Review of temperature dependence of thermal properties, dielectric properties, and perfusion of biological tissues at hyperthermic and ablation temperatures

Conductivity Rise During Irreversible Electroporation: True Permeabilization or Heat?

Purpose

Irreversible electroporation (IRE) induces apoptosis with high-voltage electric pulses. Although the working mechanism is non-thermal, development of secondary Joule heating occurs. This study investigated whether the observed conductivity rise during IRE is caused by increased cellular permeabilization or heat development.

Methods

IRE was performed in a gelatin tissue phantom, in potato tubers, and in 30 patients with unresectable colorectal liver metastases (CRLM). Continuous versus sequential pulsing protocols (10-90 vs. 10-30-30-30) were assessed. Temperature was measured using fiber-optic probes. After temperature had returned to baseline, 100 additional pulses were delivered. The primary technique efficacy of the treated CRLM was compared to the periprocedural current rise. Seven patients received ten additional pulses after a 10-min cool-down period.

Results

Temperature and current rise was higher for the continuous pulsing protocol (medians, gel: 13.05 vs. 9.55 °C and 9 amperes (A) vs. 7A; potato: 12.70 vs. 10.53 °C and 6.0A vs. 6.5A). After cooling-down, current returned to baseline in the gel phantom and near baseline values (Δ2A with continuous- and Δ5A with sequential pulsing) in the potato tubers. The current declined after cooling-down in all seven patients with CRLM, although baseline values were not reached. There was a positive correlation between current rise and primary technique efficacy (p = 0.02); however, the previously reported current increase threshold of 12–15A was reached in 13%.

Conclusion

The observed conductivity rise during IRE is caused by both cellular permeabilization and heat development. Although a correlation between current rise and efficacy exists, the current increase threshold seems unfeasible for CRLM.

Electronic supplementary material

The online version of this article (10.1007/s00270-018-1971-7) contains supplementary material, which is available to authorized users.

Locoregional hyperthermia of deep-seated tumours applied with capacitive and radiative systems: a simulation study

BACKGROUND

Locoregional hyperthermia is applied to deep-seated tumours in the pelvic region. Two very different heating techniques are often applied: capacitive and radiative heating. In this paper, numerical simulations are applied to compare the performance of both techniques in heating of deep-seated tumours.

METHODS

Phantom simulations were performed for small (30 × 20 × 50 cm³) and large (45 × 30 × 50 cm³), homogeneous fatless and inhomogeneous fat-muscle, tissue-equivalent phantoms with a central or eccentric target region. Radiative heating was simulated with the 70 MHz AMC-4 system and capacitive heating was simulated at 13.56 MHz. Simulations were performed for small fatless, small (i.e. fat layer typically <2 cm) and large (i.e. fat layer typically >3 cm) patients with cervix, prostate, bladder and rectum cancer. Temperature distributions were simulated using constant hyperthermic-level perfusion values with tissue constraints of 44 °C and compared for both heating techniques.

RESULTS

For the small homogeneous phantom, similar target heating was predicted with radiative and capacitive heating. For the large homogeneous phantom, most effective target heating was predicted with capacitive heating. For inhomogeneous phantoms, hot spots in the fat layer limit adequate capacitive heating, and simulated target temperatures with radiative heating were 2-4 °C higher. Patient simulations predicted therapeutic target temperatures with capacitive heating for fatless patients, but radiative heating was more robust for all tumour sites and patient sizes, yielding target temperatures 1-3 °C higher than those predicted for capacitive heating.

CONCLUSION

Generally, radiative locoregional heating yields more favourable simulated temperature distributions for deep-seated pelvic tumours, compared with capacitive heating. Therapeutic temperatures are predicted for capacitive heating in patients with (almost) no fat.

FEM simulation of EM field effect on body tissues with bio-nanofluid (blood with nanoparticles) for nanoparticle mediated hyperthermia

The study of temperature profiles and heat transport within the human body when subjected to electromagnetic waves is crucial for development and improvement of radiofrequency hyperthermia treatments. These treatments being minimally invasive can be a better alternative over surgery and chemotherapy for treatment of cancer. Nanoparticle-mediated hyperthermia for cancer therapy is a growing area of cancer nanomedicine because of the potential for localized and targeted destruction of cancer cells. This treatment is dependent on many factors, including thermal conductivity of bio-nanofluid, volume fraction of nanoparticles,excitation wavelength and power and metabolic heat generation. The present study employs Finite Element Method to investigate and optimize the effects of these parameters on temperature distributions and discuss the heat transport within the human body injected with nanoparticles and subjected to electromagnetic waves. The LTNE (Local Thermal Non Equilibrium) model is used to characterize the bioheat transport through the biological medium. In order to understand the effects induced by imposed electromagnetic field, the specific absorption rate (SAR) of body tissues is also studied. The results obtained have been validated against the pertinent numerical results in the literature. This study provides benchmark numerical solutions for heat transport through biological media thereby, helping in understanding the thermophysiologic response of bio-nanofluid towards imposed electromagnetic radiation.

Multifunctional fluorescent iron quantum clusters for non-invasive radiofrequency ablationof cancer cells

This work reports the potential of iron quantum clusters (FeQCs) as a hyperthermia agent for cancer, by testing its in-vitro response to shortwave (MHz range), radiofrequency (RF) waves non-invasively. Stable, fluorescent FeQCs of size ∼1 nm prepared by facile aqueous chemistry from endogenous protein haemoglobin were found to give a high thermal response, with a ΔT ∼50 °C at concentrationsas low as165 μg/mL. The as-prepared nanoclusters purified by lyophilization as well as dialysis showed a concentration, power and time-dependent RF response, with the lyophilized FeQCs exhibiting pronounced heating effects. FeQCs were found to be cytocompatible to NIH-3T3 fibroblast and 4T1 cancer cells treated at concentrations upto 1000 μg/mL for 24 h. Upon incubation with FeQCs and exposure to RF waves, significant cancer cell death was observed which proves its therapeutic ability. The fluorescent ability of the clusters could additionally be utilized for imaging cancer cells upon excitation at ∼450 nm. Further, to demonstrate the feasibility of imparting additional functionality such as drug/biomolecule/dye loading to FeQCs, they were self assembled with cationic polymers to form nanoparticles. Self assembly did not alter the RF heating potential of FeQCs and additionally enhanced its fluorescence. The multifunctional fluorescent FeQCs therefore show good promise as a novel therapeutic agent for RF hyperthermia and drug loading.

Drug release kinetics of temperature sensitive liposomes measured at high-temporal resolution with a millifluidic device

PURPOSE

Current release assays have inadequate temporal resolution ( ∼ 10 s) to characterise temperature sensitive liposomes (TSL) designed for intravascular triggered drug release, where release within the first few seconds is relevant for drug delivery.

MATERIALS AND METHODS

We developed a novel release assay based on a millifluidic device. A 500 µm capillary tube was heated by a temperature-controlled Peltier element. A TSL solution encapsulating a fluorescent compound was pumped through the tube, producing a fluorescence gradient along the tube due to TSL release. Release kinetics were measured by analysing fluorescence images of the tube. We measured three TSL formulations: traditional TSL (DPPC:DSPC:DSPE-PEF2000,80:15:5), MSPC-LTSL (DPPC:MSPC:DSPE-PEG2000,85:10:5) and MPPC-LTSL (DPPC:MMPC:PEF2000,86:10:4). TSL were loaded with either carboxyfluorescein (CF), Calcein, tetramethylrhodamine (TMR) or doxorubicin (Dox). TSL were diluted in one of the four buffers: phosphate buffered saline (PBS), 10% bovine serum albumin (BSA) solution, foetal bovine serum (FBS) or human plasma. Release was measured between 37-45 °C.

RESULTS

The millifluidic device allowed measurement of release kinetics within the first few seconds at ∼5 ms temporal resolution. Dox had the fastest release and highest release %, followed by CF, Calcein and TMR. Of the four buffers, release was fastest in human plasma, followed by FBS, BSA and PBS.

CONCLUSIONS

The millifluidic device allows measurement of TSL release at unprecedented temporal resolution, thus allowing adequate characterisation of TSL release at time scales relevant for intravascular triggered drug release. The type of buffer and encapsulated compound significantly affect release kinetics and need to be considered when designing and evaluating novel TSL-drug combinations.

Controllable Moderate Heating Enhances the Therapeutic Efficacy of Irreversible Electroporation for Pancreatic Cancer

Irreversible electroporation (IRE) as a non-thermal tumor ablation technology has been studied for the treatment of pancreatic carcinoma and has shown a significant survival benefit. We discovered that moderate heating (MH) at 43 °C for 1-2 minutes significantly enhanced ex vivo IRE tumor ablation of Pan02 cells by 5.67-fold at 750 V/cm and by 1.67-fold at 1500 V/cm. This amount of heating alone did not cause cell death. An integrated IRE system with controllable laser heating and tumor impedance monitoring was developed to treat mouse ectopic pancreatic cancer. With this novel IRE system, we were able to heat and maintain the temperature of a targeted tumor area at 42 °C during IRE treatment. Pre-heating the tumor greatly reduced the impedance of tumor and its fluctuation. Most importantly, MHIRE has been demonstrated to significantly extend median survival and achieve a high rate of complete tumor regression. Median survival was 43, 46 and 84 days, for control, IRE with 100 μs, 1 Hz, 90 pulses and electric fields 2000–2500 V/cm and MHIRE treatment respectively. 55.6% of tumor-bearing mice treated with MHIRE were tumor-free, whereas complete tumor regression was not observed in the control and IRE treatment groups.

Microwave thermal ablation: Effects of tissue properties variations on predictive models for treatment planning

Microwave thermal ablation (MTA) therapy for cancer treatments relies on the absorption of electromagnetic energy at microwave frequencies to induce a very high and localized temperature increase, which causes an irreversible thermal damage in the target zone. Treatment planning in MTA is based on experimental observations of ablation zones in ex vivo tissue, while predicting the treatment outcomes could be greatly improved by reliable numerical models. In this work, a fully dynamical simulation model is exploited to look at effects of temperature-dependent variations in the dielectric and thermal properties of the targeted tissue on the prediction of the temperature increase and the extension of the thermally coagulated zone. In particular, the influence of measurement uncertainty of tissue parameters on the numerical results is investigated. Numerical data were compared with data from MTA experiments performed on ex vivo bovine liver tissue at 2.45GHz, with a power of 60W applied for 10min. By including in the simulation model an uncertainty budget (CI=95%) of ±25% in the properties of the tissue due to inaccuracy of measurements, numerical results were achieved in the range of experimental data. Obtained results also showed that the specific heat especially influences the extension of the thermally coagulated zone, with an increase of 27% in length and 7% in diameter when a variation of -25% is considered with respect to the value of the reference simulation model.

Temperature sensitive liposomes combined with thermal ablation: Effects of duration and timing of heating in mathematical models and in vivo

BACKGROUND

Temperature sensitive liposomes (TSL) are nanoparticles that rapidly release the contained drug at hyperthermic temperatures, typically above ~40°C. TSL have been combined with various heating modalities, but there is no consensus on required hyperthermia duration or ideal timing of heating relative to TSL administration. The goal of this study was to determine changes in drug uptake when heating duration and timing are varied when combining TSL with radiofrequency ablation (RF) heating.

METHODS

We used computer models to simulate both RF tissue heating and TSL drug delivery, to calculate spatial drug concentration maps. We simulated heating for 5, 12 and 30 min for a single RF electrode, as well as three sequential 12 min ablations for 3 electrodes placed in a triangular array. To support simulation results, we performed porcine in vivo studies in normal liver, where TSL filled with doxorubicin (TSL-Dox) at a dose of 30 mg was infused over 30 min. Following infusion, RF heating was performed in separate liver locations for either 5 min (n = 2) or 12 min (n = 2). After ablation, the animal was euthanized, and liver extracted and frozen. Liver samples were cut orthogonal to the electrode axis, and fluorescence imaging was used to visualize tissue doxorubicin distribution.

RESULTS

Both in vivo studies and computer models demonstrate a ring-shaped drug deposition within ~1 cm of the visibly coagulated tissue. Drug uptake directly correlated with heating duration. In computer simulations, drug concentration increased by a factor of 2.2x and 4.3x when heating duration was extended from 5 to either 12, or 30 minutes, respectively. In vivo, drug concentration was by a factor of 2.4x higher at 12 vs 5 min heating duration (7.1 μg/g to 3.0 μg/g). The computer models suggest that heating should be timed to maximize area under the curve of systemic plasma concentration of encapsulated drug.

CONCLUSIONS

Both computer models and in vivo study demonstrate that tissue drug uptake directly correlates with heating duration for TSL based delivery. Computational models were able to predict the spatial drug delivery profile, and may serve as a valuable tool in understanding and optimizing drug delivery systems.

Microwave ablation of primary and secondary liver tumours: ex vivo, in vivo, and clinical characterisation

PURPOSE

The aim of this study was to compare the performance of a microwave ablation (MWA) apparatus in preclinical and clinical settings.

MATERIALS AND METHOD

The same commercial 2.45 GHz MWA apparatus was used throughout this study. In total 108 ablations at powers ranging from 20 to 130 W and lasting from 3 to 30 min were obtained on ex vivo bovine liver; 28 ablations at 60 W, 80 W and 100 W lasting 5 and 10 min were then obtained in an in vivo swine model. Finally, 32 hepatocellular carcinomas (HCCs) and 19 liver metastases in 46 patients were treated percutaneously by administering 60 W for either 5 or 10 min. The treatment outcome was characterised in terms of maximum longitudinal and transversal axis of the induced ablation zone.

RESULTS

Ex vivo ablation volumes increased linearly with deposited energy (r2 = 0.97), with higher sphericity obtained at lower power for longer ablation times. Larger ablations were obtained on liver metastases compared to HCCs treated with 60 W for 10 min (p < 0.003), as ablation diameters were 4.1 ± 0.6 cm for metastases and 3.7 ± 0.3 cm for HCC, with an average sphericity index of 0.70 ± 0.04. The results on the in vivo swine model at 60 W were substantially smaller than the ex vivo and clinical results (either populations). No statistically significant difference was observed between ex vivo results at 60 W and HCC results (p > 0.08).

CONCLUSIONS

For the selected MW ablation device, ex vivo data on bovine liver was more predictive of the actual clinical performance on liver malignancies than an in vivo porcine model. Equivalent MW treatments yielded a significantly different response for HCC and metastases at higher deposited energy, suggesting that outcomes are not only device-specific but must also be characterised on a tissue-by-tissue basis.

Microwave ablation of renal tumors: A narrative review of technical considerations and clinical results

PURPOSE

The purpose of this review was to identify the specific technical considerations to adequately perform microwave ablations (MWA) of renal tumors and analyze the currently available clinical results.

METHODS

Using Medline, a systematic review was performed including articles published between January 2000 and September 2016. English language original articles, reviews and editorials were selected based on their clinical relevance.

RESULTS

MWA has several theoretical advantages over radiofrequency ablation in consistently providing higher intratumoral temperatures. MWA is less dependent of electrical conductivities of tissues and the delivered energy is less limited by desiccation of heated tissues. While there are insufficient data, especially because of a lack of studies with mid- to long-term follow-up, to determine the oncologic effectiveness of MWA, this technique appears safe and effective for the ablation of T1 renal tumors. There is evidence for using mid-level settings based on experimental and clinical data. Power set at 50-65W for 5-15min appears adequate in kidney but close clinical and imaging follow-up have to be performed.

CONCLUSION

Renal MWA offers theoretical advantages by comparison with other available techniques to treat renal tumors. However, MWA suffers of less cumulative data compared to radiofrequency ablation or cryoablation. Moreover, microwaves still require further studies to identify the optimal tumor characteristics and device settings leading to predictable ablation.

Treatment planning in microwave thermal ablation: clinical gaps and recent research advances

Microwave thermal ablation (MTA) is a minimally invasive therapeutic technique aimed at destroying pathologic tissues through a very high temperature increase induced by the absorption of an electromagnetic field at microwave (MW) frequencies. Open problems, which are delaying MTA applications in clinical practice, are mainly linked to the extremely high temperatures, up to 120 °C, reached by the tissue close to the antenna applicator, as well as to the ability of foreseeing and controlling the shape and dimension of the thermally ablated area. Recent research was devoted to the characterisation of dielectric, thermal and physical properties of tissue looking at their changes with the increasing temperature, looking for possible developments of reliable, automatic and personalised treatment planning. In this paper, a review of the recently obtained results as well as new unpublished data will be presented and discussed.

Minimal vascular flows cause strong heat sink effects in hepatic radiofrequency ablation ex vivo

BACKGROUND

The present paper aims to assess the lower threshold of vascular flow rate on the heat sink effect in bipolar radiofrequency ablation (RFA) ex vivo.

METHODS

Glass tubes (vessels) of 3.4 mm inner diameter were introduced in parallel to bipolar RFA applicators into porcine liver ex vivo. Vessels were perfused with flow rates of 0 to 1,500 ml/min. RFA (30 W power, 15 kJ energy input) was carried out at room temperature and 37°C. Heat sink effects were assessed in RFA cross sections by the decrease in ablation radius, area and by a high-resolution sector planimetry.

RESULTS

Flow rates of 1 ml/min already caused a significant cooling effect (P ≤ 0.001). The heat sink effect reached a maximum at 10 ml/min (18.4 mm/s) and remained stable for flow rates up to 1,500 ml/min.

CONCLUSIONS

Minimal vascular flows of ≥1 ml/min cause a significant heat sink effect in hepatic RFA ex vivo. A lower limit for volumetric flow rate was not found. The maximum of the heat sink effect was reached at a flow rate of 10 ml/min and remained stable for flow rates up to 1,500 ml/min. Hepatic inflow occlusion should be considered in RFA close to hepatic vessels.

Experimental measurement of microwave ablation heating pattern and comparison to computer simulations

INTRODUCTION

For computational models of microwave ablation (MWA), knowledge of the antenna design is necessary, but the proprietary design of clinical applicators is often unknown. We characterised the specific absorption rate (SAR) during MWA experimentally and compared to a multi-physics simulation.

METHODS

An infrared (IR) camera was used to measure SAR during MWA within a split ex vivo liver model. Perseon Medical's short-tip (ST) or long-tip (LT) MWA antenna were placed on top of a tissue sample (n = 6), and microwave power (15 W) was applied for 6 min, while intermittently interrupting power. Tissue surface temperature was recorded via IR camera (3.3 fps, 320 × 240 resolution). SAR was calculated intermittently based on temperature slope before and after power interruption. Temperature and SAR data were compared to simulation results.

RESULTS

Experimentally measured SAR changed considerably once tissue temperatures exceeded 100 °C, contrary to simulation results. The ablation zone diameters were 1.28 cm and 1.30 ± 0.03 cm (transverse), and 2.10 cm and 2.66 ± -0.22 cm (axial), for simulation and experiment, respectively. The average difference in temperature between the simulation and experiment were 5.6 °C (ST) and 6.2 °C (LT). Dice coefficients for 1000 W/kg SAR iso-contour were 0.74 ± 0.01 (ST) and 0.77 (± 0.03) (LT), suggesting good agreement of SAR contours.

CONCLUSION

We experimentally demonstrated changes in SAR during MWA ablation, which were not present in simulation, suggesting inaccuracies in dielectric properties. The measured SAR may be used in simplified computer simulations to predict tissue temperature when the antenna geometry is unknown.

Dielectric properties measurements of brown and white adipose tissue in rats from 0.5 to 10 GHz

Brown adipose tissue (BAT) plays an important role in whole body metabolism and with appropriate stimulus could potentially mediate weight gain and insulin sensitivity. Although imaging techniques are available to detect subsurface BAT, there are currently no viable methods for continuous acquisition of BAT energy expenditure. Microwave (MW) radiometry is an emerging technology that allows the quantification of tissue temperature variations at depths of several centimeters. Such temperature differentials may be correlated with variations in metabolic rate, thus providing a quantitative approach to monitor BAT metabolism. In order to optimize MW radiometry, numerical and experimental phantoms with accurate dielectric properties are required to develop and calibrate radiometric sensors. Thus, we present for the first time, the characterization of relative permittivity and electrical conductivity of brown (BAT) and white (WAT) adipose tissues in rats across the MW range 0.5-10GHz. Measurements were carried out in situ and post mortem in six female rats of approximately 200g. A Cole-Cole model was used to fit the experimental data into a parametric model that describes the variation of dielectric properties as a function of frequency. Measurements confirm that the dielectric properties of BAT (εr = 14.0-19.4, σ = 0.3-3.3S/m) are significantly higher than those of WAT (εr = 9.1-11.9, σ = 0.1-1.9S/m), in accordance with the higher water content of BAT.

Thermal Therapy Approaches for Treatment of Brain Tumors in Animals and Humans

Primary brain tumors are often aggressive, with short survival from time of diagnosis even with standard of care therapies such as surgery, chemotherapy, and radiation therapy. Thermal therapies have been extensively investigated as both primary and adjuvant therapy. Although thermal therapies are not yet widely used clinically, there have been several promising approaches demonstrated in both animals and humans. This review presents thermal therapy approaches in animal and human studies, including both hyperthermia (temperatures ~42°C-45°C) and thermal ablation (temperatures > 50°C). Hyperthermia is primarily used as adjuvant to chemotherapy and radiotherapy, and is the most widely studied radiation sensitizer where enhanced efficacy has been shown in human patients with brain cancer. Hyperthermia has additional beneficial effects such as immunogenic effects, and opening of the bloodbrain barrier to potentially enhance drug delivery, for example in combination with nanoparticle drug delivery systems. Thermal ablation uses high temperatures for direct local tumor destruction, and it found its way into clinical use as laser interstitial thermal therapy (LITT). This review presents various hyperthermia and ablation approaches, including a review of different devices and methods that have been used for thermal therapies, such as radiofrequency/microwaves, laser, high-intensity focused ultrasound, and magnetic nanoparticles. Current research efforts include the combination of advanced thermal therapy devices, such as focused ultrasound with radiation, as well as the use of thermal therapies to enhance chemotherapy delivery across the blood-brain barrier.