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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2310856. [PMID: 38771628 PMCID: PMC11309902 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, Arizona 85054, USA
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Campbell WA, Makary MS. Advances in Image-Guided Ablation Therapies for Solid Tumors. Cancers (Basel) 2024; 16:2560. [PMID: 39061199 PMCID: PMC11274819 DOI: 10.3390/cancers16142560] [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: 05/26/2024] [Revised: 06/26/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Image-guided solid tumor ablation methods have significantly advanced in their capability to target primary and metastatic tumors. These techniques involve noninvasive or percutaneous insertion of applicators to induce thermal, electrochemical, or mechanical stress on malignant tissue to cause tissue destruction and apoptosis of the tumor margins. Ablation offers substantially lower risks compared to traditional methods. Benefits include shorter recovery periods, reduced bleeding, and greater preservation of organ parenchyma compared to surgical intervention. Due to the reduced morbidity and mortality, image-guided tumor ablation offers new opportunities for treatment in cancer patients who are not candidates for resection. Currently, image-guided ablation techniques are utilized for treating primary and metastatic tumors in various organs with both curative and palliative intent, including the liver, pancreas, kidneys, thyroid, parathyroid, prostate, lung, breast, bone, and soft tissue. The invention of new equipment and techniques is expanding the criteria of eligible patients for therapy, as now larger and more high-risk tumors near critical structures can be ablated. This article provides an overview of the different imaging modalities, noninvasive, and percutaneous ablation techniques available and discusses their applications and associated complications across various organs.
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Affiliation(s)
- Warren A. Campbell
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, VA 22903, USA
| | - Mina S. Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Yun JH, Fang A, Khorshidi F, Habibollahi P, Kutsenko O, Etezadi V, Hunt S, Nezami N. New Developments in Image-Guided Percutaneous Irreversible Electroporation of Solid Tumors. Curr Oncol Rep 2023; 25:1213-1226. [PMID: 37695398 DOI: 10.1007/s11912-023-01452-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW This review will describe the various applications, benefits, risks, and approaches of conventional irreversible electroporation (IRE), as well as highlight the new technological developments of this procedure along with their clinical applications. RECENT FINDINGS Minimally invasive image-guided percutaneous IRE ablation has emerged as a newer, non-thermal ablation technique for tumors in the solid organs, particularly within the liver, pancreas, kidney, and prostate. IRE allows for ablation near heat-sensitive structures, including major blood vessels and nerves, and is not susceptible to the heat sink effect. However, it is limited by certain requirements, such as the need for precise parallel placement of at least two probes with a maximum inter-probe distance of 2.5 cm to reduce the risk of arching phenomenon, the requirement for general anesthesia with muscle relaxant, and the need for cardiac synchronization. However, new technological advancements in the ablation system and image guidance tools have been introduced to improve the efficiency and efficacy of IRE. IRE is a safe and effective treatment option for solid tumor ablation within the liver, pancreas, kidney, and prostate. Compared with other ablation techniques, IRE has several advantages, such as the absence of heat sink effect and minimal injury to blood vessels and bile ducts while activating the immune system. Novel techniques such as H-FIRE, needle placement systems, and robotics have enhanced the accuracy and performance in placement of IRE probes. IRE can be especially beneficial when combined with chemotherapy, immunomodulation, and immunotherapy.
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Affiliation(s)
- Jung H Yun
- Division of Vascular and Interventional Radiology, Jefferson Einstein Hospital, Philadelphia, PA, USA
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Fereshteh Khorshidi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA
| | - Stephen Hunt
- Division of Interventional Radiology, Department of Radiology, the University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD, N2W79A, USA.
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
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Microwave Ablation, Radiofrequency Ablation, Irreversible Electroporation, and Stereotactic Ablative Body Radiotherapy for Intermediate Size (3-5 cm) Unresectable Colorectal Liver Metastases: a Systematic Review and Meta-analysis. Curr Oncol Rep 2022; 24:793-808. [PMID: 35298796 PMCID: PMC9054902 DOI: 10.1007/s11912-022-01248-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 12/12/2022]
Abstract
Purpose of Review Based on good local control rates and an excellent safety profile, guidelines consider thermal ablation the gold standard to eliminate small unresectable colorectal liver metastases (CRLM). However, efficacy decreases exponentially with increasing tumour size. The preferred treatment for intermediate-size unresectable CRLM remains uncertain. This systematic review and meta-analysis compare safety and efficacy of local ablative treatments for unresectable intermediate-size CRLM (3–5 cm). Recent Findings We systematically searched for publications reporting treatment outcomes of unresectable intermediate-size CRLM treated with thermal ablation, irreversible electroporation (IRE) or stereotactic ablative body-radiotherapy (SABR). No comparative studies or randomized trials were found. Literature to assess effectiveness was limited and there was substantial heterogeneity in outcomes and study populations. Per-patient local control ranged 22–90% for all techniques; 22–89% (8 series) for thermal ablation, 44% (1 series) for IRE, and 67–90% (1 series) for SABR depending on radiation dose. Summary Focal ablative therapy is safe and can induce long-term disease control, even for intermediate-size CRLM. Although SABR and tumuor-bracketing techniques such as IRE are suggested to be less susceptible to size, evidence to support any claims of superiority of one technique over the other is unsubstantiated by the available evidence. Future prospective comparative studies should address local-tumour-progression-free-survival, local control rate, overall survival, adverse events, and quality-of-life.
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Barzakova E, Senthilvel N, Bruners P, Keil S, Lurje G, Zimmermann M, Kuhl CK, Isfort P. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome. ROFO-FORTSCHR RONTG 2021; 194:515-520. [PMID: 34794185 DOI: 10.1055/a-1669-9342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations. MATERIALS AND METHODS We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL. RESULTS 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6-16.9 %] vs. 3.4 % [2/59; 0.4-11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %-30.5 %] vs. 16.9 % [10/59; 8.4-29.0 %]), or median ihPFS (15.5 months vs. 14.3 months). CONCLUSION Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement. KEY POINTS · Liver tumors can be successfully ablated even if they are not detectable on the navigational CT scan.. · Anatomical landmarks should be used and compared to preinterventional imaging.. CITATION FORMAT · Barzakova E, Senthilvel N, Bruners P et al. Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome . Fortschr Röntgenstr 2021; DOI: 10.1055/a-1669-9342.
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Affiliation(s)
- Emona Barzakova
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Niveditha Senthilvel
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Sebastian Keil
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Georg Lurje
- Department of Surgery and Transplantation, University Hospital RWTH Aachen, Germany
| | - Markus Zimmermann
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
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Recurrent Colorectal Liver Metastases in the Liver Remnant After Major Liver Surgery-IRE as a Salvage Local Treatment When Resection and Thermal Ablation are Unsuitable. Cardiovasc Intervent Radiol 2021; 45:182-189. [PMID: 34757483 PMCID: PMC8807435 DOI: 10.1007/s00270-021-02981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To examine the safety and short-term oncologic outcomes of computer-tomography-guided (CT-guided) irreversible electroporation (IRE) of recurrent, irresectable colorectal liver metastases (CRLM) after major hepatectomy deemed unsuitable for thermal ablation. PATIENTS AND METHODS Twenty-three patients undergoing CT-guided IRE of recurrent CRLM after major hepatectomy were included in this study. All tumors were located adjacent to sole remaining intrahepatic blood vessels and bile ducts, precluding thermal ablation. Patients underwent systematic clinical and imaging follow-up, including magnetic resonance imaging of the liver at 1-month and 3-month intervals thereafter. Time to local and intrahepatic tumor progression within 12 and 36 months and associated risk factors were assessed using Kaplan Meier and Cox regression analysis, respectively. RESULTS Complete ablation with a safety margin of at least 0.5 cm was achieved in 22/23 (95.6%) patients. No vessel injury or thrombosis occurred. Five patients developed moderate biliary stenosis after a median of 4 weeks, without requiring treatment. Local tumor-progression-free rates within 12/36 months were 64%/57.4%, respectively. Intrahepatic-progression-free rate within 12/36 months was 36.4%/19.5%, respectively. Five (23%) patients were tumor-free at the end of follow-up. Multivariate Cox regression analysis did not show any association between local tumor-progression-free rates and patient age, target tumor size, primary tumor side or synchronicity of liver metastases. CONCLUSION In this highly selected patient population with local recurrences of CRLM after major surgery, IRE was shown to be a safe salvage treatment option when thermal ablation is unsuitable.
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Zane KE, Cloyd JM, Mumtaz KS, Wadhwa V, Makary MS. Metastatic disease to the liver: Locoregional therapy strategies and outcomes. World J Clin Oncol 2021; 12:725-745. [PMID: 34631439 PMCID: PMC8479345 DOI: 10.5306/wjco.v12.i9.725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Secondary cancers of the liver are more than twenty times more common than primary tumors and are incurable in most cases. While surgical resection and systemic chemotherapy are often the first-line therapy for metastatic liver disease, a majority of patients present with bilobar disease not amenable to curative local resection. Furthermore, by the time metastasis to the liver has developed, many tumors demonstrate a degree of resistance to systemic chemotherapy. Fortunately, catheter-directed and percutaneous locoregional approaches have evolved as major treatment modalities for unresectable metastatic disease. These novel techniques can be used for diverse applications ranging from curative intent for small localized tumors, downstaging of large tumors for resection, or locoregional control and palliation of advanced disease. Their use has been associated with increased tumor response, increased disease-free and overall survival, and decreased morbidity and mortality in a broad range of metastatic disease. This review explores recent advances in liver-directed therapies for metastatic liver disease from primary colorectal, neuroendocrine, breast, and lung cancer, as well as uveal melanoma, cholangiocarcinoma, and sarcoma. Therapies discussed include bland transarterial embolization, chemoembolization, radioembolization, and ablative therapies, with a focus on current treatment approaches, outcomes of locoregional therapy, and future directions in each type of metastatic disease.
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Affiliation(s)
- Kylie E Zane
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Jordan M Cloyd
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid S Mumtaz
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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9
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Modern therapeutic approaches for the treatment of malignant liver tumours. Nat Rev Gastroenterol Hepatol 2020; 17:755-772. [PMID: 32681074 DOI: 10.1038/s41575-020-0314-8] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 02/06/2023]
Abstract
Malignant liver tumours include a wide range of primary and secondary tumours. Although surgery remains the mainstay of curative treatment, modern therapies integrate a variety of neoadjuvant and adjuvant strategies and have achieved dramatic improvements in survival. Extensive tumour loads, which have traditionally been considered unresectable, are now amenable to curative treatment through systemic conversion chemotherapies followed by a variety of interventions such as augmentation of the healthy liver through portal vein occlusion, staged surgeries or ablation modalities. Liver transplantation is established in selected patients with hepatocellular carcinoma but is now emerging as a promising option in many other types of tumour such as perihilar cholangiocarcinomas, neuroendocrine or colorectal liver metastases. In this Review, we summarize the available therapies for the treatment of malignant liver tumours, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy. In addition, we describe three complex case studies of patients with malignant liver tumours. Finally, we discuss the outlook for future treatment, including personalized approaches based on molecular tumour subtyping, response to targeted drugs, novel biomarkers and precision surgery adapted to the specific tumour.
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Ranieri G, Laface C, Laforgia M, De Summa S, Porcelli M, Macina F, Ammendola M, Molinari P, Lauletta G, Di Palo A, Rubini G, Ferrari C, Gadaleta CD. Bevacizumab Plus FOLFOX-4 Combined With Deep Electro-Hyperthermia as First-line Therapy in Metastatic Colon Cancer: A Pilot Study. Front Oncol 2020; 10:590707. [PMID: 33224885 PMCID: PMC7670056 DOI: 10.3389/fonc.2020.590707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/08/2020] [Indexed: 12/21/2022] Open
Abstract
Bevacizumab plus FOLFOX-4 regimen represents the first-line therapy in patients affected by metastatic colorectal cancer (mCRC). Hyperthermia has been considered an effective ancillary treatment for cancer therapy through several anti-tumor mechanisms, sharing with Bevacizumab the inhibition of angiogenesis. Up to now, scientific literature offers very few clinical data on the combination of bevacizumab plus oxaliplatin-based chemotherapy with deep electro-hyperthermia (DEHY) for metastatic colon cancer (mCC) patients. Therefore, we aimed at evaluating the efficacy of this combination based on the possible interaction between the DEHY and bevacizumab anti-tumor mechanisms. We conducted a retrospective analysis on 40 patients affected by mCC treated with the combination of bevacizumab plus FOLFOX-4 (fluorouracil/folinic acid plus oxaliplatin) and DEHY (EHY2000), between January 2017 and May 2020. DEHY treatment was performed weekly, with capacitive electrodes at 80-110 W for 50 min, during and between subsequent bevacizumab administrations, on abdomen for liver or abdominal lymph nodes metastases and thorax for lung metastases. Treatment response assessment was performed according to the Response Evaluation Criteria for Solid Tumors (RECIST). The primary endpoints were disease control rate (DCR) and progression-free survival (PFS). The secondary endpoint was overall survival (OS). DCR, counted as the percentage of patients who had the best response rating [complete response (CR), partial response (PR), or stable disease (SD)], was assessed at 90 days (timepoint-1) and at 180 days (timepoint-2). DCR was 95% and 89.5% at timepoint-1 and timepoint-2, respectively. The median PFS was 12.1 months, whereas the median OS was 21.4 months. No major toxicity related to DEHY was registered; overall, this combination regimen was safe. Our results suggest that the combined treatment of DEHY with bevacizumab plus FOLFOX-4 as first-line therapy in mCC is feasible and effective with a favorable disease control, prolonging PFS of 2.7 months with respect to standard treatment without DEHY for mCC patients. Further studies will be required to prove its merit and explore its potentiality, especially if compared to conventional treatment.
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Affiliation(s)
- Girolamo Ranieri
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Carmelo Laface
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | | | - Simona De Summa
- Molecular Diagnostics and Pharmacogenetics Unit, IRCCS-Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Mariangela Porcelli
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Francesco Macina
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Michele Ammendola
- Department of Health Science, Digestive Surgery Unit, University "Magna Graecia" Medical School, Germaneto, Italy
| | - Pasquale Molinari
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
| | - Gianfranco Lauletta
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine "G. Baccelli", University of Bari Medical School, Bari, Italy
| | - Alessandra Di Palo
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppe Rubini
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Cristina Ferrari
- Nuclear Medicine Unit, D.I.M., University of Bari "Aldo Moro", Bari, Italy
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, IRCCS Istituto Tumori "G. Paolo II", Bari, Italy
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11
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Ruarus AH, Barabasch A, Catalano O, Leen E, Narayanan G, Nilsson A, Padia SA, Wiggermann P, Scheffer HJ, Meijerink MR. Irreversible Electroporation for Hepatic Tumors: Protocol Standardization Using the Modified Delphi Technique. J Vasc Interv Radiol 2020; 31:1765-1771.e15. [PMID: 32978054 DOI: 10.1016/j.jvir.2020.02.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 02/06/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE A consensus study of panelists was performed to provide a uniform protocol regarding (contra) indications, procedural parameters, perioperative care, and follow-up of irreversible electroporation (IRE) for the treatment of hepatic malignancies. MATERIALS AND METHODS Interventional radiologists who had 2 or more publications on IRE, reporting at least 1 patient cohort in the field of hepatobiliary IRE, were recruited. The 8 panelists were asked to anonymously complete 3 iterative rounds of IRE-focused questionnaires to collect data according to a modified Delphi technique. Consensus was defined as having reached 80% or greater agreement. RESULTS Panel members' response rates were 88%, 75%, and 88% in rounds 1, 2, and 3, respectively; consensus was reached on 124 of 136 items (91%). Percutaneous or intraoperative hepatic IRE should be considered for unresectable primary and secondary malignancies that are truly unsuitable for thermal ablation because of proximity to critical structures. Absolute contraindications are ventricular arrhythmias, cardiac stimulation devices, and congestive heart failure of New York Heart Association class 3 or higher. A metal stent outside the ablation zone should not be considered a contraindication. For the only commercially available IRE device, the recommended settings are an inter-electrode distance of 10-20 mm and an exposure length of 20 mm. After 10 test pulses, 90 treatment pulses of 1500 V/cm should be delivered continuously, with a pulse length of 70-90 μs. The first post-procedural follow-up should take place 1 month after IRE and thereafter every 3 months, using cross-sectional imaging plus tumor marker assessment. CONCLUSIONS This article provides recommendations, created by a modified Delphi consensus study, regarding patient selection, workup, procedure, and follow-up of IRE treatment for hepatic malignancies.
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Affiliation(s)
- Alette H Ruarus
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
| | - Alexandra Barabasch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Orlando Catalano
- Department of Radiology, Istituto Nazionale Tumori Fondazione G.Pascale, Naples, Italy
| | - Edward Leen
- Department of Experimental Medicine, Imperial College London, London, United Kingdom
| | - Govindarajan Narayanan
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Miami, Florida
| | - Anders Nilsson
- Department of Medical Imaging and Physiology, Lund University Hospital, Lund, Sweden
| | - Siddharth A Padia
- Department of Radiology, University of California Los Angeles, Los Angeles, California
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Resectability and Ablatability Criteria for the Treatment of Liver Only Colorectal Metastases: Multidisciplinary Consensus Document from the COLLISION Trial Group. Cancers (Basel) 2020; 12:cancers12071779. [PMID: 32635230 PMCID: PMC7407587 DOI: 10.3390/cancers12071779] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/06/2023] Open
Abstract
The guidelines for metastatic colorectal cancer crudely state that the best local treatment should be selected from a ‘toolbox’ of techniques according to patient- and treatment-related factors. We created an interdisciplinary, consensus-based algorithm with specific resectability and ablatability criteria for the treatment of colorectal liver metastases (CRLM). To pursue consensus, members of the multidisciplinary COLLISION and COLDFIRE trial expert panel employed the RAND appropriateness method (RAM). Statements regarding patient, disease, tumor and treatment characteristics were categorized as appropriate, equipoise or inappropriate. Patients with ECOG≤2, ASA≤3 and Charlson comorbidity index ≤8 should be considered fit for curative-intent local therapy. When easily resectable and/or ablatable (stage IVa), (neo)adjuvant systemic therapy is not indicated. When requiring major hepatectomy (stage IVb), neo-adjuvant systemic therapy is appropriate for early metachronous disease and to reduce procedural risk. To downstage patients (stage IVc), downsizing induction systemic therapy and/or future remnant augmentation is advised. Disease can only be deemed permanently unsuitable for local therapy if downstaging failed (stage IVd). Liver resection remains the gold standard. Thermal ablation is reserved for unresectable CRLM, deep-seated resectable CRLM and can be considered when patients are in poor health. Irreversible electroporation and stereotactic body radiotherapy can be considered for unresectable perihilar and perivascular CRLM 0-5cm. This consensus document provides per-patient and per-tumor resectability and ablatability criteria for the treatment of CRLM. These criteria are intended to aid tumor board discussions, improve consistency when designing prospective trials and advance intersociety communications. Areas where consensus is lacking warrant future comparative studies.
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Geboers B, Scheffer HJ, Graybill PM, Ruarus AH, Nieuwenhuizen S, Puijk RS, van den Tol PM, Davalos RV, Rubinsky B, de Gruijl TD, Miklavčič D, Meijerink MR. High-Voltage Electrical Pulses in Oncology: Irreversible Electroporation, Electrochemotherapy, Gene Electrotransfer, Electrofusion, and Electroimmunotherapy. Radiology 2020; 295:254-272. [PMID: 32208094 DOI: 10.1148/radiol.2020192190] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This review summarizes the use of high-voltage electrical pulses (HVEPs) in clinical oncology to treat solid tumors with irreversible electroporation (IRE) and electrochemotherapy (ECT). HVEPs increase the membrane permeability of cells, a phenomenon known as electroporation. Unlike alternative ablative therapies, electroporation does not affect the structural integrity of surrounding tissue, thereby enabling tumors in the vicinity of vital structures to be treated. IRE uses HVEPs to cause cell death by inducing membrane disruption, and it is primarily used as a radical ablative therapy in the treatment of soft-tissue tumors in the liver, kidney, prostate, and pancreas. ECT uses HVEPs to transiently increase membrane permeability, enhancing cellular cytotoxic drug uptake in tumors. IRE and ECT show immunogenic effects that could be augmented when combined with immunomodulatory drugs, a combination therapy the authors term electroimmunotherapy. Additional electroporation-based technologies that may reach clinical importance, such as gene electrotransfer, electrofusion, and electroimmunotherapy, are concisely reviewed. HVEPs represent a substantial advancement in cancer research, and continued improvement and implementation of these presented technologies will require close collaboration between engineers, interventional radiologists, medical oncologists, and immuno-oncologists.
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Affiliation(s)
- Bart Geboers
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Hester J Scheffer
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Philip M Graybill
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Alette H Ruarus
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Sanne Nieuwenhuizen
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Robbert S Puijk
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Petrousjka M van den Tol
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Rafael V Davalos
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Boris Rubinsky
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Tanja D de Gruijl
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Damijan Miklavčič
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
| | - Martijn R Meijerink
- From the Departments of Radiology and Nuclear Medicine (B.G., H.J.S., A.H.R., S.N., R.S.P., M.R.M.), Surgery (P.M.v.d.T.), and Medical Oncology (T.D.d.G.), Amsterdam University Medical Centers, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands; Bioelectromechanical Systems Laboratory, Department of Biomedical Engineering and Mechanics, Virginia Tech-Wake Forest University, Blacksburg, Va (P.M.G., R.V.D.); Department of Bioengineering and Department of Mechanical Engineering, University of California, Berkeley, Berkeley, Calif (B.R.); and Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia (D.M.)
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Abstract
Colorectal cancer (CRC) is one of the most common cancers in the world. About two third of patients with CRC will develop distant recurrence at some point in time. Liver is the most common site where distant metastasis takes place. While the overall survival (OS) of patients with metastatic CRC was poor about 3 decades ago, there has been tremendous improvement in this area in the recent years. With the advent of effective systemic chemotherapy and biologic agents and better understanding of the biological behaviour of the tumour, aggressive treatment strategies such as metastatectomy of the liver metastases (or lung metastases) are now acceptable. More importantly, it has transformed the way how stage IV CRCs are being managed. From predominantly palliative as the primary aim, a comprehensive multidisciplinary approach is now the mainstay of treatment with very successful outcomes. Combination of systemic therapies with liver resection has been shown to be effective in providing promising survival benefits. In addition, other adjunctive modalities in targeting the liver metastases such as ablation, combining resection and ablation, transarterial chemoembolization, stereotactic body radiotherapy (SBRT), hepatic artery perfusion, etc. have also been demonstrated variable outcome in treating colorectal liver metastasis (CRLM). Very recently, transplant oncologists have also explored using liver transplantation as a treatment modality for unresectable CRLM, which has demonstrated very good long-term survival in well selected cases. The new paradigm in the treatment of metastatic CRC has dawned.
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Affiliation(s)
- Alfred Wei Chieh Kow
- Division of Hepatopancreaticobiliary Surgery and Liver Transplantation, Department of Surgery, National University Health System, Singapore, Singapore.,Department of Surgery, National University of Singapore, Singapore, Singapore
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15
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Lyu C, Lopez-Ichikawa M, Rubinsky B, Chang TT. Normal and fibrotic liver parenchyma respond differently to irreversible electroporation. HPB (Oxford) 2019; 21:1344-1353. [PMID: 30879992 PMCID: PMC7170179 DOI: 10.1016/j.hpb.2019.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/30/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of irreversible electroporation (IRE) in treating hepatic, biliary, and pancreatic malignancies are active areas of clinical investigation. In addition, recent studies have shown that IRE may enable regenerative surgery and in vivo tissue engineering. To use IRE effectively in these clinical applications, it is important to understand how different tissue microenvironments impact the response to IRE. In this study, we characterize the electrical and histological properties of non-fibrotic and fibrotic liver parenchyma before and after IRE treatment. METHODS Electrical resistivity and histology of fibrotic liver from C57BL/6 mice fed a 0.1% 3,5-diethylcarbonyl-1,4-dihydrocollidine (DDC) diet were compared to those of non-fibrotic liver from matched control mice before and after IRE treatment. RESULTS At baseline, the electrical resistivity of fibrotic liver was lower than that of non-fibrotic liver. Post-IRE, resistivity of non-fibrotic liver declined and then recovered back to baseline with time, correlating with hepatocyte repopulation of the ablated parenchyma without deposition of fibrotic scar. In contrast, resistivity of fibrotic liver remained depressed after IRE treatment, correlating with persistent inflammation. CONCLUSION Non-fibrotic and fibrotic liver respond to IRE differently. The underlying tissue microenvironment is an important modifying factor to consider when designing IRE protocols for tissue ablation.
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Affiliation(s)
- Chenang Lyu
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720
| | | | - Boris Rubinsky
- Department of Mechanical Engineering, University of California, Berkeley, CA 94720
| | - Tammy T. Chang
- Department of Surgery, University of California, San Francisco, CA 94143
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16
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Goswami I, Perry JB, Allen ME, Brown DA, von Spakovsky MR, Verbridge SS. Influence of Pulsed Electric Fields and Mitochondria-Cytoskeleton Interactions on Cell Respiration. Biophys J 2019; 114:2951-2964. [PMID: 29925031 DOI: 10.1016/j.bpj.2018.04.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Pulsed electric fields with microsecond pulse width (μsPEFs) are used clinically; namely, irreversible electroporation/Nanoknife is used for soft tissue tumor ablation. The μsPEF pulse parameters used in irreversible electroporation (0.5-1 kV/cm, 80-100 pulses, ∼100 μs each, 1 Hz frequency) may cause an internal field to develop within the cell because of the disruption of the outer cell membrane and subsequent penetration of the electric field. An internal field may disrupt voltage-sensitive mitochondria, although the research literature has been relatively unclear regarding whether such disruptions occur with μsPEFs. This investigation reports the influence of clinically used μsPEF parameters on mitochondrial respiration in live cells. Using a high-throughput Agilent Seahorse machine, it was observed that μsPEF exposure comprising 80 pulses with amplitudes of 600 or 700 V/cm did not alter mitochondrial respiration in 4T1 cells measured after overnight postexposure recovery. To record alterations in mitochondrial function immediately after μsPEF exposure, high-resolution respirometry was used to measure the electron transport chain state via responses to glutamate-malate and ADP and mitochondrial membrane potential via response to carbonyl cyanide-p-trifluoromethoxyphenylhydrazone. In addition to measuring immediate mitochondrial responses to μsPEF exposure, measurements were also made on cells permeabilized using digitonin and those with compromised cytoskeleton due to actin depolymerization via treatment with the drug latrunculin B. The former treatment was used as a control to tease out the effects of plasma membrane permeabilization, whereas the latter was used to investigate indirect effects on the mitochondria that may occur if μsPEFs impact the cytoskeleton on which the mitochondria are anchored. Based on the results, it was concluded that within the pulse parameters tested, μsPEFs alone do not hinder mitochondrial physiology but can be used to impact the mitochondria upon compromising the actin. Mitochondrial susceptibility to μsPEF after actin depolymerization provides, to our knowledge, a novel avenue for cancer therapeutics.
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Affiliation(s)
- Ishan Goswami
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Justin B Perry
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Mitchell E Allen
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - David A Brown
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Michael R von Spakovsky
- Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, Virginia
| | - Scott S Verbridge
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic Institute and State University, Blacksburg, Virginia.
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17
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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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Kalra N, Gupta P, Gorsi U, Bhujade H, Chaluvashetty SB, Duseja A, Singh V, Dhiman RK, Chawla YK, Khandelwal N. Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience. Cardiovasc Intervent Radiol 2019; 42:584-590. [PMID: 30697637 DOI: 10.1007/s00270-019-02164-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of irreversible electroporation (IRE) in the treatment of unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS A retrospective study was conducted from September 2014 to June 2017. A total of 21 HCCs in 21 patients with cirrhosis were treated with IRE. There were eight subcapsular or exophytic, ten perivascular and three peribiliary tumors. The median tumor size was 26 mm (range 14-40 mm). The technical success of the procedure was recorded. Median follow-up, median time to local recurrence, median local tumor progression-free survival (PFS) and complications were recorded. RESULTS Technical success was achieved in all the patients. The median follow-up was 10 months (range 2-30 months). The median time to local recurrence and local tumor PFS were 4 months (range 3-4 months) and 7 months (range 3-30 months), respectively. The tumor-related factor that was significantly associated with local PFS was the size. Maximum tumor diameter < 25 mm was significantly associated with local tumor PFS (p = 0.045). Other parameters including tumor location, segmental portal vein thrombosis, baseline alpha-fetoprotein level and underlying etiology did not affect local tumor PFS. Complications were noted in nine patients and were classified as grades 1 and 2. No procedure-related mortality was encountered. CONCLUSION IRE is an effective treatment for ablation of small HCCs. Larger prospective studies with strict selection criteria will establish the safety and efficacy of IRE in the treatment of unresectable HCC in patients who cannot undergo thermal ablation.
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Affiliation(s)
- Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Shreedhara B Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Yogesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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19
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Schicho A, Niessen C, Haimerl M, Wiesinger I, Stroszczynski C, Beyer LP, Wiggermann P. Long-term survival after percutaneous irreversible electroporation of inoperable colorectal liver metastases. Cancer Manag Res 2018; 11:317-322. [PMID: 30643457 PMCID: PMC6312065 DOI: 10.2147/cmar.s182091] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background For colorectal liver metastases (CRLM) that are not amenable to surgery or thermal ablation, irreversible electroporation (IRE) is a novel local treatment modality and additional option. Methods This study is a retrospective long-term follow-up of patients with CRLM who underwent IRE as salvage treatment. Results Of the 24 included patients, 18 (75.0%) were male, and the median age was 57 (range: 28-75) years. The mean time elapsed from diagnosis to IRE was 37.9±37.3 months. Mean overall survival was 26.5 months after IRE (range: 2.5-69.2 months) and 58.1 months after diagnosis (range: 14.8-180.1 months). One-, three-, and five-year survival rates after initial diagnosis were 100.0%, 79.2%, and 41.2%; after IRE, the respective survival rates were 79.1%, 25.0%, and 8.3%. There were no statistically significant differences detected in survival after IRE with respect to gender, age, T- or N-stage at the time of diagnosis, size of metastases subject to IRE, number of hepatic lesions, or time elapsed between IRE and diagnosis. Conclusion For nonresectable CRLM, long-term survival data emphasize the value of IRE as a new minimally invasive local therapeutic approach in multimodal palliative treatment, which is currently limited to systemic or regional therapies in this setting.
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Affiliation(s)
- Andreas Schicho
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Christoph Niessen
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Michael Haimerl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Isabel Wiesinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | | | - Lukas P Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany,
| | - Philipp Wiggermann
- Department of Radiology and Nuclear Medicine, Klinikum Braunschweig, Braunschweig, Germany
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White SB, Zhang Z, Chen J, Gogineni VR, Larson AC. Early Immunologic Response of Irreversible Electroporation versus Cryoablation in a Rodent Model of Pancreatic Cancer. J Vasc Interv Radiol 2018; 29:1764-1769. [DOI: 10.1016/j.jvir.2018.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/25/2022] Open
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Parchur AK, Sharma G, Jagtap JM, Gogineni VR, LaViolette PS, Flister MJ, White SB, Joshi A. Vascular Interventional Radiology-Guided Photothermal Therapy of Colorectal Cancer Liver Metastasis with Theranostic Gold Nanorods. ACS NANO 2018; 12:6597-6611. [PMID: 29969226 PMCID: PMC9272590 DOI: 10.1021/acsnano.8b01424] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
We report sub-100 nm optical/magnetic resonance (MR)/X-ray contrast-bearing theranostic nanoparticles (TNPs) for interventional image-guided photothermal therapy (PTT) of solid tumors. TNPs were composed of Au@Gd2O3:Ln (Ln = Yb/Er) with X-ray contrast (∼486 HU; 1014 NPs/mL, 0.167 nM) and MR contrast (∼1.1 × 108 mM-1 S-1 at 9.4 T field strength). Although TNPs are deposited in tumors following systemic administration via enhanced permeation and retention effect, the delivered dose to tumors is typically low; this can adversely impact the efficacy of PTT. To overcome this limitation, we investigated the feasibility of site-selective hepatic image-guided delivery of TNPs in rats bearing colorectal liver metastasis (CRLM). The mesenteric vein of tumor-bearing rats was catheterized, and TNPs were infused into the liver by accessing the portal vein for site-selective delivery. The uptake of TNPs with hepatic delivery was compared with systemic administration. MR imaging confirmed that delivery via the hepatic portal vein can double the CRLM tumor-to-liver contrast compared with systemic administration. Photothermal ablation was performed by inserting a 100 μm fiber-optic carrying 808 nm light via a JB1, 3-French catheter for 3 min under DynaCT image guidance. Histological analysis revealed that the thermal damage was largely confined to the tumor region with minimal damage to the adjacent liver tissue. Transmission electron microscopy imaging validated the stability of core-shell structure of TNPs in vivo pre- and post-PTT. TNPs comprising Gd-shell-coated Au nanorods can be effectively employed for the site-directed PTT of CRLM by leveraging interventional radiology methods.
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Affiliation(s)
- Abdul Kareem Parchur
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Gayatri Sharma
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Jaidip M. Jagtap
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | | | - Peter S. LaViolette
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Michael J. Flister
- Department of Physiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Sarah Beth White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
| | - Amit Joshi
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, United States
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22
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Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat? Cardiovasc Intervent Radiol 2018; 41:1257-1266. [PMID: 29687261 PMCID: PMC6021471 DOI: 10.1007/s00270-018-1971-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/18/2018] [Indexed: 12/18/2022]
Abstract
Purpose Irreversible electroporation (IRE) induces apoptosis with high-voltage electric pulses. Although the working mechanism is non-thermal, development of secondary Joule heating occurs. This study investigated whether the observed conductivity rise during IRE is caused by increased cellular permeabilization or heat development. Methods IRE was performed in a gelatin tissue phantom, in potato tubers, and in 30 patients with unresectable colorectal liver metastases (CRLM). Continuous versus sequential pulsing protocols (10-90 vs. 10-30-30-30) were assessed. Temperature was measured using fiber-optic probes. After temperature had returned to baseline, 100 additional pulses were delivered. The primary technique efficacy of the treated CRLM was compared to the periprocedural current rise. Seven patients received ten additional pulses after a 10-min cool-down period. Results Temperature and current rise was higher for the continuous pulsing protocol (medians, gel: 13.05 vs. 9.55 °C and 9 amperes (A) vs. 7A; potato: 12.70 vs. 10.53 °C and 6.0A vs. 6.5A). After cooling-down, current returned to baseline in the gel phantom and near baseline values (Δ2A with continuous- and Δ5A with sequential pulsing) in the potato tubers. The current declined after cooling-down in all seven patients with CRLM, although baseline values were not reached. There was a positive correlation between current rise and primary technique efficacy (p = 0.02); however, the previously reported current increase threshold of 12–15A was reached in 13%. Conclusion The observed conductivity rise during IRE is caused by both cellular permeabilization and heat development. Although a correlation between current rise and efficacy exists, the current increase threshold seems unfeasible for CRLM. Electronic supplementary material The online version of this article (10.1007/s00270-018-1971-7) contains supplementary material, which is available to authorized users.
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Ruarus A, Vroomen L, Puijk R, Scheffer H, Zonderhuis B, Kazemier G, van den Tol M, Berger F, Meijerink M. Irreversible Electroporation in Hepatopancreaticobiliary Tumours. Can Assoc Radiol J 2018; 69:38-50. [DOI: 10.1016/j.carj.2017.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/25/2017] [Indexed: 12/18/2022] Open
Abstract
Hepatopancreaticobiliary tumours are often diagnosed at an advanced disease stage, in which encasement or invasion of local biliary or vascular structures has already occurred. Irreversible electroporation (IRE) is an image-guided tumour ablation technique that induces cell death by exposing the tumour to high-voltage electrical pulses. The cellular membrane is disrupted, while sparing the extracellular matrix of critical tubular structures. The preservation of tissue integrity makes IRE an attractive treatment option for tumours in the vicinity of vital structures such as splanchnic blood vessels and major bile ducts. This article reviews current data and discusses future trends of IRE for hepatopancreaticobiliary tumours.
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Affiliation(s)
- A.H. Ruarus
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - L.G.P.H. Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - R.S. Puijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - H.J. Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - B.M. Zonderhuis
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - G. Kazemier
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - M.P. van den Tol
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - F.H. Berger
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - M.R. Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Wang X, Su Z, Lyu T, Figini M, Procissi D, Shangguan J, Sun C, Wang B, Shang N, Gu S, Ma Q, Gordon AC, Lin K, Wang J, Lewandowski RJ, Salem R, Yaghmai V, Larson AC, Zhang Z. 18F-FDG PET Biomarkers Help Detect Early Metabolic Response to Irreversible Electroporation and Predict Therapeutic Outcomes in a Rat Liver Tumor Model. Radiology 2017; 287:137-145. [PMID: 29232185 DOI: 10.1148/radiol.2017170920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose To test the hypothesis that biomarkers of fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) can be used for the early detection of therapeutic response to irreversible electroporation (IRE) of liver tumor in a rodent liver tumor model. Materials and Methods The institutional animal care and use committee approved this study. Rats were inoculated with McA-RH7777 liver tumor cells in the left median and left lateral lobes. Tumors were allowed to grow for 7 days to reach a size typically at least 5 mm in longest diameter, as verified with magnetic resonance (MR) imaging. IRE electrodes were inserted, and eight 100-μsec, 2000-V pulses were applied to ablate the tumor tissue in the left median lobe. Tumor in the left lateral lobe served as a control in each animal. PET/computed tomography (CT) and MR imaging measurements were performed at baseline and 3 days after IRE for each animal. Additional MR imaging measurements were obtained 14 days after IRE. After 14-day follow-up MR imaging, rats were euthanized and tumors harvested for hematoxylin-eosin, CD34, and caspase-3 staining. Change in the maximum standardized uptake value (ΔSUVmax) was calculated 3 days after IRE. The maximum lesion diameter change (ΔDmax) was measured 14 days after IRE by using axial T2-weighted imaging. ΔSUVmax and ΔDmax were compared. The apoptosis index was calculated by using caspase-3-stained slices of apoptotic tumor cells. Pearson correlation coefficients were calculated to assess the relationship between ΔSUVmax at 3 days and ΔDmax (or apoptosis index) at 14 days after IRE treatment. Results ΔSUVmax, ΔDmax, and apoptosis index significantly differed between treated and untreated tumors (P < .001 for all). In treated tumors, there was a strong correlation between ΔSUVmax 3 days after IRE and ΔDmax 14 days after IRE (R = 0.66, P = .01) and between ΔSUVmax 3 days after IRE and apoptosis index 14 days after IRE (R = 0.57, P = .04). Conclusion 18F-FDG PET imaging biomarkers can be used for the early detection of therapeutic response to IRE treatment of liver tumors in a rodent model. © RSNA, 2017.
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Affiliation(s)
- Xifu Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhanliang Su
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Tianchu Lyu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Matteo Figini
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Daniel Procissi
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Junjie Shangguan
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Chong Sun
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Bin Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Na Shang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Shanzhi Gu
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Quanhong Ma
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Gordon
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Kai Lin
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Jian Wang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Robert J Lewandowski
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Riad Salem
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Vahid Yaghmai
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Andrew C Larson
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
| | - Zhuoli Zhang
- From the Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W.). Department of Radiology, Feinberg School of Medicine, Northwestern University, 737 N Michigan Ave, 16th Floor, Chicago, IL, 60611 (X.W., Z.S., T.L., M.F., D.P., J.S., C.S., B.W., N.S., S.G., Q.M., A.C.G., K.L., R.J.L., R.S., V.Y., A.C.L., Z.Z.); Department of Radiology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China (X.W.); Department of Radiology, Tianjin Xiqing Hospital, Tianjin, China (Z.S.);.Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, China (C.S.); Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (B.W.); Department of Interventional Radiology, Hunan Cancer Hospital, Changsha, Hunan, China (S.G.); Department of Radiology, Southwest Hospital, Chongqing, China (J.W.); and Robert H. Lurie Comprehensive Cancer Center, Chicago, Ill (R.S., V.Y., A.C.L., Z.Z.)
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Chakedis J, Squires MH, Beal EW, Hughes T, Lewis H, Paredes A, Al-Mansour M, Sun S, Cloyd JM, Pawlik TM. Update on current problems in colorectal liver metastasis. Curr Probl Surg 2017; 54:554-602. [PMID: 29198365 DOI: 10.1067/j.cpsurg.2017.10.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Jeffrey Chakedis
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Malcolm H Squires
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Eliza W Beal
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Tasha Hughes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Heather Lewis
- University of Colorado Health System, Fort Collins, CO
| | - Anghela Paredes
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Mazen Al-Mansour
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Steven Sun
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Jordan M Cloyd
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, OH.
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26
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Langan RC, Goldman DA, D'Angelica MI, DeMatteo RP, Allen PJ, Balachandran VP, Jarnagin WR, Kingham TP. Recurrence patterns following irreversible electroporation for hepatic malignancies. J Surg Oncol 2017; 115:704-710. [PMID: 28493544 DOI: 10.1002/jso.24570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) has emerged as a novel, safe ablative therapy for peri-vascular lesions. However, there remains a paucity of data on long-term outcomes. METHODS We identified patients who underwent open IRE (1/2011-6/2015) for primary and secondary hepatic malignancies. Local ablation-zone recurrence (LR) was determined by cross-sectional imaging. Cumulative incidence (CumI) of LR was calculated and a competing risks regression assessed factors associated with LR. RESULTS Forty patients had 77 lesions treated. The majority of lesions were of colorectal origin (74%). Median tumor size was 1.3 cm (range 0.5-6). Most patients (86%) had prior systemic therapy and 29% received systemic therapy following IRE. With a median follow-up of 25.7 months (range 4.5-58.8 months), 10 lesions in 9 patients recurred locally (CumI: 13.4%, 95%CI: 7.8-22.2%). Median estimated time to LR was not reached and no LR occurred after 19 months. Factors significantly associated with LR included ablation zone size (HR 1.58; 95%CI 1.12-2.23; P = 0.0093) and body mass index (HR 1.21 95%CI 1.10-1.34; P = 0.0001). CONCLUSION IRE LR rates were low after the treatment of well selected, small tumors. This technique is useful for lesions in anatomic locations precluding resection or thermal ablation.
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Affiliation(s)
- Russell C Langan
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael I D'Angelica
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald P DeMatteo
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter J Allen
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vinod P Balachandran
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William R Jarnagin
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T Peter Kingham
- Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, New York
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27
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Sutter O, Calvo J, N'Kontchou G, Nault JC, Ourabia R, Nahon P, Ganne-Carrié N, Bourcier V, Zentar N, Bouhafs F, Sellier N, Diallo A, Seror O. Safety and Efficacy of Irreversible Electroporation for the Treatment of Hepatocellular Carcinoma Not Amenable to Thermal Ablation Techniques: A Retrospective Single-Center Case Series. Radiology 2017; 284:877-886. [PMID: 28453431 DOI: 10.1148/radiol.2017161413] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Purpose To assess the safety and efficacy of irreversible electroporation (IRE) in the treatment of patients with inoperable hepatocellular carcinoma (HCC) who are ineligible for thermal ablative techniques. Materials and Methods This retrospective study was approved by an ethics review board, and the requirement to obtain informed written consent was waived. From March 2012 to June 2015, 58 patients (median age, 65.4 years; range 41.6-90 years) with cirrhosis received IRE for the treatment of 75 HCC tumors. The median tumor diameter was 24 mm (range, 6-90 mm). IRE was selected because of tumor location (48 patients) or the patient's poor general condition (10 patients). Treatment response was assessed with magnetic resonance (MR) imaging 1 month after treatment and every 3 months thereafter. Overall local tumor progression-free survival (PFS) per nodule (including initial treatment failures) was assessed by using the Kaplan-Meier method. The marginal Cox proportional hazards model was used to assess the factors associated with overall local tumor PFS. Complications were recorded and graded according to the Clavien-Dindo classification. Results Of 75 tumors, 58 (77.3%), 67 (89.3%), and 69 (92%) were completely ablated after one, two, and three IRE procedures, respectively. After a median follow-up of 9 months (range, 3 days to 31 months), the 6- and 12-month overall local tumor PFS rates for the 75 treated nodules were 87% (95% confidence interval [CI]: 77%, 93%) and 70% (95% CI: 56%, 81%), respectively. A preablative serum α-fetoprotein level higher than 200 ng/mL (hazard ratio: 9.94 [95% CI: 2.82, 35.06], P = .0004) was the only factor linked with overall local tumor PFS. Complications occurred in 11 of the 58 patients (19%) and were classified as grade I in three patients, grade II in five patients, grade IV in two patients, and grade V in one patient. The three (5.2%) complications classified as grade III or higher were liver failures occurring in patients with Child-Pugh class B disease; one led to death. Conclusion IRE offers safe, complete ablation of HCC tumors in patients with contraindications to other commonly used ablative techniques. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Olivier Sutter
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Joyce Calvo
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Gisèle N'Kontchou
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Jean-Charles Nault
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Raffik Ourabia
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Pierre Nahon
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nathalie Ganne-Carrié
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Valérie Bourcier
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nora Zentar
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Fatna Bouhafs
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Nicolas Sellier
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Abou Diallo
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
| | - Olivier Seror
- From the Service de Radiologie de l'Hôpital Jean Verdier, Hôpitaux universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Avenue du 14 juillet, 93140 Bondy, France (O. Sutter, J.C., R.O., N.Z., F.B., N.S., O. Seror); Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France (J.C.N., P.N., N.G.C., O. Seror); Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France (O. Sutter, J.C.N., P.N., N.G.C., N.S., O. Seror); Service d'Hépatologie de l'Hôpital Jean Verdier, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bondy, France (G.N., J.C.N., P.N., N.G.C., V.B.); and Département d'Information Médical de l'Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance publique Hôpitaux de Paris, Bobigny, France (A.D.)
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