Synergetic Thermal Therapy for Cancer: State-of-the-Art and the Future

As a safe and minimal-invasive modality, thermal therapy has become an effective treatment in cancer treatment. Other than killing the tumor cells or destroying the tumor entirely, the thermal modality results in profound molecular, cellular and biological effects on both the targeted tissue, surrounding environments, and even the whole body, which has triggered the combination of the thermal therapy with other traditional therapies as chemotherapy and radiation therapy or new therapies like immunotherapy, gene therapy, etc. The combined treatments have shown encouraging therapeutic effects both in research and clinic. In this review, we have summarized the outcomes of the existing synergistic therapies, the underlying mechanisms that lead to these improvements, and the latest research in the past five years. Limitations and future directions of synergistic thermal therapy are also discussed.

A New Thermal Damage-Controlled Protocol for Thermal Ablation Modeled with Modified Porous Media-Based Bioheat Equation with Variable Porosity

Thermal ablation of tumors is a minimally invasive technique more and more employed in cancer treatments. The main shortcomings of this technique are, on the one hand, the risk of an incomplete ablation, and on the other hand, the destruction of the surrounding healthy tissue. In this work, thermal ablation of a spherical hepatocellular carcinoma tumor (HCC) surrounded by healthy tissue is modeled. A modified porous media-based bioheat model is employed, including porosity variability from tumor core to healthy tissue, following experimental in vivo measures. Moreover, three different protocols are investigated: a constant heating protocol, a pulsating protocol, and a new developed damage-controlled protocol. The proposed damage-controlled protocol changes the heating source from constant to pulsating according to the thermal damage probability on the tumor rim. The equations are numerically solved by means of the commercial software COMSOL Multiphysics, and the outcomes show that the new proposed protocol is able to achieve the complete ablation in less time than the completely pulsating protocol, and to reach tissue temperature on the tumor rim 10 °C smaller than the constant protocol. These results are relevant to develop and improve different patient-based and automated protocols which can be embedded in medical devices’ software or in mobile applications, supporting medical staff with innovative technical solutions.

A Computational Study on Magnetic Nanoparticles Hyperthermia of Ellipsoidal Tumors

The modelling of magnetic hyperthermia using nanoparticles of ellipsoid tumor shapes has not been studied adequately. To fill this gap, a computational study has been carried out to determine two key treatment parameters: the therapeutic temperature distribution and the extent of thermal damage. Prolate and oblate spheroidal tumors, of various aspect ratios, surrounded by a large healthy tissue region are assumed. Tissue temperatures are determined from the solution of Pennes’ bio-heat transfer equation. The mortality of the tissues is determined by the Arrhenius kinetic model. The computational model is successfully verified against a closed-form solution for a perfectly spherical tumor. The therapeutic temperature and the thermal damage in the tumor center decrease as the aspect ratio increases and it is insensitive to whether tumors of the same aspect ratio are oblate or prolate spheroids. The necrotic tumor area is affected by the tumor prolateness and oblateness. Good comparison is obtained of the present model with three sets of experimental measurements taken from the literature, for animal tumors exhibiting ellipsoid-like geometry. The computational model enables the determination of the therapeutic temperature and tissue thermal damage for magnetic hyperthermia of ellipsoidal tumors. It can be easily reproduced for various treatment scenarios and may be useful for an effective treatment planning of ellipsoidal tumor geometries.

Theoretical Evaluation of Microwave Ablation Applied on Muscle, Fat and Bone: A Numerical Study

(1) Background: Microwave ablation (MWA) is a common tumor ablation surgery. Because of the high temperature of the ablation antenna, it is strongly destructive to surrounding vital tissues, resulting in high professional requirements for clinicians. The method used to carry out temperature observation and damage prediction in MWA is significant; (2) Methods: This work employs numerical study to explore temperature distribution of typical tissues in MWA. Firstly, clinical MWA based on isolated biological tissue is implemented. Then, the Pennes models and microwave radiation physics are established based on experimental parameters and existing related research. Initial values and boundary conditions are adjusted to better meet the real clinical materials and experimental conditions. Finally, clinical MWA data test this model. On the premise that the model is matched with clinical MWA, fat and bone are deduced for further heat transfer analysis. (3) Results: Numerical study obtains the temperature distribution of biological tissue in MWA. It observes the heat transfer law of ablation antenna in biological tissue. Additionally, combined with temperature threshold, it generates thermal damage of biological tissues and predicts the possible risks in MWA; (4) Conclusions: This work proposes a numerical study of typical biological tissues. It provides a new theoretical basis for clinically thermal ablation surgery.

Numerical analysis of the pulsating heat source effects in a tumor tissue

BACKGROUND AND OBJECTIVES

Hyperthermia treatment is nowadays recognized as the fourth additional cancer therapy technique following surgery, chemotherapy, and radiation; it is a minimally or non-invasive technique which involves fewer complications, a shorter hospital stay, and fewer costs. In this paper, pulsating heat effects on heat transfer in a tumor tissue under hyperthermia are analyzed. The objective of the paper is to find and quantify the advantages of pulsatile heat protocols under different periodical heating schemes and for different tissue morphologies.

METHODS

The tumor tissue is modeled as a porous sphere made up of a solid phase (tissue, interstitial space, etc.) and a fluid phase (blood). A Local Thermal Non-Equilibrium (LTNE) model is employed to consider the local temperature difference between the two phases. Governing equations with the appropriate boundary conditions are solved with the finite-element code COMSOL Multiphysics®. The pulsating effect is modeled with references to a cosine function with different frequencies, and such different heating protocols are compared at equal delivered energy, i. e. different heating times at equal maximum power.

RESULTS

Different tissue properties in terms of blood vessels sizes and blood volume fraction in tissue (porosity) are investigated. The results are shown in terms of tissue temperature and percentage of necrotic tissue obtained. The most powerful result achieved using a pulsating heat source instead of a constant one is the decreasing of maximum temperature in any considered case, even reaching about 30% lower maximum temperatures. Furthermore, the evaluation of tissue damage at the end of treatment shows that pulsating heat allows to necrotize the same tumoral tissue area of the non-pulsating heat source.

CONCLUSIONS

Modeling pulsating heat protocols in thermal ablation under different periodical heating schemes and considering different tissues morphologies in a tumor tissue highlights how the application of pulsating heat sources allows to avoid high temperature peaks, and simultaneously to ablate the same tumoral area obtained with a non-pulsating heat source. This is a powerful result to improve medical protocols and devices in thermal ablation of tumors.

Optimization of an Endoscopic Radiofrequency Ablation Electrode

Radiofrequency ablation (RFA) is an increasingly used, minimally invasive, cancer treatment modality for patients who are unwilling or unable to undergo a major resective surgery. There is a need for RFA electrodes that generate thermal ablation zones that closely match the geometry of typical tumors, especially for endoscopic ultrasound-guided (EUS) RFA. In this paper, the procedure for optimization of an RFA electrode is presented. First, a novel compliant electrode design is proposed. Next, a thermal ablation model is developed to predict the ablation zone produced by an RFA electrode in biological tissue. Then, a multi-objective genetic algorithm is used to optimize two cases of the electrode geometry to match the region of destructed tissue to a spherical tumor of a specified diameter. This optimization procedure is then applied to EUS-RFA ablation of pancreatic tissue. For a target 2.5 cm spherical tumor, the optimal design parameters of the compliant electrode design are found for two cases. Cases 1 and 2 optimal solutions filled 70.9% and 87.0% of the target volume as compared to only 25.1% for a standard straight electrode. The results of the optimization demonstrate how computational models combined with optimization can be used for systematic design of ablation electrodes. The optimization procedure may be applied to RFA of various tissue types for systematic design of electrodes for a specific target shape.

A review of radiofrequency ablation: Large target tissue necrosis and mathematical modelling

Radiofrequency ablation (RFA) is an effective clinical method for tumour ablation with minimum intrusiveness. However, the use of RFA is mostly restricted to small tumours, especially those <3cm in diameter. This paper discusses the state-of-the-art of RFA, drawn from experimental and clinical results, for large tumours (i.e. ⩾3cm in diameter). In particular, the paper analyses clinical results related to target tissue necrosis (TTN) and mathematical modelling of the RFA procedure to understand the mechanism whereby the TTN is limited to under 3cm with RFA. This paper also discusses a strategy of controlling of the temperature of target tissue in the RFA procedure with the state-of-art device, which has the potential to increase the size of TTN. This paper ends with a discussion of some future ideas to solve the so-called 3-cm problem with RFA.

Numerical analysis of the relationship between the area of target tissue necrosis and the size of target tissue in liver tumours with pulsed radiofrequency ablation

PURPOSE

Radiofrequency ablation (RFA) is currently restricted to the treatment of target tissues with a small size (<3 cm in diameter). To overcome this problem with RFA, some phenomena need to be understood first. The study presented in this paper investigated the relationship between the area of target tissue necrosis (TTN) and the size of target tissue in pulsed radiofrequency ablation (PRFA).

MATERIALS AND METHODS

Liver tumour, one of the common targets of RFA in clinical practice, was used as the target tissue in this study. Two types of pulsed RF power supply methods (half-square and half-sine) and three target tissues with different sizes (25 mm, 30 mm and 35 mm in diameter) were studied using finite element modelling. The finite element model (FEM) was validated by using an in vitro experiment with porcine liver tissue. The first roll-off occurrence or 720 s, whichever occurs first, was chosen as the ablation termination criterion in this study.

RESULTS

For each target tissue size, the largest TTN area was obtained using the maximum voltage applied (MVA) without roll-off occurrence. In this study, target tissues with a 25 mm diameter can be ablated cleanly but target tissues with 30-mm and 35-mm failed to be ablated.

CONCLUSIONS

The half-square PRFA could achieve a larger TTN area than the half-sine PRFA. The MVA decreases with an increase in the target tissue diameter in both the half-square PRFA and the half-sine PRFA. The findings of this study are in agreement with the clinical results that lesions (≥ 3 cm in diameter) have less favourable results from RFA.

Evidence for tumor cell spread during local hepatic ablation of colorectal liver metastases

INTRODUCTION

The aim of the present study was to analyze the impact of cryosurgery (CRYO) on liver metastases compared to other thermoablative techniques. In a rat liver metastases model, evidence for tumor cell spread was analyzed comparing CRYO, radiofrequency ablation (RFA), and laser-induced thermotherapy (LITT).

METHODS

In an experimental study, we compared cell spillage in the washout of isolated perfused rat livers undergoing thermal ablation. Within the same model, CC531-GFP rat liver tumors were treated with CRYO, RFA, or LITT and the number of vital tumor cells within the perfusate was measured. Matrix metalloproteinases (MMP-2, MMP-9) were analyzed after in vivo ablation of rat colorectal liver metastases in the third experimental model.

RESULTS

Our data showed pronounced washout of cells after CRYO with a higher amount of intravascular cells and cell detritus compared to RFA and LITT. Only the effluent fluid of cryosurgery-treated livers revealed GFP-stained tumor cells. MMP-2 and MMP-9 expression was significantly higher after cryosurgery than after RFA and LITT.

CONCLUSION

When using thermoablative techniques, intravascular metastatic cell spillage is highest in CRYO, and increased expression of matrix metalloproteinases may further facilitate tumor cell spread. Therefore, RFA and LITT may be preferable whenever surgical resection of liver tumors is impossible.