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Blazevski A, Geboers B, Scheltema MJ, Gondoputro W, Doan P, Katelaris A, Agrawal S, Baretto D, Matthews J, Haynes AM, Delprado W, Shnier R, van den Bos W, Thompson JE, Lawrentschuk N, Stricker PD. Salvage irreversible electroporation for radio-recurrent prostate cancer - the prospective FIRE trial. BJU Int 2022. [PMID: 36495482 DOI: 10.1111/bju.15947] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To prospectively assess the safety, functional- and oncological-outcomes of irreversible electroporation (IRE) as salvage therapy for radio-recurrent focal prostate cancer in a multicenter setting. PATIENTS AND METHODS Men with focal recurrent PCa after external beam radiation or brachytherapy without metastatic disease on staging imaging and co-registration between mpMRI and biopsies were prospectively included in this multicenter trial. Adverse events were reported following the Clavien-Dindo classification. Validated questionnaires were used for patient-reported functional outcomes. Follow-up consisted of 3 monthly prostate specific antigen (PSA) levels, a 6-month mpMRI and standardised transperineal template mapping biopsies at 12-months. Thereafter follow-up was guided by MRI and/or PSMA-PET/CT and PSA. Local recurrence was defined as any ISUP score ≥2 on biopsies. RESULTS 37 patients were analysed with a median (interquartile range (IQR)) follow up of 29 (22-43) months. Median age was 71 (53-83), median PSA was 3.5 ng/mL (2.7-6.1). 28 (75.5%) patients harboured intermediate risk and 9 patients (24.5%) high risk PCa. Seven patients (19%) reported self-limiting urgency, frequency, or hematuria (grade 1-2). Seven patients (19%) developed a grade 3 AE; urethral sludge requiring transurethral resection. At 12 months post treatment 93% of patients remained continent and erectile function sufficient for intercourse deteriorated from 35% to 15% (4/27). Local control was achieved in 29 patients (78%) and 27 patients (73%) were clear of local and systemic disease. Four (11%) patients had local recurrence only. Six (16%) patients developed metastatic disease with a median time to metastasis of 8 months. CONCLUSION The FIRE trial shows that salvage IRE after failed radiation therapy for localised PCa is safe with minimal toxicity, and promising functional and oncological outcomes. Salvage IRE can offer a possible solution for notoriously difficult to manage radio recurrent prostate tumours.
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Affiliation(s)
- Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - William Gondoputro
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Paul Doan
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Athos Katelaris
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Daniela Baretto
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Jayne Matthews
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
| | - Warick Delprado
- Douglass Hanly Moir Pathology, Sydney, New South Wales, Australia
| | - Ron Shnier
- I-MED Radiology, Sydney, New South Wales, Australia
| | - Willemien van den Bos
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Nathan Lawrentschuk
- University of Melbourne, Melbourne, Victoria, Australia
- EJ Whitten Prostate Cancer Research Centre at Epworth, Melbourne, Victoria, Australia
| | - Phillip D Stricker
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Prostate Cancer Research Centre, Department of Urology, Darlinghurst, Sydney, New South Wales, Australia
- St. Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Scheltema MJ, Chang JI, van den Bos W, Böhm M, Delprado W, Gielchinsky I, de Reijke TM, de la Rosette JJ, Siriwardana AR, Shnier R, Stricker PD. Preliminary Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Focal Therapy with Irreversible Electroporation. Eur Urol Focus 2020; 5:585-591. [PMID: 29102671 DOI: 10.1016/j.euf.2017.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/21/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up following focal therapy of prostate cancer (PCa). OBJECTIVE To determine the diagnostic accuracy of mpMRI to detect residual PCa following focal therapy with irreversible electroporation. DESIGN, SETTING, AND PARTICIPANTS Seventy-six patients with biopsy-proven localized PCa consented for primary irreversible electroporation between February 2013 and March 2016. Final analysis was performed on 50 patients that received follow-up mpMRI at 6 mo, serial prostate-specific antigen (PSA) testing, and transperineal template-mapping biopsies at 12 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outfield regions of interest (ROI) were reported using PI-RADS version 2. A binary outcome (suspicious vs nonsuspicious) was given for the infield ablation zone. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated for different definitions of significant PCa: (1) Gleason ≥4+3 or Gleason ≥3+3 with a maximum cancer core length ≥6mm, (2) Gleason ≥3+4 or Gleason ≥3+3 with a maximum cancer core length ≥4mm, for outfield and infield ROI. Multivariate linear regression analyses evaluated the additional value of nadir PSA. RESULTS AND LIMITATIONS Sensitivity, specificity, positive predictive values, and negative predictive values of infield ROI was 43%, 86%, 33%, and 90% for definition 1 and 38%, 86%, 33%, and 88% for definition 2, respectively. For outfield ROI this was 33%, 82%, 20%, and 90% for definition 1 and 38%, 86%, 50%, and 80% for definition 2. PSA had no additional value in predicting residual significant PCa. Limitations include retrospective design, single reader, and low incidence of residual PCa. CONCLUSIONS Our preliminary data suggest that mpMRI can rule out high-volume residual PCa. However, follow-up biopsies should still be performed to determine oncological control. PATIENT SUMMARY Multiparametric magnetic resonance imaging is able to detect high-volume significant prostate cancer following focal therapy. Prostate biopsies are still required in the follow-up of focal therapy as (low-volume) significant prostate cancer is being missed by multiparametric magnetic resonance imaging.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia; Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands.
| | - John I Chang
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
| | | | - Ilan Gielchinsky
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Theo M de Reijke
- Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands
| | - Jean J de la Rosette
- Academic Medical Center, Department of Urology, University of Amsterdam, The Netherlands
| | - Amila R Siriwardana
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
| | - Ron Shnier
- Southern Radiology, Randwick, Sydney, NSW, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Centre, Department of Urology, Darlinghurst, Sydney, NSW, Australia
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Scheltema MJ, O'Brien TJ, van den Bos W, de Bruin DM, Davalos RV, van den Geld CWM, Laguna MP, Neal RE, Varkarakis IM, Skolarikos A, Stricker PD, de Reijke TM, Arena CB, de la Rosette J. Numerical simulation modeling of the irreversible electroporation treatment zone for focal therapy of prostate cancer, correlation with whole-mount pathology and T2-weighted MRI sequences. Ther Adv Urol 2019; 11:1756287219852305. [PMID: 31217820 PMCID: PMC6557022 DOI: 10.1177/1756287219852305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/29/2019] [Indexed: 12/14/2022] Open
Abstract
Background: At present, it is not possible to predict the ablation zone volume following irreversible electroporation (IRE) for prostate cancer (PCa). This study aimed to determine the necessary electrical field threshold to ablate human prostate tissue in vivo with IRE. Methods: In this prospective multicenter trial, patients with localized PCa were treated with IRE 4 weeks before their scheduled radical prostatectomy. In 13 patients, numerical models of the electrical field were generated and compared with the ablation zone volume on whole-mount pathology and T2-weighted magnetic resonance imaging (MRI) sequences. Volume-generating software was used to calculate the ablation zone volumes on histology and MRI. The electric field threshold to ablate prostate tissue was determined for each patient. Results: A total of 13 patients were included for histological and simulation analysis. The median electrical field threshold was 550 V/cm (interquartile range 383–750 V/cm) for the software-generated histology volumes. The median electrical field threshold was 500 V/cm (interquartile range 386–580 V/cm) when the ablation zone volumes were used from the follow-up MRI. Conclusions: The electrical field threshold to ablate human prostate tissue in vivo was determined using whole-mount pathology and MRI. These thresholds may be used to develop treatment planning or monitoring software for IRE prostate ablation; however, further optimization of simulation methods are required to decrease the variance that was observed between patients.
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Affiliation(s)
- Matthijs J Scheltema
- Department of Urology, Amsterdam UMC, Meibergdreef 9, Room G4-249, Amsterdam, 1105 AZ, The Netherlands
| | - Tim J O'Brien
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | | | | | - Rafael V Davalos
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Cees W M van den Geld
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Maria P Laguna
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
| | - Robert E Neal
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Ioannis M Varkarakis
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Andreas Skolarikos
- Second Urology Department, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Centre, Sydney, Australia
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Christopher B Arena
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, USA
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey Amsterdam UMC, Amsterdam, the Netherlands
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Scheltema MJ, Chang JI, van den Bos W, Gielchinsky I, Nguyen TV, Reijke TDM, Siriwardana AR, Böhm M, de la Rosette JJ, Stricker PD. Impact on genitourinary function and quality of life following focal irreversible electroporation of different prostate segments. ACTA ACUST UNITED AC 2019; 24:268-275. [PMID: 30211680 DOI: 10.5152/dir.2018.17374] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE We aimed to evaluate the genitourinary function and quality of life (QoL) following the ablation of different prostate segments with irreversible electroporation (IRE) for localized prostate cancer (PCa). METHODS Sixty patients who received primary focal IRE for organ-confined PCa were recruited for this study. Patients were evaluated for genitourinary function and QoL per prostate segment treated (anterior vs. posterior, apex vs. base vs. apex-to-base, unilateral vs. bilateral). IRE system settings and patient characteristics were compared between patients with preserved vs. those with impaired erectile function and urinary continence. Data were prospectively collected at baseline, 3, 6, and 12 months using the expanded prostate cancer index composite, American Urological Association symptom score, SF-12 physical and mental component summary surveys. Difference over time within segments per questionnaire was evaluated using the Wilcoxon's signed rank test. Outcome differences between segments were assessed using covariance models. Baseline measurements included questionnaire scores, age, and prostate volume. RESULTS There were no statistically significant changes over time for overall urinary (P = 0.07-0.89), bowel (P = 0.06-0.79), physical (P = 0.18-0.71) and mental (P = 0.45-0.94) QoL scores within each segment. Deterioration of sexual function scores was observed at 6 months within each segment (P = 0.001-0.16). There were no statistically significant differences in QoL scores between prostate segments (P = 0.08-0.97). Older patients or those with poor baseline sexual function at time of treatment were associated with a greater risk of developing erectile dysfunction. CONCLUSION IRE is a feasible modality for all prostate segments without any significantly different effect on the QoL outcomes. Older patients and those with poor sexual function need to be counseled regarding the risk of erectile dysfunction.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
| | - John I Chang
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst; St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst., St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Ilan Gielchinsky
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia, St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Tuan V Nguyen
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia,. University of New South Wales, Sydney, NSW, Australia
| | | | - Amila R Siriwardana
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Jean J de la Rosette
- Amsterdam UMC, University of Amsterdam, the Netherlands, Department of Urology, İstanbul Medipol University, İstanbul, Turkey
| | - Phillip D Stricker
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Amsterdam UMC, University of Amsterdam, the Netherlands
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Scheltema MJ, Chang JI, Böhm M, van den Bos W, Blazevski A, Gielchinsky I, Kalsbeek AMF, van Leeuwen PJ, Nguyen TV, de Reijke TM, Siriwardana AR, Thompson JE, de la Rosette JJ, Stricker PD. Pair-matched patient-reported quality of life and early oncological control following focal irreversible electroporation versus robot-assisted radical prostatectomy. World J Urol 2018; 36:1383-1389. [PMID: 29594551 PMCID: PMC6105143 DOI: 10.1007/s00345-018-2281-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 03/24/2018] [Indexed: 12/25/2022] Open
Abstract
Purpose The design, conduct and completion of randomized trials for curative prostate cancer (PCa) treatments are challenging. To evaluate the effect of robot-assisted radical prostatectomy (RARP) versus focal irreversible electroporation (IRE) on patient-reported quality of life (QoL) and early oncological control using propensity-scored matching. Methods Patients with T1c–cT2b significant PCa (high-volume ISUP 1 or any 2/3) who received unifocal IRE were pair-matched to patients who received nerve-sparing RARP. Patient-reported outcomes were prospectively assessed using the Expanded Prostate Cancer Index Composite (EPIC), AUA symptom score and Short Form of Health Survey (SF-12) physical and mental components. Oncological failure was defined as biochemical recurrence (RARP) or positive follow-up biopsies (IRE). Generalized mixed-effect models were used to compare IRE and RARP. Results 50 IRE patients were matched to 50 RARP patients by propensity score. IRE was significantly superior to RARP in preserving pad-free continence (UC) and erections sufficient for intercourse (ESI). The absolute differences were 44, 21, 13, 14% for UC and 32, 46, 27, 22% for ESI at 1.5, 3, 6, and 12 months, respectively. The EPIC summary scores showed no statistically significant differences. Urinary symptoms were reduced for IRE and RARP patients at 12 months, although IRE patient initially had more complaints. IRE patients experienced more early oncological failure than RARP patients. Conclusions These data demonstrated the superior preservation of UC and ESI with IRE compared to RARP up to 12 months after treatment. Long-term oncological data are warranted to provide ultimate proof for or against focal therapy. Electronic supplementary material The online version of this article (10.1007/s00345-018-2281-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Matthijs J Scheltema
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia.
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia.
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - John I Chang
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
| | - Willemien van den Bos
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Ilan Gielchinsky
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
| | - Anton M F Kalsbeek
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
| | - Pim J van Leeuwen
- Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - Tuan V Nguyen
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- UNSW, Sydney, NSW, Australia
- School of Biomedical Engineering, University of Technology, Sydney, Australia
| | - Theo M de Reijke
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Amila R Siriwardana
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
- UNSW, Sydney, NSW, Australia
| | - James E Thompson
- Garvan Institute of Medical Research & The Kinghorn Cancer Centre, 370 Victoria Street, Sydney, NSW, 2010, Australia
- St Vincent's Prostate Cancer Centre, Sydney, NSW, Australia
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Scheltema MJ, van den Bos W, Siriwardana AR, Kalsbeek AM, Thompson JE, Ting F, Böhm M, Haynes AM, Shnier R, Delprado W, Stricker PD. Feasibility and safety of focal irreversible electroporation as salvage treatment for localized radio-recurrent prostate cancer. BJU Int 2017; 120 Suppl 3:51-58. [DOI: 10.1111/bju.13991] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthijs J. Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Willemien van den Bos
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
- Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - Amila R. Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Anton M.F. Kalsbeek
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | | | - Francis Ting
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
- St Vincent's Prostate Cancer Centre; Darlinghurst NSW Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and Kinghorn Cancer Centre; Darlinghurst NSW Australia
| | - Ron Shnier
- Southern Radiology; Randwick NSW Australia
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van den Bos W, Scheltema MJ, Siriwardana AR, Kalsbeek AMF, Thompson JE, Ting F, Böhm M, Haynes AM, Shnier R, Delprado W, Stricker PD. Focal irreversible electroporation as primary treatment for localized prostate cancer. BJU Int 2017; 121:716-724. [PMID: 28796935 DOI: 10.1111/bju.13983] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine the safety, quality of life (QoL) and short-term oncological outcomes of primary focal irreversible electroporation (IRE) for the treatment of localized prostate cancer (PCa), and to identify potential risk factors for oncological failure. PATIENTS AND METHODS Patients who met the consensus guidelines on patient criteria and selection methods for primary focal therapy were eligible for analysis. Focal IRE was performed for organ-confined clinically significant PCa, defined as high-volume disease with Gleason sum score 6 (International Society of Urological Pathology [ISUP] grade 1) or any Gleason sum score of 7 (ISUP grades 2-3). Oncological, adverse event (AE) and QoL outcome data, with a minimum of 6 months' follow-up, were analysed. Patient characteristics and peri-operative treatment variables were compared between patients with and without oncological failure on follow-up biopsy. Wilcoxon's signed rank test, Wilcoxon's rank sum test and the chi-squared test were used to assess statistically significant differences in paired continuous, unpaired continuous and categorical variables respectively. RESULTS A total of 63 patients met all eligibility criteria and were included in the final analysis. No high-grade AEs occurred. QoL questionnaire analysis demonstrated no significant change from baseline in physical (P = 0.81), mental (P = 0.48), bowel (P = 0.25) or urinary QoL domains (P = 0.41 and P = 0.25), but there was a mild decrease in the sexual QoL domain (median score 66 at baseline vs 54 at 6 months; P < 0.001). Compared with baseline, a decline of 70% in prostate-specific antigen level (1.8 ng/mL, interquartile range 0.96-4.8 ng/mL) was seen at 6-12 months. A narrow safety margin (P = 0.047) and system errors (P = 0.010) were identified as potential early risk factors for in-field oncological failure. In-field and whole-gland oncological control on follow-up biopsies was 84% (38/45 patients) and 76% (34/45 patients); this increased to 97% (38/39 patients) and 87% (34/39 patients) when patients treated with a narrow safety margin and system errors were excluded. CONCLUSION Our data support the safety and feasibility of focal IRE as a primary treatment for localized PCa with effective short-term oncological control in carefully selected men.
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Affiliation(s)
- Willemien van den Bos
- Garvan Institute of Medical Research and Kinghorn Cancer Centre.,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre.,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia.,Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Amila R Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre.,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | | | - James E Thompson
- St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Francis Ting
- Garvan Institute of Medical Research and Kinghorn Cancer Centre.,St Vincent's Prostate Cancer Centre, Darlinghurst, NSW, Australia
| | - Maret Böhm
- Garvan Institute of Medical Research and Kinghorn Cancer Centre
| | | | | | - Warick Delprado
- Douglass Hanly Moir Pathology, Macquarie Park, NSW, Australia
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van den Bos W, de Bruin DM, van Randen A, Engelbrecht MRW, Postema AW, Muller BG, Varkarakis IM, Skolarikos A, Savci-Heijink CD, Jurhill RR, Zondervan PJ, Laguna Pes MP, Wijkstra H, de Reijke TM, de la Rosette JJMCH. MRI and contrast-enhanced ultrasound imaging for evaluation of focal irreversible electroporation treatment: results from a phase I-II study in patients undergoing IRE followed by radical prostatectomy. Eur Radiol 2016; 26:2252-60. [PMID: 26449559 PMCID: PMC4902838 DOI: 10.1007/s00330-015-4042-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/15/2015] [Accepted: 09/21/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Irreversible electroporation (IRE) is an ablative therapy with a low side-effect profile in prostate cancer. The objective was: 1) To compare the volumetric IRE ablation zone on grey-scale transrectal ultrasound (TRUS), contrast-enhanced ultrasound (CEUS) and multiparametric MRI (mpMRI) with histopathology findings; 2) To determine a reliable imaging modality to visualize the IRE ablation effects accurately. METHODS A prospective phase I-II study was performed in 16 patients scheduled for radical prostatectomy (RP). IRE of the prostate was performed 4 weeks before RP. Prior to, and 4 weeks after the IRE treatment, imaging was performed by TRUS, CEUS, and mpMRI. 3D-analysis of the ablation volumes on imaging and on H&E-stained whole-mount sections was performed. The volumes were compared and the correlation was calculated. RESULTS Evaluation of the imaging demonstrated that with T2-weighted MRI, dynamic contrast enhanced (DCE) MRI, and CEUS, effects of IRE are visible. T2MRI and CEUS closely match the volumes on histopathology (Pearson correlation r = 0.88 resp. 0.80). However, IRE is not visible with TRUS. CONCLUSIONS mpMRI and CEUS are appropriate for assessing IRE effects and are the most feasible imaging modalities to visualize IRE ablation zone. The imaging is concordant with results of histopathological examination. KEY POINTS • mpMRI and contrast-enhanced ultrasound are appropriate imaging modalities for assessing IRE effects • mpMRI and CEUS are the most feasible imaging modalities to visualize IRE ablation zone • The imaging is concordant with results of histopathological examination after IRE • Grey-scale US is insufficient for assessing IRE ablations.
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Affiliation(s)
- Willemien van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
- Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - D M de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A van Randen
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M R W Engelbrecht
- Department of Radiology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A W Postema
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - B G Muller
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - I M Varkarakis
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - A Skolarikos
- 2nd Department of Urology, University of Athens, Sismanoglio General Hospital, 1 Sismanogliou Street, 151 26, Marousi, Greece
| | - C D Savci-Heijink
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R R Jurhill
- Department of Pathology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P J Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - M P Laguna Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - H Wijkstra
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - T M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J M C H de la Rosette
- Department of Urology, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Scheltema MJV, van den Bos W, de Bruin DM, Wijkstra H, Laguna MP, de Reijke TM, de la Rosette JJMCH. Focal vs extended ablation in localized prostate cancer with irreversible electroporation; a multi-center randomized controlled trial. BMC Cancer 2016; 16:299. [PMID: 27150293 PMCID: PMC4858903 DOI: 10.1186/s12885-016-2332-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/01/2016] [Indexed: 12/17/2022] Open
Abstract
Background Current surgical and ablative treatment options for prostate cancer (PCa) may result in a high incidence of (temporary) incontinence, erectile dysfunction and/or bowel damage. These side effects are due to procedure related effects on adjacent structures including blood vessels, bowel, urethra and/or neurovascular bundle. Ablation with irreversible electroporation (IRE) has shown to be effective and safe in destroying PCa cells and also has the potential advantage of sparing surrounding tissue and vital structures, resulting in less impaired functional outcomes and maintaining men’s quality of life. Methods/Design In this randomized controlled trial (RCT) on IRE in localized PCa, 200 patients with organ-confined, unilateral (T1c-T2b) low- to intermediate-risk PCa (Gleason sum score 6 and 7) on transperineal template-mapping biopsies (TTMB) will be included. Patients will be randomized into focal or extended ablation of cancer foci with IRE. Oncological efficacy will be determined by multiparametric Magnetic Resonance Imaging, Contrast-Enhanced Ultrasound imaging if available, TTMP and Prostate Specific Antigen (PSA) follow-up. Patients will be evaluated up to 5 years on functional outcomes and quality of life with the use of standardized questionnaires. Discussion There is critical need of larger, standardized RCTs evaluating long-term oncological and functional outcomes before introducing IRE and other focal therapy modalities as an accepted and safe therapeutic option for PCa. This RCT will provide important short- and long-term data and elucidates the differences between focal or extended ablation of localized, unilateral low- to intermediate-risk PCa with IRE. Trial registration Clinicaltrials.gov database registration number NCT01835977. The Dutch Central Committee on Research Involving Human Subjects registration number NL50791.018.14.
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Affiliation(s)
- Matthijs J V Scheltema
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Willemien van den Bos
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Daniel M de Bruin
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Biomedical Engineering and Physics, AMC University Hospital, Amsterdam, The Netherlands
| | - Hessel Wijkstra
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Signal Processing Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M Pilar Laguna
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Theo M de Reijke
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Muller BG, de Bruin DM, Brandt MJ, van den Bos W, van Huystee S, Faber DJ, Savci D, Zondervan PJ, de Reijke TM, Laguna-Pes MP, van Leeuwen TG, de la Rosette JJMCH. Prostate cancer diagnosis by optical coherence tomography: First results from a needle based optical platform for tissue sampling. J Biophotonics 2016; 9:490-498. [PMID: 26856796 DOI: 10.1002/jbio.201500252] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/03/2016] [Accepted: 01/04/2016] [Indexed: 06/05/2023]
Abstract
The diagnostic accuracy of Optical Coherence Tomography (OCT) based optical attenuation coefficient analysis is assessed for the detection of prostate cancer. Needle-based OCT-measurements were performed on the prostate specimens. Attenuation coefficients were determined by an earlier described in-house developed software package. The mean attenuation coefficients (benign OCT data; malignant OCT data; p-value Mann-Whitney U test) were: (3.56 mm(-1) ; 3.85 mm(-1) ; p < 0.0001) for all patients combined. The area under the ROC curve was 0.64. In order to circumvent the effect of histopathology mismatching, we performed a sub-analysis on only OCT data in which tumor was visible in two subsequent histopathological prostate slices. This analysis could be performed in 3 patients. The mean attenuation coefficients (benign OCT data; malignant OCT data; p-value Mann-Whitney U test) were: (3.23 mm(-1) ; 4.11 mm(-1) ; p < 0.0001) for all patients grouped together. The area under the ROC curve was 0.89. Functional OCT of the prostate has shown to differentiate between cancer and healthy prostate tissue. The optical attenuation coefficient in malignant tissue was significantly higher in malignant tissue compared to benign prostate tissue. Further studies are required to validate these initial results in a larger group of patients with a more tailored histopathology matching protocol.
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Affiliation(s)
- Berrend G Muller
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands.
| | - Daniel M de Bruin
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Martin J Brandt
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Willemien van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
| | - Suzanne van Huystee
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
| | - D J Faber
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Dilaria Savci
- Department of Pathology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Patricia J Zondervan
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
| | - Theo M de Reijke
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
| | - M Pilar Laguna-Pes
- Department of Urology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105, AZ Amsterdam Z.O., The Netherlands
| | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Jean J M C H de la Rosette
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, The Netherlands
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Wagstaff PGK, Buijs M, van den Bos W, de Bruin DM, Zondervan PJ, de la Rosette JJMCH, Laguna Pes MP. Irreversible electroporation: state of the art. Onco Targets Ther 2016; 9:2437-46. [PMID: 27217767 PMCID: PMC4853139 DOI: 10.2147/ott.s88086] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The field of focal ablative therapy for the treatment of cancer is characterized by abundance of thermal ablative techniques that provide a minimally invasive treatment option in selected tumors. However, the unselective destruction inflicted by thermal ablation modalities can result in damage to vital structures in the vicinity of the tumor. Furthermore, the efficacy of thermal ablation intensity can be impaired due to thermal sink caused by large blood vessels in the proximity of the tumor. Irreversible electroporation (IRE) is a novel ablation modality based on the principle of electroporation or electropermeabilization, in which electric pulses are used to create nanoscale defects in the cell membrane. In theory, IRE has the potential of overcoming the aforementioned limitations of thermal ablation techniques. This review provides a description of the principle of IRE, combined with an overview of in vivo research performed to date in the liver, pancreas, kidney, and prostate.
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Affiliation(s)
- Peter GK Wagstaff
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
| | - Mara Buijs
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Daniel M de Bruin
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | | | | | - M Pilar Laguna Pes
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands
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12
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Scheffer HJ, Vogel JA, van den Bos W, Neal RE, van Lienden KP, Besselink MGH, van Gemert MJC, van der Geld CWM, Meijerink MR, Klaessens JH, Verdaasdonk RM. The Influence of a Metal Stent on the Distribution of Thermal Energy during Irreversible Electroporation. PLoS One 2016; 11:e0148457. [PMID: 26844550 PMCID: PMC4742246 DOI: 10.1371/journal.pone.0148457] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/18/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Irreversible electroporation (IRE) uses short duration, high-voltage electrical pulses to induce cell death via nanoscale defects resulting from altered transmembrane potential. The technique is gaining interest for ablations in unresectable pancreatic and hepatobiliary cancer. Metal stents are often used for palliative biliary drainage in these patients, but are currently seen as an absolute contraindication for IRE due to the perceived risk of direct heating of the metal and its surroundings. This study investigates the thermal and tissue viability changes due to a metal stent during IRE. METHODS IRE was performed in a homogeneous tissue model (polyacrylamide gel), without and with a metal stent placed perpendicular and parallel to the electrodes, delivering 90 and 270 pulses (15-35 A, 90 μsec, 1.5 cm active tip exposure, 1.5 cm interelectrode distance, 1000-1500 V/cm, 90 pulses/min), and in-vivo in a porcine liver (4 ablations). Temperature changes were measured with an infrared thermal camera and with fiber-optic probes. Tissue viability after in-vivo IRE was investigated macroscopically using 5-triphenyltetrazolium chloride (TTC) vitality staining. RESULTS In the gel, direct stent-heating was not observed. Contrarily, the presence of a stent between the electrodes caused a higher increase in median temperature near the electrodes (23.2 vs 13.3°C [90 pulses]; p = 0.021, and 33.1 vs 24.8°C [270 pulses]; p = 0.242). In-vivo, no temperature difference was observed for ablations with and without a stent. Tissue examination showed white coagulation 1mm around the electrodes only. A rim of vital tissue remained around the stent, whereas ablation without stent resulted in complete tissue avitality. CONCLUSION IRE in the vicinity of a metal stent does not cause notable direct heating of the metal, but results in higher temperatures around the electrodes and remnant viable tissue. Future studies should determine for which clinical indications IRE in the presence of metal stents is safe and effective.
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Affiliation(s)
- Hester J. Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jantien A. Vogel
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Robert E. Neal
- Department of Radiology, The Alfred Hospital, Melbourne, Australia
| | | | | | - Martin J. C. van Gemert
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. M. van der Geld
- Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn R. Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - John H. Klaessens
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rudolf M. Verdaasdonk
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
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van den Bos W, Muller BG, de Bruin DM, de Castro Abreu AL, Chaussy C, Coleman JA, Finelli A, Gill IS, Gross ME, Jenniskens SF, Kahmann F, Laguna-Pes MP, Rastinehad AR, Simmons LA, Sulser T, Villers A, Ward JF, de la Rosette JJ. Salvage ablative therapy in prostate cancer: International multidisciplinary consensus on trial design. Urol Oncol 2015; 33:495.e1-7. [DOI: 10.1016/j.urolonc.2015.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 11/26/2022]
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Scheffer HJ, Melenhorst MC, Echenique AM, Nielsen K, van Tilborg AA, van den Bos W, Vroomen LG, van den Tol PM, Meijerink MR. Irreversible Electroporation for Colorectal Liver Metastases. Tech Vasc Interv Radiol 2015; 18:159-69. [DOI: 10.1053/j.tvir.2015.06.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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van den Bos W, de la Rosette J. RANDOMIZED CONTROLLED TRIAL ON IRREVERSIBLE ELECTROPORATION FOR LOCALIZED PROSTATE CANCER:FOCAL ABLATION VERSUS EXTENDED ABLATION. J Endourol 2015; 29:851-4. [PMID: 26274021 DOI: 10.1089/end.2015.29001.vdb] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Muller BG, de Bruin DM, van den Bos W, Brandt MJ, Velu JF, Bus MTJ, Faber DJ, Savci D, Zondervan PJ, de Reijke TM, Pes PL, de la Rosette J, van Leeuwen TG. Prostate cancer diagnosis: the feasibility of needle-based optical coherence tomography. J Med Imaging (Bellingham) 2015; 2:037501. [PMID: 26171414 DOI: 10.1117/1.jmi.2.3.037501] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 06/04/2015] [Indexed: 01/16/2023] Open
Abstract
The objective of this study is to demonstrate the feasibility of needle-based optical coherence tomography (OCT) and functional analysis of OCT data along the full pullback trajectory of the OCT measurement in the prostate, correlated with pathology. OCT images were recorded using a commercially available C7-XR™ OCT Intravascular Imaging System interfaced to a C7 Dragonfly™ intravascular 0.9-mm-diameter imaging probe. A computer program was constructed for automated image attenuation analysis. First, calibration of the OCT system for both the point spread function and the system roll-off was achieved by measurement of the OCT signal attenuation from an extremely weakly scattering medium (Intralipid® 0.0005 volume%). Second, the data were arranged in 31 radial wedges (pie slices) per circular segments consisting of 16 A-scans per wedge and 5 axial B-scans, resulting in an average A-scan per wedge. Third, the decay of the OCT signal is analyzed over 50 pixels ([Formula: see text]) in depth, starting from the first found maximum data point. Fourth, for visualization, the data were grouped with a corresponding color representing a specific [Formula: see text] range according to their attenuation coefficient. Finally, the analyses were compared to histopathology. To ensure that each single use sterile imaging probe is comparable to the measurements of the other imaging probes, the probe-to-probe variations were analyzed by measuring attenuation coefficients of 0.03, 6.5, 11.4, 17, and 22.7 volume% Intralipid®. Experiments were repeated five times per probe for four probes. Inter- and intraprobe variation in the measured attenuation of Intralipid samples with scattering properties similar to that of the prostate was [Formula: see text] of the mean values. Mean attenuation coefficients in the prostate were [Formula: see text] for parts of the tissue that were classified as benign (SD: [Formula: see text], minimum: [Formula: see text], maximum: [Formula: see text]) and [Formula: see text] for parts of tissue that were classified as malignant (SD: [Formula: see text], minimum: [Formula: see text], maximum: [Formula: see text]). In benign areas, the tissue looked homogeneous, whereas in malignant areas, small glandular structures were seen. However, not all areas in which a high attenuation coefficient became apparent corresponded to areas of prostate cancer. This paper describes the first in-tissue needle-based OCT imaging and three-dimensional optical attenuation analysis of prostate tissue that indicates a correlation with pathology. Fully automated attenuation coefficient analysis was performed at 1300 nm over the full pullback. Correlation with pathology was achieved by coregistration of three-dimensional (3-D) OCT attenuation maps with 3-D pathology of the prostate. This may contribute to the current challenge of prostate imaging and the rising interest in focal therapy for reduction of side effects occurring with current therapies.
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Affiliation(s)
- Berrend G Muller
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Daniel M de Bruin
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands ; University of Amsterdam , Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Willemien van den Bos
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Martin J Brandt
- University of Amsterdam , Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Juliette F Velu
- University of Amsterdam , Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Mieke T J Bus
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Dirk J Faber
- University of Amsterdam , Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Dilara Savci
- University of Amsterdam , Academic Medical Center, Department of Pathology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Patricia J Zondervan
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Theo M de Reijke
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Pilar Laguna Pes
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Jean de la Rosette
- University of Amsterdam , Academic Medical Center, Department of Urology, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
| | - Ton G van Leeuwen
- University of Amsterdam , Academic Medical Center, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
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Scheffer HJ, Vogel JA, van den Bos W, Meijerink MR, Besselink MG, Verdaasdonk RM, Klaessens J, van der Geld CW, van Gemert MJ. Comment to: Månsson C, Nilsson A, Karlson B-M. Severe complications with irreversible electroporation of the pancreas in the presence of a metallic stent: a warning of a procedure that never should be performed. Acta Radiologica Short Reports 2014;3(11):1-3. Acta Radiol Open 2015; 4:2058460115584111. [PMID: 26759723 PMCID: PMC4548731 DOI: 10.1177/2058460115584111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/05/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Hester J Scheffer
- Departments of Radiology and Nuclear Medicine, Free University Medical Center, Amsterdam, The Netherlands
| | - Jantien A Vogel
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Willemien van den Bos
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn R Meijerink
- Departments of Radiology and Nuclear Medicine, Free University Medical Center, Amsterdam, The Netherlands
| | - Marc Gh Besselink
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Rudolf M Verdaasdonk
- Department of Physics and Medical Technology, Free University Medical Center, Amsterdam, The Netherlands
| | - John Klaessens
- Department of Physics and Medical Technology, Free University Medical Center, Amsterdam, The Netherlands
| | - Cees Wm van der Geld
- Department of Mechanical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martin Jc van Gemert
- Department of Biomedical Engineering and Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Muller BG, van den Bos W, Pinto PA, de la Rosette JJ. Imaging modalities in focal therapy: patient selection, treatment guidance, and follow-up. Curr Opin Urol 2014; 24:218-24. [PMID: 24637316 DOI: 10.1097/mou.0000000000000041] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Focal therapy for prostate cancer is emerging as a management option between active surveillance and radical treatments. In this article, we present two of the most important imaging modalities in focal therapy, multiparametric MRI (mpMRI) and ultrasonography. We review the recent advances within these two platforms. RECENT FINDINGS State-of-the-art imaging in all phases of focal therapy is essential for treatment safety. In patient selection, treatment guidance, and follow-up, different aspects of imaging are important. mpMRI is an imaging technology with high imaging resolution and contrast. This makes it an excellent technology for patient selection and treatment planning and follow-up. Ultrasound has the unique property of real-time image acquisition. This makes it an excellent technology for real-time treatment guidance. There are multiple novelties in these two platforms that have increased the accuracy considerably. Examples in ultrasound are contrast-enhanced ultrasonography, elastography, shear-wave elastography, and histoscanning. In mpMRI, these advantages consist of multiple sequences combined to one image and magnetic resonance thermometry. SUMMARY Standardization of multiparametric transrectal ultrasound and mpMRI is of paramount importance. For targeted treatment and follow-up, a good negative predictive value of the test is important. There is much to gain from both of these developing fields and imaging accuracy of the two platforms is comparable. Standardization in conduct and interpretation, three-dimensional reconstruction, and fusion of the two platforms can make focal therapy the standard of care for prostate cancer.
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Affiliation(s)
- Berrend G Muller
- aDepartment of Urology, AMC University Hospital, Amsterdam, The Netherlands bDepartment of Urology, National Cancer Institute, Bethesda, Maryland, USA
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Muller BG, van den Bos W, Brausi M, Cornud F, Gontero P, Kirkham A, Pinto PA, Polascik TJ, Rastinehad AR, de Reijke TM, de la Rosette JJ, Ukimura O, Villers A, Walz J, Wijkstra H, Marberger M. Role of multiparametric magnetic resonance imaging (MRI) in focal therapy for prostate cancer: a Delphi consensus project. BJU Int 2014; 114:698-707. [PMID: 24180365 DOI: 10.1111/bju.12548] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Berrend G. Muller
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Maurizio Brausi
- Department of Urology; EstenseS. Agostino Hospital; Modena Italy
| | | | - Paolo Gontero
- Department of Urology; Molinette University Hospital; Turin Italy
| | | | - Peter A. Pinto
- Department of Urology; National Cancer Institute; Bethesda MD
| | - Thomas J. Polascik
- Department of Surgery/Urology; Duke University Medical Center; Durham NC
| | | | - Theo M. de Reijke
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
| | | | - Osamu Ukimura
- Department of Urology; University of Southern California; Norris Cancer Center; Los Angeles CA USA
| | | | - Jochen Walz
- Department of Urology; Institut Paoli-Calmettes Cancer Center; Marseille France
| | - Hessel Wijkstra
- Department of Urology; AMC University Hospital; Amsterdam The Netherlands
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
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van den Bos W, Muller BG, Ahmed H, Bangma CH, Barret E, Crouzet S, Eggener SE, Gill IS, Joniau S, Kovacs G, Pahernik S, de la Rosette JJ, Rouvière O, Salomon G, Ward JF, Scardino PT. Focal therapy in prostate cancer: international multidisciplinary consensus on trial design. Eur Urol 2014; 65:1078-83. [PMID: 24444476 DOI: 10.1016/j.eururo.2014.01.001] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/02/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Focal therapy has been introduced for the treatment of localised prostate cancer (PCa). To provide the necessary data for consistent assessment, all focal therapy trials should be performed according to uniform, systematic pre- and post-treatment evaluation with well-defined end points and strict inclusion and exclusion criteria. OBJECTIVE To obtain consensus on trial design for focal therapy in PCa. DESIGN, SETTING, AND PARTICIPANTS A four-staged consensus project based on a modified Delphi process was conducted in which 48 experts in focal therapy of PCa participated. According to this formal consensus-building method, participants were asked to fill out an iterative sequence of questionnaires to collect data on trial design. Subsequently, a consensus meeting was held in which 13 panellists discussed acquired data, clarified the results, and defined the conclusions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multidisciplinary board from oncologic centres worldwide reached consensus on patient selection, pretreatment assessment, evaluation of outcome, and follow-up. RESULTS AND LIMITATIONS Inclusion criteria for candidates in focal therapy trials are patients with prostate-specific antigen <15 ng/ml, clinical stage T1c-T2a, Gleason score 3+3 or 3+4, life expectancy of >10 yr, and any prostate volume. The optimal biopsy strategy includes transrectal ultrasound-guided biopsies to be taken between 6 mo and 12 mo after treatment. The primary objective should be focal ablation of clinically significant disease with negative biopsies at 12 mo after treatment as the primary end point. CONCLUSIONS This consensus report provides a standard for designing a feasible focal therapy trial. PATIENT SUMMARY A variety of ablative technologies have been introduced and applied in a focal manner for the treatment of prostate cancer (PCa). In this consensus report, an international panel of experts in the field of PCa determined pre- and post-treatment work-up for focal therapy research.
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Affiliation(s)
| | - Berrend G Muller
- Department of Urology, AMC University Hospital, Amsterdam, The Netherlands
| | - Hashim Ahmed
- Division of Surgery and Interventional Science, London, UK
| | - Chris H Bangma
- Department of Urology, Erasmus MC Rotterdam, The Netherlands
| | - Eric Barret
- Department of Urology, Institut Montsouris, Paris, France
| | - Sebastien Crouzet
- Hospices Civils de Lyon, Department of Urology, Edouard Herriot Hospital, Lyon, France
| | - Scott E Eggener
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Inderbir S Gill
- Institute of Urology, Hillard and Roclyn Herzog Center for Prostate Cancer Focal Therapy, Keck School of Medicine, Los Angeles, CA, USA
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Belgium
| | - Gyoergy Kovacs
- Interdisciplinary Brachytherapy Unit, University of Lübeck, Lübeck, Germany
| | - Sascha Pahernik
- Department of Urology, University Clinic Heidelberg, Heidelberg, Germany
| | | | - Olivier Rouvière
- Hospices Civils de Lyon, Department of Radiology, Hôpital E. Herriot, Université de Lyon, Lyon, France
| | - Georg Salomon
- Department of Urology, University Medical Centre Hamburg, Hamburg, Germany
| | - John F Ward
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter T Scardino
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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