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Lei S, He J, Gao P, Wang Y, Hui H, An Y, Tian J. Magnetic Particle Imaging-Guided Hyperthermia for Precise Treatment of Cancer: Review, Challenges, and Prospects. Mol Imaging Biol 2023; 25:1020-1033. [PMID: 37789103 DOI: 10.1007/s11307-023-01856-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023]
Abstract
Magnetic particle imaging (MPI) is a novel quantitative imaging technique using the nonlinear magnetization behavior of magnetic nanoparticles (MNPs) to determine their local concentration. Magnetic fluid hyperthermia (MFH) is a promising non-invasive therapy using the heating effects of MNPs. MPI-MFH is expected to enable real-time MPI guidance, localized MFH, and non-invasive temperature monitoring, which shows great potential for precise treatment of cancer. In this review, we introduce the fundamentals of MPI and MFH and their applications in the treatment of cancer. Also, we discuss the challenges and prospects of MPI-MFH.
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Affiliation(s)
- Siao Lei
- School of Engineering Medicine & School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, Beijing, 100191, People's Republic of China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Jie He
- School of Engineering Medicine & School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, Beijing, 100191, People's Republic of China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Pengli Gao
- School of Engineering Medicine & School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, Beijing, 100191, People's Republic of China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Yueqi Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Hui Hui
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China
| | - Yu An
- School of Engineering Medicine & School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, Beijing, 100191, People's Republic of China.
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.
| | - Jie Tian
- School of Engineering Medicine & School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of the People's Republic of China, Beijing, 100191, People's Republic of China.
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.
- Zhuhai Precision Medical Center, Zhuhai People's Hospital, Affiliated With Jinan University, Zhuhai, 519000, China.
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Herold Z, Szasz AM, Dank M. Evidence based tools to improve efficiency of currently administered oncotherapies for tumors of the hepatopancreatobiliary system. World J Gastrointest Oncol 2021; 13:1109-1120. [PMID: 34616516 PMCID: PMC8465447 DOI: 10.4251/wjgo.v13.i9.1109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/29/2021] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatopancreatobiliary tumors are challenging to treat, and the advanced or metastatic forms have a very low 5-year survival rate. Several drug combinations have been tested, and new therapeutic approaches have been introduced in the last decades, including radiofrequency and heat based methods. Hyperthermia is the artificial heating of tumors by various biophysical methods that may possess immunostimulant, tumoricidal, and chemoradiotherapy sensitizer effects. Both whole-body and regional hyperthermia studies have been conducted since the 1980s after the introduction of deep-seated tumor hyperthermia techniques. Results of the effects of hyperthermia in hepatocellular and pancreatic cancer are known from several studies. Hyperthermia in biliary cancers is a less investigated area. High local and overall responses to treatment, increased progression-free and overall survival, and improved laboratory and quality-of-life results are associated with hyperthermia in all three tumor types. With the evolution of chemotherapeutic agents and the introduction of newer techniques, the combination of adjuvant hyperthermia with those therapies is advantageous and has not been associated with an increase in alarming adverse effects. However, despite the many positive effects of hyperthermia, its use is still only known at the experimental level, and its concomitant utilization in routine cancer treatment is not certain because of the lack of thorough clinical studies.
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Affiliation(s)
- Zoltan Herold
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest H-1083, Hungary
| | - A Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest H-1083, Hungary
| | - Magdolna Dank
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest H-1083, Hungary
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Kok HP, Cressman ENK, Ceelen W, Brace CL, Ivkov R, Grüll H, Ter Haar G, Wust P, Crezee J. Heating technology for malignant tumors: a review. Int J Hyperthermia 2021; 37:711-741. [PMID: 32579419 DOI: 10.1080/02656736.2020.1779357] [Citation(s) in RCA: 132] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 °C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 °C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.
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Affiliation(s)
- H Petra Kok
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Erik N K Cressman
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wim Ceelen
- Department of GI Surgery, Ghent University Hospital, Ghent, Belgium
| | - Christopher L Brace
- Department of Radiology and Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Mechanical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Materials Science and Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Holger Grüll
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Gail Ter Haar
- Department of Physics, The Institute of Cancer Research, London, UK
| | - Peter Wust
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Crezee
- Department of Radiation Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Lee SY, Fiorentini G, Szasz AM, Szigeti G, Szasz A, Minnaar CA. Quo Vadis Oncological Hyperthermia (2020)? Front Oncol 2020; 10:1690. [PMID: 33014841 PMCID: PMC7499808 DOI: 10.3389/fonc.2020.01690] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022] Open
Abstract
Heating as a medical intervention in cancer treatment is an ancient approach, but effective deep heating techniques are lacking in modern practice. The use of electromagnetic interactions has enabled the development of more reliable local-regional hyperthermia (LRHT) techniques whole-body hyperthermia (WBH) techniques. Contrary to the relatively simple physical-physiological concepts behind hyperthermia, its development was not steady, and it has gone through periods of failures and renewals with mixed views on the benefits of heating seen in the medical community over the decades. In this review we study in detail the various techniques currently available and describe challenges and trends of oncological hyperthermia from a new perspective. Our aim is to describe what we believe to be a new and effective approach to oncologic hyperthermia, and a change in the paradigm of dosing. Physiological limits restrict the application of WBH which has moved toward the mild temperature range, targeting immune support. LRHT does not have a temperature limit in the tumor (which can be burned out in extreme conditions) but a trend has started toward milder temperatures with immune-oriented goals, developing toward immune modulation, and especially toward tumor-specific immune reactions by which LRHT seeks to target the malignancy systemically. The emerging research of bystander and abscopal effects, in both laboratory investigations and clinical applications, has been intensified. Our present review summarizes the methods and results, and discusses the trends of hyperthermia in oncology.
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Affiliation(s)
- Sun-Young Lee
- Department of Radiation Oncology, Chonbuk National University Hospital, Jeonbuk, South Korea
| | | | - Attila Marcell Szasz
- Division of Oncology, Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Gyula Szigeti
- Innovation Center, Semmelweis University, Budapest, Hungary
| | - Andras Szasz
- Biotechnics Department, St. Istvan University, Godollo, Hungary
| | - Carrie Anne Minnaar
- Department of Radiation Oncology, Wits Donald Gordon Medical Center, Johannesburg, South Africa
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The crucial role of macromolecular engineering, drug encapsulation and dilution on the thermoresponsiveness of UCST diblock copolymer nanoparticles used for hyperthermia. Eur J Pharm Biopharm 2019; 142:281-290. [PMID: 31279918 DOI: 10.1016/j.ejpb.2019.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 11/21/2022]
Abstract
Poly(acrylamide-co-acrylonitrile) (P(AAm-co-AN)), an upper critical solution temperature (UCST)-type copolymer in water, was synthesized by reversible addition fragmentation chain transfer (RAFT) copolymerization and used as a macro-RAFT agent for the polymerization of oligo(ethylene glycol) methyl ether methacrylate (OEGMA) to yield amphiphilic diblock P(AAm-co-AN)-b-POEGMA copolymer. A series of copolymers with different AN content was obtained allowing to finely tune the UCST behavior (cloud point (Tt-UCST) from 35 to 78 °C). Addition of the POEGMA block did not modify the Tt-UCST regardless its Mn but provided a lower critical solution temperature behavior at high temperature. Nanoparticles were then formulated by the nanoprecipitation technique revealing that copolymers with higher Tt-UCST yield smaller, better-defined nanoparticles. Eventually, doxorubicin (Dox) was encapsulated into nanoparticles made from the copolymer having a Tt-UCST close to mild hyperthermia (~43 °C). Surprisingly, Dox encapsulation increased Tt-UCST and gave smaller nanoparticles as opposed to their unloaded counterparts. The dilution of the suspension also led to a decrease of Tt-UCST. No obvious hyperthermia effect was observed on the cytotoxicity of Dox-loaded nanoparticles. Our study highlighted the influence of macromolecular engineering, drug encapsulation and nanoparticle dilution on UCST behavior, important features often overlooked despite their crucial impact in the development of thermosensitive nanoscale drug delivery systems.
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Transferrin as a thermosensitizer in radiofrequency hyperthermia for cancer treatment. Sci Rep 2018; 8:13505. [PMID: 30202000 PMCID: PMC6131143 DOI: 10.1038/s41598-018-31232-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/06/2018] [Indexed: 01/05/2023] Open
Abstract
One of the main characteristics of cancer tissues is poor development of neovascularization that results in a limited blood circulation. Because of this phenomenon, it is harder for cancer tissues to diffuse their elevated heat into other parts of the body. The scientific principle of radiofrequency hyperthermia relies on this quality of cancer tissues which with higher temperature becomes more apparent. Despite the obvious necessity to selectively heat the cancer tissue for radiofrequency hyperthermia, a proper thermosensitizer has not been developed until now. Here, we show that transferrin containing ferric ion could be an ideal thermosensitizer for the increased efficiency of radiofrequency hyperthermia. In our result, the ferric ion-enriched cancer tissues dramatically react with 13.56 MHz radiofrequency wave to cause cancer-selective dielectric temperature increment. The overall anticancer efficacy of a 13.56 MHz radiofrequency hyperthermia using transferrin as a thermosensitizer was much higher than the oncotherapeutic efficacy of paclitaxel, successfully eradicating cancer in a tumor-xenografted mouse experiment.
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Guérin B, Villena JF, Polimeridis AG, Adalsteinsson E, Daniel L, White JK, Rosen BR, Wald LL. Computation of ultimate SAR amplification factors for radiofrequency hyperthermia in non-uniform body models: impact of frequency and tumour location. Int J Hyperthermia 2018; 34:87-100. [PMID: 28540815 PMCID: PMC5681886 DOI: 10.1080/02656736.2017.1319077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/10/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE We introduce a method for calculation of the ultimate specific absorption rate (SAR) amplification factors (uSAF) in non-uniform body models. The uSAF is the greatest possible SAF achievable by any hyperthermia (HT) phased array for a given frequency, body model and target heating volume. METHODS First, we generate a basis-set of solutions to Maxwell's equations inside the body model. We place a large number of electric and magnetic dipoles around the body model and excite them with random amplitudes and phases. We then compute the electric fields created in the body model by these excitations using an ultra-fast volume integral solver called MARIE. We express the field pattern that maximises the SAF in the target tumour as a linear combination of these basis fields and optimise the combination weights so as to maximise SAF (concave problem). We compute the uSAFs in the Duke body models at 10 frequencies in the 20-900 MHz range and for twelve 3 cm-diameter tumours located at various depths in the head and neck. RESULTS For both shallow and deep tumours, the frequency yielding the greatest uSAF was ∼900 MHz. Since this is the greatest frequency that we simulated, we hypothesise that the globally optimal frequency is actually greater. CONCLUSIONS The uSAFs computed in this work are very large (40-100 for shallow tumours and 4-17 for deep tumours), indicating that there is a large room for improvement of the current state-of-the-art head and neck HT devices.
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Affiliation(s)
- Bastien Guérin
- a Martinos Center for Biomedical Imaging, Department of Radiology , Massachusetts General Hospital , Charlestown , MA , USA
- b Harvard Medical School , Boston , MA , USA
| | | | | | - Elfar Adalsteinsson
- e Research Laboratory of Electronics , Massachusetts Institute of Technology , Cambridge , MA , USA
- f Harvard-MIT Division of Health Sciences Technology , Cambridge , MA , USA
| | - Luca Daniel
- e Research Laboratory of Electronics , Massachusetts Institute of Technology , Cambridge , MA , USA
| | - Jacob K White
- e Research Laboratory of Electronics , Massachusetts Institute of Technology , Cambridge , MA , USA
| | - Bruce R Rosen
- a Martinos Center for Biomedical Imaging, Department of Radiology , Massachusetts General Hospital , Charlestown , MA , USA
- b Harvard Medical School , Boston , MA , USA
- f Harvard-MIT Division of Health Sciences Technology , Cambridge , MA , USA
| | - Lawrence L Wald
- a Martinos Center for Biomedical Imaging, Department of Radiology , Massachusetts General Hospital , Charlestown , MA , USA
- b Harvard Medical School , Boston , MA , USA
- f Harvard-MIT Division of Health Sciences Technology , Cambridge , MA , USA
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Hatakeyama H, Wu SY, Lyons YA, Pradeep S, Wang W, Huang Q, Court KA, Liu T, Nie S, Rodriguez-Aguayo C, Shen F, Huang Y, Hisamatsu T, Mitamura T, Jennings N, Shim J, Dorniak PL, Mangala LS, Petrillo M, Petyuk VA, Schepmoes AA, Shukla AK, Torres-Lugo M, Lee JS, Rodland KD, Fagotti A, Lopez-Berestein G, Li C, Sood AK. Role of CTGF in Sensitivity to Hyperthermia in Ovarian and Uterine Cancers. Cell Rep 2017; 17:1621-1631. [PMID: 27806300 DOI: 10.1016/j.celrep.2016.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 09/11/2016] [Accepted: 10/05/2016] [Indexed: 12/19/2022] Open
Abstract
Even though hyperthermia is a promising treatment for cancer, the relationship between specific temperatures and clinical benefits and predictors of sensitivity of cancer to hyperthermia is poorly understood. Ovarian and uterine tumors have diverse hyperthermia sensitivities. Integrative analyses of the specific gene signatures and the differences in response to hyperthermia between hyperthermia-sensitive and -resistant cancer cells identified CTGF as a key regulator of sensitivity. CTGF silencing sensitized resistant cells to hyperthermia. CTGF small interfering RNA (siRNA) treatment also sensitized resistant cancers to localized hyperthermia induced by copper sulfide nanoparticles and near-infrared laser in orthotopic ovarian cancer models. CTGF silencing aggravated energy stress induced by hyperthermia and enhanced apoptosis of hyperthermia-resistant cancers.
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Affiliation(s)
- Hiroto Hatakeyama
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Sherry Y Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Yasmin A Lyons
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Sunila Pradeep
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Wanqin Wang
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Qian Huang
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Karem A Court
- Department of Chemical Engineering, University of Puerto Rico-Mayaguez, Mayaguez, PR 00681, Puerto Rico
| | - Tao Liu
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Song Nie
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | | | - Fangrong Shen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Yan Huang
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Takeshi Hisamatsu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Takashi Mitamura
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo 060-8648, Japan
| | - Nicholas Jennings
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Jeajun Shim
- Department of Systems Biology, MDACC, Houston, TX 77030, USA
| | - Piotr L Dorniak
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA
| | - Lingegowda S Mangala
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA
| | - Marco Petrillo
- Department of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Vladislav A Petyuk
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Athena A Schepmoes
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Anil K Shukla
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Madeline Torres-Lugo
- Department of Chemical Engineering, University of Puerto Rico-Mayaguez, Mayaguez, PR 00681, Puerto Rico
| | - Ju-Seog Lee
- Department of Systems Biology, MDACC, Houston, TX 77030, USA
| | - Karin D Rodland
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, WA 99354, USA
| | - Anna Fagotti
- Department of Medicine and Surgery, Catholic University of the Sacred Heart, Rome 00168, Italy
| | - Gabriel Lopez-Berestein
- Department of Experimental Therapeutics, MDACC, Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA; Department of Cancer Biology, MDACC, Houston, TX 77030, USA
| | - Chun Li
- Department of Cancer Systems Imaging, MDACC, Houston, TX 77030, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center (MDACC), Houston, TX 77030, USA; Center for RNA Interference and Non-Coding RNAs, MDACC, Houston, TX 77030, USA; Department of Cancer Biology, MDACC, Houston, TX 77030, USA.
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Ho JC, Nguyen L, Law JJ, Ware MJ, Keshishian V, Lara NC, Nguyen T, Curley SA, Corr SJ. Non-Invasive Radiofrequency Field Treatment to Produce Hepatic Hyperthermia: Efficacy and Safety in Swine. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2017; 5:1500109. [PMID: 28507824 PMCID: PMC5411244 DOI: 10.1109/jtehm.2017.2672965] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/29/2016] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
Abstract
The Kanzius non-invasive radio-frequency hyperthermia system (KNiRFH) has been investigated as a treatment option for hepatic hyperthermia cancer therapy. The treatment involves exposing the patient to an external high-power RF (13.56 MHz) electric field, whereby the propagating waves penetrate deep into the tumor causing targeted heating based on differential tissue dielectric properties. However, a comprehensive examination of the Kanzius system alongside any associated toxicities and its ability to induce hepatic hyperthermia in larger animal models, such as swine, are the subjects of the work herein. Ten Yucatan female mini-swine were treated with the KNiRFH system. Two of the pigs were treated a total of 17 times over a five-week period to evaluate short- and long-term KNiRFH-associated toxicities. The remaining eight pigs were subjected to single exposure sessions to evaluate heating efficacy in liver tissue. Our goal was to achieve a liver target temperature of 43°C and to evaluate toxicities and burns post-treatment. Potential toxicities were evaluated by contrast-enhanced MRI of the upper abdomen and blood work, including complete metabolic panel, complete blood count, and liver enzymes. The permittivities of subcutaneous fat and liver were also measured, which were used to calculate tissue specific absorption rates (SAR). Our results indicate negligible KNiRFH-associated toxicities; however, due to fat overheating, liver tissue temperature did not exceed 38.5°C. This experimental limitation was corroborated by tissue permittivity and SAR calculations of subcutaneous fat and liver. Significant steps must be taken to either reduce subcutaneous fat heating or increase localized heating, potentially through the use of KNiRFH-active nanomaterials, such as gold nanoparticles or single-walled carbon nanotubes, which have previously shown promising results in murine cancer models.
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Affiliation(s)
- Jason C Ho
- Baylor College of MedicineDepartment of Surgery
| | - Lam Nguyen
- Baylor College of MedicineDepartment of Surgery
| | | | | | | | - N C Lara
- Rice UniversityDepartment of Chemistry
| | - Trac Nguyen
- Baylor College of MedicineDepartment of Surgery
| | - Steven A Curley
- Baylor College of MedicineDepartment of Surgery.,Department of Mechanical Engineering and Materials ScienceRice University
| | - Stuart J Corr
- Baylor College of MedicineDepartment of Surgery.,Rice UniversityDepartment of Chemistry.,University of HoustonDepartment of Bioengineering
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Izukura R, Imada H, Hashiguchi N, Sawatari H, Ohguri T, Miyazono M, Ohta S, Takakura C, Yamasaki K, Magota C, Fujita K, Kuroda H, Hirata H, Ohkusa T, Chishaki A. Cardiac and respiratory effects of deep regional hyperthermia using an 8 MHz radiofrequency-capacitive device on patients with cancer. Int J Hyperthermia 2017; 33:428-434. [PMID: 28093005 DOI: 10.1080/02656736.2017.1283064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Hyperthermia (HT), an adjuvant therapy for variable cancers, may cause physiological changes in the patients, which may lead to cardiovascular problems. Among various HT treatments, the physiological effects of deep regional HT are still unclear. We examined the physiological alterations throughout deep regional HT to improve the HT safety. MATERIALS AND METHODS Thirty-one patients (age: 61 ± 12 years) with cancer received HT in the thoracic or upper abdominal regions using an 8-MHz radiofrequency-capacitive-device for 50 min. Rectal temperature (Trec), systolic and diastolic blood pressures (SBP and DBP), pulse rate (PR), respiratory rate (RR), percutaneous oxygen saturation (SpO2) and sweating volume were evaluated throughout HT. RESULTS At 50 min after starting HT, Trec, PR and RR were significantly increased compared with the baseline values (Trec: 38.2 ± 1.4 vs. 36.3 ± 0.8 °C, p < 0.001, PR: 104 ± 15 vs. 85 ± 16 bpm, p < 0.05, RR: 23 ± 3 vs. 21 ± 3/min, p < 0.05). Although the average SBP and DBP were both stable during HT in a recumbent position, these values dropped significantly in a standing position (SBP: 113 ± 16 vs. 127 ± 18 mmHg, p < 0.001, DBP: 70 ± 12 vs. 75 ± 13 mmHg, p < 0.01). The total amount of sweating was 356 ± 173 g/m2 on average. CONCLUSIONS Deep regional HT increased the deep body temperature and resulted in an increase of sweating with peripheral vasodilatation. Consequently, a significant reduction in BP would be induced on standing after HT. Careful attention is needed for patients receiving HT, especially when standing after HT.
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Affiliation(s)
- Rieko Izukura
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Hajime Imada
- b Cancer Treatment Center , Tobata Kyoritsu Hospital , Kitakyushu , Japan
| | - Nobuko Hashiguchi
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Hiroyuki Sawatari
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Takayuki Ohguri
- c Department of Radiology , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Mami Miyazono
- d School of Nursing , Fukuoka Prefectural University , Fukuoka , Japan
| | - Shin Ohta
- b Cancer Treatment Center , Tobata Kyoritsu Hospital , Kitakyushu , Japan
| | - Chiduko Takakura
- b Cancer Treatment Center , Tobata Kyoritsu Hospital , Kitakyushu , Japan
| | - Keiko Yamasaki
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Chie Magota
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Kanae Fujita
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Hiromi Kuroda
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
| | - Hideki Hirata
- e Department of radiotherapy , St. Mary's Hospital , Kurume , Japan
| | - Tomoko Ohkusa
- f Sleep Apnea Center, Kyushu University Hospital , Fukuoka , Japan.,g Faculty of Health Sciences , Ube Frontier University , Yamaguchi , Japan
| | - Akiko Chishaki
- a Department of Health Sciences , Kyushu University Graduate School of Medical Sciences , Fukuoka , Japan
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Haynes M, Stang J, Moghaddam M. Real-time microwave imaging of differential temperature for thermal therapy monitoring. IEEE Trans Biomed Eng 2015; 61:1787-97. [PMID: 24845289 DOI: 10.1109/tbme.2014.2307072] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A microwave imaging system for real-time 3-D imaging of differential temperature has been developed for the monitoring and feedback of thermal therapy systems. Design parameters are constrained by features of a prototype-focused microwave thermal therapy system for the breast, operating at 915 MHz. Real-time imaging is accomplished with a precomputed linear inverse scattering solution combined with continuous vector network analyzer (VNA) measurements of a 36-antenna, HFSS-modeled, cylindrical cavity. Volumetric images of differential change of dielectric constant due to temperature are formed with a refresh rate as fast as 1 frame/s and 1 (°)C resolution. Procedures for data segmentation and postprocessed S-parameter error-correction are developed. Antenna pair VNA calibration is accelerated by using the cavity as the unknown thru standard. The device is tested on water targets and a simple breast phantom. Differentially heated targets are successfully imaged in cluttered environments. The rate of change of scattering contrast magnitude correlates 1:1 with target temperature.
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Noh JM, Kim HY, Park HC, Lee SH, Kim YS, Hong SB, Park JH, Jung SH, Han Y. In vivo verification of regional hyperthermia in the liver. Radiat Oncol J 2014; 32:256-61. [PMID: 25568854 PMCID: PMC4283000 DOI: 10.3857/roj.2014.32.4.256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/21/2014] [Accepted: 09/11/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We performed invasive thermometry to verify the elevation of local temperature in the liver during hyperthermia. MATERIALS AND METHODS Three 40-kg pigs were used for the experiments. Under general anesthesia with ultrasonography guidance, two glass fiber-optic sensors were placed in the liver, and one was placed in the peritoneal cavity in front of the liver. Another sensor was placed on the skin surface to assess superficial cooling. Six sessions of hyperthermia were delivered using the Celsius TCS electro-hyperthermia system. The energy delivered was increased from 240 kJ to 507 kJ during the 60-minute sessions. The inter-session cooling periods were at least 30 minutes. The temperature was recorded every 5 minutes by the four sensors during hyperthermia, and the increased temperatures recorded during the consecutive sessions were analyzed. RESULTS As the animals were anesthetized, the baseline temperature at the start of each session decreased by 1.3℃ to 2.8℃ (median, 2.1℃). The mean increases in temperature measured by the intrahepatic sensors were 2.42℃ (95% confidence interval [CI], 1.70-3.13) and 2.67℃ (95% CI, 2.05-3.28) during the fifth and sixth sessions, respectively. The corresponding values for the intraperitoneal sensor were 2.10℃ (95% CI, 0.71-3.49) and 2.87℃ (1.13-4.43), respectively. Conversely, the skin temperature was not increased but rather decreased according to application of the cooling system. CONCLUSION We observed mean 2.67℃ and 2.87℃ increases in temperature at the liver and peritoneal cavity, respectively, during hyperthermia. In vivo real-time thermometry is useful for directly measuring internal temperature during hyperthermia.
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Affiliation(s)
- Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Young Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Hyang Lee
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Sun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Saet-Byul Hong
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Seoul, Korea
| | - Ji Hyun Park
- Laboratory Animal Research Center, Samsung Biomedical Research Institute, Seoul, Korea
| | - Sang Hoon Jung
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Izzo F, Albino V, Palaia R, Piccirillo M, Nasto A, Carbone G, Capano R, Tatangelo F, Granata V. Thermal Ablation of Extended Liver Cancers: Assessment of Two New Bipolar Needle Electrodes. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States, approximately 155,000 new cases of cancer of the liver and bile duct occur annually. Surgical resection of these tumors is considered the only treatment modality with a curative effect, but only 10% to 15% of patients with liver tumors are considered candidates for surgical resection. For this reason, several alternative treatment modalities have been developed. Radiofrequency energy has been the focus of increasing research and practice over the past few years. Recently, needle electrodes that encompass larger tissue volumes and radiofrequency generators that provide the increased power levels needed to heat these larger tissue volumes have become available. For this pilot study, we were interested in the evaluation of the capacity of larger sized needle electrodes to induce a predictable zone of tissue necrosis within diseased human liver. Furthermore, we wanted to prove safety and effectiveness of radiofrequency ablation in large sized liver tumors. In summary, the use of a bipolar 6 or 8 array electrode and power up to 180–220 watts energy was shown to produce controlled coagulation necrosis of targeted liver parenchyma and tumor with no observed complications.
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Affiliation(s)
- F. Izzo
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - V. Albino
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - R. Palaia
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - M. Piccirillo
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - A. Nasto
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - G. Carbone
- Division of Abdominal Surgical Oncology, Hepatobiliary Section, National Cancer Institute of Naples, Naples, Italy
| | - R. Capano
- Division of Pathology, National Cancer Institute of Naples, Naples, Italy
| | - F. Tatangelo
- Division of Pathology, National Cancer Institute of Naples, Naples, Italy
| | - V. Granata
- Division of Radiology, National Cancer Institute of Naples, Naples, Italy
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Yang Y, Wang C, Lu Y, Bai W, An L, Qu J, Gao X, Chen Y, Zhou L, Wu Y, Feng Y, Zhang M, Chang X, Lv J. Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 19:674-84. [PMID: 22187145 PMCID: PMC3501181 DOI: 10.1007/s00534-011-0490-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous argon-helium cryoablation for hepatocellular carcinoma (HCC) and determine appropriate indications. METHODS We reviewed outcomes of 300 HCC patients who underwent US-guided percutaneous cryoablation. RESULTS Overall, 223 tumors (mean diameter 7.2 ± 2.8 cm) in 165 patients were incompletely ablated, while 185 tumors (mean diameter 5.6 ± 0.8 cm, P = 0.0001 vs. incomplete ablation) in 135 patients were completely ablated. Nineteen patients (6.3%) developed serious complications while in hospital, including cryoshock syndrome in six patients, hepatic bleeding in five, stress-induced gastric bleeding in four, liver abscess in one and intestinal fistulas in one. Two patients died because of liver failure. The median follow-up was 36.7 months (range 6-63 months). The local tumor recurrence rate was 31%, and was related to tumor size (P = 0.029) and tumor location (P = 0.037). The mean survival duration of patients with early, intermediate and advanced HCC (Barcelona Clinic Liver Cancer staging system) was 45.7 ± 3.8, 28.4 ± 1.2 and 17.7 ± 0.6 months, respectively. CONCLUSIONS US-guided percutaneous cryoablation is a relatively safe and effective therapy for selected HCC patients.
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Affiliation(s)
- Yongping Yang
- Center of Therapeutic Research for Hepatocellular Carcinoma, Beijing 302nd Hospital, Beijing, 100039, China.
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Boone BA, Bartlett DL, Zureikat AH. Isolated Hepatic Perfusion for the Treatment of Liver Metastases. Curr Probl Cancer 2012; 36:27-76. [DOI: 10.1016/j.currproblcancer.2011.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ohtsubo K, Watanabe H, Tsuchiyama T, Mouri H, Yamaguchi Y, Motoo Y, Okai T, Sanada J, Matsui O, Kitamura T, Fujiki R, Tokuuye K, Sawabu N. Advanced hepatocellular carcinoma treated effectively with irinotecan via hepatic arterial infusion followed by proton beam therapy. J Infect Chemother 2009; 15:316-21. [PMID: 19856070 DOI: 10.1007/s10156-009-0702-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 04/28/2009] [Indexed: 02/07/2023]
Abstract
We report a 48-year-old man with hepatocellular carcinoma (HCC) treated with hepatic arterial infusion (HAI) chemotherapy followed by proton beam therapy. The HCC lesion in this patient was 88 mm in diameter, with portal vein tumor thrombosis in the right lobe of the liver. He was first treated with 5-fluorouracil, cisplatin, and isovorin, administered by HAI, combined with interferon-alpha, and he was subsequently treated with epirubicin and mitomycin-C administered by HAI. However, no definite efficacy of either of these treatments was observed. Then, after 3 weeks' continuous administration of irinotecan by HAI, the tumor size decreased to 68 mm in diameter. However, 3 months after reduction of the tumor, the tumor had become enlarged to 100 mm in diameter and intrahepatic metastases were prominent. Angiographic findings indicated that the HCC was fed not only from the right hepatic artery but also from the left gastric and right and left subphrenic arteries. After rearrangement of the arteries, and 3 months' continuous HAI chemotherapy with irinotecan, plus hyperthermia, the tumor size had decreased to 50 mm in diameter. The reduction rate of the main tumor according to the Response Evaluation Criteria in Solid Tumors was 43%; therefore, the efficacy of this treatment was judged as a partial response. Two months after reduction of the tumor, the patient's serum alpha-fetoprotein (AFP) level was elevated, and so docetaxel was administered by HAI instead of irinotecan. The liver tumors showed gradual enlargement during the administration of docetaxel, although the AFP level was suppressed. Proton beam therapy was instituted and the liver tumors showed necrosis after this therapy. The patient died of hepatic failure and distant metastases 6 years after the onset of HCC. As far as we know, this is the first case report of HCC treated effectively with irinotecan administered by HAI followed by proton beam therapy in which tumor suppression and the long-term survival of the patient were observed.
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Affiliation(s)
- Koushiro Ohtsubo
- Department of Internal Medicine and Medical Oncology, Cancer Research Institute, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-0934, Japan.
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Harima Y, Nagata K, Harima K, Ostapenko VV, Tanaka Y, Sawada S. A randomized clinical trial of radiation therapy versus thermoradiotherapy in stage IIIB cervical carcinoma. Int J Hyperthermia 2009; 25:338-43. [DOI: 10.1080/02656730903092018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Harima Y, Sawada S. Hyperthermia classic commentary: ‘A randomized clinical trial of radiation therapy versus thermoradiotherapy in stage IIIB cervical carcinoma’ by Yoko Harima,International Journal of Hyperthermia2001;17:97–105. Int J Hyperthermia 2009; 25:344-6. [DOI: 10.1080/02656730902856116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Mitsumori M, Zeng ZF, Oliynychenko P, Park JH, Choi IB, Tatsuzaki H, Tanaka Y, Hiraoka M. Regional hyperthermia combined with radiotherapy for locally advanced non-small cell lung cancers: a multi-institutional prospective randomized trial of the International Atomic Energy Agency. Int J Clin Oncol 2007; 12:192-8. [PMID: 17566842 DOI: 10.1007/s10147-006-0647-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 12/12/2006] [Indexed: 12/31/2022]
Abstract
BACKGROUND An International Atomic Energy Agency (IAEA)-sponsored, multi-institutional prospective randomized trial was conducted to clarify whether the combination of hyperthermia and radiotherapy improves the local response rate of locally advanced non-small cell lung cancer (NSCLC) compared with that obtained by radiotherapy alone. METHODS Between October 1998 and April 2002, 80 patients with locally advanced NSCLC were randomized to receive either standard radiation therapy alone (RT) or radiation therapy combined with hyperthermia (RT + HT). The primary endpoint was the local response rate. The secondary endpoints were local progression-free survival and overall survival. RESULTS The median follow-up period was 204 days for all patients and 450 days for surviving patients. There were no significant differences between the two arms with regard to local response rate (P = 0.49) or overall survival rate (P = 0.868). However, local progression-free survival was significantly better in the RT+HT arm (P = 0.036). Toxicity was generally mild and no grade 3 late toxicity was observed in either arm. CONCLUSION Although improvement of local progression-free survival was observed in the RT+HT arm, this prospective randomized study failed to show any substantial benefit from the addition of hyperthermia to radiotherapy in the treatment of locally advanced NSCLC.
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Affiliation(s)
- Michihide Mitsumori
- Department of Therapeutic Radiology and Oncology, Kyoto University Graduate School of Medicine, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, 606-8507, Japan.
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TERUNUMA HIROSHI, WADA AYANO, DENG XUEWEN, YASUMA YOSHIHIDE, ONISHI TETSURO, TOKI ATSUSHI, ABE HIROYUKI. Mild Hyperthermia Modulates the Relative Frequency of Lymphocyte Cell Subpopulations: an Increase in a Cytolytic NK Cell Subset and a Decrease in a Regulatory T Cell Subset. ACTA ACUST UNITED AC 2007. [DOI: 10.3191/thermalmedicine.23.41] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kida Y, Tsuji-Kawahara S, Ostapenko V, Kinoshita S, Kajiwara E, Kawabata H, Yuasa T, Nishide I, Yukawa S, Ichinose M, Miyazawa M. Increased liver temperature efficiently augments human cellular immune response: T-cell activation and possible monocyte translocation. Cancer Immunol Immunother 2006; 55:1459-69. [PMID: 16491400 PMCID: PMC11030585 DOI: 10.1007/s00262-006-0146-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Accepted: 01/25/2006] [Indexed: 10/25/2022]
Abstract
Hyperthermia (HT), in combination with other conventional therapeutic modalities, has become a promising approach in cancer therapy. In addition to heat-induced apoptosis, an augmented immunological effect is considered to be a benefit of hyperthermic treatment over chemo- or radiotherapy. Here, we investigated the effect of regional HT targeting the liver on immune cells, especially T cells and antigen-presenting cells, which are important in recognizing and eliminating tumor cells and pathogens such as viruses. In healthy volunteers exposed to such regional HT, both CD4(+) and CD8(+) T cells that express an activation marker CD69 increased transiently at 1 h post-treatment, with a subsequent decrease to base levels at 6 h after the treatment. At 24 h post-treatment, the percentage of CD69-positive cells significantly increased again but only among CD8(+) T cells. IFN-gamma production from PHA-stimulated peripheral blood mononuclear cells was gradually and significantly increased in the 2 days following the heating procedure, peaking at 36 h post-treatment. Furthermore, we found marked increases in plasma levels of IL-1beta and IL-6 starting at 24 h post-treatment. With regard to the number of each leukocyte subpopulation, a transient and dramatic decrease in the number of a subset of monocytes, CD14(+) CD16(-) cells, was observed at 1 h after the hyperthermic treatment, suggesting that the regional HT aimed at the liver may have influenced the extravasation of blood monocytes. No significant changes in T-cell activities or monocyte counts were observed in the volunteers exposed to heating of the lungs or the legs. These results suggest that heating of the liver may efficiently induce cellular immune responses to liver cancers.
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Affiliation(s)
- Yohei Kida
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
- Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sachiyo Tsuji-Kawahara
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
| | - Valentina Ostapenko
- Laboratory of Clinical Hyperthermia, Shousei-kai Nishide Hospital, Kaizuka, Osaka Japan
| | - Saori Kinoshita
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
| | - Eiji Kajiwara
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
| | - Hiroyuki Kawabata
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
| | - Takae Yuasa
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
| | - Iwao Nishide
- Laboratory of Clinical Hyperthermia, Shousei-kai Nishide Hospital, Kaizuka, Osaka Japan
| | - Susumu Yukawa
- Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Ichinose
- Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masaaki Miyazawa
- Department of Immunology, Kinki University School of Medicine, Osaka-Sayama, Osaka Japan
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HARIMA YOKO, SHIGA TOSHIKO, KAMATA MINORU, KOJIMA HIROYUKI, IKEDA SIGEKI, SAWADA SATOSHI. Thermoradiotherapy in Advanced Cervical Cancer: Clinical Experiments and Molecular Research. ACTA ACUST UNITED AC 2006. [DOI: 10.3191/thermalmedicine.22.141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Morris DL. Ablative Therapy for Liver Cancer: Which? Ann Surg Oncol 2005; 12:205-6. [PMID: 15827811 DOI: 10.1245/aso.2005.12.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2004] [Accepted: 01/10/2005] [Indexed: 11/18/2022]
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Vasanthan A, Mitsumori M, Park JH, Zhi-Fan Z, Yu-Bin Z, Oliynychenko P, Tatsuzaki H, Tanaka Y, Hiraoka M. Regional hyperthermia combined with radiotherapy for uterine cervical cancers: A multi-institutional prospective randomized trial of the international atomic energy agency. Int J Radiat Oncol Biol Phys 2005; 61:145-53. [PMID: 15629605 DOI: 10.1016/j.ijrobp.2004.04.057] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 03/29/2004] [Accepted: 04/20/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE Hyperthermia can be used to enhance the effects of radiation, and a combined treatment may, in some circumstances, be an advantage. Uterine cervical cancer is very common in developing countries. The control of locally advanced pelvic tumors is difficult with conventional treatment modalities. Based upon the biologic rationale and in view of the recent advances in heating and thermometry techniques, radiotherapy in combination with hyperthermia was investigated in a multi-institutional prospective randomized trial sponsored by the International Atomic Energy Agency. The primary purpose was to clarify whether the combination of hyperthermia and radiotherapy improves the rate of local control, compared with radiotherapy alone. METHODS AND MATERIALS A total of 110 patients with biopsy-proven, locally advanced carcinoma of the uterine cervix were randomized to treatment by radiotherapy with or without hyperthermia. The patients were stratified by institution, stage, and histologic type. Each patient received external beam radiation therapy and brachytherapy. For the patients randomized to receive hyperthermia, a minimum of five sessions (60 min each, once per week) were administered, employing a radiofrequency (RF) capacitive heating device. Intratumoral temperature was measured at the first hyperthermic treatment, and at least once more during the course of treatment. The equipment and the policies and procedures at each participating institution except one (Pusan) were personally inspected at least once by the corresponding author, to ensure that quality assurance procedures were in place and were followed for treatment according to the protocol guidelines. The median follow-up period was 466 days for all the patients and 512 days for the surviving patients. RESULTS The two arms were well balanced with regard to the patient factors, tumor factors, and treatment factors. The overall survival rate at 3 years was 73.2%, and the local control rate was 68.5%. There were no significant differences between the patients treated with or without hyperthermia, either with regard to the survival (p = 0.1893) or the rate of local control (p = 0.58). The survival was significantly worse among the patients with Stage IIb disease who received hyperthermia (p = 0.0162) although there was no difference in their rate of local control (p = 0.7988). Further analysis is necessary to determine if the difference in survival is due to a greater incidence of distant metastases or some other cause. Acute Grade 2-3 toxicity was seen in 10/55 patients (18%) treated by hyperthermia and in 2/55 of the patients (4%) treated without hyperthermia (p = 0.01). There was no significant difference in the late toxicity observed in the two arms. CONCLUSION This prospective randomized study failed to show any benefit from the addition of hyperthermia to radiotherapy in the treatment of locally advanced carcinoma of the uterine cervix. The acute toxicity was significantly greater among the patients receiving hyperthermia, and the survival was significantly worse among the Stage IIb patients receiving hyperthermia even though there was no difference in the local control rate.
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Gérolami R, Uch R, Bréchot C, Mannoni P, Bagnis C. Gene therapy of hepatocarcinoma: a long way from the concept to the therapeutical impact. Cancer Gene Ther 2003; 10:649-60. [PMID: 12944984 DOI: 10.1038/sj.cgt.7700610] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hepatocellular carcinoma (HCC), the most prevalent histological form of primary liver cancer is one of the most frequent cancer worldwide. This pathology still requires the development of new therapeutical approaches. Gene therapy strategies focusing on the genetic manipulation of accessory cells involved in the immune reaction against cancer cells, or on the direct transduction of tumor cells with transgenes able to "suicide" cancer cells have been largely developed for more than ten years.
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Affiliation(s)
- René Gérolami
- Département de thérapie cellulaire et génique, EFS Alpes Méditerranée, Marseille, France
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Abstract
BACKGROUND Radiofrequency ablation (RFA) is being used to treat primary and metastatic liver tumors. The indications, treatment planning, and limitations of hepatic RFA must be defined and refined by surgeons treating hepatic malignancies. METHODS A review of the experience using RFA to treat unresectable primary and secondary hepatic malignancies at the University of Texas M. D. Anderson Cancer Center in Houston, Texas, and the G. Pascale National Cancer Institute in Naples, Italy, is provided. Patient selection, treatment approach, local recurrence rates, and overall cancer recurrence rates following RFA are described. The current literature on RFA of hepatic malignancies is reviewed. RESULTS RFA of hepatic tumors can be performed percutaneously, laparoscopically, or during an open surgical procedure. Incomplete treatment manifest as local recurrence is more common with a percutaneous approach. The morbidity and mortality rates associated with hepatic RFA are low. Local recurrence rates are low if meticulous treatment planning is performed. RFA can be combined safely with partial hepatic resection of large lesions. The long-term survival rates following RFA of primary and metastatic liver tumors have not yet been established. CONCLUSIONS RFA of hepatic malignancies is a safe and promising technique to produce coagulative necrosis of unresectable hepatic malignancies. Experience with this treatment modality is not yet mature enough to establish long-term outcomes.
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Affiliation(s)
- Steven A Curley
- The University of Texas M. D. Anderson Cancer Center, Department of Surgical Oncology, Box 444, 1515 Holcombe Blvd., Houston, TX 77030-4009, USA.
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Hehr T, Budach W, Lamprecht U, Belka C, Classen J, Trübenbach J, Wehrmann M, Dietz K, Bamberg M. Experimental thermoradiotherapy in malignant hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2003; 55:1374-80. [PMID: 12654450 DOI: 10.1016/s0360-3016(02)04615-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE The human liver is known to be a relatively radiosensitive organ that develops clinically relevant late radiation hepatitis subsequent to whole liver treatment with total doses above 30 Gy in conventional fractionation. Experimental data, as well as clinical series, have demonstrated that hyperthermia of solid tumors in addition to radiotherapy enhances tumor growth inhibition and tumor control probability. We therefore developed an experimental model for combined radiotherapy and hyperthermia of the liver in transplantable rat Morris hepatoma 3924A. METHODS AND MATERIALS A cube of approximately 8 mm(3) was implanted subcapsularly into the middle liver lobe of 59 male syngenic ACI rats weighing approximately 180-200 g. On Day 16 after tumor implantation, irradiation of the tumor-bearing liver with either 0 Gy/25 Gy/35 Gy/45 Gy total dose in 10 fractions +/- hyperthermia (target temperature 40-42 degrees C) twice a week was initiated. Energy deposition was monitored by temperature probes in the liver and esophagus of the rats. Determination of tumor volume with magnetic resonance imaging was performed 2 to 5 weeks after the end of therapy. The tumor growth rates could be estimated for 44 rats. If the growth rate was positive (37 rats), the inverse of the growth rate was interpreted as the time to 10-fold tumor volume. Otherwise the maximum observation time was considered as a censored value in a parametric survival analysis. RESULTS Intrahepatic temperature probes showed a temperature plateau of greater than 40 degrees C after 5 to 8 min subsequent to initiation of hyperthermia. The target temperatures could be maintained for at least 22 min > or =40 degrees C and 10 min > or =41 degrees C, respectively. Median plateau temperature in liver, esophagus, and epicutaneously was 41.2 degrees C (standard deviation [SD] 0.7 degrees C; range 38.2 to 43.3 degrees C), 40.4 degrees C (SD 1.08 degrees C; range 38.9 to 41.8 degrees C), and 40.8 degrees C (SD 0.8 degrees C; range 38.2 to 42.7 degrees C), respectively. Elevation of the temperature in the esophagus correlated with intrahepatic temperatures in the range of 39-42 degrees C, r = 0.957. The increase in time to 10-fold tumor volume for each step of irradiation dosage was by 34% (95% confidence interval [CI] 20% to 49%) without hyperthermia and by 60% (95% CI 47% to 80%) with hyperthermia (p < 0.0001). CONCLUSION Treatment outcome after experimental percutaneous thermoradiotherapy in intrahepatically implanted Morris hepatoma 3924A was related to total dose of irradiation and concurrently administered regional hyperthermia. An increased radiosensitivity due to hyperthermia (<42 degrees C) has to be assumed.
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Affiliation(s)
- Thomas Hehr
- Department of Radiation Oncology, Eberhard-Karls University, Tübingen, Germany.
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Zeng ZC, Jiang GL, Wang GM, Tang ZY, Curran WJ, Iliakis G. DNA-PKcs subunits in radiosensitization by hyperthermia on hepatocellular carcinoma hepG2 cell line. World J Gastroenterol 2002; 8:797-803. [PMID: 12378618 PMCID: PMC4656564 DOI: 10.3748/wjg.v8.i5.797] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the role of DNA-PKcs subunits in radiosensitization by hyperthermia on hepatocellular carcinoma HepG2 cell lines.
METHODS: HepG2 cells were exposed to hyperthermia and irradiation. Hyperthermia was given at 45.5 °C. Cell survival was determined by an in vitro clonogenic assay for the cells treated with or without hyperthermia at various time points. DNA DSB rejoining was measured using asymmetric field inversion gel electrophoresis (AFIGE). The DNA-PKcs activities were measured using DNA-PKcs enzyme assay system.
RESULTS: Hyperthermia can significantly enhance irradiation-killing cells. Thermal enhancement ratio as calculated at 10% survival was 2.02. The difference in radiosensitivity between two treatment modes manifested as a difference in the α components and the almost same β components, which α value was considerably higher in the cells of combined radiation and hyperthermia as compared with irradiating cells (1.07 Gy-1vs 0.44 Gy-1). Survival fraction showed 1 logarithm increase after an 8-hour interval between heat and irradiation, whereas DNA-PKcs activity did not show any recovery. The cells were exposed to heat 5 min only, DNA-PKcs activity was inhibited at the nadir, even though the exposure time was lengthened. Whereas the ability of DNA DSB rejoining was inhibited with the increase of the length of hyperthermic time. The repair kinetics of DNA DSB rejoining after treatment with Wortmannin is different from the hyperthermic group due to the striking high slow rejoining component.
CONCLUSION: Determination with the cell extracts and the peptide phosphorylation assay, DNA-PKcs activity was inactivated by heat treatment at 45.5 °C, and could not restore. Cell survival is not associated with the DNA-PKcs inactivity after heat. DNA-PKcs is not a unique factor affecting the DNA DSB repair. This suggests that DNA-PKcs do not play a crucial role in the enhancement of cellular radiosensitivity by hyperthermia.
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Affiliation(s)
- Zhao-Chong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Curley SA, Cusack JC, Tanabe KK, Stoelzing O, Ellis LM. Advances in the treatment of liver tumors. Curr Probl Surg 2002; 39:449-571. [PMID: 12019420 DOI: 10.1067/msg.2002.122810] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Steven A Curley
- The University of Texas M.D. Anderson Cancer Center, Houston, USA
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31
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Greve JW. Alternative techniques for the treatment of colon carcinoma metastases in the liver: current status in The Netherlands. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 2002:77-81. [PMID: 11768565 DOI: 10.1080/003655201753265488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Review of current treatment modalities for liver metastases resulting from colorectal cancer. METHODS Literature review. RESULTS An increasing number of techniques are available for the treatment of colorectal liver metastases. When it is not possible to use the current gold standard, radical surgical resection, many patients can be treated with alternative techniques. Chemotherapy in its present form must be considered as purely palliative, perhaps with the exclusion of isolated liver perfusion: however, this therapy should still be considered as experimental. Most other possible treatments focus on local destruction of the metastases. This can be achieved using either immuno-guided techniques (tumor antibodies which carry a local active agent), direct local application of a toxic agent (injection) or thermo therapy, which has been applied in patients on a large scale. Thermo therapy involves either localized heating, by means or laser photocoagulation or radiofrequency or microwave ablation, or localized freezing using cryo probes. CONCLUSIONS Local destruction of liver metastases, especially by means of thermo therapy, is feasible and safe. Currently, cryotherapy is most frequently used in patients. New treatment modalities, such as radiofrequency ablation, arc very promising but their true clinical value should be determined in a randomized clinical trial.
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Affiliation(s)
- J W Greve
- Dept. of Surgery, University Hospital Maastricht, The Netherlands.
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Cryosurgical Ablation for the Management of Unresectable Hepatic Colorectal Metastases. COLORECTAL CANCER 2002. [DOI: 10.1007/978-1-59259-160-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Izzo F, Thomas R, Delrio P, Rinaldo M, Vallone P, DeChiara A, Botti G, D'Aiuto G, Cortino P, Curley SA. Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients. Cancer 2001; 92:2036-44. [PMID: 11596017 DOI: 10.1002/1097-0142(20011015)92:8<2036::aid-cncr1542>3.0.co;2-w] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The authors performed a pilot trial of ultrasound-guided percutaneous radiofrequency ablation (RFA) in patients with T1 and T2 breast tumors 1) to confirm complete coagulative necrosis of tumor tissue and 2) to determine the safety and complications related to this treatment. METHODS Twenty-six patients with biopsy-proven, invasive breast carcinoma underwent RFA of their breast tumors followed by immediate resection. Treatment was planned to ablate the tumor and a 5 mm margin of surrounding breast tissue. Tumor viability after RFA was assessed by hematoxylin and eosin and nicotinamide adenine dinucleotide vital staining. RESULTS Twenty patients (77%) had T1 tumors, and six patients (23%) had T2 tumors. The mean greatest dimension of tumors that were treated with RFA was 1.8 cm (range, 0.7-3.0 cm). The mean treatment time for two-phase RFA treatment was 15 minutes and 23 seconds (range, from 6 minutes and 25 seconds to 24 minutes and 54 seconds). Coagulation necrosis of the tumor was complete in 25 of 26 patients (96%): One patient had a microscopic focus of viable tissue adjacent to the needle shaft site. A single patient (1 of 26 patients; 4%) had a complication related to RFA: a full thickness burn of the skin overlying a tumor that was immediately beneath the skin. CONCLUSIONS This pilot experience with RFA in the treatment of patients with early-stage, primary breast carcinoma revealed that 1) coagulative necrosis of the entire tumor occurred in 96% of the patients, and 2) the treatment was safe, with only a 4% complication rate. The authors have initiated a trial of RFA alone (no resection) for patients with T1 and T2 breast tumors that will include sentinel lymph node mapping and postablation irradiation.
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Affiliation(s)
- F Izzo
- Division of Surgical Oncology, The G. Pascale National Cancer Institute, Naples, Italy
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Tang ZY. Hepatocellular carcinoma--cause, treatment and metastasis. World J Gastroenterol 2001; 7:445-54. [PMID: 11819809 PMCID: PMC4688653 DOI: 10.3748/wjg.v7.i4.445] [Citation(s) in RCA: 297] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2001] [Revised: 07/20/2001] [Accepted: 07/27/2001] [Indexed: 02/06/2023] Open
Abstract
In the recent decades, the incidence of hepatocellular carcinoma (HCC) has been found to be increasing in males in some countries. In China, HCC ranked second of cancer mortality since 1990s. Hepatitis B and C viruses (HBV and HCV) and dietary aflatoxin intake remain the major causative factors of HCC. Surgery plays a major role in the treatment of HCC, particularly for small HCC. Down-staging unresectable huge HCC to smaller HCC and followed by resection will probably be a new approach for further study. Liver transplantation is indicated for small HCC, however, some issues remain to be solved. Different modes of regional cancer therapy for HCC have been tried. Systemic chemotherapy has been disappointing in the past but the future can be promising. Biotherapy, such as cytokines, differentiation inducers, anti-angiogenic agents, gene therapy and tumor vaccine will probably play a role, particularly in the prevention of tumor recurrence. HCC invasiveness is currently the major target of study. Tremendous works have been done at the molecular level, which will provide clues for biomarker of HCC progression as well as targets for intervention.
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Affiliation(s)
- Z Y Tang
- Liver Cancer Institute of Fudan University, 136 Yixueyuan Road, Zhongshan Hospital, Shanghai 200032, China.
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Moroz P, Jones SK, Gray BN. Status of hyperthermia in the treatment of advanced liver cancer. J Surg Oncol 2001; 77:259-69. [PMID: 11473375 DOI: 10.1002/jso.1106] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The vast majority of patients with malignant liver tumors have inoperable disease. These patients must rely on chemotherapy, radiotherapy, and various locoregional treatments. Although these treatments have demonstrated encouraging response rates, symptom palliation and occasional down staging of tumors, their impact on survival is minor. As a result there has been renewed interest in hyperthermia as a treatment option. This study reviews the current modalities of hyperthermia in terms of clinical results, side effects, limitations, and therapeutic standing.
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Affiliation(s)
- P Moroz
- Centre for Applied Cancer Studies, University of Western Australia, Nedlands, 6000 Perth, Western Australia.
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Abstract
The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.
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Affiliation(s)
- S A Curley
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4095, USA.
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Harima Y, Nagata K, Harima K, Oka A, Ostapenko VV, Shikata N, Ohnishi T, Tanaka Y. Bax and Bcl-2 protein expression following radiation therapy versus radiation plus thermoradiotherapy in stage IIIB cervical carcinoma. Cancer 2000. [DOI: 10.1002/(sici)1097-0142(20000101)88:1<132::aid-cncr18>3.0.co;2-h] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cromheecke M, de Jong KP, Hoekstra HJ. Current treatment for colorectal cancer metastatic to the liver. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1999; 25:451-63. [PMID: 10527592 DOI: 10.1053/ejso.1999.0679] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Surgery is currently the only available treatment option which offers the potential for cure for patients with liver metastases from colorectal cancer. Of those who undergo a potentially curative operation for their primary tumour but subsequently recur, almost 80% will develop evidence of metastatic disease within the liver. Greater experience and improvements in technique in liver surgery, with an increasingly aggressive surgical approach to metastatic colorectal cancer to the liver, has resulted in prolonged disease-free survival with 5-year rates varying from 21% to 48%. In order to increase these numbers further and to treat patients not eligible for surgical therapy, new treatment modalities and strategies have been developed. This review presents an update of the current treatment for colorectal disease metastatic to the liver.
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Affiliation(s)
- M Cromheecke
- Department of Surgery, Division of Surgical Oncology, Groningen, The Netherlands
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Choti MA, Bulkley GB. Management of hepatic metastases. LIVER TRANSPLANTATION AND SURGERY : OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES AND THE INTERNATIONAL LIVER TRANSPLANTATION SOCIETY 1999; 5:65-80. [PMID: 9873095 DOI: 10.1002/lt.500050113] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Although the liver is the most common site of metastatic disease from a variety of tumor types, isolated hepatic metastases most commonly occur from colorectal cancer and, less frequently, from neuroendocrine tumors, gastrointestinal sarcoma, ocular melanoma, and others. Complete evaluation of the extent of metastatic disease, both intrahepatically and extrahepatically, is important before considering treatment options. Based on a preponderance of uncontrolled studies for hepatic metastatic colorectal carcinoma, surgical resection offers the only potential for cure of selected patients with completely resected disease, with 5-year survival rates of 25% to 46%. Systemic and hepatic arterial infusion chemotherapy may be useful treatment options in patients with unresectable disease and possibly as an adjuvant treatment after liver resection. Other techniques of local tumor ablation, including cryotherapy and radiofrequency ablation, although promising, remain unproved. Management of hepatic metastases from neuroendocrine tumors and other noncolorectal primary tumors should be individualized based on the patient's clinical course, extent of disease, and symptoms.
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Affiliation(s)
- M A Choti
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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