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Hensen B, Hellms S, Werlein C, Jonigk D, Gronski PA, Bruesch I, Rumpel R, Wittauer EM, Vondran FWR, Parker DL, Wacker F, Gutberlet M. Correction of heat-induced susceptibility changes in respiratory-triggered 2D-PRF-based thermometry for monitoring of magnetic resonance-guided hepatic microwave ablation in a human-like in vivo porcine model. Int J Hyperthermia 2022; 39:1387-1396. [DOI: 10.1080/02656736.2022.2138987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Bennet Hensen
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
| | - Susanne Hellms
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Danny Jonigk
- Institute of Pathology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | | | - Inga Bruesch
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Regina Rumpel
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Eva-Maria Wittauer
- Institute for Laboratory Animal Science and Central Animal Facility, Hannover Medical School, Hannover, Germany
| | - Florian W. R. Vondran
- Clinic for General, Abdominal and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Dennis L. Parker
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, USA
| | - Frank Wacker
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
| | - Marcel Gutberlet
- Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- STIMULATE-Solution Centre for Image Guided Local Therapies, Magdeburg, Germany
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Blackmon SH, Sterner RM, Eiken PW, Vogl TJ, Pua BB, Port JL, Dupuy DE, Callstrom MR. Technical and safety performance of CT-guided percutaneous microwave ablation for lung tumors: an ablate and resect study. J Thorac Dis 2022; 13:6827-6837. [PMID: 35070367 PMCID: PMC8743408 DOI: 10.21037/jtd-21-594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
Background Percutaneous image-guided thermal ablation has an increasing role in the treatment of primary and metastatic lung tumors. Achieving acceptable clinical outcomes requires better tools for pre-procedure prediction of ablation zone size and shape. Methods This was a prospective, non-randomized, single-arm, multicenter study conducted by Medtronic (ClinicalTrials.gov ID: NCT02323854). Subjects scheduled for resection of metastatic or primary lung nodules underwent preoperative percutaneous microwave ablation. Ablation zones as measured via CT imaging following ablation immediately and before resection surgically versus predicted ablation zones as prescribed by the investigational system software were compared. This CT scan occurred after the ablation was finished but the antenna still in position. Time (minutes) from antenna placement to removal was 23.7±13.1 (n=14); median: 21.0 (range, 6.0 to 48.0). The definition of the secondary endpoint of complete ablation was 100% non-viable tumor cells based on nicotinamide adenine dinucleotide hydrogen (NADH) staining. Safety endpoints were type, incidence, and severity of adverse events. Results Fifteen patients (mean age 58.9 years; 67% male; 33% female) were enrolled in the study, 33.3% (5/15) with previous thoracic surgery, 73% (11/15) with metastasis, and 27% (4/15) with primary lung tumors. All underwent percutaneous microwave ablation followed by surgical resection the same day. Complete ablation was detected in 54.4% (6/11), incomplete ablation in 36.4% (4/11), and delayed necrosis in 9.1% (1/11). There were no device-related adverse events. Ablation zone volume was overestimated in all patients. Conclusions Histological complete ablation was observed in 55% of subjects. CT scanning less than an hour after ablation and tissue shrinkage may account for the smaller zone of ablation observed compared to predicted by the investigational system software.
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Affiliation(s)
- Shanda H Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rosalie M Sterner
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Damian E Dupuy
- Department of Diagnostic Imaging, the Warren Alpert Medical School of Brown University, Providence, RI, USA
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA. AJR Am J Roentgenol 2019; 213:1388-1396. [PMID: 31593520 DOI: 10.2214/ajr.18.19856] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).
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Nelson DB, Tam AL, Mitchell KG, Rice DC, Mehran RJ, Sepesi B, Antonoff MB, Vaporciyan AA, Hofstetter WL. Local Recurrence After Microwave Ablation of Lung Malignancies: A Systematic Review. Ann Thorac Surg 2019; 107:1876-1883. [DOI: 10.1016/j.athoracsur.2018.10.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/10/2018] [Accepted: 10/16/2018] [Indexed: 11/25/2022]
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Microwave Ablation in the Management of Colorectal Cancer Pulmonary Metastases. Cardiovasc Intervent Radiol 2018; 41:1530-1544. [PMID: 29845348 DOI: 10.1007/s00270-018-2000-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/23/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To review outcomes following microwave ablation (MWA) of colorectal cancer pulmonary metastases and assess predictors of oncologic outcomes. METHODS Technical success, primary and secondary technique efficacy rates were evaluated for 50 patients with 90 colorectal cancer pulmonary metastases at immediate, 4-8 weeks post-MWA and subsequent follow-up CT and/or 18F-FDG PET/CT. Local tumor progression (LTP) rate, LTP-free survival (LTPFS), cancer-specific and overall survivals were assessed. Complications were recorded according to SIR classification. RESULTS Median follow-up was 25.6 months. Median tumor size was 1 cm (0.3-3.2 cm). Technical success, primary and secondary technique efficacy rates were 99, 90 and 92%, respectively. LTP rate was 10%. One-, 2- and 3-year LTPFS were: 93, 86 and 86%, respectively, with median LTPFS not reached. Median overall survival was 58.6 months, and median cancer-specific survival (CSS) was not reached. One-, 2- and 3-year overall and CSS were 94% and 98, 82 and 90%, 61 and 70%, respectively. On univariate analysis, minimal ablation margin (p < 0.001) and tumor size (p = 0.001) predicted LTPFS, with no LTP for minimal margin ≥ 5 mm and/or tumor size < 1 cm. Pleural-based metastases were associated with increased LTP risk (p = 0.002, SHR = 7.7). Pre-MWA CEA level > 10 ng/ml (p = 0.046) and ≥ 3 prior chemotherapy lines predicted decreased CSS (p = 0.02). There was no 90-day death. Major complications rate was 13%. CONCLUSIONS MWA with minimal ablation margin ≥ 5 mm is essential for local control of colorectal cancer pulmonary metastases. Pleural-based metastases and larger tumor size were associated with higher risk of LTP. CEA level and pre-MWA chemotherapy impacted CSS.
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Clinical Application of CT-Guided Percutaneous Microwave Ablation for the Treatment of Lung Metastasis from Colorectal Cancer. Gastroenterol Res Pract 2017; 2017:9621585. [PMID: 29225619 PMCID: PMC5684571 DOI: 10.1155/2017/9621585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 11/17/2022] Open
Abstract
Objective The aim of our research is to explore the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA) for the treatment of lung metastasis from colorectal cancer. Materials and Methods CT-guided percutaneous MWA was performed in 22 patients (male 14, female 8, mean age: 56.05 ± 12.32 years) with a total of 36 lung metastatic lesions from colorectal cancer between February 2014 and May 2017. Clinical data were retrospectively analyzed with respect to the efficacy, safety, and outcome. Results Of the 36 lesions, 34 lesions (94.4%) reduced obviously with small cavitations or fibrous stripes formed and had no evidence of recurrence during follow-up. The volume of the other 2 lesions demonstrated local progression after 6 months by follow-up CT. The primary complications included pneumothorax (28%), chest pain (21%), and fever (5%). These symptoms and signs were obviously relieved or disappeared after several-day conservative treatment. The mean follow-up of the patients was 25.54 ± 12.58 months (range 2-41 months). The estimated progression-free survival rate was 94.4%. Conclusion Our results demonstrate that CT-guided percutaneous MWA appears to be an effective, reliable, and minimally invasive method for the treatment of lung metastasis from colorectal cancer. This trial is registered with ChiCTR-ORC-17012904.
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Zhong L, Sun S, Shi J, Cao F, Han X, Bao X, You Q. Clinical analysis on 113 patients with lung cancer treated by percutaneous CT-guided microwave ablation. J Thorac Dis 2017; 9:590-597. [PMID: 28449467 DOI: 10.21037/jtd.2017.03.14] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lung Cancer is a primary tumor with poor prognosis. For early stage lung cancer, treatment options include surgical resection and microwave techniques. Percutaneous ablative techniques emerged as best therapeutic options for nonsurgical patients. METHODS The aim of this study was to retrospectively analyze the clinical effect of CT-guided microwave ablation (MWA) treatment for patients with lung cancer who were not eligible for surgical resection. MWA was used to treat the tumor lesion of 113 patients with lung cancer who were in our hospital from Jan, 2013 to Jun, 2015. The median diameter of tumors was 3.1 cm (0.7-6 cm). Follow-up were paid to all the patients who received MWA therapy. The average follow-up was 22.1±8.6 months, and the median follow-up was 18 (7-40) months. RESULTS All of 113 cases of patients with lung cancer experienced MWA therapy, and their tumors were found to have vacuolization, lower density and much smaller distinct shrinkage of tumor size with varying degrees. The local progression rate or relapse rate of the whole group was 15.9%. The counterpart of patients in the early-stage group was 5.7% (2/35), and the diameter of tumors in the two patients was more than 3 cm. The local progression rate or relapse rate of patients in advanced-stage group was 20.5%, wherein, 81.3% of local progression or relapse occurred to the patients with a tumorous diameter of more than 3 cm. The results indicated that the patients in advanced-stage group were vulnerable to local progression or relapse, the tumorous with greater diameter had higher incidence of local relapse. No mortality occurred within 30 days after surgery, the survival rate of patients in early-stage group at first, second, third year was respectively 97.1%, 94.1% and 84.7%. The counterpart of patients in advanced-stage group was respectively 93.6%, 87.7% and 71.7%. The difference of survival rate between both groups was not statistically significant (P=0.576). No perioperative deaths occurred, and the main complications i.e., fever, pneumothorax, pleural effusion, hemoptysis, pneumonia, and pain were slight and tolerable. CONCLUSIONS MWA is an effective, safe and minimally invasive treatment for the patients with lung cancer who cannot be tolerated by surgical resection.
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Affiliation(s)
- Lou Zhong
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Siyuan Sun
- Department of Clinical Medicine, Nantong University Xinglin College, Nantong 226001, China
| | - Jiahai Shi
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Fei Cao
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Xiao Han
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Xueping Bao
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Qingsheng You
- Department of thoracic surgery, Affiliated Hospital of Nantong University, Nantong 226001, China
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Sebek J, Curto S, Bortel R, Prakash P. Analysis of minimally invasive directional antennas for microwave tissue ablation. Int J Hyperthermia 2016; 33:51-60. [DOI: 10.1080/02656736.2016.1195519] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
- Department of Circuit Theory, Czech Technical University, Prague, Czech Republic
| | - Sergio Curto
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
| | - Radoslav Bortel
- Department of Circuit Theory, Czech Technical University, Prague, Czech Republic
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
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Yan SY, Zhang Y, Sun C, Cao HX, Li GM, Wang YQ, Fan JG. Comparison of real-time contrast-enhanced ultrasonography and standard ultrasonography in liver cancer microwave ablation. Exp Ther Med 2016; 12:1345-1348. [PMID: 27602065 PMCID: PMC4998355 DOI: 10.3892/etm.2016.3448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022] Open
Abstract
Primary liver cancer has a high incidence and high mortality rates, and currently the only viable option is surgery, although there are a number of difficulties related to this method. The aim of the present study was to investigate the potential advantages of the real-time contrast-enhanced ultrasonography (CEUS) for microwave ablation of primary liver cancer. One hundred patients with primary liver cancer were included in the study. The patients were divided into the ordinary ultrasonography and the CEUS groups. For the ordinary ultrasonography group, the ordinary ultrasonography-guided microwave ablation method was used, while microwave ablation under the guidance of CEUS was conducted for the CEUS group. The size of lesions and clearness of the tumor boundary prior to surgery in the two groups were compared. Additionally, postoperative complications and the survival rate were monitored. Lesion boundary areas measured by CEUS were significantly larger than those measured with ordinary ultrasonography. The incidence rate of postoperative pain, fever, intra-abdominal hemorrhage and infection and other complications in the ordinary ultrasonography group were significantly higher than that in the CEUS group. The tumor recurrence rate in the CEUS group was significantly lower than that in the ordinary ultrasonography group. Seventy-two percent of patients in the CEUS group showed no progress, compared to 48% of in the ordinary ultrasonography group. The progress-free survival rate in the CEUS group after 6 months was significantly higher than that in the ordinary ultrasonography group. Disease-free survival time in the CEUS group was considerably longer than the control group. In conclusion, the guidance of real-time CEUS on the primary liver cancer microwave ablation treatment can achieve good intra-operative results. It offers a real-time guidance effect, improves survival time and reduces the incidence of complications.
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Affiliation(s)
- Shi-Yan Yan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yi Zhang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Chao Sun
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Hai-Xia Cao
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Guang-Ming Li
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Yu-Qin Wang
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
| | - Jian-Gao Fan
- Department of Gastroenterology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, P.R. China
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Hernández JI, Cepeda MFJ, Valdés F, Guerrero GD. Microwave ablation: state-of-the-art review. Onco Targets Ther 2015; 8:1627-32. [PMID: 26185452 PMCID: PMC4500605 DOI: 10.2147/ott.s81734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This paper reviews state-of-the-art microwave ablation (MWA) of tumors. MWA is a novel method for treating inoperable tumors, ie, tumors that cannot be treated surgically. However, patients generally choose removal of the tumor by conventional techniques. A literature review of MWA for breast, liver, lung, and kidney tumors is reported here, with tabulation of our findings according to the type of technique used, with a detailed description of the time, type of microwave generator used, and number of patients treated with MWA. In some cases, the subjects were not human patients, but pig or bovine liver specimens. MWA is a technique that has proved to be promising and likely to be used increasingly in the ablation of cancerous tumors. However, MWA needs to be used more widely to establish itself as a common tool in the treatment of inoperable tumors.
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Welch BT, Brinjikji W, Schmit GD, Callstrom MR, Kurup AN, Cloft HJ, Woodrum DA, Nichols FC, Atwell TD. A National Analysis of the Complications, Cost, and Mortality of Percutaneous Lung Ablation. J Vasc Interv Radiol 2015; 26:787-91. [DOI: 10.1016/j.jvir.2015.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/22/2015] [Accepted: 02/23/2015] [Indexed: 02/07/2023] Open
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Initial institutional experience of uncooled single-antenna microwave ablation for large hepatocellular carcinoma. Clin Radiol 2015; 70:e35-40. [PMID: 25727299 DOI: 10.1016/j.crad.2015.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 01/17/2023]
Abstract
AIM To evaluate the safety, efficacy, and feasibility of a novel microwave generator, designed to deliver automatically adjusted energy by tissue permittivity feedback control into the tumour via an uncooled antenna, in patients with larger hepatocellular carcinoma (HCC). MATERIALS AND METHODS Fourteen patients with HCC >5 cm in diameter received surgical or percutaneous microwave ablation with more than 12 months of follow-up. Microwave ablation was performed using a 902-928 MHz generator at 28 W; a single 14 G antenna without water-cooled system was used. The patients were followed up with contrast-enhanced CT and serum alpha-foetoprotein to monitor for tumour recurrence at 1 month and then every 3 months after tumour ablation. RESULTS The follow-up duration for the 11 male and three female patients (mean tumour size 5.77 cm, range 5-7 cm; mean age 63.8 years) was 15.8 months. The mean ablation time was 2025 s (range 900-3600 s), and the mean ablation session was 2.5 (range 1-4). The complete ablation rate was 85% (17 of 20). Local recurrence rate was 5.8% (1 of 17). All patients survived and the morbidity and mortality rate was 21.4% and 0%, respectively. CONCLUSIONS Microwave tissue ablation using this novel system with tissue permittivity feedback control and a single uncooled antenna has a high complete ablation rate and lower morbidity. It proved to be a fast, easy, and effective option for ablation of large (>5 cm) tumours.
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Liang PC, Lai HS, Shih TTF, Wu CH, Huang KW. The pilot experience upon surgical ablation of large liver tumor by microwave system with tissue permittivity feedback control mechanism. BMC Surg 2014; 14:82. [PMID: 25336074 PMCID: PMC4274697 DOI: 10.1186/1471-2482-14-82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/17/2014] [Indexed: 12/26/2022] Open
Abstract
Background Microwave ablation (MWA) is used to treat patients with unresectable liver cancer. Our institution applied a novel microwave generator capable of automatically adjusting energy levels based on feedback related to tissue permittivity. This approach is meant to facilitate ablations over larger areas and provide results of greater predictablility. This paper reports on the safety, efficacy, and feasibility of this new system in the treatment of patients with large liver tumors. Methods Between July 2012 and December 2012, a total of 23 patients with malignant liver tumors exceeding 4 cm in diameter underwent surgical MWA using a 902–928 MHz generator. The proposed system used a 14-gauge antenna without internal-cooling. Follow up on tumor recurrence was performed using contrast-enhanced computed tomography or magnetic resonance imaging at 1 month and then at 3 month intervals for a period of at least 12 months following ablation. Results Among the cancers treated, 10 were primary hepatocellular carcinomas (HCCs) and 13 were metastatic lesions from primary colorectal cancer (CRLM). The mean tumor size was 5.40 cm (range of 4.0-7.0 cm). A total of 18 patients underwent MWA via open surgery, and 5 received laparoscopic MWA. The mean ablation time was 1982 seconds, with a range of 900-3600 seconds, and the median number of ablation sessions was 2.0 (range of 1–4 sessions). The rate of complete ablation, as defined by a total loss of contrast-enhancement one month post-treatment, was 82.6% (19 of 23 patients), and the rate of local recurrence was 26.3% (5 of 19 patients). For tumors with a diameter of 4.0-7.0 cm, the technical success rate of MWA was higher for HCC patients (70%) than for metastatic liver cancer (53.8%) patients; however, the difference was not statistically significant. All patients survived throughout the observation period, and the morbidity rate was 8.6%. Conclusions MWA treatment using the proposed system with tissue permittivity feedback control resulted in a high rate of complete ablation and reduced morbidity. This approach proved to be a fast, easy, and effective option for the ablation of large liver cancers, particularly HCCs.
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Affiliation(s)
| | | | | | | | - Kai-Wen Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
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Yang X, Ye X, Zheng A, Huang G, Ni X, Wang J, Han X, Li W, Wei Z. Percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: clinical evaluation of 47 cases. J Surg Oncol 2014; 110:758-63. [PMID: 24965604 DOI: 10.1002/jso.23701] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/07/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To retrospectively evaluate safety and effectiveness of CT-guided percutaneous microwave ablation (MWA) in 47 patients with medically inoperable stage I peripheral non-small cell lung cancer (NSCLC). METHODS From February 2008 to October 2012, 47 patients with stage I medically inoperable NSCLC were treated in 47 MWA sessions. The clinical outcomes were evaluated. Complications after MWA were also summarized. RESULTS At a median follow-up period of 30 months, the median time to the first recurrence was 45.5 months. The local control rates at 1, 3, 5 years after MWA were 96%, 64%, and 48%, respectively. The median cancer-specific and median overall survivals were 47.4 and 33.8 months. The overall survival rates at 1, 2, 3, and 5 years after MWA were 89%, 63%, 43%, and 16%, respectively. Tumors ≤3.5 cm were associated with better survival than were tumors >3.5 cm. The complications after MWA included pneumothorax (63.8%), hemoptysis (31.9%), pleural effusion (34%), pulmonary infection (14.9%), and bronchopleural fistula (2.1%). CONCLUSIONS MWA is safe and effective for the treatment of medically inoperable stage I peripheral NSCLC.
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Affiliation(s)
- Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
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16
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Lee WK, Lau EWF, Chin K, Sedlaczek O, Steinke K. Modern diagnostic and therapeutic interventional radiology in lung cancer. J Thorac Dis 2014; 5 Suppl 5:S511-23. [PMID: 24163744 DOI: 10.3978/j.issn.2072-1439.2013.07.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 07/16/2013] [Indexed: 12/13/2022]
Abstract
Imaging has an important role in the multidisciplinary management of primary lung cancer. This article reviews the current state-of-the-art imaging modalities used for the evaluation, staging and post-treatment follow-up and surveillance of lung cancers, and image-guided percutaneous techniques for biopsy to confirm the diagnosis and for local therapy in non-surgical candidates.
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Affiliation(s)
- Wai-Kit Lee
- Department of Medical Imaging, St. Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia
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17
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Ratanaprasatporn L, Charpentier KP, Resnick M, Lu S, Dupuy D. Intra-operative microwave ablation of liver malignancies with tumour permittivity feedback control: a prospective ablate and resect study. HPB (Oxford) 2013; 15:997-1001. [PMID: 23551845 PMCID: PMC3843619 DOI: 10.1111/hpb.12084] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/26/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tumour permittivity feedback control is a novel method for microwave ablation (MWA) that theoretically allows for larger, more predictable ablations. This prospective case series evaluates the feasibility and efficacy of MWA of liver malignancies using a device with tumour permittivity feedback control. METHODS Ten consecutive patients initially determined to be candidates for surgical resection of a liver malignancy underwent intra-operative MWA with tumour permittivity feedback control followed by a surgical resection. A 14-gauge Medwaves microwave antenna was used to deliver a single treatment according to the manufacturer's recommendations. Tumours were assessed grossly as well as by haematoxylin and eosin (H&E) and tetrazolium chloride staining. The primary end point was per cent tumour necrosis. RESULTS The median maximum ablation diameter measured was 4.1 cm (range 3.0-6.8). The median ablation volume was 8.7 cm(3) (range 4.84-17.55). Six of the 10 tumours demonstrated a pathological complete response (CR). Six of seven tumours ≤ 3 cm demonstrated a pathological CR. Zero of the three tumours ≥ 3 cm had a pathological CR, but all had ≥ 50% tumour necrosis. All patients survived and there were no ablation-related morbidities. DISCUSSION MWA of liver tumours with tumour permittivity feedback control is feasible and appears effective for the treatment of small (< 3 cm) liver tumours.
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Affiliation(s)
| | - Kevin P Charpentier
- Alpert Medical School at Brown UniversityProvidence, RI, USA,Department of Surgery, Rhode Island HospitalProvidence, RI, USA
| | - Murray Resnick
- Alpert Medical School at Brown UniversityProvidence, RI, USA,Department of Pathology, Rhode Island HospitalProvidence, RI, USA
| | - Shaolei Lu
- Alpert Medical School at Brown UniversityProvidence, RI, USA,Department of Pathology, Rhode Island HospitalProvidence, RI, USA
| | - Damian Dupuy
- Alpert Medical School at Brown UniversityProvidence, RI, USA,Department of Radiology, Rhode Island HospitalProvidence, RI, USA
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18
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Schneider T, Heussel CP, Herth FJF, Dienemann H. Thermal ablation of malignant lung tumors. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:394-400. [PMID: 23826028 DOI: 10.3238/arztebl.2013.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 02/18/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND About 50 000 new cases of non-small-cell carcinoma of the lung are diagnosed in Germany each year. More than 20% of the affected patients cannot be offered radical resection because of comorbidity alone. The lung is also the second most common site of distant metastases of extrathoracic tumors; it is the only site of such metastases in 20% of cases. In recent years, image-guided thermoablation has been used with increasing frequency in patients who are unable to undergo surgery for medical reasons. METHODS The PubMed database was selectively searched for publications on the indications, complications, and results of the thermoablative techniques currently in clinical use, with special attention to radiofrequency ablation (RFA). RESULTS There is only a small evidence base to date concerning the treatment of malignant lung tumors with thermoablation. Retrospective and prospective case series have been published, but no randomized controlled trials have yet been conducted. RFA, the most common technique, involves the image-guided percutaneous placement of one or more probes in the tumor, to which thermal energy is then applied. For peripherally located tumors that measure less than 3 cm in diameter, local control of tumor growth can be achieved in about 90% of cases. The long-term results that are now available from smaller series provisionally indicate 5-year survival rates of 20% to 61%. The most common complication is pneumothorax requiring drainage, which occurs in about 10% of cases. In the intermediate term, thermoablation does not cause any clinically relevant loss of pulmonary function. CONCLUSION Image-guided thermoablation cannot now be considered an alternative to surgery for the treatment of malignant lung tumors with curative intent. It does, however, widen the spectrum of therapeutic options for patients who are medically unable to undergo a surgical procedure.
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Affiliation(s)
- Thomas Schneider
- Department of Thoracic Surgery, St. Vincentius-Kliniken Karlsruhe.
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19
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Liu H, Steinke K. High-powered percutaneous microwave ablation of stage I medically inoperable non-small cell lung cancer: A preliminary study. J Med Imaging Radiat Oncol 2013; 57:466-74. [DOI: 10.1111/1754-9485.12068] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 04/04/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Howard Liu
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane; Queensland; Australia
| | - Karin Steinke
- Department of Medical Imaging; Royal Brisbane and Women's Hospital; Brisbane; Queensland; Australia
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20
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Allison RR. The electromagnetic spectrum: current and future applications in oncology. Future Oncol 2013; 9:657-67. [DOI: 10.2217/fon.13.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The electromagnetic spectrum is composed of waves of various energies that interact with matter. When focused upon and directed at tumors, these energy sources can be employed as a means of lesion ablation. While the use of x-rays is widely known in this regard, a growing body of evidence shows that other members of this family can also achieve oncologic success. This article will review therapeutic application of the electromagnetic spectrum in current interventions and potential future applications.
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Affiliation(s)
- Ron R Allison
- 21st Century Oncology, 801 WH Smith Boulevard, Greenville, NC 27834, USA
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