1
|
Marinova M, Feradova H, Gonzalez-Carmona MA, Conrad R, Tonguc T, Thudium M, Becher MU, Kun Z, Gorchev G, Tomov S, Strassburg CP, Attenberger U, Schild HH, Dimitrov D, Strunk HM. Improving quality of life in pancreatic cancer patients following high-intensity focused ultrasound (HIFU) in two European centers. Eur Radiol 2021; 31:5818-5829. [PMID: 33486605 DOI: 10.1007/s00330-020-07682-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/17/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Pancreatic cancer patients often have a high symptom burden, significantly impairing patients' quality of life (QOL). Nevertheless, there are hardly any reports on the impact of high-intensity focused ultrasound (HIFU) on the QOL of treated patients. For the first time, this study evaluated the effect of HIFU on QOL and compared these results in two European centers. METHODS Eighty patients with advanced pancreatic cancer underwent HIFU (50 in Germany, 30 in Bulgaria). Clinical assessment included evaluation of QOL and symptoms using the EORTC QLQ-C30 questionnaire at baseline and 1, 3, and 6 months after HIFU. Pain intensity was additionally evaluated with the numerical rating score (NRS). RESULTS Compared to baseline, global health significantly improved 3 and 6 months after HIFU treatment (p = 0.02). Functional subscales including physical, emotional, and social functioning were considerably improved at 6 months (p = 0.02, p = 0.01, and p = 0.01, respectively) as were leading symptom pain (p = 0.04 at 6 months), fatigue (p = 0.03 at 3 and p = 0.01 at 6 months), and appetite loss (p = 0.01 at 6 months). Moreover, pain intensity measured by NRS revealed effective and strong pain relief at all time points (p < 0.001). Reported effects were independent of tumor stage, metastatic status, and country of treatment. CONCLUSIONS This study showed that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL by increasing global health and mitigation of physical complaints with a low rate of side effects, independent of the examiner. Therefore, HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease. KEY POINTS • In a prospective two-center study, it was shown that HIFU represents an effective treatment option of advanced pancreatic cancer improving QOL. • HIFU in pancreatic cancer patients is associated with a low rate of side effects, independent of the performer. • HIFU is a worthwhile additional treatment besides systemic palliative chemotherapy or best supportive care in management of this aggressive disease.
Collapse
Affiliation(s)
- Milka Marinova
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Hyuliya Feradova
- HIFU Center, University St. Marina Hospital, Medical University-Pleven, Pleven, Bulgaria
| | | | - Rupert Conrad
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Tolga Tonguc
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Marcus Thudium
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Marc U Becher
- Clinic for Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Zhou Kun
- Clinical Center for Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Grigor Gorchev
- HIFU Center, University St. Marina Hospital, Medical University-Pleven, Pleven, Bulgaria
| | - Slavcho Tomov
- HIFU Center, University St. Marina Hospital, Medical University-Pleven, Pleven, Bulgaria
| | | | - Ulrike Attenberger
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Hans H Schild
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany
| | - Dobromir Dimitrov
- HIFU Center, University St. Marina Hospital, Medical University-Pleven, Pleven, Bulgaria
| | - Holger M Strunk
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, D-53127, Bonn, Germany.
| |
Collapse
|
2
|
UMEHARA HIDETO, SEKI TOSHIHITO, INOKUCHI RYOSUKE, TAMAI TORU, KAWAMURA RINAKO, ASAYAMA TOSHIKI, IKEDA KOZO, OKAZAKI KAZUICHI. Microwave coagulation using a perfusion microwave electrode: Preliminary experimental study using ex vivo and in vivo liver. Exp Ther Med 2012; 3:214-220. [PMID: 22969871 PMCID: PMC3438625 DOI: 10.3892/etm.2011.380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/13/2011] [Indexed: 12/18/2022] Open
Abstract
To assess the coagulation capability of a perfusion microwave electrode (PME) as a key component of microwave coagulation therapy, a preliminary experimental study was performed using ex vivo and in vivo livers. For a microwave electrode, a PME was employed. Using a PME, saline was passed through the electrode and injected continuously into the target tissue. Using an ex vivo bovine liver, the range of tissue coagulation was measured for various volumes of infused saline and microwave outputs. Using an in vivo porcine liver, the efficiency of coagulation by a PME was compared with that of radiofrequency ablation (RFA) using a cool-tip needle. In an ex vivo bovine liver, the range of tissue coagulation increased as the flow rate of saline increased. In the in vivo porcine liver, the range of coagulation was similar to that found in the ex vivo bovine liver. With a PME under conditions of a microwave output of 80 W, a flow rate of 3 ml/min and irradiation time of 5 min, the range of coagulation was 44.8±2.8 mm [maximum vertical diameter: (a)] x 31.2±2.4 mm [maximum transverse diameter: (b)]. The range of RFA (cool-tip needle) at 12 min was 46.0±2.0 mm (a) x 30.2±2.0 mm (b). With only 5 min of microwave irradiation, the use of a PME enabled induction of the same range of coagulation that was obtainable by RFA for 12 min. In comparison with microwave coagulation without saline infusion, the use of a PME made it possible to extend the range of tissue coagulation to a range equal to that of RFA in a short time. Microwave coagulation using a PME may be one of the suitable tissue coagulation systems for local ablation treatment.
Collapse
Affiliation(s)
- HIDETO UMEHARA
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - TOSHIHITO SEKI
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - RYOSUKE INOKUCHI
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - TORU TAMAI
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - RINAKO KAWAMURA
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - TOSHIKI ASAYAMA
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - KOZO IKEDA
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| | - KAZUICHI OKAZAKI
- Department of Gastroenterology and Hepatology, Kansai Medical University, Moriguchi, Osaka 570-8507, Japan
| |
Collapse
|
3
|
Pathak S, Jones R, Tang JMF, Parmar C, Fenwick S, Malik H, Poston G. Ablative therapies for colorectal liver metastases: a systematic review. Colorectal Dis 2011; 13:e252-65. [PMID: 21689362 DOI: 10.1111/j.1463-1318.2011.02695.x] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM The standard treatment for colorectal liver metastases (CRLM) is surgical resection. Only 20-30% of patients are deemed suitable for surgery. Recently, much attention has focused on ablative therapies either to treat unresectable CRLM or to extend the margins of resectability. This review aims to assess the long-term outcome and complication rates of various ablative therapies used in the management of CRLM. METHOD A literature search was performed of electronic databases including Medline, Cochrane Collaboration Library and the National Library of Medicine's ClinicalTrials.gov. Inclusion criteria were ablation for CRLM with minimum 1 year follow-up and >10 patients, published between January 1994 and January 2010. RESULTS In all, 226 potentially relevant studies were identified, of which 75 met the inclusion criteria. Cryotherapy (26 studies) had local recurrence rates of 12-39%, with mean 1-, 3- and 5-year survival rates of 84%, 37% and 17%. The major complication rate ranged from 7% to 66%. Microwave ablation (13 studies) had a local recurrence rate of 5-13%, with a mean 1-, 3- and 5-year survival of 73%, 30% and 16%, and a major complication rate ranging from 3% to 16%. Radiofrequency ablation (36 studies) had a local recurrence rate of 10-31%, with a mean 1-, 3- and 5-year survival of 85%, 36% and 24%, with major complication rate ranging from 0% to 33%. CONCLUSION Ablative therapies offer significantly improved survival compared with palliative chemotherapy alone with 5-year survival rates of 17-24%. Complication rates amongst commonly used techniques are low.
Collapse
Affiliation(s)
- S Pathak
- Department of Hepatobiliary Surgery, Aintree University NHS Foundation Trust, Liverpool, UK.
| | | | | | | | | | | | | |
Collapse
|
4
|
Fukuda H, Ito R, Ohto M, Sakamoto A, Karasawa E, Yamaguchi T, Shinozuka N, Zhu H, Wanga ZB. Treatment of small hepatocellular carcinomas with US-guided high-intensity focused ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:1222-1229. [PMID: 21645963 DOI: 10.1016/j.ultrasmedbio.2011.04.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 04/28/2011] [Accepted: 04/30/2011] [Indexed: 05/30/2023]
Abstract
High-intensity focused ultrasound (HIFU) is a noninvasive method that can cause complete coagulation necrosis without requiring the insertion of any instruments. The purpose of this study was to evaluate the safety and efficacy of HIFU treatment for small liver cancers without performing transcatheter arterial chemoembolization (TACE) or rib resection. HIFU ablation was performed without rib resection or the aid of TACE or percutaneous ethanol injection (PEI) in 12 patients with hepatocelullar carcinoma. The HIFU system (Chongqing Haifu Tech, Chongqing, China) was used under ultrasound guidance. All 12 patients completed the treatment without experiencing any adverse events. Complete coagulation was achieved by applying the sonications from the intercostal space when the tumor was located in the right lobe. After treatment, serum alanine aminotransferase (ALT) and serum aspartate aminotransferase (AST) levels were significantly higher than the baseline values; these levels recovered within 1 week. C-reactive protein (CRP) levels increased 1 week after treatment but decreased within 1 month. An epidural anesthetic provided sufficient pain suppression during the procedure. Edema of the subcutaneous tissue was detected in five cases, but the edema disappeared within 1 month. None of the patients developed acute hepatic failure, liver abscess or renal dysfunction. In conclusion, HIFU is effective for the treatment of patients with small liver cancer.
Collapse
Affiliation(s)
- Hiroyuki Fukuda
- International HIFU Center, Naruto General Hospital, Sanbu-shi, Chiba, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Sun Y, Cheng Z, Dong L, Zhang G, Wang Y, Liang P. Comparison of temperature curve and ablation zone between 915- and 2450-MHz cooled-shaft microwave antenna: results in ex vivo porcine livers. Eur J Radiol 2011; 81:553-7. [PMID: 21354733 DOI: 10.1016/j.ejrad.2011.02.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 02/02/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare temperature curve and ablation zone between 915- and 2450-MHz cooled-shaft microwave antenna in ex vivo porcine livers. MATERIALS AND METHODS The 915- and 2450-MHz microwave ablation and thermal monitor system were used in this study. A total of 56 ablation zones and 280 temperature data were obtained in ex vivo porcine livers. The output powers were 50, 60, 70, and 80 W and the setting time was 600 s. The temperature curve of every temperature spot, the short- and long-axis diameters of the coagulation zones were recorded and measured. RESULTS At all four power output settings, the peak temperatures of every temperature spot had a tendency to increase accordingly as the MW output power was increased, and except for 5mm away from the antenna, the peak temperatures for the 915 MHz cooled-shaft antenna were significantly higher than those for the 2450 MHz cooled-shaft antenna (p<0.05). Meanwhile, the short- and long-axis diameters for the 915 MHz cooled-shaft antenna were significantly larger than those for the 2450 MHz cooled-shaft antenna (p<0.05). CONCLUSION The 915 MHz cooled-shaft antenna can yield a significantly larger ablation zone and achieve higher temperature in ablation zone than a 2450 MHz cooled-shaft antenna in ex vivo porcine livers.
Collapse
Affiliation(s)
- Yuanyuan Sun
- Department of Ultrasound, The General Hospital of Jinan Military Region, Jinan 250031, China.
| | | | | | | | | | | |
Collapse
|
6
|
Fukuda H, Numata K, Nozaki A, Morimoto M, Kondo M, Tanaka K, Maeda S, Ohto M, Ito R, Zhu H, Wang ZB. Findings of multidetector row computed tomography of HCCs treated by HIFU ablation. Eur J Radiol 2011; 81:e239-43. [PMID: 21339057 DOI: 10.1016/j.ejrad.2011.01.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Revised: 01/24/2011] [Accepted: 01/28/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE We evaluated the efficacy of high-intensity focused ultrasound (HIFU) ablation for hepatocellular carcinoma (HCC), and a long-term study by follow-up multidetector-row computed tomography (CT) was conducted to evaluate the changes occurring in the treatment area following the HIFU ablation. MATERIALS AND METHODS HIFU ablation was carried out in 14 patients with small HCCs (≤3 lesions, ≤3cm in diameter). The HIFU system (Chongqing Haifu Tech) was used under ultrasound guidance. The evaluations were performed by follow-up CT at 1 week, 1, 3, 6 and 12 months after the HIFU ablation. RESULTS HIFU ablation was carried out successfully in 11 of the 14 patients. At 1 week after the HIFU, a peripheral rim enhancement was found in all cases (100%). This finding was persistent in 6 of the 11 cases (54.5%) at 1 month, and in 1 of the 11 (9%) cases at 3 months after HIFU ablation. In all cases, the rim enhancement disappeared by 6 or 12 months after the HIFU ablation. At the 12 months follow-up, a decrease in the diameter of the ablated lesions was found. The enhancement around the treated area was found to be persistent at the 12 months follow-up in the one case of recurrence of the treated site in which the safety margin was not sufficiently wide. During the follow-up period, there were 2 cases with residual of HCC tumors. We performed radiofrequency ablation (RFA) for these residual tumors after the HIFU ablation. CONCLUSION To ascertain the cause of the peripheral enhancement on follow-up CT images after the HIFU ablation, in particular, to determine whether it might be caused by residual tumor or recurrence at the treated site, careful follow-up is important, especially in cases where the safety margin of the ablated area was not sufficiently wide.
Collapse
Affiliation(s)
- Hiroyuki Fukuda
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Usefulness of US-CT 3D dual imaging for the planning and monitoring of hepatocellular carcinoma treatment using HIFU. Eur J Radiol 2011; 80:e306-10. [PMID: 21306847 DOI: 10.1016/j.ejrad.2010.12.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 12/28/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE We evaluated the safety and usefulness of high-intensity focused ultrasound (HIFU) assisted by ultrasound-computed tomography three-dimensional (US-CT 3D) dual imaging for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS HIFU ablation was performed in 13 patients with small HCC (≤3 lesions, ≤3 cm in diameter). The HIFU system (Chongqing Haifu Tech) was used under ultrasound guidance. By transferring the sagittal or axial plane of the 3D US and the CT volume data into the ZioM900, multiplanar reconstruction images were displayed in a manner resembling conventional monitor US to assist the HIFU treatment. RESULTS Overall, 69% (9/13) of the patients in whom good visualization using B-mode sonography could not be obtained because of the influence of multi-reflections, rib shadows, and unclear tumor margins were successfully treated under the guidance of US-CT 3D dual imaging. In 5 of the 13 patients, multi-reflections were responsible for the poor visualization. In 2 cases, the tumor was poorly visualized because of a rib shadow. In one case, the margin of the tumor was too unclear to be detected using ultrasography. The 3D US images obtained as part of the US-CT 3D dual imaging had a high resolution and were useful for examining the area of HCC invasion and for determining the extent of the ablation area. The CT images, which are not influenced by bone shadows or multi-reflections, were useful for detecting the tumors and for visualizing the presence of the intestines in the sonication zone. HIFU treatments were successfully performed in all the patients with the assistance of US-CT 3D dual imaging. CONCLUSION US-CT 3D dual imaging is useful for HIFU treatment for HCC, compensating for the occasionally poor visualization provided by US monitor.
Collapse
|
8
|
Pan WD, Zheng RQ, Nan L, Fang HP, Liu B, Tang ZF, Deng MH, Xu RY. Ultrasound-guided percutaneous microwave coagulation therapy with a "cooled-tip needle" for the treatment of hepatocellular carcinoma adjacent to the gallbladder. Dig Dis Sci 2010; 55:2664-9. [PMID: 19949862 DOI: 10.1007/s10620-009-1053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 11/10/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Curative percutaneous microwave coagulation therapy is difficult or contraindicated in patients with tumors adjacent to the gallbladder because of the associated risk of injury. To date, no clinical data have been published regarding the effects and safety of percutaneous microwave coagulation therapy on tumors that are adjacent to the gallbladder. AIMS We investigated the efficacy and safety of a combined treatment involving laparoscopic cholecystectomy and subsequent percutaneous microwave coagulation therapy in patients with hepatocellular carcinoma adjacent to the gallbladder. METHODS Twenty-three patients with hepatocellular carcinoma nodules (of less than 5 cm diameter) and adjacent to the gallbladder were treated by percutaneous microwave coagulation therapy with a "cooled-tip needle" after laparoscopic cholecystectomy. The therapeutic efficacy was evaluated with enhanced helical computed tomography and sonography, and the rates of complete necrosis as well as postoperative complications were also analyzed. RESULTS All of the patients exhibited complete necrosis of their tumor lesions after treatment with percutaneous microwave coagulation therapy. During the follow-up period (which lasted more than 21 months), 22 of 23 patients were alive. Recurrent nodules appeared in other subsegments, but not at the original site treated with percutaneous microwave coagulation therapy. Of note, no fatal complications were observed in any of the patients treated with percutaneous microwave coagulation therapy. CONCLUSION Our results suggest that combined treatment comprising both laparoscopic cholecystectomy and subsequent percutaneous microwave coagulation therapy is an effective and safe approach for patients with small (<5 cm) hepatocellular carcinomas that are adjacent to the gallbladder.
Collapse
Affiliation(s)
- Wei-Dong Pan
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, 510630, Guangzhou, People's Republic of China.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Li JJ, Gu MF, Luo GY, Liu LZ, Zhang R, Xu GL. Complications of High Intensity Focused Ultrasound for Patients with Hepatocellular Carcinoma. Technol Cancer Res Treat 2009; 8:217-24. [DOI: 10.1177/153303460900800306] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. This study was conducted to analyze and evaluate the complications of HIFU for the treatments of hepatocellular carcinoma. A total of 59 patients with hepatocellular carcinoma, with a total of 72 lessions were enrolled in this study. Tumor size ranged from 2.5 to 14.0 cm in diameter, with a mean diameter of 7.6 cm. All patients had accepted HIFU treatment, and the median number of HIFU sessions was 1.32 per patient. Results: The common complications from HIFU therapy were skin burns of various grades (eight cases of grade 1 skin burns, 48 of grade 2, three cases of 3), and pain in the treatment regions (15 cases of mild pain, 37 cases of moderate pain, 7 cased of severe pain). Other systemic complications were relatively rare and included fever (5 cases), hypertension (8 cases), supraventricular tachycardia (3 cases), mild impairment of hepatic function (48 cases), and mild mpairment of renal function (2 cases). Local damage consisted of acute cholecystitis (2 cases), hematuria (6 cases), cholangiectasis (5 cases), light pericardial effusion (2 cases), impairment of peripheral nerves (10 cases), pleural effusion in the right thorax (3 cases), and impairment of vertebral column (1 case). No gastric or intestinal tract perforation, big vessel rupture, or hepatic rupture occurred. Conclusions: HIFU is a minimally invasive treatment for patients with hepatocellular carcinoma; however, there are some systemic and local complications that should be taken into consideration in evaluating HIFU for therapeutic use.
Collapse
Affiliation(s)
- Jian-Jun Li
- Department of HIFU Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| | - Mo-Fa Gu
- Department of Radiation Oncology Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| | - Guang-Yu Luo
- Department of HIFU Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| | - Li-Zhi Liu
- Department of Radiology Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| | - Rong Zhang
- Department of HIFU Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| | - Guo-Liang Xu
- Department of HIFU Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China 651, Dongfengdong Road Guangzhou, 510060, PR China
| |
Collapse
|
10
|
Contrast-Enhanced Ultrasound-Guided Microwave Tissue Coagulation Therapy for Hepatic Trauma: An Experimental Study. ACTA ACUST UNITED AC 2008; 64:1079-84. [DOI: 10.1097/ta.0b013e318031ccdb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
11
|
Zhai W, Xu J, Zhao Y, Song Y, Sheng L, Jia P. Preoperative surgery planning for percutaneous hepatic microwave ablation. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2008; 11:569-77. [PMID: 18982650 DOI: 10.1007/978-3-540-85990-1_68] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
A novel preoperative surgery planning method is proposed for percutaneous hepatic microwave ablation. An iterative framework for necrosis field simulation and 3D necrosis zone reconstruction is introduced here, and the necrosis model is further superimposed to patient anatomy structures using advanced GPU-accelerated visualization techniques. The full surgery planning is performed by the surgeon in an interactively way, until the optimal surgery plan is achieved. Experiments have been performed on realistic patient with hepatic cancer and the actual necrosis zone are measured in postoperative CT images for patient. Results show that this method is relative accurate for preoperative trajectory plan and could be used as an assistant to the clinical practice.
Collapse
Affiliation(s)
- Weiming Zhai
- State Key Laboratory of Intelligent Technology and Systems, National Laboratory for Information Science and Technology, Department of Computer Science and Technology, Tsinghua University, Beijing 100084, China.
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE This article reviews the basic principles, equipment, current therapeutic status and future trends of microwave ablation (MWA) in the treatment of hepatocellular carcinoma (HCC). METHODS All articles published in English on MWA or MWA as a treatment for HCC were identified with a PubMed search from the 1990s through June 2007. Papers were reviewed on the technical advances of MWA equipment and the clinical applications of MWA including indications, techniques, therapeutic outcomes, complications and combination therapies. RESULTS MWA has several advantages, including high thermal efficiency, higher capability of coagulating blood vessels, faster ablation time, and an improved convention profile. MWA can induce large ablation volumes and yield good local tumor control, especially for small HCC. Larger HCC can also be completely ablated by using more effective antenna or simultaneous application of multiple antennae. Long-term survival comparable to that of surgery was obtained for tumors measuring 4 cm or less. Associated complications appear to be low. CONCLUSIONS MWA is a promising minimally invasive technique for the treatment of HCC. Future advances are warranted to improve the therapeutic efficacy.
Collapse
Affiliation(s)
- Ping Liang
- Department of Ultrasound, Chinese PLA General Hospital, Beijing, PR China.
| | | |
Collapse
|
13
|
Duan YQ, Gao YY, Ni XX, Wang Y, Feng L, Liang P. Changes in peripheral lymphocyte subsets in patients after partial microwave ablation of the spleen for secondary splenomegaly and hypersplenism: a preliminary study. Int J Hyperthermia 2007; 23:467-72. [PMID: 17701538 DOI: 10.1080/02656730701474533] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Microwave ablation therapy for secondary splenomegaly and hypersplenism has been shown to be effective from pre-clinical animal models and clinical investigations. This study was performed to determine its effects on the status of peripheral lymphocyte subsets in patients receiving microwave ablation of the spleen. MATERIALS AND METHODS Ten patients with secondary splenomegaly and hypersplenism received microwave ablation of the spleen during laparoscopy or percutaneously under ultrasound guidance. The percentage peripheral blood T cells, B lymphocytes and NK cells were measured using flow cytometry before and on days 1, 3 and 7 after therapy, as well as 1 and 3 months afterwards. RESULTS Percentages of CD3(+) and CD4(+) cells increased rapidly 1 month after therapy. There was no significant change in CD8(+), CD4(+)/CD8(+) or NK cells of the pre- and post-therapy levels and B lymphocytes increased significantly after therapy. In patients with an ablation volume (AV) less than 20% (group A), T cells increased 1 month after ablation but decreased 3 months after ablation. B lymphocytes increased significantly after surgery. Levels of NK cells were lower than that before therapy on each testing. In patients with 20-40% AV (group B), levels of T cells, B lymphocytes and NK cells showed an increase. Levels of CD4(+) cells were significantly higher in group B than in group A, 3 months after therapy. CONCLUSIONS Microwave ablation therapy for splenomegaly and hypersplenism appears to have a favourable effect on peripheral lymphocyte subsets. A relationship may exist between the ablation volume and the level of peripheral lymphocyte subsets.
Collapse
Affiliation(s)
- Y Q Duan
- Department of Ultrasound, Chinese PLA General Hospital, China
| | | | | | | | | | | |
Collapse
|
14
|
Wang Y, Sun Y, Feng L, Gao Y, Ni X, Liang P. Internally cooled antenna for microwave ablation: results in ex vivo and in vivo porcine livers. Eur J Radiol 2007; 67:357-361. [PMID: 17768024 DOI: 10.1016/j.ejrad.2007.07.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 05/15/2007] [Accepted: 07/05/2007] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the performance of microwave ablation with an internally cooled antenna in ex vivo and in vivo porcine livers. MATERIALS AND METHODS Microwave ablations were performed in ex vivo and in vivo porcine livers with a 1.9 mm-diameter 2450 MHz microwave needle antenna. Four power settings (50, 60, 70 and 80 W) were used in this study, while application time was fixed at 10 min. Diameters of the coagulation zone were observed on gross specimens. RESULTS Excessive elongation of coagulation along the needle shaft was not encountered in all ablations. An arrow-shaped charring was observed. As the power increases, the long-axis coagulation diameter for in vivo liver increased significantly (P<.05). The short-axis coagulation diameter for in vivo liver was significantly smaller than that for ex vivo liver (P<.05) but not statistically different among the four power settings. After 10 min of ablation at 80 W, the short-axis and long-axis coagulation diameter for in vivo liver was 4.92+/-0.15 cm and 2.37+/-0.10 cm, respectively. CONCLUSION The internally cooled microwave antenna may be advantageous to minimize collateral damages.
Collapse
Affiliation(s)
- Yang Wang
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China
| | - Yuanyuan Sun
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China
| | - Lei Feng
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China
| | - Yongyan Gao
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China
| | - Xiaoxia Ni
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China
| | - Ping Liang
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 China.
| |
Collapse
|
15
|
Abstract
Colorectal cancer is the fourth most common type of cancer in the West and the second leading cause of cancer-related deaths in the United States. Approximately 35 to 55% of patients with colorectal cancer develop hepatic metastases during the course of their disease. Surgical resection of colorectal liver metastases represents the only chance at potential cure, and long-term survival can be achieved in 35 to 58% of patients after resection. The goal of hepatic resection should be to resect all metastases with negative histologic margins while preserving sufficient functional hepatic parenchyma. In patients with extensive metastatic disease who would otherwise be unresectable, ablative approaches can be used instead of or combined with hepatic resection. The use of portal vein embolization and preoperative chemotherapy may also expand the population of patients who are candidates for surgical treatment. Despite these advances, many patients still experience a recurrence after hepatic resection. More active systemic chemotherapy agents are now available and are being increasingly employed as adjuvant therapy either before or after surgery. Modern treatment of colorectal liver metastasis requires a multidisciplinary approach in an effort to increase the number of patients who may benefit from surgical treatment of colorectal cancer liver metastasis.
Collapse
Affiliation(s)
- Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 22187-6681, USA
| | | |
Collapse
|
16
|
Clark PE, Woodruff RD, Zagoria RJ, Hall MC. Microwave ablation of renal parenchymal tumors before nephrectomy: phase I study. AJR Am J Roentgenol 2007; 188:1212-4. [PMID: 17449761 DOI: 10.2214/ajr.05.2190] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The purpose of this study was to determine, in renal neoplasms, the size of ablation zones induced in vivo with percutaneous microwave probes and whether skip areas remain within the ablation zones. CONCLUSION For a single 10-minute ablation, ablated volumes averaged 27 cm3 and 105 cm3 with a single-probe and a three-probe ablation array, respectively. There were no skip areas within the ablated zone. Microwave ablation can safely and quickly generate large ablation lesions and renal neoplasms.
Collapse
Affiliation(s)
- Peter E Clark
- Department of Urology and Comprehensive Cancer Center of Wake Forest University, Winston-Salem, NC, USA
| | | | | | | |
Collapse
|
17
|
Liapi E, Geschwind JFH. Transcatheter and ablative therapeutic approaches for solid malignancies. J Clin Oncol 2007; 25:978-86. [PMID: 17350947 DOI: 10.1200/jco.2006.09.8657] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this article is to present in a concise manner an overview of the most widely used locoregional transcatheter and ablative therapies for solid malignancies. An extensive MEDLINE search was performed for this review. Therapies used for liver cancer were emphasized because these therapies are used most commonly in the liver. Applications in pulmonary, renal, and bone tumors were also discussed. These approaches were divided into catheter-based therapies (such as transcatheter arterial chemoembolization, bland embolization, and the most recent transcatheter arterial approach with drug-eluting microspheres), ablative therapies (such as chemical [ethanol or acetic acid injection]), and thermal ablative therapies (such as radiofrequency ablation, laser induced thermotherapy, microwave ablation, cryoablation, and extracorporeal high-intensity focused ultrasound ablation). A brief description of each technique and analysis of available data was reported for all therapies. Locoregional transcatheter and ablative therapies continue to be used mostly for palliation, but have also been used with curative intent. A growing body of evidence suggests clear survival benefit, excellent results regarding local tumor control, and improved quality of life. Clinical trials are underway to validate these results. Image-guided transcatheter and ablative approaches currently play an important role in the management of patients with various types of cancer-a role that is likely to grow even more given the technological advances in imaging, image-guidance systems, catheters, ablative tools, and drug delivery systems. As a result, the outcomes of patients with cancer undoubtedly will improve.
Collapse
Affiliation(s)
- Eleni Liapi
- The Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | | |
Collapse
|
18
|
Yu NC, Lu DSK, Raman SS, Dupuy DE, Simon CJ, Lassman C, Aswad BI, Ianniti D, Busuttil RW. Hepatocellular carcinoma: microwave ablation with multiple straight and loop antenna clusters--pilot comparison with pathologic findings. Radiology 2006; 239:269-75. [PMID: 16493013 DOI: 10.1148/radiol.2383041592] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate the clinical implementation of triangular and spherical designs for simultaneous multiple-antenna ablation of human hepatocellular carcinoma (HCC) with a recently engineered microwave coagulation system. Institutional review board approval and informed consent were obtained, and the study was compliant with HIPAA requirements. Nine patients (five men, four women; age range, 53-79 years; mean age, 66.2 years) with resectable HCC (diameter, 2.9-6.0 cm; mean, 4.2 cm) underwent intraoperative ultrasonography-guided tumor ablation followed by resection and pathologic examination. Standard single-straight (n = 2), triangular triple-straight (n = 4), and spherical triple-loop (n = 3) antenna configurations produced mean estimated coagulation volumes of 16.7, 51.7, and 54.3 cm(3), respectively, during a single concurrent 5-10-minute ablation cycle. The triple-loop configuration yielded the most uniformly round ablation shape. Simultaneous activation of multiple straight or loop antennae is a potentially promising technique for rapid and effective treatment of large HCCs.
Collapse
Affiliation(s)
- Nam C Yu
- Departments of Radiological Sciences, Pathology, and Surgery, David Geffen School of Medicine at UCLA, BR-158 CHS, Box 951721, 10833 Le Conte Ave, Los Angeles, CA 90095-1721, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Wu F, Wang ZB, Zhu H, Chen WZ, Zou JZ, Bai J, Li KQ, Jin CB, Xie FL, Su HB. Feasibility of US-guided high-intensity focused ultrasound treatment in patients with advanced pancreatic cancer: initial experience. Radiology 2005; 236:1034-40. [PMID: 16055692 DOI: 10.1148/radiol.2362041105] [Citation(s) in RCA: 217] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The study was approved by the university ethics committee, and informed consent was obtained from all patients. The purpose of this study was to prospectively evaluate ultrasonographically guided high-intensity focused ultrasound in the treatment of patients with advanced-stage pancreatic cancer. Eight patients underwent high-intensity focused ultrasound ablation, and laboratory and radiologic examinations were performed after intervention. Changes in symptoms and survival time were noted at follow-up. No complications were observed, and preexisting severe back pain disappeared after intervention. Follow-up images revealed an absence of tumor blood supply and shrinkage of the ablated tumor. Four patients died, and four patients were alive at the time of this writing, with a median survival time of 11.25 months. The authors conclude that high-intensity focused ultrasound ablation is safe and feasible in the treatment of advanced pancreatic cancer.
Collapse
Affiliation(s)
- Feng Wu
- Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of 2nd Affiliated Hospital, Chongqing University of Medical Sciences, 1 Medical College Road, Box 153, Chongqing 400016, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Wu F, Wang ZB, Chen WZ, Zhu H, Bai J, Zou JZ, Li KQ, Jin CB, Xie FL, Su HB. Extracorporeal high intensity focused ultrasound ablation in the treatment of patients with large hepatocellular carcinoma. Ann Surg Oncol 2004; 11:1061-9. [PMID: 15545506 DOI: 10.1245/aso.2004.02.026] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND High intensity focused ultrasound (HIFU) is a noninvasive treatment modality that induces complete coagulative necrosis of a deep tumor through the intact skin. The current study was conducted to determine the safety, efficacy, and feasibility of extracorporeal HIFU in the treatment of patients with hepatocellular carcinoma (HCC). METHODS A total of 55 patients with HCC with cirrhosis were enrolled in this prospective, nonrandomized clinical trial. Among them, 51 patients had unresectable HCC. Tumor size ranged from 4 to 14 cm in diameter with mean diameter of 8.14 cm. According to tumor, node, metastasis (TNM) classification, 15 patients corresponded to stage II, 16 to stage IIIA, and 24 to IIIC. All patients had HIFU, and the median number of HIFU session was 1.69. Safety and efficacy of HIFU were assessed in this trial. RESULTS No severe side effect was observed in the patients treated with HIFU. Follow-up imaging showed an absence of tumor vascular supply and the shrinkage of treated lesions. Serum alpha-fetoprotein returned to normal level in 34% of patients. The overall survival rates at 6, 12, and 18 months were 86.1%, 61.5%, and 35.3%, respectively. The survival rates were significantly higher in patients in stage II than those in stage IIIA (P = .0132) and in stage IIIC (P = .0265). CONCLUSION As a noninvasive therapy, HIFU appears to be effective, safe, and feasible in the treatment of patients with HCC. It may play an important role in the ablation of large tumors.
Collapse
Affiliation(s)
- Feng Wu
- Institute of Ultrasonic Engineering in Medicine and Clinical Center for Tumor Therapy of 2nd Affiliated Hospital, Chongqing University of Medical Sciences, Chongqing, China.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Xu HX, Xie XY, Lu MD, Chen JW, Yin XY, Xu ZF, Liu GJ. Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation. Clin Radiol 2004; 59:53-61. [PMID: 14697375 DOI: 10.1016/j.crad.2003.09.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours</=2.0, 2.1-3.9 and >/=4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours</=2.0, 2.1-3.9 and >/=4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.
Collapse
Affiliation(s)
- H-X Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
23
|
Deng XD, Shen YZ, Huang M, Yan Y, Sun Q. Contrast-enhanced Doppler Ultrasound for Guiding Percutaneous Microwave Ablation of Hepatocellular Carcinoma: A Report of 32 Cases. J Med Ultrasound 2004. [DOI: 10.1016/s0929-6441(09)60068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
24
|
Teague BD, Court FG, Morrison CP, Kho M, Wemyss-Holden SA, Maddern GJ. Electrolytic liver ablation is not associated with evidence of a systemic inflammatory response syndrome. Br J Surg 2003; 91:178-83. [PMID: 14760665 DOI: 10.1002/bjs.4400] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Local ablation has been proposed for treatment of liver tumours. Cryoshock, a variant of the systemic inflammatory response syndrome (SIRS), is a potentially fatal complication of cryoablation caused by systemic release of necrotic breakdown products from ablated liver. The proinflammatory cytokines tissue necrosis factor (TNF) α and interleukin (IL) 1 are important mediators of this response. This study assessed the risk of SIRS complicating electrolytic liver ablation by measuring circulating levels of inflammatory cytokines, other inflammatory markers and clinical markers of organ function.
Methods
Electrolytic liver ablation was performed in 16 pigs and four pigs served as controls. Platelet count, and serum levels of urea, creatinine, liver enzymes, C-reactive protein (CRP), TNF-α and IL-1β were measured before treatment and for 72 h after the procedure.
Results
There were significant dose-related increases in CRP and alanine aminotransferase levels with liver electrolysis. There was no significant derangement in renal function or platelet count following ablation. A rise in serum TNF-α and IL-1β levels was not associated with liver electrolysis.
Conclusion
There was no evidence of organ failure or significantly raised levels of proinflammatory cytokines as a result of liver electrolysis, suggesting that this is a safe procedure for liver ablation.
Collapse
Affiliation(s)
- B D Teague
- University of Adelaide Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville, South Australia 5011, Australia
| | | | | | | | | | | |
Collapse
|
25
|
Garcea G, Lloyd TD, Aylott C, Maddern G, Berry DP. The emergent role of focal liver ablation techniques in the treatment of primary and secondary liver tumours. Eur J Cancer 2003; 39:2150-64. [PMID: 14522372 DOI: 10.1016/s0959-8049(03)00553-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Only 20% of patients with primary or secondary liver tumours are suitable for resection because of extrahepatic disease or the anatomical distribution of their disease. These patients could be treated by ablation of the tumour, thus preserving functioning liver. This study presents a detailed review of established and experimental ablation procedures. The relative merits of each technique will be discussed and clinical data regarding the efficacy of the techniques evaluated. A literature search from 1966 to 2003 was undertaken using Medline, Pubmed and Web of Science databases. Keywords were Hepatocellular carcinoma, liver metastases, percutaneous ethanol injection, cryotherapy, microwave coagulation therapy, radiofrequency ablation, interstitial laser photocoagulation, focused high-intensity ultrasound, hot saline injection, electrolysis and acetic acid injection. Ablative techniques offer a promising therapeutic modality to treat unresectable tumours. Large-scale randomised controlled trials are required before widespread acceptance of these techniques can occur.
Collapse
Affiliation(s)
- G Garcea
- Department of Hepatobiliary Surgery, The Leicester General Hospital, Gwendolen Road, Leicester LE2 7LX, UK.
| | | | | | | | | |
Collapse
|
26
|
Liang P, Dong B, Yu X, Yang Y, Yu D, Su L, Xiao Q, Sheng L. Prognostic Factors for Percutaneous Microwave Coagulation Therapy of Hepatic Metastases. AJR Am J Roentgenol 2003; 181:1319-25. [PMID: 14573427 DOI: 10.2214/ajr.181.5.1811319] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Microwave-induced tissue coagulation is a new approach for the local ablation of hepatic metastases. The purposes of the study were to analyze therapeutic results and those influencing factors that might be used to predict survival after percutaneous microwave coagulation therapy. SUBJECTS AND METHODS. From July 1995 to March 2002, 74 patients with 149 hepatic metastases were treated with percutaneous microwave coagulation therapy under sonographic guidance. The largest metastasis in each patient ranged from 0.7 to 6.8 cm (mean, 3.12 cm; SD, 1.81 cm). Survival rates and influencing factors were analyzed. RESULTS The cumulative survival rates of all 74 patients were 91.4% at 1 year, 59.5% at 2 years, 46.4% at 3 years, 29% at 4 years, and 29% at 5 years. Patient age (p = 0.46) and sex (p = 0.12) and site of primary malignancies (p = 0.58) were not related to prognosis, whereas tumor grade (p = 0.01), number of metastases (p = 0.00), tumor size (p = 0.03), and local recurrence or new metastasis (p = 0.00) significantly affected survival as single independent factors. Multivariate analysis revealed that tumor grade (p = 0.03), number of metastases (p = 0.025), and local recurrence or new metastasis (p = 0.04) each had a significant effect on survival. No severe complications occurred. CONCLUSION The probability of long-term survival for patients with one or two metastases, well-differentiated tumors, and without recurrence or new metastasis may be significantly higher than for other patients.
Collapse
Affiliation(s)
- Ping Liang
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing, 100853 China
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Dong B, Liang P, Yu X, Su L, Yu D, Cheng Z, Zhang J. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients. AJR Am J Roentgenol 2003; 180:1547-55. [PMID: 12760916 DOI: 10.2214/ajr.180.6.1801547] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the long-term results of percutaneous microwave coagulation therapy for the treatment of hepatocellular carcinoma in a large patient population. SUBJECTS AND METHODS Survival rates were determined in 234 patients with 339 nodules of hepatocellular carcinoma who had undergone percutaneous microwave coagulation therapy (208 men, 26 women; mean age, 54.8 years; mean tumor size, 4.1 +/- 1.9 cm; range, 1.2-8.0 cm; mean follow-up period, 27.9 months). Patients were those who had been rejected as candidates for surgery by the surgery department, who fit our study's criteria, and who agreed to participate. After baseline imaging studies were performed, the patients were followed up using the same combination of imaging (sonography, CT, or MR imaging) and posttreatment biopsy. RESULTS After percutaneous microwave coagulation therapy, color Doppler flow signals disappeared in 92.0% (263/286) of the lesions. No enhancement was apparent in 89.2% (190/213) and 89.1% (41/46) of the lesions on contrast-enhanced CT and MR imaging, respectively. Posttreatment biopsies of 194 nodules showed no evidence of surviving tumor tissue in 180 nodules (92.8%). Resections of six lesions revealed complete tumor necrosis in five. The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates were 92.70%, 81.60%, 72.85%, 66.37%, and 56.70%, respectively. The relationships between survival curves and the degree of hepatocellular carcinoma tumor differentiation and between survival curves and tumor size were statistically significant (p = 0.021). No severe complications were seen. CONCLUSION Sonographically guided microwave coagulation proved to be safe and effective for the treatment of hepatocellular carcinoma. This therapy resulted in a high percentage of cases without evidence of residual tumor and satisfactory long-term results.
Collapse
Affiliation(s)
- Baowei Dong
- Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Rd., Beijing, 100853 China
| | | | | | | | | | | | | |
Collapse
|
28
|
Ng KKC, Lam CM, Poon RTP, Ai V, Tso WK, Fan ST. Thermal ablative therapy for malignant liver tumors: a critical appraisal. J Gastroenterol Hepatol 2003; 18:616-29. [PMID: 12753142 DOI: 10.1046/j.1440-1746.2003.02991.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The management of primary and secondary malignant liver tumors poses a great challenge to clinicians. Although surgical resection is the gold-standard treatment, most patients have unresectable malignant liver tumors. Over the past decade, various modalities of loco-regional therapy have gained much interest. Among them, thermal ablative therapy, including cryotherapy, microwave coagulation, interstitial laser therapy, and radiofrequency ablation (RFA), have been proven to be safe and effective. Despite the effective tumor eradication achieved within cryotherapy, the underlying freeze/thaw mechanism has resulted in serious complications that include bleeding from liver cracking and the 'cryoshock' phenomenon. Thermal ablation using microwave and laser therapy for malignant liver tumors is curative and is associated with minimal complications. However, this treatment modality is effective only for tumors <3 cm diameter. Radiofrequency ablation seems to be the most promising form of thermal ablative therapy in terms of a lower complication rate and a larger volume of ablation. However, its use is restricted by the difficulty encountered when using imaging studies to monitor the areas of ablation during and after the procedure. Moreover, the techniques of RFA need to be refined in order to achieve the same oncological radicality of malignant liver tumors as achieved by surgical resection. As each of the loco-regional therapies has its own advantages and limitations, a multidisciplinary approach using a combination of therapies will be the future trend for the management of malignant liver tumors.
Collapse
Affiliation(s)
- Kelvin Kwok-Chai Ng
- Departments of Surgery, Centre for the Study of Liver Disease, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | | | | | | | | | | |
Collapse
|
29
|
Wright AS, Lee FT, Mahvi DM. Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis. Ann Surg Oncol 2003; 10:275-83. [PMID: 12679313 DOI: 10.1245/aso.2003.03.045] [Citation(s) in RCA: 258] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Microwave ablation is a promising treatment for unresectable liver tumors. Unlike radiofrequency ablation, microwave ablation may be performed with multiple simultaneously active antennae. METHODS Microwave ablation was performed in an in vivo porcine liver model by using a single antenna (n = 11) or three antennae in a triangular array, activated either sequentially (n = 11) or simultaneously (n = 13). Lesions were measured and assigned a qualitative shape score. RESULTS Single-antenna microwave lesions had a mean volume of 7.4 +/- 3.9 cm(3), compared with 14.6 +/- 5.2 cm(3) and 43.1 +/- 4.3 cm(3) for sequential and simultaneous multiple-probe ablations, respectively (P <.001; analysis of variance). Simultaneous lesions were rounder than sequential ablations and were more effective near blood vessels. Simultaneous lesions created with probe separation of < or =1.7 cm were round and confluent, whereas clefts were present with distances >1.7 cm (P <.001). CONCLUSIONS Microwave ablation has several theoretical advantages over currently available radiofrequency devices. Simultaneous three-probe microwave ablation lesions were three times larger than sequential lesions and nearly six times greater in volume than single-probe lesions. Additionally, simultaneous multiple-probe ablation results in qualitatively better lesions, with more uniform coagulation and better performance near blood vessels. Simultaneous multiple-probe ablation may decrease inadequate treatment of large tumors and decrease recurrence rates after tumor ablation.
Collapse
Affiliation(s)
- Andrew S Wright
- Department of Surgery, University of Wisconsin Medical School, Madison, Wisconsin, USA
| | | | | |
Collapse
|
30
|
Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003. [PMID: 12560774 DOI: 10.1097/00000658-200302000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.
Collapse
Affiliation(s)
- W Y Lau
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | | | | | | |
Collapse
|
31
|
Abstract
BACKGROUND Most patients with liver tumours are not suitable for surgery but interstitial ablative techniques may control disease progression and improve survival rates. METHODS A review was undertaken using Medline of all reported studies of cryoablation, radiofrequency ablation, microwave ablation, interstitial laser photocoagulation, high-intensity focused ultrasound and ethanol ablation of primary liver tumours and hepatic metastases. RESULTS Although there are no randomized clinical trials, cryoablation, thermal ablation and ethanol ablation have all been shown to be associated with improved palliation in patients with primary and secondary liver cancer. The techniques can be undertaken safely with minimal morbidity and mortality. CONCLUSION Although surgical resection remains the first line of treatment for selected patients with primary and secondary liver malignancies, interstitial ablative techniques are promising therapies for patients not suitable for hepatic resection or as an adjunct to liver surgery.
Collapse
Affiliation(s)
- C Erce
- Department of Clinical and Surgical Sciences (Surgery), University of Edinburgh, Edinburgh, UK
| | | |
Collapse
|
32
|
Lau WY, Leung TWT, Yu SCH, Ho SKW. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg 2003; 237:171-9. [PMID: 12560774 PMCID: PMC1522146 DOI: 10.1097/01.sla.0000048443.71734.bf] [Citation(s) in RCA: 187] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review and compare treatment result for percutaneous local ablative therapy (PLAT) with surgical resection in the treatment of small hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA PLAT is indicated for small unresectable HCC localized to the liver. From the use of ethanol to the latest technology of radiofrequency ablation, ablative techniques have been refined and their role in the management of HCC established. This review aims to give an overview of various ablative methods, including their efficacy, indications, and limitations, and also tries to look into the future of clinical trials in PLAT. METHODS The authors reviewed recent papers in the English medical literature about the use of local ablative therapy for HCC. Focus was given to the results of treatment in terms of local control, progression-free survival, and overall survival, and to compare treatment results with those of surgery. RESULTS PLAT for small HCC (<5 cm) with thermal ablation (radiofrequency ablation or microwave coagulation) can achieve effective local control of disease and is superior to ethanol injection. Progressive disease in untreated areas is a common reason for failure. Overall progression-free survival is similar to that of surgical resection. CONCLUSIONS Thermal ablation gives good local control of small HCC, is superior to ethanol, and may be comparable to surgical resection in long-term outcome.
Collapse
Affiliation(s)
- W Y Lau
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | | | | | | |
Collapse
|
33
|
Abstract
Minimally invasive therapies are gaining increasing attention as an alternative to standard surgical therapies in the treatment of primary hepatocellular carcinoma. These include therapies administered transcatheterally (arterial embolization, intraarterial chemoinfusion, and combination chemoembolization) and percutaneously (chemical ablation with ethanol or acetic acid, and thermal ablation with radiofrequency, microwave, or laser energies). Benefits over surgical resection include the anticipated reduction in morbidity and mortality, low cost, suitability for real time image guidance, the ability to perform ablative procedures on outpatients, and the potential application in a wider spectrum of patients, including nonsurgical candidates. This review examines reported clinical success, potential complications, current limitations, and future directions of development of chemoembolization, ethanol and acetic acid instillation, and radiofrequency, microwave, and laser thermal ablation.
Collapse
Affiliation(s)
- S Nahum Goldberg
- Minimally Invasive Tumor Therapy Laboratory, Department of Radiology, Beth Israel Deaconess medical Center, Harvard Medical School, Boston Massachusetts 02215, USA.
| | | |
Collapse
|
34
|
Abstract
Thermal ablation strategies, including the use of radiofrequency, microwaves, lasers, and high-intensity focused ultrasound, are gaining increasing attention as an alternative to standard surgical therapies in the treatment of primary hepatocellular carcinoma. Benefits over surgical resection include the anticipated reduction in morbidity and mortality, low cost, suitability for real-time imaging guidance, ability to perform ablative procedures on an outpatient basis, and the potential application in a wider spectrum of patients-including those who are not surgical candidates. In this review, the authors examine the reported clinical success of each of these four therapies, potential complications, current limitations, and future directions of development.
Collapse
Affiliation(s)
- Muneeb Ahmed
- Minimally Invasive Tumor Therapy Laboratory, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | | |
Collapse
|
35
|
Abstract
Intraoperative magnetic resonance imaging (iMRI) is a new development in medicine that bridges the specialties of surgery and radiology. Deficiencies in the visualization of anatomical architecture and the perception of tumour boundaries in conventional open surgery have led to the integration of imaging within surgery. The superior soft tissue and multiplanar imaging features of magnetic resonance (MR) make this imaging modality superior to that of alternatives. The unique properties of MR to detect heat change and perfusion, and diffusion characteristics of tissue enhance the usefulness of this medium. Concurrent developments in computer aided image guidance and thermoablative technology, herald the era of minimally invasive tumour ablation. Applications have been developed for areas such as neurosurgery, general surgery, gynaecology and urology.
Collapse
Affiliation(s)
- Laurence Gluch
- Magnetic Resonance Therapy Unit, Brigham and Womens' Hospital, Boston, Massachusetts, USA.
| | | |
Collapse
|
36
|
Teague BD, Wemyss-Holden SA, Fosh BG, Dennison AR, Maddern GJ. Electrolysis and other local ablative treatments for non-resectable colorectal liver metastases. ANZ J Surg 2002; 72:137-41. [PMID: 12074066 DOI: 10.1046/j.1445-2197.2002.02326.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The present paper is a review of the current ablative treatment options for the treatment of colorectal liver metastases. Cryotherapy, microwave coagulation therapy, radiofrequency ablation and laser-induced thermotherapy are discussed. Electrolysis, a novel non-thermal ablative treatment, is described. Potential benefits of electrolysis include the apparent ability to safely and effectively treat lesions abutting major hepatic structures and the lack of a systemic inflammatory reaction following electrolytic ablation. Further studies in animals and humans are needed to confirm this potential and to further refine the methods of electrolytic treatment of colorectal liver metastases.
Collapse
Affiliation(s)
- Benjamin D Teague
- Adelaide University Department of Surgery, The Queen Elizabeth Hospital, South Australia, Australia
| | | | | | | | | |
Collapse
|
37
|
|
38
|
Lu MD, Chen JW, Xie XY, Liu L, Huang XQ, Liang LJ, Huang JF. Hepatocellular carcinoma: US-guided percutaneous microwave coagulation therapy. Radiology 2001; 221:167-72. [PMID: 11568335 DOI: 10.1148/radiol.2211001783] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the use of percutaneous microwave coagulation therapy for hepatocellular carcinoma, particularly with tumor nodules larger than 2 cm in diameter. MATERIALS AND METHODS Fifty patients with 107 hepatocellular carcinoma nodules (mean diameter, 2.7 cm +/- 1.5 [SD]; range, 0.8-6.4 cm) were treated with percutaneous microwave coagulation therapy. Single electrode insertion was used in 46 nodules (43.0%) 2 cm or smaller, whereas multiple electrode insertion was applied in 61 (57.0%) nodules larger than 2 cm. RESULTS At 1 month after therapy, technical success for tumors 2 cm or smaller and those larger than 2 cm was achieved in 45 (98%) and 56 (92%) nodules, respectively. After follow-up of 9 months or longer, local recurrence was found in one nodule (2%) sized 1.8 cm and in five nodules (8%) larger than 2 cm. At the end of the study, 26 (52%) of 50 patients were free of disease, and disease-free survival rates at 1 and 2 years were 55% and 41%, respectively. Overall survival rates at 1, 2, and 3 years were 96%, 83%, and 73%, respectively. CONCLUSION Percutaneous microwave coagulation therapy is an effective and safe therapeutic modality for hepatocellular carcinoma. A multiple electrode insertion technique can enhance the effectiveness of this therapy in tumors 6 cm or smaller.
Collapse
Affiliation(s)
- M D Lu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Sun Yat-sen University of Medical Sciences, 2 Zhongshan Rd, Guangzhou, People's Republic of China.
| | | | | | | | | | | | | |
Collapse
|
39
|
Toyota N, Keller FS, Naito A, Ito K, Ono E, Fujitaka T. Re: CT-guided microwave coagulation therapy with needle guidance for hepatocellular carcinoma. Cardiovasc Intervent Radiol 2001; 24:288-9. [PMID: 11779024 DOI: 10.1007/s00270-001-0024-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Takamura M, Murakami T, Shibata T, Ishida T, Niinobu T, Kawata S, Shimizu J, Kim T, Monden M, Nakamura H. Microwave coagulation therapy with interruption of hepatic blood in- or outflow: an experimental study. J Vasc Interv Radiol 2001; 12:619-22. [PMID: 11340142 DOI: 10.1016/s1051-0443(07)61487-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To determine how interruption of hepatic blood in- or outflow affects the coagulation diameter of microwave coagulation therapy (MCT) in the liver. MATERIALS AND METHODS Laparotomic MCT at 60 W for 1 minute was performed in 11 Landrace pigs. MCT was performed under six different conditions: without occlusion (Group N; in seven lobes of seven pigs); with occlusion of the hepatic artery (Group A; in five lobes of five pigs); with occlusion of the portal vein (Group P; in five lobes of five pigs); with occlusion of the hepatic artery and portal vein (Group AP; in six lobes of six pigs); with occlusion of the hepatic vein (Group V; in five lobes of four pigs); and with occlusion of the hepatic artery and vein (Group AV; in seven lobes of seven pigs). The maximum diameters for each group were compared. RESULTS The coagulation diameters (mean +/- SD) were 8.5 mm +/- 2.0, 10.0 mm +/- 1.6, 14.3 mm +/- 2.5, 14.4 mm +/- 2.4, 13.0 mm +/- 0.8, and 14.4 mm +/- 1.5 for Groups N, A, P, AP, V, and AV, respectively. The coagulation diameters for groups P, AP, V, and AV were statistically larger than those for groups N and A (P < .05). There was no significant difference between the coagulation diameters of Groups P, AP, V, and AV. CONCLUSION The coagulation diameter depends mainly on the portal venous flow. In addition of direct interruption of the portal vein, interruption of the hepatic vein can also result in a substantial increase in the coagulation diameter.
Collapse
Affiliation(s)
- M Takamura
- Department of Radiology, Osaka University Medical School, Suita City, Osaka, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Deardorff DL, Diederich CJ, Nau WH. Control of interstitial thermal coagulation: comparative evaluation of microwave and ultrasound applicators. Med Phys 2001; 28:104-17. [PMID: 11213915 DOI: 10.1118/1.1334606] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study presents a comparative evaluation of the control of heating and thermal coagulation with microwave (MW) and ultrasound (US) interstitial applicators. Helical coil MW antennas (17 mm and 25 mm length radiating antennae) were tested using an external implant catheter (2.2 mm o.d.) with water-cooling. US applicators with tubular transducers (2.2 and 2.5 mm o.d., 10 mm length, single-element and 3-element) were utilized with a direct-coupled configuration and internal water-cooling. Measurements of E-field distributions (for MW) and acoustic beam distributions (for US) were used to characterize the applicator energy output. Thermal performance was evaluated through multiple heating trials in vitro (bovine liver) and in vivo (porcine thigh muscle and liver) at varied levels of applied power (20-40 W for microwave, 15-35 W for ultrasound) and heating times (0.5-5 min). Axial temperature distributions in the tissue were recorded during heating, and dimensions of the resulting lesions of thermal coagulation were measured. Both MW and US applicators produced large volumes of tissue coagulation ranging from 8 to 20 cm3 with singular heating times of 5 min. Radial depth of lesions for both MW and US applicators increased with heating duration and power levels, though US produced notably larger lesion diameters (30-42 mm for US vs 18-26 mm for MW, 5 min heating). Characteristic differences between the applicators were observed in axial energy distribution, tissue temperatures, and thermal lesion shapes. MW lesions increased significantly in axial dimensions (beyond the active applicator length) as applied power level and/or heating duration was increased, and lesion shapes were generally not uniform. US provided greater control and uniformity of heating, with energy deposition and axial extent of thermal lesions corresponding to the length of the active transducer(s). The improved ability to control the extent of thermal coagulation demonstrated by the US applicators provides greater potential to target a specific region of tissue.
Collapse
Affiliation(s)
- D L Deardorff
- Radiation Oncology Department, University of California, San Francisco 94143, USA
| | | | | |
Collapse
|
42
|
Hyodoh H, Furuse M, Kawamoto C, Isoda N, Ido K, Saito K. Microwave coagulation therapy: ex vivo comparison of MR imaging and histopathology. J Magn Reson Imaging 2000; 11:168-73. [PMID: 10713950 DOI: 10.1002/(sici)1522-2586(200002)11:2<168::aid-jmri14>3.0.co;2-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We compared the findings of magnetic resonance (MR) images and pathological examination to determine whether or not MR images reflect pathological changes following microwave coagulation therapy (MCT) on liver tissue. We used microwave (generating frequency 2450 Mhz, wave length 12 cm, output 50 W, 60 second duration) to irradiate six canine livers under general anesthesia. After the animals were sacrificed, the livers were resected. The irradiated regions were cut with margins and divided into two pieces, one for MR study, and the other for pathological examination. The findings were compared. From the center to the marginal layer, the irradiated region presented 4/3 laminal patterns on T1/T2-weighted images: low/high, high/low, very high/high, and iso-low/high intensity. On gradient-echo imaging, the irradiated regions presented no decreasing signals using several echo time lengths. With hematoxylin and eosin stain, MR laminar patterns reflected the histopathological changes, as follows: a tissue loss area surrounding the inserted needle, low/high; decreased sinusoidal width with/without necrotic tissue, high/low; sinusoidal width dilation at the periphery, very high/high; and fatty degenerated tissue surrounding the irradiated area at the boundary of the normal hepatocytes, iso-low/high. The MR signal intensity, which reflected the histopathological changes, presented tissue characterization after MCT, and the macromolecular hydration effect influenced the high intensity on T1-weighted images.
Collapse
Affiliation(s)
- H Hyodoh
- Department of Radiology, Jichi Medical School, Tochigi, Japan
| | | | | | | | | | | |
Collapse
|
43
|
Dodd GD, Soulen MC, Kane RA, Livraghi T, Lees WR, Yamashita Y, Gillams AR, Karahan OI, Rhim H. Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthrough. Radiographics 2000; 20:9-27. [PMID: 10682768 DOI: 10.1148/radiographics.20.1.g00ja019] [Citation(s) in RCA: 460] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Six existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumor.
Collapse
Affiliation(s)
- G D Dodd
- Department of Radiology, University of Texas Health Science Center at San Antonio, 78284-7800, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Mortensen MB. The role of gastrointestinal endosonography in diagnostic and therapeutic interventional procedures. EUROPEAN JOURNAL OF ULTRASOUND : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY 1999; 10:93-104. [PMID: 10586014 DOI: 10.1016/s0929-8266(99)00057-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past 15 years endoscopic ultrasonography (EUS) has become an integrated part of gastrointestinal imaging. The more recent development of echoendoscopes and needles for EUS guided fine needle aspiration has stimulated the interest in interventional EUS procedures, both for diagnostic and therapeutic purposes. This paper describes the technique and experience with some of the interventional EUS procedures based on the present literature. Many of the techniques must still be considered experimental and will need substantial clinical testing in larger series before any final conclusions can be made. However, the present level of interventional EUS seems to indicate, that some of these techniques could be cost-effective alternatives in specific clinical situations, and in some cases even the only possible theraputic action. Future research in interventional EUS should be concentrated in experienced endosonography centers under careful monitoring of complications and clinical outcome.
Collapse
Affiliation(s)
- M B Mortensen
- Center for Advanced Endoscopic and Intraoperative Ultrasonography, Department of Surgical Gastroenterology, Odense University Hospital, Sdr Boulevard 29, 5000, Odense, Denmark
| |
Collapse
|