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Kim DH, Lamba A, Lee S, Sayre J, Abtin F, Genshaft S, Quirk M, Suh RD. Safety and Effectiveness of Track Cauterization for Lung Cryoablation. J Vasc Interv Radiol 2024; 35:1168-1175. [PMID: 38670527 DOI: 10.1016/j.jvir.2024.04.009] [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: 06/18/2023] [Revised: 03/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE To evaluate the safety and effectiveness of track cauterization for lung cryoablation through comparison of postprocedural adverse event (AE) rates. MATERIALS AND METHODS Fifty-nine patients who underwent 164 percutaneous lung cryoablation procedures between 2013 and 2018 were included in this retrospective study. The study cohort was subdivided by whether track cauterization was conducted or not at the end of the procedure. The study cohort was also subdivided by the number of probes (1-2 probes vs 3-4 probes). Postablation AE rates were assessed by immediate and delayed (at 1 month or later) AEs, pneumothorax, hemothorax, pleural effusion, and whether intervention was required. Univariate and multivariate logistic regression analyses were used to compare differences in AE rates. RESULTS Patients who underwent procedures with track cautery were 2.6 times less likely to exhibit pleural effusion (P = .017). Patients who underwent procedures conducted with a higher number of probes were 3.8 times more likely to receive interventions (P < .001), 1.6 times more likely to experience pneumothorax (P = .037), and 2.1 times more likely to experience pleural effusion (P = .003). History of lung surgery, increased number of probes, size of the probe, and absence of track cautery were noted to be significant predictors of AEs and need for interventions (all P < .05). CONCLUSIONS Track cauterization in lung cryoablation was proven to reduce pleural effusion, but no difference in pneumothorax or delayed AEs was noted. The use of fewer probes was associated with a lower rate of AEs.
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Affiliation(s)
- Daniel H Kim
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
| | - Ashley Lamba
- Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York
| | - Shimwoo Lee
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - James Sayre
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Fereidoun Abtin
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Scott Genshaft
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Matthew Quirk
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Robert D Suh
- Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
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Wang Y, Zhao Z, Wang W, Xue H. Safety and efficacy of CT-guided percutaneous radiofrequency ablation for non-small cell lung cancer: a single-center, single-arm analysis. Lasers Med Sci 2024; 39:199. [PMID: 39078465 DOI: 10.1007/s10103-024-04153-5] [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: 06/17/2024] [Accepted: 07/22/2024] [Indexed: 07/31/2024]
Abstract
Non-small cell lung cancer (NSCLC) is a prevalent malignant tumor, and the commonly treatment modalities include surgery, radiotherapy, chemotherapy, etc. Currently, CT-guided percutaneous radiofrequency ablation (RFA) for the treatment of cancers has been widely performed. This study aimed to evaluate the safety and efficacy of this therapy in NSCLC patients. Thirty-five NSCLC patients were enrolled in this study and all received CT-guided percutaneous RFA therapy. The outcome measures included the changes in forced respiratory volume in the first second (FEV1), total lung volume (TLC), lesion size and computed tomography (CT) values of the region of interest (ROI) before and after treatment. The main efficacy measures comprised complete tumor ablation and local recurrence after initial treatment, as well as the objective response rate (ORR) and disease control rate (DCR) after 6 months of treatment. After receiving CT-guided percutaneous RFA therapy, the target lesion was effectively controlled and CT values gradually decreased. Besides, no significant changes were observed in the patient's lung function, postoperative complications were experienced by a total of 10 patients, primarily including pneumothorax, infection, lung hollowing. Fortunately, all these complications were successfully managed with appropriate treatment. Following the initial RFA treatment, 31 patients (88.57%) achieved complete ablation, while 6 patients experienced local recurrence. After 6 months of treatment, the ORR and DCR were found to be 68.57% and 82.86% respectively. CT-guided percutaneous RFA has demonstrated favorable safety and efficacy in the treatment of patients with NSCLC at different stages, which represented a promising therapeutic modality.
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Affiliation(s)
- Yafei Wang
- Department of Respiratory Medicine, The First People's Hospital of Pinghu, No. 500, Sangang Road, Tanghu Street, Pinghu, 314200, Zhejiang, China
| | - Zhengyu Zhao
- Department of Respiratory Medicine, The First People's Hospital of Pinghu, No. 500, Sangang Road, Tanghu Street, Pinghu, 314200, Zhejiang, China
| | - Wenmin Wang
- The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, Zhejiang, 314006, China
| | - Hedong Xue
- Department of Respiratory Medicine, The First People's Hospital of Pinghu, No. 500, Sangang Road, Tanghu Street, Pinghu, 314200, Zhejiang, China.
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Zhu F, Yang C, Wang J, Zhou T, Li Q, Wang S, Zhao Z. The Value of Magnetic Resonance Imaging in Assessing Immediate Efficacy After Microwave Ablation of Lung Malignancies. J Thorac Imaging 2024:00005382-990000000-00143. [PMID: 39021208 DOI: 10.1097/rti.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE To investigate the imaging performance and parametric analysis of magnetic resonance imaging (MRI) immediately after microwave ablation (MWA) of lung malignancies. MATERIALS AND METHODS We retrospectively analyzed the MRI performance immediately after MWA of 34 cases of lung malignancies. The ablation zone parameters of lung malignancies were measured, including the long diameter (L), short diameter (S), and safety margin of the ablation zone on plain computed tomography (CT), T1-weighted imaging (T1WI), and T2-weighted imaging (T2WI) after MWA. The study calculated the tumor volume (V0), the ablation zone volume (V1), and the ratio of V0 to V1 (V%). Statistical differences between the parameters were analyzed. RESULTS The ablation area of the lesion exhibited central low signal and peripheral high signal on T2WI, central high signal and peripheral equal or high signal on T1WI, and circumferential enhancement in the periphery. The safety margin measured on T2WI was greater than that measured on plain CT and T1WI. On plain CT, the L, S, and V1 were smaller in the effective treatment group than in the ineffective treatment group (P<0.05). On T1WI, the V% and safety margin were greater in the effective treatment group than in the ineffective treatment group (P=0.009 and P=0.016, respectively). CONCLUSIONS MRI may be a new, valuable method to assess immediate efficacy after MWA for lung malignancies using the ablation zone parameters V% on T1WI and safety margin on T2WI.
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Affiliation(s)
- Fandong Zhu
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Chen Yang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jianyun Wang
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Tong Zhou
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Qianling Li
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Subo Wang
- Department of Radiology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
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Carrero-Cardenal E, Vollmer-Torrubiano I, Torres-López M, Martín-Barrera G, Casanovas-Mateu G, Tercero-Machin FJ, Paez-Carpio A, Fábregas-Julià N, Valero-Castell R. Continuous positive airway pressure is unsafe for radiofrequency ablation of lung cancer under sedation: a randomised controlled trial. Insights Imaging 2024; 15:153. [PMID: 38900225 PMCID: PMC11190131 DOI: 10.1186/s13244-024-01721-9] [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: 02/14/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE To evaluate the safety of a minimum continuous positive airway pressure of 4 cmH2O (CPAP + 4) during computed tomography (CT)-guided radiofrequency ablation (RFA) for lung malignancies under procedural sedation and analgesia (PSA). METHODS This was a prospective, randomised, single-blind, parallel-group, placebo-controlled trial with an open-label medical device conducted at a single tertiary university hospital in Barcelona, Spain. Forty-six patients over 18 years of age scheduled for CT-guided RFA of a malignant pulmonary tumour under PSA were randomised to receive either CPAP + 4 or a modified mask for placebo CPAP (Sham-CPAP). Exclusion criteria included contraindications for RFA, refusal to participate, inability to understand the procedure or tolerate the CPAP test, lung biopsy just prior to RFA, intercurrent diseases, or previous randomisation for additional pulmonary RFA. Primary outcomes were the percentage of patients reporting at least one serious adverse event (SAE), classification for complications from the Cardiovascular and Interventional Radiological Society of Europe (CIRSE), and Clavien-Dindo classifications for complications, hospital stay, and readmissions. Secondary outcomes included adverse events (AEs), respiratory parameters, airway management, and the local radiological efficacy of pulmonary ablation. RESULTS CPAP + 4 prolonged hospital stay (1.5 ± 1.1 vs. 1.0 ± 0 inpatient nights, p = 0.022) and increased the risk of AE post-RFA (odds ratio (95% CI): 4.250 (1.234 to 14.637), p = 0.021 with more pneumothorax cases (n = 5/22, 22.7% vs. n = 0/24, 0%, p = 0.019). Per-protocol analysis revealed more SAEs and CIRSE grade 3 complications in the CPAP + 4 group (23.5% vs. 0%, p = 0.036). No significant differences were found in the effectiveness of oxygenation, ventilation, or pulmonary ablation. CONCLUSION CPAP is unsafe during CT-guided RFA for lung cancer under PSA even at the lowest pressure setting. TRIAL REGISTRATION ClinicalTrials.Gov, ClinicalTrials.gov ID NCT02117908, Registered 11 April 2014, https://www. CLINICALTRIALS gov/study/NCT02117908 CRITICAL RELEVANCE STATEMENT: This study highlights the hazards of continuous positive airway pressure during radiofrequency ablation of lung cancer, even at minimal pressures, deeming it unsafe under procedural sedation and analgesia in pulmonary interventional procedures. Findings provide crucial insights to prioritise patient safety. KEY POINTS No prior randomised controlled trials on CPAP safety in percutaneous lung thermo-ablation. Standardised outcome measures are crucial for radiology research. CPAP during lung RFA raises hospital stay and the risk of complications. CPAP is unsafe during CT-guided RFA of lung cancer under procedural sedoanalgesia.
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Affiliation(s)
- Enrique Carrero-Cardenal
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain.
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Ivan Vollmer-Torrubiano
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Marta Torres-López
- Centre for Biomedical Research in the Respiratory Diseases Network (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Martín-Barrera
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Surgical Area Nursing Department, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Alfredo Paez-Carpio
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Radiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Neus Fábregas-Julià
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Clinical Quality and Safety Directorate, Surgical Area, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ricard Valero-Castell
- Department of Anaesthesiology, Hospital Clínic Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institute for Biomedical Research August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Pan H, Tian Y, Pei S, Yang W, Zhang Y, Gu Z, Zhu H, Zou N, Zhang J, Jiang L, Hu Y, Shen S, Wang K, Jin H, Li Z, Zhang Y, Xiao Y, Luo Q, Wang H, Huang J. Combination of percutaneous thermal ablation and adoptive Th9 cell transfer therapy against non-small cell lung cancer. Exp Hematol Oncol 2024; 13:52. [PMID: 38760861 PMCID: PMC11100251 DOI: 10.1186/s40164-024-00520-8] [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: 10/29/2023] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is one of the predominant malignancies globally. Percutaneous thermal ablation (PTA) has gained widespread use among NSCLC patients, with the potential to elicit immune responses but limited therapeutic efficacies for advanced-stage disease. T-helper type 9 (Th9) cells are a subset of CD4+ effector T cells with robust and persistent anti-tumor effects. This study proposes to develop PTA-Th9 cell integrated therapy as a potential strategy for NSCLC treatment. METHODS The therapeutic efficacies were measured in mice models with subcutaneously transplanted, recurrence, or lung metastatic tumors. The tumor microenvironments (TMEs) were evaluated by flow cytometry. The cytokine levels were assessed by ELISA. The signaling molecules were determined by quantitative PCR and Western blotting. The translational potential was tested in the humanized NSCLC patient-derived xenograft (PDX) model. RESULTS We find that PTA combined with adoptive Th9 cell transfer therapy substantially suppresses tumor growth, recurrence, and lung metastasis, ultimately extending the survival of mice with NSCLC grafts, outperforming both PTA and Th9 cell transfer monotherapy. Analysis of TMEs indicates that combinatorial therapy significantly augments tumor-infiltrating Th9 cells, boosts anti-tumor effects of CD8+ T cells, and remodels tumor immunosuppressive microenvironments. Moreover, combinatorial therapy significantly strengthens the regional and circulation immune response of CD8+ T cells in mice with tumor lung metastasis and induces peripheral CD8+ T effector memory cells in mice with tumor recurrence. Mechanically, PTA reinforces the anti-tumor ability of Th9 cells primarily through upregulating interleukin (IL)-1β and subsequently activating the downstream STAT1/IRF1 pathway, which could be effectively blocked by intercepting IL-1β signaling. Finally, the enhanced therapeutic effect of combinatorial therapy is validated in humanized NSCLC PDX models. CONCLUSIONS Collectively, this study demonstrates that combinatorial therapy displays robust and durable anti-tumor efficacy and excellent translational potential, offering excellent prospects for translation and emerging as a promising approach for NSCLC treatment.
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Affiliation(s)
- Hanbo Pan
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yu Tian
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Siyu Pei
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Chinese Academy of Sciences Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200030, China
| | - Wanlin Yang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
- Chinese Academy of Sciences Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200030, China
| | - Yanyang Zhang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Zenan Gu
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Hongda Zhu
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ningyuan Zou
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Jiaqi Zhang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Long Jiang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yingjie Hu
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Shengping Shen
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Kai Wang
- Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Haizhen Jin
- Department of Central Laboratory, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Ziming Li
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China
| | - Yanyun Zhang
- Chinese Academy of Sciences Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200030, China
| | - Yichuan Xiao
- Chinese Academy of Sciences Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, 200030, China.
| | - Qingquan Luo
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Hui Wang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
| | - Jia Huang
- Department of Thoracic Surgical Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, China.
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Muzzolini M, Lupinacci R, Bachet JB, Lassoued D, Sauvanet A, Gaujoux S. Should liver metastases of pancreatic adenocarcinoma be resected? J Visc Surg 2024; 161:129-140. [PMID: 38262871 DOI: 10.1016/j.jviscsurg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Milena Muzzolini
- Department of hepato-biliary, pancreatic surgery and liver transplantation, hôpital la Pitié-Salpêtrière, AP-HP, Paris, France; Université de Paris Cité, Paris, France.
| | - Renato Lupinacci
- UFR des sciences de la santé Simone-Veil, université Versailles Saint-Quentin en Yvelines/Paris Saclay, Montigny-le-Bretonneux, France; Digestive and oncological surgery department, université Paris Saclay, hôpital Ambroise-Paré. AP-HP, Boulogne-Billancourt, France
| | - Jean-Baptiste Bachet
- Sorbonne université, Paris, France; Oncology department, hôpital la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Donia Lassoued
- Oncology department, hôpital la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Alain Sauvanet
- Université de Paris Cité, Paris, France; Department of hepato-biliary, pancreatic surgery and liver transplantation, hôpital Beaujon, AP-HP, Clichy, France
| | - Sébastien Gaujoux
- Department of hepato-biliary, pancreatic surgery and liver transplantation, hôpital la Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne université, Paris, France
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Fish AG, Madoff DC. An Interventional Radiologist's Guide to Lung Cancer. Semin Intervent Radiol 2024; 41:121-128. [PMID: 38993601 PMCID: PMC11236454 DOI: 10.1055/s-0044-1786725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Lung cancer continues to be the third leading cause of cancer and the leading cause of cancer deaths. As the field of interventional oncology continues to grow, interventional radiologists are increasingly treating lung cancer patients. Involvement begins with tissue diagnosis for which biomarkers and immunohistochemistry are used to guide selective and advanced medical therapies. An interventional radiologist must be aware of the rationale behind tissue diagnosis and techniques to minimize biopsy complications. Staging is an important part of tumor board conversations and drives treatment pathways. Surgical therapy remains the gold standard for early-stage disease but with an aging population the need for less invasive treatments such as radiation therapy and ablation continue to grow. The interventionalist must be aware of the indications, techniques, and pre- and posttherapy managements for percutaneous ablation. Endovascular therapy is broadly divided into therapeutic treatment of lung cancer, which is gaining traction, and treatment of lung cancer complications such as hemoptysis. This review aims to provide a good basis for interventional radiologists treating lung cancer patients.
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Affiliation(s)
- Adam G. Fish
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - David C. Madoff
- Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Section of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Hu Y, Xue G, Liang X, Li Z, Wang N, Cao P, Wang G, Zhang H, Zheng X, Wang A, Zhao W, Han C, Wei Z, Ye X. Computed tomography-guided microwave ablation for right middle lobe pulmonary nodules: a retrospective, single-center, case-control study. Int J Hyperthermia 2024; 41:2307479. [PMID: 38314666 DOI: 10.1080/02656736.2024.2307479] [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: 10/30/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
PURPOSE This retrospective, single-center, case-control study evaluated the safety and efficacy of Computed tomography (CT)-guided microwave ablation (MWA) for pulmonary nodules located in the right middle lobe (RML), a challenging location associated with a high frequency of complications. METHODS Between May 2020 and April 2022, 71 patients with 71 RML pulmonary nodules underwent 71 MWA sessions. To comparison, 142 patients with 142 pulmonary nodules in non-RML were selected using propensity score matching. The technical success, technique efficacy, complications, and associated factors were analyzed. The duration of the procedure and post-ablation hospital stay were also recorded. RESULTS Technical success was achieved in 100% of all patients. There were no significant differences in technique efficacy rates between the RML and non-RML groups (97.2% vs. 95.1%, p = 0.721). However, both major (47.9% vs. 19.7%, p < 0.001) and minor (26.8% vs. 11.3%, p = 0.004) pneumothorax were more common in the RML group than non-RML group. MWA for RML pulmonary nodules was identified as an independent risk factor for pneumothorax (p < 0.001). The duration of procedures (51.7 min vs. 35.3 min, p < 0.001) and post-ablation hospital stays (4.7 days vs. 2.8 days, p < 0.001) were longer in the RML group than non-RML group. CONCLUSIONS CT-guided MWA for RML pulmonary nodules showed comparable efficacy compared with other lobes, but posed a higher risk of pneumothorax complications, necessitating longer MWA procedure times and extended hospital stays.
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Affiliation(s)
- Yanting Hu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Guoliang Xue
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Xinyu Liang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
- Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Zhichao Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Nan Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Pikun Cao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Gang Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Haitao Zhang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Xiaohuan Zheng
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Aiguang Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Wenhua Zhao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Cuiping Han
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, China
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Chang ATC, Ng CSH, Nezami N. Treatment strategies for malignant pulmonary nodule: beyond lobectomy. Point-counterpoint. Curr Opin Pulm Med 2024; 30:35-47. [PMID: 37916619 DOI: 10.1097/mcp.0000000000001027] [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: 11/03/2023]
Abstract
PURPOSE OF REVIEW Technological advancement in low-dose computed tomography resulted in an increased incidental discovery of early-stage lung cancer and multifocal ground glass opacity. The demand for parenchyma-preserving treatment strategies is greater now than ever. Pulmonary ablative therapy is a groundbreaking technique to offer local ablative treatment in a lung-sparing manner. It has become a promising technique in lung cancer management with its diverse applicability. In this article, we will review the current development of ablative therapy in lung and look into the future of this innovative technique. RECENT FINDINGS Current literature suggests that ablative therapy offers comparable local disease control to other local therapies and stereotactic body radiation therapy (SBRT), with a low risk of complications. In particular, bronchoscopic microwave ablation (BMWA) has considerably fewer pleural-based complications due to the avoidance of pleural puncture. BMWA can be considered in the multidisciplinary treatment pathway as it allows re-ablation and allows SBRT after BMWA. SUMMARY With the benefits which ablative therapy offers and its ability to incorporate into the multidisciplinary management pathway, we foresee ablative therapy, especially BMWA gaining significance in lung cancer treatment. Future directions on developing novel automated navigation platforms and the latest form of ablative energy would further enhance clinical outcomes for our patients.
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Affiliation(s)
- Aliss Tsz Ching Chang
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Calvin S H Ng
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, the Chinese University of Hong Kong, Hong Kong, China
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore
- The Fischell Department of Bioengineering, A. James Clark School of Engineering, University of Maryland, University of Maryland, Colleague Park, , Maryland, USA
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Li Z, Zhao F, Wang G, Xue G, Wang N, Cao P, Hu Y, Wei Z, Ye X. Changes in the pulmonary function of CT-guided microwave ablation for patients with malignant lung tumors. J Cancer Res Ther 2023; 19:1669-1674. [PMID: 38156936 DOI: 10.4103/jcrt.jcrt_2048_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate the changes in pulmonary function after computed tomography (CT)-guided microwave ablation (MWA) in patients with a malignant lung tumor. MATERIALS AND METHODS From June 2020 to January 2022, 133 patients with a malignant lung tumor who underwent CT-guided percutaneous MWA were included in the study. Pulmonary function tests (PFTs) were performed before (the baseline) and 1 month after the MWA. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1%, maximum mid-expiratory flow (MMEF), and diffusion capacity of the lung for carbon monoxide (DLCO-SB) at 1 month post MWA were compared with that at the baseline. The time of procedure and post-procedure length of hospital stay were also recorded. RESULTS The mean VC, FVC, FEV1, FEV1%, MMEF, and DLCO-SB at the baseline and 1 month post MWA were 3.23 ± 0.75 and 3.22 ± 0.77 (P = 0.926), 3.20 ± 0.75 and 3.21 ± 0.77 (P = 0.702), 2.35 ± 0.70 and 2.35 ± 0.71 (P = 0.992), 91.97 ± 23.14 and 91.87 ± 23.16 (P = 0.837), 1.83 ± 0.93 and 1.81 ± 0.95 (P = 0.476), and 6.38 ± 1.67 and 6.32 ± 1.62 (P = 0.389), respectively. There was no significant difference in the PFT results before and 1 month post MWA. The mean time of procedure and post-MWA length of hospital stay were 33 min and 2.5 days, respectively. CONCLUSIONS MWA is a lung parenchyma-sparing local treatment, and pulmonary function at 1 month post MWA was not statistically different from the baseline, indicating that MWA may not affect pulmonary function.
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Affiliation(s)
- Zhichao Li
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Feng Zhao
- Department of Oncology, Shandong First Medical University, Jinan, Shandong Province, China
| | - Gang Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Guoliang Xue
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Nan Wang
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Pikun Cao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Yanting Hu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, Shandong Province, China
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Valtersson J, Vogsen M, Graumann O, Pietersen PI. Image-guided percutaneous cryoablation of a solitary subpleural lung metastasis from breast cancer. BMJ Case Rep 2023; 16:e256256. [PMID: 37857535 PMCID: PMC10603477 DOI: 10.1136/bcr-2023-256256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
This case presents CT-guided percutaneous cryoablation as a treatment option in a patient with oligometastatic breast cancer who previously had received standard-of-care treatment for metastatic breast cancer. Before cryoablation, the patient received two systemic lines of therapy, several surgeries and radiotherapy for oligometastatic disease. The cryoablation was performed in a single 7 mm subpleural oligometastatic lesion 42 months after diagnosis of metastatic breast cancer. It was performed without complications, and the patient experienced no complaints or discomfort after the procedure. A 3-month, 6-month, 9-month and 12-month follow-up fluorodeoxyglucose-positron emission tomography/CT scans showed no sign of disease progression.
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Affiliation(s)
- John Valtersson
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Vogsen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Pia Iben Pietersen
- Department of Radiology, Odense University Hospital, Odense, Denmark
- UNIFY - Research and Innovation Unit of Radiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Wei Z, Chi J, Cao P, Jin Y, Li X, Ye X. Microwave ablation with a blunt-tip antenna for pulmonary ground-glass nodules: a retrospective, multicenter, case-control study. LA RADIOLOGIA MEDICA 2023; 128:1061-1069. [PMID: 37458905 PMCID: PMC10474204 DOI: 10.1007/s11547-023-01672-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE A previous small-sample study verified that a blunt-tip antenna reduced hemorrhage during microwave ablation. We conducted this large-sample, multicenter, case-control study to further verify the efficacy and safety of microwave ablation with a blunt-tip antenna for ground-glass nodules. MATERIALS AND METHODS Patients with pulmonary ground-glass nodules were treated with either a sharp-tip (Group A) or blunt-tip antenna (Group B). A total of 147 and 150 patients were retrospectively allocated to Groups A and Group B, respectively. Group A patients underwent 151 procedures, and Group B patients underwent 153 procedures. We assessed the technical success, technique efficacy, and complications. RESULTS Technical success and overall technique efficacy were achieved in all patients (100%). Major complications of pneumothorax were more commonly observed in Group A than in Group B (19.7% vs. 2.0%, p < 0.001). Minor complications, such as intrapulmonary hemorrhage (2.0% vs. 9.5%, p = 0.005) and hemothorax (0.0% vs. 2.7%, p = 0.049), occurred less frequently in Group B compared to Group A. CONCLUSION In the treatment of ground-glass nodules, microwave ablation with a blunt-tip antenna had equal efficacy compared to microwave ablation with a sharp-tip antenna but had a decreased number of hemorrhage and hemothorax complications.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, 250014, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Jiachang Chi
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 160# Pujian Road, Shanghai, 200127, China
| | - Pikun Cao
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, 250014, Shandong, China
| | - Yong Jin
- Department of Interventional Therapy, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, China.
| | - Xiaoguang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100370, China.
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, Jinan, 250014, Shandong, China.
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Nezami N, Khorshidi F, Mansur A, Habibollahi P, Camacho JC. Primary and Metastatic Lung Cancer: Rationale, Indications, and Outcomes of Thermal Ablation. Clin Lung Cancer 2023:S1525-7304(23)00055-4. [PMID: 37127487 DOI: 10.1016/j.cllc.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/05/2023]
Abstract
The widespread use of imaging as well as the efforts conducted through screening campaigns has dramatically increased the early detection rate of lung cancer. Historically, the management of lung cancer has heavily relied on surgery. However, the increased proportion of patients with comorbidities has given significance to less invasive therapeutic options like minimally invasive surgery and image-guided thermal ablation, which could precisely target the tumor without requiring general anesthesia or a thoracotomy. Thermal ablation is considered low-risk for lung tumors smaller than 3 cm that are located in peripheral lung and do not involve major blood vessels or airways. The rationale for ablative therapies relies on the fact that focused delivery of energy induces cell death and pathologic necrosis. Image-guided percutaneous thermal ablation therapies are established techniques in the local treatment of hepatic, renal, bone, thyroid and uterine lesions. In the lung, and specifically in the setting of metastatic disease, the 3 main indications for lung ablation are to serve as (1) curative intent, (2) as a strategy to achieve a chemo-holiday in oligometastatic disease, and (3) in oligoprogressive disease. Following these premises, the current paper aims to review the rationale, indications, and outcomes of thermal ablation as a form of local therapy in the treatment of primary and metastatic lung disease.
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14
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Kong Y, Xu H, Huang Y, Wei Z, Ye X. Local thermal ablative therapies for extracranial oligometastatic disease of non-small-cell lung cancer. Asia Pac J Clin Oncol 2023; 19:3-8. [PMID: 35599449 DOI: 10.1111/ajco.13766] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 01/20/2023]
Abstract
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Clinically, 40-50% of patients with NSCLC are found to have systemic metastasis at the initial diagnosis. Meanwhile, 30-75% of patients with lung cancer who have undergone radical surgical resection have local recurrence and distant metastases. However, not all distant metastases are multiple, and some are potentially curable. In this study, among the patients with NSCLC having distant organ metastasis, approximately 7% showed extrapulmonary solitary metastasis and remained in this relatively stable state for a long time. This form of metastasis is known as NSCLC oligometastases. This review describes the concept and classification of oligometastases, as well as the local treatment and prognosis of extracranial oligometastases.
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Affiliation(s)
- Yongmei Kong
- Department of Oncology, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer, Institute, Jinan, China.,Shandong First Medical University, Jinan, China
| | - Hui Xu
- Department of Oncology, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer, Institute, Jinan, China.,Shandong First Medical University, Jinan, China
| | - Yahan Huang
- Department of Oncology, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer, Institute, Jinan, China.,Shandong First Medical University, Jinan, China
| | - Zhigang Wei
- Department of Oncology, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer, Institute, Jinan, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong, First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer, Institute, Jinan, China
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Ye X, Wei Z, Yang X, Wu J, Zhang P, Huang G, Ni Y, Xue G. SPACES: Our team's experience in lung tumor microwave ablation. J Cancer Res Ther 2023; 19:1-13. [PMID: 37006036 DOI: 10.4103/jcrt.jcrt_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The standard treatment of stage I nonsmall cell lung cancer is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I nonsmall cell lung cancer are not candidates for surgery due to severe medical comorbidities (poor cardiopulmonary function). Image-guided thermal ablation is an alternative for those patients, includes radiofrequency ablation, microwave ablation (MWA), cryoablation, and laser ablation. Compared to them, MWA is a relatively new technique with some potential advantages, such as faster heating times, higher intralesional temperatures, larger ablation zones, less procedural pain, relative insensitivity to "heat sinks," and less sensitivity to tissue types. However, some advantages of MWA mentioned above (such as higher intralesional temperatures, larger ablation zones) also have potential risks and problems, and an innovative and standardized guidance system is needed to avoid and solve these risks and problems. This article combs our team's clinical experience over the past decade, summarizes a systematic and standardized guidance system, and names it SPACES (Selection, Procedure, Assessment, Complication, Evaluation, Systemic therapy). Both primary and metastatic pulmonary tumors can be efficiently treated with image-guided thermal ablation in selected candidates. The selection and use of ablation techniques should consider the size and location of the target tumor, the risk of complications, and the expertise and skills of the professionals, among which the size of the target tumor (<3 mm) is a major factor determining the success of ablation.
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Wang N, Xu J, Xue G, Han C, Zhang H, Zhao W, Li Z, Cao P, Hu Y, Wei Z, Ye X. Synchronous computed tomography-guided percutaneous biopsy and microwave ablation for highly suspicious malignant lung ground-glass opacities adjacent to mediastinum. Int J Hyperthermia 2023; 40:2193362. [PMID: 37011911 DOI: 10.1080/02656736.2023.2193362] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND This retrospective study aimed to assess the safety and efficacy of synchronous biopsy and microwave ablation (MWA) for highly suspected malignant lung ground-glass opacities (GGOs) adjacent to the mediastinum (distance ≤10 mm). MATERIALS AND METHODS Ninety patients with 98 GGOs (diameter range, 6-30 mm), located within 10 mm of the mediastinum, underwent synchronous biopsy and MWA at a single institution from 1 May 2020, to 31 October 2021 and were enrolled in this study. Synchronous biopsy and MWA involving the completion of the biopsy and MWA in a single procedure was performed. Safety, technical success rate, and local progression-free survival (LPFS) were evaluated. The risk factors for local progression were calculated using the Mann-Whitney U test. RESULTS The technical success rate was 97.96% (96/98 patients). The LPFS rates at 3, 6, and 12 months were 95.0%, 90.0%, and 82.0%, respectively. The diagnostic rate of biopsy-proven malignancy was 72.45% (n = 71/98). Invasion of lesions into the mediastinum was a risk factor for local progression (p = 0.0077). The 30-day mortality rate was 0. The major complications were pneumothorax (13.27%), ventricular arrhythmias (3.06%), pleural effusion (1.02%), hemoptysis (1.02%), and infection (1.02%). Minor complications included pneumothorax (30.61%), pleural effusion (24.49%), hemoptysis (18.37%), ventricular arrhythmias (11.22%), structural changes in adjacent organs (3.06%), and infection (3.06%). CONCLUSIONS Synchronous biopsy and MWA was effective for treating GGOs adjacent to the mediastinum without severe complications (Society of Interventional Radiology classification E or F). Invasion of lesions into the mediastinum was identified as a risk factor for local progression.
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Affiliation(s)
- Nan Wang
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jingwen Xu
- Department of Cardiology, Shandong Medicine and Health Key Laboratory of Cardiac Electrophysiology and Arrhythmia, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Guoliang Xue
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Cuiping Han
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Haitao Zhang
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wenhua Zhao
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhichao Li
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Pikun Cao
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yanting Hu
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Zhigang Wei
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xin Ye
- Department of Oncology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
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Golin M, Izaaryene J, Dassa M, Piana G, Ferre M. An ultra-low-dose protocol for computed tomography-guided lung radiofrequency ablations. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:041510. [PMID: 36575991 DOI: 10.1088/1361-6498/acabd2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
To evaluate the safety and efficacy of ultra-low-dose (ULD) protocol for computed tomography (CT)-guided lung radiofrequency ablation (RFA). Patients who had undergone lung RFA between November 2017 and January 2021 were consecutively and retrospectively included. Thirty patients were treated using a conventional standard protocol (SP), including helical acquisitions with mA automatic adjustment and sequential CT at 80 kVp; and 31, with a ULD protocol defined with helical acquisitions with fixed mA and sequential series at 100 kVp. These parameters were selected from those used for a diagnostic lung low-dose CT scanner. Patient characteristics, dose indicators, technical efficacy (minimal margin [MM], recurrence during follow-up), and complications (pneumothorax, alveolar haemorrhage, and haemoptysis) were recorded. We included 61 patients (median age, 65 [54-73] and 33 women), with no significant differences according to the type of protocol, except for the type of anaesthesia. Even if the number of helical acquisitions did not significantly change, all dose indicators significantly decreased by 1.5-fold-3-fold. The median dose-length-product and effective dose, with their ranges, respectively, were 465 mGy cm (315-554) and 6.5 mSv (4.4-7.8) in the SP group versus 178 mGy cm (154-267) and 2.5 mSv (2.2-3.7) in the ULD group, (p< 001). The ULD group exhibited lower intraoperator variability and better interoperator alignment than those of the SP group. The MM was not significantly different between the two groups (4.6 mm versus 5 mm,p= 16). One local recurrence was observed in each group at 8 months in the SP and at one year in the ULD group (p= 1). The complication rates did not differ significantly. Implementing an ULD protocol during lung RFA may provide similar efficacy, a reduction of dose indicators, and intra- and interoperator variability, without increasing complication rates, compared to those associated with an SP.
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Affiliation(s)
- Melissa Golin
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Jean Izaaryene
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Michael Dassa
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Gilles Piana
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
| | - Marjorie Ferre
- Interventional Radiology Department, Institute Paoli Calmettes, Aix Marseille University Institute Paoli Calmettes, 232 boulevard Sainte Marguerite, Marseille, 13009, France
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Cytoreductive Surgical Treatment of Pleural Mesothelioma in a Porcine Model Using Magnetic-Resonance-Guided Focused Ultrasound Surgery (MRgFUS) and Radiofrequency Ablation (RFA). Tomography 2022; 8:2232-2242. [PMID: 36136883 PMCID: PMC9498358 DOI: 10.3390/tomography8050187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/25/2022] Open
Abstract
A combination of surgery and chemotherapy is the most effective treatment available for Malignant Pleural Mesothelioma (MPM). However, both cause significant collateral damage and cannot eliminate residual microscopic disease. This investigation aimed to compare and determine the feasibility of utilizing Radiofrequency Ablation (RFA) and Magnetic-Resonance-guided Focused Ultrasound Surgery (MRgFUS) as alternative treatments for MPM. A large animal tumor model was developed in 13 Yorkshire female pigs using the MSTO211H cell line. Two pigs were initially used to determine the cyclosporine dose required for immunosuppression and tumor development. Subsequently, 11 other pigs underwent tumor development. Of these 11, 2 died during cell inoculation. Small tumor masses and adhesions were present in the other 9, indicating mesothelioma development. Five pigs then received RFA treatment, and 4 pigs received MRgFUS treatment. Tumor model development and effect of the two treatments were examined using MRI and by necropsy. RFA and MRgFUS both successfully ablated approximately the same sized area in the same treatment time. This study demonstrates that RFA and MRgFUS are feasible for tumor debulking, and while MRgFUS requires more pretreatment planning compared to RFA, MRgFUS is a completely noninvasive procedure.
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Gao S, Zhu Y, Tong M, Wang L, Ren S, Rui L, Yang F, Lian Z, Che Y. Different effects of intravenous and local anesthesia in patients undergoing ultrasound-guided radiofrequency ablation of thyroid nodules: a prospective cohort study. Int J Hyperthermia 2022; 39:1036-1043. [PMID: 35938345 DOI: 10.1080/02656736.2022.2106384] [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: 10/15/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of intravenous anesthesia (IV) with local anesthesia (LA) in patients undergoing ultrasound (US)-guided radiofrequency ablation (RFA) of thyroid nodules. METHODS 50 patients with American Society of Anesthesiologists classification grades I-II undergoing US-guided thyroid RFA were enrolled and randomly (1:1) divided into IV (conscious sedation with Ramsay Sedation Scale [RSS] scores of 2-3 with an anesthesiologist) and LA (subcutaneous anesthesia with lidocaine without an anesthesiologist) groups. Pre-, intra- and post-procedural blood pressure (BP) (SBP0/DBP0, SBP1/DBP1, and SBP2/DBP2), intra- and post-procedural pain (NRS1 and NRS2), ablated area volume, treatment time and adverse events were analyzed and compared. RESULTS Age, sex, weight, number, nature, volume of nodules, and SBP0/DBP0 showed no difference between both groups. 11 and 0 patients' SBP1/DBP1 were elevated in the LA and IV groups. NRS1 differed between both groups. 6 patients in the LA group had moderate or severe pain, but none in the IV group. No between-group difference in SBP2/DBP2, NRS2, ablation completion rate and ablated volume was noted. The median procedure duration differed from 1109 (176) s in IV group and 723 (227) s in LA groups. There was no increased incidence of adverse events in IV group. CONCLUSIONS IV with RSS scores of 2-3 maintained intra-procedural BP and relieved intra-procedural pain better, without affecting the ablation efficacy and increasing complications. Despite increased treatment time, IV is a potential option for patients undergoing US-guided RFA of thyroid nodules.
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Affiliation(s)
- Shuhang Gao
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yalin Zhu
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Mengying Tong
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lina Wang
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuangsong Ren
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liu Rui
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fang Yang
- Department of Ultrasound, Affiliated People's Hospital of Nankai University, Tianjin, China
| | - Zhiqing Lian
- Department of Ultrasound, Central Hospital of Wafangdian, Dalian, China
| | - Ying Che
- Department of Ultrasound, the First Affiliated Hospital of Dalian Medical University, Dalian, China
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20
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Lau KK, Steinke K, Reis S, Cherukuri SP, Cejna M. Current trends in image-guided chest interventions. Respirology 2022; 27:581-599. [PMID: 35758539 PMCID: PMC9545252 DOI: 10.1111/resp.14315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/18/2022] [Indexed: 02/06/2023]
Abstract
Interventional radiology (IR) is a rapidly expanding medical subspecialty and refers to a range of image‐guided procedural techniques. The image guidance allows real‐time visualization and precision placement of a needle, catheter, wire and device to deep body structures through small incisions. Advantages include reduced risks, faster recovery and shorter hospital stays, lower costs and less patient discomfort. The range of chest interventional procedures keeps on expanding due to improved imaging facilities, better percutaneous assess devices and advancing ablation and embolization techniques. These advances permit procedures to be undertaken safely, simultaneously and effectively, hence escalating the role of IR in the treatment of chest disorders. This review article aims to cover the latest developments in some image‐guided techniques of the chest, including thermal ablation therapy of lung malignancy, targeted therapy of pulmonary embolism, angioplasty and stenting of mediastinal venous/superior vena cava occlusion, pulmonary arteriovenous malformation treatment and bronchial artery embolization for haemoptysis.
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Affiliation(s)
- Kenneth K Lau
- Monash Imaging, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Steinke
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland School of Medicine, St Lucia, Queensland, Australia
| | - Stephen Reis
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Srinivas P Cherukuri
- Division of Interventional Radiology, Department of Radiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Manfred Cejna
- Institute for Diagnostic and Interventional Radiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
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21
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Comparison of expected imaging findings following percutaneous microwave and cryoablation of pulmonary tumors: ablation zones and thoracic lymph nodes. Eur Radiol 2022; 32:8171-8181. [PMID: 35704108 DOI: 10.1007/s00330-022-08905-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/04/2022] [Accepted: 05/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare temporal changes of ablation zones and lymph nodes following lung microwave ablation (MWA) and cryoablation. METHODS This retrospective cohort study compared lung ablation zones and thoracic lymph nodes following MWA and cryoablation performed 2006-2020. In the ablation zone cohort, ablation zone volumes were measured on serial CT for 12 months. In the lymph node cohort, the sum of bidimensional products of lymph node diameters was measured before (baseline) and up to 6 months following ablation. Cumulative incidence curves estimated the time to 75% ablation zone reduction and linear mixed-effects regression models compared the temporal distribution of ablation zones and lymph node sizes between modalities. RESULTS Ablation zones of 59 tumors treated in 45 sessions (16 MWA, 29 cryoablation) in 36 patients were evaluated. Differences in the time to 75% volume reduction between modalities were not detected. Following MWA, half of the ablation zones required an estimated time of 340 days to achieve a 75% volume reduction compared to 214 days following cryoablation (p = .30). Thoracic lymph node sizes after 33 sessions (13 MWA, 20 cryoablation) differed between modalities (baseline-32 days, p = .01; 32-123 days, p = .001). Following MWA, lymph nodes increased on average by 38 mm2 (95%CI, 5.0-70.7; p = .02) from baseline to 32 days, followed by an estimated decrease of 50 mm2 (32-123 days; p = .001). Following cryoablation, changes in lymph nodes were not detected (baseline-32 days, p = .33). CONCLUSION The rate of ablation zone volume reduction did not differ between MWA and cryoablation. Thoracic lymph nodes enlarged transiently after MWA but not after cryoablation. KEY POINTS • Contrary to current belief, the rate of lung ablation zone volume reduction did not differ between microwave and cryoablation. • Transient enlargement of thoracic lymph nodes after microwave ablation was not associated with regional tumor spread and decreased within six months following ablation. • No significant thoracic lymph node enlargement was observed following cryoablation.
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22
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Kimura Y, Ghosn M, Cheema W, Adusumilli PS, Solomon SB, Srimathveeralli G. Expanding the role of interventional oncology for advancing precision immunotherapy of solid tumors. Mol Ther Oncolytics 2022; 24:194-204. [PMID: 35036524 PMCID: PMC8752905 DOI: 10.1016/j.omto.2021.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Adoptive cell therapy with chimeric antigen receptors (CAR) T cells has proven effective for hematologic malignancies, but success in solid tumors has been impeded by poor intratumoral infiltration, exhaustion of effector cells from antigen burden, and an immunosuppressive tumor microenvironment. Results from recent clinical trials and preclinical studies lend promising evidence of locoregional approaches for CAR T cell delivery, priming the tumor microenvironment, and performing adjuvant therapies that sustain T cell activity. Interventional oncology is a subspeciality of interventional radiology where imaging guidance is used to perform percutaneous and catheter-directed procedures for localized, non-surgical therapy or interrogation of solid tumors. Interventional oncology provides unique synergies with immunotherapy, which has been well-studied to improve treatment efficacy while reducing toxicities associated with systemic treatment. Besides aiding in CAR T cell delivery, priming, or the stimulation of the tumor microenvironment to promote effector survival and function, interventional oncology can also aid in the monitoring of treatment response through selective, multiplex tumor sampling and catheter-based venous sampling. This review presents an overview of interventional oncology, its various procedures, and its potential for advancing CAR T cell immunotherapy of solid tumors.
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Affiliation(s)
- Yasushi Kimura
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
| | - Mario Ghosn
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Waseem Cheema
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Prasad S. Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B. Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Govindarajan Srimathveeralli
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, MA, USA
- Department of Biomedical Engineering, University of Massachusetts at Amherst, Amherst, MA, USA
- Institute for Applied Life Sciences, University of Massachusetts at Amherst, Amherst, MA, USA
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23
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Tan Y, Wang X, Ma K, Zhang L, Li J, Chen P, Zhang B. Risk factors for the recurrence of early hepatocellular carcinoma treated by percutaneous radiofrequency ablation with a multiple-electrode switching system: a multicenter prospective study. Int J Hyperthermia 2022; 39:190-199. [PMID: 35042449 DOI: 10.1080/02656736.2021.2024279] [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: 10/19/2022] Open
Abstract
PURPOSE To investigate the long-term efficacy of radiofrequency ablation (RFA) with a multiple-electrode switching system (MESS) in the treatment of early hepatocellular carcinoma (HCC) and evaluate the patterns and risk factors of intrahepatic recurrence of HCC after RFA. METHODS In total, 139 patients with early HCC who underwent RFA with MESS as primary treatment at multiple centers were prospectively enrolled according to the inclusion criteria. We evaluated the local tumor progression (LTP), intrahepatic distant recurrence (IDR), the incidence of cumulative disease-free survival (DFS), LTP-free survival, IDR-free survival, and overall survival. We also analyzed the associated risk factors. RESULTS A total of 139 patients were included in the study and the median follow-up time was 64 months, ranging from 11 to 72 months. The complete ablation rate was 98.56%. Sixty-nine (49.64%) were found to have intrahepatic recurrence (LTP, n = 15; IDR, n = 55) during follow-up. The 1-year, 3-year and 5-year cumulative DFS, LTP-free survival, and IDR-free survival rates were 74.82, 94.46 and 78.75%; 54.68, 88.03 and 61.79%; and 51.80, 85.67 and 60.17%, respectively. In the multivariable analysis, tumor size > 4 cm was the only important risk factor for LTP. The alkaline phosphatase (ALP) level and the number of tumors were independent risk factors for IDR; α-fetoprotein (AFP) level > 400 µg/L and recurrence interval were risk factors for the overall survival period. CONCLUSIONS The MESS-RFA is an effective method for local control of tumors in early HCC. Early HCC with multiple high-ALP tumors has a higher rate of recurrence, which mainly occurs in an IDR pattern. Early HCC with high AFP levels and a shorter initial recurrence interval resulted in a poorer prognosis. Thus, treatments such as liver transplantation or surgical resection may be a good strategy in those cases. CLINICALTRIALS.GOV ID NCT02046356.
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Affiliation(s)
- Yunhua Tan
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
| | - Kuansheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Lin Zhang
- Department of Radiation, Southwest Hospital, Army Medical University, Chongqing, PR China
| | - Jing Li
- Department of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing, PR China
| | - Ping Chen
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, Chongqing, PR China
| | - Ben Zhang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, Chongqing, PR China
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24
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Wei Z, Ye X, Cao P, Meng W, Xue G, Wang N, Li Z, Kong Y. Safety and efficacy of microwave ablation to treat pulmonary nodules under conscious analgosedation with sufentanil: A single-center clinical experience. J Cancer Res Ther 2022; 18:405-410. [PMID: 35645107 DOI: 10.4103/jcrt.jcrt_1286_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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25
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Cryoablation in Locoregional Management of Complex Unresectable Chest Neoplasms. Tomography 2021; 7:688-696. [PMID: 34842836 PMCID: PMC8629000 DOI: 10.3390/tomography7040057] [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: 09/11/2021] [Revised: 10/23/2021] [Accepted: 10/26/2021] [Indexed: 01/20/2023] Open
Abstract
RATIONALE AND OBJECTIVES The aim of our retrospective study was to assess the safety and feasibility of cryoablation in high-risk patients with complex chest neoplastic lesions. MATERIALS AND METHODS Twenty patients with complex chest malignancies, both primary and secondary, located in the mediastinum, lung, and chest wall, underwent percutaneous CT-guided cryoablation treatments. Procedural success as well as complications were evaluated. RESULTS A total of 24 neoplastic lesions were treated (mean diameter: 27 mm; range: 7-54 mm). Technical success was obtained in all patients, without major complications or intraprocedural death. A pneumothorax not requiring a drainage tube placement was registered in 50% of patients, while 3/24 patients had a grade 3 pneumothorax requiring a chest tube placement. CONCLUSION Percutaneous CT-guided cryoablation seems a safe and feasible treatment for complex thoracic lesions.
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26
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Ogawa H, Yajima T, Sohda M, Shirabe K, Saeki H. Role of surgical resection and its alternative local therapy for pulmonary metastasis of colorectal cancer. Ann Gastroenterol Surg 2021; 5:747-753. [PMID: 34755006 PMCID: PMC8560592 DOI: 10.1002/ags3.12472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 12/23/2022] Open
Abstract
We reviewed surgical and alternative treatments for pulmonary metastasis of colorectal cancer, focusing on recent reports. The standard treatment for pulmonary metastasis of colorectal cancer is pulmonary resection, if resectable, despite the fact that the metastasis is hematogenous to distant organs. Guidelines in several countries, including Japan, have described pulmonary resection as a useful option because of the favorable long-term prognosis reported in various studies pertaining to pulmonary resection. The indications for pulmonary resection have been reviewed in several studies; additionally, the number of metastases, pretreatment carcinoembryonic antigen value, and disease-free interval from the primary resection to pulmonary recurrence have been proposed. However, no consensus has been reached to date. Contrastingly, recent advances in chemotherapy have remarkably improved the outcome of distant metastases, indicating that it is time to reconsider the significance of local treatment, including pulmonary resection. In addition to surgical resection, minimally invasive therapies, such as stereotactic body radiation therapy and radiofrequency ablation have been developed as local treatments for pulmonary metastases, and their long-term results have been reported. Prospective controlled trials and large-scale data analyses are needed to determine the best local treatment for pulmonary metastases and to find the appropriate indication for each treatment.
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Affiliation(s)
- Hiroomi Ogawa
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Toshiki Yajima
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
- Department of Innovative Cancer ImmunotherapyGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Makoto Sohda
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
| | - Hiroshi Saeki
- Department of General Surgical ScienceGraduate School of MedicineGunma UniversityMaebashiJapan
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27
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Henze J, Maintz D. [Interventional Radiology in Oncology - Update 2021]. Dtsch Med Wochenschr 2021; 146:966-970. [PMID: 34344031 DOI: 10.1055/a-1192-0690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Interventional radiology plays a crucial role in oncology. The most common interventional treatments are transarterial embolisation as well as percutaneous thermal ablations. Transarterial embolisation, such as transarterial chemoembolization (TACE) or selective internal radiation therapy (SIRT) are well established, usually palliatively intended treatment options for primary and secondary hepatic malignancies. Embolisation is usually well tolerated under conscious sedation and can be repeated several times. Percutaneous thermoablation is a local ablative, usually curatively intended treatment for hepatic, renal and pulmonary tumors. As a minimally invasive technique, it competes against surgery and radiation therapy. There are different types of thermoablation, most commonly used are radiofrequency ablation (RFA), microwave ablation (MWA) and cryo-ablation. Ablation is usually performed in general anesthesia, less common in conscious sedation. New interventional treatments are high intensity focused ultrasound (HIFU) and irreversible electroporation (IRE). HIFU allows a non-invasive, imaging-guided thermoablation that is currently certified for uterine myoma, prostate cancer and bone tumors. IRE is a minimal invasive non-thermal ablation that is especially established for locally advanced tumors that show a close relationship to large vessels, for example pancreatic cancer.
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Affiliation(s)
- Jörn Henze
- Institut für Diagnostische und Interventionelle Radiologie des Universitätsklinikums Köln
| | - David Maintz
- Institut für Diagnostische und Interventionelle Radiologie des Universitätsklinikums Köln
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28
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Genshaft SJ, Suh RD, Abtin F, Baerlocher MO, Chang AJ, Dariushnia SR, Devane AM, Faintuch S, Himes EA, Lisberg A, Padia S, Patel S, Tam AL, Yanagawa J. Society of Interventional Radiology Multidisciplinary Position Statement on Percutaneous Ablation of Non-small Cell Lung Cancer and Metastatic Disease to the Lungs: Endorsed by the Canadian Association for Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology. J Vasc Interv Radiol 2021; 32:1241.e1-1241.e12. [PMID: 34332724 DOI: 10.1016/j.jvir.2021.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. MATERIALS AND METHODS A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. CONCLUSION SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
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Affiliation(s)
- Scott J Genshaft
- Department of Radiologic Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Robert D Suh
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Fereidoun Abtin
- Department of Radiology, Thoracic and Interventional Section, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Albert J Chang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - A Michael Devane
- Department of Radiology, Prisma Health, University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Aaron Lisberg
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Siddharth Padia
- Department of Radiology, Section of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Sheena Patel
- Society of Interventional Radiology, Fairfax, VA
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Jane Yanagawa
- Division of Thoracic Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA
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29
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Bismuth M, Katz S, Rosenblatt H, Twito M, Aronovich R, Ilovitsh T. Acoustically Detonated Microbubbles Coupled with Low Frequency Insonation: Multiparameter Evaluation of Low Energy Mechanical Ablation. Bioconjug Chem 2021; 33:1069-1079. [PMID: 34280311 PMCID: PMC9204695 DOI: 10.1021/acs.bioconjchem.1c00203] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
![]()
Noninvasive
ultrasound surgery can be achieved using focused ultrasound
to locally affect the targeted site without damaging intervening tissues.
Mechanical ablation and histotripsy use short and intense acoustic
pulses to destroy the tissue via a purely mechanical effect. Here,
we show that coupled with low-frequency excitation, targeted microbubbles
can serve as mechanical therapeutic warheads that trigger potent mechanical
effects in tumors using focused ultrasound. Upon low frequency excitation
(250 kHz and below), high amplitude microbubble oscillations occur
at substantially lower pressures as compared to higher MHz ultrasonic
frequencies. For example, inertial cavitation was initiated at a pressure
of 75 kPa for a center frequency of 80 kHz. Low frequency insonation
of targeted microbubbles was then used to achieve low energy tumor
cell fractionation at pressures below a mechanical index of 1.9, and
in accordance with the Food and Drug Administration guidelines. We
demonstrate these capabilities in vitro and in vivo. In cell cultures,
cell viability was reduced to 16% at a peak negative pressure of 800
kPa at the 250 kHz frequency (mechanical index of 1.6) and to 10%
at a peak negative pressure of 250 kPa at a frequency of 80 kHz (mechanical
index of 0.9). Following an intratumoral injection of targeted microbubbles
into tumor-bearing mice, and coupled with low frequency ultrasound
application, significant tumor debulking and cancer cell death was
observed. Our findings suggest that reducing the center frequency
enhances microbubble-mediated mechanical ablation; thus, this technology
provides a unique theranostic platform for safe low energy tumor fractionation,
while reducing off-target effects.
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Affiliation(s)
- Mike Bismuth
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Sharon Katz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel.,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Hagar Rosenblatt
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maayan Twito
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ramona Aronovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Tali Ilovitsh
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv 6997801, Israel.,The Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
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Fallet V, Matton L, Schernberg A, Canellas A, Cornelis FH, Cadranel J. Local ablative therapy in oncogenic-driven oligometastatic non-small cell lung cancer: present and ongoing strategies-a narrative review. Transl Lung Cancer Res 2021; 10:3457-3472. [PMID: 34430380 PMCID: PMC8350076 DOI: 10.21037/tlcr-20-1152] [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: 11/08/2020] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Abstract
Oligometastatic (OM) disease is defined by a low metastatic tumor spread. OM non-small cell lung cancer (NSCLC) treatment aims to improve the patient's prognosis and quality of life, in an attempt-to-cure objective. Oncogenic-driven metastatic NSCLC accounts for about 20-25% of NSCLCs, with an ever-increasing number of potentially druggable molecular alterations. Due to specific targeted therapy, the care and prognosis of mutated NSCLC is quite different from non-oncogenic-driven NSCLC. However, OM-NSCLC treatment guidelines do not specifically discuss oncogenic-driven OM-NSCLC patients. We conducted a narrative review regarding retrospective and prospective studies published from inception to May 2020 dealing with oncogenic-driven OM-NSCLC in order to: (I) describe the specific patterns of metastatic spread of oncogenic-driven NSCLC (i.e., bone and pleural tropism in EGFR mutated NSCLC and serous and brain metastases in ALK NSCLC); (II) review the low level of current evidence for local ablative therapy (LAT) strategies in patients with oncogenic-driven OM-NSCLC, focusing on the benefit/risk of tyrosine kinase inhibitors (TKI) and LATs combination and (III) present strategies to help to select the best candidate for an attempt-to-cure approach. Finally, the optimal strategy may be to introduce a targeted therapy, then treat all tumor sites with LAT, and finally continue TKI for unknown prolonged duration in an attempt to prolong progression free survival in most patients, improve overall survival for some patients, and potentially lead to a cancer cure for a few patients.
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Affiliation(s)
- Vincent Fallet
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Lise Matton
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, DMU Orphé, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Anthony Canellas
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - François H. Cornelis
- Department of Interventional Radiology and Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
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Yan P, Tong AN, Nie XL, Ma MG. Assessment of safety margin after microwave ablation of stage I NSCLC with three-dimensional reconstruction technique using CT imaging. BMC Med Imaging 2021; 21:96. [PMID: 34098894 PMCID: PMC8185913 DOI: 10.1186/s12880-021-00626-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the ablative margin of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) using a three-dimensional (3D) reconstruction technique. Materials and methods We retrospectively analyzed 36 patients with stage I NSCLC lesions undergoing MWA and analyzed the relationship between minimal ablative margin and the local tumor progression (LTP) interval, the distant metastasis interval and disease-free survival (DFS). The minimal ablative margin was measured using the fusion of 3D computed tomography reconstruction technique. Results Univariate and multivariate analyses indicated that tumor size (hazard ratio [HR] = 1.91, P < 0.01; HR = 2.41, P = 0.01) and minimal ablative margin (HR = 0.13, P < 0.01; HR = 0.11, P < 0.01) were independent prognostic factors for the LTP interval. Tumor size (HR = 1.96, P < 0.01; HR = 2.35, P < 0.01) and minimal ablative margin (HR = 0.17, P < 0.01; HR = 0.13, P < 0.01) were independent prognostic factors for DFS by univariate and multivariate analyses. In the group with a minimal ablative margin < 5 mm, the 1-year and 2-year local progression-free rates were 35.7% and 15.9%, respectively. The 1-year and 2-year distant metastasis-free rates were 75.6% and 75.6%, respectively; the 1-year and 2-year disease-free survival rates were 16.7% and 11.1%, respectively. In the group with a minimal ablative margin ≥ 5 mm, the 1-year and 2-year local progression-free rates were 88.9% and 69.4%, respectively. The 1-year and 2-year distant metastasis-free rates were 94.4% and 86.6%, respectively; the 1-year and 2-year disease-free survival rates were 88.9% and 63.7%, respectively. The feasibility of 3D quantitative analysis of the ablative margins after MWA for NSCLC has been validated. Conclusions The minimal ablative margin is an independent factor of NSCLC relapse after MWA, and the fusion of 3D reconstruction technique can feasibly assess the minimal ablative margin. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00626-z.
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Affiliation(s)
- Peng Yan
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - An-Na Tong
- Department of Radiation, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, People's Republic of China
| | - Xiu-Li Nie
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Min-Ge Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
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Huang H, Zhang L, Moser MAJ, Zhang W, Zhang B. A review of antenna designs for percutaneous microwave ablation. Phys Med 2021; 84:254-264. [PMID: 33773908 DOI: 10.1016/j.ejmp.2021.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022] Open
Abstract
Microwave (MW) antenna is a key element in microwave ablation (MWA) treatments as the means that energy is delivered in a focused manner to the tumor and its surrounding area. The energy delivered results in a rise in temperature to a lethal level, resulting in cell death in the ablation zone. The delivery of energy and hence the success of MWA is closely dependent on the structure of the antennas. Therefore, three design criteria, such as expected ablation zone pattern, efficiency of energy delivery, and minimization of the diameter of the antennas have been the focus along the evolution of the MW antenna. To further improve the performance of MWA in the treatment of various tumors through inventing novel antennas, this article reviews the state-of-the-art and summarizes the development of MW antenna designs regarding the three design criteria.
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Affiliation(s)
- Hangming Huang
- Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Lifeng Zhang
- Department of General Surgery, the First Affiliated Hospital of Soochow University,Soochow University, Jiangsu, China
| | - Michael A J Moser
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China.
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Tetta C, Carpenzano M, Algargoush ATJ, Algargoosh M, Londero F, Maessen JG, Gelsomino S. Non-surgical Treatments for Lung Metastases in Patients with Soft Tissue Sarcoma: Stereotactic Body Radiation Therapy (SBRT) and Radiofrequency Ablation (RFA). Curr Med Imaging 2021; 17:261-275. [PMID: 32819261 DOI: 10.2174/1573405616999200819165709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radio-frequency ablation (RFA) and Stereotactic Body Radiation Therapy (SBRT) are two emerging therapies for lung metastases. INTRODUCTION Aliterature review was performed to evaluate the outcomes and complications of these procedures in patients with lung metastases from soft tissue sarcoma (STS). METHODS After selection, seven studies were included for each treatment encompassing a total of 424 patients: 218 in the SBRT group and 206 in the RFA group. RESULTS The mean age ranged from 47.9 to 64 years in the SBRT group and from 48 to 62.7 years in the RFA group. The most common histologic subtype was, in both groups, leiomyosarcoma. In the SBRT group, median overall survival ranged from 25.2 to 69 months and median disease- free interval was from 8.4 to 45 months. Two out of seven studies reported G3 and one G3 toxicity, respectively. In RFA patients, overall survival ranged from 15 to 50 months. The most frequent complication was pneumothorax. Local control showed a high percentage for both procedures. CONCLUSION SBRT is recommended in patients unsuitable to surgery, in synchronous bilateral pulmonary metastases, in case of deep lesions and patients receiving high-risk systemic therapies. RFA is indicated in case of a long disease-free interval, in oligometastatic disease, when only the lung is involved, in small size lesions far from large vessels. Further large randomized studies are necessary to establish whether these treatments may also represent a reliable alternative to surgery.
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Affiliation(s)
- Cecilia Tetta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Carpenzano
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Areej T J Algargoush
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Marwah Algargoosh
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Francesco Londero
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Center, Maastricht, Netherlands
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Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation. Cardiovasc Intervent Radiol 2021; 44:903-910. [PMID: 33492452 DOI: 10.1007/s00270-020-02745-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). MATERIALS AND METHODS In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). CONCLUSION Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.
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Zotov AK, Gavdush AA, Katyba GM, Safonova LP, Chernomyrdin NV, Dolganova IN. In situ terahertz monitoring of an ice ball formation during tissue cryosurgery: a feasibility test. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-200372SSR. [PMID: 33506657 PMCID: PMC7839928 DOI: 10.1117/1.jbo.26.4.043003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/07/2021] [Indexed: 05/03/2023]
Abstract
SIGNIFICANCE Uncontrolled cryoablation of tissues is a strong reason limiting the wide application of cryosurgery and cryotherapy due to the certain risks of unpredicted damaging of healthy tissues. The existing guiding techniques are unable to be applied in situ or provide insufficient spatial resolution. Terahertz (THz) pulsed spectroscopy (TPS) based on sensitivity of THz time-domain signal to changes of tissue properties caused by freezing could form the basis of an instrument for observation of the ice ball formation. AIM The ability of TPS for in situ monitoring of tissue freezing depth is studied experimentally. APPROACH A THz pulsed spectrometer operated in reflection mode and equipped with a cooled sample holder and ex vivo samples of bovine visceral adipose tissue is applied. Signal spectrograms are used to analyze the changes of THz time-domain signals caused by the interface between frozen and unfrozen tissue parts. RESULTS Experimental observation of TPS signals reflected from freezing tissue demonstrates the feasibility of TPS to detect ice ball formation up to 657-μm depth. CONCLUSIONS TPS could become the promising instrument for in situ control of cryoablation, enabling observation of the freezing front propagation, which could find applications in various fields of oncology, regenerative medicine, and THz biophotonics.
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Affiliation(s)
- Arsen K. Zotov
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - Arsenii A. Gavdush
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Gleb M. Katyba
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | | | - Nikita V. Chernomyrdin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Institute for Regenerative Medicine, Moscow, Russia
| | - Irina N. Dolganova
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
- Bauman Moscow State Technical University, Moscow, Russia
- Sechenov First Moscow State Medical University (Sechenov University), Institute for Regenerative Medicine, Moscow, Russia
- Address all correpsondence to Irina N. Dolganova,
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Abstract
Lung ablation has been introduced into lung cancer treatment for about two decades. Currently, 3 main choices of thermal energy for lung ablation are radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation. As a mostly palliative, occasionally curative intent local treatment, the feasibility and safety of lung ablation have been validated in small size lung cancer treatment, especially in lung tumor ≤3 cm. Improved techniques and experience in recent years help render outcomes much better than before for lung cancer patients who are medically inoperable with early stage primary lung cancer, and patients with oligometastasis or local recurrence. For stage IA non-small cell lung cancer (NSCLC) patients underwent RFA, 1- and 2-year overall survival rate were reported as 86.3% and 69.8%. And 1- and 2-year local recurrence rate were reported as 68.9% and 59.8%. Limitations, including heat sink, skin burn, and inconsistent heat conduction, are observed in the first applied ablation technique, RFA. MWA and cryoablation are developed to overcome these limitations and achieve the goal of less morbidity. Generally, imaged guided thermal ablation has a good safety profile, with pneumothorax as the most common morbidity. This article will mainly discuss the current features and application of these ablation techniques in lung cancer treatment.
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Affiliation(s)
- Miao Lin
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pat Eiken
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Shanda Blackmon
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
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Standardizing percutaneous Microwave Ablation in the treatment of Lung Tumors: a prospective multicenter trial (MALT study). Eur Radiol 2020; 31:2173-2182. [PMID: 32997180 DOI: 10.1007/s00330-020-07299-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/27/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To prospectively assess reproducibility, safety, and efficacy of microwave ablation (MWA) in the treatment of unresectable primary and secondary pulmonary tumors. METHODS Patients with unresectable primary and metastatic lung tumors up to 4 cm were enrolled in a multicenter prospective clinical trial and underwent CT-guided MWA. Treatments were delivered using pre-defined MW power and duration settings, based on target tumor size and histology classifications. Patients were followed for up to 24 months. Treatment safety, efficacy, and reproducibility were assessed. Ablation volumes were measured at CT scan and compared with ablation volumes obtained on ex vivo bovine liver using equal treatment settings. RESULTS From September 2015 to September 2017, 69 MWAs were performed in 54 patients, achieving technical success in all cases and treatment completion without deviations from the standardized protocol in 61 procedures (88.4%). Immediate post-MWA CT scans showed ablation dimensions smaller by about 25% than in the ex vivo model; however, a remarkable volumetric increase (40%) of the treated area was observed at 1 month post-ablation. No treatment-related deaths nor complications were recorded. Treatments of equal power and duration yielded fairly reproducible ablation dimensions at 48-h post-MWA scans. In comparison with the ex vivo liver model, in vivo ablation sizes were systematically smaller, by about 25%. Overall LPR was 24.7%, with an average TLP of 8.1 months. OS rates at 12 and 24 months were 98.0% and 71.3%, respectively. CONCLUSIONS Percutaneous CT-guided MWA is a reproducible, safe, and effective treatment for malignant lung tumors up to 4 cm in size. KEY POINTS • Percutaneous MWA treatment of primary and secondary lung tumors is a repeatable, safe, and effective therapeutic option. • It provides a fairly reproducible performance on both the long and short axis of the ablation zone. • When using pre-defined treatment duration and power settings according to tumor histology and size, LPR does not increase with increasing tumor size (up to 4 cm) for both primary and metastatic tumors.
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Helmberger T. The evolution of interventional oncology in the 21st century. Br J Radiol 2020; 93:20200112. [PMID: 32706978 PMCID: PMC7465871 DOI: 10.1259/bjr.20200112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
Interventional oncology (IO) has proven to be highly efficient in the local therapy of numerous malignant tumors in addition to surgery, chemotherapy, and radiotherapy. Due to the advent of immune-oncology with the possibility of tumor control at the molecular and cellular levels, a system change is currently emerging. This will significantly rule oncology in the coming decades. Therefore, one cannot think about IO in the 21st century without considering immunology. For IO, this means paying much more attention to the immunomodulatory effects of the interventional techniques, which have so far been neglected, and to explore the synergistic possibilities with immuno-oncology. It can be expected that the combined use of IO and immuno-oncology will help to overcome the limitations of the latter, such as limited local effects and a high rate of side-effects. To do this, however, sectoral boundaries must be removed and interdisciplinary research efforts must be strengthened. In case of success, IO will face an exciting future.
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Affiliation(s)
- Thomas Helmberger
- Department of Radiology, Neuroradiology, and minimal-invasive Therapy, Munich Klinik Bogenhausen Englschalkingerstr. 77 81925, Munich, Germany
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Zhang YQ, Wu YL, Feng Y, Zhou YX. A Clinical Study on Microwave Ablation in Combination with Chemotherapy in Treating Peripheral IIIB-IV Nonsmall Cell Lung Cancer. Cancer Biother Radiopharm 2020; 37:141-146. [PMID: 32822222 DOI: 10.1089/cbr.2020.3859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This study investigated the efficacy and complications of microwave ablation in combination with chemotherapy in treating peripheral IIIB-IV nonsmall cell lung cancer (NSCLC). Materials and Methods: A total of 100 patients with peripheral IIIB-IV NSCLC were randomly divided into two groups: combination group (n = 52) and chemotherapy group (n = 48). Patients in the combination group were treated with microwave ablation, radiotherapy, and chemotherapy, whereas the patients in the chemotherapy group were treated with pemetrexed disodium or gemcitabine hydrochloride, cisplatin chemotherapy, and conventional radiotherapy. Results: The effectiveness and disease control rates were significantly higher in the combination group than in the chemotherapy group (p < 0.05). The second- and third-year survival rates were significantly higher in the combination group than in the chemotherapy group (p < 0.05). However, patients in the combination group had no serious complications, and there were no intraoperative and perioperative deaths. Conclusions: Microwave ablation is safe and effective. Combination chemotherapy is superior to chemotherapy in treating peripheral IIIB-IV NSCLC in terms of effectiveness rate, disease control rate, and extended patient survival time.
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Affiliation(s)
- Ying-Qing Zhang
- Department of Respiratory, Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Precision Treatment for Lung Cancer, Jiaxing, China
| | - Yong-Lei Wu
- Department of Respiratory, Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Precision Treatment for Lung Cancer, Jiaxing, China
| | - Yan Feng
- Department of Respiratory, Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Precision Treatment for Lung Cancer, Jiaxing, China
| | - Ying-Xin Zhou
- Department of Respiratory, Affiliated Hospital of Jiaxing University, Jiaxing Key Laboratory of Precision Treatment for Lung Cancer, Jiaxing, China
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Kim MS, Hong HP, Ham SY, Koo DH, Kang DY, Oh TY. Complications after 100 sessions of cone-beam computed tomography-guided lung radiofrequency ablation: a single-center, retrospective experience. Int J Hyperthermia 2020; 37:763-771. [DOI: 10.1080/02656736.2020.1784472] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Hoe Koo
- Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Du-Young Kang
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Yoon Oh
- Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Mauri G, Cazzato RL. Introduction to image-guided thermal ablations special issue. Int J Hyperthermia 2020; 36:1-2. [PMID: 31537153 DOI: 10.1080/02656736.2019.1651906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia , IRCCS, Milano , Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Hopitaux Universitaires de Strasbourg , Strasbourg , France
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Steinke K. The debate for thermal ablation of colorectal cancer pulmonary metastases is heating up. Quant Imaging Med Surg 2020; 10:1169-1173. [PMID: 32489941 DOI: 10.21037/qims.2020.03.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Karin Steinke
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,University of Queensland School of Medicine, St Lucia, Queensland, Australia
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Liu B, Wang Y, Tian S, Hertzanu Y, Zhao X, Li Y. Salvage treatment of NSCLC recurrence after first-line chemotherapy failure: Iodine-125 seed brachytherapy or microwave ablation? Thorac Cancer 2020; 11:697-703. [PMID: 31995853 PMCID: PMC7049489 DOI: 10.1111/1759-7714.13320] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background Salvage treatments for recurrent NSCLC after first‐line chemotherapy remain challenging. This study was conducted to evaluate the clinical value of microwave ablation (MWA) and iodine‐125 brachytherapy, including overall survival (OS), disease free survival (DFS), local control, hospital stay, and health economics. Methods The data of 51 and 32 patients who were treated with MWA and brachytherapy was retrospectively analyzed. The number of lesions was limited up to two, with a diameter <4 cm and patients diagnosed with unilateral lung disease. Peripheral tumors were treated with MWA, while lesions close to the hilum were treated with brachytherapy. Contrast‐enhanced CT, blood cell count, coagulation function, liver & kidney function and tumor markers were performed for two years, with complications calculated. OS, DFS, local control rate, toxicity, hospital stay and expense were recorded. Results The one and two‐year OS rates were 96.08% and 92.16% versus 96.88% and 90.62% in the MWA and brachytherapy groups, respectively. The one and two‐year DFS rates were 92.16% and 76.47% versus 93.75% and 78.13%, respectively. No significant differences were observed in log‐rank analysis between the groups. Local control rates at six and 12 months were 100% and 96.08% versus 100% and 96.88%, while incidences of pleural effusion were 3.92% and 3.13%, respectively (P < 0.05). Medical cost was 3356.73 ± 206.87 and 6714.28 ± 35.43 U.S. dollars (P = 0.014). Conclusion MWA and brachytherapy are effective and safe options for the treatment of NSCLC recurrence after first‐line chemotherapy. Which modality should be considered is dependent upon tumor location, tumor size and experience of specialists.
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Affiliation(s)
- Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, PR China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, PR China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Shilin Tian
- School of Medicine, Shandong University, Jinan, China
| | - Yancu Hertzanu
- Department of Radiology, Ben-Gurion University, Negev, Israel
| | - Xiaogang Zhao
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, PR China.,Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, PR China.,Interventional Oncology Institute of Shandong University, Jinan, China
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Wan J, Ling X, Rao Z, Peng B, Ding G. Independent prognostic value of HIF-1α expression in radiofrequency ablation of lung cancer. Oncol Lett 2020; 19:849-857. [PMID: 31897199 PMCID: PMC6924154 DOI: 10.3892/ol.2019.11130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/20/2019] [Indexed: 01/11/2023] Open
Abstract
Radiofrequency ablation (RFA) is widely used in the treatment of lung cancer. Hypoxia-inducible factor-1α (HIF-1α) is a crucial transcription factor regulating oxygen homeostasis that is involved in tumor cell metastasis. The present study investigated the impact of HIF-1α expression and other factors, such as postoperative blood CD4+/CD8+ ratio, on the prognosis of patients with lung cancer who had received RFA treatment. A total of 80 patients with lung cancer were recruited between January 2011 and October 2016 at The Shenzhen People's Hospital. Lung cancer was confirmed following pathological or histological examination. All patients underwent RFA treatment. Patients were followed up for 6–66 months. HIF-1α expression in lung cancer tissues was assessed by immunohistochemistry. Multivariate survival analysis was performed using Cox proportional hazards model. The results demonstrated that HIF-1α level was low in 36 patients and overexpressed in 44 patients with lung cancer. Kaplan-Meier (KM) curve analysis demonstrated that the overall survival time of patients with high HIF-1α expression was significantly shorter compared with patients with low HIF-1α expression (P<0.05). Furthermore, the results from the KM model and log-rank test revealed that age, Union for International Cancer Control stage, primary or metastatic cancer, chemotherapy, postoperative blood CD4+/CD8+ ratio, Eastern Cooperative Oncology Group performance status and HIF-1α expression had significant effects on overall survival of patients with lung cancer. The results from Cox analysis demonstrated that high HIF-1α expression, advanced age, clinical staging and chemotherapy were independent risk factors for the prognosis of lung cancer following RFA treatment, and that high HIF-1α expression was associated with the increased risk (5.91-fold) of mortality. In conclusion, the present study demonstrated that HIF-1α expression was increased in lung cancer tissues and was associated with the prognosis of patients with lung cancer who were treated with RFA. These findings suggest that HIF-1α expression may be considered as a marker for evaluating the prognosis of these patients.
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Affiliation(s)
- Jun Wan
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Xiean Ling
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Zhanpeng Rao
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Bin Peng
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
| | - Guanggui Ding
- Department of Thoracic Surgery, The Shenzhen People's Hospital, The Second Clinical Medicine College of Jinan University, Shenzhen, Guangdong 518020, P.R. China
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Wilson BC, Weersink RA. The Yin and Yang of PDT and PTT. Photochem Photobiol 2019; 96:219-231. [PMID: 31769516 DOI: 10.1111/php.13184] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/24/2019] [Indexed: 12/16/2022]
Abstract
In Chinese philosophy, yin and yang ("dark-bright," "negative-positive") describe how seemingly opposite or contrary forces may actually be complementary, interconnected and interdependent. This paper provides this perspective on photodynamic and photothermal therapies, with a focus on the treatment of solid tumors. The relative strengths and weaknesses of each modality, both current and emerging, are considered with respect to the underlying biophysics, the required technologies, the biological effects, their translation into clinical practice and the realized or potential clinical outcomes. For each specific clinical application, one or the other modality may be clearly preferred, or both are effectively equivalent in terms of the various scientific/technological/practical/clinical trade-offs involved. Alternatively, a combination may the best approach. Such combined approaches may be facilitated by the use of multifunctional nanoparticles. It is important to understand the many factors that go into the selection of the optimal approach and the objective of this paper is to provide guidance on this.
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Affiliation(s)
- Brian C Wilson
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Robert A Weersink
- University Health Network/University of Toronto, Toronto, ON, M5G 1L7, Canada
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