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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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2
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Cheng JF, Sun QL, Tang L, Xu XJ, Huang XZ. Meta-analysis of transarterial chemoembolization combined with cryoablation vs transarterial chemoembolization alone for ≥ 5 cm hepatocellular carcinoma. World J Gastrointest Oncol 2024; 16:2793-2803. [DOI: 10.4251/wjgo.v16.i6.2793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/01/2024] [Accepted: 04/16/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) ranks sixth globally in cancer incidence and third in mortality rates. Unfortunately, over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations, poor physical condition, and limited organ availability upon diagnosis. Clinical guidelines endorse transarterial chemoembolization (TACE) as the frontline treatment for intermediate to advanced-stage HCC. Cryoablation (CRA) is an emerging local ablative therapy increasingly used in HCC management. Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects, potentially improving long-term survival rates. However, the superiority of combined TACE + CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.
AIM To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of ≥ 5 cm.
METHODS PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022. Meta-analysis was performed using RevMan 5.3 software.
RESULTS After screening according to the inclusion and exclusion criteria, 6 articles were included, including 2 randomized controlled trials and 4 nonrandomized controlled trials, with a total of 575 patients included in the meta-analysis. The results showed that the objective response rate [odds ratio (OR) = 2.56, 95% confidence interval (CI):1.66-3.96, P < 0.0001), disease control rate (OR = 3.03, 95%CI: 1.88-4.89, P < 0.00001), 1-year survival rate (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001), 2-year survival rate (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008), and 3-year survival rate (OR = 3.34, 95%CI: 1.61-6.94, P = 0.001) were all superior to those of the control group; the postoperative decrease in alpha-fetoprotein value (OR = 295.53, 95%CI: 250.22-340.85, P < 0.0001), the postoperative increase in CD4 value (OR = 10.59, 95%CI: 8.78-12.40, P < 0.00001), and the postoperative decrease in CD8 value (OR = 6.47, 95%CI: 4.44-8.50, P < 0.00001) were also significantly higher than those in the TACE-alone treatment group.
CONCLUSION Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.
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Affiliation(s)
- Jie-Fei Cheng
- Department of Radiology, The Fifth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
| | - Qiu-Lian Sun
- Department of Radiology, The Fifth People’s Hospital of Suzhou, Suzhou 215100, Jiangsu Province, China
| | - Ling Tang
- Department of Radiology, The Fourth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
| | - Xin-Jian Xu
- Department of Interventional Radiology, Jiangyin People Hospital, Jiangyin 214400, Jiangsu Province, China
| | - Xiang-Zhong Huang
- Department of Interventional Radiology, Jiangyin People Hospital, Jiangyin 214400, Jiangsu Province, China
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3
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Hendriks P, Rietbergen DDD, van Erkel AR, Coenraad MJ, Arntz MJ, Bennink RJ, Braat AE, Crobach S, van Delden OM, Dibbets-Schneider P, van der Hulle T, Klümpen HJ, van der Meer RW, Nijsen JFW, van Rijswijk CSP, Roosen J, Ruijter BN, Smit F, Stam MK, Takkenberg RB, Tushuizen ME, van Velden FHP, de Geus-Oei LF, Burgmans MC. Adjuvant holmium-166 radioembolization after radiofrequency ablation in early-stage hepatocellular carcinoma patients: a dose-finding study (HORA EST HCC trial). Eur J Nucl Med Mol Imaging 2024; 51:2085-2097. [PMID: 38329507 PMCID: PMC11139702 DOI: 10.1007/s00259-024-06630-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/27/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE The aim of this study was to investigate the biodistribution of (super-)selective trans-arterial radioembolization (TARE) with holmium-166 microspheres (166Ho-MS), when administered as adjuvant therapy after RFA of HCC 2-5 cm. The objective was to establish a treatment volume absorbed dose that results in an absorbed dose of ≥ 120 Gy on the hyperemic zone around the ablation necrosis (i.e., target volume). METHODS In this multicenter, prospective dose-escalation study in BCLC early stage HCC patients with lesions 2-5 cm, RFA was followed by (super-)selective infusion of 166Ho-MS on day 5-10 after RFA. Dose distribution within the treatment volume was based on SPECT-CT. Cohorts of up to 10 patients were treated with an incremental dose (60 Gy, 90 Gy, 120 Gy) of 166Ho-MS to the treatment volume. The primary endpoint was to obtain a target volume dose of ≥ 120 Gy in 9/10 patients within a cohort. RESULTS Twelve patients were treated (male 10; median age, 66.5 years (IQR, [64.3-71.7])) with a median tumor diameter of 2.7 cm (IQR, [2.1-4.0]). At a treatment volume absorbed dose of 90 Gy, the primary endpoint was met with a median absorbed target volume dose of 138 Gy (IQR, [127-145]). No local recurrences were found within 1-year follow-up. CONCLUSION Adjuvant (super-)selective infusion of 166Ho-MS after RFA for the treatment of HCC can be administered safely at a dose of 90 Gy to the treatment volume while reaching a dose of ≥ 120 Gy to the target volume and may be a favorable adjuvant therapy for HCC lesions 2-5 cm. TRIAL REGISTRATION Clinicaltrials.gov NCT03437382 . (registered: 19-02-2018).
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Affiliation(s)
- Pim Hendriks
- Interventional Radiology Research (IR2) Group, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Daphne D D Rietbergen
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arian R van Erkel
- Interventional Radiology Research (IR2) Group, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel J Bennink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn Crobach
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Otto M van Delden
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Petra Dibbets-Schneider
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom van der Hulle
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Rutger W van der Meer
- Interventional Radiology Research (IR2) Group, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina S P van Rijswijk
- Interventional Radiology Research (IR2) Group, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Joey Roosen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastian N Ruijter
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Smit
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mette K Stam
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Floris H P van Velden
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, TechMed Center, University of Twente, Enschede, The Netherlands
- Department of Radiation Sciences & Technology, Delft University of Technology, Delft, The Netherlands
| | - Mark C Burgmans
- Interventional Radiology Research (IR2) Group, Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
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Boregowda G, Mariappan P. Effect of high blood flow on heat distribution and ablation zone during microwave ablation-numerical approach. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024:e3835. [PMID: 38800993 DOI: 10.1002/cnm.3835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
Microwave ablation has become a viable alternative for cancer treatment for patients who cannot undergo surgery. During this procedure, a single-slot coaxial antenna is employed to effectively deliver microwave energy to the targeted tissue. The success of the treatment was measured by the amount of ablation zone created during the ablation procedure. The significantly large blood vessel placed near the antenna causes heat dissipation by convection around the blood vessel. The heat sink effect could result in insufficient ablation, raising the risk of local tumor recurrence. In this study, we investigated the heat loss due to large blood vessels and the relationship between blood velocity and temperature distribution. The hepatic artery, with a diameter of 4 mm and a height of 50 mm and two branches, is considered in the computational domain. The temperature profile, localized tissue contraction, and ablation zones were simulated for initial blood velocities 0.05, 0.1, and 0.16 m/s using the 3D Pennes bio-heat equation, temperature-time dependent model, and cell death model, respectively. Temperature-dependent blood velocity is modeled using the Navier-Stokes equation, and the fluid-solid interaction boundary is treated as a convective boundary. For discretization, we utilizedH curl Ω $$ H\left(\operatorname{curl},\Omega \right) $$ elements for the wave propagation model,H 1 Ω $$ {H}^1\left(\Omega \right) $$ elements for the Pennes bio-heat model, andH 1 Ω 3 × L 0 2 Ω $$ {\left({H}^1\left(\Omega \right)\right)}^3\times {L}_0^2\left(\Omega \right) $$ elements for the Navier-Stokes equation, whereΩ $$ \Omega $$ represents the computational domain. The simulated results show that blood vessels and blood velocity have a significant impact on temperature distribution, tissue contraction, and the volume of the ablation zone.
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Affiliation(s)
- Gangadhara Boregowda
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Tirupati, India
| | - Panchatcharam Mariappan
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Tirupati, India
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Keum H, Cevik E, Kim J, Demirlenk YM, Atar D, Saini G, Sheth RA, Deipolyi AR, Oklu R. Tissue Ablation: Applications and Perspectives. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024:e2310856. [PMID: 38771628 DOI: 10.1002/adma.202310856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 05/05/2024] [Indexed: 05/22/2024]
Abstract
Tissue ablation techniques have emerged as a critical component of modern medical practice and biomedical research, offering versatile solutions for treating various diseases and disorders. Percutaneous ablation is minimally invasive and offers numerous advantages over traditional surgery, such as shorter recovery times, reduced hospital stays, and decreased healthcare costs. Intra-procedural imaging during ablation also allows precise visualization of the treated tissue while minimizing injury to the surrounding normal tissues, reducing the risk of complications. Here, the mechanisms of tissue ablation and innovative energy delivery systems are explored, highlighting recent advancements that have reshaped the landscape of clinical practice. Current clinical challenges related to tissue ablation are also discussed, underlining unmet clinical needs for more advanced material-based approaches to improve the delivery of energy and pharmacology-based therapeutics.
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Affiliation(s)
- Hyeongseop Keum
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Enes Cevik
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jinjoo Kim
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Yusuf M Demirlenk
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Dila Atar
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Gia Saini
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Amy R Deipolyi
- Interventional Radiology, Department of Surgery, West Virginia University, Charleston Area Medical Center, Charleston, WV, 25304, USA
| | - Rahmi Oklu
- Laboratory for Patient Inspired Engineering, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
- Division of Vascular & Interventional Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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6
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Akhan O, Erdemir AG, Karahan S, Ünal E, Çiftçi TT, Akıncı D, Yalçın Ş. Long-term results of liver thermal ablation in patients with hepatocellular carcinoma and colorectal cancer liver metastasis regarding spatial features and tumor-specific variables. Diagn Interv Radiol 2024; 30:183-192. [PMID: 36994643 PMCID: PMC11095064 DOI: 10.4274/dir.2023.221986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/08/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE Colorectal cancer liver metastasis (CRLM) and hepatocellular carcinoma (HCC) are widely treated using microwave and radiofrequency ablation. Local tumor progression (LTP) may develop depending on the shortest vascular distance and large lesion diameter. This study aims to explore the effect of these spatial features and to investigate the correlation between tumor-specific variables and LTP. METHODS This is a retrospective study covering the period between January 2007 and January 2019. One hundred twenty-five patients (CRLM: HCC: 64:61) with 262 lesions (CRLM: HCC: 142:120) were enrolled. The correlation between LTP and the variables was analyzed using the chi-square test, Fischer's exact test, or the Fisher-Freeman-Halton test where applicable. The local progression-free survival (Loc-PFS) was analyzed using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to identify prognostic factors. RESULTS Significant correlations were observed for LTP in both CRLM and HCC at a lesion diameter of 30-50 mm (P = 0.019 and P < 0.001, respectively) and SVD of ≤3 mm (P < 0.001 for both). No correlation was found between the ablation type and LTP (CRLM: P = 0.141; HCC: P = 0.771). There was no relationship between residue and the ablation type, but a strong correlation with tumor size was observed (P = 0.127 and P < 0.001, respectively). In CRLM, LTP was associated with mutant K-ras and concomitant lung metastasis (P < 0.001 and P = 0.003, respectively). In HCC, a similar correlation was found for Child-Pugh B, serum alpha-fetoprotein (AFP) level of >10 ng/mL, predisposing factors, and moderate histopathological differentiation (P < 0.001, P = 0.008, P = 0.027, and P < 0.001, respectively). In CRLM, SVD of ≤3 mm proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.007), followed by concomitant lung metastasis (P = 0.027). In HCC, a serum AFP level of >10 ng/mL proved to be the variable with the greatest negative effect on Loc-PFS (P = 0.045). CONCLUSION In addition to the lesions' spatial features, tumor-specific variables may also have an impact on LTP.
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Affiliation(s)
- Okan Akhan
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Ahmet Gürkan Erdemir
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Sevilay Karahan
- Hacettepe University Faculty of Medicine, Department of Biostatistics, Ankara, Türkiye
| | - Emre Ünal
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Türkmen Turan Çiftçi
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Devrim Akıncı
- Hacettepe University Faculty of Medicine, Department of Radiology, Ankara, Türkiye
| | - Şuayib Yalçın
- Hacettepe University Faculty of Medicine, Department of Medical Oncology, Ankara, Türkiye
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7
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Vogl TJ, Martin SS, Gruber-Rouh T, Booz C, Koch V, Nour-Eldin NEA, Hussainy Said MN. Comparison of Microwave and Radiofrequency Ablation for the Treatment of Small- and Medium-Sized Hepatocellular Carcinomas in a Prospective Randomized Trial. ROFO-FORTSCHR RONTG 2024; 196:482-490. [PMID: 38065541 DOI: 10.1055/a-2203-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2024]
Abstract
PURPOSE To compare the therapeutic response and clinical outcome of CT-guided percutaneous microwave (MWA) and radiofrequency ablation (RFA) for the treatment of small- and medium-sized HCC. MATERIALS AND METHODS In this prospective trial, 50 patients with HCC were randomly assigned to MWA or RFA treatment. MRI was performed 24 h before and after ablation and subsequently in 3-month intervals. Ablation volumes, ablation durations, adverse events (AE), technique efficacy, technical success, local tumor progression (LTP), disease-free survival (DFS), intrahepatic distant recurrence (IDR), and overall survival (OS) rates were evaluated. RESULTS The mean ablation volume was 66.5 cm³ for MWA and 29.2 cm³ for RFA (p < 0.01). The mean ablation durations for MWA and RFA were 11.2 ± 4.0 min and 16.3 ± 4.7 min, respectively (p < 0.01). Six mild AEs were documented (p > 0.05). All treatments had a technical success rate and a technique efficacy rate of 100 % (50/50, p = 1.00). LTP within 2 years occurred in 1/25 (4 %) in the MWA group and in 4/25 (16 %) in the RFA group (p = 0.06). IDR within 2 years was 8/25 (32 %) for MWA and 14/25 (56 %) for RFA (p < 0.05). The median DFS was 24.5 months and 13.4 months for MWA and RFA, respectively (p = 0.02). The 1-, 2-, 3-year OS rates were 100 %, 80 %, 72 % in the MWA group and 72 %, 64 %, 60 % in the RFA group, respectively (p ≥ 0.14). CONCLUSION The clinical outcome after MWA or RFA for HCC treatment was very similar with no significant differences in LTP or OS. However, MWA shows a trend toward better DFS with fewer IDRs than RFA. KEY POINTS · MWA allows for larger ablation volumes and a shorter treatment duration compared to RFA in patients with HCC.. · MWA shows a trend toward better disease-free survival and fewer intrahepatic distant recurrences compared to RFA.. · The three-year survival rates show no significant difference between the two methods..
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon S Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University, Faculty of Medicine, Cairo, Egypt
| | - M N Hussainy Said
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
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Criss CR, Makary MS. Liver-Directed Locoregional Therapies for Neuroendocrine Liver Metastases: Recent Advances and Management. Curr Oncol 2024; 31:2076-2091. [PMID: 38668057 PMCID: PMC11049250 DOI: 10.3390/curroncol31040154] [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: 02/18/2024] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Neuroendocrine tumors (NETs) are a heterogeneous class of cancers, predominately occurring in the gastroenteropancreatic system, which pose a growing health concern with a significant rise in incidence over the past four decades. Emerging from neuroendocrine cells, these tumors often elicit paraneoplastic syndromes such as carcinoid syndrome, which can manifest as a constellation of symptoms significantly impacting patients' quality of life. The prognosis of NETs is influenced by their tendency for metastasis, especially in cases involving the liver, where the estimated 5-year survival is between 20 and 40%. Although surgical resection remains the preferred curative option, challenges emerge in cases of neuroendocrine tumors with liver metastasis (NELM) with multifocal lobar involvement, and many patients may not meet the criteria for surgery. Thus, minimally invasive and non-surgical treatments, such as locoregional therapies, have surfaced. Overall, these approaches aim to prioritize symptom relief and aid in overall tumor control. This review examines locoregional therapies, encompassing catheter-driven procedures, ablative techniques, and radioembolization therapies. These interventions play a pivotal role in enhancing progression-free survival and managing hormonal symptoms, contributing to the dynamic landscape of evolving NELM treatment. This review meticulously explores each modality, presenting the current state of the literature on their utilization and efficacy in addressing NELM.
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Affiliation(s)
- Cody R. Criss
- Department of Internal Medicine, OhioHealth Riverside Methodist Hospital, Columbus, OH 43214, USA;
| | - Mina S. Makary
- Division of Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43240, USA
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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [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: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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10
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Alhasan AS, Daqqaq TS, Alhasan MS, Ghunaim HA, Aboualkheir M. Complication Rates and Risk of Recurrence After Percutaneous Radiofrequency Ablation and Microwave Ablation for the Treatment of Liver Tumors: a Meta-analysis. Acad Radiol 2024; 31:1288-1301. [PMID: 38087720 DOI: 10.1016/j.acra.2023.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 04/14/2024]
Abstract
RATIONALE AND OBJECTIVES The rate of complications and risk of local recurrence following percutaneous radiofrequency ablation (RFA) and microwave ablation (MWA) for liver tumors varies significantly between investigations. This meta-analysis aimed to assess complication rates and risk of local recurrence after percutaneous RFA and MWA. MATERIALS AND METHODS PubMed, Medline, Web of Science, the Cochrane Library, Embase, Google Scholar, and CINAHL were systematically searched from database inception until August 2022 to retrieve articles reporting the complication rates and risk of recurrence after percutaneous RFA and MWA for the treatment of liver tumors. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated and displayed by forest plots. To measure heterogeneity, Cochran Q and I2 statistics were also applied. Egger's test and funnel plots were also performed to assess any potential publication bias. Additionally, subgroup analysis was done to investigate the source of heterogeneity. RESULTS 26 studies including 2026 and 1974 patients for RFA and MWA, respectively, were included. The rate of minor complications was significantly higher after MWA compared to RFA, yielding an overall OR of 0.688 (95% CI: 0.549-0.862, P = 0.001). Similarly, the rate of major complications was significantly higher after MWA than RFA (P = 0.012), yielding an overall OR of 0.639 (95% CI: 0.450-0.907). No significant difference was found between RFA and MWA in terms of local recurrence after ablation (P > 0.05). In addition, there was no statistical evidence of publication bias. CONCLUSION When most factors are considered equally, percutaneous RFA and MWA can be considered safe modalities for the treatment of liver tumors, with RFA superior in terms of the incidence of minor and major complications.
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Affiliation(s)
- Ayman S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Radiology, King Faisal Specialist Hospital and Research Centre, Madinah, Saudi Arabia (A.S.A.).
| | - Tareef S Daqqaq
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mustafa S Alhasan
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Hadeel A Ghunaim
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.)
| | - Mervat Aboualkheir
- Department of Radiology and Medical Imaging, College of Medicine, Taibah University, Madinah, Saudi Arabia (A.S.A., T.S.D., M.S.A., H.A.G., M.A.); Department of Clinical Science /College of Medicine/Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia (M.A.)
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11
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Takada H, Komiyama Y, Osawa L, Muraoka M, Suzuki Y, Sato M, Kobayashi S, Yoshida T, Takano S, Maekawa S, Enomoto N. Usefulness of Body Position Change during Local Ablation Therapies for the High-Risk Location Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:1036. [PMID: 38473393 DOI: 10.3390/cancers16051036] [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: 01/28/2024] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Local ablation therapies are important treatment options for early-stage hepatocellular carcinoma (HCC). Various techniques have been used to perform these therapies efficiently and safely. However, few reports have discussed the usefulness of body position change (BPC). This study aimed to investigate the usefulness of BPC during local ablation therapies in patients with HCC. We evaluated 283 HCC nodules that underwent local ablation therapy. These nodules were categorized into high- or low-risk locations on the basis of their proximity to large vessels, adjacent extrahepatic organs, or poor visibility under ultrasound (US) guidance. The technical success rates, procedure time, and prognosis were evaluated. In this study, 176 (62%) nodules were classified in the high-risk location group. The high-risk location group was treated with techniques such as BPC, artificial pleural fluid, artificial ascites, fusion imaging, and contrast-enhanced US more frequently than the low-risk location group. The technical success rates were 96% and 95% for the high- and low-risk location groups, respectively. Within the high-risk location group, those without BPC had a lower success rate than those with BPC (91% vs. 99%, p = 0.015). Notably, BPC emerged as the sole contributing factor to the technical success rate in the high-risk location group (OR = 10, 95% CI 1.2-86, p = 0.034). In contrast, no differences were found in the procedure time, local tumor progression rates, intrahepatic distant recurrence rates, and overall survival between the groups with and without BPC in the high-risk location group. In conclusion, BPC during local ablation therapy in patients with HCC in high-risk locations was safe and efficient. The body position should be adjusted for HCC in high-risk locations to maintain good US visibility and ensure a safe puncture route in patients undergoing local ablation therapies.
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Affiliation(s)
- Hitomi Takada
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yasuyuki Komiyama
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Leona Osawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Masaru Muraoka
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yuichiro Suzuki
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Mitsuaki Sato
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shoji Kobayashi
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takashi Yoshida
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinichi Takano
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinya Maekawa
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Nobuyuki Enomoto
- Gastroenterology and Hepatology Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
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12
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Li B, Ren ZW, Zhang C, Yu XX, Xu XX, Du Y, Yang HF. Computed tomography-guided percutaneous cryoablation and microwave ablation in the treatment of perivascular hepatocellular carcinoma: A comparative study with propensity score matching. Clin Res Hepatol Gastroenterol 2024; 48:102298. [PMID: 38367802 DOI: 10.1016/j.clinre.2024.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of cryoablation (CYA) and microwave ablation (MWA) in the treatment of patients with perivascular hepatocellular carcinoma (HCC). METHODS Patients with perivascular HCC who underwent computed tomography (CT)-guided percutaneous CYA or MVA treatment in our hospital from August 2009 to March 2019 were included. Propensity score matching (PSM) was performed to adjust for potential baseline differences in the two groups. The technical success rate (TS), complications, and visual analog scale (VAS) were analyzed. The overall survival (OS) was evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS After PSM, 32 patients from each group were selected. The technical success rate was 94 % for CYA and 91 % for MWA, and 13 patients developed recurrence (CYA, n = 5, 2 local, 3 distant; MWA, n = 8, 6 local, 2 distant). There were no significant differences in OS (36-months OS: CYA 53.1 % vs, MWA 40.6 %; P = 0.191). No intraoperative deaths or complication-related deaths were observed, and 19 patients (CYA, n = 8; MWA, n = 11) experienced complications (P = 0.435). The VAS in the MWA group (5.38 ± 1.21) was significantly higher than that in the CYA group (2.22 ± 0.87; P < 0.001). CONCLUSIONS While CYA has equal safety and high primary efficacy as MWA in the treatment of perivascular HCC, it is associated with less periprocedural pain.
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Affiliation(s)
- Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Zi Wang Ren
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xuan Yu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Yong Du
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
| | - Han Feng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
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13
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Humphrey S, Newcomer JB, Raissi D, Gabriel G. Percutaneous microwave ablation for early-stage intrahepatic cholangiocarcinoma: A single-institutional cohort. J Clin Imaging Sci 2024; 14:4. [PMID: 38469173 PMCID: PMC10927040 DOI: 10.25259/jcis_59_2023] [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: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 03/13/2024] Open
Abstract
Objectives Cholangiocarcinoma (CCA) is the second-most common primary hepatic malignancy with an increasing incidence over the past two decades. CCA arises from the epithelial cells lining the bile ducts and can be classified as intrahepatic, perihilar, or distal based on the site of origin in the biliary tree. Surgical resection is the definitive curative therapy for early-stage intrahepatic CCA; however, only a minority of patients may be ideal surgical candidates. Percutaneous microwave ablation (MWA) is a minimally invasive procedure widely used for hepatocellular carcinoma and colorectal cancer metastases to the liver. Growing evidence suggests MWA can play a role in the management of patients with early-stage intrahepatic CCA. In this study, we aim to describe the safety and efficacy of MWA for the management of intrahepatic CCA. Material and Methods A retrospective review of patients with intrahepatic CCA treated with MWA at our tertiary referral medical center was performed. Eight patients were treated between 2014 and 2019. Diagnosis of CCA was made based on histopathological studies of samples obtained by surgical resection or percutaneous liver biopsy. All procedures were performed under computed tomography (CT) guidance using a high-power single antenna MWA system. General anesthesia was used for all procedures. Patient medical history, procedural technical information, outcomes, and follow-up data were reviewed. Progression-free survival was estimated with a Kaplan-Meier curve. Results A total of 25 tumors with an average size of 2.2 ± 1.7 cm (range 0.5-7.8) were treated with MWA. Our cohort consisted of eight patients (4 males and 4 females) with an average age of 69.3 ± 5.7 years (range 61-79). Three out of eight (3/8, 37.5%) patients were treated initially with surgical resection. NASH-related cirrhosis was documented in 3/8 (37.5%) patients, while 1/8 (12.5%) had alcoholic cirrhosis; the remaining 4 patients (4/8, 50%) did not have cirrhosis. All patients were discharged within 24 h after ablation. Average total follow-up time was 10.6 ± 11.8 months (range 0-41). The incomplete ablation rate and local recurrence rate were 4% (1/25 lesions) and 12% (3/25 lesions), respectively. Conclusion In patients who do not qualify for surgical resection, MWA is a safe alternative therapy for the treatment of intrahepatic CCA.
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Affiliation(s)
- Sophia Humphrey
- Department of Radiology, University of Kentucky College of Medicine, Lexington, United States
| | - Jack Bailey Newcomer
- Department of Radiology, University of Kentucky College of Medicine, Lexington, United States
| | - Driss Raissi
- Department of Radiology, University of Kentucky College of Medicine, Lexington, United States
| | - Gaby Gabriel
- Department of Radiology, University of Kentucky College of Medicine, Lexington, United States
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14
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Suhail Najm Alareer H, Arian A, Fotouhi M, Taher HJ, Dinar Abdullah A. Evidence Supporting Diagnostic Value of Liver Imaging Reporting and Data System for CT- and MR Imaging-based Diagnosis of Hepatocellular Carcinoma: A Systematic Review and Meta-analysis. J Biomed Phys Eng 2024; 14:5-20. [PMID: 38357604 PMCID: PMC10862115 DOI: 10.31661/jbpe.v0i0.2211-1562] [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: 11/08/2022] [Accepted: 03/12/2023] [Indexed: 02/16/2024]
Abstract
Background Based on the Liver Imaging Data and Reporting System (LI-RADS) guidelines, Hepatocellular Carcinoma (HCC) can be diagnosed using imaging criteria in patients at risk of HCC. Objective This study aimed to assess the diagnostic value of LI-RADS in high-risk patients with HCC. Material and Methods This systematic review is conducted on international databases, including Google Scholar, Web of Science, PubMed, Embase, PROQUEST, and Cochrane Library, with appropriate keywords. Using the binomial distribution formula, the variance of each study was calculated, and all the data were analyzed using STATA version 16. The pooled sensitivity and specificity were determined using a random-effects meta-analysis approach. Also, we used the chi-squared test and I2 index to calculate heterogeneity among studies, and Funnel plots and Egger tests were used for evaluating publication bias. Results The pooled sensitivity was estimated at 0.80 (95% CI 0.76-0.84). According to different types of Liver Imaging Reporting and Data Systems (LI-RADS), the highest pooled sensitivity was in version 2018 (0.83 (95% CI 0.79-0.87) (I2: 80.6%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). The pooled specificity was estimated as 0.89 (95% CI 0.87-0.92). According to different types of LI-RADS, the highest pooled specificity was in version 2014 (93.0 (95% CI 89.0-96.0) (I2: 81.7%, P of chi 2 test for heterogeneity <0.001 and T2: 0.001). Conclusion LI-RADS can assist radiologists in achieving the required sensitivity and specificity in high-risk patients suspected to have HCC. Therefore, this strategy can serve as an appropriate tool for identifying HCC.
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Affiliation(s)
- Hayder Suhail Najm Alareer
- Department of Radiology, College of Health and Medical Technology, Al-Ayen University, Thi-Qar, 64001, Iraq
| | - Arvin Arian
- Cancer Institute ADIR, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Maryam Fotouhi
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Centre for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Ayoob Dinar Abdullah
- Department of Radiology Technology, Al-Manara College for Medical Sciences, Missan, Iraq
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15
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Matevish L, Patel MS, Vagefi PA. Downstaging Techniques for Hepatocellular Carcinoma in Candidates Awaiting Liver Transplantation. Surg Clin North Am 2024; 104:145-162. [PMID: 37953033 DOI: 10.1016/j.suc.2023.07.004] [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] [Indexed: 11/14/2023]
Abstract
During the last decade, downstaging for hepatocellular carcinoma has expanded the pool of patients eligible for liver transplantation. The literature is rife with attempts to elucidate best treatment strategies with novel locoregional and systemic therapies continuing to emerge. Several trials have confirmed the large-scale success of downstaging protocols, with equitable long-term survival and recurrence rates after liver transplant. We review the currently available techniques used for downstaging, including their indications, complications, and efficacies. New frontiers have focused on the potential role of immunotherapy in the neoadjuvant setting, although more research is needed to delineate its role in current treatment paradigms.
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Affiliation(s)
- Lauren Matevish
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar S Patel
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Parsia A Vagefi
- Division of Surgical Transplantation, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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16
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Dai W, Fang S, Mo C, Liu Y, Shen T, Li M, Zhou H, Miao H, Chen M, Tan X, Bao S, Xu X, Chen N. Comparison of laparoscopic radiofrequency ablation with percutaneous radiofrequency ablation in the treatment of chronic hepatitis B-related hepatocellular carcinoma involving specific sites: A retrospective cohort study. Asian J Surg 2024; 47:100-106. [PMID: 37183108 DOI: 10.1016/j.asjsur.2023.04.073] [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: 01/02/2023] [Revised: 03/15/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND This study compared the effectiveness and safety of laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in the treatment of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) involving specific sites. METHODS This retrospective cohort study included patients with HBV-related HCC involving specific sites treated with LRFA or PRFA between January 2012 and December 2020. The overall survival (OS), disease-free survival (DFS), and complications were compared between the LRFA and PRFA groups. The Cox proportional-hazards regression model was used to determine the factors affecting prognosis. RESULTS This study included 109 patients: 69 in the LRFA group and 40 cases in the PRFA group. No significant differences were found in the 3-year OS rate between the two groups (73.7% vs. 70.0%, P = 0.514), but the LRFA group showed a higher 3-year DFS rate than the PRFA group (58.2% vs. 42.5%, P = 0.018). The RFA method was not associated with OS but was independently associated with DFS (LRPA vs. PRFA, HR = 2.078, P = 0.012). The common complications were ascites, pleural effusion, and fever in the two groups. The occurrence of complications in patients treated with LRFA or PRFA was similar (15.9% vs. 12.5%, P = 0.785). CONCLUSION LRFA was associated with a better DFS in patients with HBV-related HCC involving specific sites. Thus, LRFA might have more advantages in treating liver cancer involving specific sites.
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Affiliation(s)
- Wei Dai
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Shuo Fang
- Department of Oncology, The Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Cong Mo
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Yuxin Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Tingyun Shen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Mingyi Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Honglian Zhou
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Huilai Miao
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Ming Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaoyu Tan
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Shiting Bao
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaohong Xu
- Department of Ultrasound, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Nianping Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
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17
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Servin F, Collins JA, Heiselman JS, Frederick-Dyer KC, Planz VB, Geevarghese SK, Brown DB, Jarnagin WR, Miga MI. Simulation of Image-Guided Microwave Ablation Therapy Using a Digital Twin Computational Model. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:107-124. [PMID: 38445239 PMCID: PMC10914207 DOI: 10.1109/ojemb.2023.3345733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Abstract
Emerging computational tools such as healthcare digital twin modeling are enabling the creation of patient-specific surgical planning, including microwave ablation to treat primary and secondary liver cancers. Healthcare digital twins (DTs) are anatomically one-to-one biophysical models constructed from structural, functional, and biomarker-based imaging data to simulate patient-specific therapies and guide clinical decision-making. In microwave ablation (MWA), tissue-specific factors including tissue perfusion, hepatic steatosis, and fibrosis affect therapeutic extent, but current thermal dosing guidelines do not account for these parameters. This study establishes an MR imaging framework to construct three-dimensional biophysical digital twins to predict ablation delivery in livers with 5 levels of fat content in the presence of a tumor. Four microwave antenna placement strategies were considered, and simulated microwave ablations were then performed using 915 MHz and 2450 MHz antennae in Tumor Naïve DTs (control), and Tumor Informed DTs at five grades of steatosis. Across the range of fatty liver steatosis grades, fat content was found to significantly increase ablation volumes by approximately 29-l42% in the Tumor Naïve and 55-60% in the Tumor Informed DTs in 915 MHz and 2450 MHz antenna simulations. The presence of tumor did not significantly affect ablation volumes within the same steatosis grade in 915 MHz simulations, but did significantly increase ablation volumes within mild-, moderate-, and high-fat steatosis grades in 2450 MHz simulations. An analysis of signed distance to agreement for placement strategies suggests that accounting for patient-specific tumor tissue properties significantly impacts ablation forecasting for the preoperative evaluation of ablation zone coverage.
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Affiliation(s)
- Frankangel Servin
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jarrod A. Collins
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jon S. Heiselman
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | | | - Virginia B. Planz
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | | | - Daniel B. Brown
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | - William R. Jarnagin
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | - Michael I. Miga
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTN37235USA
- Department of OtolaryngologyVanderbilt University Medical CenterNashvilleTN37235USA
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18
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Muglia R, Marra P, Pinelli D, Dulcetta L, Carbone FS, Barbaro A, Celestino A, Colledan M, Sironi S. Technical and Clinical Outcomes of Laparoscopic-Laparotomic Hepatocellular Carcinoma Thermal Ablation with Microwave Technology: Case Series and Review of Literature. Cancers (Basel) 2023; 16:92. [PMID: 38201536 PMCID: PMC10778313 DOI: 10.3390/cancers16010092] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC. MATERIALS AND METHODS This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule's suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls. RESULTS A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6-50 mm) were treated for 7 min (2-30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1-51 days), and patients were followed up on average for 238 days (13-1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge. CONCLUSIONS Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.
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Affiliation(s)
- Riccardo Muglia
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Domenico Pinelli
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Ludovico Dulcetta
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Francesco Saverio Carbone
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
| | - Alessandro Barbaro
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Antonio Celestino
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
| | - Michele Colledan
- Department of General Surgery, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (D.P.); (M.C.)
| | - Sandro Sironi
- Department of Radiology, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (P.M.); (L.D.); (F.S.C.)
- School of Medicine, University of Milano-Bicocca, 20126 Milano, Italy (A.C.)
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19
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Kanu EN, Rhodin KE, Masoud SJ, Eckhoff AM, Bartholomew AJ, Howell TC, Bao J, Befera NT, Kim CY, Blazer DG, Zani S, Nussbaum DP, Allen PJ, Lidsky ME. Tumor size and survival in intrahepatic cholangiocarcinoma treated with surgical resection or ablation. J Surg Oncol 2023; 128:1329-1339. [PMID: 37671594 PMCID: PMC10841223 DOI: 10.1002/jso.27435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/26/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVES We performed a retrospective analysis within a national cancer registry on outcomes following resection or ablation for intrahepatic cholangiocarcinoma (iCCA). METHODS The National Cancer Database was queried for patients with clinical stage I-III iCCA diagnosed during 2010-2018, who underwent resection or ablation. Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods. RESULTS Of 2140 patients, 1877 (87.7%) underwent resection and 263 (12.3%) underwent ablation, with median tumor sizes of 5.5 and 3 cm, respectively. Overall, resection was associated with greater median OS (41.2 months (95% confidence interval [95% CI]: 37.6-46.2) vs. 28 months (95% CI: 15.9-28.6) on univariable analysis (p < 0.0001). There was no significant difference on multivariable analysis (p = 0.42); however, there was a significant interaction between tumor size and management. On subgroup analysis of patients with tumors <3 cm, there was no difference in OS between resection versus ablation. However, ablation was associated with increased mortality for tumors ≥3 cm. CONCLUSION Although resection is associated with improved OS for tumors ≥3 cm, we observed no difference in survival between management strategies for tumors < 3 cm. Ablation may be an alternative therapeutic strategy for small iCCA, particularly in patients at risk for high surgical morbidity.
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Affiliation(s)
- Elishama N Kanu
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Kristen E Rhodin
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Sabran J Masoud
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Austin M Eckhoff
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Thomas C Howell
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Jiayin Bao
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Charles Y Kim
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Dan G Blazer
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Sabino Zani
- Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Peter J Allen
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Michael E Lidsky
- Department of Surgery, Duke University Medical Center, Durham, NC
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20
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DiLeo DA, Gidener T, Aytaman A. Chronic Liver Disease in the Older Patient-Evaluation and Management. Curr Gastroenterol Rep 2023; 25:390-400. [PMID: 37991713 DOI: 10.1007/s11894-023-00908-2] [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] [Accepted: 11/01/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE OF REVIEW As our population ages, the number of elderly patients with advanced chronic liver disease (ACLD) will increase. In this review we explore risk factors for liver injury, noninvasive assessment of liver disease, complications of cirrhosis, and management of frailty and sarcopenia in the older patient with ACLD. RECENT FINDINGS Multiple guidelines regarding ACLD have been updated over the past few years. New cutoffs for FIB-4 and NAFLD (MASLD - Metabolic Dysfunction Associated Steatotic Liver Disease) fibrosis scores for elderly patients are being validated. Older patients with MASLD benefit from caloric restriction, exercise programs, and GLP-1 agonists. Patients with ACLD need to be screened for alcohol use disorder with modified scoring systems, and if positive, benefit from referral to chemical dependency programs. Carvedilol and diuretics may safely be used in the elderly for portal hypertension and ascites, respectively, with careful monitoring. Malnutrition, frailty, sarcopenia, and bone mineral disease are common in older patients with ACLD, and early intervention may improve outcomes. Early identification of ACLD in elderly patients allows us to manage risk factors for liver injury, screen for complications, and implement lifestyle and pharmacological therapy to reduce decompensation and death. Future studies may clarify the role of noninvasive imaging in assessing liver fibrosis in the elderly and optimal interventions for nutrition, frailty, sarcopenia, bone health in addition to reevaluation of antibiotic prophylaxis for liver conditions with rising antibiotic resistance.
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Affiliation(s)
- Daniel Anthony DiLeo
- Department of Gastroenterology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY, 11209, USA.
| | - Tolga Gidener
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, 11203, USA
| | - Ayse Aytaman
- Department of Gastroenterology, Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY, 11209, USA
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21
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McClure T, Lansing A, Ferko N, Wright G, Ghosh SK, Raza S, Kalsekar I, Clarke K, Talenfeld A. A Comparison of Microwave Ablation and Cryoablation for the Treatment of Renal Cell Carcinoma: A Systematic Literature Review and Meta-analysis. Urology 2023; 180:1-8. [PMID: 37331485 DOI: 10.1016/j.urology.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis comparing microwave ablation (MWA) and cryoablation for renal cell carcinoma (RCC). METHODS The systematic search was performed in MEDLINE, Embase, and Cochrane databases. Studies published in English from January 2006 to February 2022 that assessed adults with primary RCC who received MWA or cryoablation were included. Study arms from RCTs, comparative observational, and single-arm studies were eligible. The outcomes included local tumor recurrence (LTR), overall survival, disease-free survival, overall/major complications, procedure/ablation time, 1- to 3-month primary technique efficacy, and technical success. Single-arm meta-analyses were performed using the random effects model. Sensitivity analyses excluding low-quality studies assessed using the MINORs scale were performed. Univariable and multivariable examined the effects of prognostic factors. RESULTS Baseline characteristics were similar between groups and mean tumor size for MWA and cryoablation were 2.74 and 2.69 cm. Single-arm meta-analyses were similar for LTR and secondary outcomes between cryoablation and MWA. Ablation time was significantly shorter with MWA than with cryoablation (meta-regression weighted mean difference 24.55 minutes, 95% confidence interval -31.71, -17.38, P < .0001). One-year LTR was significantly lower with MWA than cryoablation (odds ratio 0.33, 95% confidence interval 0.10-0.93, P = .04). There were no significant differences for other outcomes. CONCLUSION MWA provides significantly improved 1-year LTR and ablation time compared with cryoablation for patients with RCC. Other outcomes appeared similar or favorable for MWA; however, results were not statistically significant. MWA of primary RCC is as safe and effective as cryoablation, which should be confirmed with future comparative studies.
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Affiliation(s)
- Timothy McClure
- Departments of Radiology and Urology, Weill Cornell Medical College, New York, NY.
| | | | | | | | | | - Sajjad Raza
- Johnson & Johnson Services Inc, New Brunswick, NJ
| | | | | | - Adam Talenfeld
- Departments of Radiology and Urology, Weill Cornell Medical College, New York, NY
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22
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Hui TCH, How GY, Chim MSM, Pua U. Comparative Study of Ablation Zone of EMPRINT HP Microwave Device with Contemporary 2.4 GHz Microwave Devices in an Ex Vivo Porcine Liver Model. Diagnostics (Basel) 2023; 13:2702. [PMID: 37627962 PMCID: PMC10453042 DOI: 10.3390/diagnostics13162702] [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: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Percutaneous microwave ablation (MWA) is an accepted treatment of non-operative liver cancer. This study compares the ablation zones of four commercially available 2.45 GHz MWA systems (Emprint, Eco, Neuwave, and Solero) in an ex vivo porcine liver model. (2) Methods: Ex vivo porcine livers (n = 85) were obtained. Two ablation time setting protocols were evaluated, the manufacturer's recommended maximum time and a 3 min time, performed at the manufacturer-recommended maximum power setting. A total of 236 ablation samples were created with 32 (13.6%) samples rejected. A total of 204 samples were included in the statistical analysis. (3) Results: For single-probe protocols, Emprint achieved ablation zones with the largest SAD. Significant differences were found in all comparisons for the 3 min time setting and for all comparisons at the 10 min time setting except versus Neuwave LK15 and Eco. Emprint produced ablation zones that were also significantly more spherical (highest SI) than the single-probe ablations from all other manufacturers. No statistical differences were found for ablation shape or SAD between the single-probe protocols for Emprint and the three-probe protocols for Neuwave. (4) Conclusions: The new Emprint HP system achieved large and spherical ablation zones relative to other 2.45 GHz MWA systems.
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Affiliation(s)
- Terrence C. H. Hui
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Guo Yuan How
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Michelle S. M. Chim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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23
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Wu X, Lokken RP, Mehta N. Optimal treatment for small HCC (<3 cm): Resection, liver transplantation, or locoregional therapy? JHEP Rep 2023; 5:100781. [PMID: 37456674 PMCID: PMC10339255 DOI: 10.1016/j.jhepr.2023.100781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/30/2023] [Indexed: 07/18/2023] Open
Abstract
Hepatocellular carcinoma (HCC) remains the most common form of liver cancer, accounting for 90% of all primary liver cancers. Up to 30% of HCC cases could be small (2-3 cm in diameter) at the time of diagnosis with advances in imaging techniques and surveillance programmes. Treating patients with early-stage HCC can be complex and often requires interdisciplinary care, owing to the wide and increasing variety of treatment options, which include liver resection, liver transplantation, and various locoregional therapies offered by interventional radiology and radiation oncology. Decisions regarding the optimal management strategy for a patient involve many considerations, including patient- and tumour-specific characteristics, as well as socioeconomic factors. In this review, we aim to comprehensively summarise the commonly used therapies for single, small HCC (<3 cm), with a focus on the impact of tumour size (<2 cm vs. 2-3 cm), as well as a brief discussion on the cost-effectiveness of the different treatment options.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Ryan Peter Lokken
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Neil Mehta
- Department of General Hepatology and Liver Transplantation, University of California, San Francisco, CA, USA
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24
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Boregowda G, Mariappan P. 3D modeling of vector/edge finite element method for multi-ablation technique for large tumor-computational approach. PLoS One 2023; 18:e0289262. [PMID: 37506084 PMCID: PMC10381062 DOI: 10.1371/journal.pone.0289262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Microwave ablation (MWA) is a cancer thermal ablation treatment that uses electromagnetic waves to generate heat within the tissue. The goal of this treatment is to eliminate tumor cells while leaving healthy cells unharmed. During MWA, excess heat generation can kill healthy cells. Hence, mathematical models and numerical techniques are required to analyze the heat distribution in the tissue before the treatment. The aim of this research is to explain the implementation of the 3D vector finite element method in a wave propagation model that simulates the specific absorption rate in the liver. The 3D Nedelec elements from H(curl; Ω) space are used to discretize the wave propagation model, and this implementation is helpful in solving many real-world problems that involve electromagnetic propagation with perfect conducting and absorbing boundary conditions. One of the difficulties in ablation treatment is creating a large ablation zone for a large tumor (diameter greater than 3 cm) in a short period of time with minimum damage to the surrounding tissue. This article addresses the aforementioned issue by introducing four antennas into the different places of the tumor sequentially and producing heat uniformly over the tumor. The results demonstrated that 95.5% of the tumor cells were killed with minimal damage to the healthy cells when the heating time was increased to 4 minutes at each position. Subsequently, we studied the temperature distribution and localised tissue contraction in the tissue using the three-dimensional bio-heat equation and temperature-time dependent model, respectively. The local tissue contraction is measured at arbitrary points in the domain and is more noticeable at temperatures higher than 102°C. The thermal damage in the liver during MWA treatment is investigated using the three-state cell death model. The system of partial differential equations is solved numerically due to the complex geometry of the domain, and the results are compared with experimental data to validate the models and parameters.
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Affiliation(s)
- Gangadhara Boregowda
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Andhra Pradesh, India
| | - Panchatcharam Mariappan
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Andhra Pradesh, India
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25
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Criss CR, Makary MS. Recent Advances in Image-Guided Locoregional Therapies for Primary Liver Tumors. BIOLOGY 2023; 12:999. [PMID: 37508428 PMCID: PMC10376862 DOI: 10.3390/biology12070999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Primary liver cancer is the leading cause of cancer-related deaths worldwide. with incidences predicted to rise over the next several decades. Locoregional therapies, such as radiofrequency or microwave ablation, are described as image-guided percutaneous procedures, which offer either a curative intent for early-stage hepatocellular carcinoma or bridging/downstaging for surgical resection or transplantation. Catheter-driven locoregional therapies, such as transarterial chemoembolization and radioembolization, induce tumor hypoxia, can be palliative, and improve survival for early-to-intermediate hepatocellular carcinoma and unresectable intrahepatic cholangiocarcinoma. Herein, we provide a comprehensive overview of the antineoplastic mechanisms underpinning locoregional therapies, different treatment approaches, and the current state of the literature for the efficacy of locoregional therapies for primary liver cancer. We also discuss emerging advancements, such as the adjuvant use of immunotherapies and molecular targeting agents with locoregional therapy, for the treatment of primary liver cancer.
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Affiliation(s)
- Cody R Criss
- OhioHealth Riverside Methodist Hospital, Columbus, OH 43214, USA
| | - Mina S Makary
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, USA
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26
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Ishikawa T, Hasegawa I, Hirosawa H, Honmou T, Sakai N, Igarashi T, Yamazaki S, Kobayashi T, Sato T, Iwanaga A, Sano T, Yokoyama J, Honma T. Comparison of Ablation Volume Between Emprint ® and Mimapro ® Systems for Hepatocellular Carcinoma -A Preliminary Study. J Hepatocell Carcinoma 2023; 10:979-985. [PMID: 37377842 PMCID: PMC10292608 DOI: 10.2147/jhc.s412642] [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: 03/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Background Microwave ablation (MWA) is a standard percutaneous local therapy for hepatocellular carcinoma (HCC). Next-generation MWA is reported to create a more spherical ablation zone than radiofrequency ablation (RFA). We compared the ablation zone and aspect ratio of two 2.45 GHz MWA ablation probes; Emprint® (13G) and Mimapro® (17G). We compared the ablation zone to the applied energy after MWA in patients with hepatocellular carcinoma (HCC). Furthermore, we investigated local recurrence. Materials and Methods We included 20 patients with HCC, with an average tumour diameter of 33.2 ± 12.2 mm, who underwent MWA using Emprint®, and 9 patients who underwent MWA using Mimapro® with an average tumour diameter of 31.1 ± 10.5 mm. Both groups underwent the same ablation protocol using the same power settings. The images obtained after MWA showed the treatment ablation zone and aspect ratio, which were measured and compared using three-dimensional image analysis software. Results The aspect ratios in the Emprint® and Mimapro® groups were 0.786 ± 0.105 and 0.808 ± 0.122, respectively, with no significant difference (p = 0.604). The ablation time was significantly shorter in the Mimapro® group than in the Emprint® group, and there was no significant difference in the frequency of popping or the ablation volume. There were no significant differences in local recurrence between the two groups. Conclusion There was no significant difference in the aspect ratios of the ablation diameter, and the ablation zone was almost spherical in both cases. Mimapro® at 17G was less invasive than Emprint® at 13G.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Iori Hasegawa
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hiroshi Hirosawa
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Tsubasa Honmou
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Nobuyuki Sakai
- Department of Clinical Engineering, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takanori Igarashi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shun Yamazaki
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takamasa Kobayashi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Toshifumi Sato
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Akito Iwanaga
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Tomoe Sano
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Junji Yokoyama
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
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27
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Laeseke P, Ng C, Ferko N, Naghi A, Wright GWJ, Zhang Y, Laidlaw A, Kalsekar I, Laxmanan B, Ghosh SK, Zhou M, Szapary P, Pritchett M. Stereotactic body radiation therapy and thermal ablation for treatment of NSCLC: A systematic literature review and meta-analysis. Lung Cancer 2023; 182:107259. [PMID: 37321074 DOI: 10.1016/j.lungcan.2023.107259] [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: 02/20/2023] [Revised: 04/17/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
RATIONALE Stereotactic body radiation therapy (SBRT) is the standard of care for inoperable early stage non-small cell lung cancer (NSCLC). Use of image guided thermal ablation (IGTA; including microwave ablation [MWA] and radiofrequency ablation [RFA]) has increased in NSCLC, however there are no studies comparing all three. OBJECTIVE To compare the efficacy of IGTA (including MWA and RFA) and SBRT for the treatment of NSCLC. METHODS Published literature databases were systematically searched for studies assessing MWA, RFA, or SBRT. Local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were assessed with single-arm pooled analyses and meta-regressions in NSCLC patients and a stage IA subgroup. Study quality was assessed with a modified methodological index for non-randomized studies (MINORS) tool. RESULTS Forty IGTA study-arms (2,691 patients) and 215 SBRT study-arms (54,789 patients) were identified. LTP was lowest after SBRT at one and two years in single-arm pooled analyses (4% and 9% vs. 11% and 18%) and at one year in meta-regressions when compared to IGTA (OR = 0.2, 95%CI = 0.07-0.63). MWA patients had the highest DFS of all treatments in single-arm pooled analyses. In meta-regressions at two and three-years, DFS was significantly lower for RFA compared to MWA (OR = 0.26, 95%CI = 0.12-0.58; OR = 0.33, 95%CI = 0.16-0.66, respectively). OS was similar across modalities, timepoints, and analyses. Older age, male patients, larger tumors, retrospective studies, and non-Asian study region were also predictors of worse clinical outcomes. In high-quality studies (MINORS score ≥ 7), MWA patients had better clinical outcomes than the overall analysis. Stage IA MWA patients had lower LTP, higher OS, and generally lower DFS, compared to the main analysis of all NSCLC patients. CONCLUSIONS NSCLC patients had comparable outcomes after SBRT and MWA, which were better than those with RFA.
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Affiliation(s)
- Paul Laeseke
- Radiology, University of Wisconsin, Madison, WI, United States.
| | - Calvin Ng
- Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
| | | | | | | | | | | | - Iftekhar Kalsekar
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Balaji Laxmanan
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Sudip K Ghosh
- Health Economics and Market Access, Johnson & Johnson, Cincinnati, OH, United States.
| | - Meijia Zhou
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Philippe Szapary
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Michael Pritchett
- Pulmonary and Critical Care Medicine, FirstHealth Moore Regional Hospital, and Pinehurst Medical Clinic, Pinehurst, NC, United States.
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28
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Wang L, Liu BX, Long HY. Ablative strategies for recurrent hepatocellular carcinoma. World J Hepatol 2023; 15:515-524. [PMID: 37206650 PMCID: PMC10190693 DOI: 10.4254/wjh.v15.i4.515] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/14/2023] [Accepted: 03/29/2023] [Indexed: 04/20/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.
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Affiliation(s)
- Lin Wang
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Bao-Xian Liu
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
| | - Hai-Yi Long
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China
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29
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Cheng PL, Wu PH, Kao WY, Lai YT, Hsu JC, Chiou JF, Wu MH, Lee HL. Comparison of local ablative therapies, including radiofrequency ablation, microwave ablation, stereotactic ablative radiotherapy, and particle radiotherapy, for inoperable hepatocellular carcinoma: a systematic review and meta-analysis. Exp Hematol Oncol 2023; 12:37. [PMID: 37046292 PMCID: PMC10091829 DOI: 10.1186/s40164-023-00400-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Surgical intervention is the first-line treatment in well-selected hepatocellular carcinoma (HCC) patients. However, only a few patients are suitable to receive radical surgery. We conducted a systematic review and meta-analysis to evaluate local control among four local ablative therapies in inoperable HCC patients, including radiofrequency ablation therapy (RFA), microwave ablation therapy (MWA), stereotactic ablative radiotherapy (SABR), and particle radiotherapy. The primary outcome was the local control rate and the secondary were regional and distant progression rates, overall survival rate, and adverse events. We included twenty-six studies from PubMed, EMBASE, and Cochrane Library databases. MWA (p < 0.001) and particle radiotherapy (p < 0.001) showed better performance of local control compared to RFA, while SABR (p = 0.276) showed a non-significant trend. However, SABR (p = 0.002) and particle radiotherapy (p < 0.001) showed better performance than RFA in HCCs of ≥ 30 mm in size. MWA showed a similar result to RFA while SABR and particle radiotherapy showed a lower survival rate in the 2-, 3-, and 4-year overall survival rates. Our results indicate that MWA, SABR and particle radiotherapy were safe and no inferior to RFA in local control rate. Besides, the local control rates of SABR and particle radiotherapy are better than RFA in HCC of ≥ 30 mm in size. As a result, we suggested that MWA, SABR and particle radiotherapy to be effective alternatives to RFA for inoperable HCC. Moreover, the tumor size should be taken into consideration for optimal treatment selection between local ablative therapies.
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Affiliation(s)
- Po-Lung Cheng
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Medical Education, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Hsiu Wu
- Department of Radiation Oncology, Taipei Medical University Hospital, Wuxing street, No. 252, Taipei, 11031, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Proton Center, Taipei Medical University, Taipei, Taiwan
| | - We-Yu Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Research Center for Digestive Medicine, Taipei Medical University, Taipei, Taiwan
- Taipei Cancer Center, Taipei Medical University, Taipei, Taiwan
| | - Yen-Ting Lai
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jason C Hsu
- International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan
- Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Wuxing street, No. 252, Taipei, 11031, Taiwan
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- TMU Proton Center, Taipei Medical University, Taipei, Taiwan
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan
| | - Meng-Huang Wu
- Spine Division, Department of Orthopedics, Taipei Medical University Hospital, Wuxing street, No. 252, 11031, Taipei, Taiwan.
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Prospective Innovation Center, Taipei Medical University Hospital, Taipei, Taiwan.
- TMU Biodesign Center, Taipei Medical University, Taipei, Taiwan.
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Wuxing street, No. 252, Taipei, 11031, Taiwan.
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- TMU Proton Center, Taipei Medical University, Taipei, Taiwan.
- The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan.
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30
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Singh SK, Yadav AN. Novel tumor localization model and prediction of ablation zone using an intertwined helical antenna for the treatment of hepatocellular carcinoma. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3686. [PMID: 36690467 DOI: 10.1002/cnm.3686] [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: 06/14/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 05/12/2023]
Abstract
Hepatocellular carcinoma has been the leading cause of death in recent centuries and with the advent of newer technologies, several thermal and cryo-ablation techniques have been introduced in the recent past. In this regard, microwave ablation has developed into a promising method for thermal ablation technique. However, due to clinical obligations, in-vivo analysis is not feasible and ex-vivo analysis is inaccurate due to changes in the electrical and thermal properties of the tissue. Therefore, in this study, temperature-dependent permittivity, electrical conductivity, and thermal conductivity along with phase change effect due to temperature reaching above 100°C are incorporated using finite element method model. Further, using an intertwined normal mode helical antenna ablation probe, a change in resonant frequency (Δf) and reflection coefficient (ΔS11 ) from the actual value (antenna parameter in the air at 5 GHz) is modeled using second-order polynomial curve fitting to predict the surrounding permittivity in the range of 30-70. A maximum deviation of 0.8 value in permittivity from the actual value is observed. However, to obtain a generalized methodology, XG Boost and CAT Boost algorithms are used. Further, since ablation diameter plays a crucial role in achieving optimal tumor ablation, an artificial neural network (ANN) algorithm with three different optimizers is incorporated to predict ablation diameter using five critical parameters. Such an ANN algorithm which can predict the transversal and axial ablation zone may provide optimal ablation outcomes.
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Affiliation(s)
- Suyash Kumar Singh
- Electronics and Communication Engineering Department, Indian Institute of Information Technology, Allahabad, India
| | - Amar Nath Yadav
- Electronics and Communication Engineering Department, Indian Institute of Information Technology, Allahabad, India
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31
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Daly ME, Beagen P, Madani MH. Nonsurgical Therapy for Early-Stage Lung Cancer. Hematol Oncol Clin North Am 2023; 37:499-512. [PMID: 37024386 DOI: 10.1016/j.hoc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Treatment options for medically inoperable, early-stage non-small cell lung cancer (NSCLC) include stereotactic ablative radiotherapy (SABR) and percutaneous image guided thermal ablation. SABR is delivered over 1-5 sessions of highly conformal ablative radiation with excellent tumor control. Toxicity is depending on tumor location and anatomy but is typically mild. Studies evaluating SABR in operable NSCLC are ongoing. Thermal ablation can be delivered via radiofrequency, microwave, or cryoablation, with promising results and modest toxicity. We review the data and outcomes for these approaches and discuss ongoing studies.
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32
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Koza A, Bhogal RH, Fotiadis N, Mavroeidis VK. The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes. Biomedicines 2023; 11:biomedicines11041062. [PMID: 37189680 DOI: 10.3390/biomedicines11041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.
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Tabari A, D’Amore B, Cox M, Brito S, Gee MS, Wehrenberg-Klee E, Uppot RN, Daye D. Machine-Learning-Based Radiomic Features on Pre-Ablation MRI as Predictors of Pathologic Response in Patients with Hepatocellular Carcinoma Who Underwent Hepatic Transplant. Cancers (Basel) 2023; 15:cancers15072058. [PMID: 37046718 PMCID: PMC10092969 DOI: 10.3390/cancers15072058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
Background: The aim was to investigate the role of pre-ablation tumor radiomics in predicting pathologic treatment response in patients with early-stage hepatocellular carcinoma (HCC) who underwent liver transplant. Methods: Using data collected from 2005–2015, we included adult patients who (1) had a contrast-enhanced MRI within 3 months prior to ablation therapy and (2) underwent liver transplantation. Demographics were obtained for each patient. The treated hepatic tumor volume was manually segmented on the arterial phase T1 MRI images. A vector with 112 radiomic features (shape, first-order, and texture) was extracted from each tumor. Feature selection was employed through minimum redundancy and maximum relevance using a training set. A random forest model was developed based on top radiomic and demographic features. Model performance was evaluated by ROC analysis. SHAP plots were constructed in order to visualize feature importance in model predictions. Results: Ninety-seven patients (117 tumors, 31 (32%) microwave ablation, 66 (68%) radiofrequency ablation) were included. The mean model for end-stage liver disease (MELD) score was 10.5 ± 3. The mean follow-up time was 336.2 ± 179 days. Complete response on pathology review was achieved in 62% of patients at the time of transplant. Incomplete pathologic response was associated with four features: two first-order and two GLRM features using univariate logistic regression analysis (p < 0.05). The random forest model included two radiomic features (diagnostics maximum and first-order maximum) and four clinical features (pre-procedure creatinine, pre-procedure albumin, age, and gender) achieving an AUC of 0.83, a sensitivity of 82%, a specificity of 67%, a PPV of 69%, and an NPV of 80%. Conclusions: Pre-ablation MRI radiomics could act as a valuable imaging biomarker for the prediction of tumor pathologic response in patients with HCC.
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Mankertz F, Gemeinhardt O, Felbor U, Hadlich S, Hosten N. Spacer-Supported Thermal Ablation to Prevent Carbonisation and Improve Ablation Size: A Proof of Concept Study. Biomedicines 2023; 11:biomedicines11020575. [PMID: 36831111 PMCID: PMC9952941 DOI: 10.3390/biomedicines11020575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Thermal ablation offers a minimally invasive alternative in the treatment of hepatic tumours. Several types of ablation are utilised with different methods and indications. However, to this day, ablation size remains limited due to the formation of a central non-conductive boundary layer. In thermal ablation, this boundary layer is formed by carbonisation. Our goal was to prevent or delay carbonisation, and subsequently increase ablation size. We used bovine liver to compare ablation diameter and volume, created by a stand-alone laser applicator, with those created when utilising a spacer between laser applicator and hepatic tissue. Two spacer variants were developed: one with a closed circulation of cooling fluid and one with an open circulation into hepatic tissue. We found that the presence of a spacer significantly increased ablation volume up to 75.3 cm3, an increase of a factor of 3.19 (closed spacer) and 3.02 (open spacer) when compared to the stand-alone applicator. Statistical significance between spacer variants was also present, with the closed spacer producing a significantly larger ablation volume (p < 0.001, MDiff = 3.053, 95% CI[1.612, 4.493]) and diameter (p < 0.001, MDiff = 4.467, 95% CI[2.648, 6.285]) than the open spacer. We conclude that the presence of a spacer has the potential to increase ablation size.
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Affiliation(s)
- Fiona Mankertz
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence:
| | - Ole Gemeinhardt
- Department of Radiology, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ute Felbor
- Institute for Human Genetics, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stefan Hadlich
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, 17475 Greifswald, Germany
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Robinson TP, Pebror T, Krosin ME, Koniaris LG. Ablative Therapy in Non-HCC Liver Malignancy. Cancers (Basel) 2023; 15:cancers15041200. [PMID: 36831543 PMCID: PMC9954041 DOI: 10.3390/cancers15041200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.
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Affiliation(s)
- Tyler P. Robinson
- Department of Surgery, Indiana University, Indianapolis, IN 46202, USA
- Correspondence: ; Tel.: +1-312-371-8360
| | - Travis Pebror
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
| | - Matthew E. Krosin
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
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36
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Criss CR, Makary MS. Salvage locoregional therapies for recurrent hepatocellular carcinoma. World J Gastroenterol 2023; 29:413-424. [PMID: 36688022 PMCID: PMC9850930 DOI: 10.3748/wjg.v29.i3.413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/20/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death worldwide. Despite the advent of screening efforts and algorithms to stratify patients into appropriate treatment strategies, recurrence rates remain high. In contrast to first-line treatment for HCC, which relies on several factors, including clinical staging, tumor burden, and liver function, there is no consensus or general treatment recommendations for recurrent HCC (R-HCC). Locoregional therapies include a spectrum of minimally invasive liver-directed treatments which can be used as either curative or neoadjuvant therapy for HCC. Herein, we provide a comprehensive review of recent evidence using salvage loco-regional therapies for R-HCC after failed curative-intent.
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Affiliation(s)
- Cody R Criss
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio 45701, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210, United States
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Shi Q, Zhou X, Zhang Z, Zhang W, Ma J, Yang M, Yu J, Luo J, Liu L, Yan Z. Microwave ablation and synchronous transarterial chemoembolization combined with PD-1 inhibitor in patients with hepatocellular carcinoma following tyrosine kinase inhibitor intolerance. Front Immunol 2023; 13:1097625. [PMID: 36703965 PMCID: PMC9871779 DOI: 10.3389/fimmu.2022.1097625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose To determine the safety and efficacy of microwave ablation (MWA) and synchronous transarterial chemoembolization (TACE) combined with or without PD-1 inhibitor in patients with hepatocellular carcinoma (HCC) following tyrosine kinase inhibitor (TKI) intolerance. Materials and methods This study retrospectively enrolled TKI-intolerant HCC patients who underwent MWA-TACE combined with PD-1 inhibitor (MTP) or MWA-TACE (MT) from January 2019 to June 2021. MWA and TACE were performed simultaneously, and PD-1 inhibitor was administered intravenously at a dose of 200 mg once every three weeks after MWA-TACE. Adverse events (AEs) related to treatment were recorded during the follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Results A total of 87 patients were included and classified into the MTP group (n =42) and MT group (n=45). Complications related to MWA-TACE in the MTP group were similar to that in the MT group (21.4% vs. 24.4%, P = 0.738). Moreover, 35 (83.3%) patients had eighty-four AEs related to PD-1 inhibitor in the MTP group, and 8 (19.0%) patients developed grade 3. Patients who underwent MWA-TACE combined with PD-1 inhibitor had better PFS (median, 10.0 vs. 4.7 months, P < 0.001) and OS (median, 17.0 vs. 8.5 months, P < 0.001) than those who underwent MWA-TACE alone. Treatment method and Child-Pugh class were independent prognostic factors for survival in the univariate and multivariate analysis. Conclusion MWA and synchronous TACE combined with PD-1 inhibitor might be a favorable treatment option in TKI-intolerant HCC patients.
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Affiliation(s)
- Qin Shi
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Zhou
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zihan Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingqin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minjie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiaze Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
| | - Zhiping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China,Department of Interventional Radiology, Shanghai Institution of Medical Imaging, Shanghai, China,National Clinical Research Center for Interventional Medicine, Zhongshan Hospital, Fudan University, Shanghai, China,*Correspondence: Lingxiao Liu, ; Zhiping Yan,
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Gangadhara B, Mariappan P. A vector finite element approach to temperature dependent parameters of microwave ablation for liver cancer. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3661. [PMID: 36385734 DOI: 10.1002/cnm.3661] [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: 06/24/2022] [Revised: 10/23/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
Microwave ablation (MWA) is a minimally invasive treatment for cancer that uses electromagnetic waves to kill the tumor cells without significantly damaging the surrounding healthy cells. A three-state cell death model calculates the thermal damage around the Hepatocellular carcinoma (HCC) tumor in the liver tissue. The temperature profile is simulated for a single-slot co-axial antenna with a 1 mm air slot located near the tip of the antenna to produce an adequate amount of heat. The aims of this study are (1) to use the vector/edge finite element method (VFEM) to simulate the electromagnetic wave propagation to obtain the specific absorption rate, which is an input for the bio-heat equation that predicts the heat distribution in the liver tissue during MWA treatment, and (2) to compare the computational costs of VFEM and the finite element method (FEM) when different types of input powers and dielectric properties are used in the wave propagation equation. This study claims that the accuracy level increases marginally with less computation cost while using VFEM for temperature-dependent wave propagation equation.
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Affiliation(s)
- Boregowda Gangadhara
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Chindepalle, Andhra Pradesh, India
| | - Panchatcharam Mariappan
- Department of Mathematics and Statistics, Indian Institute of Technology Tirupati, Chindepalle, Andhra Pradesh, India
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Lanza C, Carriero S, Ascenti V, Tintori J, Ricapito F, Lavorato R, Biondetti P, Angileri SA, Piacentino F, Fontana F, Venturini M, Ierardi AM, Carrafiello G. Percutaneous Application of High Power Microwave Ablation With 150 W for the Treatment of Tumors in Lung, Liver, and Kidney: A Preliminary Experience. Technol Cancer Res Treat 2023; 22:15330338231185277. [PMID: 37608585 PMCID: PMC10467382 DOI: 10.1177/15330338231185277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/27/2022] [Accepted: 06/07/2023] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the feasibility, safety, and short-term effectiveness of a high-power (150 W) microwave ablation (MWA) device for tumor ablation in the lung, liver, and kidney. METHODS Between December 2021 and June 2022, patients underwent high-power MWA for liver, lung, and kidney tumors. A retrospective observational study was conducted in accordance with the Declaration of Helsinki. The MWA system utilized a 150-W, 2.45-GHz microwave generator (Emprint™ HP Ablation System, Medtronic). The study assessed technical success, safety, and effectiveness, considering pre- and post-treatment diameter and volume, lesion location, biopsy and/or cone beam computed tomography (CBCT) usage, MWA ablation time, MWA power, and dose-area product (DAP). RESULTS From December 2021 to June 2022, 16 patients were enrolled for high-power MWA. Treated lesions included hepatocellular carcinoma (10), liver metastasis from colon cancer (1), liver metastasis from pancreatic cancer (1), squamous cell lung carcinoma (2), renal cell carcinoma (1), and renal oncocytoma (1). Technical success rate was 100%. One grade 1 complication (6.25%) was reported according to CIRSE classification. Overall effectiveness was 92.8%. Pre- and post-treatment mean diameters for liver lesions were 19.9 mm and 37.5 mm, respectively; for kidney lesions, 34 mm and 35 mm; for lung lesions, 29.5 mm and 31.5 mm. Pre- and post-treatment mean volumes for liver lesions were 3.4 ml and 24 ml, respectively; for kidney lesions, 8.2 ml and 20.5 ml; for lung lesions, 10.2 ml and 32.7 ml. The mean ablation time was 48 minutes for liver, 42.5 minutes for lung, and 42.5 minutes for renal ablation. The mean DAP for all procedures was 40.83 Gcm2. CONCLUSION This preliminary study demonstrates the feasibility, safety, and effectiveness of the new 150 W MWA device. Additionally, it shows reduced ablation times for large lesions.
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Affiliation(s)
- Carolina Lanza
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Jacopo Tintori
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesco Ricapito
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Roberto Lavorato
- Diagnostic and Interventional Radiology Department, IRCCS Ca’ Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - Pierpaolo Biondetti
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- Department of Health Science, Università degli Studi di Milano, Milano, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
- Insubria University, Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Varese, Italy
- Insubria University, Varese, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Cà Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
- Department of Health Science, Università degli Studi di Milano, Milano, Italy
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40
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Kernot D, Yang J, Williams N, Thomas T, Ledger P, Arora H, van Loon R. Transient changes during microwave ablation simulation : a comparative shape analysis. Biomech Model Mechanobiol 2023; 22:271-280. [PMID: 36287313 PMCID: PMC9957862 DOI: 10.1007/s10237-022-01646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/04/2022] [Indexed: 11/02/2022]
Abstract
Microwave ablation therapy is a hyperthermic treatment for killing cancerous tumours whereby microwave energy is dispersed into a target tissue region. Modelling can provide a prediction for the outcome of ablation, this paper explores changes in size and shape of temperature and Specific absorption rate fields throughout the course of simulated treatment with different probe concepts. Here, an axisymmetric geometry of a probe embedded within a tissue material is created, solving coupled electromagnetic and bioheat equations using the finite element method, utilizing hp discretisation with the NGSolve library. Results show dynamic changes across all metrics, with different responses from different probe concepts. The sleeve probe yielded the most circular specific absorption rate pattern with circularity of 0.81 initially but suffered the largest reduction throughout ablation. Similarly, reflection coefficients differ drastically from their initial values, with the sleeve probe again experiencing the largest change, suggesting that it is the most sensitive the changes in the tissue dielectric properties in these select probe designs. These collective characteristic observations highlight the need to consider dielectric property changes and probe specific responses during the design cycle.
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Affiliation(s)
- Dale Kernot
- School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan, SA1 8EN, UK.
| | - Jimmy Yang
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Nicholas Williams
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Tudor Thomas
- Olympus Surgical Technologies Europe, Fortran road, Cardiff, Glamorgan CF3 0LT UK
| | - Paul Ledger
- grid.9757.c0000 0004 0415 6205School of Computing and Mathematics, Keele University, Keele, Staffordshire ST5 5BG UK
| | - Hari Arora
- grid.4827.90000 0001 0658 8800School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan SA1 8EN UK
| | - Raoul van Loon
- grid.4827.90000 0001 0658 8800School of Engineering and Applied Sciences, Faculty of Science and Engineering, Swansea University, Fabian Way, Swansea, Glamorgan SA1 8EN UK
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41
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Abdalla M, Collings AT, Dirks R, Onkendi E, Nelson D, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Abou-Setta A, Sucandy I, Kchaou A, Douglas S, Polanco P, Vreeland T, Buell J, Ansari MT, Pryor AD, Slater BJ, Awad Z, Richardson W, Alseidi A, Jeyarajah DR, Ceppa E. Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis. Surg Endosc 2022; 37:3340-3353. [PMID: 36542137 DOI: 10.1007/s00464-022-09815-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm. METHODS A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data. RESULTS From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm. CONCLUSION The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.
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Affiliation(s)
- Moustafa Abdalla
- Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA
| | - Daniel Nelson
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Chowk, Lucknow, India
| | - Emily Miraflor
- Department of Surgery, University of California, San Francisco - East Bay, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Subhashini Ayloo
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed Abou-Setta
- Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada
| | - Iswanto Sucandy
- Department of Surgery, University of Central Florida, Tampa, FL, USA
| | - Ali Kchaou
- Department of Surgery, University of Sfax, Sfax, Tunisia
| | | | - Patricio Polanco
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Center, Houston, TX, USA
| | - Joseph Buell
- Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
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Locatelli A, Treggiari E, Innocenti M, Romanelli G. Percutaneous ultrasound-guided microwave ablation for treatment of hepatocellular carcinomas in dogs: four cases (2019-2020). J Small Anim Pract 2022; 63:897-903. [PMID: 36000486 DOI: 10.1111/jsap.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 07/10/2022] [Accepted: 07/16/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe ultrasound-guided microwave ablation as a minimally invasive treatment option for primary or metastatic hepatocellular carcinomas. METHODS Four client-owned dogs underwent percutaneous ultrasound-guided microwave ablation of three primary and one metastatic hepatocellular carcinoma, diagnosed on cytology/histopathology. In each case, multiple ultrasound-guided thermal lesions were created in a 10 to 40 minutes ablation at 30 to 35 W. Real-time monitoring was performed using 10 MHz diagnostic ultrasound transducers. The procedures were performed without complication and CT scans or abdominal ultrasounds were repeated immediately after. Patients were discharged on oral analgesia on the same day or 24 hours later. RESULTS Hepatocellular carcinomas were successfully ablated, which in some cases resulted in an improvement in clinical signs and laboratory values. The patients were followed up for a time ranging between 39 and 649 days and no evidence of disease progression was found. Three out of four patients are still alive at the time of writing. CLINICAL SIGNIFICANCE In these four patients, minimally invasive ultrasound-guided microwave ablation was feasible and resulted in no immediate complications. Regular imaging follow-up is recommended after the procedure and further studies on microwave ablation are warranted to establish its effectiveness in dogs with hepatocellular carcinomas.
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Affiliation(s)
- A Locatelli
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - E Treggiari
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - M Innocenti
- Centro Specialistico Veterinario, 20141, Milan, Italy
| | - G Romanelli
- Centro Specialistico Veterinario, 20141, Milan, Italy
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Radonjić T, Dukić M, Jovanović I, Zdravković M, Mandić O, Popadić V, Popović M, Nikolić N, Klašnja S, Divac A, Todorović Z, Branković M. Aging of Liver in Its Different Diseases. Int J Mol Sci 2022; 23:13085. [PMID: 36361873 PMCID: PMC9656219 DOI: 10.3390/ijms232113085] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/24/2022] [Accepted: 10/01/2022] [Indexed: 09/05/2023] Open
Abstract
The proportion of elderly people in the world population is constantly increasing. With age, the risk of numerous chronic diseases and their complications also rises. Research on the subject of cellular senescence date back to the middle of the last century, and today we know that senescent cells have different morphology, metabolism, phenotypes and many other characteristics. Their main feature is the development of senescence-associated secretory phenotype (SASP), whose pro-inflammatory components affect tissues and organs, and increases the possibility of age-related diseases. The liver is the main metabolic organ of our body, and the results of previous research indicate that its regenerative capacity is greater and that it ages more slowly compared to other organs. With age, liver cells change under the influence of various stressors and the risk of developing chronic liver diseases such as non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), alcoholic steatohepatitis (ASH) and hepatocellular carcinoma (HCC) increases. It has been proven that these diseases progress faster in the elderly population and in some cases lead to end-stage liver disease that requires transplantation. The treatment of elderly people with chronic liver diseases is a challenge and requires an individual approach as well as new research that will reveal other safe and effective therapeutic modalities.
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Affiliation(s)
- Tijana Radonjić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Marija Dukić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Igor Jovanović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Marija Zdravković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Olga Mandić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Višeslav Popadić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Maja Popović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Novica Nikolić
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Slobodan Klašnja
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Anica Divac
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
| | - Zoran Todorović
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marija Branković
- University Hospital Medical Center Bežanijska Kosa, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Bazeed AY, Day CM, Garg S. Pancreatic Cancer: Challenges and Opportunities in Locoregional Therapies. Cancers (Basel) 2022; 14:cancers14174257. [PMID: 36077794 PMCID: PMC9454856 DOI: 10.3390/cancers14174257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Pancreatic cancer is a serious ongoing global health burden, with an overall 5-year survival rate of less than 5%. One major hurdle in the treatment of this disease is the predominantly elderly patient population, leading to their ineligibility for curative surgery and a low rate of successful outcomes. Systemic administration introduces chemo-agents throughout the body via the blood, attacking not only tumours but also healthy organs. When localised interventions are employed, chemo-agents are retained specifically at tumour site, minimizing unwanted toxicity. As a result, there is a growing interest in finding novel localised interventions as alternatives to systemic therapy. Here, we present a detailed review of current locoregional therapies used in pancreatic cancer therapy. This work aims to present a thorough guide for researchers and clinicians intended to employ established and novel localised interventions in the treatment of pancreatic cancer. Furthermore, we present our insights and opinions on the potential ideals to improve these tools. Abstract Pancreatic cancer (PC) remains the seventh leading cause of cancer-related deaths worldwide and the third in the United States, making it one of the most lethal solid malignancies. Unfortunately, the symptoms of this disease are not very apparent despite an increasing incidence rate. Therefore, at the time of diagnosis, 45% of patients have already developed metastatic tumours. Due to the aggressive nature of the pancreatic tumours, local interventions are required in addition to first-line treatments. Locoregional interventions affect a specific area of the pancreas to minimize local tumour recurrence and reduce the side effects on surrounding healthy tissues. However, compared to the number of new studies on systemic therapy, very little research has been conducted on localised interventions for PC. To address this unbalanced focus and to shed light on the tremendous potentials of locoregional therapies, this work will provide a detailed discussion of various localised treatment strategies. Most importantly, to the best of our knowledge, the aspect of localised drug delivery systems used in PC was unprecedentedly discussed in this work. This review is meant for researchers and clinicians considering utilizing local therapy for the effective treatment of PC, providing a thorough guide on recent advancements in research and clinical trials toward locoregional interventions, together with the authors’ insight into their potential improvements.
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Osman AMA, Abdelaziz AO, Deweir M, Salah A, Harb STE, Nabeel MM, Abdelmaksoud AH, Shousha HI, Elbaz TM, Hashem MB. Hepatic resection versus microwave ablation for the treatment of early hepatocellular carcinoma: a comparative analysis of treatment outcomes and survival predictors. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00210-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Liver resection and local ablation are the two primary curative treatments for early-stage hepatocellular carcinoma (HCC). Microwave ablation (MWA) shows promising performance in terms of early tumor response, recurrence, and survival. This study aims to determine whether MWA would be comparable to liver resection in treating early-stage HCC.
Methods
This study included patients with hepatitis C-related HCC attending the multidisciplinary HCC clinic, Kasr Al-Ainy Hospital (March 2018 to September 2020). We included adults with early-stage HCC (BCLC stages 0-A). We studied patients and tumor characteristics, HCC treatment response, recurrence, and overall survival.
Results
Thirty-one patients were treated with liver resection and 41 patients were treated with MWA, including 4 patients who received intraoperative MWA. By the end of the study, 21 patients (28.77%) died. Patients who underwent MWA were younger compared to the hepatectomy group with lower baseline AFP (21 (6.7–54) versus 77 (31.3–136.0), respectively, (P value 0.024) and tumor size (2.78 (0.87) cm versus 3.77 (0.97) cm, respectively, (P value < 0.001). We found no differences between the studied groups in terms of treatment response, post-treatment decompensation, recurrence, or overall survival. One-year survival probability in the MWA and resection groups was 75.5% and 76.3% respectively. Post-procedure hepatic decompensation was the only independent predictor of lower survival by multivariate logistic regression analysis (OR 37.74, 95%CI 6.251–227.87, P value < 0.001) after adjusting for age, AFP, and tumor size.
Conclusion
Liver resection and MWA showed similar satisfactory results in the treatment of early-stage HCC, in terms of treatment response, recurrence, and overall survival.
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Xu ZJ, Wei MJ, Zhang XM, Liu HG, Wu JP, Huang JF, Li YF, Huang ZJ, Yan YY. Effects of microwave ablation on serum Golgi protein 73 in patients with primary liver cancer. World J Gastroenterol 2022; 28:3971-3980. [PMID: 36157538 PMCID: PMC9367227 DOI: 10.3748/wjg.v28.i29.3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Microwave ablation (MWA) is an effective treatment option for patients with primary liver cancer. However, it has been reported that the MWA procedure induces a hepatic inflammatory response and injury, which may negatively affect the efficacy of MWA. As such, the discovery of reliable markers to monitor the patient’s response to MWA is needed. Golgi protein 73 (GP73) has been shown to be associated with chronic liver disease. To date, the potential value of serum GP73 in the dynamic monitoring during MWA of liver cancer remains unclear.
AIM To examine the effects of MWA on the serum levels of GP73 in patients with primary liver cancer.
METHODS A total of 150 primary liver cancer patients with a single small lesion (≤ 3 cm in diameter) were retrospectively enrolled spanning the period between January 2016 and October 2018. All of the patients received MWA for the treatment of primary liver cancer. Serum GP73, alpha-fetoprotein (AFP), and widely used liver biochemical indicators [serum albumin, total bilirubin (TBIL), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] were compared before MWA and at different time points, including 1, 2, and 4 wk following the ablation procedure.
RESULTS Complete tumor ablation was achieved in 95.33% of the patients at 1 mo after MWA. The 1-, 2-, and 3-year disease-free survival rates were 74.67%, 59.33%, and 54.00%, respectively. The serum AFP levels were significantly decreased at 1, 2, and 4 wk after MWA; they returned to the normal range at 12 wk after MWA; and they remained stable thereafter during follow-up in those cases without recurrence. In contrast, the serum GP73 levels were significantly increased at 1 and 2 wk after MWA. The serum GP73 levels reached the peak at 2 wk after MWA, started to decline after hepatoprotective treatment with glycyrrhizin and reduced glutathione, and returned to the pretreatment levels at 12 and 24 wk after MWA. Notably, the changes of serum GP73 in response to MWA were similar to those of TBIL, ALT, and AST.
CONCLUSION Serum GP73 is markedly increased in response to MWA of liver cancer. Thus, serum GP73 holds potential as a marker to monitor MWA-induced inflammatory liver injury in need of amelioration.
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Affiliation(s)
- Zheng-Ju Xu
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Mei-Juan Wei
- Central Laboratory, Decheng Hospital, Quanzhou 362104, Fujian Province, China
| | - Xiao-Man Zhang
- Central Laboratory of Clinical Hepatology, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Hui-Guo Liu
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Jin-Piao Wu
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Jin-Fa Huang
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Yong-Fei Li
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Zhi-Jie Huang
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
| | - Yan-Yan Yan
- The Liver Disease Center, The 910th Hospital of the PLA Joint Logistics Support Force, Quanzhou 362000, Fujian Province, China
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Nguyen DT, Vu NT, Dinh TTH. Massive lung necrosis due to microwave ablation in an octogenarian required urgent lobectomy. BMJ Case Rep 2022; 15:15/8/e249610. [PMID: 35918079 PMCID: PMC9351336 DOI: 10.1136/bcr-2022-249610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We present a rare complication of microwave ablation (MWA) in a male patient in his 80s. His massive pulmonary necrosis and tension pneumothorax required urgent surgery. However, the damage to the lung tissue was too large, deep and fragile. We failed to suture or conduct wedge resection on the lung lesion, so, left upper lobectomy was necessary. Therefore, we suggest that it is probably possible to reduce the frequency and time threshold when performing MWA for the elderly with comorbidities.
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Affiliation(s)
- Duy Thang Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
- Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Ngoc Tu Vu
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam
- Department of Cardiovascular and Thoracic Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Thi Thanh Hong Dinh
- Department of Respiratory, Hanoi Medical University Hospital, Hanoi, Viet Nam
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Li S, Tsui PH, Song S, Wu W, Zhou Z, Wu S. Detection of microwave ablation coagulation areas using ultrasound Nakagami imaging based on Gaussian pyramid decomposition: A feasibility study. ULTRASONICS 2022; 124:106758. [PMID: 35617777 DOI: 10.1016/j.ultras.2022.106758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 03/14/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
In this paper, we explored the feasibility of using ultrasound Nakagami-m parametric imaging based on Gaussian pyramid decomposition (GPD) to detect microwave ablation coagulation areas. Monte Carlo simulation and phantom simulation results demonstrated that a 2-layer GPD model was sufficient to achieve the same m parameter estimation accuracy, smoothness and resolution as 3-layer and 4-layer. The performances of GPD, moment-based estimator (MBE) and window-modulated compounding (WMC) algorithms were compared in terms of parameter estimation, smoothness, resolution and contrast-to-noise (CNR). Results showed that the m parameter estimation obtained by GPD algorithm was better than that of MBE and WMC algorithms except the small window size (27 × 5). When using a window size of >3 pulse lengths, GPD algorithm could achieve better smoothness and CNR than MBE and WMC algorithms, but there was a certain loss of axial resolution. The computation time of GPD algorithm was less than that of WMC algorithm, while about 2.24 times that of MBE algorithm. Experimental results of porcine liver microwave ablation ex vivo (n = 20) illustrated that the average areas under the operating characteristic curve (AUCs) of Nakagami mGPD, mMBE and mWMC parametric imaging and homodyned-K (HK) α and k parametric imaging to detect coagulation areas were significantly improved by polynomial approximation (PAX). Kruskal-Wallis test showed that the accuracy of coagulation area detection obtained by PAX imaging of mGPD parameter had no significant difference with that of mMBE, mWMC, HK_α and HK_k parameters. This preliminary study suggested that Nakagami imaging based on GPD algorithm may have the potential to detect microwave ablation coagulation areas.
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Affiliation(s)
- Sinan Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Po-Hsiang Tsui
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute for Radiological Research, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shuang Song
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Weiwei Wu
- College of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Zhuhuang Zhou
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
| | - Shuicai Wu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
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Dou Z, Lu F, Ren L, Song X, Li B, Li X. Efficacy and safety of microwave ablation and radiofrequency ablation in the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29321. [PMID: 35905207 PMCID: PMC9333547 DOI: 10.1097/md.0000000000029321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with limited cirrhosis. Radiofrequency ablation and Microwave ablation are 2 main types of percutaneous thermal ablation for the treatment of HCC. The efficacy and safety between these 2 therapy methods are still under a debate. OBJECTIVE To compare the efficacy and safety of Radiofrequency ablation and Microwave ablation in treating HCC. METHODS PubMed, EMBASE, the Cochrane databases and Web of Science were systematically searched. We included randomized controlled trials and cohort studies comparing the efficacy and safety of Radiofrequency ablation and Microwave ablation in HCC patients. Outcome measures on local tumor progression, complete ablation, disease-free survival, overall survival, or major complications were compared between the 2 groups. The random effect model was used when there was significant heterogeneity between studies, otherwise the fixed effect model was used. RESULTS A total of 33 studies, involving a total of 4589 patients were identified, which included studies comprised 7 RCTs, 24 retrospective observational trials, and 2 prospective observational trial. Microwave ablation had a lower local tumor progression than Radiofrequency ablation in cohort studies (OR = 0.78, 95% CI 0.64-0.96, P = .02). Complete ablation rate of Microwave ablation was higher than that of Radiofrequency ablation in cohort studies (OR = 1.54, 95% CI 1.05-2.25, P = .03). There was no significant difference in overall survival and disease-free survival between the 2 groups. Meta-analysis showed that there was no significant difference in the main complications between Microwave ablation and Radiofrequency ablation. CONCLUSIONS Microwave ablation has higher complete ablation and lower local tumor progression than Radiofrequency ablation in the ablation treatment of HCC nodules. There was no significant difference in overall survival between the 2 therapy methods.
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Affiliation(s)
- Zhimin Dou
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The Department of Critical Care Medicine of The First Hospital of Lanzhou University, Lanzhou, China
| | - Fei Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Longfei Ren
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaojing Song
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
| | - Bin Li
- The Department of Critical Care Medicine of The First Hospital of Lanzhou University, Lanzhou, China
| | - Xun Li
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
- The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou, China
- *Correspondence: Xun Li, The Second Department of General Surgery of The First Hospital of Lanzhou University, Lanzhou 730000, China (e-mail: )
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Wang Z, Liu M, Zhang DZ, Wu SS, Hong ZX, He GB, Yang H, Xiang BD, Li X, Jiang TA, Li K, Tang Z, Huang F, Lu M, Chen JA, Lin YC, Lu X, Wu YQ, Zhang XW, Zhang YF, Cheng C, Ye HL, Wang LT, Zhong HG, Zhong JH, Wang L, Chen M, Liang FF, Chen Y, Xu YS, Yu XL, Cheng ZG, Liu FY, Han ZY, Tang WZ, Yu J, Liang P. Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC. Hepatology 2022; 76:66-77. [PMID: 35007334 DOI: 10.1002/hep.32323] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS The study objective was to compare the effectiveness of microwave ablation (MWA) and laparoscopic liver resection (LLR) on solitary 3-5-cm HCC over time. APPROACH AND RESULTS From 2008 to 2019, 1289 patients from 12 hospitals were enrolled in this retrospective study. Diagnosis of all lesions were based on histopathology. Propensity score matching was used to balance all baseline variables between the two groups in 2008-2019 (n = 335 in each group) and 2014-2019 (n = 257 in each group) cohorts, respectively. For cohort 2008-2019, during a median follow-up of 35.8 months, there were no differences in overall survival (OS) between MWA and LLR (HR: 0.88, 95% CI 0.65-1.19, p = 0.420), and MWA was inferior to LLR regarding disease-free survival (DFS) (HR 1.36, 95% CI 1.05-1.75, p = 0.017). For cohort 2014-2019, there was comparable OS (HR 0.85, 95% CI 0.56-1.30, p = 0.460) and approached statistical significance for DFS (HR 1.33, 95% CI 0.98-1.82, p = 0.071) between MWA and LLR. Subgroup analyses showed comparable OS in 3.1-4.0-cm HCCs (HR 0.88, 95% CI 0.53-1.47, p = 0.630) and 4.1-5.0-cm HCCs (HR 0.77, 95% CI 0.37-1.60, p = 0.483) between two modalities. For both cohorts, MWA shared comparable major complications (both p > 0.05), shorter hospitalization, and lower cost to LLR (all p < 0.001). CONCLUSIONS MWA might be a first-line alternative to LLR for solitary 3-5-cm HCC in selected patients with technical advances, especially for patients unsuitable for LLR.
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Affiliation(s)
- Zhen Wang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
- Guangxi Clinical Research Center for CRC, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Miao Liu
- Graduate School of Chinese PLA General Hospital, Beijing, China
| | - De-Zhi Zhang
- Abdominal Ultrasound Department, the First Hospital of Jilin University, Changchun, China
| | - Song-Song Wu
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Zhi-Xian Hong
- Department of Hepatobiliary Surgery, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Guang-Bin He
- Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xian, China
| | - Hong Yang
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Bang-de Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kai Li
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhe Tang
- Department of Surgery, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, P. R. China
| | - Fei Huang
- Department of General Surgery, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Man Lu
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ji-An Chen
- Department of General Surgery, the Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu-Cheng Lin
- Department of Ultrasonography, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Xiao Lu
- Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xian, China
| | - Yu-Quan Wu
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiao-Wu Zhang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Fan Zhang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Cheng
- Department of Ultrasound Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huo-Lin Ye
- Department of Ultrasound, Guangdong Key Laboratory of Liver Disease Research, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lan-Tian Wang
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P. R. China
| | - Hua-Ge Zhong
- Guangxi Clinical Research Center for CRC, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jian-Hong Zhong
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Lu Wang
- Ultrasound Medical Center, Sichuan Cancer Hospital Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Miao Chen
- Department of Radiology, Guangxi Medical University Cancer Hospital, Guangxi Medical University, Nanning, P. R. China
| | - Fang-Fang Liang
- Department of Medical Oncology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Yi Chen
- Guangxi Clinical Research Center for CRC, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yan-Song Xu
- Department of Emergency, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Wei-Zhong Tang
- Guangxi Clinical Research Center for CRC, Department of Gastrointestinal Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jie Yu
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
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