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Bossi A, Bianchi L, Saccomandi P, Pifferi A. Optical signatures of thermal damage on ex-vivo brain, lung and heart tissues using time-domain diffuse optical spectroscopy. BIOMEDICAL OPTICS EXPRESS 2024; 15:2481-2497. [PMID: 38633088 PMCID: PMC11019675 DOI: 10.1364/boe.517376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 04/19/2024]
Abstract
Thermal therapies treat tumors by means of heat, greatly reducing pain, post-operation complications, and cost as compared to traditional methods. Yet, effective tools to avoid under- or over-treatment are mostly needed, to guide surgeons in laparoscopic interventions. In this work, we investigated the temperature-dependent optical signatures of ex-vivo calf brain, lung, and heart tissues based on the reduced scattering and absorption coefficients in the near-infrared spectral range (657 to 1107 nm). These spectra were measured by time domain diffuse optics, applying a step-like spatially homogeneous thermal treatment at 43 °C, 60 °C, and 80 °C. We found three main increases in scattering spectra, possibly due to the denaturation of collagen, myosin, and the proteins' secondary structure. After 75 °C, we found the rise of two new peaks at 770 and 830 nm in the absorption spectra due to the formation of a new chromophore, possibly related to hemoglobin or myoglobin. This research marks a significant step forward in controlling thermal therapies with diffuse optical techniques by identifying several key markers of thermal damage. This could enhance the ability to monitor and adjust treatment in real-time, promising improved outcomes in tumor therapy.
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Affiliation(s)
- Alessandro Bossi
- Department of Mechanical Engineering, Politecnico di Milano, via Giuseppe La Masa 1, 20156 Milan, Italy
- Department of Physics, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Leonardo Bianchi
- Department of Mechanical Engineering, Politecnico di Milano, via Giuseppe La Masa 1, 20156 Milan, Italy
| | - Paola Saccomandi
- Department of Mechanical Engineering, Politecnico di Milano, via Giuseppe La Masa 1, 20156 Milan, Italy
| | - Antonio Pifferi
- Department of Physics, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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Ali MAM, Harmsen WS, Morsy KH, Galal GMK, Therneau TM, Roberts LR. Prognostic utility of systemic inflammatory markers and chronic hepatitis C virus infection status in hepatocellular carcinoma patients treated with local ablation. BMC Cancer 2022; 22:221. [PMID: 35227234 PMCID: PMC8887142 DOI: 10.1186/s12885-021-09121-8] [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: 01/15/2021] [Accepted: 12/13/2021] [Indexed: 12/30/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) has high incidence and mortality worldwide. Local ablation using radiofrequency ablation (RFA) or microwave ablation (MWA) is potentially curative for early-stage HCC with outcomes comparable to surgical resection. We explored the influence of demographic, clinical, and laboratory factors on outcomes of HCC patients receiving ablation. Methods This retrospective cohort study included 221 HCC patients receiving local ablation at Mayo Clinic between January 2000 and October 2018, comprising 140 RFA and 81 MWA. Prognostic factors determining overall survival (OS) and disease-free survival (DFS) were identified using multivariate analysis. Results There was no clinically significant difference in OS or DFS between RFA and MWA. In multivariate analysis of OS, pre-ablation lymphocyte-monocyte ratio [Hazard ratio (HR) 0.7, 95% confidence interval (CI) 0.58–0.84, P = 0.0001], MELD score [HR 1.12, 95%CI 1.068–1.17, P < 0.0001], tumor number [HR 1.23, 95%CI 1.041–1.46, P = 0.015] and tumor size [HR 1.18, 95%CI 1.015–1.37, P = 0.031] were clinically-significant prognostic factors. Among HCC patients with chronic hepatitis C (HCV) infection, positive HCV PCR at HCC diagnosis was associated with 1.4-fold higher hazard of death, with 5-year survival of 32.8% vs 53.6% in HCV PCR-negative patients. Regarding DFS, pre-ablation lymphocyte-monocyte ratio [HR 0.77, 95%CI 0.66–0.9, P = 0.001], MELD score [HR 1.06, 95%CI 1.022–1.11, P = 0.002], Log2 AFP [HR 1.11, 95%CI 1.033–1.2, P = 0.005], tumor number [HR 1.29, 95%CI 1.078–1.53, P = 0.005] and tumor size [HR 1.25, 95%CI 1.043–1.51 P = 0.016] were independently prognostic. Conclusions Pre-ablation systemic inflammation represented by lymphocyte-monocyte ratio is significantly associated with OS and DFS in HCC patients treated with local ablation. HCV viremia is associated with poor OS. Tumor biology represented by tumor number and size are strongly prognostic for OS and DFS while AFP is significantly associated with DFS only.
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Affiliation(s)
| | - William Scott Harmsen
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, 205 Third Street SW, Rochester, MN, 55905, USA
| | - Khairy Hammam Morsy
- Department of Tropical Medicine and Gastroenterology, Sohag Faculty of Medicine, Naser City, Sohag, 82524, Egypt
| | - Ghada Moustapha Kamal Galal
- Department of Tropical Medicine and Gastroenterology, Sohag Faculty of Medicine, Naser City, Sohag, 82524, Egypt
| | - Terry M Therneau
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, 205 Third Street SW, Rochester, MN, 55905, USA
| | - Lewis Rowland Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
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Mauri G, Monfardini L, Garnero A, Zampino MG, Orsi F, Della Vigna P, Bonomo G, Varano GM, Busso M, Gazzera C, Fonio P, Veltri A, Calandri M. Optimizing Loco Regional Management of Oligometastatic Colorectal Cancer: Technical Aspects and Biomarkers, Two Sides of the Same Coin. Cancers (Basel) 2021; 13:cancers13112617. [PMID: 34073585 PMCID: PMC8198296 DOI: 10.3390/cancers13112617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary The treatments for patients with oligometastatic colorectal carcinoma are rapidly evolving. The present review focuses on the role of minimally invasive techniques since they can now be used as an alternative to surgical management in selected cases in association with systemic therapies according to ESMO and NCCN guidelines. In recent years, biomarkers (both at molecular and imaging level) have emerged as a relevant and potential criteria for treatment strategy decision and will be crucial in the future for patients selection. Tumor molecular profile impacts on local outcome of image guide ablation as well as metabolic imaging which predicts the outcome of both percutaneous and trans-arterial treatments. Oncologists should be aware of advantages and disadvantages of those treatments options as well as the potential role of molecular profile for a better patient selection. Abstract Colorectal cancer (CRC) is the third most common cancer worldwide and has a high rate of metastatic disease which is the main cause of CRC-related death. Oligometastatic disease is a clinical condition recently included in ESMO guidelines that can benefit from a more aggressive locoregional approach. This review focuses the attention on colorectal liver metastases (CRLM) and highlights recommendations and therapeutic locoregional strategies drawn from the current literature and consensus conferences. The different percutaneous therapies (radiofrequency ablation, microwave ablation, irreversible electroporation) as well as trans-arterial approaches (chemoembolization and radioembolization) are discussed. Ablation margins, the choice of the imaging guidance as well as characteristics of the different ablation techniques and other technical aspects are analyzed. A specific attention is then paid to the increasing role of biomarkers (in particular molecular profiling) and their role in the selection of the proper treatment for the right patient. In conclusion, in this review an up-to-date state of the art of the application of locoregional treatments on CRLM is provided, highlighting both technical aspects and the role of biomarkers, two sides of the same coin.
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Affiliation(s)
- Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, 20122 Milan, Italy
| | - Lorenzo Monfardini
- Divisione di Radiologia, Fondazione Poliambulanza, 25124 Brescia, Italy
- Correspondence: or
| | - Andrea Garnero
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Surgical Sciences, University of Turin, 10124 Torino, Italy;
| | - Maria Giulia Zampino
- Divisione di Oncologia Medica Gastrointestinale e Tumori Neuroendocrini, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy;
| | - Franco Orsi
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Paolo Della Vigna
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Guido Bonomo
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Gianluca Maria Varano
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, 20141 Milan, Italy; (G.M.); (F.O.); (P.D.V.); (G.B.); (G.M.V.)
| | - Marco Busso
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
| | - Carlo Gazzera
- Radiodiagnostica 1 U, A.O.U. Città della Scienza e della Salute, 10126 Torino, Italy;
| | - Paolo Fonio
- Department of Surgical Sciences, University of Turin, 10124 Torino, Italy;
- Radiodiagnostica 1 U, A.O.U. Città della Scienza e della Salute, 10126 Torino, Italy;
| | - Andrea Veltri
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Oncology, University of Turin, 10124 Torino, Italy
| | - Marco Calandri
- Radiodiagnostica 1 U. A.O.U., San Luigi Gonzaga di Orbassano, Regione Gonzole 10, 10043 Orbassano, Torino, Italy; (A.G.); (M.B.); (A.V.); (M.C.)
- Department of Oncology, University of Turin, 10124 Torino, Italy
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Beisenova A, Issatayeva A, Ashikbayeva Z, Jelbuldina M, Aitkulov A, Inglezakis V, Blanc W, Saccomandi P, Molardi C, Tosi D. Distributed Sensing Network Enabled by High-Scattering MgO-Doped Optical Fibers for 3D Temperature Monitoring of Thermal Ablation in Liver Phantom. SENSORS (BASEL, SWITZERLAND) 2021; 21:828. [PMID: 33513666 PMCID: PMC7865229 DOI: 10.3390/s21030828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 01/19/2023]
Abstract
Thermal ablation is achieved by delivering heat directly to tissue through a minimally invasive applicator. The therapy requires a temperature control between 50-100 °C since the mortality of the tumor is directly connected with the thermal dosimetry. Existing temperature monitoring techniques have limitations such as single-point monitoring, require costly equipment, and expose patients to X-ray radiation. Therefore, it is important to explore an alternative sensing solution, which can accurately monitor temperature over the whole ablated region. The work aims to propose a distributed fiber optic sensor as a potential candidate for this application due to the small size, high resolution, bio-compatibility, and temperature sensitivity of the optical fibers. The working principle is based on spatial multiplexing of optical fibers to achieve 3D temperature monitoring. The multiplexing is achieved by high-scattering, nanoparticle-doped fibers as sensing fibers, which are spatially separated by lower-scattering level of single-mode fibers. The setup, consisting of twelve sensing fibers, monitors tissue of 16 mm × 16 mm × 25 mm in size exposed to a gold nanoparticle-mediated microwave ablation. The results provide real-time 3D thermal maps of the whole ablated region with a high resolution. The setup allows for identification of the asymmetry in the temperature distribution over the tissue and adjustment of the applicator to follow the allowed temperature limits.
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Affiliation(s)
- Aidana Beisenova
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
| | - Aizhan Issatayeva
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
| | - Zhannat Ashikbayeva
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
- Laboratory of Biosensors and Bioinstruments, National Laboratory of Astana, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan
| | - Madina Jelbuldina
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
| | - Arman Aitkulov
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
| | - Vassilis Inglezakis
- Department of Chemical and Process Engineering, University of Strathclyde, 75 Montrose Street, Glasgow G1 1XJ, UK;
| | - Wilfried Blanc
- Université Côte d’Azur, INPHYNI, CNRS UMR 7010, Parc Valrose, 06108 Nice, France;
| | - Paola Saccomandi
- Politechnico di Milano, Department of Mechanical Engineering, Giuseppe La Masa, 20156 Milano, Italy;
| | - Carlo Molardi
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
| | - Daniele Tosi
- Department of Computer and Electrical Engineering, Nazarbayev University, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan; (A.B.); (Z.A.); (M.J.); (A.A.); (C.M.); (D.T.)
- Laboratory of Biosensors and Bioinstruments, National Laboratory of Astana, Kabanbay batyr, Nur-Sultan 010000, Kazakhstan
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Pacella CM, Di Stasio E, Guglielmi R, Baroli A, Pedrazzini L, Misischi I, Persichetti A, Papini E. Role of laser ablation in multimodal treatment of radioiodine- refractory bone metastases of thyroid cancer: a retrospective study. Endocrine 2020; 70:338-347. [PMID: 32378155 DOI: 10.1007/s12020-020-02314-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma (DTC). PATIENTS AND METHODS The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated. RESULTS Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58-72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0-12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1-2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred. CONCLUSIONS IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
- UOC Chemistry, Biochemistry and Clinical Molecular Biology, A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Alberto Baroli
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Luca Pedrazzini
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Agnese Persichetti
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Safety and Local Efficacy of Laser Ablation for the Extrahepatic Metastasis of Hepatocellular Carcinoma: An Available Treatment Strategy. COATINGS 2020. [DOI: 10.3390/coatings10100951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thermal ablation plays an important role in the treatment of extrahepatic metastasis of hepatocellular carcinoma (HCC). Yet laser ablation (LA), as a safe thermal ablative modality, is less investigated in this field. In this study, the safety and local effectiveness of LA in the treatment for the extrahepatic metastasis of HCC were evaluated. From May 2012 to May 2019, 17 patients (13 males and 4 females; mean age, 54.1 ± 14.6 years; age range, 34–80 years), who underwent LA for treatment of extrahepatic metastasis of HCC at the First Affiliated Hospital of Sun Yat-sen University, were retrospectively enrolled in this study. Local effectiveness, complications, local tumor progression (LTP), and overall survival (OS) were evaluated. Finally, a total of 28 LA treated extrahepatic metastatic lesions of HCC were reviewed. Neither LA-related mortality nor major complication occurred. Complete ablation (CA) was achieved in 20 out of 28 lesions (71.4%). During the follow-up (mean, 19.5 ± 12.8 months; range, 5–42.7 months), LTP developed in 4 out of 20 lesions with CA (20%). Four patients died of tumor progression or multiple organ dysfunction syndrome. The accumulative one- and three-year OS rates were 79.0% and 65.8%, respectively. In conclusion, LA is a safe and effective therapeutic option in the treatment of extrahepatic metastasis of HCC. Further studies are necessary to evaluate the benefit of LA.
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He Z, Dong Z, Fang G, Ho JDL, Cheung CL, Chang HC, Chong CCN, Chan JYK, Chan DTM, Kwok KW. Design of a Percutaneous MRI-Guided Needle Robot With Soft Fluid-Driven Actuator. IEEE Robot Autom Lett 2020. [DOI: 10.1109/lra.2020.2969929] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lewis AR, Padula CA, McKinney JM, Toskich BB. Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions. Semin Intervent Radiol 2019; 36:303-309. [PMID: 31680721 DOI: 10.1055/s-0039-1697641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Thermal ablation is widely regarded as definitive therapy for early-stage hepatocellular carcinoma, but its efficacy decreases in tumors greater than 3 cm. Extensive clinical studies have supported improved outcomes provided through combining transarterial embolic therapy with ablation in the treatment of larger tumors. This article will provide a survey of the science and data for combination therapy in both thermal and nonthermal ablation modalities, as well as describe emerging applications.
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Affiliation(s)
- Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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The Evolving Role of Ultrasound Guided Percutaneous Laser Ablation in Elderly Unresectable Breast Cancer Patients: A Feasibility Pilot Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9141746. [PMID: 29992167 PMCID: PMC6016148 DOI: 10.1155/2018/9141746] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 03/14/2018] [Indexed: 12/29/2022]
Abstract
Background and Objectives Breast-conserving surgery represents the standard of care for the treatment of small breast cancers. However, there is a population of patients who cannot undergo the standard surgical procedures due to several reasons such as age, performance status, or comorbidity. Our aim was to investigate the feasibility and safety of percutaneous US-guided laser ablation for unresectable unifocal breast cancer (BC). Methods Between December 2012 and March 2017, 12 consecutive patients underwent percutaneous US-guided laser ablation as radical treatment of primary inoperable unifocal BC. Results At median follow-up of 28.5 months (range 6-51), no residual disease or progression occurred; the overall success rate for complete tumor ablation was therefore 100%. No significant operative side effects were observed, with only 2 (13.3%) experiencing slight to mild pain during the procedure, and all patients complained of a mild dull aching pain in the first week after procedure. Conclusions Laser ablation promises to be a safe and feasible approach in those patients who are not eligible to the standard surgical approach. However, longer follow-up results and larger studies are strongly needed.
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Sartori S, Mauri G, Tombesi P, Di Vece F, Bianchi L, Pacella CM. Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk. Int J Hyperthermia 2018; 35:19-25. [PMID: 29749271 DOI: 10.1080/02656736.2018.1468038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding. MATERIAL AND METHODS From 2013 to 2017, nine patients (six males, three females, aged 68.5 ± 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded. RESULTS Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11-49 months). CONCLUSIONS LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding.
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Affiliation(s)
- Sergio Sartori
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Paola Tombesi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Francesca Di Vece
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Lara Bianchi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Claudio Maurizio Pacella
- c Department of Diagnostic Imaging and Interventional Radiology , Regina Apostolorum Hospital , Albano Laziale, Rome , Italy
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Morisco F, Camera S, Guarino M, Tortora R, Cossiga V, Vitiello A, Cordone G, Caporaso N, Di Costanzo GG. Laser ablation is superior to TACE in large-sized hepatocellular carcinoma: a pilot case-control study. Oncotarget 2018; 9:17483-17490. [PMID: 29707122 PMCID: PMC5915130 DOI: 10.18632/oncotarget.24756] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/27/2018] [Indexed: 12/25/2022] Open
Abstract
Background Limited therapies are available for large (≥40 mm) unresectable hepatocellular carcinoma (HCC). Currently, the standard treatment with transarterial chemoembolisation (TACE) is unsatisfactory with high recurrence rate and limited effect on survival. Laser Ablation (LA) has emerged as a relatively new technique characterized by high efficacy and good safety. This study is aimed to evaluate the efficacy of LA in comparison to TACE in patients with large HCC. Methods Eighty-two patients with a single HCC nodule ≥40 mm (BCLC stage A or B) were enrolled in this case-control study. Forty-one patients were treated with LA and 41 patients were treated with TACE. Response to therapy was evaluated according to the mRECIST criteria. Survival was calculated with Kaplan-Meier from the time of cancer diagnosis to death with values censored at the date of the last follow-up. Results Twenty-six (63.4%) and 8 (19.5%) patients had a complete response after LA and TACE, respectively (p < 0.001). Subsequently we stratified the HCCs in 3 categories according to the nodule size: 40–50 mm, 51–60 mm, and >60 mm. LA resulted superior to TACE especially in nodules ranging between 51 and 60 mm in diameter, with a complete response rate post-LA and post-TACE of 75% and 14.3%, respectively (p = 0.0133). The 36 months cumulative survival rate in patients treated with LA and TACE was 55.4% and 48.8%, respectively. The disease recurrence rates after LA and TACE were 19.5% and 75.0%, respectively. Conclusions LA is a more effective therapeutic option than TACE in patients with solitary large HCC.
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Affiliation(s)
- Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Silvia Camera
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maria Guarino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Valentina Cossiga
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Anna Vitiello
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | | | - Nicola Caporaso
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Jiang T, Tian G, Bao H, Chen F, Deng Z, Li J, Chai W. EUS dating with laser ablation against the caudate lobe or left liver tumors: a win-win proposition? Cancer Biol Ther 2018; 19:145-152. [PMID: 29303406 DOI: 10.1080/15384047.2017.1414760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Endoscopic ultrasound (EUS) have been not only a diagnostic tool, but also available in interventional therapy, which often previously needed surgical approaches to achieve. The study aimed to evaluate the effectiveness and safety of EUS-guided Nd:YAG laser ablation in unresectable tumors of the caudate lobe and left liver. We discussed ten cases of the caudate lobe and left liver tumors underwent laser ablation with EUS guidance. And we also have reviewed previous publication of EUS-guided thermal ablation for liver tumors in several decade years. EUS-guided Nd:YAG laser ablation (LA) of these tumors were successfully completed in ten patients, who had favourable prognosis with no complications in two-month follow-up. Based on our early observations, this suggested that EUS-guided LA might be technically feasible in selected patients with tumors of the caudate lobe and left liver. However, the safety of this technique need to be further confirmed in the future and if possible larger, prospective trials.
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Affiliation(s)
- Tian'an Jiang
- a Department of Ultrasound Medicine , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.,b Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
| | - Guo Tian
- b Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China.,c State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Haiwei Bao
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Fen Chen
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Zhuang Deng
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Ju Li
- d Department of Hepatobiliary and Pancreatic Surgery , The First Affiliated Hospital, College of Medicine, Zhejiang University , Hangzhou , China
| | - Weilu Chai
- a Department of Ultrasound Medicine , The First Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou , China
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Vannacci E, Granchi S, Breschi L, Biagi E. A feasibility study of a novel spectral method using radiofrequency ultrasound data for monitoring laser tissue ablation. ULTRASONICS 2017; 78:83-95. [PMID: 28324777 DOI: 10.1016/j.ultras.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/21/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
This paper presents preliminary results of a new non-invasive ultrasound monitoring method called TUV (Thermotherapy Ultrasonic View) able to investigate structural tissue modifications caused by minimally invasive percutaneous laser ablation. The method, based on the spectral analysis of the raw ultrasound radiofrequency signal, develops spectral parameters in a multidimensional space and its N dimensions are represented by the central frequencies of the sub bands the signal spectrum is decomposed into. Signal processing has been performed on the data related to 7 laser treatments performed on 4 samples of removed prostatic glands which underwent laser ablation at power of 3W, 4W and 5W and energy of 1800J. In this preliminary study, clusters of these parameters, referred to tissue areas at different distances from the light laser source, modified their shape and position in different ways, during ablation treatment. TUV results have been represented by a chromatic code superimposed to the corresponding ultrasound conventional image, in order to highlight the alteration intensities occurred in the ablated tissue. Resulting images of ablated area have been compared to histological specimens to evaluate the degree of similarity between them by means of Dice and Jaccard coefficients.
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Affiliation(s)
- Enrico Vannacci
- Department of Information Engineering (DINFO), University of Florence, Via Santa Marta 3, 50139 Florence, Italy
| | - Simona Granchi
- Department of Information Engineering (DINFO), University of Florence, Via Santa Marta 3, 50139 Florence, Italy.
| | | | - Elena Biagi
- Department of Information Engineering (DINFO), University of Florence, Via Santa Marta 3, 50139 Florence, Italy
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Facciorusso A, Serviddio G, Muscatiello N. Local ablative treatments for hepatocellular carcinoma: An updated review. World J Gastrointest Pharmacol Ther 2016; 7:477-489. [PMID: 27867681 PMCID: PMC5095567 DOI: 10.4292/wjgpt.v7.i4.477] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/06/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Ablative treatments currently represent the first-line option for the treatment of early stage unresectable hepatocellular carcinoma (HCC). Furthermore, they are effective as bridging/downstaging therapies before orthotopic liver transplantation. Contraindications based on size, number, and location of nodules are quite variable in literature and strictly dependent on local expertise. Among ablative therapies, radiofrequency ablation (RFA) has gained a pivotal role due to its efficacy, with a reported 5-year survival rate of 40%-70%, and safety. Although survival outcomes are similar to percutaneous ethanol injection, the lower local recurrence rate stands for a wider application of RFA in hepato-oncology. Moreover, RFA seems to be even more cost-effective than liver resection for very early HCC (single nodule ≤ 2 cm) and in the presence of two or three nodules ≤ 3 cm. There is increasing evidence that combining RFA to transarterial chemoembolization may increase the therapeutic benefit in larger HCCs without increasing the major complication rate, but more robust prospective data is still needed to validate these pivotal findings. Among other thermal treatments, microwave ablation (MWA) uses high frequency electromagnetic energy to induce tissue death via coagulation necrosis. In comparison to RFA, MWA has several theoretical advantages such as a broader zone of active heating, higher temperatures within the targeted area in a shorter treatment time and the lack of heat-sink effect. The safety concerns raised on the risks of this procedure, due to the broader and less predictable necrosis areas, have been recently overcome. However, whether MWA ability to generate a larger ablation zone will translate into a survival gain remains unknown. Other treatments, such as high-intensity focused ultrasound ablation, laser ablation, and cryoablation, are less investigated but showed promising results in early HCC patients and could be a valuable therapeutic option in the next future.
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Pacella CM, Nasoni S, Grimaldi F, Di Stasio E, Misischi I, Bianchetti S, Papini E. Laser ablation with or without chemoembolization for unresectable neuroendocrine liver metastases: a pilot study. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2016. [DOI: 10.2217/ije.15.34] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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17
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Shi Y, Zhai B. A Recent Advance in Image-Guided Locoregional Therapy for Hepatocellular Carcinoma. Gastrointest Tumors 2016; 3:90-102. [PMID: 27904861 DOI: 10.1159/000445888] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the third most common cause of cancer-related deaths. Hepatic resection and liver transplantation are considered to be the preferred treatment for HCC. However, as novel therapeutic options such as image-guided locoregional therapies have emerged and been refined, the manner in which HCC is treated has changed dramatically compared with what it was considered just 2 decades earlier. SUMMARY This study reviews the current results of various image-guided locoregional therapies for treating HCC, especially focusing on thermal ablative and transarterial techniques. KEY MESSAGE Advances in image-guided locoregional therapies, including local ablative therapy and transarterial therapy, have led to a major breakthrough in the management of HCC. Both survival rates and cure rates of patients with HCC have improved markedly since the introduction of these techniques. PRACTICAL IMPLICATIONS Radiofrequency ablation is currently considered as an alternative to surgical resection for patients with early-stage HCC. A newer technique of ablation such as microwave ablation is increasingly being used, especially for large HCC. Transarterial chemoembolization has become a standard care for asymptomatic patients with multinodular tumors in intermediate-stage disease, and transarterial radioembolization has become the method of choice in HCC cases with portal vein thrombosis. Moreover, combination treatment modalities, such as thermal-based ablation combined with transarterial chemoembolization or 125I seed implant brachytherapy, may further broaden their clinical indications for HCC. Moreover, use of localized radiation in combination with thermal ablation has been reported to improve tumor control and long-term survival.
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Affiliation(s)
- Yaoping Shi
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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18
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Di Costanzo GG, Tortora R, D'Adamo G, De Luca M, Lampasi F, Addario L, Galeota Lanza A, Picciotto FP, Tartaglione MT, Cordone G, Imparato M, Mattera S, Pacella CM. Radiofrequency ablation versus laser ablation for the treatment of small hepatocellular carcinoma in cirrhosis: a randomized trial. J Gastroenterol Hepatol 2015; 30:559-65. [PMID: 25251043 DOI: 10.1111/jgh.12791] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM In patients with cirrhosis and small hepatocellular carcinoma (HCC), thermal ablation is currently recognized as an effective local treatment. Among thermal procedures, radiofrequency ablation (RFA) is the most diffusely used and is the standard against which any new treatment should be compared. In retrospective studies, laser ablation (LA) resulted as safe and effective as RFA. Therefore, we performed a non-inferiority randomized trial comparing RFA with LA in patients with cirrhosis and HCC within Milan criteria. METHODS Overall, 140 patients with 157 HCC nodules were randomly assigned to receive RFA or LA. The primary end-point was the proportion of complete tumor ablation (CTA). Secondary end-points were time to local progression (TTLP) and overall survival (OS). RESULTS Per patient CTA rates after RFA and LA were 97.4% (95% CI, 91.0-99.3) and 95.7% (88.1-98.5), respectively (difference = 1.4%, 95% CI from -6.0% to + 9.0%). Per nodule CTA rates for RFA and LA were 97.4% (91.0-99.3) and 96.3% (89.6-98.7), respectively (difference = 1.1%, from -5.7% to + 8.1%). The mean TTLP was comparable between RFA group (42.0 months; 95% CI, 36.83-47.3) and LA group (46.7 months; 95% CI, 41.5-51.9) (P = .591). The mean OS was 42 months in both groups and survival probability at 1 and 3 years was 94% and 89% in RFA group, and 94% and 80% in LA group. CONCLUSION LA resulted not inferior to RFA in inducing the CTA of HCC nodules and therefore it should be considered as an evaluable alternative for thermal ablation of small HCC in cirrhotic patients.
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Costanzo GGD, Francica G, Pacella CM. Laser ablation for small hepatocellular carcinoma: State of the art and future perspectives. World J Hepatol 2014; 6:704-715. [PMID: 25349642 PMCID: PMC4209416 DOI: 10.4254/wjh.v6.i10.704] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 06/17/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
During the last two decades, various local thermal ablative techniques for the treatment of unresectable hepatocellular carcinoma (HCC) have been developed. According to internationally endorsed guidelines, percutaneous thermal ablation is the mainstay of treatment in patients with small HCC who are not candidates for surgical resection or transplantation. Laser ablation (LA) represents one of currently available loco-ablative techniques. In this article, the general principles, technique, image guidance, and patient selection are reported. Primary effectiveness, long-term outcome, and complications are also discussed. A review of published data suggests that LA is equivalent to the more popular and widespread radiofrequency ablation in both local tumor control and long-term outcome in the percutaneous treatment of early HCC. In addition, the LA technique using multiple thin laser fibres allows improved ablative effectiveness in HCCs greater than 3 cm. Reference centres should be equipped with all the available techniques so as to be able to use the best and the most suitable procedure for each type of lesion for each patient.
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20
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Radiofrequency thermoablation of HCC larger than 3 cm and less than 5 cm proximal to the gallbladder without gallbladder isolation: a single center experience. BIOMED RESEARCH INTERNATIONAL 2014; 2014:896527. [PMID: 25247192 PMCID: PMC4163369 DOI: 10.1155/2014/896527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/07/2014] [Indexed: 12/12/2022]
Abstract
Radiofrequency ablation (RFA) is an effective minimally invasive treatment for nonsurgical hepatocellular carcinoma (HCC), but ablation of tumors close to the gallbladder could be associated with several complications. We report our experience on the treatment of HCC close to the gallbladder with RFA. Eight RFA procedures were performed in eight patients with HCC larger than 3 cm and less than 5 cm close to the gallbladder. In all cases, a percutaneous approach was used. There were no major complications. Only in two patients a minimal wall thickening of the gallbladder was observed. Contrast enhanced computed tomography carried out after 30 days from the first procedure showed complete necrosis in seven patients (87%). Only one patient had local recurrence at 11 months of followup. Although limited, our experience suggests that, after careful preprocedural planning, in experienced hands and with appropriate technology, percutaneous RFA could be safely performed even for lesions larger than 3 cm located in close adjacency to the gallbladder.
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21
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Thandassery RB, Goenka U, Goenka MK. Role of local ablative therapy for hepatocellular carcinoma. J Clin Exp Hepatol 2014; 4:S104-11. [PMID: 25755601 PMCID: PMC4284241 DOI: 10.1016/j.jceh.2014.03.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 03/03/2014] [Indexed: 02/08/2023] Open
Abstract
Percutaneous local ablation (PLA) techniques are currently considered as the best treatment option for patients with early-stage hepatocellular carcinoma (HCC) who are not candidates for surgical resection. They are safe, minimally invasive, efficacious and cost-effective. Radiofrequency ablation (RFA) is considered as the first line treatment in some centers, though most of the guidelines recommend it for small HCCs, where surgical resection is not feasible. In developing countries percutaneous ethanol injection (PEI) and percutaneous acetic acid injection (PAI) may be used instead of RFA. For large HCCs, advances in electrode designs and newer techniques of ablation, including microwave ablation, are increasingly been used. Combination treatment modalities have shown promising results as compared to single modality for large tumors. The selection of the most appropriate modality depends on the size, number of lesions, the liver function status, patient's financial resources, availability of a particular technique and the expertise available.
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Affiliation(s)
| | | | - Mahesh K. Goenka
- Address for correspondence: Mahesh Kumar Goenka, Institute of Gastroscience, Apollo Gleneagles Hospital, Kolkata, West Bengal, India. Tel.: +91 9830040599 (mobile).
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Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol 2014; 31:129-37. [PMID: 25071303 PMCID: PMC4078184 DOI: 10.1055/s-0034-1373788] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity-focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T. Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Orlacchio A, Bolacchi F, Chegai F, Bergamini A, Costanzo E, Del Giudice C, Angelico M, Simonetti G. Comparative evaluation of percutaneous laser and radiofrequency ablation in patients with HCC smaller than 4 cm. Radiol Med 2013; 119:298-308. [PMID: 24277510 DOI: 10.1007/s11547-013-0339-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 02/24/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study was done to compare percutaneous laser ablation (PLA) and radiofrequency thermoablation (RFA) for the treatment of hepatocellular carcinoma (HCC) ≤ 4 cm, in patients with liver cirrhosis. MATERIALS AND METHODS Thirty patients with single HCC ≤ 4 cm in diameter were randomly assigned to one of two treatments: 15 patients were treated with PLA, using a multifibre system connected to a neodymium yttrium-aluminium-garnet laser source; 15 patients were treated with RFA, using an expandable needle electrode. Patients were followed up for up to 12 months. RESULTS A complete response was obtained in 87 % lesions treated with PLA and in 93 % lesions treated with RFA (p = ns). The overall local recurrence-free survival rates at 3, 6 and 12 months were comparable. However, a higher rate of recurrence was observed in the PLA group for lesions ≥ 21 mm (p = 0.0081). A postablation syndrome was documented in 13 patients (1 PLA; 12 RFA). Tumour necrosis factor-α was significantly higher in the RFA group (p < 0.05). CONCLUSIONS RFA is more effective in the treatment of HCC compared to PLA for lesions ≥ 21 mm. However, PLA should be considered a viable treatment option for HCC ≤ 20 mm, in view of the lower incidence of complications.
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Affiliation(s)
- Antonio Orlacchio
- Dipartimento di Diagnostica per Immagini, Imaging Molecolare, Radiologia Interventistica e Radioterapia, Policlinico Universitario "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy,
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Di Costanzo GG, D'Adamo G, Tortora R, Zanfardino F, Mattera S, Francica G, Pacella CM. A novel needle guide system to perform percutaneous laser ablation of liver tumors using the multifiber technique. Acta Radiol 2013; 54:876-81. [PMID: 23761559 DOI: 10.1177/0284185113489825] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies have shown that laser ablation with the multifiber technique is effective in the treatment of liver tumors. However, the correct positioning of multiple needles may be challenging. PURPOSE To investigate the use of a novel needle guide system that was developed to perform percutaneous laser ablation of liver tumors with the multifiber technique under ultrasonographic guidance. MATERIAL AND METHODS Between February 2009 and June 2011, 116 patients (104 hepatocellular carcinomas and 12 metastases) with 127 liver nodules (median diameter, 3.0 cm; range, 1.5-6.0) were treated. Nineteen nodules were in high-risk locations. A needle guide with separate channels to insert two needles in a parallel position and at a prefixed distance was used. RESULTS Needles were positioned inside the target nodule easily and quickly, and correct spacing (1.5-1.8 cm) between light sources was immediately achieved. Complete tumor ablation was achieved in a single session in 112 (88.2%) lesions. In nodules ≤3.0 cm and >3.0 cm in size, ablation was complete in 93.6% and 79.6% of cases, respectively. Of note, complete ablation was achieved in 91.7% of nodules up to 5.0 cm. CONCLUSION With the new guidance system, needles could be inserted in parallel fashion, which facilitated positioning the needles in geometrical configurations to maximize the ablative effect. Worthy of note, the complete ablation rate in nodules >3.0 cm using the new guide system was higher than what has been reported in the literature so far.
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Affiliation(s)
| | | | | | | | | | - Giampiero Francica
- Diagnostic and Interventional Ultrasound Unit, Camilliani Hospital, Naples
| | - Claudio Maurizio Pacella
- Regina Apostolorum Hospital, Diagnostic Imaging and Interventional Radiology, Albano Laziale, Italy
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Zou X, Liu Q, Zhou X, He G, Yu M, Han Z, Meng X, Su H. Ultrasound-guided percutaneous laser and ethanol ablation of rabbit VX2 liver tumors. Acta Radiol 2013; 54:181-7. [PMID: 23482351 DOI: 10.1258/ar.2012.110723] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Only a small percentage of patients with hepatocellular carcinoma (HCC) may benefit out of surgical resection. Thus, lots of these patients are in need of local control, such as percutaneous ethanol injection (PEI), percutaneous laser ablation (PLA), or radiofrequency thermal ablation (RF). PURPOSE To investigate the effects of ultrasound-guided PLA combined with PEI on rabbit VX2 liver tumors, using conventional gray-scale ultrasonography (US), color/power Doppler (CD/PD)US, contrast-enhanced (CE) US, and histologic examination. MATERIAL AND METHODS VX2 tumors were implanted in the livers of 80 rabbits. Fourteen days after implantation, animals were randomly separated into four groups of 20 rabbits. Treatment of the four groups was with: (i) PLA; (ii) PEI; (iii) combined therapy of PLA immediately followed by PEI; and (iv) combined therapy of PEI immediately followed by PLA. Conventional gray-scale US, CD US, PD US, and CE US were performed before and after ablation. The effects on ablated areas were assessed by histologic examination. RESULTS Conventional gray-scale US showed a clear boundary around the ablated area in groups 1, 3, and 4. An isoechoic treated region with an irregular boundary was seen in group 2. On CE US, coagulated areas demonstrated a perfusion defect. Both conventional gray-scale US and CE US showed that the ablated volume in group 4 was larger than that in groups 1, 2, and 3. CD US and PD US demonstrated residual tumor in the periphery of ablated areas in groups 1 and 2, but not in groups 3 and 4. CE US demonstrated no residual tumor in group 4, unlike in groups 1, 2, and 3. Examination of treated tumors demonstrated necrosis in the ablated zones and increasing surrounding fibrous bands in the four treatment groups. Residual viable tissue in group 4 was less than that in groups 1, 2, and 3. CONCLUSION Combined therapy of PEI immediately followed by PLA can coagulate significantly larger volumes of tumor and reduce residual tumor.
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Affiliation(s)
- Xiaojuan Zou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Qing Liu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaodong Zhou
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guangbin He
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ming Yu
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zenghui Han
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xin Meng
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haili Su
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Effectiveness, safety, and local progression after percutaneous laser ablation for hepatocellular carcinoma nodules up to 4 cm are not affected by tumor location. AJR Am J Roentgenol 2013; 199:1393-401. [PMID: 23169736 DOI: 10.2214/ajr.11.7850] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A high-risk location--defined as the tumor margin being less than 5 mm from large vessels or vital structures--represents a well-known limitation and contraindication for radiofrequency ablation of hepatocellular carcinoma (HCC) nodules. The aim of this study was to verify whether HCC nodule location negatively affected the outcome of percutaneous laser ablation in terms of its primary effectiveness, safety, and ability to prevent local tumor progression. MATERIALS AND METHODS The medical records and radiologic examinations of 164 cirrhotic patients (90 men, 74 women; mean age ± SD, 68.6 ± 8.3 years) with 182 HCC nodules 4 cm or smaller (mean diameter ± SD, 2.7 ± 0.78 cm) that had been treated by laser ablation between 1996 and 2008 were retrospectively analyzed. One hundred six patients had 116 nodules in high-risk sites (high-risk group), whereas 58 patients had 66 tumors located elsewhere (standard-risk group). RESULTS The overall median follow-up was 81 months (range, 6-144 months). The initial complete ablation rate per nodule did not significantly differ between the high-risk group and the standard-risk group (92.2% vs 95.5%, respectively; p = 0.2711). Rates of major complications (high-risk group vs standard-risk group, 1.9% [including one death] vs 0%) and minor complications (5.6% vs 1.0%) were not statistically different between the two groups. Only side effects were recorded significantly more often in high-risk patients than in standard-risk patients (31.5% vs 19.8%; p = 0.049). There was no significant difference in either cumulative incidence of local tumor progression (p = 0.499) or local tumor progression-free survival (p = 0.499, log rank test) between the high-risk group and the standard-risk group. CONCLUSION When laser ablation is used to treat small HCC nodules, tumor location does not have a significant negative impact on the technique's primary effectiveness or safety or on its ability to achieve local control of disease.
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Imani F, Abolmaesumi P, Wu MZ, Lasso A, Burdette EC, Ghoshal G, Heffter T, Williams E, Neubauer P, Fichtinger G, Mousavi P. Ultrasound-guided characterization of interstitial ablated tissue using RF time series: feasibility study. IEEE Trans Biomed Eng 2013; 60:1608-18. [PMID: 23335657 DOI: 10.1109/tbme.2013.2240300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents the results of a feasibility study to demonstrate the application of ultrasound RF time series imaging to accurately differentiate ablated and nonablated tissue. For 12 ex vivo and two in situ tissue samples, RF ultrasound signals are acquired prior to, and following, high-intensity ultrasound ablation. Spatial and temporal features of these signals are used to characterize ablated and nonablated tissue in a supervised-learning framework. In cross-validation evaluation, a subset of four features extracted from RF time series produce a classification accuracy of 84.5%, an area under ROC curve of 0.91 for ex vivo data, and an accuracy of 85% for in situ data. Ultrasound RF time series is a promising approach for characterizing ablated tissue.
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Affiliation(s)
- Farhad Imani
- Department of Electrical and Computer Engineering, Queen’s university, Kingston, ON K7L 3N6, Canada.
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Pacella CM, Papini E. Image-guided percutaneous ablation therapies for local recurrences of thyroid tumors. J Endocrinol Invest 2013; 36:61-70. [PMID: 23391859 DOI: 10.1007/bf03346744] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The incidence of thyroid carcinoma has increased steadily over the last few decades. Most differentiated thyroid carcinomas (DTC) are cured thanks to the initial treatment with surgery and radioiodine therapy. Nevertheless, neck lymph node metastases are found in a few of these patients during their long-term clinical and ultrasound follow-up. In some of these cases radioiodine treatment may not be effective in eradicating nodal metastases due to scant 131-I uptake. Additionally, a few of these patients undergo repeated neck explorations and/or resections. Based on these considerations and on the frequently indolent course of DTC neck metastases, a non-surgical therapeutic approach should be considered to control small local foci of DTC. There is increasing interest in mini-invasive image-guided procedures that can be performed under local anesthesia which do not affect the performance status of the patient. Image-guided minimally invasive ablative therapies delivered by using needle-like applicators include both thermal and non-thermal source techniques. Over the past 25 years, these therapies have gained widespread attention and, in many cases, broad clinical acceptance as methods for treating focal malignancies. In an attempt to overcome the limitations of treating certain unresectable tumor types not amenable to a further surgical treatment, a few investigators have reported successfully combining percutaneous therapies with other oncologic treatment strategies (combined treatments). In this review, we reported mini-invasive techniques more commonly employed in selected cases to ameliorate local compressive symptoms, control hormonal production, and reduce the volume of neoplastic tissue prior to traditional palliative treatment.
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Affiliation(s)
- C M Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Via San Francesco 50, Albano Laziale - Rome, Italy.
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Magnetic resonance-guided laser-induced thermotherapy in patients with oligonodular hepatocellular carcinoma: long-term results over a 15-year period. J Clin Gastroenterol 2012; 46:796-801. [PMID: 22955262 DOI: 10.1097/mcg.0b013e3182641806] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS To prospectively evaluate the therapeutic potential of magnetic resonance (MR)-guided laser-induced thermotherapy (LITT) in patients with oligonodular hepatocellular carcinoma. STUDY A total of 113 patients with 175 intrahepatic lesions were treated with MR-guided LITT. The Nd-YAG laser fiber was introduced with a percutaneously positioned irrigated laser application system. Qualitative and quantitative MR parameters and clinical data were evaluated. Survival data were calculated using the Kaplan-Meier method. RESULTS All patients tolerated the procedure well under local anesthesia. The total procedure time was 90 minutes. All observed complications were minor and no further treatment was necessary. Online MR thermometry allowed exact visualization of the extension of laser-induced changes and their relationship to the neighboring anatomy. Lesions up to 2 cm in diameter could be efficiently treated with a single laser application; larger lesions were treated with a dual, triple, and quadruple simultaneous application. In 98% of the patients we achieved a complete necrosis of the tumor and up to 5 mm of safety margin. The mean survival rate for all patients, with calculation started on the date of diagnosis of the HCC nodules treated with LITT, was 4.9 years (95% confidence interval, 3.6, 5.1). The median survival rate for all patients, with calculation started on the date of diagnosis of the HCC nodules treated with LITT, was 3.5 years (95% confidence interval, 2.7, 4.2). One-year survival was 95%; 2-year survival 72%, 3-year survival 54%; and 5-year survival 30%. CONCLUSIONS In intrahepatic oligonodular involvement of hepatocellular carcinoma LITT appears to be an effective therapeutic procedure.
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Francica G, Petrolati A, Di Stasio E, Pacella S, Stasi R, Pacella CM. Influence of ablative margin on local tumor progression and survival in patients with HCC ≤4 cm after laser ablation. Acta Radiol 2012; 53:394-400. [PMID: 22393158 DOI: 10.1258/ar.2012.110471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ablation of the normal hepatic parenchyma surrounding the tumor (ablative margin [AM]) is necessary to prevent local tumor progression. PURPOSE To assess the prognostic value of the ablative margin in patients with HCC ≤4 cm treated with US-guided laser ablation. MATERIAL AND METHODS A cohort of 116 patients (53 women and 63 men, age range 42-82 years) with 132 HCC nodules ≤4 cm completely ablated by US-guided laser ablation was retrospectively analyzed. Rates of local tumor progression were compared using different ablative margin cut-offs (≥2.5, 5.0, 7.5, and 10.0 mm). Survival probability curves were obtained with the Kaplan-Meier method. RESULTS The mean period of follow-up was 42 months (range 3-114 months). Local tumor progression was identified in 24 out of 132 lesions (18%), with an average time to progression of 24 months (range 6-36 months). A significant difference in local tumor progression was observed only if the ablative margin was ≥7.5 mm (7% vs. 23%, P = 0.020). Survival curves of patients with or without an ablative margin ≥7.5 mm were not different (P = 0.665; mean survival time 43.8 ± 3.1 and 46.8 ± 6.1 for an AM < or ≥7.5 mm, respectively). CONCLUSION An ablative margin ≥7.5 mm turned out to be useful in preventing local tumor progression but did not affect long-term survival in patients with HCC ≤4 cm treated with laser ablation.
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Affiliation(s)
- Giampiero Francica
- Gastroenterology Department, Diagnostic and Interventional Ultrasound Unit, S Maria della Pietà Hospital, Casoria, Italy
| | - Alesssandra Petrolati
- Department of Endocrine, Metabolic and Digestive Diseases, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Roberto Stasi
- Department of Haematology, St George's Hospital, London, UK
| | - Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Laser ablation for small hepatocellular carcinoma. Radiol Res Pract 2011; 2011:595627. [PMID: 22191028 PMCID: PMC3236316 DOI: 10.1155/2011/595627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 10/20/2011] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and is increasingly detected at small size (<5 cm) owing to surveillance programmes in high-risk patients. For these cases, curative therapies such as resection, liver transplantation, or percutaneous ablation have been proposed. When surgical options are precluded, image-guided tumor ablation is recommended as the most appropriate therapeutic choice in terms of tumor local control, safety, and improvement in survival. Laser ablation (LA) represents one of currently available loco-ablative techniques: light is delivered via flexible quartz fibers of diameter from 300 to 600 μm inserted into tumor lesion through either fine needles (21g Chiba needles) or large-bore catheters. The thermal destruction of tissue is achieved through conversion of absorbed light (usually infrared) into heat. A range of different imaging modalities have been used to guide percutaneous laser ablation, but ultrasound and magnetic resonance imaging are most widely employed, according to local experience and resource availability. Available clinical data suggest that LA is highly effective in terms of tumoricidal capability with an excellent safety profile; the best results in terms of long-term survival are obtained in early HCC so that LA can be proposed not only in unresectable cases but, not differently from radiofrequency ablation, also as the first-line treatment.
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Baek JH, Lee JH, Valcavi R, Pacella CM, Rhim H, Na DG. Thermal ablation for benign thyroid nodules: radiofrequency and laser. Korean J Radiol 2011; 12:525-40. [PMID: 21927553 PMCID: PMC3168793 DOI: 10.3348/kjr.2011.12.5.525] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 05/23/2011] [Indexed: 02/05/2023] Open
Abstract
Although ethanol ablation has been successfully used to treat cystic thyroid nodules, this procedure is less effective when the thyroid nodules are solid. Radiofrequency (RF) ablation, a newer procedure used to treat malignant liver tumors, has been valuable in the treatment of benign thyroid nodules regardless of the extent of the solid component. This article reviews the basic physics, techniques, applications, results, and complications of thyroid RF ablation, in comparison to laser ablation.
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Affiliation(s)
- Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.
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Abstract
Locoregional therapies for hepatocellular carcinoma have progressed greatly in the last 30 years, beginning with the introduction of chemoembolization. Embolization techniques have evolved with the use of drug-eluting beads and radioembolization with yttrium-90. In the last 10 years, several new ablation techniques were developed including radiofrequency ablation, microwave ablation, cryoablation, laser ablation, and irreversible electroporation. Isolated or in combination, these techniques have already shown that they can improve patient survival and/or provide acceptable palliation.
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Affiliation(s)
- Marcelo Guimaraes
- Division of Vascular & Interventional Radiology, Medical University of South Carolina, 25 Courtenay Drive, MSC 226, Charleston, SC 29425, USA.
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Di Matteo F, Grasso R, Pacella CM, Martino M, Pandolfi M, Rea R, Luppi G, Silvestri S, Zardi E, Costamagna G. EUS-guided Nd:YAG laser ablation of a hepatocellular carcinoma in the caudate lobe. Gastrointest Endosc 2011; 73:632-6. [PMID: 21030019 DOI: 10.1016/j.gie.2010.08.019] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 08/11/2010] [Indexed: 02/07/2023]
Affiliation(s)
- Francesco Di Matteo
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Via Álvaro del Portillo, 200, 00128 Rome, Italy
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Sun Y, Cheng Z, Dong L, Zhang G, Wang Y, Liang P. Comparison of temperature curve and ablation zone between 915- and 2450-MHz cooled-shaft microwave antenna: results in ex vivo porcine livers. Eur J Radiol 2011; 81:553-7. [PMID: 21354733 DOI: 10.1016/j.ejrad.2011.02.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 02/02/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare temperature curve and ablation zone between 915- and 2450-MHz cooled-shaft microwave antenna in ex vivo porcine livers. MATERIALS AND METHODS The 915- and 2450-MHz microwave ablation and thermal monitor system were used in this study. A total of 56 ablation zones and 280 temperature data were obtained in ex vivo porcine livers. The output powers were 50, 60, 70, and 80 W and the setting time was 600 s. The temperature curve of every temperature spot, the short- and long-axis diameters of the coagulation zones were recorded and measured. RESULTS At all four power output settings, the peak temperatures of every temperature spot had a tendency to increase accordingly as the MW output power was increased, and except for 5mm away from the antenna, the peak temperatures for the 915 MHz cooled-shaft antenna were significantly higher than those for the 2450 MHz cooled-shaft antenna (p<0.05). Meanwhile, the short- and long-axis diameters for the 915 MHz cooled-shaft antenna were significantly larger than those for the 2450 MHz cooled-shaft antenna (p<0.05). CONCLUSION The 915 MHz cooled-shaft antenna can yield a significantly larger ablation zone and achieve higher temperature in ablation zone than a 2450 MHz cooled-shaft antenna in ex vivo porcine livers.
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Affiliation(s)
- Yuanyuan Sun
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China.
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Valcavi R, Riganti F, Bertani A, Formisano D, Pacella CM. Percutaneous laser ablation of cold benign thyroid nodules: a 3-year follow-up study in 122 patients. Thyroid 2010; 20:1253-61. [PMID: 20929405 DOI: 10.1089/thy.2010.0189] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Percutaneous laser ablation (PLA) is a proposed therapeutic procedure for the management of benign thyroid nodules. However, long-term results are unknown. The aim of this study was to evaluate retrospectively the safety and effects of PLA treatment in patients with benign nonfunctioning thyroid nodules in a 3-year follow-up. METHODS One hundred twenty-two patients (95 women and 27 men; age 52.2 ± 12.3 years) with benign cold thyroid solitary nodules or a dominant nodule within a normo-functioning multinodular goiter (volume range: 2.6-86.4 mL) underwent thermal Nd:YAG laser ablation of thyroid nodular tissue by 1-4 optical fibers positioned into the tissue by 21-gauge needles under ultrasound real-time assistance. The setting was an interventional suite and outpatient endocrine clinics in a community hospital in Italy. Nodule volume, ablation volume, side effects, serum thyroid-stimulating hormone (TSH), free triiodothyronine, free thyroxine (fT4), thyroglobulin (Tg), anti-Tg, anti-thyroperoxidase antibodies, symptoms, and cosmetic signs were recorded. RESULTS Data are mean ± standard deviation. Energy delivered was 8522 ± 5365 J with an output power of 3.1 ± 0.5 W. Three years after PLA, nodule volume decreased from 23.1 ± 21.3 to 12.5 ± 18.8 mL (-47.8% ± 33.1% of initial volume, p ≤ 0.001). At day 1, TSH and fT4 values significantly changed (time 0 vs. day 1: TSH = 1.16 ± 1.06 vs. 0.62 ± 0.81 μU/mL, p ≤ 0.001; fT4 = 11.68 ± 1.88 vs. 13.20 ± 3.32 pg/mL, p ≤ 0.01) and normalized within 1 month. No change in free triiodothyronine, thyroperoxidase antibodies, and Tg antibodies values was observed. Symptoms improved in 89 patients (73.0%), were unchanged in 28 (22.9%), and worsened in 5 (4.1%). Cosmetic signs improved in 87 patients (71.3%), were unchanged in 29 (23.8%), and worsened in 6 (4.9%). In 11 patients (9%), nodules regrew above baseline. Two patients (1.6%) experienced delayed (12-24 hours) laryngeal dysfunction with vocal cord motility recovery after 6-10 weeks. Two patients (1.6%) became hypothyroid and two patients (1.6%) hyperthyroid after PLA. CONCLUSIONS After 3 years, the PLA technique achieved shrinkage of about 50% of the initial volume in a wide size range of benign cold thyroid nodules, with an improvement in local symptoms and signs. Side effects and failures were few although not negligible. PLA may be a new option for the management of benign cold thyroid nodules. Long-term controlled studies are required to establish the eligibility of patients for routine PLA.
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Affiliation(s)
- Roberto Valcavi
- Endocrinology Division and Thyroid Disease Center, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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Di Matteo F, Martino M, Rea R, Pandolfi M, Rabitti C, Masselli GMP, Silvestri S, Pacella CM, Papini E, Panzera F, Valeri S, Coppola R, Costamagna G. EUS-guided Nd:YAG laser ablation of normal pancreatic tissue: a pilot study in a pig model. Gastrointest Endosc 2010; 72:358-63. [PMID: 20541187 DOI: 10.1016/j.gie.2010.02.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 02/12/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laser ablation with a neodymium:yttrium aluminum garnet (Nd:YAG) laser can achieve a high rate of complete tissue necrosis and has been applied as a minimally invasive, palliative option in hepatocellular carcinoma, liver metastasis in colorectal cancer, and malignant thyroid nodules. OBJECTIVE To assess the in vivo feasibility of EUS-guided laser ablation with an Nd:YAG laser of normal pancreatic tissue of a porcine model. DESIGN Prospective investigation. SETTING Hospital animal laboratory. SUBJECTS Eight pigs. INTERVENTIONS EUS-guided puncture of the pancreatic tail with a laser-beam fiber. An Nd:YAG laser (1.064 nm) was used, with an output power of 2 and 3 W and a total delivered energy of 500 and 1000 J in continuous mode. MAIN OUTCOME MEASUREMENTS The 24-hour follow-up of the pigs was focused on clinical and laboratory aspects. Results of histological studies of the pancreas were obtained 24 hours after the procedure on necroscopy tissue. RESULTS There were no technical limitations to the performance of the procedure. Tissue necrosis, localized in the pancreatic parenchyma, was observed in all animals on histological examination. The volume of ablation tissue ranged from a mean of 314 mm(3) to 483 mm(3). The ablation area ranged from a mean of 49 mm(2) to 80 mm(2). No major postprocedure complications were recorded, and all the pigs survived at 24 hours. LIMITATION Animal study. CONCLUSIONS EUS-guided laser ablation of the pancreas with an Nd:YAG laser is feasible in a porcine model.
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Affiliation(s)
- Francesco Di Matteo
- Digestive Endoscopy Unit, Campus Bio-Medico, University of Rome, Rome, Italy.
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Seinstra BA, van Delden OM, van Erpecum KJ, van Hillegersberg R, Mali WPTM, van den Bosch MAAJ. Minimally invasive image-guided therapy for inoperable hepatocellular carcinoma: What is the evidence today? Insights Imaging 2010; 1:167-81. [PMID: 23100194 PMCID: PMC3288853 DOI: 10.1007/s13244-010-0027-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/23/2010] [Accepted: 05/28/2010] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a primary malignant tumor of the liver that accounts for an important health problem worldwide. Only 10-15% of HCC patients are suitable candidates for hepatic resection and liver transplantation due to the advanced stage of the disease at time of diagnosis and shortage of donors. Therefore, several minimally invasive image-guided therapies for locoregional treatment have been developed. Tumor ablative techniques are either based on thermal tumor destruction, as in radiofrequency ablation, cryoablation, microwave ablation, laser ablation and high-intensity focused ultrasound, or chemical tumor destruction, as in percutaneous ethanol injection. Image-guided catheter-based techniques rely on intra-arterial delivery of embolic, chemoembolic or radioembolic agents. These minimally invasive image-guided therapies have revolutionized the management of inoperable HCC. This review provides a description of all minimally invasive image-guided therapies currently available, an up-to-date overview of the scientific evidence for their clinical use, and thoughts for future directions.
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Affiliation(s)
- Beatrijs A. Seinstra
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Otto M. van Delden
- Department of Radiology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Willem P. Th. M. Mali
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Maurice A. A. J. van den Bosch
- Department of Radiology, University Medical Center Utrecht, Room E.01.132, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Microwave ablation treatment of liver cancer with 2,450-MHz cooled-shaft antenna: an experimental and clinical study. J Cancer Res Clin Oncol 2010; 136:1507-16. [PMID: 20174824 DOI: 10.1007/s00432-010-0808-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Accepted: 01/28/2010] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate effects of microwave ablation with a 2,450-MHz internally cooled-shaft antenna in animal experiments and in a clinical study. METHODS Microwave ablation was performed using a cooled-shaft antenna in eight in vivo (36 ablations) porcine livers. The coagulation diameters achieved in different microwave ablation parameter groups were compared. Sixty patients (44 men, 16 women; mean age 53 years) with 96, 1-8 cm (mean 3.20 +/- 0.17 cm) liver cancers were treated with the same microwave ablation technique. Complete ablation (CA), local tumor progression (LTP) rates and complications were determined. RESULTS In vivo livers, short axis diameter correlated with the coagulation duration in a sigmoidal curve fashion (60-W group R(2) = 0.76, 80-W group R(2) = 0.87), with a relative plateau achieved within 10 min for power settings of 60 or 80 W. Within 10 min in the 60 and 80-W groups, respectively, 89 and 85.76% of maximum short axis diameter were achieved. CA rates in small (3.0 cm), intermediate (3.1-5.0 cm) and large (5.1-8.0 cm) liver cancers were 96.43% (54/56), 92.31% (24/26) and 78.57% (11/14), respectively. During a mean follow-up period of 17.17 +/- 6.52 months, LTP occurred in five (5.21%) treated cancers. There was no significant difference in the CA and LTP rate between the HCC and liver metastasis patient subgroups (P > 0.05). CONCLUSIONS The short axis diameter enlargement has a relative plateau within 10 min by fixing power output to 60 or 80 W, using the 2,450-MHz internally cooled-shaft antenna in vivo porcine livers. Effective local tumor control was achieved during one microwave ablation session.
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Percutaneous laser ablation of hepatocellular carcinoma in patients with liver cirrhosis awaiting liver transplantation. Eur J Radiol 2009; 74:e6-e11. [PMID: 19345541 DOI: 10.1016/j.ejrad.2009.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 01/30/2009] [Accepted: 03/06/2009] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effectiveness and safety of percutaneous laser ablation for the treatment of cirrhotic patients with hepatocellular carcinoma awaiting liver transplantation. MATERIALS AND METHODS The data of 9 male cirrhotic patients (mean age 50 years, range 45-60 years) with 12 biopsy proven nodules of hepatocellular carcinoma (mean diameter 2.0 cm, range 1.0-3.0 cm) treated by laser ablation before liver transplantation between June 2000 and January 2006 were retrospectively reviewed. Laser ablation was carried out by inserting 300 nm optical fibers through 21-Gauge needles (from two to four) positioned under ultrasound guidance into the target lesions. A continuous wave Neodymium:Yttrium Aluminium Garnet laser was used. Transarterial chemoembolization prior to liver transplantation was performed in two incompletely ablated tumors. RESULTS No procedure-related major complications were recorded. During the waiting time to liver transplantation local tumor progression after ablation occurred in 3 nodules (25%). At histological examination of the explanted livers complete necrosis was found in 8 nodules (66.7%, all treated exclusively with laser ablation), partial necrosis >50% in 3 nodules (25%), and partial necrosis <50% in 1 nodule. CONCLUSION In patients with cirrhotic livers awaiting liver transplantation, percutaneous laser ablation is safe and effective for the management of small hepatocellular carcinoma.
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Abstract
Hepatocellular carcinoma is increasingly detected at small size, usually 5 cm or smaller in diameter. For small hepatocellular carcinoma, percutaneous ablation is a potentially curative treatment. Ethanol injection is able to achieve a complete response of 70-80% and a 5-year survival of 40-60% in the treatment of hepatocellular carcinoma of 3 cm or less. Radiofrequency ablation has emerged as the more powerful alternative method. Randomized controlled trials show that radiofrequency ablation offers a higher complete response at fewer treatment sessions and better survival compared with ethanol injection. Microwave ablation has been demonstrated to be equivalent to radiofrequency ablation in both local efficacy and long-term outcome. Laser ablation is mainly applied in clinical settings in Europe. Nowadays, percutaneous ablation is commonly accepted as the best option for patients with small hepatocellular carcinoma who are not candidates for surgical resection or liver transplantation. However, whether it can compete with surgery as the first-line treatment has long been debated. There are some retrospective studies and only a few randomized controlled trials to compare the two modalities. The currently available data are not robust enough to draw a solid conclusion. This review article provides an overview of the current status of percutaneous ablation in management of small hepatocellular carcinoma and also focuses on comparison with surgical resection.
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Affiliation(s)
- Xiao-Yu Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, People's Republic of China
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42
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Pacella CM, Francica G, Di Lascio FML, Arienti V, Antico E, Caspani B, Magnolfi F, Megna AS, Pretolani S, Regine R, Sponza M, Stasi R. Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 2009; 27:2615-21. [PMID: 19332729 DOI: 10.1200/jco.2008.19.0082] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Percutaneous laser ablation (PLA) has been proposed as an active treatment in patients with hepatocellular carcinoma (HCC). However, large multicenter studies using this technique have not been reported. PATIENTS AND METHODS We retrospectively analyzed treatment and survival parameters of 432 cirrhotic patients with nonsurgical early HCC (single nodule < or = 4 cm or three nodules < or = 3 cm each) who had received PLA in nine Italian centers. RESULTS Single tumors were seen in 344 (80%) of 432 patients, and two to three nodules were seen in 88 patients (20%), for a total of 548 tumors. An initial complete response after PLA was observed in 338 patients (78%). Median overall survival time was 47 months (95% CI, 41 to 53 months). The 3- and 5-year cumulative survival rates were 61% and 34%, respectively. In multivariate analysis, independent predictors of survival were serum albumin levels more than 3.5 g/dL (P = .002; risk ratio [RR] = 0.580; 95% CI, 0.409 to 0.821), the achievement of a complete tumor ablation (P = .001; RR = 0.517; 95% CI, 0.346 to 0.771), and age less than 73 years (P < .001; RR = 0.466; 95% CI, 0.320 to 0.681). Child-Turcotte-Pugh class A patients had a 5-year cumulative survival rate of 41%; this figure increased up to 60% with a median survival time of 63 months (95% CI, 48 to 78 months) in patients with tumors < or = 2.0 cm. CONCLUSION This analysis confirms that a complete tumor ablation results in improved survival in patients with nonsurgical HCC. Ideal candidates for PLA are younger patients with normal serum albumin levels and tumor size < or = 2 cm.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Radiology and Diagnostic Imaging and Medical Sciences, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
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Pleguezuelo M, Germani G, Marelli L, Xiruochakis E, Misseri M, Manousou P, Arvaniti V, Burroughs AK. Evidence-based diagnosis and locoregional therapy for hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2008; 2:761-84. [PMID: 19090737 DOI: 10.1586/17474124.2.6.761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Early identification of hepatocellular carcinoma (HCC) is crucial to improving the results of therapy and for patients to be eligible for liver transplantation. Recent advances in noninvasive imaging technology include various techniques of harmonic ultrasound, new ultrasound contrast agents, multislice helical computed tomography and rapid high-quality magnetic resonance. The imaging diagnosis relies on the hallmark of arterial hypervascularity with portal venous washout. Since the use of better radiological techniques has improved the accuracy of noninvasive diagnosis, the role of liver biopsy in the diagnosis of HCC has declined. With recent advances in genomics and proteomics, a great number of potential markers have been identified and developed as new candidate markers for HCC. Locoregional therapies currently constitute the best options for early nonsurgical treatment of HCC. Percutaneous ethanol injection shows similar results to resection surgery for single tumors less than 3 cm in diameter. Radiofrequency ablation is superior to percutaneous ethanol injection in terms of local recurrence. Transarterial chemoembolization is currently the most common approach for the management of HCC without curative options since it improves patient survival, but the optimal embolizing agent, length of interval between sessions and whether the chemotherapeutic agent has any effect have not yet been determined. Combining transarterial chemoembolization with antiangiogenic agents, as well as with other techniques, such as radiofrequency ablation, may improve the results. Injection of radioisotopes such as yttrium-90, via the hepatic artery, may be particularly useful in patients with portal vein thrombosis. Comparisons with other transarterial techniques are needed.
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Affiliation(s)
- Maria Pleguezuelo
- The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
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Papini E, Bizzarri G, Pacella CM. Percutaneous laser ablation of benign and malignant thyroid nodules. Curr Opin Endocrinol Diabetes Obes 2008; 15:434-9. [PMID: 18769216 DOI: 10.1097/med.0b013e32830eb89a] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Percutaneous image-guided procedures, largely based on thermal ablation, are at present under investigation for achieving a nonsurgical targeted cytoreduction in benign and malignant thyroid lesions. RECENT FINDINGS In several uncontrolled clinical trials and in two randomized clinical trials, laser ablation has demonstrated a good efficacy and safety for the shrinkage of benign cold thyroid nodules. In hyperfunctioning nodules, laser ablation induced a nearly 50% volume reduction with a variable frequency of normalization of thyroid-stimulating hormone levels. Laser ablation has been tested for the palliative treatment of poorly differentiated thyroid carcinomas, local recurrences or distant metastases. SUMMARY Laser ablation therapy is indicated for the shrinkage of benign cold nodules in patients with local pressure symptoms who are at high surgical risk. The treatment should be performed only by well trained operators and after a careful cytological evaluation. Laser ablation does not seem to be consistently effective in the long-term control of hyperfunctioning thyroid nodules and is not an alternative treatment to 131I therapy. Laser ablation may be considered for the cytoreduction of tumor tissue prior to external radiation therapy or chemotherapy of local or distant recurrences of thyroid malignancy that are not amenable to surgical or radioiodine treatment.
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Affiliation(s)
- Enrico Papini
- Department of Endocrinology, Regina Apostolorum Hospital, Albano, Rome, Italy.
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Xu LX, Zhang A, Liu P, Chen C, Sun J, Sabados DM. Energy-based diagnostic and treatment techniques. IEEE ENGINEERING IN MEDICINE AND BIOLOGY MAGAZINE : THE QUARTERLY MAGAZINE OF THE ENGINEERING IN MEDICINE & BIOLOGY SOCIETY 2008; 27:72-77. [PMID: 18799393 DOI: 10.1109/memb.2008.923960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Lisa X Xu
- School of Life Sciences and Technology, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai 200240, People's Republic of China.
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Arienti V, Pretolani S, Pacella CM, Magnolfi F, Caspani B, Francica G, Megna AS, Regine R, Sponza M, Antico E, Di Lascio FML. Complications of Laser Ablation for Hepatocellular Carcinoma: A Multicenter Study. Radiology 2008; 246:947-55. [DOI: 10.1148/radiol.2463070390] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Pacella CM, Stasi R, Bizzarri G, Pacella S, Graziano FM, Guglielmi R, Papini E. Percutaneous laser ablation of unresectable primary and metastatic adrenocortical carcinoma. Eur J Radiol 2007; 66:88-94. [PMID: 17498906 DOI: 10.1016/j.ejrad.2007.04.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the feasibility, safety, and clinical benefits of percutaneous laser ablation (PLA) in patients with unresectable primary and metastatic adrenocortical carcinoma (ACC). PATIENTS AND METHODS Four patients with hepatic metastases from ACC and a Cushing's syndrome underwent ultrasound-guided PLA. In one case the procedure was performed also on the primary tumor. RESULTS After three sessions of PLA, the primary tumor of 15 cm was ablated by 75%. After 1-4 (median 1) sessions of PLA, five liver metastases ranging from 2 to 5 cm were completely ablated, while the sixth tumor of 12 cm was ablated by 75%. There were no major complications. Treatment resulted in an improvement of performance status and a reduction of the daily dosage of mitotane in all patients. The three patients with liver metastases presented a marked decrease of 24-h urine cortisol levels, an improved control of hypertension and a mean weight loss of 2.8 kg. After a median follow-up after PLA of 27.0 months (range, 9-48 months), two patients have died of tumor progression, while two other patients remain alive and free of disease. CONCLUSIONS Percutaneous laser ablation is a feasible, safe and well tolerated procedure for the palliative treatment of unresectable primary and metastatic ACC. Further study is required to evaluate the impact of PLA on survival.
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Affiliation(s)
- Claudio M Pacella
- Regina Apostolorum Hospital, Department of Diagnostic Imaging and Interventional Radiology, Via San Francesco 50, Albano Laziale, Rome 00041, Italy.
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48
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Laser literature watch. Photomed Laser Surg 2006; 24:424-53. [PMID: 16875454 DOI: 10.1089/pho.2006.24.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pacella CM, Bizzarri G, Francica G, Forlini G, Petrolati A, Valle D, Anelli V, Bianchini A, Nuntis SD, Pacella S, Rossi Z, Osborn J, Stasi R. Analysis of factors predicting survival in patients with hepatocellular carcinoma treated with percutaneous laser ablation. J Hepatol 2006; 44:902-9. [PMID: 16545480 DOI: 10.1016/j.jhep.2006.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 01/15/2006] [Accepted: 01/22/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS The factors which predict the long-term outcome in patients with hepatocellular carcinoma who are treated with percutaneous laser ablation (PLA) are not well established. METHODS We prospectively analyzed treatment and survival parameters of 148 cirrhotic patients with nonsurgical hepatocellular carcinoma who had undergone PLA at a single institution during an 11-year period. RESULTS Single tumors were seen in 129 of 148 (87%) patients, and 2-3 nodules were seen in 19 (13%) patients, for a total of 169 tumors. The median overall time survival was 39 months (95% confidence interval [CI], 30-47 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 89, 75, 52, 43, and 27%, respectively. From multiple regression analysis, the independent predictors of survival were found to be tumor grading (P=0.002; risk ratio [RR] 0.37, 95% CI 0.20-0.70), bilirubin levels < or =2.5mg/dl (P=0.014; RR 1.58, 95% CI 1.09-2.28), and the achievement of complete tumor ablation (P=0.020; RR 0.53, 95% CI 0.31-0.90). An initial complete tumor ablation was the only factor associated with longer survival in patients with Child-Turcotte-Pugh class A cirrhosis (P=0.012; hazard ratio [HR] 0.48, 95% CI 0.23-1.03). CONCLUSIONS A complete tumor ablation results in improved survival in all patients with nonsurgical hepatocellular carcinoma. Ideal candidates for PLA are those with a well-differentiated histology, and normal bilirubin levels.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Ospedale Regina Apostolorum, Via San Francesco, 50-00041, Albano Laziale, Rome, Italy.
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Walser EM. Percutaneous laser ablation in the treatment of hepatocellular carcinoma with a tumor size of 4 cm or smaller: analysis of factors affecting the achievement of tumor necrosis. J Vasc Interv Radiol 2006; 16:1427-9. [PMID: 16319147 DOI: 10.1097/01.rvi.0000188755.61481.e8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Eric M Walser
- Department of Radiology, Mayo Clinic Jacksonville, 4500 San Pablo Road, Jacksonville, Florida 32224, USA.
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