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Wu J, Zhou Z, Huang Y, Deng X, Zheng S, He S, Huang G, Hu B, Shi M, Liao W, Huang N. Radiofrequency ablation: mechanisms and clinical applications. MedComm (Beijing) 2024; 5:e746. [PMID: 39359691 PMCID: PMC11445673 DOI: 10.1002/mco2.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
Radiofrequency ablation (RFA), a form of thermal ablation, employs localized heat to induce protein denaturation in tissue cells, resulting in cell death. It has emerged as a viable treatment option for patients who are ineligible for surgery in various diseases, particularly liver cancer and other tumor-related conditions. In addition to directly eliminating tumor cells, RFA also induces alterations in the infiltrating cells within the tumor microenvironment (TME), which can significantly impact treatment outcomes. Moreover, incomplete RFA (iRFA) may lead to tumor recurrence and metastasis. The current challenge is to enhance the efficacy of RFA by elucidating its underlying mechanisms. This review discusses the clinical applications of RFA in treating various diseases and the mechanisms that contribute to the survival and invasion of tumor cells following iRFA, including the roles of heat shock proteins, hypoxia, and autophagy. Additionally, we analyze the changes occurring in infiltrating cells within the TME after iRFA. Finally, we provide a comprehensive summary of clinical trials involving RFA in conjunction with other treatment modalities in the field of cancer therapy, aiming to offer novel insights and references for improving the effectiveness of RFA.
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Affiliation(s)
- Jianhua Wu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhiyuan Zhou
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yuanwen Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xinyue Deng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Siting Zheng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Shangwen He
- Department of Respiratory and Critical Care MedicineChronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Genjie Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Binghui Hu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Min Shi
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Wangjun Liao
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Na Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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Rey I, Darmadi D. Comparative Efficacy of Microwave versus Radiofrequency Ablation in Hepatocellular Carcinoma: Systematic Review and Meta-Analysis of Randomized-Controlled Trials. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 0:rjim-2024-0022. [PMID: 38905615 DOI: 10.2478/rjim-2024-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Indexed: 06/23/2024]
Abstract
Introduction: Hepatocellular carcinoma (HCC) is a leading global cause of cancer-related deaths. Thermal ablation techniques, especially radiofrequency ablation (RFA) and microwave ablation (MWA), have become pivotal treatments for HCC. This systematic review and meta-analysis aim to compare these modalities, highlighting their efficacy, strengths, and limitations in treating HCC. Methods: A comprehensive literature search was conducted across major databases (PubMed, MEDLINE, Springer, ProQuest, EBSCOhost, Cochrane, and EMBASE) targeting studies on hepatocellular carcinoma with RFA and MWA. Heterogeneity analyses and pooled outcomes using random-effect models with were evaluated to compare both thermal ablation methods. Results: Nine studies, which consists of 368 patients underwent RFA and 387 patients underwent MWA, were included in review. The findings showed no significant differences in pooled analysis of volume of ablation, complete ablation rate, local tumor progression, survival rates, major complications, and adverse events. Subgroup analysis showed significantly higher risk of local tumor progression in RFA in African populations. Conclusion: No statistically significant difference was seen between outcomes across studies. MWA may offer a potential for longer therapeutic response with comparable risk of complications and adverse outcomes.
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Affiliation(s)
- Imelda Rey
- 1Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Darmadi Darmadi
- 1Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Furuta A, Oura S, Shintani H, Kataoka N, Tanaka H, Takamatsu S, Ono W. Focal coagulative necrosis of the liver in a patient with sustained virologic response to anti-hepatitis C virus therapy. Radiol Case Rep 2024; 19:1514-1518. [PMID: 38304350 PMCID: PMC10830427 DOI: 10.1016/j.radcr.2024.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 02/03/2024] Open
Abstract
A 69-year-old woman with chronic hepatitis C virus (HCV) infection was referred to our hospital due to liver enzyme abnormalities. Four years after anti-HCV therapy, the patient with sustained virologic response and no clinical symptoms developed an oval hepatic mass with mixed high and low internal echoes near the portal vein on ultrasound. Magnetic resonance imaging (MRI) of the liver lesion showed a slightly hypo intense pattern on T1-weighted images, a hyper intense pattern both on T2- and diffusion-weighted images, a slight rim enhancement pattern with no intra-lesional enhancement up to the late phase, and a very low intense pattern on hepatobiliary phase images. Positron emission tomography/computed tomography (PET / CT) showed no areas of avid radiotracer uptake in the liver. No tumor markers showed abnormally high values. All these images and laboratory findings led us to the assessment of the liver lesion as a non-neoplastic disorder. However, due to the patient's strong preference to get both definitive diagnosis and cure of the lesion, the patient underwent laparoscopic partial hepatectomy. Pathological study showed 2 necrotic areas surrounded by multiple lymph follicles, epithelioid cells, lymphocytes, collagen fibers, and plasma cells, leading to the diagnosis of focal coagulative necrosis of the liver (FCNL). Physicians should note that FCNL can occur without any symptoms and can be diagnosed at least as a non-neoplastic disorder with combined MRI and PET/CT analysis.
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Affiliation(s)
- Akito Furuta
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan
| | - Shoji Oura
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada-city, Osaka, 596-8522, Japan
| | - Hiroshi Shintani
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada-city, Osaka, 596-8522, Japan
| | - Naoki Kataoka
- Department of Surgery, Kishiwada Tokushukai Hospital, 4-27-1, Kamori-cho, Kishiwada-city, Osaka, 596-8522, Japan
| | - Hiroto Tanaka
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan
| | - Seigo Takamatsu
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan
| | - Wataru Ono
- Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada-city, Osaka, Japan
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Arnold L, Hendricks-Wenger A, Coutermarsh-Ott S, Gannon J, Hay AN, Dervisis N, Klahn S, Allen IC, Tuohy J, Vlaisavljevich E. Histotripsy Ablation of Bone Tumors: Feasibility Study in Excised Canine Osteosarcoma Tumors. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3435-3446. [PMID: 34462159 PMCID: PMC8578360 DOI: 10.1016/j.ultrasmedbio.2021.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 05/29/2023]
Abstract
Osteosarcoma (OS) is a primary bone tumor affecting both dogs and humans. Histotripsy is a non-thermal, non-invasive focused ultrasound method using controlled acoustic cavitation to mechanically disintegrate tissue. In this study, we investigated the feasibility of treating primary OS tumors with histotripsy using a 500-kHz transducer on excised canine OS samples harvested after surgery at the Veterinary Teaching Hospital at Virginia Tech. Samples were embedded in gelatin tissue phantoms and treated with the 500-kHz histotripsy system using one- or two-cycle pulses at a pulse repetition frequency of 250 Hz and a dosage of 4000 pulses/point. Separate experiments also assessed histotripsy effects on normal canine bone and nerve using the same pulsing parameters. After treatment, histopathological evaluation of the samples was completed. To determine the feasibility of treating OS through intact skin/soft tissue, additional histotripsy experiments assessed OS with overlying tissues. Generation of bubble clouds was achieved at the focus in all tumor samples at peak negative pressures of 26.2 ± 4.5 MPa. Histopathology revealed effective cell ablation in treated areas for OS tumors, with no evidence of cell death or tissue damage in normal tissues. Treatment through tissue/skin resulted in generation of well-confined bubble clouds and ablation zones inside OS tumors. Results illustrate the feasibility of treating OS tumors with histotripsy.
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Affiliation(s)
- Lauren Arnold
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
| | - Alissa Hendricks-Wenger
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA
| | - Sheryl Coutermarsh-Ott
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Jessica Gannon
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; Department of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia, USA
| | - Alayna N Hay
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Nikolaos Dervisis
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA; Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Shawna Klahn
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Irving C Allen
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, Virginia, USA; Graduate Program in Translational Biology, Medicine and Health, Virginia Tech, Roanoke, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA
| | - Joanne Tuohy
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA; ICTAS Center for Engineered Health, Virginia Tech, Kelly Hall, Blacksburg, Virginia, USA.
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Vidal-Jove J, Serres-Creixams X, Ziemlewicz TJ, Cannata JM. Liver Histotripsy Mediated Abscopal Effect-Case Report. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2021; 68:3001-3005. [PMID: 34310299 DOI: 10.1109/tuffc.2021.3100267] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We present a case report that shows an abscopal effect in the context of a safety and efficacy clinical trial for histotripsy as ablation technique in liver tumors. The abscopal effect appears in the form of reduction in the volume of nontreated tumor lesions in the same organ, as well as sustained reduction of tumor marker [carcinoembryonic antigen (CEA)] that extends weeks away of the procedure. Histotripsy is a novel noninvasive, nonthermal, and nonionizing precise ablation technique for tissue destruction guided by ultrasonography. We discuss the feasibility of this technique compared with other focal therapies and its possibilities as immune system enhancer.
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6
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Bader KB, Wallach EL, Shekhar H, Flores-Guzman F, Halpern HJ, Hernandez SL. Estimating the mechanical energy of histotripsy bubble clouds with high frame rate imaging. Phys Med Biol 2021; 66:10.1088/1361-6560/ac155d. [PMID: 34271560 PMCID: PMC10680990 DOI: 10.1088/1361-6560/ac155d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
Mechanical ablation with the focused ultrasound therapy histotripsy relies on the generation and action of bubble clouds. Despite its critical role for ablation, quantitative metrics of bubble activity to gauge treatment outcomes are still lacking. Here, plane wave imaging was used to track the dissolution of bubble clouds following initiation with the histotripsy pulse. Information about the rate of change in pixel intensity was coupled with an analytic diffusion model to estimate bubble size. Accuracy of the hybrid measurement/model was assessed by comparing the predicted and measured dissolution time of the bubble cloud. Good agreement was found between predictions and measurements of bubble cloud dissolution times in agarose phantoms and murine subcutaneous SCC VII tumors. The analytic diffusion model was extended to compute the maximum bubble size as well as energy imparted to the tissue due to bubble expansion. Regions within tumors predicted to have undergone strong bubble expansion were collocated with ablation. Further, the dissolution time was found to correlate with acoustic emissions generated by the bubble cloud during histotripsy insonation. Overall, these results indicate a combination of modeling and high frame rate imaging may provide means to quantify mechanical energy imparted to the tissue due to bubble expansion for histotripsy.
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Affiliation(s)
- Kenneth B Bader
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Emily L Wallach
- Department of Radiology, University of Chicago, Chicago, IL, United States of America
| | - Himanshu Shekhar
- Discipline of Electrical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, Gujarat, India
| | | | - Howard J Halpern
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL United States of America
| | - Sonia L Hernandez
- Department of Surgery, University of Chicago, Chicago, IL, United States of America
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Day NB, Wixson WC, Shields CW. Magnetic systems for cancer immunotherapy. Acta Pharm Sin B 2021; 11:2172-2196. [PMID: 34522583 PMCID: PMC8424374 DOI: 10.1016/j.apsb.2021.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/05/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
Immunotherapy is a rapidly developing area of cancer treatment due to its higher specificity and potential for greater efficacy than traditional therapies. Immune cell modulation through the administration of drugs, proteins, and cells can enhance antitumoral responses through pathways that may be otherwise inhibited in the presence of immunosuppressive tumors. Magnetic systems offer several advantages for improving the performance of immunotherapies, including increased spatiotemporal control over transport, release, and dosing of immunomodulatory drugs within the body, resulting in reduced off-target effects and improved efficacy. Compared to alternative methods for stimulating drug release such as light and pH, magnetic systems enable several distinct methods for programming immune responses. First, we discuss how magnetic hyperthermia can stimulate immune cells and trigger thermoresponsive drug release. Second, we summarize how magnetically targeted delivery of drug carriers can increase the accumulation of drugs in target sites. Third, we review how biomaterials can undergo magnetically driven structural changes to enable remote release of encapsulated drugs. Fourth, we describe the use of magnetic particles for targeted interactions with cellular receptors for promoting antitumor activity. Finally, we discuss translational considerations of these systems, such as toxicity, clinical compatibility, and future opportunities for improving cancer treatment.
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Key Words
- BW, body weight
- Biomaterials
- CpG, cytosine-phosphate-guanine
- DAMP, damage associated molecular pattern
- Drug delivery
- EPR, enhanced permeability and retention
- FFR, field free region
- HS-TEX, heat-stressed tumor cell exosomes
- HSP, heat shock protein
- ICD, immunogenic cell death
- IVIS, in vivo imaging system
- Immunotherapy
- MICA, MHC class I-related chain A
- MPI, magnetic particle imaging
- Magnetic hyperthermia
- Magnetic nanoparticles
- Microrobotics
- ODNs, oligodeoxynucleotides
- PARP, poly(adenosine diphosphate-ribose) polymerase
- PDMS, polydimethylsiloxane
- PEG, polyethylene glycol
- PLGA, poly(lactic-co-glycolic acid)
- PNIPAM, poly(N-isopropylacrylamide)
- PVA, poly(vinyl alcohol)
- SDF, stromal cell derived-factor
- SID, small implantable device
- SLP, specific loss power
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Affiliation(s)
- Nicole B Day
- Department of Chemical & Biological Engineering, University of Colorado, Boulder, CO 80303, USA
| | - William C Wixson
- Department of Chemical & Biological Engineering, University of Colorado, Boulder, CO 80303, USA
| | - C Wyatt Shields
- Department of Chemical & Biological Engineering, University of Colorado, Boulder, CO 80303, USA
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Vaidya N, Baragona M, Lavezzo V, Maessen R, Veroy K. Simulation study of the cooling effect of blood vessels and blood coagulation in hepatic radio-frequency ablation. Int J Hyperthermia 2021; 38:95-104. [PMID: 33530763 DOI: 10.1080/02656736.2020.1866217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Computer simulations of hepatic radio-frequency ablation (RFA) were performed to: (i) determine the dependence of the vessel wall heat transfer coefficient on geometrical parameters; (ii) study the conditions required for the occurrence of the directional effect of blood; and (iii) classify blood vessels according to their effect on the thermal lesion while considering blood coagulation. The information thus obtained supports the development of a multi-scale bio-heat model tailored for more accurate prediction of hepatic RFA outcomes in the vicinity of blood vessels. MATERIALS AND METHODS The simulation geometry consisted of healthy tissue, tumor tissue, a mono-polar RF-needle, and a single cylindrical blood vessel. The geometrical parameters of interest were the RF-needle active length and those describing blood vessel configuration. A simple, novel method to incorporate the effects of blood coagulation into the simulation was developed and tested. RESULTS A closed form expression giving the dependence of the vessel wall heat transfer coefficient on geometrical parameters was obtained. Directional effects on the thermal lesion were found to occur for blood vessel radii between 0.4 mm and 0.5 mm. Below 0.4 mm blood coagulation blocked the flow. CONCLUSIONS The closed form expression for the heat transfer coefficient can be used in models of RFA to speed up computation. The conditions on vessel radii required for the occurrence of directional effects on the thermal lesion were determined. These conditions allow the classification of blood vessels. Different approximations to the thermal equation can thus be used for these vessel classes.
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Affiliation(s)
- Nikhil Vaidya
- Faculty of Civil Engineering, RWTH Aachen University, Aachen, Germany.,Philips Research, Eindhoven, The Netherlands
| | | | | | | | - Karen Veroy
- Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
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Chan KS, Chuang YC, Lin TY, Shaw SW. A Taiwan's experience: A case report and review of literature of successful early intrauterine treatment with radiofrequency ablation in twin reversed arterial perfusion (TRAP) sequence. J Formos Med Assoc 2021; 120:1394-1399. [PMID: 33583701 DOI: 10.1016/j.jfma.2021.01.022] [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: 09/08/2020] [Revised: 01/20/2021] [Accepted: 01/24/2021] [Indexed: 11/30/2022] Open
Abstract
Acardiac twin or twin reversed arterial perfusion (TRAP) sequence is a rare medical complication of Monozygotic twins. Taiwanese Obstetricians usually treat TRAP sequence conservatively. Occasionally, repeated amnio-reduction is performed to decompress the polyhydramnios caused by the TRAP sequence, even though there was no correction of the pathophysiologic mechanism. Radiofrequency ablation is a minimally invasive, percutaneous technique that can effectively obliterate blood supply to an acardiac twin to preserve and protect the pump twin. This recent technique has never been used before for the treatment of the TRAP sequence in Taiwan. This article reported the first-hand experience of acardiac twin management with RFA in Taipei Chang Gung Memorial Hospital.
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Affiliation(s)
- Kok-Seong Chan
- Malaysian Ministry of Health, Malaysia; Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ya-Chun Chuang
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tzu-Yi Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Steven W Shaw
- Department of Obstetrics and Gynecology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Prenatal Cell and Gene Therapy Group, Institute for Women's Health University College London, London, United Kingdom.
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10
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Lusutrombopag Is Safe and Efficacious for Treatment of Thrombocytopenia in Patients With and Without Hepatocellular Carcinoma. Clin Gastroenterol Hepatol 2020; 18:2600-2608.e1. [PMID: 32205226 DOI: 10.1016/j.cgh.2020.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 02/04/2020] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Patients with hepatocellular carcinoma (HCC) secondary to chronic liver disease often require invasive procedures but frequently have thrombocytopenia. Lusutrombopag is an agonist of the thrombopoietin receptor that activates platelet production. METHODS We performed an integrated analysis of data from 2 phase 3 trials (L-PLUS 1, Japan, October 2013 to May 2014, and L-PLUS 2, global, June 2015 to April 2017) that compared the efficacy and safety of lusutrombopag with placebo in patients with chronic liver disease, with and without HCC. Our analysis included patients with Eastern Cooperative Oncology Group grades of 0 or 1, Child-Pugh classes A or B, and a platelet count less than 50 × 109/L who were scheduled to undergo invasive procedures in 9 to 14 days. Patients received lusutrombopag (3 mg) or placebo daily for 7 days or fewer before an invasive procedure. Imaging studies assessed treatment-emergent adverse events, including asymptomatic portal vein thrombosis. The primary end point was no requirement for platelet transfusion before the invasive procedure and rescue therapies for bleeding 7 days or fewer after the invasive procedure. RESULTS The per-protocol population included 270 patients (95 with HCC). A significantly higher proportion of patients with HCC who received lusutrombopag achieved the primary end point (68.0%) vs patients who received placebo (8.9%) (P < .0001); in patients without HCC, these proportions were 77.0% vs 21.6% (P < .0001). Lusutrombopag reduced the need for platelet transfusions, increased platelet counts for 3 weeks, and reduced the number of bleeding events in patients with and without HCC compared with placebo. Risk of thrombosis was similar to that of placebo. CONCLUSIONS Patients with and without HCC receiving lusutrombopag had a reduction in the number of platelet transfusions before invasive procedures compared with patients receiving placebo, with no increase in thrombosis or bleeding. L-PLUS 1: JapicCTI-132323; L-PLUS 2: ClinicalTrials.gov number no: NCT02389621.
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11
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Liver metastases in gastroenteropancreatic neuroendocrine tumours - treatment methods. GASTROENTEROLOGY REVIEW 2020; 15:207-214. [PMID: 33005265 PMCID: PMC7509904 DOI: 10.5114/pg.2020.91501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/30/2019] [Indexed: 12/13/2022]
Abstract
Surgical approaches that allow the safe treatment of multiple, bilateral, large tumours, and that combine extirpative, ablative and interventional therapies, have expanded the population of patients with neuroendocrine tumors (NET) liver metastases (LMs) who can benefit from aggressive treatment of their liver disease. Pre-treatment staging often includes the biochemical assessment of serologic markers such as serotonin, insulin, vasoactive intestinal peptide, and chromogranin, even in patients without clinically apparent hormonal excess. Radiofrequency ablation (RFA) is a technique that involves the use of thermal energy to induce coagulation necrosis, thereby destroying tumour cells. Resection plus RFA is increasingly used in patients with bilateral NET LMs. Resection is performed for large or dominant lesions, while ablation is used to treat small lesions. Hepatic arterial embolization, typically termed transarterial embolization, and transarterial chemoembolization have been shown to induce a reduction in tumour size and to ameliorate symptoms of excess hormonal secretion.
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12
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Sheka AC, Altman A, Gasparetto A, Spilseth B, Muratore S, Jensen EH. Tumor Lysis Syndrome After Laparoscopic Microwave Ablation of Colorectal Liver Metastases. J Gastrointest Cancer 2019; 51:631-635. [PMID: 31542881 DOI: 10.1007/s12029-019-00308-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adam C Sheka
- Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Ariella Altman
- Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | | | - Benjamin Spilseth
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Sydne Muratore
- Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Eric H Jensen
- Department of Surgery, University of Minnesota, MMC 195, 420 Delaware St. SE, Minneapolis, MN, 55455, USA.
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13
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Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P, Carrafiello G, Azoulay D, Petrillo A, Curley SA. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. Oncologist 2019; 24:e990-e1005. [PMID: 31217342 DOI: 10.1634/theoncologist.2018-0337] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 ± 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 ± 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion ≤3 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size. IMPLICATIONS FOR PRACTICE: Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size.
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Affiliation(s)
- Francesco Izzo
- Divisions of Hepatobiliary Surgery, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Vincenza Granata
- Divisions of Radiology, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Roberto Grassi
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Roberta Fusco
- Divisions of Radiology, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Raffaele Palaia
- Divisions of Hepatobiliary Surgery, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Paolo Delrio
- Divisions of Abdominal Surgery, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Gianpaolo Carrafiello
- Division of Radiology, Department of Health Science, University of Milan, Milan, Italy
| | - Daniel Azoulay
- Hepatobiliray Surgery and Liver Transplantation, Henri-Mondor Hospital, University Paris Est Creteil, Creteil, France
| | - Antonella Petrillo
- Divisions of Hepatobiliary Surgery, "Istituto Nazionale dei Tumori IRCCS Fondazione G. Pascale", Naples, Italy
| | - Steven A Curley
- Surgical Oncology, CHRISTUS Mother Frances Hospital, Tyler, Texas, USA
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Bader KB, Vlaisavljevich E, Maxwell AD. For Whom the Bubble Grows: Physical Principles of Bubble Nucleation and Dynamics in Histotripsy Ultrasound Therapy. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1056-1080. [PMID: 30922619 PMCID: PMC6524960 DOI: 10.1016/j.ultrasmedbio.2018.10.035] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 05/04/2023]
Abstract
Histotripsy is a focused ultrasound therapy for non-invasive tissue ablation. Unlike thermally ablative forms of therapeutic ultrasound, histotripsy relies on the mechanical action of bubble clouds for tissue destruction. Although acoustic bubble activity is often characterized as chaotic, the short-duration histotripsy pulses produce a unique and consistent type of cavitation for tissue destruction. In this review, the action of histotripsy-induced bubbles is discussed. Sources of bubble nuclei are reviewed, and bubble activity over the course of single and multiple pulses is outlined. Recent innovations in terms of novel acoustic excitations, exogenous nuclei for targeted ablation and histotripsy-enhanced drug delivery and image guidance metrics are discussed. Finally, gaps in knowledge of the histotripsy process are highlighted, along with suggested means to expedite widespread clinical utilization of histotripsy.
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Affiliation(s)
- Kenneth B Bader
- Department of Radiology and Committee on Medical Physics, University of Chicago, Chicago, Illinois, USA.
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Tech University, Blacksburg, Virginia, USA
| | - Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA
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15
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Huo J, Aloia TA, Xu Y, Chung TH, Sheu T, Tina Shih YC. Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:284-292. [PMID: 30832966 PMCID: PMC6402784 DOI: 10.1016/j.jval.2018.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 10/04/2018] [Accepted: 10/16/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression. OBJECTIVES To evaluate whether the trend of image guidance for RFA is moving toward the more expensive computed tomography (CT) technology and to determine the clinical benefits of CT guidance over the ultrasound (US) guidance. METHODS A cohort of 463 patients was identified from the Surveillance, Epidemiology, and End Results and Medicare-linked database. The temporal trends in use of image guidance were assessed using the Cochrane-Armitage test. The associations between modality of image guidance and survival, complications, and costs were assessed using the Cox regression model, the logistic regression model, and the generalized linear model, respectively. RESULTS The use of CT-guided RFA increased sharply, from 20.7% in 2002 to 75.9% in 2011. Compared with CT-guided RFA, those who received US-guided RFA had comparable risk of periprocedural and delayed postprocedural complications. Stratified analyses by tumor size also showed no statistically significant difference. In adjusted survival analysis, no statistically significant difference was observed in overall and cancer-specific survival. Nevertheless, the cost of CT-guided RFA ($2847) was higher than that of US-guided RFA ($1862). CONCLUSIONS Despite its rapid adoption over time, CT-guided RFA incurred higher procedural costs than US-guided RFA but did not significantly improve postprocedural complications and survival. Echoing the American Board of Internal Medicine's Choosing Wisely campaign and the American Society of Clinical Oncology's Value of Cancer Care initiative, findings from our study call for critical evaluation of whether CT-guided RFA provides high-value care for patients with HCC.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
| | - Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ying Xu
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tong Han Chung
- Healthcare Transformation Initiatives, University of Texas Health Science Center-Houston, Houston, TX, USA
| | - Tommy Sheu
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ya-Chen Tina Shih
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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16
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Worlikar T, Vlaisavljevich E, Gerhardson T, Greve J, Wan S, Kuruvilla S, Lundt J, Ives K, Hall T, Welling TH, Lee F, Xu Z. Histotripsy for Non-Invasive Ablation of Hepatocellular Carcinoma (HCC) Tumor in a Subcutaneous Xenograft Murine Model. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:6064-6067. [PMID: 30441719 DOI: 10.1109/embc.2018.8513650] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Histotripsy fractionates tissue through a mechanical, non-invasive ultrasonic ablation process that precisely controls acoustic cavitation while utilizing real-time ultrasound (US) imaging guidance. This study investigates the potential, feasibility and tumor volume reduction effects of histotripsy for liver cancer ablation in a subcutaneous in vivo murine Hepatocellular Carcinoma (HCC) model. Hep3B tumors were generated in the right flanks of 14 NSG and 7 NOD-SCID mice. The mice were grouped as follows: A (acute, NSG with n=9 treatment and n=1 control), B (chronic, NSG with n=2 treatment and n=2 control) and C (chronic NODSCID, with n=6 treatment and n=1 control). Treatment was performed when the tumor diameters reached >5 mm. 1-2 cycle histotripsy pulses at 100 Hz PRF (p- >30 MPa) were delivered using a custom built 1 MHz therapy transducer attached to a motorized positioner, which scanned the transducer focus to traverse the targeted tumor volume, guided by real-time US imaging. Tumor ablation effectiveness was assessed by obtaining T1, T2 and T2* weighted MR images. Post euthanasia, treated tumor, brain, and lung tissue samples were harvested for histology. Histology of acute group A showed fractionation of targeted region with a sharp boundary separating it from untreated tissue. Groups B and C demonstrated effective tumor volume reduction post treatment on MRI as the homogenate and edema were resorbed within 23 weeks. However, as the tumor was subcutaneous, it was not possible to set adequate treatment margin and since the mice were immune-compromised, residual viable tumor cells eventually developed into tumor regrowth at 3-9 weeks after histotripsy. Groups B and C showed no signs of metastasis in the lung and brain. Our study successfully demonstrated the potential of histotripsy for non-invasive HCC ablation in a subcutaneous murine model. Additional work is ongoing to study the response of histotripsy in immune-competent orthotopic liver tumor models.
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17
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Zhang Q, Zhang K, Xie B, Ren Y, Li G, Zhang L, Wang A, Li Y. Analysis of curative effect of I 125 implantation combined with radiofrequency ablation in treating bone metastases. J Bone Oncol 2018; 11:23-26. [PMID: 29892521 PMCID: PMC5993946 DOI: 10.1016/j.jbo.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 12/28/2017] [Accepted: 01/07/2018] [Indexed: 12/25/2022] Open
Abstract
The aims of this study were to investigate the clinical effects of I125 implantation combined with radiofrequency ablation in treating bone metastases (BM) and analyze its clinical application so as to provide better treatment protocols for the treatment of BM. A total of 63 BM patients were randomly divided into the I125 implantation group (CON, treated with I125 seeds alone, 33 patients) and the combination group (I125-MA, 30 patients) to compare the clinical efficacy and adverse effects. After treatment, the clinical efficacy of Group I125-MA was significantly better than Group CON, and the quality of life was improved significantly (P< 0.05). I125-MA has relatively better clinical efficacy in treating BM, which can not only significantly improve patients' life quality but also cause no serious adverse reaction. The therapy of I125 implantation combined with radiofrequency ablation provides a new idea for treating bone metastases. Compare Group I125-MA and Group CON, remission rates of bone pain were 76.7% vs 42.4% (P< 0.05); movement ability: 73.3% vs 39.4% (P< 0.05); quality of life: improvement rates: 70% vs 42.4% (P< 0.05), the median initial time of relieve pain: 3.5 days vs 7.6 days (P< 0.05).
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Affiliation(s)
- Qizhou Zhang
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Kunyao Zhang
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Bing Xie
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Yimin Ren
- Department of Intervention, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Guoliang Li
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Liping Zhang
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Aijing Wang
- Department of Oncology, Guangdong TCM-Integrated Hospital, Foshan 528200, China
| | - Yang Li
- Department of Stomatology, Affiliated Shenzhen 9th People's Hospital, Zunyi Medical University, Shenzhen 518116, China
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18
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Bruenn K, Beyer L, Haimerl M, Pregler B, Stroszczynski C, Jung E, Wiggermann P. Comparison of computed tomography (CT) and contrast-enhanced ultrasound (CEUS) for the quantitative evaluation of an ablation defect following radiofrequency ablation of malignant liver lesions. Clin Hemorheol Microcirc 2017; 67:445-451. [DOI: 10.3233/ch-179225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- K. Bruenn
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - L. Beyer
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - M. Haimerl
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - B. Pregler
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - P. Wiggermann
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
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19
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Lundt JE, Allen SP, Shi J, Hall TL, Cain CA, Xu Z. Non-invasive, Rapid Ablation of Tissue Volume Using Histotripsy. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2834-2847. [PMID: 28935135 PMCID: PMC5693635 DOI: 10.1016/j.ultrasmedbio.2017.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/22/2017] [Accepted: 08/08/2017] [Indexed: 05/09/2023]
Abstract
Histotripsy is a non-invasive, non-thermal ablation technique that uses high-amplitude, focused ultrasound pulses to fractionate tissue via acoustic cavitation. The goal of this study was to illustrate the potential of histotripsy with electronic focal steering to achieve rapid ablation of a tissue volume at a rate matching or exceeding those of current clinical techniques (∼1-2 mL/min). Treatment parameters were established in tissue-mimicking phantoms and applied to ex vivo tissue. Six-microsecond pulses were delivered by a 250-kHz array. The focus was electrically steered to 1000 locations at a pulse repetition frequency of 200 Hz (0.12% duty cycle). Magnetic resonance imaging and histology of the treated tissue revealed a distinct region of necrosis in all samples. Mean lesion volume was 35.6 ± 4.3 mL, generated at 0.9-3.3 mL/min, a speed faster than that of any current ablation method for a large volume. These results suggest that histotripsy has the potential to achieve non-invasive, rapid, homogeneous ablation of a tissue volume.
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Affiliation(s)
- Jonathan E Lundt
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
| | - Steven P Allen
- Department Biomedical Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles A Cain
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
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20
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Biomineral Nano-Theranostic agent for Magnetic Resonance Image Guided, Augmented Radiofrequency Ablation of Liver Tumor. Sci Rep 2017; 7:14481. [PMID: 29101365 PMCID: PMC5670219 DOI: 10.1038/s41598-017-14976-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/18/2017] [Indexed: 11/08/2022] Open
Abstract
Theranostic nanoparticles based on biocompatible mineral compositions can significantly improve the translational potential of image guided cancer nano-therapy. Here, we report development of a single-phase calcium phosphate biomineral nanoparticle (nCP) with dual-mode magnetic resonance contrast (T1-T2) together with radiofrequency (RF) mediated thermal response suitable for image-guided RF ablation of cancer. The nanoparticles (NP) are engineered to provide dual MR contrast by an optimized doping concentration (4.1 at%) of paramagnetic ion, Fe3+, which also renders lossy dielectric character for nCP leading to thermal response under RF exposure. In vivo compatibility and dual-mode MR contrast are demonstrated in healthy rat models. MRI and T2 mapping suggest hepatobiliary clearance by ~96 hours. MRI guided intratumoral injection in subcutaneous rat glioma and orthotopic liver tumor models provide clear visualization of NP in MRI which also helps in quantifying NP distribution within tumor. Furthermore, by utilising RF mediated thermal response, NP treated tumor could be ablated using clinically approved RF ablation system (10 W,13.3 GHz). Real-time in vivo thermal imaging exhibits 119 ± 10% increase in temperature change (ΔT) for NP treated orthotopic liver tumor (ΔT = 51.5 ± 2 °C), compared to untreated healthy liver control (ΔT = 21.5 ± 2 °C). In effect, we demonstrate a promising nano-biomineral theranostic agent for dual-mode MRI combined with radiofrequency ablation of solid tumors.
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21
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Tak WY, Lin SM, Wang Y, Zheng J, Vecchione A, Park SY, Chen MH, Wong S, Xu R, Peng CY, Chiou YY, Huang GT, Cai J, Abdullah BJJ, Lee JS, Lee JY, Choi JY, Gopez-Cervantes J, Sherman M, Finn RS, Omata M, O'Neal M, Makris L, Borys N, Poon R, Lencioni R. Phase III HEAT Study Adding Lyso-Thermosensitive Liposomal Doxorubicin to Radiofrequency Ablation in Patients with Unresectable Hepatocellular Carcinoma Lesions. Clin Cancer Res 2017; 24:73-83. [PMID: 29018051 DOI: 10.1158/1078-0432.ccr-16-2433] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/17/2017] [Accepted: 10/05/2017] [Indexed: 12/17/2022]
Abstract
Purpose: Lyso-thermosensitive liposomal doxorubicin (LTLD) consists of doxorubicin contained within a heat-sensitive liposome. When heated to ≥40°C, LTLD locally releases a high concentration of doxorubicin. We aimed to determine whether adding LTLD improves the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) lesions with a maximum diameter (dmax) of 3 to 7 cm.Experimental Design: The HEAT Study was a randomized, double-blind, dummy-controlled trial of RFA ± LTLD. The 701 enrolled patients had to have ≤4 unresectable HCC lesions, at least one of which had a dmax of 3 to 7 cm. The primary endpoint was progression-free survival (PFS) and a key secondary endpoint was overall survival (OS). Post hoc subset analyses investigated whether RFA duration was associated with efficacy.Results: The primary endpoint was not met; in intention-to-treat analysis, the PFS HR of RFA + LTLD versus RFA alone was 0.96 [95% confidence interval (CI), 0.79-1.18; P = 0.71], and the OS HR ratio was 0.95 (95% CI, 0.76-1.20; P = 0.67). Among 285 patients with a solitary HCC lesion who received ≥45 minutes RFA dwell time, the OS HR was 0.63 (95% CI, 0.41-0.96; P < 0.05) in favor of combination therapy. RFA + LTLD had reversible myelosuppression similar to free doxorubicin.Conclusions: Adding LTLD to RFA was safe but did not increase PFS or OS in the overall study population. However, consistent with LTLD's heat-based mechanism of action, subgroup analysis suggested that RFA + LTLD efficacy is improved when RFA dwell time for a solitary lesion ≥45 minutes. Clin Cancer Res; 24(1); 73-83. ©2017 AACR.
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Affiliation(s)
- Won Young Tak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Shi-Ming Lin
- Chang Gung Memorial Hospital - Linkou, Taoyuan, Taiwan
| | - Yijun Wang
- Third Central Hospital of Tianjin, Tianjin, China
| | - Jiasheng Zheng
- Beijing You'an Hospital, Capital Medical University, Beijing, China
| | | | - Soo Young Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Min Hua Chen
- Peking University Cancer Hospital, Department of Ultrasound, Beijing, China
| | | | - Ruocai Xu
- Hunan Cancer Hospital, Department of Hepatobiliary and Pancreatic Internal Medicine, Changsha, China
| | | | - Yi-You Chiou
- Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Jianqiang Cai
- Cancer Institute, Chinese Academy of Medical Sciences, Beijing, China
| | | | - June Sung Lee
- Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Jae Young Lee
- Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | - Richard S Finn
- Department of Medicine, Geffen School of Medicine at UCLA, Los Angeles, California
| | - Masao Omata
- Yamanashi Prefectural Central Hospital, Yamanashi, Japan
| | | | | | | | - Ronnie Poon
- Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Riccardo Lencioni
- University of Miami Miller School of Medicine, Section of Vascular and Interventional Radiology, Sylvester Comprehensive Cancer Center, Miami, Florida
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Hodul P, Malafa M, Choi J, Kvols L. The Role of Cytoreductive Hepatic Surgery as an Adjunct to the Management of Metastatic Neuroendocrine Carcinomas. Cancer Control 2017; 13:61-71. [PMID: 16508628 DOI: 10.1177/107327480601300109] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Patients with metastatic neuroendocrine cancers to the liver often present with disabling endocrinopathies and pain associated with bulky disease. Quality of life for these patients is poor and can require long-term therapy with somatostatin analogs for control of their symptoms. Alternative therapies to decrease tumor burden and subsequent hormone release have been investigated. Of these, cytoreductive surgery was found to have the most consistent and profound impact on symptom regression and overall survival. METHODS Several cases are reported that illustrate an aggressive multimodality approach in the treatment of metastatic neuroendocrine cancers to the liver. The literature is reviewed and the role of cytoreductive surgery in the management of hepatic neuroendocrine metastases is discussed. RESULTS Cytoreductive surgery can be performed safely with minimal morbidity and mortality. Regression of symptoms occurs in the majority of patients and survival is prolonged. CONCLUSIONS Surgical intervention as part of an aggressive multimodality treatment plan results in improved outcomes for patients with advanced hepatic metastases of neuroendocrine origin. Future directions may include earlier surgical intervention with adjuvant therapies reserved for aggressive recurrent disease.
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Affiliation(s)
- Pamela Hodul
- Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612-9497, USA
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Jutric Z, Grendar J, Brown WL, Cassera MA, Wolf RF, Hansen PD, Hammill CW. Novel Simulation Device for Targeting Tumors in Laparoscopic Ablation: A Learning Curve Study. Surg Innov 2017. [DOI: 10.1177/1553350617715833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. A novel 3-dimensional (3D) guidance system was developed to aid accurate needle placement during ablation. Methods. Five novices and 5 experienced hepatobiliary surgeons were recruited. Using an agar block with analog tumor, participants targeted under 4 conditions: in-line with the ultrasound plane using ultrasound, in-line using 3D guidance, 45° off-axis using ultrasound, and off-axis using 3D guidance. Time to target the tumor, number of withdrawals, and the National Aeronautics and Space Administration Task Load Index were collected. Initial and final parameters for each of the conditions were compared using a within-subjects paired t test. Results. A significant reduction was seen in the number of required withdrawals in all situations when using the 3D guidance (0.75 vs 3.65 in-line and 0.25 vs 3.6 for off-axis). Mental workload was significantly lower when using 3D guidance compared with ultrasound both for novices (29.85 vs 41.03) and experts (31.98 vs 44.57), P < .001 for both. The only difference in targeting time between first and last attempt was in the novice group during off-axis targeting using 3D guidance (115 vs 32.6 seconds, P = .03). Conclusion. Though 3D guidance appeared to decrease time to target, this was not statistically significant likely as a result of lack of power in our trial. Three-dimensional guidance did reduce the number of required withdrawals, potentially decreasing complications, as well as mental workload after proficiency was achieved. Furthermore, novices without experience in ultrasound were able to learn targeting with the 3D guidance system at a faster pace than targeting with ultrasound alone.
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Affiliation(s)
- Zeljka Jutric
- Portland Providence Cancer Institute, Portland, OR, USA
| | - Jan Grendar
- Portland Providence Cancer Institute, Portland, OR, USA
| | - William L. Brown
- The Oregon Clinic, Portland, OR, USA
- Meharry Medical College, Nashville, TN, USA
| | | | - Ronald F. Wolf
- Portland Providence Cancer Institute, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Paul D. Hansen
- Portland Providence Cancer Institute, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Chet W. Hammill
- Washington University School of Medicine in St Louis, St Louis, MO, USA
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24
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Vlaisavljevich E, Owens G, Lundt J, Teofilovic D, Ives K, Duryea A, Bertolina J, Welling TH, Xu Z. Non-Invasive Liver Ablation Using Histotripsy: Preclinical Safety Study in an In Vivo Porcine Model. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1237-1251. [PMID: 28318889 DOI: 10.1016/j.ultrasmedbio.2017.01.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
This study investigates the safety profile for use of histotripsy, a non-invasive ultrasonic ablation method currently being developed for the treatment of liver cancer, for liver ablation in an in vivo porcine model. Histotripsy treatments were applied to the liver and hepatic veins of 22 porcine subjects, with half of the subjects receiving systemic heparinization. Vital signs (heart rate, blood pressure, temperature, electrocardiogram and SpO2) were monitored throughout the procedure and for 1 h post-treatment. Blood was drawn at six points during the experiment to analyze blood gases, liver function and free hemoglobin levels. All treatments were guided and monitored by real-time ultrasound imaging. After treatment, the tissue was harvested for histological analysis. Results indicated that histotripsy generated well-defined lesions inside the liver and around the treated hepatic veins of all subjects in both treatment groups. Vital signs and blood analysis revealed that animals responded well to histotripsy, with all animals surviving the treatment. One animal in the non-heparinized group had a transient increase in pH and decreases in blood pressure, heart rate and PCO2 during the 15-min vessel treatment, with these changes returning to baseline levels soon after the treatment. Overall, the results indicate that histotripsy can safely be performed on the liver without the need for systemic heparinization, even in regions containing large hepatic vessels, supporting its future use for the treatment of liver cancer.
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Affiliation(s)
- Eli Vlaisavljevich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA; HistoSonics, Inc., Ann Arbor, Michigan, USA.
| | - Gabe Owens
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
| | - Jonathan Lundt
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Kimberly Ives
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA
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Kotewall CN, Cheung TT, She WH, Ma KW, Tsang SHY, Dai JWC, Chan ACY, Chok KSH, Lo CM. The role of radiofrequency ablation to liver transection surface in patients with close tumor margin of HCC during hepatectomy-a case matched study. Transl Gastroenterol Hepatol 2017; 2:33. [PMID: 28529987 DOI: 10.21037/tgh.2017.03.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/10/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To review the outcome of using radiofrequency ablation (RFA) for patients with close resection margin during hepatectomy. METHODS From Oct 2004 to Sept 2013, 862 patients received hepatectomy for hepatocellular carcinoma (HCC) in the Department of Surgery, Queen Mary Hospital in Hong Kong. Fourteen patients received additional RFA because of close resection margin (<1 cm) during the operation for HCC. The result of 28 patients with close liver resection margin was selected for comparison. The two groups of patients were matched in terms of tumor size, tumor number, stage of disease and magnitude of resection. RESULTS In the RFA group (n=14), the median age of the patients was 58.5 (range, 25-78 years). The median tumor size was 2.25 cm (range, 1.2-12 cm). In the resection alone group (n=28), the median age for the patients was 61 (range, 36-79 years). The median tumor size was 2.7 cm (range, 1-11 cm). There was no difference in terms of liver function assessment between the two groups. There was no RFA related complication recorded during the study period. There was no hospital mortality in both groups. The 1- and 3-year disease free survival was 38.3% and 25.5% respectively in the RFA group vs. 57.4% and 39.3% respectively in the liver resection alone group (P=0.563). The 1- and 3-year overall survival was 81.5% and 69.8% respectively in the RFA group vs .88.4% and 59.9% respectively in the liver resection alone group (P=0.83). CONCLUSIONS RFA to hepatectomy resection surface in patients with close margin is a safe treatment option but its effectiveness on prevention of local recurrence has yet to be confirmed.
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Affiliation(s)
- C Nicholas Kotewall
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Simon Hing Ying Tsang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Jeff Wing Chiu Dai
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | | | | | - Chung Mau Lo
- Departments of Pathology and Surgery, State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong 999077, China
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Qi X, Li G, Liu D, Motamarry A, Huang X, Wolfe AM, Helke KL, Haemmerich D, Staveley-O'Carroll KF, Kimchi ET. Development of a radiofrequency ablation platform in a clinically relevant murine model of hepatocellular cancer. Cancer Biol Ther 2016; 16:1812-9. [PMID: 26537481 DOI: 10.1080/15384047.2015.1095412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RFA is used in treatment of patients with hepatocellular cancer (HCC); however, tumor location and size often limit therapeutic efficacy. The absence of a realistic animal model and a radiofrequency ablation (RFA) suitable for small animals presents significant obstacles in developing new strategies. To establish a realistic RFA platform that allows the development of effective RFA-integrated treatment in an orthotopic murine model of HCC, a human cardiac radiofrequency generator was modified for murine use. Parameters were optimized and RFA was then performed in normal murine livers and HCCs. The effects of RFA were monitored by measuring the ablation zone and transaminases. The survival of tumor-bearing mice with and without RFA was monitored, ablated normal liver and HCCs were evaluated macroscopically and histologically. We demonstrated that tissue-mimicking media was able to optimize RFA parameters. Utilizing this information we performed RFA in normal and HCC-bearing mice. RFA was applied to hepatic parenchyma and completely destroyed small tumors and part of large tumors. Localized healing of the ablation and normalization of transaminases occurred within 7 days post RFA. RFA treatment extended the survival of small tumor-bearing mice. They survived at least 5 months longer than the controls; however, mice with larger tumors only had a slight therapeutic effect after RFA. Collectively, we performed RFA in murine HCCs and observed a significant therapeutic effect in small tumor-bearing mice. The quick recovery of tumor-bearing mice receiving RFA mimics observations in human subjects. This platform provides us a unique opportunity to study RFA in HCC treatment.
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Affiliation(s)
- Xiaoqiang Qi
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
| | - Guangfu Li
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
| | - Dai Liu
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
| | - Anjan Motamarry
- d Department of Pathology and Laboratory Medicine; Medical University of South Carolina ; Charleston , SC USA
| | - Xiangwei Huang
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
| | - A Marissa Wolfe
- c Department of Comparative Medicine; Medical University of South Carolina ; Charleston , SC USA
| | - Kristi L Helke
- c Department of Comparative Medicine; Medical University of South Carolina ; Charleston , SC USA.,d Department of Pathology and Laboratory Medicine; Medical University of South Carolina ; Charleston , SC USA
| | - Dieter Haemmerich
- e Department of Pediatrics ; Medical University of South Carolina ; Charleston , SC USA
| | - Kevin F Staveley-O'Carroll
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
| | - Eric T Kimchi
- a Department of Surgery ; Division of Surgical Oncology; Medical University of South Carolina ; Charleston , SC USA.,b Hollings Cancer Center; Medical University of South Carolina ; Charleston , SC USA
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Bimonte S, Leongito M, Piccirillo M, de Angelis C, Pivonello C, Granata V, Izzo F. Radio-frequency ablation-based studies on VX2rabbit models for HCC treatment. Infect Agent Cancer 2016; 11:38. [PMID: 27525037 PMCID: PMC4981963 DOI: 10.1186/s13027-016-0082-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 05/30/2016] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most frequent cancer worldwide with high morbidity, mortality and increasing incidence. It is of note that the main curative therapies for HCC are hepatic resection and transplantation although the majority of patients at the time of presentation are not eligible for resection or orthotopic liver transplantation (OLT) due to the underlying cirrhosis. Currently, a variety of loco-regional therapies, including radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), microwave coagulation therapy (MCT), transarterial chemoembolization (TACE) and others, have been developed as alternative treatment options for HCC. Among these techniques, RFA is currently the most widely used treatment, due to its several advantages, such as safety and efficacy. To date, the effectiveness of RFA for HCC is reduced by the presence of residual tumor as a consequence of insufficient treatment. In order to ameliorate the effects of RFA on HCC, several in vivo studies, have been performed on its application as single or in combination treatment with drugs or others loco-regional therapies, by using rabbit VX2 liver model. This represents an ideal model of liver cancers and is widely used for imaging and other experimental studies due to the rapid growth of these tumors and their similarity to human hepatocellular carcinoma. In order to elucidate the therapeutic potential of RFA with adjuvant treatments for HCC, we reviewed the latest findings on the RFA-based studies in rabbit VX2 hepatocarcinoma models.
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Affiliation(s)
- Sabrina Bimonte
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", - IRCCS, Via Mariano Semmola, 80131 Naples, Italy
| | - Maddalena Leongito
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", - IRCCS, Via Mariano Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", - IRCCS, Via Mariano Semmola, 80131 Naples, Italy
| | | | - Claudia Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università di Napoli Federico II, Naples, Italy
| | - Vincenza Granata
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", - IRCCS, Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Izzo
- Division of Abdominal Surgical Oncology, Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", - IRCCS, Via Mariano Semmola, 80131 Naples, Italy
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Vlaisavljevich E, Greve J, Cheng X, Ives K, Shi J, Jin L, Arvidson A, Hall T, Welling TH, Owens G, Roberts W, Xu Z. Non-Invasive Ultrasound Liver Ablation Using Histotripsy: Chronic Study in an In Vivo Rodent Model. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1890-902. [PMID: 27140521 PMCID: PMC4912895 DOI: 10.1016/j.ultrasmedbio.2016.03.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 02/17/2016] [Accepted: 03/20/2016] [Indexed: 05/15/2023]
Abstract
Hepatocellular carcinoma, or liver cancer, has the fastest growing incidence among cancers in the United States. Current liver ablation methods are thermal-based and share limitations due to the heat sink effect from the blood flow through the highly vascular liver. Recently, our group has investigated histotripsy as a non-invasive liver cancer ablation method. Histotripsy is a non-thermal ultrasonic ablation method that fractionates tissue through the control of acoustic cavitation. Previous experiments in an in vivo porcine model show that histotripsy can create well-confined lesions in the liver through ribcage obstruction without damaging the overlying ribs and other tissues. Histotripsy can also completely fractionate liver tissue surrounding major vessels while preserving the vessels. In this study, we investigate the long-term effects of histotripsy liver ablation in a rodent model. We hypothesize that the fractionated histotripsy lesion will be resorbed by the liver, resulting in effective tissue healing. To test this hypothesis, the livers of 20 healthy rats were treated with histotripsy using an 8-element 1-MHz histotripsy transducer. Rats were euthanized after 0, 3, 7, 14 and 28 days (n = 4). In vivo and post mortem results showed histotripsy lesions were successfully generated through the intact abdomen in all 20 rats. Magnetic resonance imaging found primarily negative contrast on day 0, positive contrast on day 3 and rapid normalization of signal intensity thereafter (i.e., signal amplitude returned to baseline levels seen in healthy liver tissue). Histologically, lesions were completely fractionated into an acellular homogenate. The lesions had a maximum cross-sectional area of 17.2 ± 1.9 mm(2) and sharp boundaries between the lesion and the healthy surrounding tissue after treatment. As the animals recovered after treatment, the histotripsy tissue homogenate was almost completely replaced by regenerated liver parenchyma, resulting in a small fibrous lesion (<1 mm(2) maximum cross-section) remaining after 28 d. The results of this study suggest that histotripsy has potential as a non-invasive liver ablation method for effective tissue removal.
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Affiliation(s)
- Eli Vlaisavljevich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Joan Greve
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Xu Cheng
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Kimberly Ives
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jiaqi Shi
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Lifang Jin
- Department of Ultrasound, Shanghai Jiaotong University, Shanghai, China
| | - Alexa Arvidson
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Tim Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Gabe Owens
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
| | - William Roberts
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA
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Clinical results of mean GTV dose optimized robotic guided SBRT for liver metastases. Radiat Oncol 2016; 11:74. [PMID: 27236333 PMCID: PMC4884398 DOI: 10.1186/s13014-016-0652-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background We retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV) mean-dose-optimized and real-time motion-compensated robotic stereotactic body radiation therapy (SBRT) in the treatment of liver metastases. Methods Between March 2011 and July 2015, 52 patients were treated with SBRT for a total of 91 liver metastases (one to four metastases per patient) with a median GTV volume of 12 cc (min 1 cc, max 372 cc). The optimization of mean GTV dose was prioritized during treatment planning at the potential cost of planning target volume (PTV) coverage reduction while adhering to safe normal tissue constraints. The delivered median GTV biological effective dose (BED10) was 142.1 Gy10 (range, 60.2 Gy10 –165.3 Gy10) and the prescribed PTV BED10 ranged from 40.6 Gy10 to 112.5 Gy10 (median, 86.1 Gy10). We analyzed local control (LC), progression-free interval (PFI), overall survival (OS), and toxicity. Results Median follow-up was 17 months (range, 2–49 months). The 2-year actuarial LC, PFI, and OS rates were 82.1, 17.7, and 45.0 %, and the median PFI and OS were 9 and 23 months, respectively. In univariate analysis histology (p < 0.001), PTV prescription BED10 (HR 0.95, CI 0.91–0.98, p = 0.002) and GTV mean BED10 (HR 0.975, CI 0.954–0.996, p = 0.011) were predictive for LC. Multivariate analysis showed that only extrahepatic disease status at time of treatment was a significant factor (p = 0.033 and p = 0.009, respectively) for PFI and OS. Acute nausea or fatigue grade 1 was observed in 24.1 % of the patients and only 1 patient (1.9 %) had a side effect of grade ≥ 2. Conclusions Robotic real-time motion-compensated SBRT is a safe and effective treatment for one to four liver metastases. Reducing the PTV prescription dose and keeping a high mean GTV dose allowed the reduction of toxicity while maintaining a high local control probability for the treated lesions.
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Wu F. Heat-Based Tumor Ablation: Role of the Immune Response. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 880:131-53. [DOI: 10.1007/978-3-319-22536-4_8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Local tumour hyperthermia for cancer treatment is currently used either for ablation purposes as an alternative to surgery or less frequently, in combination with chemotherapy and/or radiation therapy to enhance the effects of those traditional therapies. As it has become apparent that activating the immune system is crucial to successfully treat metastatic cancer, the potential of boosting anti-tumour immunity by heating tumours has become a growing area of cancer research. After reviewing the history of hyperthermia therapy for cancer and introducing methods for inducing local hyperthermia, this review describes different mechanisms by which heating tumours can elicit anti-tumour immune responses, including tumour cell damage, tumour surface molecule changes, heat shock proteins, exosomes, direct effects on immune cells, and changes in the tumour vasculature. We then go over in vivo studies that provide promising results showing that local hyperthermia therapy indeed activates various systemic anti-tumour immune responses that slow growth of untreated tumours. Finally, future research questions that will help bring the use of local hyperthermia as systemic immunotherapy closer to clinical application are discussed.
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Affiliation(s)
- Seiko Toraya-Brown
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth , Hanover , New Hampshire
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Izzo F, Palaia R, Albino V, Amore A, di Giacomo R, Piccirillo M, Leongito M, Nasto A, Granata V, Petrillo A, Lastoria S. Hepatocellular carcinoma and liver metastases: clinical data on a new dual-lumen catheter kit for surgical sealant infusion to prevent perihepatic bleeding and dissemination of cancer cells following biopsy and loco-regional treatments. Infect Agent Cancer 2015; 10:11. [PMID: 25897320 PMCID: PMC4403704 DOI: 10.1186/s13027-015-0006-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/11/2015] [Indexed: 11/26/2022] Open
Abstract
Background RFA is a safe and effective procedure for treating unresectable primary or secondary liver malignancies, but it is not without complications. The most common reported complications include abdominal hemorrhage, bile leakage, biloma formation, hepatic abscesses, and neoplastic seeding. The aim of this study is to evaluate the feasibility of percutaneous use of surgical sealant with a new coaxial bilumen catheter, to prevent the perihepatic bleeding and dissemination of cancer cells through the needle-electrode (neoplastic seeding) or along the needle track. Methods We designed a novel dual-lumen catheter to facilitate the optimal application of fibrin sealant after diagnostic and therapeutic percutaneous procedures. Percutaneous RFA has been performed using mask ventilation or neuroleptanalgesia. The main aims of this study, after the ablation procedure, in the treatment of unresectable liver cancer were to prevent major adverse events: a) the perihepatic bleeding; b) dissemination of cancer cells through the needle-electrode and or needle track. Results A total of 181 patients were evaluated for this study at National Cancer Institute of Naples from January 2012 to January 2014. The association of blood loss (≤1 g/dl; ≥1 g/dl) with age, gender, histological diagnosis were analyzed. No statistical significance was observed between bleeding and age (p = 0.840), gender (p = 0.607) and histological diagnosis (p = 0,571), respectively. Conclusions This study demonstrated that fibrin sealant or other surgical sealant injection, after any locoregional procedure such as biopsy or ablation, could make adverse events even more rare.
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Affiliation(s)
- Francesco Izzo
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Raffaele Palaia
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Vittorio Albino
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Alfonso Amore
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Raimondo di Giacomo
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Maddalena Leongito
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Aurelio Nasto
- Abdominal Surgical Oncology and Hepatobiliary Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Vincenza Granata
- Radiology Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Antonella Petrillo
- Radiology Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
| | - Secondo Lastoria
- Nuclear Medicine Unit, Istituto Nazionale Tumori, IRCCS Fondazione "G. Pascale", Via M.Semmola, 80131 Naples, Italy
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Sasidharan A, Sivaram AJ, Retnakumari AP, Chandran P, Malarvizhi GL, Nair S, Koyakutty M. Radiofrequency ablation of drug-resistant cancer cells using molecularly targeted carboxyl-functionalized biodegradable graphene. Adv Healthc Mater 2015; 4:679-84. [PMID: 25586821 DOI: 10.1002/adhm.201400670] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/18/2014] [Indexed: 12/12/2022]
Abstract
Under ultralow radiofrequency (RF) power, transferrin-conjugated graphene nanoparticles can thermally ablate drug- or radiation-resistant cancer cells very effectively. The results suggest that graphene-based RF hyperthermia can be an efficient method to manage drug-/radiation-resistant cancers.
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Affiliation(s)
- Abhilash Sasidharan
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
| | - Amal J. Sivaram
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
| | - Archana P. Retnakumari
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
| | - Parwathy Chandran
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
| | | | - Shantikumar Nair
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
| | - Manzoor Koyakutty
- Amrita Centre for Nanosciences and Molecular Medicine; Amrita Vishwa Vidyapeetham University; Cochin 682 041 Kerala India
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Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, Morris DL. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore) 2015; 94:e580. [PMID: 25738477 PMCID: PMC4553952 DOI: 10.1097/md.0000000000000580] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Thermal ablation of liver tumors near large blood vessels is affected by the cooling effect of blood flow, leading to incomplete ablation. Hence, we conducted a comparative investigation of heat sink effect in monopolar (MP) and bipolar (BP) radiofrequency ablation (RFA), and microwave (MW) ablation devices.With a perfused calf liver, the ablative performances (volume, mass, density, dimensions), with and without heat sink, were measured. Heat sink was present when the ablative tip of the probes were 8.0 mm close to a major hepatic vein and absent when >30 mm away. Temperatures (T1 and T2) on either side of the hepatic vein near the tip of the probes, heating probe temperature (T3), outlet perfusate temperature (T4), and ablation time were monitored.With or without heat sink, BP radiofrequency ablated a larger volume and mass, compared with MP RFA or MW ablation, with latter device producing the highest density of tissue ablated. MW ablation produced an ellipsoidal shape while radiofrequency devices produced spheres.Percentage heat sink effect in Bipolar radiofrequency : Mono-polar radiofrequency : Microwave was (Volume) 33:41:22; (mass) 23:56:34; (density) 9.0:26:18; and (relative elipscity) 5.8:12.9:1.3, indicating that BP and MW devices were less affected.Percentage heat sink effect on time (minutes) to reach maximum temperature (W) = 13.28:9.2:29.8; time at maximum temperature (X) is 87:66:16.66; temperature difference (Y) between the thermal probes (T3) and the temperature (T1 + T2)/2 on either side of the hepatic vessel was 100:87:20; and temperature difference between the (T1 + T2)/2 and temperature of outlet circulating solution (T4), Z was 20.33:30.23:37.5.MW and BP radiofrequencies were less affected by heat sink while MP RFA was the most affected. With a single ablation, BP radiofrequency ablated a larger volume and mass regardless of heat sink.
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Affiliation(s)
- Krishna Pillai
- From the Department of Surgery, University of New South Wales, St. George Hospital, Kogarah, New South Wales, Australia
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Local hyperthermia treatment of tumors induces CD8(+) T cell-mediated resistance against distal and secondary tumors. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2014; 10:1273-1285. [PMID: 24566274 DOI: 10.1016/j.nano.2014.01.011] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 01/24/2014] [Accepted: 01/31/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Combinatorial use of iron oxide nanoparticles (IONPs) and an alternating magnetic field (AMF) can induce local hyperthermia in tumors in a controlled and uniform manner. Heating B16 primary tumors at 43°C for 30 min activated dendritic cells (DCs) and subsequently CD8(+) T cells in the draining lymph node (dLN) and conferred resistance against rechallenge with B16 (but not unrelated Lewis Lung carcinoma) given 7 days post hyperthermia on both the primary tumor side and the contralateral side in a CD8(+) T cell-dependent manner. Mice with heated primary tumors also resisted rechallenge given 30 days post hyperthermia. Mice with larger heated primary tumors had greater resistance to secondary tumors. No rechallenge resistance occurred when tumors were heated at 45°C. Our results demonstrate the promising potential of local hyperthermia treatment applied to identified tumors in inducing anti-tumor immune responses that reduce the risk of recurrence and metastasis. FROM THE CLINICAL EDITOR Local heating of tumors via iron oxide NPs and an alternating magnetic field led to activation of anti-cancer CD8 T cells, which resulted in resistance against re-challenge and greater resistance to secondary tumors. Similar local heating-based strategies may become an important weapon in enhancing tumor elimination via a naturally existing but attenuated immune response.
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Vlaisavljevich E, Kim Y, Owens G, Roberts W, Cain C, Xu Z. Effects of tissue mechanical properties on susceptibility to histotripsy-induced tissue damage. Phys Med Biol 2013; 59:253-70. [PMID: 24351722 DOI: 10.1088/0031-9155/59/2/253] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Histotripsy is a non-invasive tissue ablation method capable of fractionating tissue by controlling acoustic cavitation. To determine the fractionation susceptibility of various tissues, we investigated histotripsy-induced damage on tissue phantoms and ex vivo tissues with different mechanical strengths. A histotripsy bubble cloud was formed at tissue phantom surfaces using 5-cycle long ultrasound pulses with peak negative pressure of 18 MPa and PRFs of 10, 100, and 1000 Hz. Results showed significantly smaller lesions were generated in tissue phantoms of higher mechanical strength. Histotripsy was also applied to 43 different ex vivo porcine tissues with a wide range of mechanical properties. Gross morphology demonstrated stronger tissues with higher ultimate stress, higher density, and lower water content were more resistant to histotripsy damage in comparison to weaker tissues. Based on these results, a self-limiting vessel-sparing treatment strategy was developed in an attempt to preserve major vessels while fractionating the surrounding target tissue. This strategy was tested in porcine liver in vivo. After treatment, major hepatic blood vessels and bile ducts remained intact within a completely fractionated liver volume. These results identify varying susceptibilities of tissues to histotripsy therapy and provide a rational basis to optimize histotripsy parameters for treatment of specific tissues.
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Affiliation(s)
- Eli Vlaisavljevich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
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Grotenhuis B, Vrijland W, Klem T. Radiofrequency ablation for early-stage breast cancer: Treatment outcomes and practical considerations. Eur J Surg Oncol 2013; 39:1317-24. [DOI: 10.1016/j.ejso.2013.09.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/16/2013] [Accepted: 09/05/2013] [Indexed: 12/24/2022] Open
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Guo WX, Sun JX, Cheng YQ, Shi J, Li N, Xue J, Wu MC, Chen Y, Cheng SQ. Percutaneous radiofrequency ablation versus partial hepatectomy for small centrally located hepatocellular carcinoma. World J Surg 2013; 37:602-7. [PMID: 23212793 DOI: 10.1007/s00268-012-1870-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND It is not known whether percutaneous radiofrequency ablation (PRFA) could get the same treatment efficacy and fewer complications as partial hepatectomy (PH) in patients with small centrally located hepatocellular carcinoma (HCC). The present study was designed to evaluate the efficacy of PH and PRFA in the treatment of small centrally located HCC. METHODS From January 2002 until December 2007, 196 patients with small centrally located HCC (≤5 cm) were included. Of these 196 patients, 94 received PRFA and 102 patients were treated with PH. Treatment outcomes, including major complications and survival data, were studied. RESULTS No treatment-related death occurred in either group. There were no significant differences in survival rates between the two groups. The 1-, 3-, and 5-year disease-free survival rates for the PRFA and PH groups were 57.9%, 36.4%, 34.0%, and 59.8%, 42.4%, 40.8%, respectively (P = 0.50). The 1-, 3-, and 5-year overall survival rates for the two groups were 94.3%, 74.7%, and 49.8%, and 89.2%, 74.1%, and 63.1%, respectively (P = 0.96). PRFA had a lower rate of major complications than PH (8.5 vs. 19.6%), and the hospital stay was also shorter in the PRFA group than in the PH subgroup (4 vs. 13 days). CONCLUSIONS Based on the data obtained, we concluded that PRFA might be equal to PH for the treatment of small centrally located HCC. However, PRFA has the benefits of shorter hospital stay as well as a lower rate of complications.
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Affiliation(s)
- Wei-Xing Guo
- Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, No. 225 Changhai Road, Shanghai, 200438, People's Republic of China
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Vlaisavljevich E, Kim Y, Allen S, Owens G, Pelletier S, Cain C, Ives K, Xu Z. Image-guided non-invasive ultrasound liver ablation using histotripsy: feasibility study in an in vivo porcine model. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1398-409. [PMID: 23683406 PMCID: PMC3709011 DOI: 10.1016/j.ultrasmedbio.2013.02.005] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 02/07/2013] [Accepted: 02/11/2013] [Indexed: 05/04/2023]
Abstract
Hepatocellular carcinoma (HCC), or liver cancer, is one of the fastest growing cancers in the United States. Current liver ablation methods are thermal based and share limitations resulting from the heat sink effect of blood flow through the highly vascular liver. In this study, we explore the feasibility of using histotripsy for non-invasive liver ablation in the treatment of liver cancer. Histotripsy is a non-thermal ablation method that fractionates soft tissue through the control of acoustic cavitation. Twelve histotripsy lesions ∼1 cm(3) were created in the livers of six pigs through an intact abdomen and chest in vivo. Histotripsy pulses of 10 cycles, 500-Hz pulse repetition frequency (PRF), and 14- to 17-MPa estimated in situ peak negative pressure were applied to the liver using a 1-MHz therapy transducer. Treatments were performed through 4-6 cm of overlying tissue, with 30%-50% of the ultrasound pathway covered by the rib cage. Complete fractionation of liver parenchyma was observed, with sharp boundaries after 16.7-min treatments. In addition, two larger volumes of 18 and 60 cm(3) were generated within 60 min in two additional pigs. As major vessels and gallbladder have higher mechanical strength and are more resistant to histotripsy, these remained intact while the liver surrounding these structures was completely fractionated. This work shows that histotripsy is capable of non-invasively fractionating liver tissue while preserving critical anatomic structures within the liver. Results suggest histotripsy has potential for the non-invasive ablation of liver tumors.
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Affiliation(s)
- Eli Vlaisavljevich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
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Karampatzakis A, Kühn S, Tsanidis G, Neufeld E, Samaras T, Kuster N. Antenna design and tissue parameters considerations for an improved modelling of microwave ablation in the liver. Phys Med Biol 2013; 58:3191-206. [DOI: 10.1088/0031-9155/58/10/3191] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Szurowska E, Nowicki TK, Izycka-Swieszewska E, Zadrozny D, Markiet K, Studniarek M. Predictive value of apparent diffusion coefficient in evaluation of colorectal carcinoma hepatic metastases' response to radiofrequency ablation. J Magn Reson Imaging 2013; 38:1027-32. [PMID: 23526807 DOI: 10.1002/jmri.24089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/30/2013] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To establish the apparent diffusion coefficient (ADC) suitability to evaluate the radiofrequency ablation (RFA) outcome in patients with chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastases. MATERIALS AND METHODS A total of 56 patients with 116 metastatic foci over 10 mm in diameter were examined with 1.5 Tesla MRI scanner 1 day before percutaneous RFA treatment. Lesions were evaluated in echo-planar diffusion-weighted images with b = 0, 15 and 500 s/mm(2) . On basis of computed tomography scan at 6 weeks, 3 and 6 months after RFA and serum CEA (carcinoembryonic antigen) level lesion were recognized as responding or nonresponding lesions. ADC values for b = 0-15 and 0-500 s/mm(2) of responding and nonresponding lesions were compared. RESULTS Noncomplete ablation concerned 28 lesions. Mean pretreatment ADC values for b = 0-15 and 0-500 s/mm(2) of responding metastases were significantly lower (2.14 and 1.48 × 10(-3) mm(2) /s) than those of nonresponding tumors (2.7 and 1.74 × 10(-3) mm(2) /s). Sensitivity, specificity, and accuracy of ADC values for b = 0-15 s/mm(2) were 79 (95%CI = 59-92), 85 (95%CI = 76-92), 84%; and for b = 0-500 s/mm(2) , the efficacy parameters were, respectively, 78 (95%CI = 56-92), 78 (95%CI = 67-86), and 78%. The P value was under 0.001 for both b parameters. CONCLUSION The pretreatment ADCs values of chemotherapy resistant or partially responding colorectal adenocarcinoma liver metastatic lesion can be predictive factor of tumors response to RFA therapy.
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Affiliation(s)
- Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
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Metrakos P, Kakiashvili E, Aljiffry M, Hassanain M, Chaudhury P. Role of Surgery in the Diagnosis and Management of Metastatic Cancer. EXPERIMENTAL AND CLINICAL METASTASIS 2013:381-399. [DOI: 10.1007/978-1-4614-3685-0_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
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Liu Y, Zheng Y, Li S, Li B, Zhang Y, Yuan Y. Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 2012; 68:21-6. [PMID: 22766484 DOI: 10.1016/j.crad.2012.05.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 01/30/2023]
Abstract
AIM To evaluate the efficacy and safety of percutaneous microwave ablation (MWA) in patients with larger hepatocellular carcinoma (HCC) tumours. MATERIALS AND METHODS Eighty HCC patients with the maximum tumour measuring between 3 and 8 cm were treated using MWA. Of these patients, 57 had initial HCC, while 23 had recurrent HCC. Fifty-two patients had a main tumour measuring 3-5 cm, and 28 had a main tumour measuring 5-8 cm. Local tumour control, complications, long-term survival, and prognostic factors were analysed. RESULTS Complete ablation after the initial treatment was achieved in 70 of 80 (87.5%) patients. Sixteen of the 72 (22.2%) successfully treated patients developed local recurrence. Major complications occurred in 7.5% patients. No procedure-related mortality was observed. The 1, 2, 3, and 5 year overall survival rates after the initial ablation were 81.1, 68.2, 56.5, and 34.6%, with a median survival of 56 months. Univariate analysis revealed that small tumour size (p = 0.003) and pre-ablation α-foetoprotein (AFP) level ≤400 ng/ml (p = 0.042) were favourable prognostic factors of overall survival. Multivariate analysis identified only tumour size as the independent prognosis factor (p = 0.008). CONCLUSION Percutaneous MWA is effective and safe for treating larger HCC tumours. The local tumour control and long-term survival are acceptable.
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Affiliation(s)
- Y Liu
- State Key Laboratory of Oncology in South China and Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Poulou LS, Ziakas PD, Ziogas DC, Doxani C, Xyla V, Vakrinos G, Voulgarelis M, Thanos L. FDG-PET for detecting local tumor recurrence of ablated liver metastases: a diagnostic meta-analysis. Biomarkers 2012; 17:532-8. [DOI: 10.3109/1354750x.2012.699553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wu H, Patel RB, Zheng Y, Solorio L, Krupka TM, Ziats NP, Haaga JR, Exner AA. Differentiation of benign periablational enhancement from residual tumor following radio-frequency ablation using contrast-enhanced ultrasonography in a rat subcutaneous colon cancer model. ULTRASOUND IN MEDICINE & BIOLOGY 2012; 38:443-453. [PMID: 22266229 PMCID: PMC3280615 DOI: 10.1016/j.ultrasmedbio.2011.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 12/02/2011] [Accepted: 12/06/2011] [Indexed: 05/31/2023]
Abstract
Benign periablational enhancement (BPE) response to thermal injury is a barrier to early detection of residual tumor in contrast enhanced imaging after radio-frequency (RF) ablation. The objective of this study was to evaluate the role of quantitative of contrast-enhanced ultrasound (CEUS) in early differentiation of BPE from residual tumor in a BD-IX rat subcutaneous colon cancer model. A phantom study was first performed to test the validity of the perfusion parameters in predicting blood flow of two US contrast imaging modes-contrast harmonic imaging (CHI) and microflow imaging (MFI). To create a simple model of BPE, a peripheral portion of the tumor was ablated along with surrounding normal tissue, leaving part of the tumor untreated. First-pass dynamic enhancement (FPDE) and MFI scans of CEUS were performed before ablation and immediately, 1, 4 and 7 days after ablation. Time-intensity-curves in regions of BPE and residual tumor were fitted to the function y = A(1-exp[-β{t-t0}])+C, in which A, β, t0 and C represent blood volume, flow speed, time to start and baseline intensity, respectively. In the phantom study, positive linear correlations were noted between A, β, Aβ and contrast concentration, speed and flow rate, respectively, in both CHI and MFI. On CEUS images of the in vivo study, the unenhanced ablated zone was surrounded by BPE and irregular peripheral enhancement consistent with residual tumor. On days 0, 4 and 7, blood volume (A) in BPE was significantly higher than that in residual tumor in both FPDE imaging and MFI. Significantly greater blood flow (Aβ) was seen in BPE compared with residual tumor tissue in FPDE on day 7 and in MFI on day 4. The results of this study demonstrate that qualitative CEUS can be potentially used for early detection of viable tumor in post-ablation assessment.
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Affiliation(s)
- Hanping Wu
- Department of Radiology, Case Western Reserve University, Cleveland, OH 44106, USA
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Perera RH, Krupka TM, Wu H, Traughber B, Dremann D, Broome AM, Exner AA. Role of Pluronic block copolymers in modulation of heat shock protein 70 expression. Int J Hyperthermia 2012; 27:672-81. [PMID: 21992560 DOI: 10.3109/02656736.2011.608218] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE The goal of this study was to evaluate the relationship between previously demonstrated thermosensitising effects of the block copolymer, Pluronic, and heat shock protein 70 (Hsp70) expression in an experimental colorectal cancer model in vitro and in vivo. MATERIALS AND METHODS Rat colorectal carcinoma cells were treated with low-grade hyperthermia (43°C) alone or in combination with Pluronics L10 (3 mg/mL), L61 (0.3 mg/mL), or L64 (0.5 mg/mL) for 20 min. Adinosine triphosphate (ATP) levels and cell viability were determined using standard assays. Hsp70 expression was quantified by western blot for cells treated with L10, L61, and L64 at doses specified above and Pluronic P85 (10 mg/mL) alone and in combination with heat. BDIX rats with flank tumours were used to study the effect of L61 and hyperthermia on Hsp70 expression in vivo. RESULTS In vitro, treatment with L10, L61, and L64 plus low-grade hyperthermia lead to depletion of ATP levels to between 8 and 66% of untreated control after 24 h. Maximum expression of Hsp70 was observed at 9 h following hyperthermia alone. The combination of low-grade hyperthermia and Pluronic treatment reduced Hsp70 expression for up to 6 hours, and L10 appeared to completely inhibit the Hsp70 expression. In vivo, Hsp70 expression was increased 5 h after hyperthermia in BDIX rat tumour models and no Hsp70 expression was observed in L61 pre-treated and control groups. CONCLUSION Pluronic effectively improves hyperthermic and low-grade hyperthermic treatment in part due to reduction of Hsp70 expression.
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Affiliation(s)
- Reshani H Perera
- Department of Radiology, Case Western Reserve University , Cleveland, OH 44106-5056, USA
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Jin Y, Cai YC, Cao Y, Cai XY, Tan YT, Shi YX, Jiang WQ. Radiofrequency ablation combined with systemic chemotherapy in nasopharyngeal carcinoma liver metastases improves response to treatment and survival outcomes. J Surg Oncol 2012; 106:322-6. [PMID: 22271524 DOI: 10.1002/jso.23034] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/14/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Systemic chemotherapy is the major treatment modality for nasopharyngeal carcinoma (NPC) liver metastases. We investigated the effectiveness of radiofrequency ablation (RFA) treatment, which has not been well explored in this disease. METHODS One-hundred and thirty-four cases of NPC with liver metastases treated with chemotherapy, chemotherapy with RFA, or RFA alone were retrospectively analyzed. Patient survival was evaluated by the log-rank test. Survival was analyses using the Kaplan-Meier method. Cox multivariate analyses of clinicopathological features and different treatment approaches were conducted. RESULTS Local response rates were 58% in the RFA group, 78% in the chemotherapy group and 93% in the chemotherapy with RFA group (P < 0.001). Increased progression-free survival (PFS) and overall survival (OS) were observed in the chemotherapy with RFA group (P < 0.001). Cox multivariate analysis indicated that the number of liver metastases (1 vs. >1), the dimension of the largest liver metastases (≤3 cm vs. >3 cm), evaluation of treatment (response vs. no response) and disease-free survival (≤12 months vs. >12 months) were independent prognostic factors. CONCLUSIONS RFA combined with chemotherapy is a promising treatment for NPC metastatic liver disease with improved local response, PFS, and OS compared to current chemotherapy protocols.
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Affiliation(s)
- Ying Jin
- Department of Medical Oncology, Zhejiang Cancer Hospital, China
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McBride JF, Atwell TD, Charboneau WJ, Young WF, Wass TC, Callstrom MR. Minimally invasive treatment of metastatic pheochromocytoma and paraganglioma: efficacy and safety of radiofrequency ablation and cryoablation therapy. J Vasc Interv Radiol 2011; 22:1263-70. [PMID: 21856504 DOI: 10.1016/j.jvir.2011.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 06/18/2011] [Accepted: 06/25/2011] [Indexed: 10/17/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous ablation methods for the treatment of metastatic pheochromocytomas (PCCs) and paragangliomas (PGLs). MATERIALS AND METHODS From May 2001 to November 2009, 10 patients (mean age 45 years) with metastatic PCCs and PGLs were identified and treated with percutaneous ablation. All patients were given appropriate medication before the ablation procedure. Vital signs were monitored before, during, and after the procedure. There were 47 tumor ablations performed using radiofrequency (RF) ablation, cryoablation, or ethanol injection as determined by tumor location. RESULTS In all patients, all metastatic lesions amendable to percutaneous ablation were treated; for 2 of 10 patients, all known metastases were treated. Successful ablation without evidence of recurrence was achieved in 56% (15 of 27) of primarily treated lesions in patients with available follow-up imaging. The time to disease progression after ablation was 7.2 months ± 4.0. Amelioration of breakthrough hypertensive symptoms or metastasis-related pain was achieved in two of two patients and four of four patients, respectively, at clinical follow-up. Comparison of intra-arterial blood pressure before, during, and after the procedures showed statistically significant differences in these median blood pressures (P = .004-.05). Major complications occurred after 2 of 18 (11%) ablation sessions, including one unplanned increase in level of patient care and one periprocedural death from complications related to bowel perforation. CONCLUSIONS Local control of metastatic PCCs and PGLs with percutaneous ablation can play an important role in disease management when the lesions are unresectable surgically, and there is potential for prolongation of patient function or amelioration of metastasis-related symptoms.
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Affiliation(s)
- Jeremy F McBride
- Department of Radiology, Mayo Clinic College of Medicine and Mayo Foundation, Rochester, MN 55905, USA.
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Huang SC, Chang YY, Chao YJ, Shan YS, Lin XZ, Lee GB. Dual-row needle arrays under an electromagnetic thermotherapy system for bloodless liver resection surgery. IEEE Trans Biomed Eng 2011; 59:824-31. [PMID: 22194233 DOI: 10.1109/tbme.2011.2180381] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Electromagnetic thermotherapy has been extensively investigated recently and may become a new surgical modality for a variety of medical applications. It applies a high-frequency alternating magnetic field to heat up magnetic materials inserted within the human body to generate tissue coagulation or cell apoptosis. Using a new procedure with dual-row needle arrays under an electromagnetic thermotherapy system with a feedback temperature control system, this study demonstrates bloodless porcine liver resection, which is challenging using existing methods. In vitro experiments showed that hollowed, stainless-steel needles could be heated up to more than 300 °C within 30 s when centered under the induction coils of the electromagnetic thermotherapy system. In order to generate a wide ablation zone and to prevent the dual-row needle arrays from sticking to the tissue after heating, a constant temperature of 120 °C was applied using a specific treatment protocol. The temperature distribution in the porcine livers was also measured to explore the effective coagulation area. Liver resection was then performed in Lan-Yu pigs. Experimental results showed that seven pigs underwent liver resection without bleeding during surgery and no complications afterward. The dual-row needle arrays combined with the electromagnetic thermotherapy system are thus shown to be promising for bloodless tissue resection.
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Affiliation(s)
- Sheng Chieh Huang
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu 30013, Taiwan.
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Lee J, Lee JM, Yoon JH, Lee JY, Kim SH, Lee JE, Han JK, Choi BI. Percutaneous radiofrequency ablation with multiple electrodes for medium-sized hepatocellular carcinomas. Korean J Radiol 2011; 13:34-43. [PMID: 22247634 PMCID: PMC3253401 DOI: 10.3348/kjr.2012.13.1.34] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 08/26/2011] [Indexed: 12/29/2022] Open
Abstract
Objective To prospectively evaluate the safety and short-term therapeutic efficacy of switching monopolar radiofrequency ablation (RFA) with multiple electrodes to treat medium-sized (3.1-5.0 cm), hepatocellular carcinomas (HCC). Materials and Methods In this prospective study, 30 patients with single medium-sized HCCs (mean, 3.5 cm; range, 3.1-4.4 cm) were enrolled. The patients were treated under ultrasonographic guidance by percutaneous switching monopolar RFA with a multichannel RF generator and two or three internally cooled electrodes. Contrast-enhanced CT scans were obtained immediately after RFA, and the diameters and volume of the ablation zones were then measured. Follow-up CT scans were performed at the first month after ablation and every three months thereafter. Technical effectiveness, local progression and remote recurrence of HCCs were determined. Results There were no major immediate or periprocedural complications. However, there was one bile duct stricture during the follow-up period. Technical effectiveness was achieved in 29 of 30 patients (97%). The total ablation time of the procedures was 25.4 ± 8.9 minutes. The mean ablation volume was 73.8 ± 56.4 cm3 and the minimum diameter was 4.1 ± 7.3 cm. During the follow-up period (mean, 12.5 months), local tumor progression occurred in three of 29 patients (10%) with technical effectiveness, while new HCCs were detected in six of 29 patients (21%). Conclusion Switching monopolar RFA with multiple electrodes in order to achieve a sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up for the treatment of medium-sized HCCs.
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Affiliation(s)
- Jung Lee
- Seoul National University Hospital, Seoul 110-744, Korea
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