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Bianchi V, Nure E, Nesci C, Pascale MM, Sganga G, Agnes S, Brisinda G. Bridge Therapy before Liver Transplant for Advanced Hepatocellular Carcinoma. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1010. [PMID: 38929627 PMCID: PMC11205611 DOI: 10.3390/medicina60061010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
Hepatocellular carcinoma is the most common primary liver tumor. Orthotopic liver transplant is one of the best treatment options, but its waiting list has to be considered. Bridge therapies have been introduced in order to limit this issue. The aim of this study is to evaluate if bridge therapies in advanced hepatocellular carcinoma can improve overall survival and reduce de-listing. We selected 185 articles. The search was limited to English articles involving only adult patients. These were deduplicated and articles with incomplete text or irrelevant conclusions were excluded. Sorafenib is the standard of care for advanced hepatocellular carcinoma and increases overall survival without any significant drug toxicity. However, its survival benefit is limited. The combination of transarterial chemoembolization + sorafenib, instead, delays tumor progression, although its survival benefit is still uncertain. A few studies have shown that patients undergoing transarterial chemoembolization + radiation therapy have similar or even better outcomes than those undergoing transarterial chemoembolization or sorafenib alone for rates of histopathologic complete response (89% had no residual in the explant). Also, the combined therapy of transarterial chemoembolization + radiotherapy + sorafenib was compared to the association of transarterial chemoembolization + radiotherapy and was associated with a better survival rate (24 vs. 17 months). Moreover, immunotherapy revealed new encouraging perspectives. Combination therapies showed the most encouraging results and could become the gold standard as a bridge to transplant for patients with advanced hepatocellular carcinoma.
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Affiliation(s)
- Valentina Bianchi
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (V.B.); (C.N.); (G.S.)
| | - Erida Nure
- General and Transplant Surgery, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (E.N.); (M.M.P.); (S.A.)
| | - Carmen Nesci
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (V.B.); (C.N.); (G.S.)
| | - Marco Maria Pascale
- General and Transplant Surgery, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (E.N.); (M.M.P.); (S.A.)
| | - Gabriele Sganga
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (V.B.); (C.N.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Salvatore Agnes
- General and Transplant Surgery, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (E.N.); (M.M.P.); (S.A.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
| | - Giuseppe Brisinda
- Emergency Surgery and Trauma Center, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy; (V.B.); (C.N.); (G.S.)
- Catholic School of Medicine “Agostino Gemelli”, 00168 Rome, Italy
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Santucci KL, Snyder KK, Van Buskirk RG, Baust JG, Baust JM. Investigation of Lung Cancer Cell Response to Cryoablation and Adjunctive Gemcitabine-Based Cryo-Chemotherapy Using the A549 Cell Line. Biomedicines 2024; 12:1239. [PMID: 38927445 PMCID: PMC11200978 DOI: 10.3390/biomedicines12061239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/17/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Due to the rising annual incidence of lung cancer (LC), new treatment strategies are needed. While various options exist, many, if not all, remain suboptimal. Several studies have shown cryoablation to be a promising approach. Yet, a lack of basic information pertaining to LC response to freezing and requirement for percutaneous access has limited clinical use. In this study, we investigated the A549 lung carcinoma cell line response to freezing. The data show that a single 5 min freeze to -15 °C did not affect cell viability, whereas -20 °C and -25 °C result in a significant reduction in viability 1 day post freeze to <10%. These populations, however, were able to recover in culture. Application of a repeat (double) freeze resulted in complete cell death at -25 °C. Studies investigating the impact of adjunctive gemcitabine (75 nM) pretreatment in combination with freezing were then conducted. Exposure to gemcitabine alone resulted in minimal cell death. The combination of gemcitabine pretreatment and a -20 °C single freeze as well as combination treatment with a -15 °C repeat freeze both resulted in complete cell death. This suggests that gemcitabine pretreatment may be synergistically effective when combined with freezing. Studies into the modes of cell death associated with the increased cell death revealed the increased involvement of necroptosis in combination treatment. In summary, these results suggest that repeat freezing to -20 °C to -25 °C results in a high degree of LC destruction. Further, the data suggest that the combination of gemcitabine pretreatment and freezing resulted in a shift of the minimum lethal temperature for LC from -25 °C to -15 °C. These findings, in combination with previous reports, suggest that cryoablation alone or in combination with chemotherapy may provide an improved path for the treatment of LC.
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Affiliation(s)
| | - Kristi K. Snyder
- CPSI Biotech, Owego, NY 13827, USA
- Phase Therapeutics, Inc., Owego, NY 13827, USA
| | - Robert G. Van Buskirk
- CPSI Biotech, Owego, NY 13827, USA
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY 13902, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY 13902, USA
| | - John G. Baust
- Center for Translational Stem Cell and Tissue Engineering, Binghamton University, Binghamton, NY 13902, USA
- Department of Biological Sciences, Binghamton University, Binghamton, NY 13902, USA
| | - John M. Baust
- CPSI Biotech, Owego, NY 13827, USA
- Phase Therapeutics, Inc., Owego, NY 13827, USA
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Young S, Abamyan A, Goldberg D, Hannallah J, Schaub D, Kalarn S, Fitzgerald Z, Woodhead G. Cryoablation in the liver: how accurately does the iceball predict the ablation zone? Abdom Radiol (NY) 2024; 49:625-630. [PMID: 38036773 DOI: 10.1007/s00261-023-04117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023]
Abstract
PURPOSE To evaluate the accuracy with which the iceball predicts the realized ablation zone in patients undergoing cryoablation of the liver. MATERIALS AND METHODS Continuous patients who underwent cryoablation of primary or secondary malignancies of the liver were retrospectively reviewed. Iceball and ablation zone dimensions on 1 month follow up imaging were collected in three orientations, the long axis (LA), perpendicular transverse (PTR), and perpendicular craniocaudal (PCC). Factors which may predict differences in the measurements were evaluated with regression analysis. Oncologic outcomes were also collected. RESULTS The mean size of the iceball was 5.5 ± 1.1 cm, 3.9 ± 1.1 cm, and 4.4 ± 1.4 cm in the LA, PTR, and PCC orientations, respectively. The mean size of the one-month ablation cavity was 4.3 ± 1.3 cm, 3 ± 1.1 cm, and 3 ± 1.3 cm in the LA, PTR, and PCC orientations, respectively. The iceball was significantly larger than the ablation zone in all orientations (p < 0.001). When comparing HCC and non-HCC patients the Kaplan-Meier analysis of TTLP, the Kaplan Meier curves deviated significantly (p = 0.015, HR 2.26 (95%CI 1.17-4.37)). When a similar analysis was performed looking at TTP again the curves diverged significantly (p = 0.002, HR 2.4 (95%CI 1.37-4.19)). CONCLUSION The iceball seems to overestimate the realized ablation zone by about 1 cm in all orientations during hepatic cryoablation.
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Affiliation(s)
- Shamar Young
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA.
| | - Art Abamyan
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Dan Goldberg
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Jack Hannallah
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - David Schaub
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Salil Kalarn
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Zachary Fitzgerald
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
| | - Gregory Woodhead
- Division of Interventional Radiology, Department of Radiology, University of Arizona, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ, 85724, USA
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Ablation zone considerations in cryoablation of RCC: accuracy of manufacturer provided model and change from first to second freeze cycle. Clin Imaging 2022; 89:10-15. [DOI: 10.1016/j.clinimag.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
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Computed Tomography Thermography for Ablation Zone Prediction in Microwave Ablation and Cryoablation: Advantages and Challenges in an Ex Vivo Porcine Liver Model. J Comput Assist Tomogr 2020; 44:744-749. [PMID: 32842063 DOI: 10.1097/rct.0000000000001081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate the diagnostic accuracy of computed tomography (CT) for the prediction of ablation zones from microwave ablation (MWA) and cryoablation (CA) in an ex vivo porcine liver model. METHODS Sequential (30 seconds) CT scans were acquired during and after MWA and CA in an ex vivo porcine liver model. We generated 120-kVp equivalent reconstructions of generic dual-energy CT data sets, and comprehensive region-of-interest measurements were statistically correlated with invasive temperature monitoring using Pearson correlation coefficient. Binary logistic regression was performed for prediction of successful ablation. RESULTS With the use of pooled data from 6 lesions in 2 separate experiments, correlation analysis of attenuation in Hounsfield units (HU) and temperature yielded r = -0.79 [confidence interval (CI), -0.85 to -0.71] for MWA and r = 0.62 (CI, 0.55 to 0.67) for CA.For MWA, there was a linear association between attenuation and temperature up to 75°C; thus, linear regression yielded a slope of -2.00 HU/°C (95% CI, -1.58 to -2.41). For CA, a linear association between attenuation and temperature was observed in the cooling phase with a slope of 2.11 HU/°C (95% CI, 1.79 to 2.58). In MWA treatment, binary logistic regression separated less than 70°C and greater than 70°C with 89.2% accuracy. Within the ice ball, temperatures above and below -20°C were distinguished with 65.3% accuracy. CONCLUSIONS Our experiments reveal several difficulties in predicting ablation zone temperature from CT attenuation. Microwave ablation leads to gas production in the tissue, which degrades the accuracy of noninvasive temperature measurement, especially at higher temperatures. In CA, CT thermometry is limited by ice ball formation, which leads to homogeneous attenuation, nearly independent of temperature. Further research is needed to define the role of CT thermography in ablation zone monitoring in liver malignancies.
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Camacho JC, Petre EN, Sofocleous CT. Thermal Ablation of Metastatic Colon Cancer to the Liver. Semin Intervent Radiol 2019; 36:310-318. [PMID: 31680722 DOI: 10.1055/s-0039-1698754] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
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Affiliation(s)
- Juan C Camacho
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
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Yakkala C, Chiang CLL, Kandalaft L, Denys A, Duran R. Cryoablation and Immunotherapy: An Enthralling Synergy to Confront the Tumors. Front Immunol 2019; 10:2283. [PMID: 31608067 PMCID: PMC6769045 DOI: 10.3389/fimmu.2019.02283] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022] Open
Abstract
Treatment of solid tumors by ablation techniques has gained momentum in the recent years due to their technical simplicity and reduced morbidity as juxtaposed to surgery. Cryoablation is one of such techniques, known for its uniqueness to destroy the tumors by freezing to lethal temperatures. Freezing the tumor locally and allowing it to remain in situ unleashes an array of tumor antigens to be exposed to the immune system, paving the way for the generation of anti-tumor immune responses. However, the immune responses triggered in most cases are insufficient to eradicate the tumors with systemic spread. Therefore, combination of cryoablation and immunotherapy is a new treatment strategy currently being evaluated for its efficacy, notably in patients with metastatic disease. This article examines the mechanistic fabric of cryoablation for the generation of an effective immune response against the tumors, and various possibilities of its combination with different immunotherapies that are capable of inducing exceptional therapeutic responses. The combinatorial treatment avenues discussed in this article if explored in sufficient profundity, could reach the pinnacle of future cancer medicine.
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Affiliation(s)
- Chakradhar Yakkala
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Cheryl Lai-Lai Chiang
- Vaccine Development Laboratory, Ludwig Center for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Lana Kandalaft
- Vaccine Development Laboratory, Ludwig Center for Cancer Research, University of Lausanne, Lausanne, Switzerland.,Department of Oncology, Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Alban Denys
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Rafael Duran
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
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Pulmonary Cryoablation Zones: More Aggressive Ablation Is Warranted In Vivo. AJR Am J Roentgenol 2019; 212:195-200. [DOI: 10.2214/ajr.18.19527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pan PJ, Bansal AK, Genshaft SJ, Kim GH, Suh RD, Abtin F. Comparison of Double-Freeze versus Modified Triple-Freeze Pulmonary Cryoablation and Hemorrhage Volume Using Different Probe Sizes in an In Vivo Porcine Lung. J Vasc Interv Radiol 2018; 29:722-728. [DOI: 10.1016/j.jvir.2017.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 11/13/2017] [Accepted: 11/20/2017] [Indexed: 10/17/2022] Open
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10
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Lyons GR, Askin G, Pua BB. Clinical Outcomes after Pulmonary Cryoablation with the Use of a Triple Freeze Protocol. J Vasc Interv Radiol 2018; 29:714-721. [DOI: 10.1016/j.jvir.2017.12.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/18/2017] [Accepted: 12/31/2017] [Indexed: 12/12/2022] Open
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Abstract
Local ablation therapy is considered as a conventional treatment option for patients with early stage hepatocellular carcinoma (HCC). Although radiofrequency (RF) ablation is widely used for HCC, the use of cryoablation has been increasing as newer and safer cryoablation systems have developed. The thermodynamic mechanism of freezing and thawing used in cryoablation is the Joule-Thomson effect. Cryoablation destroys tissue via direct tissue destruction and vascular-related injury. A few recent comparative studies have shown that percutaneous cryoablation for HCCs is comparable to percutaneous RF ablation in terms of long term therapeutic outcomes and complications. Cryoablation has several advantages over RF ablation such as well visualization of iceball, no causation of severe pain, and lack of severe damage to great vessels and gallbladder. It is important to know the advantages and disadvantages of cryoablation compared with RF ablation for improvement of therapeutic efficacy and safety.
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Affiliation(s)
- Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Buethe JY, Abboud S, Brock K, Nizialek G, Rezaee R, Wasman J, Frankel J, Nakamoto DA. Percutaneous CT–Guided Cryoablation of the Salivary Glands in a Porcine Model. J Vasc Interv Radiol 2016; 27:1907-1912. [DOI: 10.1016/j.jvir.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022] Open
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Nomori H, Yamazaki I, Kondo T, Kanno M. The cryoablation of lung tissue using liquid nitrogen in gel and in the ex vivo pig lung. Surg Today 2016; 47:259-264. [PMID: 27262677 DOI: 10.1007/s00595-016-1363-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/09/2016] [Indexed: 11/26/2022]
Abstract
PURPOSES To examine the efficiency of cryoablation using liquid nitrogen in lung tissue, we measured the size and temperature distribution of the frozen area (iceball) in gel and in the ex vivo pig lungs. METHODS Cryoprobes with diameters of 2.4 and 3.4 mm (2.4D and 3.4D, respectively) were used. Three temperature sensors were positioned at the surface of the cryoprobe and at distances of 0.5 and 1.5 cm from the cryoprobe. The ex vivo pig lungs were perfused with 37 °C saline and inflated using ventilator to simulate in vivo lung conditions. RESULTS In gel, the 2.4D and 3.4D probes made iceballs of 3.9 ± 0.1 and 4.8 ± 0.3 cm in diameter, respectively, and the temperature at 1.5 cm from those probes reached -32 ± 8 and -53 ± 5 °C, respectively. In the pig lung, the 2.4D and 3.4D probes made iceballs of 5.2 ± 0.1 and 5.5 ± 0.4 cm in diameter, respectively, and the temperature at 1.5 cm from these probes reached -49 ± 5 and -58 ± 3 °C, respectively. CONCLUSION Liquid nitrogen cryoablation using both 2.4D and 3.4D probes made iceballs that were of sufficient size, and effective temperatures were reached in both gel and the ex vivo pig lung.
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Affiliation(s)
- Hiroaki Nomori
- Departments of Thoracic Surgery, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, 296-8602, Japan.
| | - Ikuo Yamazaki
- Diagnostic Radiology, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshiya Kondo
- Clinical Engineering, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masaya Kanno
- Clinical Engineering, Kameda Medical Center, Kamogawa, Chiba, Japan
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Habib A, Desai K, Hickey R, Thornburg B, Lewandowski R, Salem R. Locoregional therapy of hepatocellular carcinoma. Clin Liver Dis 2015; 19:401-20. [PMID: 25921670 DOI: 10.1016/j.cld.2015.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatocellular carcinoma can be treated using minimally invasive, image-guided, catheter-based or percutaneous techniques. Such procedures offer compelling clinical outcomes with a favorable side-effect profile in a population of patients who are poor candidates for surgical or systemic treatment. This article discusses key data regarding the effectiveness of locoregional therapies in treating these patients. Disease-specific treatment is discussed in the context of hepatocellular carcinoma, with additional data discussed in the context of transplantation. As rapid innovation occurs in the realm of oncology, interventional oncology represents a safe, effective alternative that continues to generate impressive data that could potentially change treatment paradigms.
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Affiliation(s)
- Ali Habib
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Kush Desai
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Ryan Hickey
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Bartley Thornburg
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Robert Lewandowski
- Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Vascular and Interventional Radiology, Image-Guided Therapy, Section of Interventional Radiology, Division of Interventional Oncology, Department of Radiology, Northwestern University, 676 North St. Clair, Suite 800, Chicago, IL 60611, USA.
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15
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de Freitas RMC, Andrade CS, Caldas JGMP, Tsunemi MH, Ferreira LB, Arana-Chavez VE, Cury PM. Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy. Cardiovasc Intervent Radiol 2015; 38:1261-70. [DOI: 10.1007/s00270-014-1043-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/30/2014] [Indexed: 01/23/2023]
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16
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Chheang S, Abtin F, Guteirrez A, Genshaft S, Suh R. Imaging Features following Thermal Ablation of Lung Malignancies. Semin Intervent Radiol 2014; 30:157-68. [PMID: 24436532 DOI: 10.1055/s-0033-1342957] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Percutaneous image-guided thermal ablation is gaining attraction as an effective alternative to surgical resection for patients with primary and secondary malignancies of the lung. Currently, no standard follow-up imaging protocol has been established or uniformly accepted. The early identification of residual or recurrent tumor would in theory enable the practitioner to offer expeditious retreatment or alternative treatment. This review elaborates on the imaging findings following thermal ablation, both heat- and cold-based, of nonresectable pulmonary malignancies.
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Affiliation(s)
- Sophie Chheang
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Feredoin Abtin
- Thoracic Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Antonio Guteirrez
- Thoracic Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Scott Genshaft
- Thoracic Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Robert Suh
- Thoracic Imaging Section, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
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Molla N, AlMenieir N, Simoneau E, Aljiffry M, Valenti D, Metrakos P, Boucher LM, Hassanain M. The role of interventional radiology in the management of hepatocellular carcinoma. ACTA ACUST UNITED AC 2014; 21:e480-92. [PMID: 24940108 DOI: 10.3747/co.21.1829] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (hcc) is one of the most common causes of cancer-related death worldwide. Overall, liver transplantation and resection are the only available treatments with potential for cure. Various locoregional therapies are widely used to manage patients with advanced hcc or as a bridging therapy for patients with early and intermediate disease. This article reviews and evaluates the role of interventional radiology in the management of such cases by assessing various aspects of each method, such as effect on rates of survival, recurrence, tumour response, and complications. METHODS A systemic search of PubMed, medline, Ovid Medline In-Process, and the Cochrane Database of Systematic Reviews retrieved all related scientific papers for review. RESULTS Needle core biopsy is a highly sensitive, specific, and accurate method for hcc grading. Portal-vein embolization provides adequate expansion of the future liver remnant, making more patients eligible for resection. In focal or multifocal unresectable early-stage disease, radiofrequency ablation tops all other thermoablative methods. However, microwave ablation is preferred in large tumours and in patients with Child-Pugh B disease. Cryoablation is preferred in recurrent disease and in patients who are poor candidates for anesthesia. Of the various transarterial modalities-transarterial chemoembolization (tace), drug-eluting beads, and transarterial radio-embolization (tare)-tace is the method of choice in Child-Pugh A disease, and tare is the method of choice in hcc cases with portal vein thrombosis. CONCLUSIONS The existing data support the importance of a multidisciplinary approach in hcc management. Large randomized controlled studies are needed to provide clear indication guidelines for each method.
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Affiliation(s)
- N Molla
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia. ; Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - N AlMenieir
- Department of Radiology, King Saud University, Riyadh, Saudi Arabia
| | - E Simoneau
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - M Aljiffry
- Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - D Valenti
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
| | - L M Boucher
- Department of Radiology, McGill University Health Centre, Montreal, QC
| | - M Hassanain
- Section of Hepatopancreatobiliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Department of Surgery, King Saud University, Riyadh, Saudi Arabia
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18
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Prologo JD, Patel I, Buethe J, Bohnert N. Ablation Zones and Weight-Bearing Bones: Points of Caution for the Palliative Interventionalist. J Vasc Interv Radiol 2014; 25:769-775.e2. [DOI: 10.1016/j.jvir.2014.01.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/16/2014] [Accepted: 01/26/2014] [Indexed: 10/25/2022] Open
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19
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Niu L, Li J, Zeng J, Zhou L, Wang S, Zhou X, Sheng L, Chen J, Xu K. Comparison of percutaneous cryoablation with microwave ablation in a porcine liver model. Cryobiology 2014; 68:194-9. [PMID: 24485805 DOI: 10.1016/j.cryobiol.2014.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 12/19/2013] [Accepted: 01/13/2014] [Indexed: 11/26/2022]
Abstract
We compared imaging and pathological changes between argon-helium cryosurgical (AH) and microwave (MW) ablation in a porcine liver model. Immediately after ablation, computed tomography (CT) imaging showed that the area affected by MW ablation was considerably greater than that affected by AH ablation; moreover, the surface area of necrotic tissue was considerably greater in the AH group, whereas the depth of the necrotic area was similar. Seven days after ablation, the affected area had not changed much in the AH group, but it had significantly increased in the MW group; similarly, the surface and depth of the necrotic areas had not changed much in the AH group, but they had increased significantly in the MW group. The pathological findings showed similar definitive areas for both groups at both time points. The findings indicated that long time after both therapies, complete tissue necrosis can be achieved, but the extent and depth of necrosis differ: necrosis foci after AH ablation could be predicted by ice ball under CT image, and necrosis foci after MW ablation will increase obviously. MW ablation might therefore be suitable for tumors with a larger volume and simple anatomical structures, and AH ablation might be suitable for tumors with complex anatomical structures or those located near important organs. These two methods could therefore be used in combination in clinical settings, but details of the procedure need to be studied.
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Affiliation(s)
- Lizhi Niu
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 of Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jialiang Li
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China
| | - Jianying Zeng
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China
| | - Liang Zhou
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China
| | - Song Wang
- Department of Interventional Ultrasound, Yuquan Hospital, Tsinghua University, No. 5 of Shijingshan Road, Shijingshan District, Beijing 100049, China
| | - Xulong Zhou
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China
| | - Lin Sheng
- Department of Interventional Ultrasound, Yuquan Hospital, Tsinghua University, No. 5 of Shijingshan Road, Shijingshan District, Beijing 100049, China.
| | - Jibing Chen
- Fuda Institute of Cryosurgery for Cancer, No. 2 of Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Kecheng Xu
- Fuda Cancer Hospital, School of Medicine, Jinan University, No. 2 of Tangdexi Road, Tianhe District, Guangzhou, Guangdong 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 of Tangdexi Road, Tianhe District, Guangzhou 510665, China
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20
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Xu J, Li J, Zhou X, Zeng J, Yao F, Wang Y, Mu F, Niu L, Chen J, Liu J, Xu K. Cryotherapy for local recurrent dermatofibrosarcoma protuberans: experience in 19 patients. Cryobiology 2014; 68:134-8. [PMID: 24463091 DOI: 10.1016/j.cryobiol.2014.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/18/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive, cutaneous, malignant tumor characterized by a high propensity for local relapse. Wide and deep local excision with reconstructive surgery is the current standard therapy for DFSP, with a local recurrence rate (LRR) of nearly 40%. In this study, we cured 19 patients with local recurrence of DFSP with 39 sessions of percutaneous cryoablation performed between July 2004 and August 2008. The LRRs after one, two and three cryosurgery sessions per patient were 68%, 54% and 0%, respectively. Moreover, the LRR did not differ with tumor location or size. Furthermore, all patients had a progression-free survival of >5 years. Only minor complications such as fever, local edema, mild nerve injury and local pain occurred, and were resolved within 1 week with symptomatic treatment. In our experience, percutaneous cryoablation is a relatively safe and efficient technique for the treatment of local recurrence of DFSPs.
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Affiliation(s)
- Jiongyuan Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jialiang Li
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Xulong Zhou
- Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jianying Zeng
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Fei Yao
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Yuan Wang
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Feng Mu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Lizhi Niu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jibing Chen
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Jianguo Liu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Kecheng Xu
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
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22
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Lee KS, Pua BB. Alternative to surgery in early stage NSCLC-interventional radiologic approaches. Transl Lung Cancer Res 2013; 2:340-53. [PMID: 25806253 DOI: 10.3978/j.issn.2218-6751.2013.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/24/2013] [Indexed: 12/22/2022]
Abstract
Interventional radiologists have a variety of techniques in their armamentarium to treat pulmonary tumors. While most therapies are targeted to metastasis or palliation, percutaneous thermal ablation represents a potential therapy for not only palliation, but to treat inoperable early stage disease. Although radiofrequency ablation (RFA) is the most studied of these ablative techniques, newer technologies of thermal ablation, such as microwave and cryoablation have emerged as additional options. In this article, we will review the three different thermal ablative modalities, including patient selection, technique, outcomes, complications, and imaging follow-up. A brief discussion of state of the art techniques such as irreversible electroporation (IRE) and catheter directed therapies will also be included.
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Affiliation(s)
- Kyungmouk Steve Lee
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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23
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Factors Affecting Local Progression after Percutaneous Cryoablation of Lung Tumors. J Vasc Interv Radiol 2013; 24:813-21. [DOI: 10.1016/j.jvir.2012.12.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 12/27/2012] [Accepted: 12/30/2012] [Indexed: 01/20/2023] Open
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24
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Mu F, Liu SP, Zhou XL, Chen JB, Li HB, Zuo JS, Xu KC. Prevention of needle-tract seeding by two-step freezing after lung cancer biopsy. Pathol Oncol Res 2013; 19:447-50. [PMID: 23361472 DOI: 10.1007/s12253-012-9601-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 12/21/2012] [Indexed: 10/27/2022]
Abstract
Fine-needle aspiration biopsy is a method to detect malignancy for undetermined pulmonary nodules, but has the potential to spread malignant cells from the tumor to the pleural cavity or chest wall. We developed a two-step freezing method to avoid needle-tract seeding, by use of percutaneous cryoablation after biopsy but before the biopsy needle was removed. A man aged 72 years was admitted because of a large mass in right upper lobe. After biopsy, the patient underwent surgery. Pathological assessment of the resected tumor showed that tissue around the biopsy probe and cryoprobe had been killed before needle withdrawal.
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Affiliation(s)
- Feng Mu
- Guangzhou Fuda Hospital, Institutes of Biomedicine and Health, Chinese Academy of Science, No. 91 Judezhong Road, Haizhu District, Guangzhou, Guangdong 510305, China
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25
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Sharma A, Abtin F, Shepard JAO. Image-Guided Ablative Therapies for Lung Cancer. Radiol Clin North Am 2012; 50:975-99. [DOI: 10.1016/j.rcl.2012.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Abstract
Although nephron-sparing surgery remains the gold standard treatment for small renal tumors, minimally invasive image-guided percutaneous ablation is becoming a viable alternative to operative resection. Percutaneous radiofrequency ablation (RFA) and cryoablation show high technical success rates, a relatively low incidence of residual or recurrent tumor, and competitive rates of patient survival. In this review, an overview of the current status of image-guided percutaneous ablation of renal tumors is presented, with a focus on procedure indications and patient selection, technical aspects of ablation procedures, and treatment outcomes and patient follow-up.
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Affiliation(s)
- Majid Maybody
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
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27
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Computed Tomographic Appearance of Lung Tumors Treated with Percutaneous Cryoablation. J Vasc Interv Radiol 2012; 23:1043-52. [DOI: 10.1016/j.jvir.2012.04.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/07/2012] [Accepted: 04/29/2012] [Indexed: 11/21/2022] Open
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28
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Tissue temperature feedback control of power: the key to successful ablation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2012; 6:276-82. [PMID: 22437990 DOI: 10.1097/imi.0b013e31822b4d22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multiple ablation technologies are used to treat atrial fibrillation during cardiac operations. All such ablation technologies use locally induced temperature extremes (>50°C or <-20°C) to kill tissue and create a lesion pattern in the atria which blocks activation pathways that initiate and sustain atrial fibrillation. The technologies used to heat tissue have included radiofrequency (RF), microwave, high-intensity focused ultrasound, and infrared laser. RF accounts for more than 95% of the heating-based ablation technology used by cardiac surgeons. Energy delivery with RF is easier to control than with some other technologies, the heating produced by the energy source is well understood, and manufacturing costs are not excessive. Whichever heating technology is used, control of energy delivery is required to ensure both safe and effective heating of the targeted tissue. All targeted tissue needs to be heated above 50°C to achieve cell death. However, the targeted tissue should not be heated above 100°C, as this can cause perforation due to a steam pop. In addition, adjacent noncardiac tissues must not be damaged during the ablation procedure. The best method to achieve this control uses direct measurement of tissue temperature, because the tissue temperature defines both the safe and effective limits for the ablative process.
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29
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Energy Ablative Techniques in Renal Cell Carcinoma. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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30
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Swanson DK, Smith WJ, Ibrahim T, Wechsler AS. Tissue Temperature Feedback Control of Power the Key to Successful Ablation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - Andrew S. Wechsler
- Department of Cardiothoracic Surgery, Drexel University College of Medicine, Philadelphia, PA USA
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31
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Goetz JE, Robinson DA, Pedersen DR, Conzemius MG, Brown TD. Cryoinsult parameter effects on the histologically apparent volume of experimentally induced osteonecrotic lesions. J Orthop Res 2011; 29:931-7. [PMID: 21259339 PMCID: PMC3082588 DOI: 10.1002/jor.21342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 12/06/2010] [Indexed: 02/04/2023]
Abstract
Investigation of femoral head osteonecrosis would benefit from an animal model whose natural history includes progression to bony collapse of a segmental necrotic lesion. The bipedal emu holds attraction for systematic organ-level study of collapse mechanopathology. One established method of experimentally inducing segmental lesions is liquid nitrogen cryoinsult. Four cryoinsult parameters-hold temperature, freeze duration, freeze/thaw repetition, and thaw duration-were investigated to determine their individual and combined effects on resulting necrotic lesion morphology. 3D distributions of histologically apparent osteocyte necrosis from 24 emus receiving varying cryoinsults were used to develop univariate and multivariate linear regression models relating resulting necrotic lesion morphology to particular cryoinsult input parameters. These models were then applied to predict lesion size in four additional emus receiving differing input cryoinsults. The best multivariate regression model predicted lesion volumes that were accurate to better than 8% of overall emu femoral head volume. The hold temperature during cryoinsult was by far the most influential cryoinsult input parameter. The utility of this information is to enhance the consistency and predictability of cryoinsult-induced segmental lesion size for the purposes of systematic laboratory studies at the whole-organ level.
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Affiliation(s)
- Jessica E Goetz
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA,Biomedical Engineering, University of Iowa, Iowa City, IA
| | - Duane A Robinson
- College of Veterinary Medicine, University of Minnesota, St. Paul, MN
| | - Douglas R Pedersen
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA,Biomedical Engineering, University of Iowa, Iowa City, IA
| | | | - Thomas D Brown
- Department of Orthopaedics & Rehabilitation, University of Iowa, Iowa City, IA,Biomedical Engineering, University of Iowa, Iowa City, IA
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32
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Ahmed M, Brace CL, Lee FT, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011; 258:351-69. [PMID: 21273519 DOI: 10.1148/radiol.10081634] [Citation(s) in RCA: 541] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Image-guided tumor ablation with both thermal and nonthermal sources has received substantial attention for the treatment of many focal malignancies. Increasing interest has been accompanied by continual advances in energy delivery, application technique, and therapeutic combinations with the intent to improve the efficacy and/or specificity of ablative therapies. This review outlines clinical percutaneous tumor ablation technology, detailing the science, devices, techniques, technical obstacles, current trends, and future goals in percutaneous tumor ablation. Methods such as chemical ablation, cryoablation, high-temperature ablation (radiofrequency, microwave, laser, and ultrasound), and irreversible electroporation will be discussed. Advances in technique will also be covered, including combination therapies, tissue property modulation, and the role of computer modeling for treatment optimization.
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Affiliation(s)
- Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapy, Section of Interventional Radiology, and Section of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Rd, Boston, MA 02215, USA.
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33
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Allen BC, Remer EM. Percutaneous cryoablation of renal tumors: patient selection, technique, and postprocedural imaging. Radiographics 2010; 30:887-900. [PMID: 20631358 DOI: 10.1148/rg.304095134] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous cryoablation of renal tumors requires a number of important steps for success and relies heavily on imaging for treatment planning, intraprocedural guidance and monitoring, detection of untreated tumor, and surveillance for disease progression. Imaging-guided percutaneous cryoablation has several advantages over laparoscopic cryoablation. In particular, computed tomography (CT) and magnetic resonance (MR) imaging allow global evaluation of the ablation zone and an accurate depiction of the treatment margin. Ultrasonography allows real-time guidance of probe placement but cannot help depict ice ball formation as accurately as CT or MR imaging. Multiphasic CT or MR imaging should be performed at structured intervals following ablation. Treated tumors are expected to decrease in size over time, and lesion growth and internal or nodular enhancement are suspicious for tumor recurrence or progression. Complications include probe site pain, hematoma, incomplete ablation, and recurrent tumor. Current limitations of percutaneous cryoablation include the inability to control hemorrhage without intraarterial access and a lack of long-term follow-up data. Nevertheless, percutaneous cryoablation is an effective choice for minimally invasive nephron-sparing treatment of renal tumors.
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Affiliation(s)
- Brian C Allen
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
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34
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Pua BB, Thornton RH, Solomon SB. Ablation of pulmonary malignancy: current status. J Vasc Interv Radiol 2010; 21:S223-32. [PMID: 20656232 DOI: 10.1016/j.jvir.2010.01.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/05/2009] [Accepted: 01/19/2010] [Indexed: 12/26/2022] Open
Abstract
Since the first reported use of radiofrequency ablation of the lung in 2000, the field of image-guided lung ablation has received a considerable amount of attention. Survival studies have demonstrated the potential utility of thermal ablation in the treatment of patients with early-stage primary and limited secondary pulmonary tumors with promising results. Diagnostic imaging studies have advanced the understanding of the expected immediate postablation appearance of treated lesions, leading the way for early detection of local tumor progression. These survival studies and the expected imaging follow-up of these patients are reviewed herein.
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Affiliation(s)
- Bradley B Pua
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10021, USA
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35
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On freeze-thaw sequence of vital organ of assuming the cryoablation for malignant lung tumors by using cryoprobe as heat source. Cryobiology 2010; 61:317-26. [PMID: 21036162 DOI: 10.1016/j.cryobiol.2010.10.157] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 09/21/2010] [Accepted: 10/18/2010] [Indexed: 11/23/2022]
Abstract
Regarding cryoablation for the malignant lung tumors, multiple trials of the freeze-thaw process have been made, and we considered it necessary to view and analyze the freeze-thaw process as a freeze-thaw sequence. We caused the sequence in a porcine lung in vivo by using an acicular, cylindrical stainless-steel probe as the heat source for the freeze-thaw sequence and cooling to -150 °C with super high-pressure argon gas by causing the Joule-Thomson effect phenomenon at the tip of the probe. In this experiment, we examined the sequence by measuring the temperature and using the isothermal curve and the freezing function. As a result, it was demonstrated that the freezing characteristics considerably differed in the first sequence and the second sequence from those of non-aerated organs such as liver and kidney. In our experiments on porcine lung, thermal properties were considered to change as the bleeding caused by the first thawing infiltrated in the lung parenchyma, and it was confirmed that the frozen area in the second cycle was dramatically enlarged as compared with the first cycle (when a similar sequence is continuously repeated, we say it as cycle). This paper provides these details.
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36
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Hinshaw JL, Lee FT, Laeseke PF, Sampson LA, Brace C. Temperature isotherms during pulmonary cryoablation and their correlation with the zone of ablation. J Vasc Interv Radiol 2010; 21:1424-8. [PMID: 20688532 DOI: 10.1016/j.jvir.2010.04.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/07/2010] [Accepted: 04/12/2010] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the expected ablation zone size and associated isotherms when using clinically available percutaneous cryoprobes for pulmonary cryoablation in a porcine lung model. MATERIALS AND METHODS Seven ablations were performed in the lungs of three adult pigs using clinically available 2.4-mm cryoprobes (Endocare, Inc, Irvine, California) and a 10-minute double-freeze protocol. Five 18-gauge thermocouples were positioned at 5-mm increments (ie, 5, 10, 15, 20, and 25 mm) from the cryoprobe. Real-time tissue temperatures were recorded during the cryoablation. The isotherms obtained during the ablation and the pathological ablation zones were measured. RESULTS The pathologic zone of complete necrosis had a mean diameter of 2.4 + or - 0.2 cm, with a mean area of 4.6 + or - 0.6 cm(2) and a circularity of 0.95 + or - 0.04. In comparison, the mean diameter (+ or - standard deviation) of the 0 degrees C, -20 degrees C, and -40 degrees C isotherms were 3.1 + or - 0.2 cm, 2.3 + or - 0.3 cm, and 1.8 + or - 0.4 cm, respectively. The -20 degrees C isotherm was most closely related to the pathologic zone of ablation. CONCLUSIONS This study establishes the temperature isotherms and associated ablation zone size that can be expected with modern percutaneous cryoprobes in an in vivo porcine lung model.
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Affiliation(s)
- J Louis Hinshaw
- University of Wisconsin Department of Radiology, E3/311 CSC, 600 Highland Avenue, Madison, WI 53792, USA.
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37
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Abstract
BACKGROUND Locoregional treatments of hepatocellular carcinoma (HCC) have evolved over the past 20 years. Interventional radiologists have developed an important role in the palliative and curative treatment of the disease. This review summarizes commonly used interventional radiological treatment protocols to assist practitioners in understanding the techniques used to treat HCC. METHODS Various searches were performed to evaluate recent publications regarding systemic treatments of HCC as well as transplant/surgery, chemoembolization, yttrium-90 radioembolization, percutaneous radiofrequency ablation (RFA), cryoablation, and percutaneous ethanol injection (PEI). RESULTS No standard for chemoembolization was found. Two studies evaluating survival with chemoembolization vs medical therapy found benefits with the former. PEI offers favorable outcomes in small HCC but has increased recurrence and decreased long-term survival compared with RFA. Local recurrence, response rates, and mortality from RFA rival surgical resection in HCC less than 3 cm. Cryoablation appears to be effective, and yttrium-90 radioembolization is an additional tool. CONCLUSIONS Chemoembolization improves survival and offers improved tumor response compared to systemic treatment. More studies are needed to standardize chemoembolization preparations and techniques. RFA provides better results than PEI but has not been compared with cryoablation. Radioembolization appears to be as effective as chemoembolization, but the preprocedure evaluation and costs may limit its use.
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Affiliation(s)
- Cliff R Davis
- Tampa General Hospital, Radiology Association of Tampa/Department of Interventional Radiology, Tampa, FL 33606, USA.
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38
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Hinshaw JL, Littrup PJ, Durick N, Leung W, Lee FT, Sampson L, Brace CL. Optimizing the protocol for pulmonary cryoablation: a comparison of a dual- and triple-freeze protocol. Cardiovasc Intervent Radiol 2010; 33:1180-5. [PMID: 20437048 DOI: 10.1007/s00270-010-9868-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/26/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to compare a double freeze-thaw protocol to a triple freeze-thaw protocol for pulmonary cryoablation utilizing an in vivo porcine lung model. A total of 18 cryoablations were performed in normal porcine lung utilizing percutaneous technique with 9 each in a double- (10-5-10) and triple-freeze (3-3-7-7-5) protocol. Serial noncontrast CT images were obtained during the ablation. CT imaging findings and pathology were reviewed. No imaging changes were identified during the initial freeze cycle with either protocol. However, during the first thaw cycle, a region of ground glass opacity developed around the probe with both protocols. Because the initial freeze was shorter with the triple freeze-thaw protocol, the imaging findings were apparent sooner with this protocol (6 vs. 13 min). Also, despite a shorter total freeze time (15 vs. 20 min), the ablation zone identified with the triple freeze-thaw protocol was not significantly different from the double freeze-thaw protocol (mean diameter: 1.67 ± 0.41 cm vs. 1.66 ± 0.21 cm, P = 0.77; area: 2.1 ± 0.48 cm(2) vs. 1.99 ± 0.62 cm(2), P = 0.7; and circularity: 0.95 ± 0.04 vs. 0.96 ± 0.03, P = 0.62, respectively). This study suggests that there may be several advantages of a triple freeze-thaw protocol for pulmonary cryoablation, including earlier identification of the imaging findings associated with the ablation, the promise of a shorter procedure time or larger zones of ablation, and theoretically, more effective cytotoxicity related to the additional freeze-thaw cycle.
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Affiliation(s)
- J Louis Hinshaw
- Department of Radiology, University of Wisconsin, Mail Code 3252, 600 Highland Ave, Madison, WI 53792-3252, USA.
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Gage AA, Baust JM, Baust JG. Experimental cryosurgery investigations in vivo. Cryobiology 2009; 59:229-43. [PMID: 19833119 DOI: 10.1016/j.cryobiol.2009.10.001] [Citation(s) in RCA: 174] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/30/2009] [Accepted: 10/01/2009] [Indexed: 12/16/2022]
Abstract
Cryosurgery is the use of freezing temperatures to elicit an ablative response in a targeted tissue. This review provides a global overview of experimentation in vivo which has been the basis of advancement of this widely applied therapeutic option. The cellular and tissue-related events that underlie the mechanisms of destruction, including direct cell injury (cryolysis), vascular stasis, apoptosis and necrosis, are described and are related to the optimal methods of technique of freezing to achieve efficacious therapy. In vivo experiments with major organs, including wound healing, the putative immunological response following thawing, and the use of cryoadjunctive strategies to enhance cancer cell sensitivity to freezing, are described.
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Affiliation(s)
- A A Gage
- Department of Surgery, SUNY Buffalo, Buffalo, NY, USA
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Littrup PJ, Jallad B, Vorugu V, Littrup G, Currier B, George M, Herring D. Lethal isotherms of cryoablation in a phantom study: effects of heat load, probe size, and number. J Vasc Interv Radiol 2009; 20:1343-51. [PMID: 19695903 DOI: 10.1016/j.jvir.2009.05.038] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 05/27/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To assess the effects on the proportions of lethal ice (ie, colder than -30 degrees C) in phantoms with different heat loads created by varying the size and number of cryoprobes spaced 2 cm apart. MATERIALS AND METHODS Thermocouples at 0.5-, 1.0-, and 1.5-cm intervals from 1.7- or 2.4-mm-diameter cryoprobes were held by jigs accommodating a maximum of four cryoprobes. Agar phantoms (N = 24) used three sets of baseline temperatures: approximately 6 degrees C, 24 degrees C, and 39 degrees C. Temperatures during 15-minute freeze cycles were correlated with actual thermocouple locations seen within the ice by computed tomography (CT). Diameters and surface areas of the -30 degrees C lethal isotherm were assessed over time as percentages of the overall ice ball. RESULTS The high-heat load phantom experiments (39 degrees C) showed the greatest impact on lethal zones by percentage for all probe configurations. At 15 minutes, single-, double-, triple-, and quadruple-probe arrangements of 2.4-mm cryoprobes had average lethal ice diameters of 1.2, 3.3, 4.1, and 4.9 cm, respectively, comprising 13%, 46%, 51%, and 56% surface areas of lethal ice, respectively. Surface areas and diameters of lethal ice made by 1.7-mm cryoprobes were 71% and 84% of those made by 2.4-mm cryoprobes, respectively. Lethal ice resides less than 1 cm behind the leading edge for nearly all probe configurations and heat loads. CONCLUSIONS Single cryoprobes create very low percentages of lethal ice. Multiple cryoprobes overcome the high heat load of body temperature phantoms and help compensate for the lower freeze capacity of thinner cryoprobes.
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Affiliation(s)
- Peter J Littrup
- Department of Radiology, Karmanos Cancer Institute, 721 Harper Professional Building, Detroit, MI 48201, USA.
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Radiofrequency thermocoagulation of lung tumours. Where we are, where we are headed. Clin Transl Oncol 2009; 11:28-34. [PMID: 19155201 DOI: 10.1007/s12094-009-0307-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Only 25% of all lung cancers are diagnosed in an early stage allowing surgical treatment. Primary tumours usually concerning lung metastasis are breast, colon, kidney, uterus/cervix, prostate, and head and neck tumours. During recent years many publications have confirmed the effectiveness and reliability of lung radiofrequency ablation (RFA) alone or together with other techniques (chemotherapy, radiotherapy...). Results suggest that survival increase and curative rates of lung radiofrequency are similar to those achieved by more aggressive procedures and present lower rates of complications. Pneumothorax, pleural effusion and alveolar haemorrhage are the most frequent complications. Indications for lung RFA must be individually evaluated by lung cancer committees. Percutaneous lung RFA may be useful in patients with pulmonary primary tumours and metastases, especially in those with nodules smaller than 3 cm and a peripheral location (>1 cm from the hilum). PET/CT seems to be the most accurate technique in patient follow up.
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Beemster PW, Lagerveld BW, Witte LPW, de la Rosette JJMCH, Pes MPL, Wijkstra H. The Performance of 17-gauge Cryoprobes In Vitro. Technol Cancer Res Treat 2008; 7:321-7. [DOI: 10.1177/153303460800700406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In cryosurgery it is crucial that the performance of cryoprobes is predictable and constant. In this study we tested the intra- and interneedle variation between 17-gauge cryoprobes in two homogeneous mediums. Also, a multiprobe setup was tested. Cryoprobe performance was defined as the time it takes one cryoprobe to lower the temperature from 0 to −20 °C as measured by four thermosensors each at 3 mm distance from the cryoprobe. In agar eight cryoprobes were tested during six freeze cycles, and in gel four cryoprobes during four freeze cycles; each freeze cycle in a different cup of agar or gel. Using more accurate ‘bare’ thermosensors three cryoprobes were tested in gel during two freeze cycles. A multiprobe configuration with four cryoprobes was tested during two freeze cycles in both agar and gel. Statistical analyses were done using ANOVA for repeated measures. There was no significant intraneedle variation, whereas both in agar and gel there was a significant interneedle variation (p<0.05). Mean performance in gel was better than in agar (p<0.001). Also, there was a significant variation between the four thermosensors (p< 0.001). Using bare thermosensors mean performance was 2.7 times faster compared to measurements by regular thermosensors (p<0.001). In a multiprobe configuration, overall performance seems less variable and more reproducible compared to a single cryoprobe. In conclusion, the performance of cryoprobes differs depending on the medium and measuring device used. Cryoprobes deliver reproducible freeze cycles, although there is variation between different cryoprobes. In a multiprobe configuration performance seems less variable.
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Affiliation(s)
- Patricia W.T. Beemster
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Brunolf W. Lagerveld
- Department of Urology St. Lucas Andreas Hospital Jan Tooropstraat 164 1061 AE Amsterdam The Netherlands and Onze Lieve Vrouwen Gasthuis Oosterpark 9 1091 AC Amsterdam The Netherlands
| | - Lambertus P. W. Witte
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Jean J. M. C. H. de la Rosette
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - M. Pilar Laguna Pes
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
| | - Hessel Wijkstra
- Department of Urology Academic Medical Center University of Amsterdam Meibergdreef 9 1105 AZ Amsterdam ZO The Netherlands
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Does selective intubation increase ablation zone size during pulmonary cryoablation? J Vasc Interv Radiol 2008; 19:1497-501. [PMID: 18662888 DOI: 10.1016/j.jvir.2008.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 06/11/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the effect of selective intubation on ablation zone size during pulmonary cryoablation. MATERIALS AND METHODS Selective bronchial intubation and aeration was performed in three domestic swine. A total of 20 cryoablations (ventilated, n = 10; nonventilated, n = 10) were performed. The animals were immediately sacrificed, and their lungs were removed and sectioned along the axis of ablation in 5-mm intervals. The diameter and area of the ablation zone were recorded, and the isoperimetric ratio (measure of circularity) and estimated volume were calculated. RESULTS There was no significant difference in maximum diameter, minimum diameter, area, circularity, or estimated volume of the ablation zones between the aerated and nonaerated groups (mean diameter, 2.4 cm vs 2.4 cm, respectively, P = .99; area, 4.6 cm(2) vs 4.8 cm(2), P = .7; circularity, 0.94 vs 0.94, P = .99; estimated volume, 11.5 cm(3) vs 11.3 cm(3), P = .99). CONCLUSIONS In contrast to radiofrequency ablation, selective bronchial intubation did not have a significant effect on the resulting ablation zones. This suggests that selective intubation may not be warranted in the setting of pulmonary cryoablation.
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Maybody M, Solomon SB. Image-Guided Percutaneous Cryoablation of Renal Tumors. Tech Vasc Interv Radiol 2007; 10:140-8. [DOI: 10.1053/j.tvir.2007.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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