for Donated Organ Procurement, Hubei Key Laboratory of Medical Technology on Transplantation, Hubei Clinical Research Center for Natural Polymer Biological Liver, Hubei Engineering Center of Natural Polymer-Based Medical Materials, Wuhan 430071, China
- The Third Xiangya Hospital of Central South University, Research Center of National Health Ministry on Transplantation Medicine Engineering and Technology, Changsha 410013, China
- Correspondence:
| |
Collapse
|
9
|
Andresciani F, Pacella G, Vertulli D, Altomare C, Bitonti MT, Bruno A, Cea L, Faiella E, Beomonte Zobel B, Grasso RF. Microwave ablation using two simultaneous antennas for the treatment of liver malignant lesions: a 3 year single-Centre experience. Int J Hyperthermia 2023; 40:2163309. [PMID: 36599421 DOI: 10.1080/02656736.2022.2163309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND sequential or simultaneous applications of multiple antennas have been proposed to create larger ablation zone; however, there is a lack of data in patients affected by liver tumors, with potentially different results from animal liver models. The purpose of this study was to evaluate efficacy and safety of liver percutaneous microwave ablation using simultaneous activation of two antennas to treat lesions bigger than 2,5 cm; particularly the focus was assessing whether the ratio of ablation zone volume in millimeters to applied energy in kilojoules [R(AZ:E)] differs between hepatocellular carcinoma in a cirrhotic liver and liver metastasis and if it is correlated to complications incidence or recurrence of disease. METHODS Fifty-five liver microwave ablation performed with two simultaneous antennas from March 2017 to June 2021 were retrospectively reviewed; 9 procedures were excluded due to the association with Chemoembolization. Size, shape, volume of lesions and ablation zones were recorded. Technical success was defined as complete devascularization of the treated area at the post-procedural CT. R(AZ:E) was determined dividing the ablation zone volume in mm3 by the amount of energy in kilojoules applied in each procedure and complications were reported. RESULTS Technical success was achieved in all the procedures. Mean R(AZ:E) was 0,75 ± 0,58. T-student test for patients with HCC and patients with metastasis about R(AZ:E) was significant (p = 0.03). The incidence of bilomas was lower for HCC (p = 0.022). One-month follow-up showed Complete Response (CR) in 44/46 (95,6%) patients; Three-six months follow-up demonstrated: CR in 43/46 (93.5%) cases and 12 months follow-up highlighted CR in 40/45 (88,9%) cases. CONCLUSIONS These results provide preliminary evidence of efficacy and safety of simultaneous liver MWA using two antennas, highlighting the importance of procedural indications.
Collapse
Affiliation(s)
- Flavio Andresciani
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppina Pacella
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Daniele Vertulli
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Altomare
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Maria Teresa Bitonti
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Amalia Bruno
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Laura Cea
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Bruno Beomonte Zobel
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Rosario Francesco Grasso
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| |
Collapse
|
10
|
Hoffer EK, Borsic A, Patel SD. Validation of Software for Patient-Specific Real-Time Simulation of Hepatic Radiofrequency Ablation. Acad Radiol 2022; 29:e219-e227. [PMID: 35039220 PMCID: PMC9276838 DOI: 10.1016/j.acra.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES CT-guided radiofrequency ablation (RFA) is a potentially curative minimally invasive treatment for liver cancer. Local tumor recurrence limits the success of RFA for large or irregular tumors as it is difficult to visualize the tissue destroyed. This study was designed to validate a real-time software-simulated ablation volume for intraprocedural guidance. MATERIALS AND METHODS Software that simulated RFA physics calculated ablation volumes in 17 agar-albumin phantoms (7 with a simulated vessel) and in six in-vivo (porcine) ablations. The software-modeled volumes were compared with the actual ablations (physical lesion in agar, contrast CT in the porcine model) and to the volume predicted by the manufacturer's charts. Error was defined as the distance from evenly distributed points on the segmented true ablation volume surfaces to the closest points on the corresponding computer-generated model, and for the porcine model, to the manufacturer-specified ablation volume. RESULTS The average maximum error of the simulation was 2.8 mm (range to 4.9 mm) in the phantoms. The heat-sink effect from the simulated vessel was well-modeled by the simulation. In the porcine model, the average maximum error of the simulation was 5.2 mm (range to 8.1 mm) vs 7.8 mm (range to 10.0mm) for the manufacturer's model (p = 0.009). CONCLUSION A real-time computer-generated RFA model incorporated tine position, energy deposited, and large vessel proximity to predict the ablation volume in agar phantoms with less than 3mm maximum error. Although the in-vivo model had slightly higher maximum error, the software better predicted the achieved ablation volume compared to the manufacturer's ablation maps.
Collapse
Affiliation(s)
- Eric K Hoffer
- Director of Interventional Radiology, Dartmouth Hitchcock Medical Center (E.K.H.), One Medical Center Dr., Lebanon, New Hampshire 03755; CEO NE Scientific LLC (A.B.), Boston, Massachusetts; Geisel School of Medicine at Dartmouth, Hanover, NH 03755 (S.D.P.).
| | - Andrea Borsic
- Director of Interventional Radiology, Dartmouth Hitchcock Medical Center (E.K.H.), One Medical Center Dr., Lebanon, New Hampshire 03755; CEO NE Scientific LLC (A.B.), Boston, Massachusetts; Geisel School of Medicine at Dartmouth, Hanover, NH 03755 (S.D.P.)
| | - Sohum D Patel
- Director of Interventional Radiology, Dartmouth Hitchcock Medical Center (E.K.H.), One Medical Center Dr., Lebanon, New Hampshire 03755; CEO NE Scientific LLC (A.B.), Boston, Massachusetts; Geisel School of Medicine at Dartmouth, Hanover, NH 03755 (S.D.P.)
| |
Collapse
|
11
|
Ierardi AM, Grillo P, Bonanno MC, Coppola A, Vespro V, Andrisani MC, Tosi D, Mendogni P, Franzi S, Venturini M, Carrafiello G. Prediction of Ablation Volume in Percutaneous Lung Microwave Ablation: A Single Centre Retrospective Study. Tomography 2022; 8:2475-2485. [PMID: 36287805 PMCID: PMC9607488 DOI: 10.3390/tomography8050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous Microwave Ablation (MWA) of lung malignancies is a procedure with many technical challenges, among them the risk of residual disease. Recently, dedicated software able to predict the volume of the ablated area was introduced. Cone-beam computed tomography (CBCT) is the imaging guidance of choice for pulmonary ablation in our institution. The volumetric prediction software (VPS) has been installed and used in combination with CBCT to check the correct position of the device. Our study aimed to compare the results of MWA of pulmonary tumours performed using CBCT with and without VPS. METHODS We retrospectively reviewed 1-month follow-up enhanced contrast-enhanced computed tomography (CECT) scans of 10 patients who underwent ablation with the assistance of VPS (group 1) and of 10 patients who were treated without the assistance of VPS (group 2). All patients were treated for curative purposes, the maximum axial diameter of lesions ranged between 5 and 22 mm in group 1 and between 5 and 25 mm in group 2. We compared the presence of residual disease between the two groups. RESULTS In group 1 residual disease was seen in only 1 patient (10%) in which VPS had ensured complete coverage of the tumour. In group 2 residual disease was found in 3 patients (30%). CONCLUSIONS Using this software during MWA of lung malignancies could improve the efficacy of the treatment compared to the conventional only CBCT guidance.
Collapse
Affiliation(s)
- Anna Maria Ierardi
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Pasquale Grillo
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Maria Chiara Bonanno
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Valentina Vespro
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Carmela Andrisani
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sara Franzi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
- Department of Health Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
| |
Collapse
|
12
|
Zhu Y, Yang Z, Pan Z, Hao Y, Wang C, Dong Z, Li Q, Han Y, Tian L, Feng L, Liu Z. Metallo-alginate hydrogel can potentiate microwave tumor ablation for synergistic cancer treatment. SCIENCE ADVANCES 2022; 8:eabo5285. [PMID: 35921425 PMCID: PMC9348787 DOI: 10.1126/sciadv.abo5285] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Microwave ablation (MWA) as a local tumor ablation strategy suffers from posttreatment tumor recurrence. Development of adjuvant biomaterials to potentiate MWA is therefore of practical significance. Here, the high concentration of Ca2+ fixed by alginate as Ca2+-surplus alginate hydrogel shows enhanced heating efficiency and restricted heating zone under microwave exposure. The high concentration of extracellular Ca2+ synergizes with mild hyperthermia to induce immunogenic cell death by disrupting intracellular Ca2+ homeostasis. Resultantly, Ca2+-surplus alginate hydrogel plus MWA can ablate different tumors on both mice and rabbits at reduced operation powers. This treatment can also elicit antitumor immunity, especially if synergized with Mn2+, an activator of the stimulation of interferon genes pathway, to suppress the growth of both untreated distant tumors and rechallenged tumors. This work highlights that in situ-formed metallo-alginate hydrogel could act as microwave-susceptible and immunostimulatory biomaterial to reinforce the MWA therapy, promising for clinical translation.
Collapse
|
13
|
Huang X, Zhou Y, Wang C, Qi F, Luo P, Du H, Zhang Q, Liu Z, Yuan K, Qiu B. Development of a novel MR-conditional microwave needle for MR-guided interventional microwave ablation at 1.5T. Magn Reson Med 2022; 88:1886-1900. [PMID: 35775830 DOI: 10.1002/mrm.29289] [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: 12/13/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop an MR-conditional microwave needle that generates a spherical ablation zone and clear MRI visibility for MR-guided microwave ablation. METHODS An MR-conditional microwave needle consisting of zirconia tip and TA18 titanium alloy tube was investigated. The numerical model was created to optimize the needle's geometry and analyze its performance. A geometrically optimized needle was produced using non-magnetic materials based on the electromagnetics simulation results. The needle's mechanical properties were tested per the Chinese pharmaceutical industry standard YY0899-2013. The MRI visibility performance and ablation characteristics of the needle was tested both in vitro (phantom) and in vivo (rabbit) at 1.5T. The RF-induced heating was evaluated in ex vivo porcine liver. RESULTS The needle's mechanical properties met the specified requirements. The needle susceptibility artifact was clearly visible both in vitro and in vivo. The needle artifact diameter (A) was small in in vivo (Ashaft: 4.96 ± 0.18 mm for T1W-FLASH, 3.13 ± 0.05 mm for T2-weighted fast spin-echo (T2W-FSE); Atip: 2.31 ± 0.09 mm for T1W-FLASH, 2.29 ± 0.08 mm for T2W-FSE; tip location error [TLE]: -0.94 ± 0.07 mm for T1W-FLASH, -1.10 ± 0.09 mm for T2W-FSE). Ablation zones generated by the needle were nearly spherical with an elliptical aspect ratio ranging from 0.79 to 0.90 at 30 W, 50 W for 3, 5, 10 min duration ex vivo ablations and 0.86 at 30 W for 10 min duration in vivo ablations. CONCLUSION The designed MR-conditional microwave needle offers excellent mechanical properties, reliable MRI visibility, insignificant RF-induced heating, and a sufficiently spherical ablation zone. Further clinical development of MR-guided microwave ablation appears warranted.
Collapse
Affiliation(s)
- Xiaoyan Huang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Yufu Zhou
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Changliang Wang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Fulang Qi
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Penghui Luo
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Huiyu Du
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Qing Zhang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Zhengrong Liu
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Kecheng Yuan
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Bensheng Qiu
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| |
Collapse
|
14
|
Zhao Y, McKillop IH, Davalos RV. Modeling of a single bipolar electrode with tines for irreversible electroporation delivery. Comput Biol Med 2022; 142:104870. [PMID: 35051854 PMCID: PMC10037907 DOI: 10.1016/j.compbiomed.2021.104870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/24/2021] [Accepted: 09/12/2021] [Indexed: 01/07/2023]
Abstract
Irreversible electroporation (IRE) is a non-thermal tumor ablation technology employed to treat solid tumors not amenable to resection or thermal ablation. The IRE systems currently in clinical use deliver electrical pulses via multiple monopolar electrodes. This approach can present significant technical challenges due to the requirement for accurate placement of multiple electrodes and maintenance of parallel electrode alignment during pulse delivery. In this study, we sought to evaluate a novel IRE electrode configuration consisting of a single bipolar electrode with deployable tines. Using commercial finite element software predicted ablation outcomes, thermal damage, ablation sphericity, and energy delivery were calculated for existing monopolar and bipolar electrodes, and bipolar electrodes with either 4 or 8 deployable tines. The bipolar electrodes with tines generated larger predicted ablations compared to existing monopolar (>100%) and bipolar (>10%) arrangements, and the ablation shape using bipolar electrodes with tines were more spherical than those modeled for bipolar electrodes. Thermal damage modeled for bipolar electrodes and bipolar electrodes with tines was less than that of monopolar electrodes (using identical pulse parameters), and bipolar electrodes with tines delivered less energy than monopolar or bipolar electrodes. These studies using a single point of device insertion suggest the potential for developing alternative IRE delivery techniques, and may simplify clinical use and increase the predicted ablation shape/volume.
Collapse
Affiliation(s)
- Yajun Zhao
- College of Electrical Engineering and Control Science, Nanjing Tech. University, Nanjing, 211816, China; Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA.
| | - Iain H McKillop
- Department of Surgery, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC, 28203, USA
| | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, 24061, USA
| |
Collapse
|
15
|
Jonsdottir G, Beermann M, Lundgren Cronsioe A, Hasselrot K, Kopp Kallner H. Ultrasound guided microwave ablation compared to uterine artery embolization treatment for uterine fibroids - a randomized controlled trial. Int J Hyperthermia 2022; 39:341-347. [PMID: 35134317 DOI: 10.1080/02656736.2022.2034991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy, feasibility and acceptability of microwave ablation (MWA) compared to uterine artery embolization (UAE) as treatment for uterine fibroids. METHOD A randomized controlled superiority trial, including premenopausal women 30-55 years, with symptomatic uterine fibroids without any single fibroid exceeding mean diameter of eight centimeters. Patients were randomized to receive microwave ablation, performed abdominally or vaginally, or to uterine artery embolization. The primary outcome was volume difference of the three largest fibroids at 6 months post treatment evaluated by magnetic resonance imaging (MRI) by a blinded radiologist analyzed by Mann-Whitney U-test. Secondary outcomes included symptom severity score (SSS), health related quality of life (HR-QoL), amount of menstrual bleeding, postoperative pain, length of hospitalization, need for additional treatment, adverse events and if patients would recommend the treatment to a friend. RESULTS Patients were recruited from 30 January 2017 to 12 September 2019, with a total of 17 patients treated in each group from May 2017 to December 2019. Superiority of MWA could not be established. The volume reduction was 41.8% (Interquartile range, IQR, 14-63) in the MWA group compared to 62.2% (IQR 34.9-80.1) in the UAE group (p = 0.29). Effects on symptoms, HR-QoL and acceptability did not differ between groups. Days of hospitalization and sick leave were significantly fewer in the MWA group (p < 0.001 and p = 0.001). CONCLUSIONS Although superiority of MWA could not be established, it is a promising technique for treating uterine fibroids. It was well tolerated and associated with lower use of health care resources. Trial registration: NCT02942537, www.clincialtrials.gov.
Collapse
Affiliation(s)
- Gudny Jonsdottir
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marie Beermann
- Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Danderyd Hospital, Stockholm, Sweden
| | | | - Klara Hasselrot
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Helena Kopp Kallner
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden.,Department of Clinical Sciences at, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
Yao J, Liu B, Wang X, Yu J, Cheng Z, Han Z, Liu F, Zheng R, Cheng W, Wei Q, Yu S, Li K, Chen P, Luo Y, Yu X, Liang P. Long-term efficacy of microwave ablation in the treatment of subcapsular hepatocellular carcinomas of ≤3 cm in diameter: a multicenter, propensity score-matched study. Int J Hyperthermia 2022; 39:209-216. [PMID: 35067144 DOI: 10.1080/02656736.2021.2023228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jundong Yao
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Binbin Liu
- Henan University of Science and Technology School of Nursing, Luoyang, China
| | - Xiaohui Wang
- Department of Ultrasound Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rongqin Zheng
- Department of Medical Ultrasonics, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wen Cheng
- Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qiang Wei
- Department of Ultrasound, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Songyuan Yu
- Department of Ultrasound, Wuhan University of science and technology, Tianyou Hospital, Wuhan, China
| | - Kai Li
- Chinese PLA Medical School, Beijing, China
| | - Peng Chen
- Chinese PLA Medical School, Beijing, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, 5th Medical Center of Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
17
|
Microwave versus radiofrequency ablation for the treatment of liver malignancies: a randomized controlled phase 2 trial. Sci Rep 2022; 12:316. [PMID: 35013377 PMCID: PMC8748896 DOI: 10.1038/s41598-021-03802-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022] Open
Abstract
Microwave (MWA) and radiofrequency ablation (RFA) are main ablative techniques for hepatocellular carcinoma (HCC) and colorectal liver metastasis (MT). This randomized phase 2 clinical trial compares the effectiveness of MWA and RFA as well as morphology of corresponding ablation zones. HCC and MT patients with 1.5–4 cm tumors, suitable for ablation, were randomized into MWA or RFA Groups. The primary endpoint was short-to-long diameter ratio of ablation zone (SLR). Primary technical success (TS) and a cumulative local tumor progression (LTP) after a median 2-year follow-up were compared. Between June 2015 and April 2020, 82 patients were randomly assigned (41 patients per group). For the per-protocol analysis, five patients were excluded. MWA created larger ablation zones than RFA (p = 0.036) although without differences in SLR (0.5 for both groups, p = 0.229). The TS was achieved in 98% (46/47) and 90% (45/50) (p = 0.108), and LTP was observed in 21% (10/47) vs. 12% (6/50) (OR 1.9 [95% CI 0.66–5.3], p = 0.238) of tumors in MWA vs. RFA Group, respectively. Major complications were found in 5 cases (11%) vs. 2 cases (4%), without statistical significance. MWA and RFA show similar SLR, effectiveness and safety in liver tumors between 1.5 and 4 cm.
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Vogl TJ, Jaraysa Y, Martin SS, Gruber-Rouh T, Savage RH, Nour-Eldin NEA, Mehmedovic A. A prospective randomized trial comparing microwave and radiofrequency ablation for the treatment of liver metastases using a dual ablation system ─ The Mira study. Eur J Radiol Open 2022; 9:100399. [PMID: 35155721 PMCID: PMC8822176 DOI: 10.1016/j.ejro.2022.100399] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/22/2022] Open
Abstract
Purpose The aim of this study was to prospectively compare the therapy response and safety of microwave (MWA) and radiofrequency ablation (RFA) for the treatment of liver metastases using a dual ablation system. Methods Fifty patients with liver metastases (23 men, mean age: 62.8 ± 11.8 years) were randomly assigned to MWA or RFA for thermal ablation using a one generator dual ablation system. Magnetic resonance imaging (MRI) was acquired before treatment and 24 h post ablation. The morphologic responses to treatment regarding size, volume, necrotic areas, and diffusion characteristics were evaluated by MRI. Imaging follow-up was obtained for one year in three months intervals, whereas clinical follow-up was obtained for two years in all patients. Results Twenty-six patients received MWA and 24 patients received RFA (mean diameter: 1.6 cm, MWA: 1.7 cm, RFA: 1.5 cm). The mean volume 24 h after ablation was 37.0 cm3 (MWA: 50.5 cm3, RFA: 22.9 cm3, P < 0.01). The local recurrence rate was 0% (0/26) in the MWA-group and 8.3% (2/24) in the RFA-group (P = 0.09). The rate of newly developed malignant formations was 38.0% (19/50) for both groups (MWA: 38.4%, RFA: 37.5%, P = 0.07). The overall survival rate was 70.0% (35/50) after two years (MWA: 76.9%, RFA: 62.5%, P = 0.60). No major complications were reported. Conclusion In conclusion, MWA and RFA are both safe and effective methods for the treatment of liver metastases with MWA generating greater volumes of ablation. No significant differences were found for overall survival, rate of neoplasm, or major complications between both groups. A dual ablation system allows for MWA and RFA treatment using the same hardware. Both methods are safe and effective for the treatment of liver metastases. MWA generates greater volumes of ablation and larger ablative margins compared to RFA.
Collapse
Affiliation(s)
- Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Correspondence to: University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
| | - Yousef Jaraysa
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Simon S. Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Rock H. Savage
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Nour-Eldin A. Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| | - Amela Mehmedovic
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
| |
Collapse
|
21
|
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.
Collapse
Affiliation(s)
- Hideyuki Tamai
- Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan
| | - Jumpei Okamura
- Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan
| |
Collapse
|
22
|
Tsochatzis A, Mazioti A, Iliadis G, Velonakis G, Efthymiou E, Kelekis A, Kelekis N, Filippiadis D. Percutaneous Microwave Ablation of Liver Lesions: Differences on the Sphericity Index of the Ablation Zone between Cirrhotic and Healthy Liver Parenchyma. Diagnostics (Basel) 2021; 11:diagnostics11040655. [PMID: 33916400 PMCID: PMC8066372 DOI: 10.3390/diagnostics11040655] [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: 03/20/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022] Open
Abstract
To compare different parameters of the sphericity index of the ablation zone following microwave ablation (MWA) on cirrhotic- and healthy-liver parenchyma in a series of patients treated with the same MWA system. Institutional database research identified 46 patients (77 lesions) who underwent MWA. “Cirrhotic liver group” (CLG) included 35 hepatocellular carcinoma lesions; “healthy liver group” (HLG) included 42 metastatic lesions. The long axis (LAD), short axis 1 (SAD-1) and 2 (SAD-2), the mean SAD-1 and SAD-2 (mSAD) diameter (in mm) and the mean sphericity (mSPH) index of the ablation zones were evaluated for each treated lesion in both groups from baseline to follow-up. A mixed model analysis of variance reported significant main effect of group on SAD-1 (p = 0.023), SAD-2 (p = 0.010) and mSAD (p = 0.010), with HLG showing lower values compared to CLG. No differences were detected on the LAD (pFDR = 0.089; d = 0.45), and mSPH (pFDR = 0.148, d = 0.40) between the two groups. However, a significant main effect of time was found on LAD (p < 0.001), SAD-1 (p < 0.001), SAD-2 (p < 0.001) and mSAD (p < 0.001), with decreased values in all indices at follow-up compared to baseline. A significant group by time interaction was observed on mSPH (p = 0.044); HLG had significantly lower mSPH at follow-up where CLG did not show any significant change. Our findings indicate that although in cirrhotic liver short axis diameter of the MWA zone seems to be significantly longer, this has no effect on the sphericity index which showed no significant difference between cirrhotic vs. healthy liver lesions. On the contrary, on one month follow-up ablation zones tend to become significant more ellipsoid in healthy whilst remains stable in cirrhotic liver.
Collapse
|
23
|
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.
Collapse
|
24
|
Radiofrequency ablation vs microwave ablation for osteoid osteomas: long-term results. Skeletal Radiol 2020; 49:1995-2000. [PMID: 32564104 DOI: 10.1007/s00256-020-03518-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoid osteomas are benign bone tumors commonly treated using thermal ablation. We compare the technical success, complication rates, and long-term efficacy of the two most common ablation types: radiofrequency and microwave. MATERIALS AND METHODS A retrospective study was performed of all osteoid osteoma ablation procedures between 2007 and 2017. A ten-point numerical pain scale was used to quantify symptoms before and after the procedures with > 12-month follow-up. Complications were reported using the Society of Interventional Radiology Adverse Events reporting criteria. RESULTS Twenty-nine patients successfully underwent 15 radiofrequency ablations and 15 microwave ablations with a technical success rate of 83% for radiofrequency and 100% for microwave (p = 0.23). Long-term recurrence rates (p = 1.0) and complication rates (p = 0.60) were not significantly different for the groups. One patient developed a skin burn following microwave ablation and another developed 12 months of sciatic neuropathy following radiofrequency ablation. CONCLUSION Microwave and radiofrequency ablation are safe and effective methods for treating osteoid osteomas with similar long-term efficacies. Although radiofrequency ablation is more commonly reported to result in skin burns, this complication can arise during microwave ablation.
Collapse
|
25
|
Vo Chieu VD, Wacker F, Rieder C, Pöhler GH, Schumann C, Ballhausen H, Ringe KI. Ablation zone geometry after CT-guided hepatic microwave ablation: evaluation of a semi-automatic software and comparison of two different ablation systems. Int J Hyperthermia 2020; 37:533-541. [PMID: 32468872 DOI: 10.1080/02656736.2020.1766704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: The aims of this study were to evaluate a semi-automatic segmentation software for assessment of ablation zone geometry in computed tomography (CT)-guided microwave ablation (MWA) of liver tumors and to compare two different MWA systems.Material and Methods: 27 patients with 40 hepatic tumors (primary liver tumor n = 20, metastases n = 20) referred for CT-guided MWA were included in this retrospective IRB-approved study. MWA was performed using two systems (system 1: 915 MHz; n = 20; system 2: 2.45 GHz; n = 20). Ablation zone segmentation and ellipticity index calculations were performed using SAFIR (Software Assistant for Interventional Radiology). To validate semi-automatic software calculations, results (2 perpendicular diameters, ellipticity index, volume) were compared with those of manual analysis (intraclass correlation, Pearson's correlation, Mann-Whitney U test; p < 0.05 deemed significant.Results: Manual measurements of mean maximum ablation zone diameters were 43 mm (system 1) and 34 mm (system 2), respectively. Correlations between manual and semi-automatic measurements were r = 0.72 and r = 0.66 (both p < 0.0001) for perpendicular diameters, and r = 0.98 (p < 0.001) for volume. Manual analysis demonstrated that ablation zones created with system 2 had a significantly lower ellipticity index compared to system 1 (mean 1.17 vs. 1.86, p < 0.0001). Results correlated significantly with semi-automatic software measurements (r = 0.71, p < 0.0001).Conclusion: Semi-automatic assessment of ablation zone geometry using SAFIR is feasible. Software-assisted evaluation of ablation zones may prove beneficial with complex ablation procedures, especially for less experienced operators. The 2.45 GHz MWA system generated a significantly more spherical ablation zone compared to the 915 MHz system. The choice of a specific MWA system significantly influences ablation zone geometry.
Collapse
Affiliation(s)
- Van Dai Vo Chieu
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Christian Rieder
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Gesa H Pöhler
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Hanne Ballhausen
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
26
|
Camacho JC, Petre EN, Sofocleous CT. Thermal Ablation of Metastatic Colon Cancer to the Liver. Semin Intervent Radiol 2019; 36:310-318. [PMID: 31680722 DOI: 10.1055/s-0039-1698754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
Collapse
Affiliation(s)
- Juan C Camacho
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
27
|
Grimm A, Winkelmann M, Weiß J, Gohla G, Blumenstock G, Nikolaou K, Clasen S, Hoffmann R. Artefact and ablation performance of an MR-conditional high-power microwave system in bovine livers: an ex vivo study. Eur Radiol Exp 2019; 3:39. [PMID: 31549338 PMCID: PMC6757083 DOI: 10.1186/s41747-019-0115-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated a magnetic resonance (MR)-conditional high-power microwave ablation system. Methods An exvivo 1.5-T evaluation was conducted by varying the sequence (T1-weighted volume interpolated breath-hold examination, T1w-VIBE; T1-weighted fast low-angle shot, T1w-FLASH; T2-weighted turbo spin-echo, T2w-TSE), applicator angulation to B0 (A-to-B0), slice orientation, and encoding direction. Tip location error (TLE) and artefact diameters were measured, and influence of imaging parameters was assessed with analysis of variance and post hoc testing. Twenty-four exvivo ablations were conducted in three bovine livers at 80 W and 120 W. Ablation durations were 5, 10, and 15 min. Ablation zones were compared for short-axis diameter (SAD), volume, and sphericity index (SI) with unpaired t test. Results The artefact pattern was similar for all sequences. The shaft artefact (4.4 ± 2.9 mm, mean ± standard deviation) was dependent on the sequence (p = 0.012) and the A-to-B0 (p < 0.001); the largest shaft diameter was measured with T1w-FLASH (6.3 ± 3.4 mm) and with perpendicular A-to-B0 (6.7 ± 2.4 mm). The tip artefact (1.6 ± 0.7 mm) was dependent on A-to-B0 (p = 0.001); TLE was -2.6 ± 1.0 mm. Ablation results at the maximum setting (15 min, 120 W) were SAD = 42.0 ± 1.41 mm; volume = 56.78 ± 3.08 cm3, SI = 0.68 ± 0.05. In all ablations, SI ranged 0.68–0.75 with the smallest SI at 15 min and 120 W (p = 0.048). Conclusion The system produced sufficiently large ablation zones and the artefact was appropriate for MR-guided interventions.
Collapse
Affiliation(s)
- Antonia Grimm
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Moritz Winkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
| |
Collapse
|
28
|
Cazzato RL, De Marini P, Leclerc L, Dalili D, Koch G, Rao P, Auloge P, Garnon J, Gangi A. Large nearly spherical ablation zones are achieved with simultaneous multi-antenna microwave ablation applied to treat liver tumours. Eur Radiol 2019; 30:971-975. [PMID: 31529251 DOI: 10.1007/s00330-019-06431-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022]
Abstract
AIM To investigate the shape and the volume of ablation zones obtained with microwave ablation (MWA) performed with multiple antennas in liver tumours. MATERIALS AND METHODS Tumour volume, number of antennas, size (long diameter (Dl), along the antenna axis; short diameter (Ds), perpendicular to the antenna axis; vertical diameter (Dv), vertical to both Dl and Ds) and shape (roundness index (RI); 1 corresponds to a sphere) of the ablation zone, ablation volume, and complications were evaluated. RESULTS Mean Dl, Ds, and Dv were 4.7 ± 1.4 cm, 3.9 ± 1.4 cm, and 3.8 ± 1.0 cm, respectively. Mean RIs (Ds/Dl, Dv/Dl, and Dv/Ds) were 0.83 ± 0.13, 0.83 ± 0.17, and 1.02 ± 0.23, respectively, without any difference between the mean RI obtained with the double (0.84 ± 0.01) and that with the triple-antenna (0.93 ± 0.13) approach (p = 0.25). Mean ablation volume was 41 ± 32 cm3 (vs. mean tumour volume 13 ± 10 cm3; range 1-40; p < 0.001). No complications were noted. CONCLUSIONS Simultaneous multi-antenna MWA of liver tumours results in large nearly spherical ablation zones. KEY POINTS • Simultaneous multi-antenna microwave ablation of liver tumours results in nearly spherical ablation zones. • The multi-antenna approach generates oversized ablation volumes compared with the target tumour volume. • The multi-antenna approach is safe.
Collapse
Affiliation(s)
- Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France.
| | - Pierre De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Loïc Leclerc
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
- Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Pramod Rao
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| |
Collapse
|
29
|
Ruiter SJS, Heerink WJ, de Jong KP. Liver microwave ablation: a systematic review of various FDA-approved systems. Eur Radiol 2019; 29:4026-4035. [PMID: 30506218 PMCID: PMC6611060 DOI: 10.1007/s00330-018-5842-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the present study is to analyze preclinical and clinical data on the performance of the currently US Food and Drug Administration (FDA)-approved microwave ablation (MWA) systems. METHODS A review of the literature, published between January 1, 2005, and December 31, 2016, on seven FDA-approved MWA systems, was conducted. Ratio of ablation zone volume to applied energy R(AZ:E) and sphericity indices were calculated for ex vivo and in vivo experiments. RESULTS Thirty-four studies with ex vivo, in vivo, and clinical data were summarized. In total, 14 studies reporting data on ablation zone volume and applied energy were included for comparison R(AZ:E). A significant correlation between volume and energy was found for the ex vivo experiments (r = 0.85, p < 0.001) in contrast to the in vivo experiments (r = 0.54, p = 0.27). CONCLUSION Manufacturers' algorithms on microwave ablation zone sizes are based on preclinical animal experiments with normal liver parenchyma. Clinical data reporting on ablation zone volume in relation to applied energy and sphericity index during MWA are scarce and require more adequate reporting of MWA data. KEY POINTS • Clinical data reporting on the ablation zone volume in relation to applied energy during microwave ablation are scarce. • Manufacturers' algorithms on microwave ablation zone sizes are based on preclinical animal experiments with normal liver parenchyma. • Preclinical data do not predict actual clinical ablation zone volumes in patients with liver tumors.
Collapse
Affiliation(s)
- Simeon J S Ruiter
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Wouter J Heerink
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Center for Medical Imaging, University of Groningen, Groningen, Netherlands
| | - Koert P de Jong
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Center for Medical Imaging, University of Groningen, Groningen, Netherlands
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Kaye EA, Cornelis FH, Petre EN, Tyagi N, Shady W, Shi W, Zhang Z, Solomon SB, Sofocleous CT, Durack JC. Volumetric 3D assessment of ablation zones after thermal ablation of colorectal liver metastases to improve prediction of local tumor progression. Eur Radiol 2018; 29:2698-2705. [PMID: 30402706 DOI: 10.1007/s00330-018-5809-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE The goal of this study was to develop and evaluate a volumetric three-dimensional (3D) approach to improve the accuracy of ablation margin assessment following thermal ablation of hepatic tumors. METHODS The 3D margin assessment technique was developed to generate the new 3D assessment metrics: volumes of insufficient coverage (VICs) measuring volume of tissue at risk post-ablation. VICs were computed for the tumor and tumor plus theoretical 5- and 10-mm margins. The diagnostic accuracy of the 3D assessment to predict 2-year local tumor progression (LTP) was compared to that of manual 2D assessment using retrospective analysis of a patient cohort that has previously been reported as a part of an outcome-centered study. Eighty-six consecutive patients with 108 colorectal cancer liver metastases treated with radiofrequency ablation (2002-2012) were used for evaluation. The 2-year LTP discrimination power was assessed using receiver operating characteristic area under the curve (AUC) analysis. RESULTS A 3D assessment of margins was successfully completed for 93 out of 108 tumors. The minimum margin size measured using the 3D method had higher discrimination power compared with the 2D method, with an AUC value of 0.893 vs. 0.790 (p = 0.01). The new 5-mm VIC metric had the highest 2-year LTP discrimination power with an AUC value of 0.923 (p = 0.004). CONCLUSIONS Volumetric semi-automated 3D assessment of the ablation zone in the liver is feasible and can improve accuracy of 2-year LTP prediction following thermal ablation of hepatic tumors. KEY POINTS • More accurate prediction of local tumor progression risk using volumetric 3D ablation zone assessment can help improve the efficacy of image-guided percutaneous thermal ablation of hepatic tumors. • The accuracy of evaluation of ablation zone margins after thermal ablation of colorectal liver metastases can be improved using a volumetric 3D semi-automated assessment approach and the volume of insufficient coverage assessment metric. • The new 5-mm volume-of-insufficient-coverage metric, indicating the volume of tumor plus 5-mm margin that remained untreated, had the highest 2-year local tumor progression discrimination power.
Collapse
Affiliation(s)
- Elena A Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room S1212B, New York, NY, 10065, USA.
| | - Francois H Cornelis
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Sorbonne Université -ISCD / APHP - HUEP, Tenon Hospital, 4 rue de la Chine, 75020, Paris, France
| | - Elena N Petre
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Room S1212B, New York, NY, 10065, USA
| | - Waleed Shady
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Mallinckrodt Institute of Radiology, 216 S Kingshighway Blvd, St. Louis, MO, USA
| | - Weiji Shi
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Stephen B Solomon
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Constantinos T Sofocleous
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Jeremy C Durack
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| |
Collapse
|