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Spiliotis AE, Holländer S, Rudzitis-Auth J, Wagenpfeil G, Eisele R, Nika S, Mallis Kyriakides O, Laschke MW, Menger MD, Glanemann M, Gäbelein G. Evaluation of Electrochemotherapy with Bleomycin in the Treatment of Colorectal Hepatic Metastases in a Rat Model. Cancers (Basel) 2023; 15:cancers15051598. [PMID: 36900388 PMCID: PMC10000671 DOI: 10.3390/cancers15051598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/15/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The available ablative procedures for the treatment of hepatic cancer have contraindications due to the heat-sink effect and the risk of thermal injuries. Electrochemotherapy (ECT) as a nonthermal approach may be utilized for the treatment of tumors adjacent to high-risk regions. We evaluated the effectiveness of ECT in a rat model. METHODS WAG/Rij rats were randomized to four groups and underwent ECT, reversible electroporation (rEP), or intravenous injection of bleomycin (BLM) eight days after subcapsular hepatic tumor implantation. The fourth group served as Sham. Tumor volume and oxygenation were measured before and five days after the treatment using ultrasound and photoacoustic imaging; thereafter, liver and tumor tissue were additionally analysed by histology and immunohistochemistry. RESULTS The ECT group showed a stronger reduction in tumor oxygenation compared to the rEP and BLM groups; moreover, ECT-treated tumors exhibited the lowest levels of hemoglobin concentration compared to the other groups. Histological analyses further revealed a significantly increased tumor necrosis of >85% and a reduced tumor vascularization in the ECT group compared to the rEP, BLM, and Sham groups. CONCLUSION ECT is an effective approach for the treatment of hepatic tumors with necrosis rates >85% five days following treatment.
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Affiliation(s)
- Antonios E. Spiliotis
- Department of Surgery, Campus Charité Mitte, Campus Virchow Klinikum, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence: or ; Tel.: +49-0304-5065-2625
| | - Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Jeannette Rudzitis-Auth
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, 66421 Homburg, Germany
| | - Robert Eisele
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Spyridon Nika
- Department of Urology and Pediatric Urology, Saarland University Medical Center, 66421 Homburg, Germany
| | - Orestis Mallis Kyriakides
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Matthias W. Laschke
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Michael D. Menger
- Institute for Clinical and Experimental Surgery, Saarland University, 66421 Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, 66421 Homburg, Germany
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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Poulkouras R, Dijk G, Lefevre M, Bača M, Moreau D, O'Connor RP. PEDOT:PSS coated electrodes reduce intracellular oxidation and cell damage with pulsed electric field application. Bioelectrochemistry 2022; 147:108163. [DOI: 10.1016/j.bioelechem.2022.108163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
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Distinct roles but cooperative effect of TLR3/9 agonists and PD-1 blockade in converting the immunotolerant microenvironment of irreversible electroporation-ablated tumors. Cell Mol Immunol 2021; 18:2632-2647. [PMID: 34782757 PMCID: PMC8633376 DOI: 10.1038/s41423-021-00796-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/05/2021] [Accepted: 09/30/2021] [Indexed: 01/16/2023] Open
Abstract
Irreversible electroporation (IRE) is a new cancer ablation technology, but methods to improve IRE-induced therapeutic immunity are only beginning to be investigated. We developed a mouse model bearing large primary (300 mm3) and medium distant (100 mm3) EG7 lymphomas engineered to express ovalbumin (OVA) as a nominal tumor antigen. We established experimental protocols including IRE alone and IRE combined with Toll-like receptor (TLR)3/9 agonists (poly I:C/CpG) (IRE + pIC/CpG), PD-1 blockade (IRE + PD-1 blockade), or both (IRE + Combo) to investigate therapeutic effects on primary and distant EG7 tumors and conversion-promoting effects on the immunotolerant tumor microenvironment (TME). We demonstrated that IRE alone simulated very weak OVA-specific CD8+ T cell responses and did not inhibit primary tumor growth. IRE + pIC/CpG synergistically stimulated more efficient OVA-specific CD8+ T cell responses and primary tumor growth inhibition than IRE + PD-1 blockade. IRE + pIC/CpG played a major role in the modulation of immune cell profiles but a minor role in the downregulation of PD-L1 expression in the TME and vice versa for IRE + PD-1 blockade. IRE + Combo cooperatively induced potent OVA-specific CD8+ T cell immunity and rescued exhausted intratumoral CD8+ T cells, leading to eradication of not only primary tumors but also untreated concomitant distant tumors and lung metastases. IRE + Combo efficiently modulated immune cell profiles, as evidenced by reductions in immunotolerant type-2 (M2) macrophages, myeloid-derived suppressor-cells, plasmacytoid dendritic cells, and regulatory T cells and by increases in immunogenic M1 macrophages, CD169+ macrophages, type-1 conventional dendritic cells, and CD8+ T cells, leading to conversion of immunotolerance in not only primary TMEs but also untreated distant TMEs. IRE + Combo also showed effective therapeutic effects in two breast cancer models. Therefore, our results suggest that IRE + Combo is a promising strategy to improve IRE ablation therapy in cancer.
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Ye X, Liu S, Yin H, He Q, Xue Z, Lu C, Su S. Study on Optimal Parameter and Target for Pulsed-Field Ablation of Atrial Fibrillation. Front Cardiovasc Med 2021; 8:690092. [PMID: 34621795 PMCID: PMC8490619 DOI: 10.3389/fcvm.2021.690092] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
Pulsed-field ablation (PFA) had potential advantages in atrial fibrillation ablation, and we aim to confirm the optimal parameter and target of PFA for atrial fibrillation. Two ablation modes in vitro of single-cell system (ablation in electrode cup) and monolayer cell system (ablation in inserts with electrode tips) were established to perform PFA for myocardial cell H9C2 and smooth muscle cell A7r5. Ablation effect, calcium ion influx, the expression of Cx45, and surface morphological change were observed. Three Bama minipigs were used to verify the in vivo ablation effect of PFA. In monolayer cell system, H9C2 was significantly sensitive to PFA compared with A7r5, with shrinking of the whole monolayer. The ablation effect of bidirectional pulse was weaker than that of the two mono-polar pulses. Expressed Cx45 proteins were increased in H9C2 but decreased in A7r5 cells. Bidirectional PFA performed on Bama minipigs was able to effectively block electrical activity from the pulmonary vein to the atrium with week muscle contraction, not generating pulmonary vein stenosis. Bidirectional PFA was able to significantly ablate myocardial cells, maintain cell–cell connection, and reduce muscle contraction, which was a kind of optimized PFA strategy for atrial fibrillation.
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Affiliation(s)
- Xuying Ye
- The First Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Shangzhong Liu
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China
| | - Huijuan Yin
- Institute of Biomedical Engineering, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qiang He
- Department of cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Zhixiao Xue
- School of Biomedical Engineering and Technology, Tianjin Medical University, Tianjin, China.,Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China
| | - Chengzhi Lu
- The First Central Clinical College of Tianjin Medical University, Tianjin, China.,Department of cardiology, Tianjin First Central Hospital, Tianjin, China
| | - Siying Su
- Tianjin Intelligent Health Medical Co., Ltd, Tianjin, China
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Truong VG, Kim H, Park JS, Tran VN, Kang HW. Multiple cylindrical interstitial laser ablations (CILAs) of porcine pancreas in ex vivo and in vivo models. Int J Hyperthermia 2021; 38:1313-1321. [PMID: 34472992 DOI: 10.1080/02656736.2021.1972171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The therapeutic capacity of multiple cylindrical interstitial laser ablations (CILAs) of pancreatic tissue was evaluated with 1064 nm laser light in ex vivo and in vivo porcine pancreatic models. METHODS A diffusing applicator was sequentially employed to deliver 1064 nm laser light in a cylindrical distribution to ablate a large volume of pancreatic tissue. Ex vivo tissue was tested at various power levels (5, 7, and 10 W) under US imaging. An in vivo porcine model was used to evaluate the clinical feasibility of multiple CILAs on pancreatic tissue at 5 W via laparotomy (N = 3). RESULTS Multiple CILAs symmetrically ablated a range of ex vivo tissue volumes (2.4-6.0 cm3) at various power levels. Multiple CILAs warranted a therapeutic capacity of symmetrically ablating in vivo pancreatic tissue. Both ex vivo and in vivo pancreatic tissues after multiple CILAs at 5 W confirmed the absence of or minimal thermal injury to the peripheral tissue and carbonization. CONCLUSIONS The current findings suggest that the collective thermal effects from multiple CILAs can help widely ablate pancreatic tissue with minimal thermal injury. Further in vivo studies will investigate the safety of the proposed CILA treatment as well as acute/chronic responses of pancreatic tissue for clinical translations.
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Affiliation(s)
- Van Gia Truong
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyeonsoo Kim
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Jin-Seok Park
- Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Inha University Hospital, Incheon, Republic of Korea
| | - Van Nam Tran
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea
| | - Hyun Wook Kang
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan, Republic of Korea.,Department of Biomedical Engineering and Marine-Integrated Biomedical Technology Center, Pukyong National University, Busan, Republic of Korea
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7
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Electrochemotherapy of Deep-Seated Tumors: State of Art and Perspectives as Possible "EPR Effect Enhancer" to Improve Cancer Nanomedicine Efficacy. Cancers (Basel) 2021; 13:cancers13174437. [PMID: 34503247 PMCID: PMC8431574 DOI: 10.3390/cancers13174437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Electroporation-based therapies (reversible electroporation, irreversible electroporation, electrochemotherapy) are used for the selective treatment of deep-seated tumors. The combination of the structural modifications of the lipid bilayer of cell membranes, due to the application of electrical pulses in the targeted tissue, with the concomitant systemic (intravenous) administration of drugs can be considered as a sort of bridge between local-regional and systemic treatments. A possible further application of these techniques can be envisaged in their use as enhancers of the so-called “enhanced permeability and retention” effect. The intratumoral uptake of drug-loaded nanocarriers concomitant with the application of electric pulses in the target tumor is a new scenario worthy of attention and can represent a potential new frontier for drug delivery in oncology. Abstract Surgical resection is the gold standard for the treatment of many kinds of tumor, but its success depends on the early diagnosis and the absence of metastases. However, many deep-seated tumors (liver, pancreas, for example) are often unresectable at the time of diagnosis. Chemotherapies and radiotherapies are a second line for cancer treatment. The “enhanced permeability and retention” (EPR) effect is believed to play a fundamental role in the passive uptake of drug-loaded nanocarriers, for example polymeric nanoparticles, in deep-seated tumors. However, criticisms of the EPR effect were recently raised, particularly in advanced human cancers: obstructed blood vessels and suppressed blood flow determine a heterogeneity of the EPR effect, with negative consequences on nanocarrier accumulation, retention, and intratumoral distribution. Therefore, to improve the nanomedicine uptake, there is a strong need for “EPR enhancers”. Electrochemotherapy represents an important tool for the treatment of deep-seated tumors, usually combined with the systemic (intravenous) administration of anticancer drugs, such as bleomycin or cisplatin. A possible new strategy, worthy of investigation, could be the use of this technique as an “EPR enhancer” of a target tumor, combined with the intratumoral administration of drug-loaded nanoparticles. This is a general overview of the rational basis for which EP could be envisaged as an “EPR enhancer” in nanomedicine.
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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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Gurusamy KS, Moher D, Loizidou M, Ahmed I, Avey MT, Barron CC, Davidson B, Dwek M, Gluud C, Jell G, Katakam K, Montroy J, McHugh TD, Osborne NJ, Ritskes-Hoitinga M, van Laarhoven K, Vollert J, Lalu M. Clinical relevance assessment of animal preclinical research (RAA) tool: development and explanation. PeerJ 2021; 9:e10673. [PMID: 33569250 DOI: 10.7717/peerj.10673] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/09/2020] [Indexed: 12/09/2022] Open
Abstract
Background Only a small proportion of preclinical research (research performed in animal models prior to clinical trials in humans) translates into clinical benefit in humans. Possible reasons for the lack of translation of the results observed in preclinical research into human clinical benefit include the design, conduct, and reporting of preclinical studies. There is currently no formal domain-based assessment of the clinical relevance of preclinical research. To address this issue, we have developed a tool for the assessment of the clinical relevance of preclinical studies, with the intention of assessing the likelihood that therapeutic preclinical findings can be translated into improvement in the management of human diseases. Methods We searched the EQUATOR network for guidelines that describe the design, conduct, and reporting of preclinical research. We searched the references of these guidelines to identify further relevant publications and developed a set of domains and signalling questions. We then conducted a modified Delphi-consensus to refine and develop the tool. The Delphi panel members included specialists in evidence-based (preclinical) medicine specialists, methodologists, preclinical animal researchers, a veterinarian, and clinical researchers. A total of 20 Delphi-panel members completed the first round and 17 members from five countries completed all three rounds. Results This tool has eight domains (construct validity, external validity, risk of bias, experimental design and data analysis plan, reproducibility and replicability of methods and results in the same model, research integrity, and research transparency) and a total of 28 signalling questions and provides a framework for researchers, journal editors, grant funders, and regulatory authorities to assess the potential clinical relevance of preclinical animal research. Conclusion We have developed a tool to assess the clinical relevance of preclinical studies. This tool is currently being piloted.
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Affiliation(s)
- Kurinchi S Gurusamy
- Research Department of Surgical Biotechnology, University College London, London, England, UK.,Surgery and Interventional Trials Unit, University College London, London, England, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marilena Loizidou
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, Scotland, UK
| | - Marc T Avey
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Carly C Barron
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Brian Davidson
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Miriam Dwek
- School of Life Sciences, University of Westminster, London, England, UK
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copehagen, Denmark
| | - Gavin Jell
- Research Department of Surgical Biotechnology, University College London, London, England, UK
| | - Kiran Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copehagen, Denmark
| | - Joshua Montroy
- Department of Anesthesiology and Pain Medicine, Blueprint Translational Research Group, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa Hospital, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Timothy D McHugh
- UCL Centre for Clinical Microbiology, Division of Infection & Immunity, University College London, London, England, UK
| | | | - Merel Ritskes-Hoitinga
- SYRCLE, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kees van Laarhoven
- Department of Surgery, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Jan Vollert
- Pain Research, Department of Surgery & Cancer, Imperial College, London, England, UK.,Center of Biomedicine and Medical Technology Mannheim CBTM, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manoj Lalu
- Department of Anesthesiology and Pain Medicine, Blueprint Translational Research Group, Clinical Epidemiology and Regenerative Medicine Programs, Ottawa Hospital Research Institute, Ottawa Hospital, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
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Garnon J, Cazzato RL, Auloge P, Ramamurthy N, Koch G, Gangi A. Adjunctive hydrodissection of the bare area of liver during percutaneous thermal ablation of sub-cardiac hepatic tumours. Abdom Radiol (NY) 2020; 45:3352-3360. [PMID: 32211949 DOI: 10.1007/s00261-020-02463-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To report the technique of hydrodissection of the sub-diaphragmatic bare area of the liver, in order to protect the diaphragm/heart during percutaneous thermal ablation (PTA) of sub-cardiac hepatic tumours. MATERIALS AND METHODS Between January 2016 and December 2018, five patients (four female, one male; mean age 56.2 years) with five sub-cardiac liver tumours (two hepatocellular carcinoma, three metastases; mean size 39 mm) abutting the bare area (segments II/IVA) with expected ablation zones ≤ 5 mm from the myocardium were treated with PTA and adjunctive hydrodissection. Time to perform hydrodissection, distance between superior hepatic and diaphragmatic/pericardial surfaces before and after hydrodissection, ablation efficacy, complications, and local tumour progression (LTP) at last imaging follow-up were recorded. RESULTS Technical feasibility was 100%, with mean hydrodissection-volume of 126 ml (range 80-200 ml) and median hydrodissection-time of 9 min (range 8-45 min). Liver-diaphragmatic and liver-pericardial distance increased, respectively, from 2.4 mm (range 0-8 mm) to 10.8 mm (range 6-19 mm) and from 4 mm (range 1-10 mm) to 12.6 mm (range 8-20 mm) post-hydrodissection. All procedures were performed at full-power with complete tumour ablation and without complications (including peri-procedural haemodynamic/electrocardiographic disturbances, pericardial effusion and diaphragmatic hernia) or evidence of LTP at mean 12.2-month (range 1-26 month) follow-up. CONCLUSION Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours.
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Ultrastructural changes in hepatocellular carcinoma cells induced by exponential pulses of nanosecond duration delivered via a transmission line. Bioelectrochemistry 2020; 135:107548. [PMID: 32408094 DOI: 10.1016/j.bioelechem.2020.107548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 12/21/2022]
Abstract
Clinical applications of high-intensity pulsed electric fields have proven useful in ablating solid tumors. However, novel ideas for the development of an effective tumor ablation device are urgently needed. Here, we studied cellular effects of the nanosecond exponential pulse, which is generated by a capacitor-discharging circuit and delivered via a transmission line. Pulses of peak voltage boosted by transmission line oscillation possess high capability to induce swelling and to cause loss of viability in cells. The appropriate parameter of the pulse was selected to investigate the ultrastructural changes in swollen cells, which present smoothened plasma membrane, loss of microvilli, and lowered cytoplasm electron density. We propose the equivalent force field hypothesis to understand the mechanism underlying cell swelling induced by pulsing. Wrinkles on the plasma membrane might indicate recovery from cell swelling, and this was verified by co-culture of pulsed PKH26-Cells with sham-treated PKH67-Cells. We concluded that the ultrastructural changes, such as irregular pores formed on the plasma membrane, were mainly induced by the effect of electric pulse applied on the charged molecules in the membrane.
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Satiya J, Schwartz I, Tabibian JH, Kumar V, Girotra M. Ablative therapies for hepatic and biliary tumors: endohepatology coming of age. Transl Gastroenterol Hepatol 2020; 5:15. [PMID: 32258519 DOI: 10.21037/tgh.2019.10.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Ablative therapies refer to minimally invasive procedures performed to destroy abnormal tissue that may arise with many conditions, and can be achieved clinically using chemical, thermal, and other techniques. In this review article, we explore the different ablative therapies used in the management of hepatic and biliary malignancies, namely hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), with a particular focus on radiofrequency ablation (RFA) and photodynamic therapy (PDT) techniques.
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Affiliation(s)
- Jinendra Satiya
- Internal Medicine, University of Miami/JFK Medical Center Palm Beach Regional GME Consortium, West Palm Beach, FL, USA
| | - Ingrid Schwartz
- Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL, USA
| | - James H Tabibian
- Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Division of Gastroenterology, Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Vivek Kumar
- Gastroenterology and Hepatology, UPMC Susquehanna, Williamsport, PA, USA
| | - Mohit Girotra
- Division of Gastroenterology and Hepatology, University of Miami Miller School of Medicine, Miami, FL, USA
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Hu S, Sun C, Wang B, Zhou K, Pan L, Shangguan J, Yang J, Yaghmai V, Figini M, Zhang Z. Diffusion-Weighted MR Imaging to Evaluate Immediate Response to Irreversible Electroporation in a Rabbit VX2 Liver Tumor Model. J Vasc Interv Radiol 2019; 30:1863-1869. [PMID: 31542271 DOI: 10.1016/j.jvir.2019.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/26/2019] [Accepted: 05/31/2019] [Indexed: 02/09/2023] Open
Abstract
PURPOSE To evaluate the feasibility of diffusion-weighted imaging (DWI) in magnetic resonance imaging for quantitative measurement of responses following irreversible electroporation (IRE) in a rabbit liver tumor model. MATERIALS AND METHODS Twelve rabbits underwent ultrasound-guided VX2 tumor implantation in the left medial and left lateral liver lobes. The tumors in the left medial lobe were treated with IRE, whereas those in the left lateral lobe served as internal controls. DWI was performed before and immediately after IRE. Tumors were then harvested for histopathologic staining. The apparent diffusion coefficient (ADC) and change in ADC (ΔADC) were calculated based on DWI. Tumor apoptosis index (AI) was assessed by terminal deoxynucleotidyl transferase dUTP nick-end labeling. These measurements from DWI and histopathology were compared between untreated and treated tumors. RESULTS The ADC values, ΔADC, and AI showed statistically significant differences between treated and untreated tumors (P < .05 for all). ADC values were higher in treated tumors than in untreated tumors (1.08 × 10-3 mm2/s ± 0.15 vs 0.88 × 10-3 mm2/s ± 0.19; P = .042). CONCLUSIONS DWI can be used to quantitatively evaluate treatment response in liver tumors immediately after IRE.
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Affiliation(s)
- Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Chong Sun
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, China
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N. Michigan Ave., 16th Floor, Chicago, IL 60611; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
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Ridouani F, Srimathveeravalli G. Percutaneous image-guided ablation: From techniques to treatments. Presse Med 2019; 48:e219-e231. [PMID: 31447333 DOI: 10.1016/j.lpm.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Image-guided ablation is performed by percutaneously introducing ablation probes to deliver energy into a tumor to destroy it in a controlled and localized fashion. Ablation modalities can be broadly classified as thermal or non-thermal based on the mechanism of tumor destruction and are performed using different types of image guidance for planning, delivering and follow-up of the treatment. Ablation is performed in a minimally invasive fashion, providing greater residual organ preservation with minimal morbidity to the patient. Image-guided ablation is being used in the clinic for the treatment of primary and metastatic tumors, and this article reviews state of the art for the treatment of malignancies in the liver, lung, kidney and musculoskeletal tissue.
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Affiliation(s)
- Fourat Ridouani
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, USA
| | - Govindarajan Srimathveeravalli
- University of Massachusetts, Institute for Applied Life Sciences, Department of Mechanical and Industrial Engineering, Amherst, USA.
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Kemeny N, Kurilova I, Li J, Camacho JC, Sofocleous CT. Liver-Directed and Systemic Therapies for Colorectal Cancer Liver Metastases. Cardiovasc Intervent Radiol 2019; 42:1240-1254. [DOI: 10.1007/s00270-019-02284-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 07/03/2019] [Indexed: 02/07/2023]
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Is irreversible electroporation safe and effective in the treatment of hepatobiliary and pancreatic cancers? Hepatobiliary Pancreat Dis Int 2019; 18:117-124. [PMID: 30655073 DOI: 10.1016/j.hbpd.2019.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Irreversible electroporation (IRE) is a novel ablative technique for hepatobiliary and pancreatic cancers. This review summarizes the data regarding the safety and efficacy of IRE in the treatment of hepatobiliary and pancreatic cancers. DATA SOURCES Studies were identified by searching PubMed and Embase for articles published in English from database inception through July 31, 2017. For inclusion, each clinical study had to report morbidity and survival data on hepatobiliary and pancreatic cancers treated with IRE and contain at least 10 patients. Studies that met these criteria were included for analysis. Two authors assessed each clinical study for data extraction. The controversial parts were resolved through discussion with seniors. RESULTS A total of 24 clinical studies were included. Fourteen focused on hepatic ablation with IRE comprising 437 patients with 666 lesions of different tumor types. Two patients (0.5%) died after the IRE procedure. Morbidity of hepatic ablation with IRE ranged from 7% to 35%. Most complications were mild. Complete response for hepatic tumors was reported as 57%-97%. Ten studies with 455 patients focused on pancreatic IRE. The overall mortality of IRE in pancreatic cancer was 2%. Overall severe morbidity of IRE in pancreatic cancer ranged from 0 to 20%. The median overall survival after IRE ranged from 7 to 23 months. Patients treated with IRE combined with surgical resection showed a longer overall survival. CONCLUSIONS IRE significantly improves the prognosis of advanced hepatobiliary and pancreatic malignances, and companied with less complications. Hence, IRE is a relatively safe and effective non-thermal ablation strategy and potentially recommended as an option for therapy of patients with hepatobiliary and pancreatic malignances.
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Giorgio A, Amendola F, Calvanese A, Ingenito E, Santoro B, Gatti P, Ciracì E, Matteucci P, Giorgio V. Ultrasound-guided percutaneous irreversible electroporation of hepatic and abdominal tumors not eligible for surgery or thermal ablation: a western report on safety and efficacy. J Ultrasound 2019; 22:53-58. [PMID: 30843171 DOI: 10.1007/s40477-019-00372-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To report our first results on sixteen patients affected by liver and abdominal malignant tumors, unfit for surgery or thermal ablation, treated with US-guided percutaneous irreversible electroporation (IRE). METHODS From June 2014 to December 2016, all patients meeting the inclusion criteria (malignant hepatic or abdominal tumors not eligible for resection or thermal ablation) and not meeting the exclusion criteria (heart arrhythmia, pro-hemorrhagic hematological alterations, tumor size > 8 cm, presence of a biliary metallic stent) referred to our institutions were prospectively enrolled to undergo percutaneous US-guided irreversible electroporation (IRE). Sixteen patients (age range 59-68 years, mean 63; 7 females) with 18 tumors (diameter range 1.3-7.5 cm) fulfilled the inclusion criteria and were included in the study. Data concerning efficacy (tested by a 1-week CEUS and a 4-week enhanced CT and/or enhanced MRI) and safety were recorded during a 18-month follow up. RESULTS All patients completed a 35-50-min procedure without complications. One patient with 6 cm Klatskin tumor also underwent a second session for 1 month. A 1-week CEUS and a 4-week e-CT and/or e-MRI arterial phase contrast enhancement analysis showed an overall reduction of arterial flow with confirmation of unenhanced lesions for seven nodules. After 1-18 months of follow up, no major complications were recorded and no tumor-related death occurred. The lesions of two patients disappeared 3 and 6 months after their treatment, respectively. CONCLUSIONS IRE is a promising ablation modality in the treatment of malignant hepatic and abdominal tumors unsuitable for resection or thermal ablation.
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Affiliation(s)
- A Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
| | - F Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - A Calvanese
- Oncology Unit, Tortorella Clinical Institute, Salerno, Italy
| | - E Ingenito
- Oncology Unit, Tortorella Clinical Institute, Salerno, Italy
| | - B Santoro
- Interventional Ultrasound Unit, Athena Clinical Institute, Caserta, Italy
| | - P Gatti
- Internal Medicine Unit, Ostuni Hospital, Ostuni (BR), Italy
| | - E Ciracì
- Internal Medicine Unit, Ostuni Hospital, Ostuni (BR), Italy
| | - P Matteucci
- Radiation Therapy Unit, Campus Biomedico University, Rome, Italy
| | - V Giorgio
- Pediatric Gastroenterology Unit, Fondazione Policlinico A.Gemelli IRCCS, Department of Woman and Child Health and Public Health; Roma- Italy, Rome, Italy
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The Accumulation and Effects of Liposomal Doxorubicin in Tissues Treated by Radiofrequency Ablation and Irreversible Electroporation in Liver: In Vivo Experimental Study on Porcine Models. Cardiovasc Intervent Radiol 2019; 42:751-762. [DOI: 10.1007/s00270-019-02175-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/31/2019] [Indexed: 12/18/2022]
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Alnaggar M, Qaid AM, Chen J, Niu L, Xu K. Irreversible electroporation of malignant liver tumors: Effect on laboratory values. Oncol Lett 2018; 16:3881-3888. [PMID: 30128002 PMCID: PMC6096204 DOI: 10.3892/ol.2018.9058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/25/2018] [Indexed: 12/18/2022] Open
Abstract
Liver cancer is often associated with chronic liver diseases. Treatment with percutaneous irreversible electroporation (IRE) may preserve liver function. In the present study, the clinical data of 29 patients with liver tumors between July 2015 and December 2016, all of whom underwent liver IRE at Fuda Cancer Hospital, Guangzhou, China was retrospectively reviewed. All the patients survived the treatment. Of the 29 patients, 7 were positive for hepatitis B, 15 had hepatocellular carcinoma (HCC) and 7 had pancreatic cancer with liver metastases. All patients survived IRE. Despite liver-protective treatment prior to IRE, the mean alanine transaminase (ALT) and aspartate transaminase (AST) levels were significantly elevated 1-2 days after IRE, to 540 and 712 U/l, respectively; however they had returned to the preoperative values by 2 weeks following IRE. Prior to IRE, the mean total bilirubin and direct bilirubin measurement levels were normal; however, 8-10 days after IRE, they had increased to 24 U/l and 12 µmol/l, respectively, and had returned back to the preoperative levels by 2 weeks after IRE. This first group included all patients. The result of the 4 subgroups of cancer patients demonstrated a variation between different measurement days and recovery with patients positive for the hepatitis B virus taking the longest duration to recover (17±3 days) meanwhile patients with pancreatic cancer with liver metastases took the shortest time to achieve recovery (10.78±2 days). The findings of the present study indicate that hepatic injury caused by IRE is transient and self-limiting in patients with liver tumors.
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Affiliation(s)
- Mohammed Alnaggar
- Biomedical Translational Research Institute and The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510632, P.R. China
- Department of Oncology, Guangzhou Fuda Cancer Hospital, School of Medicine, Jinan University, Guangzhou, Guangdong 510665, P.R. China
| | - Ammar M. Qaid
- Department of Oncology, Affiliated Union Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China
| | - Jibing Chen
- Department of Oncology, Guangzhou Fuda Cancer Hospital, School of Medicine, Jinan University, Guangzhou, Guangdong 510665, P.R. China
| | - Lizhi Niu
- Department of Oncology, Guangzhou Fuda Cancer Hospital, School of Medicine, Jinan University, Guangzhou, Guangdong 510665, P.R. China
- Correspondence to: Dr Lizhi Niu, Department of Oncology, Guangzhou Fuda Cancer Hospital, School of Medicine, Jinan University, 2 Tangdexi Road, Guangzhou, Guangdong 510665, P.R. China, E-mail:
| | - Kecheng Xu
- Department of Oncology, Guangzhou Fuda Cancer Hospital, School of Medicine, Jinan University, Guangzhou, Guangdong 510665, P.R. China
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Figini M, Wang X, Lyu T, Su Z, Wang B, Sun C, Shangguan J, Pan L, Zhou K, Ma Q, Yaghmai V, Procissi D, Larson AC, Zhang Z. Diffusion MRI biomarkers predict the outcome of irreversible electroporation in a pancreatic tumor mouse model. Am J Cancer Res 2018; 8:1615-1623. [PMID: 30210929 PMCID: PMC6129492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/29/2017] [Indexed: 06/08/2023] Open
Abstract
The purpose of this work is to explore the potential contribution of diffusion MRI to predict the effects of irreversible electroporation (IRE) in a pancreatic ductal adenocarcinoma (PDAC) mouse model. Thirteen mice were injected with Panc-02 PDAC cells in both flanks. One tumor was treated with IRE when it reached a diameter of about 5 mm. T2- and diffusion-weighted MRI sequences were acquired before IRE treatment and 1, 3 and 7 days later. The mice were euthanized 1 day (n = 6) or 2 weeks (n = 7) after treatment. The tumors were excised and stained with H&E, caspase-3, CD-3, F4/80. The volume and the mean and standard deviation of the apparent diffusion coefficient (ADC) were compared between treated and untreated lesions and correlated with histology-derived measures. At 1-day post-treatment, a dramatic ADC increase (+50.81%, P < 0.05) was found in ablated lesions, strongly correlated with apoptosis (τ = 0.90). At later time points the ADC returned to pre-treatment values, though histopathology showed a quite different scenario compared to the untreated controls. The ADC standard deviation measured within the treated tumors 1 day after IRE treatment had a strong negative correlation with the number of tumor cells found 14 days later (τ = 0.80). There was also a strong correlation between 1-day ADC and 14-day apoptosis in untreated tumors (τ = 0.95). In conclusion, diffusion MRI is sensitive to the short-term effects of IRE in PDAC tumors, and can help predict the long-term treatment outcome.
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Affiliation(s)
- Matteo Figini
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Xifu Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong UniversityShanghai, People’s Republic of China
| | - Tianchu Lyu
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Zhanliang Su
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, Tianjin Xiqing HospitalTianjin, People’s Republic of China
| | - Bin Wang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong provincial Engineering Technology Research Center of Minimally Invasive SurgeryGuangzhou, People’s Republic of China
| | - Chong Sun
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Orthopedics, Qilu Hospital, Shandong UniversityJinan, Shandong, People’s Republic of China
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Liang Pan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Kang Zhou
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Quanhong Ma
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
| | - Daniele Procissi
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Andrew C Larson
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern UniversityChicago, IL, USA
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Castellví Q, Mercadal B, Moll X, Fondevila D, Andaluz A, Ivorra A. Avoiding neuromuscular stimulation in liver irreversible electroporation using radiofrequency electric fields. Phys Med Biol 2018; 63:035027. [PMID: 29235992 DOI: 10.1088/1361-6560/aaa16f] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Electroporation-based treatments typically consist of the application of high-voltage dc pulses. As an undesired side effect, these dc pulses cause electrical stimulation of excitable tissues such as motor nerves. The present in vivo study explores the use of bursts of sinusoidal voltage in a frequency range from 50 kHz to 2 MHz, to induce irreversible electroporation (IRE) whilst avoiding neuromuscular stimulation. A series of 100 dc pulses or sinusoidal bursts, both with an individual duration of 100 µs, were delivered to rabbit liver through thin needles in a monopolar electrode configuration, and thoracic movements were recorded with an accelerometer. Tissue samples were harvested three hours after treatment and later post-processed to determine the dimensions of the IRE lesions. Thermal damage due to Joule heating was ruled out via computer simulations. Sinusoidal bursts with a frequency equal to or above 100 kHz did not cause thoracic movements and induced lesions equivalent to those obtained with conventional dc pulses when the applied voltage amplitude was sufficiently high. IRE efficacy dropped with increasing frequency. For 100 kHz bursts, it was estimated that the electric field threshold for IRE is about 1.4 kV cm-1 whereas that of dc pulses is about 0.5 kV cm-1.
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Affiliation(s)
- Quim Castellví
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain. Author to whom any correspondence should be addressed
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