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Khanmohammadi S, Behnoush AH, Akhlaghpoor S. Survival outcomes and quality of life after percutaneous cryoablation for liver metastasis: A systematic review and meta-analysis. PLoS One 2023; 18:e0289975. [PMID: 37585405 PMCID: PMC10431656 DOI: 10.1371/journal.pone.0289975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/29/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Liver metastasis is present in a wide range of malignancies, with colorectal cancer as the most common site. Several minimally invasive treatments have been suggested for managing hepatic metastases, and cryoablation is among them, yet not widely used. In this systematic review, we aimed to assess the effectiveness of percutaneous cryoablation in all types of liver metastases. METHODS A systematic search was performed in international databases, including PubMed, Scopus, Embase, and Web of Science, to find relevant studies reporting outcomes for percutaneous cryoablation in liver metastasis patients. In addition to baseline features such as mean age, gender, metastasis origin, and procedure details, procedure outcomes, including overall survival, local recurrence, quality of life (QoL), and complications, were extracted from the studies. Random-effect meta-analysis was performed to calculate the mean difference (MD) and 95% confidence interval for comparison of QoL. RESULTS We screened 2131 articles. Fifteen studies on 692 patients were included. Mean overall survival ranged from 14.5-29 months. The rate of local recurrence in the included studies ranged from 9.4% to 78%, and local control progression-free survival ranged from 1 to 31 months. The total QoL decreased one week after the cryoablation procedure (-3.08 [95% Confidence interval: -4.65, -1.50], p-value <0.01) but increased one month (5.69 [3.99, 7.39], p-value <0.01) and three months (3.75 [2.25, 5.24], p-value <0.01) after the procedure. CONCLUSION Cryoablation is an effective procedure for the treatment of liver metastases, especially in cases that are poor candidates for liver resection. It could significantly improve QoL with favorable local recurrence.
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Affiliation(s)
- Shaghayegh Khanmohammadi
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Population Sciences Institute, Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Vogl TJ, Zitsch M, Albrecht M, D'Angelo T, Basten L, Gruber-Rouh T, Nour-Eldin NEA, Naguib NNN. Long-term outcomes following percutaneous microwave ablation for colorectal cancer liver metastases. Int J Hyperthermia 2022; 39:788-795. [PMID: 35658772 DOI: 10.1080/02656736.2022.2077991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To evaluate the overall survival (OS), local progression-free survival (PFS) and prognostic factors of patients with colorectal cancer liver metastases (CRLM) undergoing microwave ablation (MWA). METHOD A total of 132 patients were retrospectively enrolled who had been treated between 2010 and 2018. For the evaluation of survival rates, all patients were divided according to their indications (curative n = 57 and debulking (patients with additional non-target extrahepatic metastases) n = 75). In total, 257 ablations were evaluated for prognostic factors: number of liver metastases, primary tumor origin (PTO), diameter and volume of metastases, duration and energy of ablation. RESULTS The OS was 32.1 months with 93.2% of patients free from recurrence at 28.3 months (median follow-up time). The one- year and three-year OS were 82.72% and 41.66%, respectively. The OS and recurrence-free survival of the curative group were statistically significantly higher than the debulking group (p < .001). Statistically significant prognostic factors for OS included the location of the primary tumor (p < .038) and the number of metastases (all p < .017). Metastasis diameter and volume and ablation duration and energy had no significant correlation with survival (p > .05). CONCLUSIONS Satisfactory OS and local tumor PFS can be achieved in patients with CRLM using MWA with the number of metastases and the location of the primary tumor influencing the outcome of patients. The metastasis's size and the duration and energy used for ablation were not of significant prognostic value.
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Affiliation(s)
- Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Maximilian Zitsch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Moritz Albrecht
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Funktional Imaging, University Hospital Messina, Messina, Italy
| | - Lajos Basten
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Nour-Eldin A Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.,Radiology Department, Faculty of Medicine, Cairo University Kasr Alainy, Cairo, Egypt
| | - Nagy N N Naguib
- Radiology Department, AMEOS Klinikum Halberstadt GmbH, Halberstadt, Germany.,Radiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Chang X, Sun P, Zhang J, Zhang L, Wu H, Xie Y, Liu J. CalliSpheres drug-eluting beads transarterial-chemoembolization in the treatment of liver metastases from breast cancer: Initial experience in 14 patients. Medicine (Baltimore) 2021; 100:e28407. [PMID: 34967376 PMCID: PMC8718222 DOI: 10.1097/md.0000000000028407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
Breast cancer patients with liver metastases are associated with high mortality. However, no standardized treatment approach is available for these patients who have undergone chemotherapy and hormonal therapy. We aimed to assess the clinical outcomes of patients with breast cancer liver metastases (BCLM) who underwent drug-eluting beads used for transarterial-chemoembolization (DEB-TACE).We retrospectively enrolled 14 patients with 39 lesions who underwent DEB-TACE for liver metastases following mastectomy for primary breast cancer. The incidence of complications, overall survival (OS), and local tumor progression-free survival (PFS) were assessed.A total of 14 patients with 39 liver metastases were treated with DEB-TACE from July 2017 to July 2020. The objective response rates (ORR) and disease control rates (DCR) were 71.4% and 92.8% at the 3-month period and 50% and 71.4% at the 6-month period, respectively. During the follow-up period the local tumor PFS was 8.0 months. The median OS was 20.0 months (range, 8-40 months) and the 1-, 2-year OS rates were 84.4% and 47.4%, respectively. No severe complications caused by this technique were detected.DEB-TACE for BCLM was characterized as a low trauma technique, with a limited number of complications. The results indicated that this method was safe and effective for patients with BCLM and could be widely adopted as a palliative treatment in clinical practice.
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Affiliation(s)
- Xu Chang
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Peng Sun
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jianxin Zhang
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lin Zhang
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Huiyong Wu
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yinfa Xie
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jibing Liu
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Jinan, China
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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ARIBAL S, KAYA E. Capsule and Ablation Tract Related Features of Local Recurrence in Ultrasound Guided Microwave Ablation of Liver Metastases. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.766188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Yang DP, Zhuang BW, Wang YZ, Lin MX, Xu M, Kuang M, Lei YY, Xie XY, Xie XH. Thermal ablation versus hepatic resection for the treatment of liver metastases from gastrointestinal stromal tumors: a retrospective study. Int J Hyperthermia 2020; 37:592-599. [PMID: 32484012 DOI: 10.1080/02656736.2020.1772513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: The study aimed to compare effectiveness and safety of thermal ablation and hepatic resection in patients with liver metastases of gastrointestinal stromal tumors (GISTs).Method: A total of 55 patients (27 in the ablation group and 28 in the surgery group) with liver metastases were included. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier's survival estimate curves. Univariate and multivariate regression analyses were carried out to identify potential prognostic factors.Results: The median OS was 102.0 months in the ablation group and 117.0 months in the surgery group (p = .875). The 1-, 3- and 5-year OS rates were 100%, 88.9% and 74.1% in the ablation group and 92.8%, 82.1% and 78.6% in the surgery group, respectively. The 1-, 3- and 5-year PFS rates were 48.1%, 25.9% and 18.5% in the ablation group and 67.8%, 64.3% and 64.3% in the surgery group, respectively. Multivariate analysis showed that preoperative tyrosine kinase inhibitor (TKI) treatment (progressive disease, PD) (HR, 13.985; 95% CI, 1.791-109.187; p = .012) was the only significant independent prognostic factor for OS. Tumor number (HR, 1.318; 95% CI, 1.021-1.702; p = .034) was identified as an independent predictor for PFS in multivariate analysis. There were fewer postoperative complications (18.5% vs. 78.6%, p = .001) and shorter lengths of hospital stay (8.0 vs. 16.5 days, p = .001) in the ablation group.Conclusion: Compared with resection, thermal ablation offered comparable OS for liver metastases of GISTs. Furthermore, thermal ablation had the advantages of fewer complications and shorter lengths of hospital stay.
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Affiliation(s)
- Dao-Peng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhao Wang
- Sun Yat-Sen University School of Medicine, Guangzhou, China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang-Yang Lei
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Kessner R, Nakamoto DA, Kondray V, Partovi S, Ahmed Y, Azar N. Contrast-Enhanced Ultrasound Guidance for Interventional Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2541-2557. [PMID: 30714653 DOI: 10.1002/jum.14955] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Since its introduction, contrast-enhanced ultrasound (CEUS) has gained an important role in the diagnosis and management of abdominal and pelvic diseases. Contrast-enhanced ultrasound can improve lesion detection rates as well as success rates of interventional procedures when compared to conventional ultrasound alone. Additionally, CEUS enables the interventionalist to assess the dynamic enhancement of different tissues and lesions, without the adverse effects of contrast-enhanced computed tomography, such as exposure to ionizing radiation and nephrotoxicity from iodinated contrast material. This review article describes the various applications and advantages of the use of CEUS to enhance performance of ultrasound-guided interventions in the abdomen and pelvis.
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Affiliation(s)
- Rivka Kessner
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Dean A Nakamoto
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yasmine Ahmed
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
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Qin S, Liu GJ, Huang M, Huang J, Luo Y, Wen Y, Wang Y, Chen L. The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center. Int J Hyperthermia 2018; 36:36-43. [PMID: 30489175 DOI: 10.1080/02656736.2018.1528511] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To investigate the clinical effectiveness and safety of ultrasound (US)-guided percutaneous microwave ablation (MWA) for colorectal liver metastasis (CRLM) and evaluate the influencing factors of local efficacy. METHODS From January 2013 to January 2017, 137 CRLM patients accepting US-guided percutaneous MWA were included. The 2450-MHz microwave ablation system and a cooled-shaft antenna were used. All patients were regularly followed up for at least 6 months. Technical success, complete ablation, local tumor progression (LTP), complications and side effects were assessed. Logistic regression analysis was used to identify the independent prognostic factors for LTP. RESULTS In total, 411 lesions (mean diameter 15.4 ± 7.2 mm, range 5-67 mm) were treated. Complete ablation was achieved in 99.27% (408/411) of lesions and 97.81% (134/137) of patients. LTP occurred in 5.35% (22/411) of lesions and 16.06% (22/137) of patients. LTP was more likely to occur in lesions larger than 3 cm in diameter (OR: 14.71; p < .001; 95% CI: 3.7 3-57.92), near a large vascular structure (OR: 7.04; p < .001; 95% CI: 2.41-20.60), near the diaphragm (OR: 4.02; p = .049; 95% CI: 1.05-16.11) and in patients with no response to chemotherapy before MWA (OR: 3.25; p = .032; 95% CI: 1.14-15.30). MWA was well tolerated, with a major complication rate of 3.65%, a minor complication rate of 8.03% and a mortality rate of 0%. Fever and pain were the most common side effects after MWA. CONCLUSIONS US-guided percutaneous MWA of CRLM is a safe and effective method that is expected to become a routine treatment for local tumor control of CRLM.
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Affiliation(s)
- Si Qin
- a Department of Medical Ultrasonics , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Guang-Jian Liu
- a Department of Medical Ultrasonics , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Meijin Huang
- b Department of Gastrointestinal Surgery , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Jun Huang
- b Department of Gastrointestinal Surgery , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Yanxin Luo
- b Department of Gastrointestinal Surgery , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Yanling Wen
- a Department of Medical Ultrasonics , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Yimin Wang
- a Department of Medical Ultrasonics , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
| | - Limei Chen
- a Department of Medical Ultrasonics , The Sixth Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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Francica G, Meloni MF, Riccardi L, de Sio I, Terracciano F, Caturelli E, Iadevaia MD, Amoruso A, Roselli P, Chiang J, Scaglione M, Pompili M. Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study. Eur J Radiol 2018; 105:96-101. [DOI: 10.1016/j.ejrad.2018.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
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Nolsøe CP, Nolsøe AB, Klubien J, Pommergaard HC, Rosenberg J, Meloni MF, Lorentzen T. Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures: A Systematic Review and Pictorial Essay. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1305-1324. [PMID: 29230842 DOI: 10.1002/jum.14498] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/28/2017] [Accepted: 09/08/2017] [Indexed: 06/07/2023]
Abstract
The aim of this article is to provide an inventory of the use of contrast-enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS-guided procedures. A literature search identified 3109 records. After abstract screening, 55 articles were analyzed and supplemented with pictorial material to explain the techniques. In conclusion, the best-evidenced indications for CEUS-guided interventions are biopsy and ablation of inconspicuous or B-mode-invisible tumors, intraprocedural ablation control and follow-up, as well as percutaneous transhepatic cholangiography and drainage procedures.
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Affiliation(s)
- Christian Pállson Nolsøe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Alexander Bjørneboe Nolsøe
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Jeanett Klubien
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Hans-Christian Pommergaard
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, and Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Herlev, Denmark
| | - Maria Franca Meloni
- Interventional Ultrasound Section, Department of Radiology, Institute of Care Igea, Milan, Italy
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Liu XP, Zhou YW, Liu QH, Jiang LL. Microwave ablation combined with hepatic artery embolization for treatment of liver metastasis after surgery for colorectal cancer : Efficacy and effect on liver function. Shijie Huaren Xiaohua Zazhi 2018; 26:587-593. [DOI: 10.11569/wcjd.v26.i10.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To compare the therapeutic effects and prognosis in patients with liver metastasis of colorectal cancer treated by transcatheter arterial chemoembolization (TACE) alone and those treated by TACE combined with microwave ablation (MWA).
METHODS The clinical data of 84 patients with primary colorectal cancer treated at our hospital from January 2013 to January 2015 were retrospectively analyzed. The patients were divided into either a combination group (TACE combined with MWA; n = 40) or a TACE alone group (n = 44) according to different treatment plans. The therapeutic effect and adverse reactions were compared between the two groups, and the changes of liver function, quality of life, and survival were also compared.
RESULTS At one month after treatment, the effective rate and disease control rate were significantly higher in the combination group than in the TACE alone group (77.5% vs 38.6%, 85.0% vs 56.8%, P < 0.05). After 1 wk of treatment, there was no significant difference in serum total bilirubin, ALT, or albumin levels in the two groups (t = 3.662, 2.816, 2.578, P > 0.05). During the treatment period, there was no significant difference in the incidence of nausea, vomiting, thrombocytopenia, leukocyte reduction, hemoglobin reduction, mucositis, cholinergic syndrome, or delayed diarrhea between the two groups (χ2 = 1.056, 0.784, 1.022, 2.103, 0.668, P > 0.05). After 6 mo of treatment, the physiological status, emotional status, functional status, family and social status, and quality of life scores were significantly higher in the combination group than in the TACE group alone (t = 5.139, 6.052, 4.331, 4.508, 4.417, P < 0.05). There was no significant difference in the survival rates at six months and 1 year (χ2 = 0.216, 1.492, P > 0.05), but the 2- and 3- year survival rates were significantly higher than those in the TACE alone group(χ2 = 3.894, 4.017, P < 0.05).
CONCLUSION Microwave ablation combined with TACE is effective in the treatment of liver metastases from colorectal cancer. Compared with TACE alone, microwave ablation combined with TACE can further improve the quality of life and prolong the survival time, without increasing the incidence of adverse reactions.
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Affiliation(s)
- Xue-Ping Liu
- Department of ultrasound, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Yu-Wang Zhou
- Department of ultrasound, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Qing-Hua Liu
- Department of ultrasound, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
| | - Lou-Lou Jiang
- Department of ultrasound, Quzhou People's Hospital, Quzhou 324000, Zhejiang Province, China
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Mouli SK, Gupta R, Sheth N, Gordon AC, Lewandowski RJ. Locoregional Therapies for the Treatment of Hepatic Metastases from Breast and Gynecologic Cancers. Semin Intervent Radiol 2018; 35:29-34. [PMID: 29628613 DOI: 10.1055/s-0038-1636518] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra-arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies.
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Affiliation(s)
- Samdeep K Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ramona Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Neil Sheth
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois.,Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
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12
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Colorectal Liver Metastasis: Overview of Treatment Paradigm Highlighting the Role of Ablation. AJR Am J Roentgenol 2018; 210:883-890. [DOI: 10.2214/ajr.17.18574] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Gao F, Wang GB, Xiang ZW, Yang B, Xue JB, Mo ZQ, Zhong ZH, Zhang T, Zhang FJ, Fan WJ. A preoperative mathematic model for computed tomographic guided microwave ablation treatment of hepatic dome tumors. Oncotarget 2017; 7:25949-59. [PMID: 27028994 PMCID: PMC5041956 DOI: 10.18632/oncotarget.8299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/06/2016] [Indexed: 12/14/2022] Open
Abstract
Purpose This study sought to prospectively evaluate the feasibility and safety of a preoperative mathematic model for computed tomographic(CT) guided microwave(MW) ablation treatment of hepatic dome tumors. Methods This mathematic model was a regular cylinder quantifying appropriate puncture routes from the bottom up. A total of 103 patients with hepatic dome tumors were enrolled and randomly divided into 2 groups based on whether this model was used or not: Group A (using the model; n = 43) versus Group B (not using the model; n = 60). All tumors were treated by CT-guided MW ablation and follow-up contrast CT were reviewed. Results The average number of times for successful puncture, average ablation time, and incidence of right shoulder pain were less in Group A than Group B (1.4 vs. 2.5, P = 0.001; 8.8 vs. 11.1 minutes, P = 0.003; and 4.7% vs. 20%, P = 0.039). The technical success rate was higher in Group A than Group B (97.7% vs. 85.0%, P = 0.032). There were no significant differences between the two groups in primary and secondary technique efficacy rates (97.7% vs. 88.3%, P = 0.081; 90.0% vs. 72.7%, P = 0.314). No major complications occurred in both groups. Conclusion The mathematic model of regular cylinder is feasible and safe for CT-guided MW ablation in treating hepatic dome tumors.
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Affiliation(s)
- Fei Gao
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Guo-Bao Wang
- State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China
| | - Zhan-Wang Xiang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, PR China
| | - Jing-Bing Xue
- Imaging Sciences, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Zhi-Qiang Mo
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Zhi-Hui Zhong
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Tao Zhang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Fu-Jun Zhang
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
| | - Wei-Jun Fan
- Department of Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, PR China.,State Key Laboratory of Oncology in South China, Guangzhou 510060, PR China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, PR China
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14
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Golse N, Adam R. Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results. Clin Breast Cancer 2017; 17:256-265. [DOI: 10.1016/j.clbc.2016.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
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15
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Wong J, Cooper A. Local Ablation for Solid Tumor Liver Metastases: Techniques and Treatment Efficacy. Cancer Control 2016; 23:30-5. [PMID: 27009454 DOI: 10.1177/107327481602300106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Treatment options for liver metastases from solid tumors, such as colon cancer, breast cancer, neuroendocrine tumors, and sarcomas, have expanded in recent years and now include nonresection methods. METHODS The literature focused on the treatment of liver metastases was reviewed for technique, perioperative, and long-term outcomes specifically related to local ablation techniques for liver metastases. RESULTS Ablation modalities have become popular as therapies for patients who are not appropriate candidates for surgical resection. Use of these techniques, alone or in combination with other liver-directed therapies (and often systemic therapy), has extended the rate of survival for patients with liver metastases and, at times, offers nearly equivalent disease-free survival rates to surgical resection. CONCLUSIONS Although surgical resection remains the optimal treatment for liver metastasis, local options, including microwave ablation and radiofrequency ablation, can offer similar long-term local control in appropriately selected patients.
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Affiliation(s)
- Joyce Wong
- Department of Surgical Oncology, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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16
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Vogl TJ, Hagar A, Nour-Eldin NEA, Gruber-Rouh T, Eichler K, Ackermann H, Bechstein WO, Naguib NNN. High-frequency versus low-frequency microwave ablation in malignant liver tumours: evaluation of local tumour control and survival. Int J Hyperthermia 2016; 32:868-875. [DOI: 10.1080/02656736.2016.1212107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Thomas J. Vogl
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Ahmad Hagar
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Nour-Eldin A. Nour-Eldin
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Department of Biomedical Statistics, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Wolf O. Bechstein
- Department of General Surgery, Frankfurt University Hospital, Frankfurt am Main, Germany
| | - Nagy N. N. Naguib
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt am Main, Germany
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17
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Meloni MF, Chiang J, Laeseke PF, Dietrich CF, Sannino A, Solbiati M, Nocerino E, Brace CL, Lee FT. Microwave ablation in primary and secondary liver tumours: technical and clinical approaches. Int J Hyperthermia 2016; 33:15-24. [PMID: 27416729 DOI: 10.1080/02656736.2016.1209694] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation is increasingly being utilised in the treatment of primary and metastatic liver tumours, both as curative therapy and as a bridge to transplantation. Recent advances in high-powered microwave ablation systems have allowed physicians to realise the theoretical heating advantages of microwave energy compared to other ablation modalities. As a result there is a growing body of literature detailing the effects of microwave energy on tissue heating, as well as its effect on clinical outcomes. This article will discuss the relevant physics, review current clinical outcomes and then describe the current techniques used to optimise patient care when using microwave ablation systems.
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Affiliation(s)
- Maria Franca Meloni
- a Department of Radiology , Interventional Ultrasound, Institute of Care IGEA , Milan , Italy
| | - Jason Chiang
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Paul F Laeseke
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Christoph F Dietrich
- c Department of Internal Medicine , Caritas Krankenhas Bad Mergentheim , Bad Mergentheim , Germany
| | - Angela Sannino
- d Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Marco Solbiati
- e Department of Electronics, Information and Bioengineering , Politecnico Milano , Milan , Italy
| | - Elisabetta Nocerino
- f Department of Radiology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Christopher L Brace
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Fred T Lee
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
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18
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Chen CN, Liang P, Yu J, Yu XL, Cheng ZG, Han ZY, Liu FY, Li X. Contrast-enhanced ultrasound-guided percutaneous microwave ablation of renal cell carcinoma that is inconspicuous on conventional ultrasound. Int J Hyperthermia 2016; 32:607-13. [PMID: 27269816 DOI: 10.3109/02656736.2016.1172118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chao-nan Chen
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiao-ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fang-yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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19
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Nolsøe CP, Lorentzen T. International guidelines for contrast-enhanced ultrasonography: ultrasound imaging in the new millennium. Ultrasonography 2015; 35:89-103. [PMID: 26867761 PMCID: PMC4825210 DOI: 10.14366/usg.15057] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 12/12/2022] Open
Abstract
The intent of this review is to discuss and comment on common clinical scenarios in which contrast-enhanced ultrasonography (CEUS) may play a decisive role and to illustrate important points with typical cases. With the advent of CEUS, the scope of indications for ultrasonography has been dramatically extended, and now includes functional imaging and tissue characterization, which in many cases enable tumor diagnosis without a biopsy. It is virtually impossible to imagine the practice of modern medicine as we know it in high-income countries without the use of imaging, and yet, an estimated two thirds of the global population may receive no such care. Ultrasound imaging with CEUS has the potential to correct this inequity.
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Affiliation(s)
- Christian Pállson Nolsøe
- Ultrasound Section, Department of Gastric Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Torben Lorentzen
- Ultrasound Section, Department of Gastric Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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20
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Liu D, Brace CL. CT imaging during microwave ablation: analysis of spatial and temporal tissue contraction. Med Phys 2015; 41:113303. [PMID: 25370671 DOI: 10.1118/1.4897381] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To analyze the spatial distribution and temporal development of liver tissue contraction during high-temperature ablation by using intraprocedural computed tomography (CT) imaging. METHODS A total of 46 aluminum fiducial markers were positioned in a 60 × 45 mm grid, in a single plane, around a microwave ablation antenna in each of six ex vivo bovine liver samples. Ablations were performed for 10 min at 100 W. CT data of the liver sample were acquired every 30 s during ablation. Fiducial motion between acquisitions was tracked in postprocessing and used to calculate measures of tissue contraction and contraction rates. The spatial distribution and temporal evolution of contraction were analyzed. RESULTS Fiducial displacement indicated that the zone measured postablation was 8.2 ± 1.8 mm (∼20%) smaller in the radial direction and 7.1 ± 1.0 mm (∼10%) shorter in the longitudinal direction than the preablation tissue dimension. Therefore, the total ablation volume was reduced from its preablation value by approximately 45%. Very little longitudinal contraction was noted in the distal portion of the ablation zone. Central tissues contracted more than 60%, which was near an estimated limit of ∼70% based on initial water content. More peripheral tissues contracted only 15% in any direction. Contraction rates peaked during the first 60 s of heating with a roughly exponential decay over time. CONCLUSIONS Ablation zones measured posttreatment are significantly smaller than the pretreatment tissue dimensions. Tissue contraction is spatially dependent, with the greatest effect occurring in the central ablation zone. Contraction rate peaks early and decays over time.
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Affiliation(s)
- Dong Liu
- Departments of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53705
| | - Christopher L Brace
- Departments of Radiology and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53705
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21
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Yu J, Liang P, Yu XL, Cheng ZG, Han ZY, Mu MJ, Li QY, Liu YM. Local tumour progression after ultrasound-guided microwave ablation of liver malignancies: risk factors analysis of 2529 tumours. Eur Radiol 2014; 25:1119-26. [PMID: 25407661 DOI: 10.1007/s00330-014-3483-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 10/25/2014] [Accepted: 10/30/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To identify the incidence and risk factors that predict local tumour progression (LTP) after ultrasound-guided percutaneous microwave ablation (MWA) of liver malignancies. MATERIALS AND METHODS One thousand two hundred and nine patients with 2,529 malignant nodules (mean size 2.8 ± 1.4 cm, range 0.9-8.0 cm) were treated by MWA between July 2005 and December 2012. The influence of 11 factors on the risk of LTP was assessed. Univariate Kaplan-Meier and Cox proportional hazard models were used for statistical analysis. RESULTS The overall LTP was 4.2 % per tumour and 8.6 % per patient with a median follow-up of 20.3 months. LTP per tumour was 4.3 % for primary liver cancer and 4.1 % for metastases (p = 0.32). The survival of LTP and free-LTP patients at 1, 3, and 5 years was 92.4 %, 71.6 %, and 45.1 %, respectively, and 92.9 %, 70.1 %, and 52.4 %, respectively (p = 0.93). By univariate analysis, tumour location, size and ablation time were significant risk factors of LTP. Multivariate analysis identified tumour size (>3.0 cm) to be the only independent predictor of LTP. CONCLUSIONS MWA of liver malignancies achieves a relatively low-incidence LTP, although LTP risk significantly increases if tumour size >3.0 cm. The technique seems to be appropriate even for patients with a tumour at a risk location. KEY POINTS • Microwave ablation of liver malignancies achieves a low incidence local tumour progression. • LTP risk significantly increases if the tumour size is >3.0 cm. • MWA seems to be appropriate even for patients with a tumour at a risk location.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China,
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22
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Vogl TJ, Farshid P, Naguib NNN, Darvishi A, Bazrafshan B, Mbalisike E, Burkhard T, Zangos S. Thermal ablation of liver metastases from colorectal cancer: radiofrequency, microwave and laser ablation therapies. Radiol Med 2014; 119:451-61. [PMID: 24894923 DOI: 10.1007/s11547-014-0415-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 03/26/2014] [Indexed: 12/14/2022]
Abstract
Surgery is currently considered the treatment of choice for patients with colorectal cancer liver metastases (CRLM) when resectable. The majority of these patients can also benefit from systemic chemotherapy. Recently, local or regional therapies such as thermal ablations have been used with acceptable outcomes. We searched the medical literature to identify studies and reviews relevant to radiofrequency (RF) ablation, microwave (MW) ablation and laser-induced thermotherapy (LITT) in terms of local progression, survival indexes and major complications in patients with CRLM. Reviewed literature showed a local progression rate between 2.8 and 29.7 % of RF-ablated liver lesions at 12-49 months follow-up, 2.7-12.5 % of MW ablated lesions at 5-19 months follow-up and 5.2 % of lesions treated with LITT at 6-month follow-up. Major complications were observed in 4-33 % of patients treated with RF ablation, 0-19 % of patients treated with MW ablation and 0.1-3.5 % of lesions treated with LITT. Although not significantly different, the mean of 1-, 3- and 5-year survival rates for RF-, MW- and laser ablated lesions was (92.6, 44.7, 31.1 %), (79, 38.6, 21 %) and (94.2, 61.5, 29.2 %), respectively. The median survival in these methods was 33.2, 29.5 and 33.7 months, respectively. Thermal ablation may be an appropriate alternative in patients with CRLM who have inoperable liver lesions or have operable lesions as an adjunct to resection. However, further competitive evaluation should clarify the efficacy and priority of these therapies in patients with colorectal cancer liver metastases.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany,
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23
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Evolution of surgical microwave ablation for the treatment of colorectal cancer liver metastasis: review of the literature and a single centre experience. Surg Today 2014; 45:407-15. [DOI: 10.1007/s00595-014-0879-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/03/2014] [Indexed: 02/07/2023]
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24
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Wichmann JL, Beeres M, Borchard BM, Naguib NNN, Bodelle B, Lee C, Zangos S, Vogl TJ, Mack MG, Eichler K. Evaluation of MRI T1-based treatment monitoring during laser-induced thermotherapy of liver metastases for necrotic size prediction. Int J Hyperthermia 2013; 30:19-26. [DOI: 10.3109/02656736.2013.854931] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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25
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Andreano A, Galimberti S, Franza E, Knavel EM, Sironi S, Lee FT, Meloni MF. Percutaneous microwave ablation of hepatic tumors: prospective evaluation of postablation syndrome and postprocedural pain. J Vasc Interv Radiol 2013; 25:97-105.e1-2. [PMID: 24286938 DOI: 10.1016/j.jvir.2013.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/01/2013] [Accepted: 09/04/2013] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To prospectively investigate the frequency and severity of postablation syndrome (PAS) and postprocedural pain in a cohort of patients undergoing hepatic microwave ablation. MATERIALS AND METHODS From March 2009 to November 2011, 54 consecutive patients undergoing microwave ablation for liver tumors were enrolled. A questionnaire was administered to investigate PAS and pain at 1, 7, and 40 days after ablation. Four patients did not complete all three questionnaires and were excluded from the analysis. Additionally, laboratory tests with results known to significantly increase or decrease after ablation were performed, and ablation parameters were recorded. Potential predictors of PAS and pain at 1 and 7 days were evaluated by a logistic regression model. RESULTS Fifty patients underwent a single microwave ablation session, 33 for hepatocellular carcinoma (HCC) and 17 for liver metastasis. Median ablation volumes on computed tomography were 31 cm(3) for HCC and 42 cm(3) for metastasis. Sixty percent of patients experienced PAS in the first week. Aspartate aminotransferase (AST) levels after ablation were significantly associated with PAS during postprocedure days 1-7. Median visual analog scale scores for pain at the puncture site were 1 and 0.24 at 1 and 7 days, respectively. The risk of having at least moderate pain in the first week was significantly related to ablation volume and time and postablation increase in AST level. CONCLUSIONS The incidence and severity of PAS with hepatic microwave ablation is similar to that reported for radiofrequency ablation, with the best predictive factor being postablation AST level elevation. Postablation pain was best predicted by total ablation volume and AST level.
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Affiliation(s)
- Anita Andreano
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Stefania Galimberti
- Department of Health Sciences, University of Milano-Bicocca, Monza; Centre of Biostatistics for Clinical Epidemiology, University of Milano-Bicocca, Monza
| | - Elvira Franza
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Erica M Knavel
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Sandro Sironi
- Department of Health Sciences, University of Milano-Bicocca, Monza
| | - Fred T Lee
- Department of Radiology, University of Wisconsin, Madison, Wisconsin
| | - Maria Franca Meloni
- Department of Health Sciences, University of Milano-Bicocca, Monza; Department of Radiology, Ospedale Valduce, via Dante 11, Como 22100, Italy.
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26
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Zhang W, Yu H, Guo Z, Li B, Si T, Yang X, Wang H. Percutaneous cryoablation of liver metastases from breast cancer: initial experience in 17 patients. Clin Radiol 2013; 69:231-8. [PMID: 24238876 DOI: 10.1016/j.crad.2013.09.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/19/2013] [Accepted: 09/10/2013] [Indexed: 12/25/2022]
Abstract
AIM To assess the feasibility, safety, and effectiveness of percutaneous cryoablation for the treatment of liver metastases from breast cancer. MATERIALS AND METHODS This study included 39 liver metastases in 17 female breast cancer patients who underwent computed tomography (CT)-guided percutaneous cryoablation. The mean age of the cohort was 55 years (range 30-66 years). The tumour response was evaluated by CT performed before treatment, 1 month after treatment, and every 3 months thereafter. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) was used to assess the patients' quality of life before, 1 week, 1 month, and 3 months after cryoablation. The primary endpoints were technique effectiveness, quality of life, and complications. RESULTS The technical success rate was 92% with no major complication reported. At the 1-month follow-up, the primary technique effectiveness was 87.1% (34 of 39 tumours). At the 3-months follow-up, local tumour progression was observed in six of 39 lesions (15.4%). The 1-year survival from the time of cryoablation was 70.6%. The quality of life symptoms and functioning scales were preserved in patients alive at 3 months after cryoablation. The global quality of life, mean value of "pain" and "fatigue" between 3 months after cryoablation and prior to treatment showed statistically significant differences, but no clinical significance. CONCLUSIONS Cryoablation is a safe and effective ablative therapy, providing a high rate of local tumour control in breast cancer liver metastases.
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Affiliation(s)
- W Zhang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - H Yu
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Z Guo
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China.
| | - B Li
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - T Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - X Yang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - H Wang
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
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27
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Microwave ablation of liver metastases to overcome the limitations of radiofrequency ablation. Radiol Med 2013; 118:949-61. [PMID: 23892957 DOI: 10.1007/s11547-013-0968-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/08/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of our study was to evaluate technical success, effectiveness and safety of microwave ablation (MWA) in patients with unresectable liver metastases, where radiofrequency ablation (RFA) presents some limits. MATERIALS AND METHODS Twenty-five patients (17 men, 8 women) with 31 liver metastases >3 cm or located near vessels (>3 mm) were treated in a total of 29 sessions. Tumours were subdivided as follows: colorectal metastases (n=21) and no colorectal metastases (n=10). All procedures were performed percutaneously under ultrasound (US) guidance. Follow-up was performed with computed tomography (CT) scan at 1, 3, 6 and 12 months after treatment; mean follow-up period was 12.04 (range, 3-36) months. Technical success, mean disease-free survival, effectiveness and safety were evaluated. RESULTS Technical success was obtained in all cases. Mean disease-free survival was of 20.5 months. Local recurrence was recorded in 12.9% of metastases treated (4/31). No major complications were recorded. The rate of minor complications was 44.8% (13/29 sessions). Mortality at 30 days was 0%. CONCLUSIONS Percutaneous MWA of liver metastases >3 cm or located near vessels (>3 mm) can be considered a valid and safe option, probably preferable to RFA. Further studies are required to confirm these encouraging initial results.
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28
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Guye ML, Schoellhammer HF, Chiu LW, Kim J, Lai LL, Singh G. Designing liver resections and pushing the envelope with resections for hepatic colorectal metastases. Indian J Surg Oncol 2013; 4:349-55. [PMID: 24426756 DOI: 10.1007/s13193-013-0256-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/25/2013] [Indexed: 12/24/2022] Open
Abstract
Current concepts in the management of hepatic metastases have changed dramatically over the past two decades. Multidisciplinary therapies including chemotherapy, surgery, and regional therapy have alone and in combination significantly improved the survival of patients with metastatic colorectal cancer. Conditions that were previously considered hopeless and treated merely for palliation can now be approached with curative intent. In this paper, we review the surgical treatment for colorectal cancer liver metastasis (CRLM) and describe a paradigm-shift in the management of complex heretofore-considered unresectable CRLM. Utilizing advanced multidisciplinary treatment strategies has improved the prognosis of patients with stage IV colorectal cancer to the point where we may question whether CRLM are now a chronic disease.
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Affiliation(s)
- Mary L Guye
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
| | - Hans F Schoellhammer
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
| | - Louisa W Chiu
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
| | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
| | - Lily L Lai
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
| | - Gagandeep Singh
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA 91010 USA
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Abstract
OBJECTIVE Thermal ablation is safe and effective for the treatment of hepatocellular carcinoma. However, it remains problematic with respect to liver metastases. Here, we aimed to evaluate the efficacy and safety of thermal ablation in patients with liver metastases. METHODS Eighty-nine patients with 132 liver metastases measuring 0.8-5.0 cm were treated with microwave ablation (MWA) or radiofrequency ablation (RFA). The primary lesions were colorectal cancer in 38 cases and others in 51, respectively. Local tumor control, complications, and long-term survival were analyzed. RESULTS Complete ablation was achieved in 117 of 132 (88.6%) nodules. Seventeen of the 117 (14.5%) successfully treated nodules developed local recurrence. In a univariate analysis, a significant trend toward a lower local recurrence rate with MWA was observed (8.6% for MWA vs. 20.3% for RFA, P=0.072). Multivariate analysis showed that number of cycles of chemotherapy was the significant prognostic factor for overall recurrence (P=0.015), whereas disease-free interval was the significant prognostic factor for distant recurrence (P=0.030). Ablation modality showed potential prognostic significance for local recurrence (P=0.053). Major complications occurred in 1.1% of patients. No procedure-related mortalities were observed. The 1, 2, 3, and 5-year overall survival rates after the initial ablation were 84.9, 59.6, 48.8, and 36.3%, respectively. CONCLUSION Thermal ablation is a safe and effective treatment for patients with liver metastases. MWA has the potential to result in less local recurrence than RFA.
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Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 2012; 265:958-68. [PMID: 23091175 DOI: 10.1148/radiol.12111851] [Citation(s) in RCA: 242] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine the long-term (10-year) survival of patients with colorectal liver metastases treated with radiofrequency (RF) ablation and systemic chemotherapy with intention to treat. MATERIALS AND METHODS Institutional review board approval was obtained for this study. From 1997 to 2006, 99 consecutive patients with 202 small (0.8-4.0 cm; mean: 2.2 cm ± 1.1) metachronous colorectal liver metastases underwent ultrasonography-guided percutaneous RF ablation with internally-cooled electrodes in association with systemic chemotherapy. Patients ineligible for surgery (n = 80) or whose lesions were potentially resectable and who refused surgery (n = 19) were included. Patients were followed up with contrast agent-enhanced computed tomography and/or magnetic resonance imaging for a minimum of 3 years to more than 10 years after RF ablation (n = 99, 67, 49, and 25 for 3, 5, 7, and 10 or more years, respectively). Overall local response rates and long-term survival rates were assessed. For each of these primary endpoints, Kaplan-Meier curves were generated and log-rank tests were used to assess for statistically significant differences. RESULTS Primary and secondary technical success rates were 93.1% (188 of 202) and 100% (14 of 14), respectively. Local tumor progression occurred in 11.9% (24 of 202) metastases, and 54.2% (13 of 24) of these were re-treated. Patient survival rates increased with re-treatment versus no re-treatment (P < .001). At follow-up, 125 new liver metastases were found, and of these 32.8% (41 of 125) were treated with RF ablation. Overall survival rates were 98.0%, 69.3%, 47.8%, 25.0%, and 18.0% (median: 53.2 months) at 1, 3, 5, 7, and 10 years, respectively. The major complication rate was 1.3% (two of 156), and there were no procedure-related deaths. At the time this article was written, 32.3% (32 of 99) of the patients were alive, and 67.7% (67 of 99) were deceased, with a median follow-up of 72 months. CONCLUSION Adding RF ablation to systemic chemotherapy achieved local control in a large majority of metachronous colorectal liver metastases. The 3- to 10-year survival rates of this relatively large series of patients were essentially equivalent to those of most surgical series reported in the literature.
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Affiliation(s)
- Luigi Solbiati
- Department of Interventional Oncologic Radiology, General Hospital of Busto Arsizio, Busto Arsizio, Italy
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Thermal ablation therapies in patients with breast cancer liver metastases: a review. Eur Radiol 2012; 23:797-804. [PMID: 23064713 DOI: 10.1007/s00330-012-2662-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 08/22/2012] [Accepted: 08/27/2012] [Indexed: 01/07/2023]
Abstract
BACKGROUND The liver is involved in about half of patients with metastatic breast cancer. Unfortunately systemic chemotherapy as the treatment of choice is limited. Due to multifocality and/or insufficient remnant liver volume, the majority of liver metastases are also unresectable. Currently, thermal ablations are used in these patients with acceptable impact. METHODS We reviewed studies on radiofrequency ablation (RFA), laser-induced thermotherapy (LITT) and microwave ablation (MWA) regarding local tumour response, progression and survival indexes in patients with breast cancer liver metastases (BCLM). RESULTS The reviewed literature showed positive response rates of 63 % to 97 % in RF-ablated lesions, 98.2 % in LITT-treated lesions and 34.5-62.5 % in MW-ablated lesions. Median survival was 10.9-60 months using RFA, 51-54 months after LITT and 41.8 months using MWA. Five-year survival rates were 27-30 %, 35 % and 29 %, respectively. Local tumour progression ranged from 13.5 % to 58 % using RFA, 2.9 % with LITT and 9.6 % with MWA. CONCLUSION The reviewed literature demonstrated that ablation therapies either as single therapy or combined with other locoregional therapies are a good alternative as an adjunction to resection in patients with resectable lesions or with positive response using chemotherapy. However, multicentre randomised studies should be conducted to obtain further evidence of the benefits of these treatments in patients with BCLM.
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