Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy

Biological and Medical Disturbances Due to Exposure to Fields Emitted by Electromagnetic Energy Devices—A Review

The use of electromagnetic systems in daily life is on the rise. The immediate environment, of these electromagnetic energy devices, is exposed to their emitted fields. Environmental disturbances from such exposure could be severe in many ways; one of the most important is health. This could be directly related to the human body or to healthcare sensing and interventional devices. The review of the biological effects and disturbances of medical instruments due to electromagnetic field exposure is the subject of this article. The analysis of the different types of exposure as well as their control to meet safety requirements are investigated involving energy devices covering wide ranges of power and frequency. Thus, biological effects of both wireless telecommunications tools and inductive charging systems are reviewed. Next, we survey electromagnetic disturbances in sensing and stimulation instruments joint to the human body as well as devices used in medical interventions. Means of evaluating and controlling the effects of electromagnetic fields, through electromagnetic compatibility analysis, experimentally and by numerical modeling are conferred and assessed.

Coupled Models in Electromagnetic and Energy Conversion Systems from Smart Theories Paradigm to That of Complex Events: A Review

In this article, we evaluate the modeling of a real operation of a real system using the corresponding adequate theory. We show that the smart theories often used do not directly correspond to reality because these theories have been established in idealized frameworks. The need to adapt such frames to real landscape situations necessitates modifying the models used. This can be achieved by taking into account the different existing physical phenomena, which are normally overlooked in smart idealized models, in a revised coupled model. This contribution aims to analyze and illustrate the relationship between smart theories and coupled realistic models through a literature review. The strategy for constructing such models is discussed and highlighted. The understanding of this approach is illustrated by an application to the case of electromagnetic and energy conversion systems. In these systems, intelligent energy management, conversion and control involve the use of an accurate realistic coupled model in system design, optimization and control. It is a question of coupling and solving equations representing these systems by taking into account the real phenomena involved, which are electrical, magnetic, mechanical, thermal and material. The obvious advantage of using such realistic models in computer-aided design and optimization tools is illustrated. Moreover, the interest of using such models in the supervision of systems is assessed. These demonstrations are supported by a review of examples of work carried out in the field.

Long-Term Comparative Study on the Local Tumour Control of Different Ablation Technologies in Primary and Secondary Liver Malignancies

Purpose: To evaluate local tumour control (LTC) by local ablation techniques (LAT) in liver malignancies. Materials and methods: In patients treated with LAT between January 2013 and October 2020 target lesions were characterised by histology, dimensions in three spatial axes, volume, vascularisation and challenging (CL) location. LAT used were: Radiofrequency Ablation (RFA), Microwave Ablation (MWA), Cryoablation (CRYO), Electrochemotherapy (ECT), and Interstitial Brachytherapy (IBT). Results: 211 LAT were performed in 155 patients. Mean follow-up including MRI for all patients was 11 months. Lesions treated with ECT and IBT were significantly larger and significantly more often located in CL in comparison to RFA, MWA and CRYO. Best LTC (all data for 12 months are given below) resulted after RFA (93%), followed by ECT (81%), CRYO (70%), IBT (68%) and MWA (61%), and further, entity-related for HCC (93%), followed by CRC (83%) and BrC (72%), without statistically significant differences. LTC in hypovascular lesions was worse (64%), followed by intermediate (82% p = 0.01) and hypervascular lesions (92% p = 0.07). Neither diameter (<3 cm: 81%/3−6 cm: 74%/>6 cm: 70%), nor volume (<10 cm3: 80%/10−20 cm3: 86%/>20 cm3: 67%), nor CL (75% in CL vs. 80% in non CL) had a significant impact on LTC. In CL, best LTC resulted after ECT (76%) and IBT (76%). Conclusion: With suitable LAT, similarly good local tumour control can be achieved regardless of lesion size and location of the target.

Percutaneous electrochemotherapy in primary and secondary liver malignancies - local tumor control and impact on overall survival

Background

Local nonsurgical tumor ablation currently represents a further option for the treatment of patients with liver tumors or metastases. Electrochemotherapy (ECT) is a welcome addition to the portfolio of local therapies. A retrospective analysis of patients with liver tumors or metastases treated with ECT is reported. Attention is given to the safety and efficacy of the treatment over time.

Patients and methods

Eighteen consecutive patients were recruited with measurable liver tumors of different histopatologic origins, mainly colorectal cancer, breast cancer, and hepatocellular cancer. They were treated with percutaneous ECT following the standard operating procedures (SOP) for ECT under general anaesthesia and muscle relaxation. Treatment planning was performed based on MRI preoperative images. The follow-up assessment included contrast-enhanced MR within at least 1–3 months after treatment and then after 5, 7, 9, 12, and 18 months until progression of the disease or death.

Results

Only mild or moderate side effects were observed after ECT. The objective response rate was 85.7% (complete response 61.9%, partial 23.8%), the mean progression-free survival (PFS) was 9.0 ± 8.2 months, and the overall survival (OS) was 11.3 ± 8.6 months. ECT performed best (PFS and OS) in lesions within 3 and 6 cm diameters (p = 0.0242, p = 0.0297)_. The effectiveness of ECT was independent of the localization of the lesions: distant, close or adjacent to vital structures. Progression-free survival and overall survival were independent of the primary histology considered.

Conclusions

Electrochemotherapy provides an effective valuable option for the treatment of unresectable liver metastases not amenable to other ablative techniques.