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Han X, Ni JY, Li SL, Deng HX, Liang HM, Xu YY, Huang ZM, Zhang TQ, Huang JH. Radiofrequency versus microwave ablation for hepatocellular carcinoma within the Milan criteria in challenging locations: a retrospective controlled study. Abdom Radiol (NY) 2021; 46:3758-3771. [PMID: 34032898 DOI: 10.1007/s00261-021-03105-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to compare the safety and efficacy of radiofrequency ablation (RFA) with microwave ablation (MWA) for hepatocellular carcinoma (HCC) within the Milan criteria in challenging locations. METHODS This study retrospectively investigated 201 consecutive patients with Milan criteria HCCs who underwent RFA (RFA group, n = 150) or MWA (MWA group, n = 51) between January 2012 and December 2016. Overall survival (OS), recurrence-free survival (RFS), local tumor control, and treatment-related complications were compared between the two groups. Prognostic factors were analyzed using the Cox proportional hazard regression model. RESULTS Median follow-up duration was 36.7 months (range: 6.2-64.0 months). Cumulative 1-, 3-, and 5-year OS rates were 97.9%, 92.3%, and 80.6% in the MWA group and 96.4%, 87.4%, and 78.2% in the RFA group, respectively, (P = 0.450). Cumulative RFS rates at 1, 3, and 5 years were 93.2%, 74.4%, and 63.7% in the MWA group and 80.3%, 57.3%, and 49.6% in the RFA group, respectively, (P = 0.097). Multivariate analyses showed that variable categories "patient age above 65 years" (P = 0.004) and "more than one tumor" (P = 0.004) were associated with overall mortality, and "patient age above 65 years" (P = 0.048) and "tumor size greater than 3 cm" (P = 0.009) were associated with inferior RFS. The incidences of major complications were not significantly different between the two groups (3.3% vs 3.9%, P = 0.843). CONCLUSIONS RFA and MWA were associated with comparable safety and efficacy for HCC within the Milan criteria in challenging locations. Further study in a large, multi-center patient cohort is necessary to validate the results.
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Affiliation(s)
- Xue Han
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Jia-Yan Ni
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Department of Interventional Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
| | - Shao-Long Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Han-Xia Deng
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Hui-Ming Liang
- School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Ying-Ying Xu
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Zhi-Mei Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Tian-Qi Zhang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China
| | - Jin-Hua Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Cancer for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong Province, People's Republic of China.
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Real-time virtual sonography-assisted radiofrequency ablation in liver tumors with conspicuous or inconspicuous images or peritumoral landmarks under ultrasonography. Abdom Radiol (NY) 2021; 46:2814-2822. [PMID: 33388803 PMCID: PMC8205891 DOI: 10.1007/s00261-020-02875-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/08/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023]
Abstract
Objectives The objectives of this study were to determine the primary technique effectiveness (PTE), to compare the complete response and local recurrence rates between conspicuous and inconspicuous tumors using single and switching electrodes of real-time virtual sonography (RVS)-assisted radiofrequency ablation (RFA) in conspicuous and inconspicuous hepatic tumors under conventional ultrasonography (US). Subjects and method We compared the complete ablation of inconspicuous tumors with and without anatomical landmark (N = 54) with conspicuous liver tumors (N = 272). Conventional US imaging was done initially, and then these images were fused with CT or MRI arterial-venous-wash-out cross-sectional studies and synchronized with real-time US images. Results RVS-assisted RFA was technically feasible in all patients. The PTE rate after the first ablation was 94% (245/261) for conspicuous tumors, 88% (7/8) in inconspicuous tumors with landmark, and 78% (36/46) in inconspicuous tumors without landmark. The complete response (p = 0.1912 vs. p = 0.4776) and local recurrence rate (p = 0.1557 vs. p = 0.7982) were comparable in conspicuous tumors of both HCC and liver metastasis group when single or multiple switching was used. The cumulative local recurrence in the conspicuous and inconspicuous tumors of the HCC group (p = 0.9999) was almost parallel after 12 (10% vs. 4%) and 24 (13% vs. 4%) months of follow-up. In the liver metastasis group, the cumulative local recurrence for conspicuous tumors (p = 0.9564) was nearly equal after 12 and 24 months of monitoring (24% vs. 27%) while no recurrence was incurred for the inconspicuous tumors. Conclusion RVS-assisted RFA is an effective tool for the treatment of conspicuous and inconspicuous HCC and hepatic metastasis.
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Qian J, Chen T, Wu Q, Zhou L, Zhou W, Wu L, Wang S, Lu J, Wang W, Li D, Xie H, Su R, Guo D, Liu Z, He N, Yin S, Zheng S. Blocking exposed PD-L1 elicited by nanosecond pulsed electric field reverses dysfunction of CD8 + T cells in liver cancer. Cancer Lett 2020; 495:1-11. [PMID: 32949680 DOI: 10.1016/j.canlet.2020.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/26/2020] [Accepted: 09/12/2020] [Indexed: 12/20/2022]
Abstract
As a promising method for local tumor treatment, nanosecond pulsed electric field (nsPEF) ablation elicits a potent anti-tumor immune response. However, the mechanism of the nsPEF-mediated anti-tumor immune response and its effects on the tumor microenvironment remains unclear. Here, we demonstrated that nsPEF treatment increased the level of membrane PD-L1 in liver cancer cells. Furthermore, nsPEF induced the release of PD-L1-associated extra-cellular vesicles, leading to the dysfunction of CD8+ T cells, which could potentially be reversed by PD-L1 blockade. Biological and functional assays also demonstrated that nsPEF treatment resulted in the increased PD-L1 level and dysfunction of infiltrated CD8+ T cells in tumor tissues in vivo, indicating the long term antitumor efficacy of nsPEF treatment. A combination of nsPEF treatment and PD-L1 blockade effectively inhibited tumor growth and improved the survival of the tumor-bearing mouse. In conclusion, nsPEF treatment induced the translocation and release of PD-L1 and contributed to the dysfunction of infiltrated CD8+ T cells, resulting in tumor progression at later stages. The combination of nsPEF treatment and PD-L1 blockade is a promising therapeutic strategy for liver cancer.
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Affiliation(s)
- Junjie Qian
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Tianchi Chen
- Department of of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Qinchuan Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Lin Zhou
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China; Collaborative innovation center for Diagnosis treatment of infectious diseases, Zhejiang Province, Hangzhou 310003, China
| | - Wuhua Zhou
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China; Department of hepatobiliary and pancreatic surgery, Taihe Hospital, Hubei University of Medicine, Hubei 442000, China
| | - Liming Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shuai Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Jiahua Lu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Wenchao Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Dazhi Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Haiyang Xie
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Rong Su
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Danjing Guo
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China
| | - Zhen Liu
- Institute of Industrial Ecology and Environment, Zhejiang University, Hangzhou, Zhejiang Province, 310007, China
| | - Ning He
- Department of Urinary Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
| | - Shengyong Yin
- NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China.
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China; NHFPC Key Laboratory of Combined Multi-organ Transplantation, Hangzhou 310003, China; Key Laboratory of the diagnosis and treatment of organ Transplantation, CAMS, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Zhejiang Province, Hangzhou 310003, China; Collaborative innovation center for Diagnosis treatment of infectious diseases, Zhejiang Province, Hangzhou 310003, China.
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Renzulli M, Tovoli F, Clemente A, Ierardi AM, Pettinari I, Peta G, Marasco G, Festi D, Piscaglia F, Cappabianca S, Carrafiello G, Golfieri R. Ablation for hepatocellular carcinoma: beyond the standard indications. Med Oncol 2020; 37:23. [PMID: 32166482 DOI: 10.1007/s12032-020-01348-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/20/2020] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC), the most common primary liver neoplasia, represents the fifth most common malignant disease in men. Percutaneous ablation treatment is recommended among the treatments suggested for HCC patients in the very early/early stage. In the last decade, very important results in terms of survival benefits have been obtained with local ablative therapies, also outside the standard indications, thanks to many technical innovations. In particular, important results of ablation as a safe and effective technique have been obtained in the treatment of intermediate- or advanced-stage patients with HCC, and in the treatment of unfavourable tumour locations. Moreover, awareness is growing regarding the necessity of overcoming the rigidity of traditional guidelines in the treatment of HCC due to the complexity of patients with HCC, focusing on Precision Medicine. In this context, it is important to know the standard and non-standard indications of ablation in the treatment of HCC in order to offer the best therapeutic option tailored for each patient. The aim of this study was to analyse the possible clinical applications of ablative therapies for HCC patients, beyond the traditional indications recommended in the most widespread clinical practice guidelines for the management of HCC.
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Affiliation(s)
- Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy.
| | - Francesco Tovoli
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Irene Pettinari
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giuliano Peta
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Fabio Piscaglia
- Unit of Internal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Via Albertoni 15, 40138, Bologna, Italy
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Wang Y, Yin S, Zhou Y, Zhou W, Chen T, Wu Q, Zhou L, Zheng S. Dual-function of Baicalin in nsPEFs-treated Hepatocytes and Hepatocellular Carcinoma cells for Different Death Pathway and Mitochondrial Response. Int J Med Sci 2019; 16:1271-1282. [PMID: 31588193 PMCID: PMC6775272 DOI: 10.7150/ijms.34876] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/03/2019] [Indexed: 12/24/2022] Open
Abstract
Nanosecond pulsed electric fields (nsPEFs) is emerged as a potential curative modality to ablate hepatocellular carcinoma (HCC). The application of local ablation is usually limited by insufficiency of liver function. While baicalin, a flavonoid isolated from Scutellaria baicalensis Georgi, has been proven to possess both anti-tumor and protective effects. Our study aimed to estimate different responses of hepatic cancer cells and hepatocytes to the combination of nsPEFs and baicalin. Cell viability, apoptosis and necrosis, mitochondrial transmembrane potential (MTP) and reactive oxygen species (ROS) were examined by CCK-8, FCM, JC-1 and fluorescent probe, respectively. After treatment by nsPEFs, most hepatocytes died by apoptosis, nevertheless, nearly all cancer cells were killed through necrosis. Low concentration of baicalin synergically enhanced nsPEFs-induced suppression and necrosis of HCC cells, nevertheless, the application of baicalin protected normal hepatocytes from the injury caused by nsPEFs, owing to elevating mitochondrial transmembrane potential and reducing ROS generation. Our work provided an advantageous therapy for HCC through the enhanced combination treatment of nsPEFs and baicalin, with which could improve the tumor-ablation effect and alleviate the injury of hepatic tissues simultaneously.
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Affiliation(s)
- Yubo Wang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Shengyong Yin
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Yuan Zhou
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Wuhua Zhou
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China.,Department of hepatobiliary and pancreatic surgery, Taihe Hospital, Hubei University of Medicine, Hubei, China
| | - Tianchi Chen
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Qinchuan Wu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Lin Zhou
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
| | - Shusen Zheng
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Key Laboratory of Combined Multi-Organ Transplantation, Ministry of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province 310003, China
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Negussie AH, Dreher MR, Johnson CG, Tang Y, Lewis AL, Storm G, Sharma KV, Wood BJ. Synthesis and characterization of image-able polyvinyl alcohol microspheres for image-guided chemoembolization. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:198. [PMID: 26105830 PMCID: PMC6663481 DOI: 10.1007/s10856-015-5530-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/10/2015] [Indexed: 05/15/2023]
Abstract
Therapeutic embolization of blood vessels is a minimally invasive, catheter-based procedure performed with solid or liquid emboli to treat bleeding, vascular malformations, and vascular tumors. Hepatocellular carcinoma (HCC) affects about half a million people per year. When unresectable, HCC is treated with embolization and local drug therapy by transarterial chemoembolization (TACE). For TACE, drug eluting beads (DC Bead(®)) may be used to occlude or reduce arterial blood supply and deliver chemotherapeutics locally to the tumor. Although this treatment has been shown to be safe and to improve patient survival, the procedure lacks imaging feedback regarding the location of embolic agent and drug coverage. To address this shortcoming, herein we report the synthesis and characterization of image-able drug eluting beads (iBeads) from the commercial DC Bead(®) product. Two different radiopaque beads were synthesized. In one approach, embolic beads were conjugated with 2,3,5-triiodobenzyl alcohol in the presence of 1,1'-carbonyldiimidazol to give iBead I. iBead II was synthesized with a similar approach but instead using a trimethylenediamine spacer and 2,3,5-triiodobenzoic acid. Doxorubicin was loaded into the iBeads II using a previously reported method. Size and shape of iBeads were evaluated using an upright microscope and their conspicuity assessed using a clinical CT and micro-CT. Bland and Dox-loaded iBeads II visualized with both clinical CT and microCT. Under microCT, individual bland and Dox loaded beads had a mean attenuation of 7904 ± 804 and 11,873.96 ± 706.12 HU, respectively. These iBeads have the potential to enhance image-guided TACE procedures by providing localization of embolic-particle and drug.
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Affiliation(s)
- Ayele H. Negussie
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20814
- Department of Targeted Therapeutics, MIRA Institute, University of Twente, The Netherlands
| | - Matthew R. Dreher
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20814
| | - Carmen Gacchina Johnson
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20814
| | - Yiqing Tang
- Bioccompatibles UK Ltd., Farnham Business Park, Weydon Lane, Farnham, Survey, GU98QL, UK
| | - Andrew L. Lewis
- Bioccompatibles UK Ltd., Farnham Business Park, Weydon Lane, Farnham, Survey, GU98QL, UK
| | - Gert Storm
- Department of Targeted Therapeutics, MIRA Institute, University of Twente, The Netherlands
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands
| | - Karun V. Sharma
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20814
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20814
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Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol 2015; 7:1054-1063. [PMID: 26052394 PMCID: PMC4450182 DOI: 10.4254/wjh.v7.i8.1054] [Citation(s) in RCA: 223] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.
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Bimonte S, Barbieri A, Palaia R, Leongito M, Albino V, Piccirillo M, Arra C, Izzo F. An overview of loco-regional treatments in patients and mouse models for hepatocellular carcinoma. Infect Agent Cancer 2015; 10:9. [PMID: 25755676 PMCID: PMC4353675 DOI: 10.1186/s13027-015-0004-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/20/2015] [Indexed: 12/20/2022] Open
Abstract
Hepatocellular carcinoma is a highly aggressive malignancy and is the third leading cause of cancer-related deaths worldwide. Although surgery is currently considered the most effective curative treatment for this type of cancer, it is note that most of patients have a poor prognosis due to chemioresistence and tumor recurrence. Loco-regional therapies, including radiofrequency ablation, surgical resection and transcatheter arterial chemoembolization play a major role in the clinical management of hepatocellular carcinoma. In order to improve the treatment outcome of patients diagnosed with this disease, several in vivo studies by using different techniques on cancer mouse models have been performed. This review will focus on the latest papers on the efficacy of loco-regional therapy and combined treatments in patients and mouse models of hepatocellular carcinoma.
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Affiliation(s)
- Sabrina Bimonte
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Antonio Barbieri
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Maddalena Leongito
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Vittorio Albino
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Mauro Piccirillo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Claudio Arra
- INT Facility, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Unit, Istituto Nazionale per lo studio e la cura dei Tumori "Fondazione G. Pascale", IRCCS- Via Mariano Semmola, 80131 Naples, Italy
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Nanosecond pulsed electric field (nsPEF) treatment for hepatocellular carcinoma: a novel locoregional ablation decreasing lung metastasis. Cancer Lett 2014; 346:285-91. [PMID: 24462824 DOI: 10.1016/j.canlet.2014.01.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a highly aggressive malignancy. Nanosecond pulsed electric field (nsPEF) is a new technology destroying tumor cells with a non-thermal high voltage electric field using ultra-short pulses. The study's aim was to evaluate the ablation efficacy of nsPEFs with human HCC cell lines and a highly metastatic potential HCC xenograft model on BALB/c nude mice. The in vivo study showed nsPEFs induced HCC cell death in a dose dependent manner. On the high metastatic hepatocellular carcinoma cell line (HCCLM3) xenograft mice model, tumor growth was inhibited significantly in nsPEF-treated- groups (single dose and multi-fractionated dose). Besides a local effect, the nsPEF treatment reduced pulmonary metastases. The nsPEFs also enhanced HCC cell phagocytosis by human macrophage cell (THP1) in vitro. The nsPEF is efficient in controlling HCC progression and reducing its metastasis. NsPEF treatment may elicit a host immune response against tumor cells. This study suggests nsPEF therapy could be used as a potential locoregional therapy for hepatocellular carcinoma.
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Ni JY, Xu LF, Sun HL, Zhou JX, Chen YT, Luo JH. Percutaneous ablation therapy versus surgical resection in the treatment for early-stage hepatocellular carcinoma: a meta-analysis of 21,494 patients. J Cancer Res Clin Oncol 2013; 139:2021-33. [PMID: 24072235 DOI: 10.1007/s00432-013-1530-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 09/14/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare comprehensively the benefits of radiofrequency ablation (RFA) and percutaneous ethanol injection (PEI) with those of surgical resection (SR) in early-stage hepatocellular carcinoma (HCC). METHODS The potentially relevant studies comparing the efficacy and safety of RFA and/or PEI with those of SR were searched using the databases such as PubMed, MEDLINE, Embase and Chinese databases (CNKI and Wanfang data). Overall survival rate, recurrence-free survival rate and complications were compared and analyzed. Pooled odds ratios with 95 % confidence intervals (95 % CIs) were calculated using either the fixed-effects model or random-effects model. All statistic analyses were conducted using the Review Manager (version 5.1.) from the Cochrane Collaboration. RESULTS Our analysis showed that the overall survival rate in patients treated with SR was significantly higher than that of percutaneous ablation therapy (PAT) [SR vs. PAT: 95 % confidence interval (95 % CI)2-year 0.46-0.89, P = 0.009; 95 % CI3-year 0.57-0.83, P < 0.0001; 95 % CI5-year 0.45-0.46, P < 0.0001]. SR was associated with significantly higher recurrence-free survival rate compared with PAT (SR vs. PAT: 95 % CI1-year 0.51-0.90, P = 0.008; 95 % CI2-year 0.41-0.78, P = 0.0004; 95 % CI3-year 0.38-0.77, P = 0.0006; 95 % CI5-year 0.33-0.61, P < 0.0001). SR resulted in longer survival than PAT in HCCs no larger than 3 cm. PAT was associated with less complications compared with SR (PAT vs. SR: 95 % CI 0.14-0.76, P = 0.01). CONCLUSIONS Although SR was associated with more complications, SR was superior to RFA and PEI for treatment of patients with early-stage HCC.
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Affiliation(s)
- Jia-yan Ni
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang Road West, Guangzhou, 510210, Guangdong Province, People's Republic of China,
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Ishikawa T, Kubota T, Horigome R, Kimura N, Honda H, Iwanaga A, Seki K, Honma T, Yoshida T. Radiofrequency ablation during continuous saline infusion can extend ablation margins. World J Gastroenterol 2013; 19:1278-1282. [PMID: 23483097 PMCID: PMC3587485 DOI: 10.3748/wjg.v19.i8.1278] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/24/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether fluid injection during radiofrequency ablation (RFA) can increase the coagulation area.
METHODS: Bovine liver (1-2 kg) was placed on an aluminum tray with a return electrode affixed to the base, and the liver was punctured by an expandable electrode. During RFA, 5% glucose; 50% glucose; or saline fluid was infused continuously at a rate of 1.0 mL/min through the infusion line connected to the infusion port. The area and volume of the thermocoagulated region of bovine liver were determined after RFA. The Joule heat generated was determined from the temporal change in output during the RFA experiment.
RESULTS: No liquid infusion was 17.3 ± 1.6 mL, similar to the volume of a 3-cm diameter sphere (14.1 mL). Mean thermocoagulated volume was significantly larger with continuous infusion of saline (29.3 ± 3.3 mL) than with 5% glucose (21.4 ± 2.2 mL), 50% glucose (16.5 ± 0.9 mL) or no liquid infusion (17.3 ± 1.6 mL). The ablated volume for RFA with saline was approximately 1.7-times greater than for RFA with no liquid infusion, representing a significant difference between these two conditions. Total Joule heat generated during RFA was highest with saline, and lowest with 50% glucose.
CONCLUSION: RFA with continuous saline infusion achieves a large ablation zone, and may help inhibit local recurrence by obtaining sufficient ablation margins. RFA during continuous saline infusion can extend ablation margins, and may be prevent local recurrence.
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