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Mactier M, McIntosh SA, Sharma N. Minimally invasive treatment of early, good prognosis breast cancer-is this feasible? Br J Radiol 2024; 97:886-893. [PMID: 38310343 PMCID: PMC11075978 DOI: 10.1093/bjr/tqae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/15/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
Breast cancer screening programmes frequently detect early, good prognosis breast cancers with significant treatment burden for patients, and associated health-cost implications. Emerging evidence suggests a role for minimally invasive techniques in the management of these patients enabling many women to avoid surgical intervention. Minimally invasive techniques include vacuum-assisted excision, cryoablation, and radiofrequency ablation. We review published evidence in relation to the risks and benefits of each technique and discuss ongoing trials. Data to date are promising, and we predict a trend towards minimally invasive treatment for early, good-prognosis breast cancer as technical skills, suitability criteria, and follow-up protocols are established.
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Affiliation(s)
- Mhairi Mactier
- Golden Jubilee National Hospital, Clydebank G81 4DY, United Kingdom
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast BT9 7AE, United Kingdom
| | - Nisha Sharma
- Breast Unit, St James Hospital, Leeds LS9 7TF, United Kingdom
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Ji Y, Zhuo Y, Li T, Lian J, Wang Z, Guo X, Kong D, Li K. MR-guided percutaneous microwave coagulation of small breast tumors. Insights Imaging 2024; 15:76. [PMID: 38499835 PMCID: PMC10948645 DOI: 10.1186/s13244-024-01645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/10/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND To evaluate the technical success and patient safety of magnetic resonance-guided percutaneous microwave coagulation (MR-guided PMC) for breast malignancies. METHODS From May 2018 to December 2019, 26 patients with breast tumors measuring 2 cm or less were recruited to participate in a prospective, single-institution clinical study. The primary endpoint of this study was the evaluation of treatment efficacy for each patient. Histochemical staining with α-nicotinamide adenine dinucleotide and reduced (NADH)-diaphorase was used to determine cell viability following and efficacy of PMC. The complications and self-reported sensations from all patients during and after ablation were also assessed. The technical success of the PMC procedure was defined when the area of the NADH-diaphorase negative region fully covered the hematoxylin-eosin (H&E) staining region in the tumor. RESULTS All patients had a complete response to ablation with no residual carcinoma on histopathological specimen. The mean energy, ablation duration, and procedure duration per tumor were 36.0 ± 4.2 kJ, 252.9 ± 30.9 S, and 104.2 ± 13.5 min, respectively. During the ablation, 14 patients underwent prolonged ablation time, and 1 patient required adjusting of the antenna position. Eleven patients had feelings of subtle heat or swelling, and 3 patients experienced slight pain. After ablation, one patient took two painkillers because of moderate pain, and no patients had postoperative oozing or other complications after PMC. Induration around the ablation area appeared in 16 patients. CONCLUSION MR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future. CRITICAL RELEVANCE STATEMENT MR-guided PMC of small breast tumors is feasible and could be applied in clinical practice in the future. KEY POINTS • MR-guided PMC of small breast tumors is feasible. • PMC was successfully performed for all patients. • All patients were satisfied with the final cosmetic result.
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Affiliation(s)
- Ying Ji
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Yaoyao Zhuo
- Department of Radiology, Zhongshan Hospital, Fudan University School of Medicine, Shanghai, 200000, China
| | - Ting Li
- Department of Radiology, First People's Hospital of Changzhou, Jiangsu, 213003, China
| | - Jingge Lian
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Zilin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Xinyu Guo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 650 New Songjiang Road, Shanghai, 201620, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, Zhejiang, 310027, China
| | - Kangan Li
- Department of Radiology, Songjiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 201600, China.
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Toi M, Kinoshita T, Benson JR, Jatoi I, Kataoka M, Han W, Yamauchi C, Inamoto T, Takada M. Non-surgical ablation for breast cancer: an emerging therapeutic option. Lancet Oncol 2024; 25:e114-e125. [PMID: 38423057 DOI: 10.1016/s1470-2045(23)00615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024]
Abstract
Non-surgical ablation is emerging as an alternative local therapy option for patients with early-stage breast cancer and encompasses two main types of percutaneous therapeutic procedures: radiofrequency ablation and cryoablation. Both techniques involve obliteration of a spherical lesion and feasibility studies have shown that complete tumour ablation is achievable with good or excellent cosmetic results. Although few clinical studies have directly compared non-surgical ablation with conventional surgical resection, observational studies indicate that clinical outcomes are favourable with acceptable rates of local control and no detriment to long-term survival. There remain outstanding issues with these percutaneous ablative techniques that require resolution before they could be incorporated into routine clinical practice. Hence, a consensus meeting was convened to discuss the challenges of non-surgical ablation and clarify indications for its use alongside clinical management pathways. In this Policy Review we will address some of the broader biological aspects of non-surgical ablation, including immune-modulatory effects and potential novel applications for the future.
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Affiliation(s)
- Masakazu Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan; Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Takayuki Kinoshita
- Department of Breast Surgery, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan
| | - John R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK; School of Medicine, Anglia Ruskin University, Chelmsford, UK
| | - Ismail Jatoi
- Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Masako Kataoka
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Chikako Yamauchi
- Department of Radiation Oncology, Shiga General Hospital, Moriyama, Japan
| | - Takashi Inamoto
- Breast Center, Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Masahiro Takada
- Department of Breast Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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4
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van Oossanen R, Maier A, Godart J, Pignol JP, Denkova AG, van Rhoon GC, Djanashvili K. Magnetic hybrid Pd/Fe-oxide nanoparticles meet the demands for ablative thermo-brachytherapy. Int J Hyperthermia 2024; 41:2299480. [PMID: 38189281 DOI: 10.1080/02656736.2023.2299480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE To investigate the potential of hybrid Pd/Fe-oxide magnetic nanoparticles designed for thermo-brachytherapy of breast cancer, considering their specific loss power (SLP) and clinical constraints in the applied magnetic field. METHODS Hybrid nanoparticles consisting of palladium-core and iron oxide shell of increasing thickness, were suspended in water and their SLPs were measured at varying magnetic fields (12-26 mT peak) and frequencies (50-730 kHz) with a commercial alternating magnetic field generator (magneTherm™ Digital, nanoTherics Ltd.). RESULTS Validation of the heating device used in this study with commercial HyperMag-C nanoparticles showed a small deviation (±4%) over a period of 1 year, confirming the reliability of the method. The integration of dual thermometers, one in the center and one at the bottom of the sample vial, allowed monitoring of homogeneity of the sample suspensions. SLPs measurements on a series of nanoparticles of increasing sizes showed the highest heating for the diameter of 21 nm (SLP = 225 W/g) at the applied frequencies of 346 and 730 kHz. No heating was observed for the nanoparticles with the size <14 nm, confirming the importance of the size-parameter. The heating ability of the best performing Pd/Fe-oxide-21 was calculated to be sufficient to ablate tumors with a radius ±4 and 12 mm using 10 and 1 mg/mL nanoparticle concentration, respectively. CONCLUSIONS Nanoparticles consisting of non-magnetic palladium-core and magnetic iron oxide shell are suitable for magnetic hyperthermia/thermal ablation under clinically safe conditions of 346 kHz and 19.1 mT, with minimal eddy current effects in combination with maximum SLP.
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Affiliation(s)
- Rogier van Oossanen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | - Alexandra Maier
- Department of Biotechnology, Delft University of Technology, Delft, The Netherlands
| | - Jérémy Godart
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Jean-Philippe Pignol
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Antonia G Denkova
- Department of Radiation Science and Technology, Delft University of Technology, Delft, The Netherlands
| | - Gerard C van Rhoon
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Kristina Djanashvili
- Department of Biotechnology, Delft University of Technology, Delft, The Netherlands
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Orsi F. Interventional oncology in breast cancer. J Med Imaging Radiat Oncol 2023; 67:876-885. [PMID: 37964687 DOI: 10.1111/1754-9485.13600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well-selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra-arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well-selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described.
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Affiliation(s)
- Franco Orsi
- IRCCS Istituto Europeo di Oncologia, Milan, Italy
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Ji Y, Xu J, Wang Z, Guo X, Kong D, Wang H, Li K. Application of advanced diffusion models from diffusion weighted imaging in a large cohort study of breast lesions. BMC Med Imaging 2023; 23:52. [PMID: 37041466 PMCID: PMC10091641 DOI: 10.1186/s12880-023-01005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND To evaluate multiple parameters in multiple b-value diffusion-weighted imaging (DWI) in characterizing breast lesions and predicting prognostic factors and molecular subtypes. METHODS In total, 504 patients who underwent 3-T magnetic resonance imaging (MRI) with T1-weighted dynamic contrast-enhanced (DCE) sequences, T2-weighted sequences and multiple b-value (7 values, from 0 to 3000 s/mm2) DWI were recruited. The average values of 13 parameters in 6 models were calculated and recorded. The pathological diagnosis of breast lesions was based on the latest World Health Organization (WHO) classification. RESULTS Twelve parameters exhibited statistical significance in differentiating benign and malignant lesions. alpha demonstrated the highest sensitivity (89.5%), while sigma demonstrated the highest specificity (77.7%). The stretched-exponential model (SEM) demonstrated the highest sensitivity (90.8%), while the biexponential model demonstrated the highest specificity (80.8%). The highest AUC (0.882, 95% CI, 0.852-0.912) was achieved when all 13 parameters were combined. Prognostic factors were correlated with different parameters, but the correlation was relatively weak. Among the 6 parameters with significant differences among molecular subtypes of breast cancer, the Luminal A group and Luminal B (HER2 negative) group had relatively low values, and the HER2-enriched group and TNBC group had relatively high values. CONCLUSIONS All 13 parameters, independent or combined, provide valuable information in distinguishing malignant from benign breast lesions. These new parameters have limited meaning for predicting prognostic factors and molecular subtypes of malignant breast tumors.
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Affiliation(s)
- Ying Ji
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650, New Songjiang Road, Shanghai, 201620, China
| | - Junqi Xu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, No. 220, Handan Road, Shanghai, 200433, China
| | - Zilin Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650, New Songjiang Road, Shanghai, 201620, China
| | - Xinyu Guo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650, New Songjiang Road, Shanghai, 201620, China
| | - Dexing Kong
- School of Mathematical Sciences, Zhejiang University, No. 866, Yuhangtang Road, Zhejiang, 310027, China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, No. 220, Handan Road, Shanghai, 200433, China
| | - Kangan Li
- Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 650, New Songjiang Road, Shanghai, 201620, China.
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Yao C, Dong J, Ren K, Sun L, Wang H, Zhang J, Wang H, Xu X, Yao B, Zhou H, Zhao L, Peng R. Accumulative Effects of Multifrequency Microwave Exposure with 1.5 GHz and 2.8 GHz on the Structures and Functions of the Immune System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4988. [PMID: 36981897 PMCID: PMC10049199 DOI: 10.3390/ijerph20064988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
Microwave ablation can produce immune activation due to thermal effects. However, the nonthermal effects of microwaves on the immune system are still largely unexplored. In this study, we sequentially exposed rats to 1.5 GHz microwave for 6 min and 2.8 GHz microwave for 6 min at an average power density of 5, 10, and 30 mW/cm2. The structure of the thymus, spleen, and mesenteric lymph node were observed, and we showed that multifrequency microwave exposure caused tissue injuries, such as congestion and nuclear fragmentation in lymphocytes. Ultrastructural injuries, including mitochondrial swelling, mitochondrial cristae rupture, and mitochondrial cavitation, were observed, especially in the 30 mW/cm2 microwave-exposed group. Generally, multifrequency microwaves decreased white blood cells, as well as lymphocytes, monocytes, and neutrophils, in peripheral blood, from 7 d to 28 d after exposure. Microwaves with an average density of 30 mW/cm2 produced much more significant inhibitory effects on immune cells. Moreover, multifrequency microwaves at 10 and 30 mW/cm2, but not 5 mW/cm2, reduced the serum levels of several cytokines, such as interleukin-1 alpha (IL-1α), IL-1β, interferon γ (IFN-γ) and tumor necrosis factor α (TNF-α), at 7 d and 14 d after exposure. We also found similar alterations in immunoglobulins (Igs), IgG, and IgM in serum. However, no obvious changes in complement proteins were detected. In conclusion, multifrequency microwave exposure of 1.5 GHz and 2.8 GHz caused both structural injuries of immune tissues and functional impairment in immune cells. Therefore, it will be necessary to develop an effective strategy to protect people from multifrequency microwave-induced immune suppression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Li Zhao
- Correspondence: (L.Z.); (R.P.)
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Dai YQ, Liang P, Wang J, Luo YC, Yu XL, Han ZY, Liu FY, Li X, Tan SL, Wang Z, Wu C, Li JM, Yu J. Microwave ablation without subsequent lumpectomy versus breast-conserving surgery for early breast cancer: a propensity score matching study. Int J Hyperthermia 2023; 40:2186325. [PMID: 36944374 DOI: 10.1080/02656736.2023.2186325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
PURPOSE To compare the efficacy of ultrasound-guided percutaneous microwave ablation (MWA) without subsequent lumpectomy and breast-conserving surgery (BCS) in patients with early breast cancer (BC). MATERIALS AND METHODS This retrospective cohort study enrolled 106 patients with early BC (T0/1/2 N0/1 M0) treated by MWA (n = 21) or BCS (n = 85) from October 2014 to December 2020. Propensity score matching (PSM) was performed to balance the baseline characteristics between MWA and BCS groups. The tumor progression, overall survival (OS), disease-specific survival (DSS), complications, and cosmetic results were compared. RESULTS After PSM, there were 21 patients with balanced baseline characteristics in each group. After a median follow-up of 43 months (range, 15-89 months), there was no significant difference in tumor progression (10% vs 2%, p = 0.18), OS (96% vs 99%, p = 0.36), DSS (100% vs 99%, p > 0.99), and complications (0% vs 19%, p = 0.58). The operation time of MWA was shorter (60 min vs 101 min, p < 0.001) than that of BCS. For the management of metastatic lymph nodes, five (5/21, 24%) patients with six metastatic nodes underwent ablation in the MWA group and three patients (3/21, 14%) with six metastatic nodes underwent axillary lymph node dissection in the BCS group. All the patients in the MWA group reported excellent cosmetic results, but 29% of BCS patients expressed dissatisfaction with breast asymmetry (10%) and scar formation (19%) (p < 0.001). CONCLUSION This pilot study indicated that in selected early BC patients, microwave ablation without subsequent lumpectomy had comparable tumor control effect with breast-conserving surgery and better cosmetic results at an intermediate follow-up.HighlightsMWA without subsequent lumpectomy has a comparable interim survival effect and better cosmetic results as BCS in the treatment of selected early breast cancer.MWA has the potential to be a viable and promising therapeutic option for breast cancer patients reluctant or intolerant to surgery with the advantage of minimal invasion.
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Affiliation(s)
- Yu-Qing Dai
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jiandong Wang
- Department of Breast Surgery, Chinese PLA Medical College, Beijing, China
| | - Yan-Chun Luo
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Ling Yu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Li
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Shui-Lian Tan
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhen Wang
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chong Wu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian-Ming Li
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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Percutaneous Management of Breast Cancer: a Systematic Review. Curr Oncol Rep 2022; 24:1443-1459. [PMID: 35699836 DOI: 10.1007/s11912-022-01290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Surgical treatment of breast cancer is becoming increasingly more minimally invasive. We review the development status of percutaneous management for primary breast cancer and the evidence relating to tumor size as a fundamental determinant of treatment clinical outcome. RECENT FINDINGS It is safe and feasible for percutaneous management to treat breast cancer. For tumor size ≤ 2 cm, percutaneous management is a promising alternative modality. For tumor size ≤ 3 cm, it is controversial whether percutaneous management can achieve similar effects to surgery, especially its long-term effects. For tumor size > 3 cm, it is still in the initial exploration stage and showed the potential in the treatment of unresectable cancer by benefitting the local control of primary cancer. Percutaneous management of breast cancer is a valuable method for breast cancer treatment in selected patients. However, it will be necessary to provide the high level of evidence for widespread clinical application.
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Newbury A, Ferguson C, Valero DA, Kutcher-Diaz R, McIntosh L, Karamanian A, Harman A. Interventional oncology update. Eur J Radiol Open 2022; 9:100430. [PMID: 35761853 PMCID: PMC9233207 DOI: 10.1016/j.ejro.2022.100430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 12/29/2022] Open
Abstract
Interventional Oncology (IO) is a subspecialty field of Interventional Radiology bridging between diagnostic radiology and the clinical oncology team, addressing the diagnosis and treatment of cancer. There have been many exciting advancements in the field of IO in recent years; far too many to cover in a single paper. To give each topic sufficient attention, we have limited the scope of this review article to four topics which we feel have the potential to drastically change how cancer is treated managed in the immediate future.
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Affiliation(s)
- Alex Newbury
- UMass Memorial Medical Center, Worcester, MA, USA
| | | | | | | | | | | | - Aaron Harman
- UMass Memorial Medical Center, Worcester, MA, USA
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Liu S, Cai W, Luo Y, Dou J, Wu J, Wu H, Han Z, Yu J, Liang P. CEUS Versus MRI in Evaluation of the Effect of Microwave Ablation of Breast Cancer. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:617-625. [PMID: 35063290 DOI: 10.1016/j.ultrasmedbio.2021.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/13/2021] [Accepted: 11/22/2021] [Indexed: 06/14/2023]
Abstract
Percutaneous microwave ablation (MWA) is a new minimally invasive technique for breast cancer treatment. The aim of this research was to compare the differences in performance between contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging (MRI) with respect to the curative effect of MWA in the treatment of breast cancer. Between 2015 and 2019, 26 patients with breast cancer underwent ultrasound-guided MWA. All patients underwent both CEUS and MRI within 3 d after ablation. If either of the two imaging modalities revealed suspicious enhancement of the ablation zone and the ultrasound-guided biopsy confirmed residual tumor in the suspicious area, supplementary MWA was applied. The diagnostic efficacy of CEUS and MRI within 3 d after ablation was evaluated based on a >6-mo follow-up of 26 patients. Two cases were diagnosed with residual tumors by ultrasound that were missed by MRI. Three cases were diagnosed with residual tumors by MRI that were missed by CEUS. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of CEUS in the diagnosis of complete ablation were 100%, 40%, 87.5%, 100% and 88.5%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of MRI in the diagnosis of complete ablation were 100%, 60%, 91.3%, 100% and 92.3%, respectively. Within 3 d, both CEUS and MRI can efficiently assess the efficacy of MWA of breast cancer.
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Affiliation(s)
- Sisi Liu
- Medical School of Chinese PLA General Hospital, Beijing, China; Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Wenjia Cai
- Medical School of Chinese PLA General Hospital, Beijing, China; Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yanchun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jiapeng Wu
- Medical School of Chinese PLA General Hospital, Beijing, China; Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Ultrasound, Qingdao Municipal Hospital, Qingdao, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
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12
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Chen Y, Huang H, Li Y, Xiao W, Liu Y, Chen R, Zhu Y, Zheng X, Wu C, Chen L. TIGIT Blockade Exerts Synergistic Effects on Microwave Ablation Against Cancer. Front Immunol 2022; 13:832230. [PMID: 35320940 PMCID: PMC8935077 DOI: 10.3389/fimmu.2022.832230] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/16/2022] [Indexed: 12/19/2022] Open
Abstract
Background Combination immunotherapy based on immune checkpoint inhibitors (ICIs) has shown great success in the treatment of many types of cancers and has become the mainstream in the comprehensive treatment of cancers. Ablation in combination with immunotherapy has achieved tremendous efficacy in some preclinical and clinical studies. To date, our team proved that ablation in combination with ICIs was a promising antitumor therapeutic strategy for the liver metastasis of colorectal cancer (CRC). Moreover, we found that the expression of T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) expression was up-regulated after microwave ablation (MWA), indicating that TIGIT was involved in immunosuppression, and the combination of MWA and TIGIT blockade represented a potential clinical treatment strategy. Methods In the present study, we examined the expression of TIGIT using a preclinical mouse model treated with MWA. Moreover, we evaluated the antitumor functions of MWA alone or in combination with TIGIT blockade by monitoring tumor growth and survival of the mice. Besides, we also detected the numbers of tumor-infiltrating lymphocytes (TILs), and effector molecules of CD8+ T cells using flow cytometry. Finally, we analyzed the single-cell RNA sequencing (scRNA-seq) data from the MWA and MWA plus anti-TIGIT groups. Results The expression of TIGIT in various immune cells was up-regulated after MWA, and the addition of TIGIT blockade to MWA prolonged survival and delayed tumor growth in the MC38 tumor model. Taken together, our findings showed that TIGIT blockade in combination with MWA significantly promoted the expansion and functions of CD8+ TILs and reshaped myeloid cells in the tumor microenvironment (TME) using flow cytometry and scRNA-seq analysis. Conclusions TIGIT blockade in combination with MWA was a novel treatment strategy for the liver metastasis of CRC, and this combination therapy could reprogram the TME toward an antitumor environment.
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Affiliation(s)
- Yaping Chen
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hao Huang
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yuan Li
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenlu Xiao
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yingting Liu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Rongzhang Chen
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yulan Zhu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao Zheng
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xiao Zheng, ; Changping Wu, ; Lujun Chen,
| | - Changping Wu
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xiao Zheng, ; Changping Wu, ; Lujun Chen,
| | - Lujun Chen
- Department of Tumor Biological Treatment, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Jiangsu Engineering Research Center for Tumor Immunotherapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- Institute of Cell Therapy, The Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xiao Zheng, ; Changping Wu, ; Lujun Chen,
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13
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van de Voort EMF, Struik GM, Koppert LB, Moelker A, Debets R, Yo G, Macco MJPV, Sinke RHJA, Franckena M, Birnie E, Verhoef C, Klem TMAL. Treatment of early-stage breast cancer with percutaneous thermal ablation, an open-label randomised phase 2 screening trial: rationale and design of the THERMAC trial. BMJ Open 2021; 11:e052992. [PMID: 34489297 PMCID: PMC8422491 DOI: 10.1136/bmjopen-2021-052992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Breast cancer is the most frequently diagnosed malignancy worldwide but almost half of the patients have an excellent prognosis with a 5-year survival rate of 98%-99%. These patients could potentially be treated with thermal ablation to avoid surgical excision, reduce treatment-related morbidity and increase patients' quality of life without jeopardising treatment effectiveness. Previous studies showed highest complete ablation rates for radiofrequency, microwave and cryoablation. However, due to heterogeneity among studies, it is unknown which of these three techniques should be selected for a phase 3 comparative study. METHODS AND ANALYSIS The aim of this phase 2 screening trial is to determine the efficacy rate of radiofrequency, microwave and cryoablation with the intention to select one treatment for further testing in a phase 3 trial. Additionally, exploratory data are obtained for the phase 3 trial. The design is a multicentre open-label randomised phase 2 screening trial. Patients with unifocal, invasive breast cancer with a maximum diameter of 2 cm without lymph node or distant metastases are included. Triple negative, Bloom-Richardson grade 3 tumours and patients with an indication for neoadjuvant chemotherapy will be excluded. Included patients will be allocated to receive one of the three thermal ablation techniques. Three months later surgical excision will be performed to determine the efficacy of thermal ablation. Treatment efficacy in terms of complete ablation rate will be assessed with CK 8/18 and H&E staining. Secondary outcomes include feasibility of the techniques in an outpatient setting, accuracy of MRI for complete ablation, patient satisfaction, adverse events, side effects, cosmetic outcome, system usability and immune response. ETHICS AND DISSEMINATION This study protocol was approved by Medical Research Ethics Committee of the Erasmus Medical Center, Rotterdam, the Netherlands. Study results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NL9205 (www.trialregister.nl); Pre-results.
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Affiliation(s)
- Elles M F van de Voort
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Linetta B Koppert
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Reno Debets
- Laboratory of Tumor Immunology, Department of Medical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Glenn Yo
- Department of Radiology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Maura J P V Macco
- Department of Radiology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | | | - Martine Franckena
- Department of Radiotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
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14
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Roknsharifi S, Wattamwar K, Fishman MDC, Ward RC, Ford K, Faintuch S, Joshi S, Dialani V. Image-guided Microinvasive Percutaneous Treatment of Breast Lesions: Where Do We Stand? Radiographics 2021; 41:945-966. [PMID: 34197250 DOI: 10.1148/rg.2021200156] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Treatment of breast lesions has evolved toward the use of less-invasive or minimally invasive techniques. Minimally invasive treatments destroy focal groups of cells without surgery; hence, less anesthesia is required, better cosmetic outcomes are achieved because of minimal (if any) scarring, and recovery times are shorter. These techniques include cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused US, laser therapy, vacuum-assisted excision, and irreversible electroporation. Each modality involves the use of different mechanisms and requires specific considerations for application. To date, only cryoablation and vacuum-assisted excision have received U.S. Food and Drug Administration approval for treatment of fibroadenomas and have been implemented as part of the treatment algorithm by the American Society of Breast Surgeons. Several clinical studies on this topic have been performed on outcomes in patients with breast cancer who were treated with these techniques. The results are promising, with more data for radiofrequency ablation and cryoablation available than for other minimally invasive methods for treatment of early-stage breast cancer. Clinical decisions should be made on a case-by-case basis, according to the availability of the technique. MRI is the most effective imaging modality for postprocedural follow-up, with the pattern of enhancement differentiating residual or recurrent disease from postprocedural changes. ©RSNA, 2021.
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Affiliation(s)
- Shima Roknsharifi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kapil Wattamwar
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Michael D C Fishman
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Robert C Ward
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Kelly Ford
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Salomao Faintuch
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Surekha Joshi
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
| | - Vandana Dialani
- From the Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (S.R., K.W.); Department of Radiology, Boston Medical Center/Boston University School of Medicine, Boston, Mass (M.D.C.F.); Department of Diagnostic Imaging, Rhode Island Hospital/Alpert Medical School of Brown University, Providence, RI (R.C.W.); Department of Radiology, Memphis Radiological PC, University of Tennessee Health Science Center, Memphis, Tenn (K.F., S.J.); and Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Mass (S.F., V.D.)
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15
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Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, Ter Haar G, Wust P, Crezee J. Heating technology for malignant tumors: a review. Int J Hyperthermia 2021; 37:711-741. [PMID: 32579419 DOI: 10.1080/02656736.2020.1779357] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik N K Cressman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christopher L Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Holger Grüll
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Gail Ter Haar
- Department of Physics, The Institute of Cancer Research, London, UK
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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16
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Pan H, Qian M, Chen H, Wang H, Yu M, Zhang K, Wang S, Deng J, Xu Y, Ling L, Ding Q, Xie H, Wang S, Zhou W. Precision Breast-Conserving Surgery With Microwave Ablation Guidance: A Pilot Single-Center, Prospective Cohort Study. Front Oncol 2021; 11:680091. [PMID: 34123849 PMCID: PMC8187871 DOI: 10.3389/fonc.2021.680091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Negative margins in breast-conserving surgery (BCS) are essential for preventing recurrence. The aim of this study was to determine the use of preoperative microwave ablation (MWA) in the guidance of BCS for early-stage breast cancer and access whether MWA could influence the rates of positive resection margins. Methods From 2016 to 2018, 22 women with T1/T2 invasive breast cancer were enrolled for MWA prospectively in the guidance of BCS. US-guided MWA was performed under local anesthesia, followed by BCS and sentinel lymph node biopsy (SLNB) one week after ablation. Women who underwent palpation-guided BCS directly were included as control, and propensity score matching analysis was applied. Results MWA was performed in 22 patients. Of the 21 MWA cases with effect information, the mean tumor size in US was 20.9 ± 6.2 mm (6-37 mm). Compared with control group (BCS directly), a lower rate of positive/close margins was observed in MWA guidance group (P = 0.018), and MWA caused a higher rate of accurate surgery (the largest margin ≤ 3 cm and the smallest margin ≥ 1mm, P = 0.042). Of these 21 patients treated with MWA, 18 were candidates for SLNB. And sentinel lymph nodes were successfully identified in all cases, and no recurrence was found with a mean follow-up of 23 months. Conclusion For patients with T1/T2 breast cancer, the application of preoperative MWA could guide BCS accurately without impairing SLNB. Clinical trials with long-term results are required to validate MWA in the guidance for breast cancer excision.
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Affiliation(s)
- Hong Pan
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengjia Qian
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hao Chen
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Muxin Yu
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Kai Zhang
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China.,Pancreatic Center & Department of General Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Pancreas Institute of Nanjing Medical University, Nanjing, China
| | - Siqi Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jing Deng
- Department of Ultrasonography, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yi Xu
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Lijun Ling
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiang Ding
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hui Xie
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Shui Wang
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wenbin Zhou
- Department of Breast Surgery, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center For Cancer Personalized Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
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17
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Xia LY, Hu QL, Xu WY. Efficacy and Safety of Radiofrequency Ablation for Breast Cancer Smaller Than 2 cm: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:651646. [PMID: 34012918 PMCID: PMC8126716 DOI: 10.3389/fonc.2021.651646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate the efficacy and safety of radiofrequency ablation (RFA) of breast cancer smaller than 2 cm. Methods A systematic search was conducted in the PubMed and EMBASE databases to identify published studies investigating the efficacy and safety of RFA for breast cancer smaller than 2 cm. The main outcomes were technical success rate of the ablation, complete ablation rate, complications and local recurrence. Secondary considerations were mode of anesthesia, pain tolerance, mean ablation time and surgical excision after ablation. Results Seventeen studies involving 399 patients and 401 lesions met the inclusion criteria. Nearly 99%(95%CI=0.98-1.00) of lesions achieved good technical success rate.Notably, 83.88% of the patients received RFA under general anesthesia (333/397) whereas 15.87% received RFA under local anesthesia (63/397). Of the 63, 98.41% tolerated the pain associated with the procedure. Majority of patients (65.74%, 261/397) underwent surgical excision of the tumor after ablation whereas in a few patients (34.26%, 136/397), the tumor tissue was retained in the breast after ablation. Complete ablation was achieved in 96% of patients for a mean time of 15.8 minutes (95%CI=0.93-0.99). Overall, only 2% (95%CI=0.01-0.04) of the individuals developed complications. Skin burns (2.02%, 8/397) were the most common complications. There was no local recurrence after a median follow-up of 27.29 months, whether or not they underwent surgical resection following RFA. Conclusion The results show that RFA for breast cancer smaller than 2 cm is safe and effective. However, prospective studies are needed to validate this conclusion.
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Affiliation(s)
- Lin-Yu Xia
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Qing-Lin Hu
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wei-Yun Xu
- Department of Breast Surgery, Mianyang Central Hospital, Mianyang, China
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18
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van de Voort EMF, Struik GM, Birnie E, Moelker A, Verhoef C, Klem TMAL. Thermal Ablation as an Alternative for Surgical Resection of Small (≤ 2 cm) Breast Cancers: A Meta-Analysis. Clin Breast Cancer 2021; 21:e715-e730. [PMID: 33840627 DOI: 10.1016/j.clbc.2021.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 02/23/2021] [Accepted: 03/06/2021] [Indexed: 12/12/2022]
Abstract
Women with early-stage breast cancer have an excellent prognosis with current therapy, but could presumably be treated less invasively, without the need for surgery. The primary goal of this meta-analysis was to examine whether thermal ablation is an effective method to treat early-stage breast cancer. Studies reporting on complete ablation rate after thermal ablation as a treatment of small breast cancers (≤ 2 cm) were included. Methodologic quality of included studies was assessed using MINORS criteria. Complete ablation rates are given as proportions, and meta-regression and subgroup analyses were performed. The overall complete ablation rate in 1266 patients was 86% and was highest after radiofrequency ablation (RFA) (92%). Local recurrence rates varied from 0% to 3%, with a median follow-up of 15 to 61 months. Overall, complication rates were low (5%-18% across techniques) and were highest after high-intensity focused ultrasound ablation and lowest after cryoablation. Cosmetic outcome was good to excellent in at least 85% of patients but was reported infrequently and long-term results of cosmetic outcome after thermal ablation and radiotherapy are still lacking. Thermal ablation techniques treating early-stage breast cancer (≤ 2 cm) are safe and effective based on complete ablation rate and short-term local recurrence rates. Especially, RFA, microwave ablation, and cryoablation are promising techniques as an alternative to surgical resection without jeopardizing current treatment effectiveness or safety. Owing to great heterogeneity in the included studies, a formal recommendation on the best technique is not possible. These findings warrant the design of large randomized controlled trials comparing thermal ablation and breast-conserving surgery in the treatment of T1 breast cancer.
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Affiliation(s)
| | - Gerson M Struik
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Surgery, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Adriaan Moelker
- Department of Interventional Radiology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Taco M A L Klem
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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19
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Ultrasound-guided percutaneous microwave ablation for 755 benign breast lesions: a prospective multicenter study. Eur Radiol 2020; 30:5029-5038. [DOI: 10.1007/s00330-020-06868-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/13/2020] [Accepted: 04/06/2020] [Indexed: 02/03/2023]
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20
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Jiménez Mazure C, Ribeiro González M, Soto Aguilar C, Hidalgo Martín MT, Jiménez Fernández AJ, Ferrer González MA, Pulido Roa Y, Santoyo Santoyo J. Radiofrequency Ablation of the Surgical Bed After Lumpectomy in Breast-conserving Surgery. Cir Esp 2020; 98:472-477. [PMID: 32192688 DOI: 10.1016/j.ciresp.2020.01.010] [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: 12/09/2019] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obtaining tumor-free margins during breast conservative surgery (BCS) is essential to avoid local recurrence and frequently requires reoperation. Radiofrequency ablation (RFA) of surgical margins after lumpectomy seems to be a helpful tool to avoid reoperations, but evidence is insufficient. This study analyzes the efficacy and safety of RFA after BCS to obtain free surgical margins. METHODS Non-randomized experimental study performed in an intervention group of 40 patients assigned to receive RFA after lumpectomy and successive resection of surgical margins, and a historical control group of 40 patients treated with BCS alone. In the intervention group, the RFA effect on tumor cell viability in the surgical margins was analyzed. Also, reoperation rate, complications and cosmetic results were compared in both groups. RESULTS A total of 240 excised margins were analyzed after RFA, obtaining a high number of tumor-free margins. Compared to the control group, the reoperation rate decreased significantly (0% vs 12%; P=.02), without differences in terms of postoperative complications (10% vs 5%; P=.67) or cosmetic results (excellent or good 92.5% vs 95%; P=.3). CONCLUSIONS RFA after lumpectomy is a reliable, safe and successful procedure to obtain tumor-free surgical margins and to decrease the reoperation rate without affecting complications or compromising cosmetic results.
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Affiliation(s)
- Carolina Jiménez Mazure
- Unidad de Mama, Hospital Regional Universitario de Málaga, Málaga, España; Unidad de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Marta Ribeiro González
- Unidad de Mama, Hospital Regional Universitario de Málaga, Málaga, España; Unidad de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, Málaga, España
| | - Carmen Soto Aguilar
- Unidad de Radiodiagnóstico y Radiología Intervencionista, Hospital Regional Universitario de Málaga, Málaga, España
| | - María Teresa Hidalgo Martín
- Unidad de Radiodiagnóstico y Radiología Intervencionista, Hospital Regional Universitario de Málaga, Málaga, España
| | | | - María Auxiliadora Ferrer González
- Unidad de Mama, Hospital Regional Universitario de Málaga, Málaga, España; Unidad de Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, Málaga, España
| | - Ysabel Pulido Roa
- Unidad de Mama, Hospital Regional Universitario de Málaga, Málaga, España; Unidad de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, Málaga, España
| | - Julio Santoyo Santoyo
- Unidad de Cirugía General y Digestiva, Hospital Regional Universitario de Málaga, Málaga, España
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21
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Alessio N, Santoro E, Squillaro T, Aprile D, Briccola M, Giubbini P, Marchesani R, Muoio MR, Lamberti M. Low-Level Radiofrequency Exposure Does Not Induce Changes in MSC Biology: An in vitro Study for the Prevention of NIR-Related Damage. STEM CELLS AND CLONING-ADVANCES AND APPLICATIONS 2020; 12:49-59. [PMID: 31908499 PMCID: PMC6927227 DOI: 10.2147/sccaa.s204166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/10/2019] [Indexed: 12/23/2022]
Abstract
Background The ubiquitous diffusion of radiofrequency (RF) radiation across human living environments has attracted the attention of scientists. Though the adverse health effects of RF exposure remain debatable, it has been reported that the interaction of such radiation with biological macromolecular structures can be deleterious for stem cells, inducing impairment of their main functions involving self-renewal and differentiation. Purpose The purpose of this study was to determine whether exposure to RF of 169 megahertz (MHz) that is part of very high radiofrequency (VHF) range 30–300 MHz, could cause damage to stem cells by inducing senescence and loss of regenerative and DNA repair capacity. Methods The study was conducted on mesenchymal stromal cells (MSCs) containing a subpopulation of stem cells. The MSCs were exposed to RFs of 169 MHz administered via an open meter 2G “Smart Meter” for different durations of time. Result We did not observe modifications in MSC biology as a result of the RF exposure conducted in our experiments. Conclusion We concluded that MSCs are insensitive to RF radiation exposure at 169 MHz for various time intervals, including longer durations.
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Affiliation(s)
- Nicola Alessio
- Department of Experimental Medicine, Biotechnology and Molecular Biology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elisa Santoro
- Department of Experimental Medicine, Occupational Medicine Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Tiziana Squillaro
- Department of Medical, Surgical, Neurological, Metabolic Sciences, and Aging, 2nd Division of Neurology, Center for Rare Diseases and InterUniversity Center for Research in Neurosciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Domenico Aprile
- Department of Experimental Medicine, Biotechnology and Molecular Biology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | | | | | - Maria Rosaria Muoio
- Department of Experimental Medicine, Occupational Medicine Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Monica Lamberti
- Department of Experimental Medicine, Occupational Medicine Section, University of Campania "Luigi Vanvitelli", Naples, Italy
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22
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Yu J, Wu H, Meng XW, Mu MJ, Dou JP, Ahmed M, Liang P. Ultrasound-guided percutaneous microwave ablation of central intraductal papilloma: a prospective pilot study. Int J Hyperthermia 2019; 36:606-612. [PMID: 31179781 DOI: 10.1080/02656736.2019.1619849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xian-Wei Meng
- CAS Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing, China
| | - Meng-Juan Mu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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23
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Ringel-Scaia VM, Beitel-White N, Lorenzo MF, Brock RM, Huie KE, Coutermarsh-Ott S, Eden K, McDaniel DK, Verbridge SS, Rossmeisl JH, Oestreich KJ, Davalos RV, Allen IC. High-frequency irreversible electroporation is an effective tumor ablation strategy that induces immunologic cell death and promotes systemic anti-tumor immunity. EBioMedicine 2019; 44:112-125. [PMID: 31130474 PMCID: PMC6606957 DOI: 10.1016/j.ebiom.2019.05.036] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/18/2022] Open
Abstract
Background Despite promising treatments for breast cancer, mortality rates remain high and treatments for metastatic disease are limited. High-frequency irreversible electroporation (H-FIRE) is a novel tumor ablation technique that utilizes high-frequency bipolar electric pulses to destabilize cancer cell membranes and induce cell death. However, there is currently a paucity of data pertaining to immune system activation following H-FIRE and other electroporation based tumor ablation techniques. Methods Here, we utilized the mouse 4T1 mammary tumor model to evaluate H-FIRE treatment parameters on cancer progression and immune system activation in vitro and in vivo. Findings H-FIRE effectively ablates the primary tumor and induces a pro-inflammatory shift in the tumor microenvironment. We further show that local treatment with H-FIRE significantly reduces 4T1 metastases. H-FIRE kills 4T1 cells through non-thermal mechanisms associated with necrosis and pyroptosis resulting in damage associated molecular pattern signaling in vitro and in vivo. Our data indicate that the level of tumor ablation correlates with increased activation of cellular immunity. Likewise, we show that the decrease in metastatic lesions is dependent on the intact immune system and H-FIRE generates 4T1 neoantigens that engage the adaptive immune system to significantly attenuate tumor progression. Interpretation Cell death and tumor ablation following H-FIRE treatment activates the local innate immune system, which shifts the tumor microenvironment from an anti-inflammatory state to a pro-inflammatory state. The non-thermal damage to the cancer cells and increased innate immune system stimulation improves antigen presentation, resulting in the engagement of the adaptive immune system and improved systemic anti-tumor immunity.
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Affiliation(s)
- Veronica M Ringel-Scaia
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Natalie Beitel-White
- Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA; Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Melvin F Lorenzo
- Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA; Virginia Tech - Wake Forest University, Virginia Tech, School of Biomedical Engineering & Sciences, Blacksburg, VA, USA
| | - Rebecca M Brock
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kathleen E Huie
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kristin Eden
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA; Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Dylan K McDaniel
- Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Scott S Verbridge
- Virginia Tech - Wake Forest University, Virginia Tech, School of Biomedical Engineering & Sciences, Blacksburg, VA, USA; Center for Engineered Health, Virginia Tech, Institute for Critical Technology and Applied Science, Blacksburg, VA, USA
| | - John H Rossmeisl
- Center for Engineered Health, Virginia Tech, Institute for Critical Technology and Applied Science, Blacksburg, VA, USA; Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA
| | - Kenneth J Oestreich
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA; Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Center for Engineered Health, Virginia Tech, Institute for Critical Technology and Applied Science, Blacksburg, VA, USA; Virginia Tech, Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Rafael V Davalos
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA; Virginia Tech - Wake Forest University, Virginia Tech, School of Biomedical Engineering & Sciences, Blacksburg, VA, USA; Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Center for Engineered Health, Virginia Tech, Institute for Critical Technology and Applied Science, Blacksburg, VA, USA
| | - Irving C Allen
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA; Department of Biomedical Sciences and Pathobiology, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA, USA; Department of Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA; Center for Engineered Health, Virginia Tech, Institute for Critical Technology and Applied Science, Blacksburg, VA, USA.
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24
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Mauri G, Sconfienza LM, Sardanelli F. Imaging-guided Percutaneous Ablation: A Step Forward to Minimize the Invasiveness of Breast Cancer Treatment. Radiology 2019; 290:849-850. [DOI: 10.1148/radiol.2019182448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Unit of Diagnostics and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Radiology Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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