Thermal ablation of biological tissues in disease treatment: A review of computational models and future directions

Computational study on the effect of thermal deformation of myocardium on lesion formation during radiofrequency ablation

Radiofrequency (RF) catheter ablation treats cardiac diseases by inducing thermal lesion of cardiac tissues through radiofrequency energy operating at around 500 kHz. The electromagnetic wavelength is significantly longer than the size of the radiofrequency active electrode, the tissue is heated through resistive heating. During thermal ablation, the coupled thermo-mechanical property of cardiac tissue influencing the contact area between the electrode and tissue plays a crucial role in the formation of thermal lesions, yet the literature often overlooks the effect of thermal deformation. This paper proposes a thermo-hyperelastic constitutive model for myocardium that models thermal contraction and expansion during ablation. Furthermore, a finite element model was established to investigate the effect of the electro-thermo-mechanical coupling property of myocardium on lesion formation under different contact forces. To ensure convergence, we solved the fully coupled electro-thermo-mechanical finite element model using the segregated step method. The computational results demonstrate that thermal deformation, which causes an expansion in the tissue-electrode contact area, increases lesion width and volume, while its influence on lesion depth is negligible. Specifically, after a 30-s ablation under contact forces of 0.1, 0.15, and 0.2 N, the lesion volume increased from 4.53, 7.66, and 10.62 mm3 (without thermo-mechanical coupling) to 5.36, 8.33, and 13.34 mm3 (with thermo-mechanical coupling), respectively. Similarly, the lesion width increased from 2.68, 3.12, and 3.44 mm to 2.78, 3.22, and 3.62 mm. Moreover, both thermal deformation and contact force exert a minimal effect on lesion formation time.

Computed Tomography-Guided Radiofrequency Ablation of Nasal Carcinomas in Dogs

Nasal carcinomas in dogs are locally invasive neoplasms with a low metastatic rate that pose significant treatment challenges due to their location and aggressiveness. This study evaluates the safety, feasibility, and therapeutic outcomes of computed tomography-guided radiofrequency ablation (CT-guided RFA) in 15 dogs diagnosed with nasal adenocarcinoma. All patients underwent staging and histopathological diagnosis before treatment. CT-guided RFA achieved a significant tumor volume reduction (82.8%) and improvement in clinical signs such as nasal discharge, epistaxis, and respiratory distress, without complications. Post-RFA CT examinations demonstrated a significant decrease in Hounsfield units and tumor volume. This study has shown that CT-guided RFA is an effective cytoreductive option for minimally invasive management of nasal adenocarcinomas in dogs, particularly when traditional therapies like radiation therapy or surgery are not feasible.

Percutaneous Ultrasound-Guided Radiofrequency Ablation as a Therapeutic Approach for the Management of Insulinomas and Associated Metastases in Dogs

Insulinomas are the most common neoplasms of the endocrine pancreas in dogs, leading to persistent hypoglycemia due to inappropriate insulin secretion. The standard treatment is surgical resection, but it carries significant risks, including pancreatitis and diabetes mellitus. This study investigates the efficacy and safety of percutaneous ultrasound-guided radiofrequency ablation (RFA) as an alternative to surgery. A total of 29 dogs diagnosed with insulinoma were treated with RFA, targeting both primary pancreatic tumors and metastases in regional lymph nodes or the liver. Blood glucose levels and tumor size were monitored before and after the procedure. RFA led to a significant increase in blood glucose levels and a reduction in tumor size in all patients, with minimal postoperative complications. The results suggest that RFA is a feasible and effective treatment option for insulinomas in dogs.

Comparative efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma: Systematic review including traditional pooling and Bayesian network meta-analysis

PURPOSE

To compare the efficacy of different thermal ablation and conventional surgery for the treatment of Papillary Thyroid Microcarcinoma, using a systematic review including traditional pooling and Bayesian network meta-analysis.

MATERIALS AND METHODS

A comprehensive literature search in PubMed, EMBASE, and the Cochrane Library databases identified retrospective studies evaluating the tumor volume change after different thermal ablation or conventional surgery. Studies from the date of their inception to January 6, 2024, were included. A review of 4463 potential papers, including a full-text review of 23, identified 10 eligible papers covering a total of 2658 patients for meta-analysis. The tumor volume change over a 12-month follow-up was compared between different thermal ablations. Tumor diameter change, complications, recurrence, operation and hospitalization time were evaluated by network meta-analysis.

RESULTS

Based on the traditional frequentist approach, the overall pooled estimates for the standardized mean difference (SMD) in tumor volume change of radiofrequency ablation (RFA), laser ablation (LA), and microwave ablation (MWA) were 1.38 (95 % credibility interval (CI), 0.62-2.13), 1.94 (95%CI, 0.78-3.10) and 1.38 (95%CI, 1.01-1.75), respectively. Based on the Bayesian network meta-analysis, in examining the surface under the cumulative ranking area (SUCRA) ranking, RFA (SUCRA, 76.6), MWA (SUCRA, 66.6), and LA (SUCRA, 39.8) were identified as the three interventions that were associated with the greatest reduction in risk for complications compared with conventional surgery (CS), with RFA (SUCRA, 76.6) being ranked as the highest in safety. MWA, SMD 4.43 [95%CI, 2.68-6.17], RFA SMD 4.24 [95 % CI, 1.66-6.82], and LA SMD 4.24 [95 % CI, 1.48-7.00] were associated with the shorter operation time compared with CS. LA SMD 4.61 [95 % CI, 1.79-7.44] and MWA SMD 3.07 [95 % CI, 1.32-4.83] were associated with the shorter hospitalization time compared with CS, with LA (SUCRA, 86.5) yielding the highest ranking. MWA was associated with a reduced risk for tumor recurrence RR 0.02 [95 % CI, -0.44-0.49], compared with CS.

CONCLUSION

We conducted a comprehensive review of the published literature on the effectiveness and safety of different thermal ablation techniques and conventional surgery for papillary thyroid microcarcinoma. Important research gaps persist due to a lack of long-term data and high-quality randomized controlled trials (RCTs).

Salvage radiofrequency ablation for microwave ablation treated hepatocellular carcinoma complicated by gas gangrene: case report

AIM

Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA).

CASE PRESENTATION

A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up.

CONCLUSION

Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.

Fusion and Validation Method for Laser Interstitial Thermal Therapy Simulation Model and MRI

In this paper, we present a simulation program based on Monte Carlo simulation and bio-heat transfer models for laser interstitial thermal therapy (LITT). Additionally, we present a data fusion strategy that synchronizes MRI data with simulation results. The simulation model's validity was checked and proven by using this method to combine simulation calculations with MRI-measured temperature data from cases of brain lesions. For LITT treatment planning, the alignment fusion method and higher temporal-spatial resolution simulation model developed in this paper provide a clear three-dimensional visualization of the ablation temperature field displayed in situ on MRI images. This enables the preoperative planning of LITT to be conducted efficiently.

Modeling pulsed dye laser treatment of psoriatic plaques by combining numerical methods and image-derived lesion morphologies

OBJECTIVES

Knowledge of the physical effects of pulsed dye laser (PDL) treatment of psoriatic lesions is essential in unraveling the remedial mechanisms of this treatment and hence also in maximizing in its disease-modifying potential. Therefore, the main objective of this study was to provide estimates of these physical effects (for laser wavelengths of 585 and 595 nm), with the aim of identifying pathogenic processes that may be affected by these conditions.

METHODS

We modeled the laser light propagation and subsequent photothermal heating by numerically solving the transient diffusion and heat equations simultaneously. To this end, we used the finite element method in conjunction with an image-derived psoriatic lesion morphology (which was defined by segmenting blood vessels from a confocal microscopy image of a fluorescently labeled section of a 3 mm punch biopsy of a psoriatic lesion). The resulting predictions of the generated temperature field within the lesion were then used to assess the possibility of stalling or arresting some suspected pathogenic processes.

RESULTS

According to our results, it is conceivable that perivascular nerves are thermally denatured, as almost all locations that reach 60°C were found to be within 18 µm (at 585 nm) and 11 µm (at 595 nm) of a blood vessel wall. Furthermore, activation of TRPV1 and TRPV2 channels in perivascular neuronal and immune cells is highly likely, since a critical temperature of 43°C is generated at locations within up to 350 µm of a vessel wall (at both wavelengths) and sustained for up to 700 ms (at 585 nm) and 40 ms (at 595 nm), while a critical temperature of 52°C is reached by locations within 80 µm (at 585 nm) and 30 µm (at 595 nm) of a vessel wall and sustained for up to 100  ms (at 585 nm) and 30 ms (at 595 nm). Finally, we found that the blood vessel coagulation-inducing temperature of 70°C is sustained in the vascular epithelium for up to 19 and 5 ms at 585 and 595 nm, respectively, rendering partial or total loss of vascular functionality a distinct possibility.

CONCLUSIONS

The presented approach constitutes a useful tool to provide realistic estimates of the photothermal effects of PDL treatment of psoriatic plaques (as well as other selective photothermolysis-based treatments), yielding information that is essential in guiding future experimental studies toward unraveling the remedial mechanisms of these treatments.

Treatment Planning Strategies for Interstitial Ultrasound Ablation of Prostate Cancer

PURPOSE

To develop patient-specific 3D models using Finite-Difference Time-Domain (FDTD) simulations and pre-treatment planning tools for the selective thermal ablation of prostate cancer with interstitial ultrasound. This involves the integration with a FDA 510(k) cleared catheter-based ultrasound interstitial applicators and delivery system.

METHODS

A 3D generalized "prostate" model was developed to generate temperature and thermal dose profiles for different applicator operating parameters and anticipated perfusion ranges. A priori planning, based upon these pre-calculated lethal thermal dose and iso-temperature clouds, was devised for iterative device selection and positioning. Full 3D patient-specific anatomic modeling of actual placement of single or multiple applicators to conformally ablate target regions can be applied, with optional integrated pilot-point temperature-based feedback control and urethral/rectum cooling. These numerical models were verified against previously reported ex-vivo experimental results obtained in soft tissues.

RESULTS

For generic prostate tissue, 360 treatment schemes were simulated based on the number of transducers (1-4), applied power (8-20 W/cm2), heating time (5, 7.5, 10 min), and blood perfusion (0, 2.5, 5 kg/m3/s) using forward treatment modelling. Selectable ablation zones ranged from 0.8-3.0 cm and 0.8-5.3 cm in radial and axial directions, respectively. 3D patient-specific thermal treatment modeling for 12 Cases of T2/T3 prostate disease demonstrate applicability of workflow and technique for focal, quadrant and hemi-gland ablation. A temperature threshold (e.g., Tthres = 52 °C) at the treatment margin, emulating placement of invasive temperature sensing, can be applied for pilot-point feedback control to improve conformality of thermal ablation. Also, binary power control (e.g., Treg = 45 °C) can be applied which will regulate the applied power level to maintain the surrounding temperature to a safe limit or maximum threshold until the set heating time.

CONCLUSIONS

Prostate-specific simulations of interstitial ultrasound applicators were used to generate a library of thermal-dose distributions to visually optimize and set applicator positioning and directivity during a priori treatment planning pre-procedure. Anatomic 3D forward treatment planning in patient-specific models, along with optional temperature-based feedback control, demonstrated single and multi-applicator implant strategies to effectively ablate focal disease while affording protection of normal tissues.

Computer simulation-based nanothermal field and tissue damage analysis for cardiac tumor ablation

Radiofrequency ablation is a nominally invasive technique to eradicate cancerous or non-cancerous cells by heating. However, it is still hampered to acquire a successful cell destruction process due to inappropriate RF intensities that will not entirely obliterate tumorous tissues, causing in treatment failure. In this study, we are acquainted with a nanoassisted RF ablation procedure of cardiac tumor to provide better outcomes for long-term survival rate without any recurrences. A three-dimensional thermo-electric energy model is employed to investigate nanothermal field and ablation efficiency into the left atrium tumor. The cell death model is adopted to quantify the degree of tissue injury while injecting the Fe3O4 nanoparticles concentrations up to 20% into the target tissue. The results reveal that when nanothermal field extents as a function of tissue depth (10 mm) from the electrode tip, the increasing thermal rates were approximately 0.54362%, 3.17039%, and 7.27397% for the particle concentration levels of 7%, 10%, and 15% compared with no-particle case. In the 7% Fe3O4 nanoparticles, 100% fractional damage index is achieved after ablation time of 18 s whereas tissue annihilation approach proceeds longer to complete for no-particle case. The outcomes indicate that injecting nanoparticles may lessen ablation time in surgeries and prevent damage to adjacent healthy tissue.

Non-Fourier Bioheat Transfer Analysis in Brain Tissue During Interstitial Laser Ablation: Analysis of Multiple Influential Factors

This work presents the dual-phase lag-based non-Fourier bioheat transfer model of brain tissue subjected to interstitial laser ablation. The finite element method has been utilized to predict the brain tissue's temperature distributions and ablation volumes. A sensitivity analysis has been conducted to quantify the effect of variations in the input laser power, treatment time, laser fiber diameter, laser wavelength, and non-Fourier phase lags. Notably, in this work, the temperature-dependent thermal properties of brain tissue have been considered. The developed model has been validated by comparing the temperature obtained from the numerical and ex vivo brain tissue during interstitial laser ablation. The ex vivo brain model has been further extended to in vivo settings by incorporating the blood perfusion effects. The results of the systematic analysis highlight the importance of considering temperature-dependent thermal properties of the brain tissue, non-Fourier behavior, and microvascular perfusion effects in the computational models for accurate predictions of the treatment outcomes during interstitial laser ablation, thereby minimizing the damage to surrounding healthy tissue. The developed model and parametric analysis reported in this study would assist in a more accurate and precise prediction of the temperature distribution, thus allowing to optimize the thermal dosage during laser therapy in the brain.

Saline-Infused Radiofrequency Ablation: A Review on the Key Factors for a Safe and Reliable Tumour Treatment

Radiofrequency ablation (RFA) combined with saline infusion into tissue is a promising technique to ablate larger tumours. Nevertheless, the application of saline-infused RFA remains at clinical trials due to the contradictory findings as a result of the inconsistencies in experimental procedures. These inconsistencies not only magnify the number of factors to consider during the treatment, but also obscure the understanding of the role of saline in enlarging the coagulation zone. Consequently, this can result in major complications, which includes unwanted thermal damages to adjacent tissues and also incomplete ablation of the tumour. This review aims to identify the key factors of saline responsible for enlarging the coagulation zone during saline-infused RFA, and provide a proper understanding on their effects that is supported with findings from computational studies to ensure a safe and reliable cancer treatment.

Magnetic hybrid Pd/Fe-oxide nanoparticles meet the demands for ablative thermo-brachytherapy

OBJECTIVE

To investigate the potential of hybrid Pd/Fe-oxide magnetic nanoparticles designed for thermo-brachytherapy of breast cancer, considering their specific loss power (SLP) and clinical constraints in the applied magnetic field.

METHODS

Hybrid nanoparticles consisting of palladium-core and iron oxide shell of increasing thickness, were suspended in water and their SLPs were measured at varying magnetic fields (12-26 mT peak) and frequencies (50-730 kHz) with a commercial alternating magnetic field generator (magneTherm™ Digital, nanoTherics Ltd.).

RESULTS

Validation of the heating device used in this study with commercial HyperMag-C nanoparticles showed a small deviation (±4%) over a period of 1 year, confirming the reliability of the method. The integration of dual thermometers, one in the center and one at the bottom of the sample vial, allowed monitoring of homogeneity of the sample suspensions. SLPs measurements on a series of nanoparticles of increasing sizes showed the highest heating for the diameter of 21 nm (SLP = 225 W/g) at the applied frequencies of 346 and 730 kHz. No heating was observed for the nanoparticles with the size <14 nm, confirming the importance of the size-parameter. The heating ability of the best performing Pd/Fe-oxide-21 was calculated to be sufficient to ablate tumors with a radius ±4 and 12 mm using 10 and 1 mg/mL nanoparticle concentration, respectively.

CONCLUSIONS

Nanoparticles consisting of non-magnetic palladium-core and magnetic iron oxide shell are suitable for magnetic hyperthermia/thermal ablation under clinically safe conditions of 346 kHz and 19.1 mT, with minimal eddy current effects in combination with maximum SLP.

Enlarging the thermal coagulation volume during thermochemical ablation with alternating acid-base injection by shortening the injection interval: A computational study

BACKGROUND AND OBJECTIVES

Thermochemical ablation (TCA) is a cancer treatment that utilises the heat released from the neutralisation of acid and base to raise tissue temperature to levels sufficient to induce thermal coagulation. Computational studies have demonstrated that the coagulation volume produced by sequential injection is smaller than that with simultaneous injection. By injecting the reagents in an ensuing manner, the region of contact between acid and base is limited to a thin contact layer sandwiched between the distribution of acid and base. It is hypothesised that increasing the frequency of acid-base injections into the tissue by shortening the injection interval for each reagent can increase the effective area of contact between acid and base, thereby intensifying neutralisation and the exothermic heat released into the tissue.

METHODS

To verify this hypothesis, a computational model was developed to simulate the thermochemical processes involved during TCA with sequential injection. Four major processes that take place during TCA were considered, i.e., the flow of acid and base, their neutralisation, the release of exothermic heat and the formation of thermal damage inside the tissue. Equimolar acid and base at 7.5 M was injected into the tissue intermittently. Six injection intervals, namely 3, 6, 15, 20, 30 and 60 s were investigated.

RESULTS

Shortening of the injection interval led to the enlargement of coagulation volume. If one considers only the coagulation volume as the determining factor, then a 15 s injection interval was found to be optimum. Conversely, if one places priority on safety, then a 3 s injection interval would result in the lowest amount of reagent residue inside the tissue after treatment. With a 3 s injection interval, the coagulation volume was found to be larger than that of simultaneous injection with the same treatment parameters. Not only that, the volume also surpassed that of radiofrequency ablation (RFA); a conventional thermal ablation technique commonly used for liver cancer treatment.

CONCLUSION

The numerical results verified the hypothesis that shortening the injection interval will lead to the formation of larger thermal coagulation zone during TCA with sequential injection. More importantly, a 3 s injection interval was found to be optimum for both efficacy (large coagulation volume) and safety (least amount of reagent residue).

Tumor size dependent MNP dose evaluation in realistic breast tumor models for effective magnetic hyperthermia

The goal of the current investigation is to determine the breast tumor size-dependent MNP (Magnetic nano-particle) dose (mg/cm3) that can induce the required therapeutic effects during magnetic nanoparticle hyperthermia (MNH). The investigation is done through the MNH simulations on the tumor models generated from DCE_MRI DICOM images of breast cancer from TCIA ('The Cancer Imaging Archive'). Five tumor models are created from MRI data using 3D slicer software having size range of 3 cm3 to 15 cm3. The FEM-based solver (COMSOL multi-physics) is used to simulate bioheat transfer physics in all five extracted models. Single and multi-point injection strategies have been adopted to induce MNP in tumor tissues. The required MNP dose that may induce necessary therapeutic effects is evaluated by comparing the therapeutic effects produced by constant dose (CD) (5 mg/cm3) and variable reduced dose (RD) (5.5-2.8 mg/cm3) methodologies. Results show that for the requisite therapeutic effects, injected MNP doses (mg/cm3) should not remain constant as the size of the tumor increases. In fact, MNP dose  (mg/cm3) should be reduced as the size of the tumor increases. Results also show that RD works better with a multi-injection strategy than a single injection of MNP. It has been found that the effective MNP dose  (mg/cm3) is reduced by 50 % for the biggest tumor size (15 cm3) using multi-injection MNP delivery with respect to the smallest tumor (3 cm3) selected in this study.

Model-Optimizing Radiofrequency Parameters of 3D Finite Element Analysis for Ablation of Benign Thyroid Nodules

Radiofrequency (RF) ablation represents an efficient strategy to reduce the volume of thyroid nodules. In this study, a finite element model was developed with the aim of optimizing RF parameters, e.g., input power and treatment duration, in order to achieve the target volume reduction rate (VRR) for a thyroid nodule. RF ablation is modelled as a coupled electro-thermal problem wherein the electric field is applied to induce tissue heating. The electric problem is solved with the Laplace equation, the temperature distribution is estimated with the Pennes bioheat equation, and the thermal damage is evaluated using the Arrhenius equation. The optimization model is applied to RF electrode with different active tip lengths in the interval from 5 mm to 40 mm at the 5 mm step. For each case, we also explored the influence of tumour blood perfusion rate on RF ablation outcomes. The model highlights that longer active tips are more efficient as they require lesser power and shorter treatment time to reach the target VRR. Moreover, this condition is characterized by a reduced transversal ablation zone. In addition, a higher blood perfusion increases the heat dispersion, requiring a different combination of RF power and time treatment to achieve the target VRR. The model may contribute to an improvement in patient-specific RF ablation treatment.

Numerical Modeling and Simulation of Non-Invasive Acupuncture Therapy Utilizing Near-Infrared Light-Emitting Diode

Acupuncture is one of the most extensively used complementary and alternative medicine therapies worldwide. In this study, we explore the use of near-infrared light-emitting diodes (LEDs) to provide acupuncture-like physical stimulus to the skin tissue, but in a completely non-invasive way. A computational modeling framework has been developed to investigate the light-tissue interaction within a three-dimensional multi-layer model of skin tissue. Finite element-based analysis has been conducted, to obtain the spatiotemporal temperature distribution within the skin tissue, by solving Pennes' bioheat transfer equation, coupled with the Beer-Lambert law. The irradiation profile of the LED has been experimentally characterized and imposed in the numerical model. The experimental validation of the developed model has been conducted through comparing the numerical model predictions with those obtained experimentally on the agar phantom. The effects of the LED power, treatment duration, LED distance from the skin surface, and usage of multiple LEDs on the temperature distribution attained within the skin tissue have been systematically investigated, highlighting the safe operating power of the selected LEDs. The presented information about the spatiotemporal temperature distribution, and critical factors affecting it, would assist in better optimizing the desired thermal dosage, thereby enabling a safe and effective LED-based photothermal therapy.

Theoretical Estimation of Tissue Thermal Response and Associated Thermal Damage During Gold Nanorod-enhanced Photothermal Therapy of Tumors

In the present work, we implemented a computational framework of in vivo gold nanorod (GNR)-enhanced photothermal therapy (PTT) for tumor treatment. The temperature-dependent thermophysical properties of biological tissue and the optical properties of both GNRs and the biological media were included. The latter were modulated during the treatment simulation to account for their variation, from the native to the coagulated state. The contribution of tissue injury-dependent blood perfusion was also considered. The developed model allowed for the estimation of temperature distribution during the photothermal procedure at different procedural settings and amounts of GNRs embedded in the tumor region (i.e., 12.5 μg, 25 μg, and 50 μg). Furthermore, the influence of GNRs on thermal injury, estimated with different damage models, was assessed. The inclusion of GNRs in the tumor entailed an increment of maximum tissue temperature, and faster heating kinetics, as witnessed by the lower time needed to reach complete thermal damage at the tumor center. The percentage of tumor thermal damage evaluated at the end of the simulated treatment was 48%, 69%, and 90%, for PTT in the presence of 12.5 μg, 25 μg, and 50 μg of GNRs, respectively.Clinical Relevance-This establishes that simulation-based tools, modeling the tissue properties variation during the photothermal treatment, can serve as promising preplanning platforms for nanoparticle-assisted light therapies.

Minimally Invasive Live Tissue High-Fidelity Thermophysical Modeling Using Real-Time Thermography

We present a novel thermodynamic parameter estimation framework for energy-based surgery on live tissue, with direct applications to tissue characterization during electrosurgery. This framework addresses the problem of estimating tissue-specific thermodynamics in real-time, which would enable accurate prediction of thermal damage impact to the tissue and damage-conscious planning of electrosurgical procedures. Our approach provides basic thermodynamic information such as thermal diffusivity, and also allows for obtaining the thermal relaxation time and a model of the heat source, yielding in real-time a controlled hyperbolic thermodynamics model. The latter accounts for the finite thermal propagation time necessary for modeling of the electrosurgical action, in which the probe motion speed often surpasses the speed of thermal propagation in the tissue operated on. Our approach relies solely on thermographer feedback and a knowledge of the power level and position of the electrosurgical pencil, imposing only very minor adjustments to normal electrosurgery to obtain a high-fidelity model of the tissue-probe interaction. Our method is minimally invasive and can be performed in situ. We apply our method first to simulated data based on porcine muscle tissue to verify its accuracy and then to in vivo liver tissue, and compare the results with those from the literature. This comparison shows that parameterizing the Maxwell-Cattaneo model through the framework proposed yields a noticeably higher fidelity real-time adaptable representation of the thermodynamic tissue response to the electrosurgical impact than currently available. A discussion on the differences between the live and the dead tissue thermodynamics is also provided.

Dual Targeted Delivery of Liposomal Hybrid Gold Nano-Assembly for Enhanced Photothermal Therapy against Lung Carcinomas

The delivery and accumulation of therapeutic drugs into cancer cells without affecting healthy cells are a major challenge for antitumor therapy. Here, we report the synthesis of a liposomal hybrid gold nano-assembly with enhanced photothermal activity for lung cancer treatment. The core components of the nano-assembly include gold nanorods coated with a mesoporous silica shell that offers an excellent drug-loading surface for encapsulation of doxorubicin. To enhance the photothermal capacity of nano-assembly, IR 780 dye was loaded inside a thermo-sensitive liposome, and then, the core nano-assembly was wrapped within the liposome, and GE-11 peptide and folic acid were conjugated onto the surface of the liposome to give the final nano-assembly [(GM@Dox) LI]-PF. The dual targeting approach of [(GM@Dox) LI]-PF leads to enhanced cellular uptake and improves the accumulation of nano-assemblies in cancer cells that overexpress the epidermal growth factor receptor and folate. The exposure of near-infrared laser irradiation can trigger photothermal-induced structural disruption of the nano-assembly, which allows for the precise and controllable release of Dox at targeted sites. Additionally, chemo-photothermal therapy was shown to be 11 times more effective in cancer cell treatment when compared to Dox alone. Our systematic study suggests that the nano-assemblies facilitate the cancer cells undergoing apoptosis via an intrinsic mitochondrial pathway that can be directly triggered by the chemo-photothermal treatment. This study offers an appealing candidate that holds great promise for synergistic cancer treatment.

Refined Dual-Phase-Lag Theory for the 1D Behavior of Skin Tissue under Ramp-Type Heating

In this article, a mathematical analysis of thermoelastic skin tissue is presented based on a refined dual-phase-lag (DPL) thermal conduction theory that considers accounting for the effect of multiple time derivatives. The thin skin tissue is regarded as having mechanically clamped surfaces that are one-dimensional. Additionally, the skin tissue undergoes ramp-type heating on its outer surface, whereas its inner surface keeps the assessed temperature from vanishing. Some of the previous generalized thermoelasticity theories were obtained from the proposed model. The distributions of temperature, displacement, dilatation, and stress are attained by applying the Laplace transform and its numerical reversal approaches. The outcomes are explicitly illustrated to examine the significant influences on the distributions of the field variables. The refined DPL bioheat conduction model in this study predicts temperature, and the findings revealed that the model is located among the existing generalized thermoelastic theories. These findings offer a more thorough understanding of how skin tissue behaves when exposed to a particular boundary condition temperature distribution.

Heat transfer analysis for tissue with surface heat flux based on the non-linearized form of the three-phase-lag model

The three-phase-lag model of heat conduction has been proposed for considering thermoelastic effect in medium. The bioheat transfer equations based on Taylor's series approximation of the three-phase-lag model were derived in conjunction with a modified energy conservation equation. For exploring the effect of non-linear expansion in the phase lag times, the Taylor's series of second-order expansion was applied. The resulting equation involves mixed derivative terms and higher-order derivatives of temperature with respect to time. The hybrid application of the Laplace transform method and a modified discretization technique was extended to solve the equations and explore the effect of thermoelasticity on the thermal behavior in living tissue with surface heat flux. The influence of thermoelastic parameters and phase lags on heat transfer in tissue has been investigated. The present results illustrate the thermal response oscillation is excited in medium for the thermoelastic effect, the phase lag times significantly affect the amplitude and frequency of the oscillation, and the expansion order of TPL model evidently affects the predicted temperature.

Infinite-Dimensional Adaptive Boundary Observer for Inner-Domain Temperature Estimation of 3D Electrosurgical Processes using Surface Thermography Sensing

We present a novel 3D adaptive observer framework for use in the determination of subsurface organic tissue temperatures in electrosurgery. The observer structure leverages pointwise 2D surface temperature readings obtained from a real-time infrared thermographer for both parameter estimation and temperature field observation. We introduce a novel approach to decoupled parameter adaptation and estimation, wherein the parameter estimation can run in real-time, while the observer loop runs on a slower time scale. To achieve this, we introduce a novel parameter estimation method known as attention-based noise-robust averaging, in which surface thermography time series are used to directly estimate the tissue's diffusivity. Our observer contains a real-time parameter adaptation component based on this diffusivity adaptation law, as well as a Luenberger-type corrector based on the sensed surface temperature. In this work, we also present a novel model structure adapted to the setting of robotic surgery, wherein we model the electrosurgical heat distribution as a compactly supported magnitude- and velocity-controlled heat source involving a new nonlinear input mapping. We demonstrate satisfactory performance of the adaptive observer in simulation, using real-life experimental ex vivo porcine tissue data.

Meta-Analysis of the Application Effect of Different Modalities of Thermal Ablation and Surgical Treatment in Papillary Thyroid Microcarcinoma

Background

Papillary thyroid microcarcinoma (PTMC) refers to papillary thyroid carcinoma (PTC) with a maximum diameter of 10 mm. Thermal ablation, including radiofrequency ablation (RFA), microwave ablation (MWA), and laser ablation (LA), has been applied in the treatment of benign thyroid nodules and captured extensive attention. At present, the application of thermal ablation in PTMC has been extensively reported, but outcomes such as volume reduction rate (VRR), complete remission rate (CRR), and adverse reaction rate (ARR) vary considerably. Therefore, this meta-analysis was performed to evaluate the safety and efficacy of different treatment methods of PTMC.

Methods

We did a systematic review and network meta-analysis. We searched PubMed, EMBase, and Cochrane-Library from the date of inception to January 10, 2022, to retrieve the VRR, CRR, and ARR of MWA, RFA, LA and surgical treatment of PTMC, and a meta-analysis was performed using the R meta-package. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated, and sensitivity analyses, cumulative meta-analyses, and publication bias were also performed. Relevant literature was retrieved with keywords; the eligible cohort studies were screened based on the established inclusion and exclusion criteria.

Results

A total of 1515 patients were included in the 12-month follow-up. The overall VRR was 86.25% (95% CI: 77.89, 94.60), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1483 patients were included in the last follow-up. The overall VRR was 99.41% (95% CI: 99.11, 99.72), and the VRR was RFA > WMA > LA, but the differences were not significant. A total of 1622 patients showed complete remission at the last follow-up, and the overall CRR was 0.63 (95% CI: 0.46, 0.79). The CRR was RFA > LA > WMA, but the differences were not significant. A total of 1883 patients had adverse reactions at the last follow-up, and the overall ARR was 0.06 (95% CI: 0.03, 0.08). The ARR at the last follow-up was RFA = Surg < LA < WMA. The ARR of the RFA and Surg subgroups was significantly lower than that of the WMA subgroup.

Conclusions

Similar good efficacy and safety profiles were observed in WMA, RFA, LA, and surgical treatment in PTMC, among which RFA showed the best volume reduction, complete remission rate, and adverse reaction reduction. However, there is a slight bias in the limited literature included in this study, and we did not conduct or refer to mechanistic studies to confirm its specific mechanism of action. Clinicians are advised to use their discretion in the choice of treatment.

Refined Lord-Shulman Theory for 1D Response of Skin Tissue under Ramp-Type Heat

In this article, we present a mathematical model of thermoelastic skin tissue based on a refined Lord-Shulman heat conduction theory. A small thickness of skin tissue is considered to be one-dimensional with mechanical clamped surfaces. In addition, the skin tissue's outer surface is subjected to ramp-type heating while its inner surface is adiabatic. A simple Lord-Shulman theory, as well as the classical coupled thermoelasticity, are also applied in this article. Laplace transform techniques and their inversions are calculated to return to the time domain. Numerical outcomes are represented graphically to discuss the significant impacts on the temperature, dilatation, displacement, and stress distributions. Such results provide a more comprehensive and better insight for understanding the behavior of skin tissue during the temperature distribution of a specific boundary condition.

Effect of Transarterial Chemoembolization Plus Percutaneous Ethanol Injection or Radiofrequency Ablation for Liver Tumors

Background

The efficacy of the transarterial chemoembolization (TACE) process combined with percutaneous ethanol injection (PEI, TACE-P) or the radiofrequency ablation (RFA, TACE-R) process was found to be good when used for the treatment of patients suffering from early or intermediate hepatocellular carcinoma (eiHCC). The study was conducted to compare the efficacy and safety of the TACE-P with TACE-A processes followed during the treatment of patients with eiHCC.

Methods

A total of 241 patients suffering from eiHCC, subjected to TACE-P (147 patients) or TACE-R (94 patients) processes from January 1, 2014, to December 31, 2018, were retrospectively reviewed and included. The propensity score matching (PSM) method was used to reduce selection bias.

Results

The median overall survival (mOS) and progression-free survival (mPFS) of the TACE-P group were similar to those recorded for the TACE-R group (P>0.05) before using the PSM technique. Similar results were obtained post the use of the PSM technique. In the subgroup analysis after PSM, patients with single tumor (dimension: ≤5 cm), who were subjected to TACE-P-based treatment methods, exhibited worse tumor response than patients subjected to TACE-R-based methods (HR: 1.804, 95% CI: 1.083–3.005, P=0.023). Seven adverse events were reported. A statistically significant difference for all grades of adverse events (and grade III or IV adverse events) between the two groups (all P>0.05) was not reported.

Conclusion

The benefits and advantages of using the TACE-P based method was similar was those obtained using the TACE-R in patients with eiHCC, especially for patients with a single large tumor or multiple tumors.

Microwave ablation with local pleural anesthesia for subpleural pulmonary nodules: our experience

Objectives

To explore the efficacy and safety of local pleural anesthesia (LPA) for relieving pain during microwave ablation (MWA) of pulmonary nodules in the subpleural regions.

Materials and Methods

From June 2019 to December 2021, 88 patients with 97 subpleural nodules underwent percutaneous CT-guided MWA. Patients were divided into two groups according to whether LPA was applied; 53 patients with local pleural anesthesia during MWA; and 35 patients with MWA without LPA. The differences in technical success, pre-and post- and intra-operative visual analog scale (VAS) pain scores, complications of the procedure, and local progression-free survival (LPFS) between the two groups were assessed. Thus, to evaluate the efficacy and safety of MWA combined with LPA for treating subpleural nodules.

Results

In this study, the procedures in all patients of both groups achieved technical success according to pre-operative planning. There was no statistically significant difference in the pre-operative VAS pain scores between the two groups. Intra-operative VAS scores were significantly higher in the non-LPA (NLPA) group than in the LPA group. They remained significantly higher in the NLPA group than in the LPA group during the short postoperative period. Analgesics were used more in the NLPA group than in the LPA group intra- and postoperatively, with a statistically significant difference, especially during the MWA procedures. The overall LPFS rates were 100%, 98.333%, 98.333%, and 98.333% at 1, 3, 6, and 12 months postoperatively in the LPA group and 100%, 97.297%, 94.595%, and 94.595% postoperatively in the NLPA group, respectively. Tumor recurrence occurred in one and two patients with lung adenocarcinoma in the LPA and NLPA groups. The incidence of pneumothorax was significantly higher in the NLPA group (25,714%, 9/35) than in the LPA group (15.094%, 8/53), and there were three cases of pleural effusion (blood collection) and one case of pulmonary hemorrhage in the NLPA group.

Conclusion

Percutaneous CT-guided MWA is a safe and effective treatment for subpleural pulmonary nodules. Applying a combined LPA technique can reduce the patient's pain and complications during and after the MWA. The long-term efficacy must be verified in more patients and a longer follow-up.

Impact of electrode tip shape on catheter performance in cardiac radiofrequency ablation

Background

The role of catheter tip shape on the safety and efficacy of radiofrequency (RF) ablation has been overlooked, although differences have been observed in clinical and research fields.

Objective

The purpose of this study was to analyze the role of electrode tip shape in RF ablation using a computational model.

Methods

We simulated 108 RF ablations through a realistic 3-dimensional computational model considering 2 clinically used, open-irrigated catheters (spherical and cylindrical tip), varying contact force (CF), blood flow, and irrigation. Lesions are defined by the 50°C isotherm contour and evaluated by means of width, depth, depth at maximum width, and volume. Ablations are deemed as safe, critical (tissue temperature >90°C), and pop (tissue temperature >100°C).

Results

Tissue-electrode contact is less for the spherical tip at low CF but the relationship is inverted at high CF. At low CF, the cylindrical tip generates deeper and wider lesions and a 4-fold larger volume. With increasing CF, the lesions generated by the spherical tip become comparable to those generated by the cylindrical tip. The 2 tips feature different safety profiles: CF and power are the main determinants of pops for the spherical tip; power is the main factor for the cylindrical tip; and CF has a marginal effect. The cylindrical tip is more prone to pop generation at higher powers. Saline irrigation and blood flow effect do not depend on tip shape.

Conclusion

Tip shape determines the performance of ablation catheters and has a major impact on their safety profile. The cylindrical tip shows more predictable behavior in a wide range of CF values.

Spatiotemporal Temperature Distribution of NIR Irradiated Polypyrrole Nanoparticles and Effects of pH

The spatiotemporal temperature distributions of NIR irradiated polypyrrole nanoparticles (PPN) were evaluated by varying PPN concentrations and the pH of suspensions. The PPN were synthesized by oxidative chemical polymerization, resulting in a hydrodynamic diameter of 98 ± 2 nm, which is maintained in the pH range of 4.2–10; while the zeta potential is significantly affected, decreasing from 20 ± 2 mV to −5 ± 1 mV at the same pH range. The temperature profiles of PPN suspensions were obtained using a NIR laser beam (1.5 W centered at 808 nm). These results were analyzed with a three-dimensional predictive unsteady-state heat transfer model that considers heat conduction, photothermal heating from laser irradiation, and heat generation due to the water absorption. The temperature profiles of PPN under laser irradiation are concentration-dependent, while the pH increase only induces a slight reduction in the temperature profiles. The model predicts a value of photothermal transduction efficiency (η) of 0.68 for the PPN. Furthermore, a linear dependency was found for the overall heat transfer coefficient (U) and η with the suspension temperature and pH, respectively. Finally, the model developed in this work could help identify the exposure time and concentration doses for different tissues and cells (pH-dependent) in photothermal applications.

Study on the Microwave Ablation Effect of Inflated Porcine Lung

(1) Background: Microwave ablation (MWA) has an efficient killing effect on primary and metastatic lung cancer. However, the treatment effect will be affected by the air in the lung, which makes it very difficult to accurately predict and control the ablation area; (2) Methods: In this paper, in vitro experiments combined with simulations are used to study the microwave ablation area of inflated porcine lung. The in vitro experiment is divided into inflated group and deflated group, combined with different ablation power (40 W, 50 W, 60 W) and ablation time (100 s, 200 s, 300 s) for experiment, each power and time combination are repeated five times. A total of 90 ablation experiments were performed. The simulation experiment uses COMSOL Multiphysics software to simulate the microwave ablation area of the inflated lung; (3) Results and Conclusions: When the ablation power is 40 W, 50 W, and 60 W, the average long diameter of the deflated group are 20.8–30.9%, 7.6–22.6%, 10.4–19.8% larger than those of the inflated group, respectively; the average short diameter of the deflated group is 24.5–41.4%, 31.6–45.7%, 27.3–42.9% larger than that of the inflated group. The results show that the ablation area of inflated lung is smaller than deflated lung, which is mainly due to the smaller ablation short diameter.

Radiofrequency ablation for liver tumors abutting complex blood vessel structures: treatment protocol optimization using response surface method and computer modeling

OBJECTIVE

To achieve a result of a large tumor ablation volume with minimal thermal damage to the surrounding blood vessels by designing a few clinically-adjustable operating parameters in radiofrequency ablation (RFA) for liver tumors abutting complex vascular structures.

METHODS

Response surface method (RSM) was employed to correlate the ablated tumor volume (Ra) and thermal damage to blood vessels (Dt) based on RFA operating parameters: ablation time, electrode position, and insertion angle. A coupled electric-thermal-fluid RFA computer model was created as the testbed for RSM to simulate RFA process. Then, an optimal RFA protocol for the two conflicting goals, namely (1) large tumor ablation and (2) small thermal damage to the surrounding blood vessels, has been achieved under a specific ablation environment.

RESULTS

Linear regression analysis confirmed that the RFA protocol significantly affected Ra and Dt (the adjusted coefficient of determination Radj2 = 93.61% and 95.03%, respectively). For a proposed liver tumor scenario (liver tumor with a dimension of 4×3×2.9 cm³ abutting a complex vascular structure), an optimized RFA protocol was found based on the regression results in RSM. Compared with a reference RFA protocol, in which the electrode was centered in the tumor with a 12-min ablation time, the optimized RFA protocol has increased Ra  from 98.1% to 99.6% and decreased Dt from 4.1% to 0.4%, achieving nearly the complete ablation of proposed liver tumor and ignorable thermal damages to vessels.

CONCLUSION

This work showed that it is possible to design a few clinically-adjustable operating parameters of RFA for achieving a large tumor ablation volume while minimizing thermal damage to the surrounding blood vessels.

Three-Phase-Lag Bio-Heat Transfer Model of Cardiac Ablation

Significant research efforts have been devoted in the past decades to accurately modelling the complex heat transfer phenomena within biological tissues. These modeling efforts and analysis have assisted in a better understanding of the intricacies of associated biological phenomena and factors that affect the treatment outcomes of hyperthermic therapeutic procedures. In this contribution, we report a three-dimensional non-Fourier bio-heat transfer model of cardiac ablation that accounts for the three-phase-lags (TPL) in the heat propagation, viz., lags due to heat flux, temperature gradient, and thermal displacement gradient. Finite element-based COMSOL Multiphysics software has been utilized to predict the temperature distributions and ablation volumes. A comparative analysis has been conducted to report the variation in the treatment outcomes of cardiac ablation considering different bio-heat transfer models. The effect of variations in the magnitude of different phase lags has been systematically investigated. The fidelity and integrity of the developed model have been evaluated by comparing the results of the developed model with the analytical results of the recent studies available in the literature. This study demonstrates the importance of considering non-Fourier lags within biological tissue for predicting more accurately the characteristics important for the efficient application of thermal therapies.

Experimental Evaluation of Radiation Response and Thermal Properties of NPs-Loaded Tissues-Mimicking Phantoms

Many efforts have recently concentrated on constructing and developing nanoparticles (NPs) as promising thermal agent for optical hyperthermia and photothermal therapy. However, thermal energy transfer in biological tissue is a complex process involving different mechanisms such as conduction, convection, radiation. Therefore, having information about thermal properties of tissue especially when NPs are embedded in is a necessity for predicting the heat transfer during hyperthermia. In this work, the thermal properties of solid phantom based on agar in the presence of three different nanoparticles (BPSi, tNAs, GNRs) and alone were measured and reported as a function of temperature (ranging from 22 to 62 °C). The thermal response of these NPs to an 808 nm laser beam with three different powers were studied in the water comparatively. Agar and tNAs have almost constant thermal properties in the considered range. Among the three NPs, gold has the highest conductivity and diffusivity. At 62 °C BPSi NPs have the similar amount of increase for the diffusivity. The thermal parameters reported in this paper can be useful for the mathematical modeling. Irradiation of the NPs-loaded water phantom displayed the highest radiosensitivity of gold among the three mentioned NPs. However, for the higher power of irradiation, BPSi and tNAs NPs showed the increased absorption of heat during shorter time and the increased temperature gradient slope for the initial 15 s after the irradiation started. The three NPs showed different thermal and irradiation response behavior; however, this comparison study notes the worth of having information about thermal parameters of NPs-loaded tissue for pre-clinical planning.

Computer modeling of radiofrequency cardiac ablation: 30 years of bioengineering research

This review begins with a rationale of the importance of theoretical, mathematical and computational models for radiofrequency (RF) catheter ablation (RFCA). We then describe the historical context in which each model was developed, its contribution to the knowledge of the physics of RFCA and its implications for clinical practice. Next, we review the computer modeling studies intended to improve our knowledge of the biophysics of RFCA and those intended to explore new technologies. We describe the most important technical details of the implementation of mathematical models, including governing equations, tissue properties, boundary conditions, etc. We discuss the utility of lumped element models, which despite their simplicity are widely used by clinical researchers to provide a physical explanation of how RF power is absorbed in different tissues. Computer model verification and validation are also discussed in the context of RFCA. The article ends with a section on the current limitations, i.e. aspects not yet included in state-of-the-art RFCA computer modeling and on future work aimed at covering the current gaps.

Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs

Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the first description of percutaneous echo-guided radiofrequency ablation of aortic body tumors. This minimally invasive treatment is based on high frequency alternating electrical currents from an electrode that produces ionic agitation and generates frictional heat, causing coagulation necrosis. Five dogs with an echocardiographic and cytological diagnosis of chemodectoma underwent percutaneous echo-guided radiofrequency ablation. At the time of presentation, all the dogs showed clinical signs, such as ascites and/or collapse. There were no complications either during the procedure or in the following 24 hours. Rapid clinical improvement associated with a reduction in size and change in sonographic appearance of the mass were achieved with no complications. Six months follow-up was carried out in all dogs. A second percutaneous echo-guided RFA was performed eight months after the first procedure in one dog. Based on our experience, radiofrequency ablation seems to be a feasible and safe technique, making it a potential alternative therapeutic approach in the clinical management of aortic body tumors leading to severe clinical compromise.

Fluid–Structure Interaction and Non-Fourier Effects in Coupled Electro-Thermo-Mechanical Models for Cardiac Ablation

In this study, a fully coupled electro-thermo-mechanical model of radiofrequency (RF)-assisted cardiac ablation has been developed, incorporating fluid–structure interaction, thermal relaxation time effects and porous media approach. A non-Fourier based bio-heat transfer model has been used for predicting the temperature distribution and ablation zone during the cardiac ablation. The blood has been modeled as a Newtonian fluid and the velocity fields are obtained utilizing the Navier–Stokes equations. The thermal stresses induced due to the heating of the cardiac tissue have also been accounted. Parametric studies have been conducted to investigate the effect of cardiac tissue porosity, thermal relaxation time effects, electrode insertion depths and orientations on the treatment outcomes of the cardiac ablation. The results are presented in terms of predicted temperature distributions and ablation volumes for different cases of interest utilizing a finite element based COMSOL Multiphysics software. It has been found that electrode insertion depth and orientation has a significant effect on the treatment outcomes of cardiac ablation. Further, porosity of cardiac tissue also plays an important role in the prediction of temperature distribution and ablation volume during RF-assisted cardiac ablation. Moreover, thermal relaxation times only affect the treatment outcomes for shorter treatment times of less than 30 s.

New approaches and procedures for cancer treatment: Current perspectives

Cancer is a global health problem responsible for one in six deaths worldwide. Treating cancer has been a highly complex process. Conventional treatment approaches, such as surgery, chemotherapy, and radiotherapy, have been in use, while significant advances are being made in recent times, including stem cell therapy, targeted therapy, ablation therapy, nanoparticles, natural antioxidants, radionics, chemodynamic therapy, sonodynamic therapy, and ferroptosis-based therapy. Current methods in oncology focus on the development of safe and efficient cancer nanomedicines. Stem cell therapy has brought promising efficacy in regenerating and repairing diseased or damaged tissues by targeting both primary and metastatic cancer foci, and nanoparticles brought new diagnostic and therapeutic options. Targeted therapy possessed breakthrough potential inhibiting the growth and spread of specific cancer cells, causing less damage to healthy cells. Ablation therapy has emerged as a minimally invasive procedure that burns or freezes cancers without the need for open surgery. Natural antioxidants demonstrated potential tracking down free radicals and neutralizing their harmful effects thereby treating or preventing cancer. Several new technologies are currently under research in clinical trials, and some of them have already been approved. This review presented an update on recent advances and breakthroughs in cancer therapies.

Thermomechanical Modeling of Laser Ablation Therapy of Tumors: Sensitivity Analysis and Optimization of Influential Variables

In cancer treatment, laser ablation is a promising technique used to induce localized thermal damage. Different variables influence the temperature distribution in the tissue and the resulting therapy efficacy; thus, the optimal therapy settings are required for obtaining the desired clinical outcome. In this work, thermomechanical modeling of contactless laser ablation was implemented to analyze the sensitivity of independent variables on the optimal treatment conditions. The Finite Element Method was utilized to solve the governing equations, i.e., the bioheat, mechanical deformation, and the Navier-Stokes equations. Validation of the model was evaluated by comparing experimental and simulated temperatures, which indicated high accuracy for estimating temperature. In particular, the results showed that the model is capable of estimating temperature with a good correlation factor (R=0.98) and low Mean Absolute Error (3.9 C). A sensitivity analysis based on laser irradiation time, power, beam distribution, and the blood vessel depth on temperature distribution and fraction of necrotic tissue was performed. Based on the most significant variables i.e., laser irradiation time and power, an optimization process was performed. This resulted into an indication of the optimal therapy settings for achieving maximum procedure efficiency i.e., the required fraction of necrotic tissue within the target volume, constituted by tumor and safety margins around it.

Measurement of Ex Vivo Liver, Brain and Pancreas Thermal Properties as Function of Temperature

The ability to predict heat transfer during hyperthermal and ablative techniques for cancer treatment relies on understanding the thermal properties of biological tissue. In this work, the thermal properties of ex vivo liver, pancreas and brain tissues are reported as a function of temperature. The thermal diffusivity, thermal conductivity and volumetric heat capacity of these tissues were measured in the temperature range from 22 to around 97 °C. Concerning the pancreas, a phase change occurred around 45 °C; therefore, its thermal properties were investigated only until this temperature. Results indicate that the thermal properties of the liver and brain have a non-linear relationship with temperature in the investigated range. In these tissues, the thermal properties were almost constant until 60 to 70 °C and then gradually changed until 92 °C. In particular, the thermal conductivity increased by 100% for the brain and 60% for the liver up to 92 °C, while thermal diffusivity increased by 90% and 40%, respectively. However, the heat capacity did not significantly change in this temperature range. The thermal conductivity and thermal diffusivity were dramatically increased from 92 to 97 °C, which seems to be due to water vaporization and state transition in the tissues. Moreover, the measurement uncertainty, determined at each temperature, increased after 92 °C. In the temperature range of 22 to 45 °C, the thermal properties of pancreatic tissue did not change significantly, in accordance with the results for the brain and liver. For the three tissues, the best fit curves are provided with regression analysis based on measured data to predict the tissue thermal behavior. These curves describe the temperature dependency of tissue thermal properties in a temperature range relevant for hyperthermia and ablation treatments and may help in constructing more accurate models of bioheat transfer for optimization and pre-planning of thermal procedures.

Nanobiotechnology-enabled energy utilization elevation for augmenting minimally-invasive and noninvasive oncology thermal ablation

Depending on the local or targeted treatment, independence on tumor type and minimally-invasive and noninvasive feature, various thermal ablation technologies have been established, but they still suffer from the intractable paradox between safety and efficacy. It has been extensively accepted that improving energy utilization efficiency is the primary means of decreasing thermal ablation power and shortening ablation time, which is beneficial for concurrently improving both treatment safety and treatment efficiency. Recent efforts have been made to receive a significant advance in various thermal methods including non-invasive high-intensity focused ultrasound, minimally-invasive radiofrequency and microwave, and non-invasive and minimally-invasive photothermal ablation, and so on. Especially, various nanobiotechnologies and design methodologies were employed to elevate the energy utilization efficiency for acquiring unexpected ablation outcomes accompanied with tremendously reduced power and time. More significantly, some combined technologies, for example, chemotherapy, photodynamic therapy (PDT), gaseous therapy, sonodynamic therapy (SDT), immunotherapy, chemodynamic therapy (CDT), or catalytic nanomedicine, were used to assist these ablation means to repress or completely remove tumors. We discussed and summarized the ablation principles and energy transformation pathways of the four ablation means, and reviewed and commented the progress in this field including newly developed technology or new material types with a highlight on nanobiotechnology-inspired design principles, and provided the deep insights into the existing problems and development direction. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Therapeutic Approaches and Drug Discovery > Emerging Technologies.

Nanomaterials responding to microwaves: an emerging field for imaging and therapy

In recent years, new microwave-based imaging, sensing and hyperthermia applications have emerged in the field of diagnostics and therapy. For diagnosis, this technology involves the application of low power microwaves, utilising contrast between the relative permittivity of tissues to identify pathologies. This contrast can be further enhanced through the implementation of nanomaterials. For therapy, this technology can be applied in tissues either through hyperthermia, which can help anti-cancer drug tumour penetration or as ablation to destroy malignant tissues. Nanomaterials can absorb electromagnetic radiation and can enhance the microwave hyperthermic effect. In this review we aim to introduce this area of renewed interest and provide insights into current developments in its technologies and companion nanoparticles, as well as presenting an overview of applications for diagnosis and therapy.

Numerical Investigation of a Thermal Ablation Porous Media-Based Model for Tumoral Tissue with Variable Porosity

Thermal ablation is a minimally or noninvasive cancer therapy technique that involves fewer complications, shorter hospital stays, and fewer costs. In this paper, a thermal-ablation bioheat model for cancer treatment is numerically investigated, using a porous media-based model. The main objective is to evaluate the effects of a variable blood volume fraction in the tumoral tissue (i.e., the porosity), in order to develop a more realistic model. A modified local thermal nonequilibrium model (LTNE) is implemented including the water content vaporization in the two phases separately and introducing the variable porosity in the domain, described by a quadratic function changing from the core to the rim of the tumoral sphere. The equations are numerically solved employing the finite-element commercial code COMSOL Multiphysics. Results are compared with the results obtained employing two uniform porosity values (ε = 0.07 and ε = 0.23) in terms of coagulation zones at the end of the heating period, maximum temperatures reached in the domain, and temperature fields and they are presented for different blood vessels. The outcomes highlight how important is to predict coagulation zones achieved in thermal ablation accurately. In this way, indeed, incomplete ablation, tumor recurrence, or healthy tissue necrosis can be avoided, and medical protocols and devices can be improved.

A review of antenna designs for percutaneous microwave ablation

Microwave (MW) antenna is a key element in microwave ablation (MWA) treatments as the means that energy is delivered in a focused manner to the tumor and its surrounding area. The energy delivered results in a rise in temperature to a lethal level, resulting in cell death in the ablation zone. The delivery of energy and hence the success of MWA is closely dependent on the structure of the antennas. Therefore, three design criteria, such as expected ablation zone pattern, efficiency of energy delivery, and minimization of the diameter of the antennas have been the focus along the evolution of the MW antenna. To further improve the performance of MWA in the treatment of various tumors through inventing novel antennas, this article reviews the state-of-the-art and summarizes the development of MW antenna designs regarding the three design criteria.

Strategies for Cancer Treatment Based on Photonic Nanomedicine

Traditional cancer treatments, such as surgery, radiotherapy, and chemotherapy, are still the most effective clinical practice options. However, these treatments may display moderate to severe side effects caused by their low temporal or spatial resolution. In this sense, photonic nanomedicine therapies have been arising as an alternative to traditional cancer treatments since they display more control of temporal and spatial resolution, thereby yielding fewer side effects. In this work, we reviewed the challenge of current cancer treatments, using the PubMed and Web of Science database, focusing on the advances of three prominent therapies approached by photonic nanomedicine: (i) photothermal therapy; (ii) photodynamic therapy; (iii) photoresponsive drug delivery systems. These photonic nanomedicines act on the cancer cells through different mechanisms, such as hyperthermic effect and delivery of chemotherapeutics and species that cause oxidative stress. Furthermore, we covered the recent advances in materials science applied in photonic nanomedicine, highlighting the main classes of materials used in each therapy, their applications in the context of cancer treatment, as well as their advantages, limitations, and future perspectives. Finally, although some photonic nanomedicines are undergoing clinical trials, their effectiveness in cancer treatment have already been highlighted by pre-clinical studies.

Numerical analysis of the pulsating heat source effects in a tumor tissue

BACKGROUND AND OBJECTIVES

Hyperthermia treatment is nowadays recognized as the fourth additional cancer therapy technique following surgery, chemotherapy, and radiation; it is a minimally or non-invasive technique which involves fewer complications, a shorter hospital stay, and fewer costs. In this paper, pulsating heat effects on heat transfer in a tumor tissue under hyperthermia are analyzed. The objective of the paper is to find and quantify the advantages of pulsatile heat protocols under different periodical heating schemes and for different tissue morphologies.

METHODS

The tumor tissue is modeled as a porous sphere made up of a solid phase (tissue, interstitial space, etc.) and a fluid phase (blood). A Local Thermal Non-Equilibrium (LTNE) model is employed to consider the local temperature difference between the two phases. Governing equations with the appropriate boundary conditions are solved with the finite-element code COMSOL Multiphysics®. The pulsating effect is modeled with references to a cosine function with different frequencies, and such different heating protocols are compared at equal delivered energy, i. e. different heating times at equal maximum power.

RESULTS

Different tissue properties in terms of blood vessels sizes and blood volume fraction in tissue (porosity) are investigated. The results are shown in terms of tissue temperature and percentage of necrotic tissue obtained. The most powerful result achieved using a pulsating heat source instead of a constant one is the decreasing of maximum temperature in any considered case, even reaching about 30% lower maximum temperatures. Furthermore, the evaluation of tissue damage at the end of treatment shows that pulsating heat allows to necrotize the same tumoral tissue area of the non-pulsating heat source.

CONCLUSIONS

Modeling pulsating heat protocols in thermal ablation under different periodical heating schemes and considering different tissues morphologies in a tumor tissue highlights how the application of pulsating heat sources allows to avoid high temperature peaks, and simultaneously to ablate the same tumoral area obtained with a non-pulsating heat source. This is a powerful result to improve medical protocols and devices in thermal ablation of tumors.

Numerical Simulations as Means for Tailoring Electrically Conductive Hydrogels Towards Cartilage Tissue Engineering by Electrical Stimulation

Cartilage regeneration is a clinical challenge. In recent years, hydrogels have emerged as implantable scaffolds in cartilage tissue engineering. Similarly, electrical stimulation has been employed to improve matrix synthesis of cartilage cells, and thus to foster engineering and regeneration of cartilage tissue. The combination of hydrogels and electrical stimulation may pave the way for new clinical treatment of cartilage lesions. To find the optimal electric properties of hydrogels, theoretical considerations and corresponding numerical simulations are needed to identify well-suited initial parameters for experimental studies. We present the theoretical analysis of a hydrogel in a frequently used electrical stimulation device for cartilage regeneration and tissue engineering. By means of equivalent circuits, finite element analysis, and uncertainty quantification, we elucidate the influence of the geometric and dielectric properties of cell-seeded hydrogels on the capacitive-coupling electrical field stimulation. Moreover, we discuss the possibility of cellular organisation inside the hydrogel due to forces generated by the external electric field. The introduced methodology is easily reusable by other researchers and allows to directly develop novel electrical stimulation study designs. Thus, this study paves the way for the design of future experimental studies using electrically conductive hydrogels and electrical stimulation for tissue engineering.

Computational Modeling of Cardiac Ablation Incorporating Electrothermomechanical Interactions

The application of radio frequency ablation (RFA) has been widely explored in treating various types of cardiac arrhythmias. Computational modeling provides a safe and viable alternative to ex vivo and in vivo experimental studies for quantifying the effects of different variables efficiently and reliably, apart from providing a priori estimates of the ablation volume attained during cardiac ablation procedures. In this contribution, we report a fully coupled electrothermomechanical model for a more accurate prediction of the treatment outcomes during the radio frequency cardiac ablation. A numerical model comprising of cardiac tissue and the cardiac chamber has been developed in which an electrode has been inserted perpendicular to the cardiac tissue to simulate actual clinical procedures. Temperature-dependent heat capacity, electrical and thermal conductivities, and blood perfusion rate have been considered to model more realistic scenarios. The effects of blood flow and contact force of the electrode tip on the treatment outcomes of a fully coupled model of RFA have been systematically investigated. The numerical study demonstrates that the predicted ablation volume of RFA is significantly dependent on the blood flow rate in the cardiac chamber and also on the tissue deformation induced due to electrode insertion depth of 1.5 mm or higher.