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Fazlollahi F, Makary MS. Precision oncology: The role of minimally-invasive ablation therapy in the management of solid organ tumors. World J Radiol 2025; 17:98618. [PMID: 39876886 PMCID: PMC11755905 DOI: 10.4329/wjr.v17.i1.98618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 12/16/2024] [Accepted: 01/18/2025] [Indexed: 01/21/2025] Open
Abstract
Solid organ tumors present a significant healthcare challenge, both economically and logistically, due to their high incidence and treatment complexity. In 2023, out of the 1.9 million new cancer cases in the United States, over 73% were solid organ tumors. Ablative therapies offer minimally invasive solutions for malignant tissue destruction in situ, often with reduced cost and morbidity compared to surgical resection. This review examines the current Food and Drug Administration-approved locoregional ablative therapies (radiofrequency, microwave, cryogenic, high-intensity focused ultrasound, histotripsy) and their evolving role in cancer care. Data were collected through a comprehensive survey of the PubMed-indexed literature on tumor ablation techniques, their clinical indications, and outcomes. Over time, emerging clinical data will help establish these therapies as the standard of care in solid organ tumor treatment, supported by improved long-term outcomes and progression-free survival.
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Affiliation(s)
- Farbod Fazlollahi
- College of Medicine, The Ohio State University, Columbus, OH 43210, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Medical Center, Columbus, OH 43210, United States
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Du QW, Xiao F, Zheng L, Chen RD, Dong LN, Liu FY, Cheng ZG, Yu J, Liang P. Importance of the enhanced cooling system for more spherical ablation zones: Numerical simulation, ex vivo and in vivo validation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108383. [PMID: 39260163 DOI: 10.1016/j.cmpb.2024.108383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION This study aimed to investigate the efficacy of a small-gauge microwave ablation antenna (MWA) with an enhanced cooling system (ECS) for generating more spherical ablation zones. METHODS A comparison was made between two types of microwave ablation antennas, one with ECS and the other with a conventional cooling system (CCS). The finite element method was used to simulate in vivo ablation. Two types of antennas were used to create MWA zones for 5, 8, 10 min at 50, 60, and 80 W in ex vivo bovine livers (n = 6) and 5 min at 60 W in vivo porcine livers (n = 16). The overtreatment ratio, ablation aspect ratio, carbonization area, and other characteristcs of antennas were measured and compared using numerical simulation and gross pathologic examination. RESULTS In numerical simulation, the ECS antenna demonstrated a lower overtreatment ratio than the CCS antenna (1.38 vs 1.43 at 50 W 5 min, 1.19 vs 1.35 at 50 W 8 min, 1.13 vs 1.32 at 50 W 10 min, 1.28 vs 1.38 at 60 W 5 min, 1.14 vs 1.32 at 60 W 8 min, 1.10 vs 1.30 at 60 W 10 min). The experiments revealed that the ECS antenna generated ablation zones with a more significant aspect ratio (0.92 ± 0.03 vs 0.72 ± 0.01 at 50 W 5 min, 0.95 ± 0.02 vs 0.70 ± 0.01 at 50 W 8 min, 0.96 ± 0.01 vs 0.71 ± 0.04 at 50 W 10 min, 0.96 ± 0.01 vs 0.73 ± 0.02 at 60 W 5 min, 0.94 ± 0.03 vs 0.71 ± 0.03 at 60 W 8 min, 0.96 ± 0.02 vs 0.69 ± 0.04 at 60 W 10 min) and a smaller carbonization area (0.00 ± 0.00 cm2 vs 0.54 ± 0.06 cm2 at 50 W 5 min, 0.13 ± 0.03 cm2 vs 0.61 ± 0.09 cm2 at 50 W 8 min, 0.23 ± 0.05 cm2 vs 0.73 ± 0.05 m2 at 50 W 10 min, 0.00 ± 0.00 cm2 vs 1.59 ± 0.41 cm2 at 60 W 5 min, 0.23 ± 0.22 cm2 vs 2.11 ± 0.63 cm2 at 60 W 8 min, 0.57 ± 0.09 cm2 vs 2.55 ± 0.51 cm2 at 60 W 10 min). Intraoperative ultrasound images revealed a hypoechoic area instead of a hyperechoic area near the antenna. Hematoxylin-eosin staining of the dissected tissue revealed a correlation between the edge of the ablation zone and that of the hypoechoic area. CONCLUSIONS The ECS antenna can produce more spherical ablation zones with less charring and a clearer intraoperative ultrasound image of the ablation area than the CCS antenna.
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Affiliation(s)
- Qiao-Wei Du
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Fan Xiao
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Lin Zheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Ren-Dong Chen
- The Yuquan Campus, Zhejiang University, Hangzhou, Zhejiang, China
| | - Li-Nan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital Fifth Medical Center, Beijing, 100853, China.
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Wu J, Sami S, Lajkosz K, Kishibe T, Ordon M. An Updated Systematic Review and Meta-Analysis on the Technical, Oncologic, and Safety Outcomes of Microwave Ablation in Patients with Renal Cell Carcinoma. J Endourol 2023; 37:1314-1330. [PMID: 37819699 DOI: 10.1089/end.2023.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Introduction: Percutaneous microwave ablation (MWA) has emerged as a new energy modality for percutaneous renal tumor ablation with potential advantages over radiofrequency and cryoablation. The goal of our study was to determine MWA outcomes for suspicious renal masses, with a subset analysis for biopsy-proven renal cell carcinoma (RCC) and larger (T1b) tumors. Methods: Studies reporting outcomes of MWA for RCC were identified. Random-effects models with inverse-variance weighting were used to pool outcomes, including technical success rate (TSR), technical efficacy rate (TER), local recurrence rate (LRR), cancer-specific survival rate (CSSR), overall survival rate (OSR), and complications. Results: Among 914 studies captured, 27 studies with 1584 patients (1683 malignant renal tumors) were included. The pooled TSR and TER were 99.6% (95% confidence interval [CI], 98.0%-100%) and 96.2% (95% CI, 93.8%-98.2%). The pooled LRR was 3.2% (95% CI, 1.9%-4.7%). At 1, 3, and 5 years, the pooled CSSRs were 100% (95% CI, 99.4%-100%), 100% (95% CI, 98.4%-100%), and 97.7% (95% CI, 94.5%-99.7%), while pooled OSRs were 99.0% (95% CI, 97.5%-99.9%), 96.0% (95% CI, 93.1%-98.3%), and 88.1% (95% CI, 80.3%-94.2%). The pooled minor and major complication rates were 10.3% (95% CI, 7.1%-13.9%) and 1.0% (95% CI, 0.3%-2.1%). In 204 patients with 208 T1b tumors, the pooled TSR and TER were 100% (95% CI, 96.6%-100%) and 85.2% (95% CI, 71.0%-95.8%). The pooled LRR was 4.2% (95% CI, 0.9%-8.9%). At 1, 3, and 5 years, the pooled CSSRs were 98.2% (95% CI, 88.7%-100%), 97.2% (95% CI, 78.5%-100%), and 98.1% (95% CI, 72.3%-100%). At 1 and 3 years, the pooled OSRs were 94.3% (95% CI, 85.7%-99.6%) and 89.3% (95% CI, 68.7%-100%). The pooled minor and major complication rates were 14.8% (95% CI, 7.4%-23.8%) and 2.6% (95% CI, 0%-7.8%). Conclusions: MWA demonstrated favorable short- to intermediate-term oncologic outcomes with low complication rates, including in the T1b subset, with moderate quality of data and heterogeneity of assessed outcomes. This supports MWA as a safe and effective treatment for RCC and a potential viable option for larger tumors.
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Affiliation(s)
- Jeremy Wu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samir Sami
- Division of Urology, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Teruko Kishibe
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Michael Ordon
- Division of Urology, Department of Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Microwave ablation trocar for ablating cancerous tumors: a numerical analysis. Med Biol Eng Comput 2023; 61:1113-1131. [PMID: 36680706 DOI: 10.1007/s11517-023-02781-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
Microwave ablation (MWA) is a newly developing minimally invasive thermal therapies technology. The ablation region obtained during MWA mainly depends on the type and efficiency of the trocar as well as the energy transfer from the generator to the biological tissue. In the present article, a novel trocar for MWA therapies has been proposed. A 3-dimensional tumor-embedded hepatic gland ablated with the novel MWA trocar has been numerically analyzed using finite element method-based software. The novel trocar consists of a flexible dual tine supplied with a microwave power of 15 W at 2.45/6 GHz for an ablation time of 10 min for all the cases. Various combinations of supplied energy and deploying lengths result in tumor ablations ranging from 2.7 to 4 cm in diameter. Supplying energy at high frequency (6 GHz) to the trocar results in ablating tumors (> 4 cm) with spherical ablation region. The novel trocar generated large ablation regions which are 2-3 times bigger than the tumors obtained using existing single-slot non-cooled trocars. This research on novel trocar may help clinicians in treating large size tumors of symmetric and asymmetric shapes by overcoming the problem associated with precise position of trocar into the tissue.
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Huang H, Zhang L, Moser MAJ, Zhang W, Zhang B. A review of antenna designs for percutaneous microwave ablation. Phys Med 2021; 84:254-264. [PMID: 33773908 DOI: 10.1016/j.ejmp.2021.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/03/2021] [Accepted: 03/06/2021] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Hangming Huang
- Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Lifeng Zhang
- Department of General Surgery, the First Affiliated Hospital of Soochow University,Soochow University, Jiangsu, China
| | - Michael A J Moser
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, Saskatoon, Canada
| | - Bing Zhang
- Energy-based Tumor Ablation Laboratory, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China.
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Hu J, Chen S, Wang X, Lin N, Yang J, Wu S. Image-Guided Percutaneous Microwave Ablation Versus Cryoablation For Hepatocellular Carcinoma In High-Risk Locations: Intermediate-Term Results. Cancer Manag Res 2019; 11:9801-9811. [PMID: 31819618 PMCID: PMC6873974 DOI: 10.2147/cmar.s227961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/25/2019] [Indexed: 12/24/2022] Open
Abstract
Objective The aims of this study were to compare the clinical outcomes between image-guided percutaneous microwave ablation (MWA) and cryoablation (CRA) in patients with hepatocellular carcinoma (HCC) in high-risk locations and to identify the prognostic factors associated with the two treatment methods. Methods This retrospective study was institutional review board approved. A total of 120 patients (88 men and 32 women) with one hundred and thirty-four HCC lesions in high-risk locations from April 2014 to March 2018 were reviewed. Sixty-four patients underwent MWA and 56 patients underwent CRA. Survival, recurrence and complications were compared between the two groups. Effect of changes in key outcomes (i.e., overall survival (OS), recurrence-free survival (RFS) and local tumor progression (LTP)) was statistically analyzed with the log rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting intermediate-term outcomes. Results The OS and RFS after MWA were comparable to those of CRA (P =0.141, and P=0.469, respectively). The LTP and major complication in MWA group was higher than those in CRA group (P=0.003, and P=0.039). Univariate analysis showed that age (P=0.007), tumor size (P=0.001), and Child-Turcotte-Pugh (CTP) grade (P=0.003) were risk factors for OS, and multivariate analysis results showed that older age (≥65 years) (P=0.002, HR:3.338, 95% CI:1.928–5.281), 3.0–5.0 cm in size (P<0.001, HR: 3.312, 95% CI: 1.872–4.489) and CTP grade B (P=0.001, HR:3.382, 95% CI: 1.882–5.902) were independently associated with poor OS. Conclusion CRA had comparable oncologic outcomes with MWA and could be a safe and effective treatment for HCC in high-risk locations.
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Affiliation(s)
- Jiahui Hu
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, People's Republic of China
| | - Sheng Chen
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Xin Wang
- Department of Oncology, Fuzhou Hospital of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou 350001, People's Republic of China
| | - Ning Lin
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Jianchuan Yang
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
| | - Songsong Wu
- Department of Ultrasonography, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou 350001, People's Republic of China
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Abstract
Microwave (MW) ablation has emerged as a minimally invasive therapeutic modality and is in clinical use for treatment of unresectable tumors and cardiac arrhythmias, neuromodulation, endometrial ablation, and other applications. Components of image-guided MW ablation systems include high-power MW sources, ablation applicators that deliver power from the generator to the target tissue, cooling systems, energy-delivery control algorithms, and imaging guidance systems tailored to specific clinical indications. The applicator incorporates a MW antenna that radiates MW power into the surrounding tissue. A variety of antenna designs have been developed for MW ablation with the objective of efficiently transferring MW power to tissue, with a radiation pattern well matched to the size and shape of the targeted tissue. Here, we survey advances in percutaneous, endocavitary, and endoscopic antenna designs as an integral element of MW ablation applicators for a diverse set of clinical applications.
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Affiliation(s)
- Hojjatollah Fallahi
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas
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Glassberg MB, Ghosh S, Clymer JW, Qadeer RA, Ferko NC, Sadeghirad B, Wright GW, Amaral JF. Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. Onco Targets Ther 2019; 12:6407-6438. [PMID: 31496742 PMCID: PMC6698169 DOI: 10.2147/ott.s204340] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer. Methods The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted. Results Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results. Conclusion MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.
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Affiliation(s)
| | - Sudip Ghosh
- Health Economics and Market Access, Ethicon Inc, Cincinnati, OH, USA
| | | | | | | | | | | | - Joseph F Amaral
- Health Economics and Market Access, Ethicon Inc, Cincinnati, OH, USA
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Abstract
Over the past decade, interventional oncology techniques have become integrated into the treatment plans of companion animals with cancer on a regular basis. Although procedures such as stenting are performed commonly, other less frequently utilized techniques for locoregional therapy, such as embolization and ablation, are emerging and demonstrating promise. Tumor ablation techniques are categorized into two subgroups: chemical ablation and energy-based ablation. Increased utilization of ablation will allow for the determination of specific indications and evaluation of outcomes for these techniques.
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Fallahi H, Clausing D, Shahzad A, O’Halloran M, Dennedy MC, Prakash P. Microwave antennas for thermal ablation of benign adrenal adenomas. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab068b] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Sartori S, Mauri G, Tombesi P, Di Vece F, Bianchi L, Pacella CM. Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk. Int J Hyperthermia 2018; 35:19-25. [PMID: 29749271 DOI: 10.1080/02656736.2018.1468038] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding. MATERIAL AND METHODS From 2013 to 2017, nine patients (six males, three females, aged 68.5 ± 12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23 mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6 min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded. RESULTS Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11-49 months). CONCLUSIONS LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding.
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Affiliation(s)
- Sergio Sartori
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Giovanni Mauri
- b Department of Interventional Radiology , European Institute of Oncology , Milan , Italy
| | - Paola Tombesi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Francesca Di Vece
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Lara Bianchi
- a Section of Interventional Ultrasound, Department of Internal Medicine , St. Anna Hospital , Ferrara , Italy
| | - Claudio Maurizio Pacella
- c Department of Diagnostic Imaging and Interventional Radiology , Regina Apostolorum Hospital , Albano Laziale, Rome , Italy
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Klapperich ME, Abel EJ, Ziemlewicz TJ, Best S, Lubner MG, Nakada SY, Hinshaw JL, Brace CL, Lee FT, Wells SA. Effect of Tumor Complexity and Technique on Efficacy and Complications after Percutaneous Microwave Ablation of Stage T1a Renal Cell Carcinoma: A Single-Center, Retrospective Study. Radiology 2017; 284:272-280. [PMID: 28076721 DOI: 10.1148/radiol.2016160592] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To evaluate the effects of tumor complexity and technique on early and midterm oncologic efficacy and rate of complications for 100 consecutive biopsy-proved stage T1a renal cell carcinomas (RCCs) treated with percutaneous microwave ablation. Materials and Methods This HIPAA-compliant, single-center retrospective study was approved by the institutional review board. The requirement to obtain informed consent was waived. Ninety-six consecutive patients (68 men, 28 women; mean age, 66 years ± 9.4) with 100 stage T1a N0M0 biopsy-proved RCCs (median diameter, 2.6 cm ± 0.8) underwent percutaneous microwave ablation between March 2011 and June 2015. Patient and procedural data were collected, including body mass index, comorbidities, tumor histologic characteristics and grade, RENAL nephrometry score, number of antennas, generator power, and duration of ablation. Technical success, local tumor progression, and presence of complications were assessed at immediate and follow-up imaging. The Kaplan-Meier method was used for survival analyses. Results Technical success was achieved for all 100 tumors (100%), including 47 moderately and five highly complex RCCs. Median clinical and imaging follow-up was 17 months (range, 0-48 months) and 15 months (range, 0-44 months), respectively. No change in estimated glomerular filtration rate was noted after the procedure (P = .49). There were three (3%) procedure-related complications and six (6%) delayed complications, all urinomas. One case of local tumor progression (1%) was identified 25 months after the procedure. Three-year local progression-free survival, cancer-specific survival, and overall survival were 88% (95% confidence interval: 0.52%, 0.97%), 100% (95% confidence interval: 1.0%, 1.0%), and 91% (95% confidence interval: 0.51%, 0.99%), respectively. Conclusion Percutaneous microwave ablation is an effective and safe treatment option for stage T1a RCC, regardless of tumor complexity. Long-term follow-up is needed to establish durable oncologic efficacy and survival relative to competing ablation modalities and surgery. © RSNA, 2017.
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Affiliation(s)
- Marki E Klapperich
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - E Jason Abel
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Timothy J Ziemlewicz
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Sara Best
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Meghan G Lubner
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Stephen Y Nakada
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - J Louis Hinshaw
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Christopher L Brace
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Fred T Lee
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
| | - Shane A Wells
- From the School of Medicine and Public Health (M.E.K.) and Departments of Urology (E.J.A., S.B., S.Y.N., J.L.H., C.L.B., F.T.L., S.A.W.), Radiology (T.J.Z., M.G.L., J.L.H., F.T.L.), and Biomedical Engineering (C.L.B., F.T.L.), University of Wisconsin, 600 Highland Ave, E3/376 Clinical Science Center, Madison, WI 53792
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Krokidis ME, Orsi F, Katsanos K, Helmberger T, Adam A. CIRSE Guidelines on Percutaneous Ablation of Small Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2016; 40:177-191. [DOI: 10.1007/s00270-016-1531-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 12/01/2016] [Indexed: 01/09/2023]
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15
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D’Onofrio M, Ciaravino V, De Robertis R, Barbi E, Salvia R, Girelli R, Paiella S, Gasparini C, Cardobi N, Bassi C. Percutaneous ablation of pancreatic cancer. World J Gastroenterol 2016; 22:9661-9673. [PMID: 27956791 PMCID: PMC5124972 DOI: 10.3748/wjg.v22.i44.9661] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/13/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
Pancreatic ductal adenocarcinoma is a highly aggressive tumor with an overall 5-year survival rate of less than 5%. Prognosis and treatment depend on whether the tumor is resectable or not, which mostly depends on how quickly the diagnosis is made. Chemotherapy and radiotherapy can be both used in cases of non-resectable pancreatic cancer. In cases of pancreatic neoplasm that is locally advanced, non-resectable, but non-metastatic, it is possible to apply percutaneous treatments that are able to induce tumor cytoreduction. The aim of this article will be to describe the multiple currently available treatment techniques (radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation), their results, and their possible complications, with the aid of a literature review.
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Ryan TP, Brace CL. Interstitial microwave treatment for cancer: historical basis and current techniques in antenna design and performance. Int J Hyperthermia 2016; 33:3-14. [DOI: 10.1080/02656736.2016.1214884] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
| | - Christopher L. Brace
- Departments of Radiology and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
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17
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Kim HJ, Rhim H, Lee MW, Jeong WK. Measurement of Intrahepatic Pressure during Microwave Ablation in an Ex Vivo Bovine Liver Model. Gut Liver 2016; 9:784-90. [PMID: 25963083 PMCID: PMC4625709 DOI: 10.5009/gnl14272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background/Aims We experimented with different ablation methods and two types of microwave antennas to determine whether microwave ablation (MWA) increases intrahepatic pressure and to identify an MWA protocol that avoids increasing intrahepatic pressure. Methods MWA was performed using either a single-step standard ablation or a stepwise increment ablation paired with either a 16-gauge (G) 2-cm antenna or a 14G 4-cm antenna. We compared the maximum pressures and total ablation volumes. Results The mean maximum intrahepatic pressures and ablation volumes were as follows: 16G single-step: 37±33.4 mm Hg and 4.63 cm3; 16G multistep: 31±18.7 mm Hg and 3.75 cm3; 14G single-step: 114±45.4 mm Hg and 15.33 cm3; and 14G multistep: 106±43.8 mm Hg and 10.98 cm3. The intrahepatic pressure rose during MWA, but there were no statistically significant differences between the single and multistep methods when the same gauge antennae were used. The total ablation volume was different only in the 14G groups (p<0.05). Conclusions We demonstrated an increase in intrahepatic pressure during MWA. The multistep method may be used to prevent increased intrahepatic pressure after applying the proper power.
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Affiliation(s)
- Hae Jin Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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18
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Wells SA, Wheeler KM, Mithqal A, Patel MS, Brace CL, Schenkman NS. Percutaneous microwave ablation of T1a and T1b renal cell carcinoma: short-term efficacy and complications with emphasis on tumor complexity and single session treatment. Abdom Radiol (NY) 2016; 41:1203-11. [PMID: 27167230 DOI: 10.1007/s00261-016-0776-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To update the oncologic outcomes and safety for microwave (MW) ablation of T1a (≤4.0 cm) and T1b (4.1-7.0 cm) renal cell carcinoma (RCC) with emphasis on tumor complexity and single session treatment. MATERIALS AND METHODS Retrospective review of 29 consecutive patients (30 tumors) with localized (NOMO) RCC (23 T1a; 7 T1b) treated with percutaneous MW ablation between 3/2013 and 6/2014. Primary outcomes investigated were technical success, local tumor progression (LTP), and complications. Technical success was assessed with contrast-enhanced computed tomography (CECT) immediately after MW ablation. Presence of LTP was assessed with CECT or contrast-enhanced magnetic resonance at 6-month target intervals for the first two years and annually thereafter. Complications were categorized using the Clavien-Dindo classification system. RESULTS Median tumor diameter was 2.8 cm [IQR 2.1-3.3] for T1a and 4.7 cm [IQR 4.1-5.7] for T1b tumors. Median RENAL nephrometry score was 7 [IQR 4-8] for T1a tumors and 9 [IQR 6.25-9.75] for T1b tumors. Technical success was achieved for 22 T1a (96%) and 7 T1b (100%) tumors. There were no LTP during a median imaging follow-up of 12.0 months [IQR 6-18] for the 23 patients (24 tumors) with greater than 6 months of follow-up. There were three Clavien-Dindo grade I-II complication (10%) and no Clavien-Dindo grade III-V complications (0%). All but two patients (93%) are alive without metastatic disease; two patients died after 12-month follow-up of causes unrelated to the MW ablation. CONCLUSION Percutaneous MW ablation appears to be a safe and effective treatment option for low, moderate, and highly complex T1a and T1b RCC in early follow-up.
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Poggi G, Tosoratti N, Montagna B, Picchi C. Microwave ablation of hepatocellular carcinoma. World J Hepatol 2015; 7:2578-2589. [PMID: 26557950 PMCID: PMC4635143 DOI: 10.4254/wjh.v7.i25.2578] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/17/2015] [Accepted: 10/19/2015] [Indexed: 02/06/2023] Open
Abstract
Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma (HCC) in patients with well compensated cirrhosis, thermal ablation techniques provide a valid non-surgical treatment alternative, thanks to their minimal invasiveness, excellent tolerability and safety profile, proven efficacy in local disease control, virtually unlimited repeatability and cost-effectiveness. Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules. Among them, radiofrequency (RF) currents are the most used, while microwave ablations (MWA) are becoming increasingly popular. Starting from the 90s’, RF ablation (RFA) rapidly became the standard of care in ablation, especially in the treatment of small HCC nodules; however, RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks. MWA, first introduced in the Far Eastern clinical practice in the 80s’, showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors, resulting in a poor coagulative performance and a relatively high complication rate, nowadays shows better results both in terms of treatment controllability and of overall coagulative performance, thanks to the improvement of technology. In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems, and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications, both in absolute terms and in comparison with RFA.
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Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2015; 10:47-57. [PMID: 25208284 DOI: 10.1053/j.tvir.2007.08.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients.
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Affiliation(s)
- J Louis Hinshaw
- From the Departments of Radiology (J.L.H., M.G.L., T.J.Z., F.T.L., C.L.B.), Biomedical Engineering (C.L.B.), and Medical Physics (C.L.B.), University of Wisconsin, 600 Highland Ave, E3 366, Madison, WI 53792-3252
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Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2015; 34:1344-62. [PMID: 25208284 DOI: 10.1148/rg.345140054] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Image-guided thermal ablation is an evolving and growing treatment option for patients with malignant disease of multiple organ systems. Treatment indications have been expanding to include benign tumors as well. Specifically, the most prevalent indications to date have been in the liver (primary and metastatic disease, as well as benign tumors such as hemangiomas and adenomas), kidney (primarily renal cell carcinoma, but also benign tumors such as angiomyolipomas and oncocytomas), lung (primary and metastatic disease), and soft tissue and/or bone (primarily metastatic disease and osteoid osteomas). Each organ system has different underlying tissue characteristics, which can have profound effects on the resulting thermal changes and ablation zone. Understanding these issues is important for optimizing clinical results. In addition, thermal ablation technology has evolved rapidly during the past several decades, with substantial technical and procedural improvements that can help improve clinical outcomes and safety profiles. Staying up to date on these developments is challenging but critical because the physical properties underlying the different ablation modalities and the appropriate use of adjuncts will have a tremendous effect on treatment results. Ultimately, combining an understanding of the physical properties of the ablation modalities with an understanding of the thermal kinetics in tissue and using the most appropriate ablation modality for each patient are key to optimizing clinical outcomes. Suggested algorithms are described that will help physicians choose among the various ablation modalities for individual patients.
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Affiliation(s)
- J Louis Hinshaw
- From the Departments of Radiology (J.L.H., M.G.L., T.J.Z., F.T.L., C.L.B.), Biomedical Engineering (C.L.B.), and Medical Physics (C.L.B.), University of Wisconsin, 600 Highland Ave, E3 366, Madison, WI 53792-3252
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Poulou LS, Botsa E, Thanou I, Ziakas PD, Thanos L. Percutaneous microwave ablation vs radiofrequency ablation in the treatment of hepatocellular carcinoma. World J Hepatol 2015; 7:1054-1063. [PMID: 26052394 PMCID: PMC4450182 DOI: 10.4254/wjh.v7.i8.1054] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/22/2014] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular cancer ranks fifth among cancers and is related to chronic viral hepatitis, alcohol abuse, steatohepatitis and liver autoimmunity. Surgical resection and orthotopic liver transplantation have curative potential, but fewer than 20% of patients are suitable candidates. Interventional treatments are offered to the vast majority of patients. Radiofrequency (RFA) and microwave ablation (MWA) are among the therapeutic modalities, with similar indications which include the presence of up to three lesions, smaller than 3 cm in size, and the absence of extrahepatic disease. The therapeutic effect of both methods relies on thermal injury, but MWA uses an electromagnetic field as opposed to electrical current used in RFA. Unlike MWA, the effect of RFA is partially limited by the heat-sink effect and increased impedance of the ablated tissue. Compared with RFA, MWA attains a more predictable ablation zone, permits simultaneous treatment of multiple lesions, and achieves larger coagulation volumes in a shorter procedural time. Major complications of both methods are comparable and infrequent (approximately 2%-3%), and they include haemorrhage, infection/abscess, visceral organ injury, liver failure, and pneumothorax. RFA may incur the additional complication of skin burns. Nevertheless, there is no compelling evidence for differences in clinical outcomes, including local recurrence rates and survival.
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Horn JC, Patel RS, Kim E, Nowakowski FS, Lookstein RA, Fischman AM. Percutaneous microwave ablation of renal tumors using a gas-cooled 2.4-GHz probe: technique and initial results. J Vasc Interv Radiol 2014; 25:448-53. [PMID: 24581469 DOI: 10.1016/j.jvir.2013.10.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 12/22/2022] Open
Abstract
The feasibility, safety, and preliminary effectiveness of microwave ablation (MWA) in the treatment of renal tumors using a high-powered, carbon dioxide-cooled probe were evaluated. There were 15 tumors treated in 14 patients. Computed tomography was performed immediately after MWA, and follow-up imaging was performed to evaluate for recurrence. Immediate technical effectiveness was 100%. One complication involved the formation of a renal artery pseudoaneurysm. At follow-up (mean interval, 12.5 wk) evaluation, 14 of 15 (93.3%) tumors demonstrated complete necrosis. MWA is a safe, effective treatment modality; larger studies are warranted to demonstrate long-term oncologic outcomes.
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Affiliation(s)
- Jeremy C Horn
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Rahul S Patel
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Edward Kim
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - F Scott Nowakowski
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Robert A Lookstein
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Aaron M Fischman
- Division of Interventional Radiology, Department of Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1234, New York, NY 10029.
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Moreland AJ, Lubner MG, Ziemlewicz TJ, Kitchin DR, Hinshaw JL, Johnson AD, Lee FT, Brace CL. Evaluation of a thermoprotective gel for hydrodissection during percutaneous microwave ablation: in vivo results. Cardiovasc Intervent Radiol 2014; 38:722-30. [PMID: 25394594 DOI: 10.1007/s00270-014-1008-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/18/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate whether thermoreversible poloxamer 407 15.4 % in water (P407) can protect non-target tissues adjacent to microwave (MW) ablation zones in a porcine model. MATERIALS AND METHODS MW ablation antennas were placed percutaneously into peripheral liver, spleen, or kidney (target tissues) under US and CT guidance in five swine such that the expected ablation zones would extend into adjacent diaphragm, body wall, or bowel (non-target tissues). For experimental ablations, P407 (a hydrogel that transitions from liquid at room temperature to semi-solid at body temperature) was injected into the potential space between target and non-target tissues, and the presence of a gel barrier was verified on CT. No barrier was used for controls. MW ablation was performed at 65 W for 5 min. Thermal damage to target and non-target tissues was evaluated at dissection. RESULTS Antennas were placed 7 ± 3 mm from the organ surface for both control and gel-protected ablations (p = 0.95). The volume of gel deployed was 49 ± 27 mL, resulting in a barrier thickness of 0.8 ± 0.5 cm. Ablations extended into non-target tissues in 12/14 control ablations (mean surface area = 3.8 cm(2)) but only 4/14 gel-protected ablations (mean surface area = 0.2 cm(2); p = 0.0005). The gel barrier remained stable at the injection site throughout power delivery. CONCLUSION When used as a hydrodissection material, P407 protected non-targeted tissues and was successfully maintained at the injection site for the duration of power application. Continued investigations to aid clinical translation appear warranted.
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Affiliation(s)
- Anna J Moreland
- Department of Radiology, E3/366 Clinical Science Center, University of Wisconsin - Madison, 600 Highland Avenue, Madison, WI, 53792-3252, USA,
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Development of a Novel Switched-Mode 2.45 GHz Microwave Multiapplicator Ablation System. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/973736] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The development of a novel switched-mode 2.45 GHz microwave (MW) multiapplicator system intended for laparoscopic and open surgical thermoablative treatments is presented. The system differs from the other synchronous and asynchronous commercially available equipments because it employs a fast sequential switching (FSS) technique for feeding an array of up to four high efficiency MW applicators. FSS technology, if properly engineered, allows improving system compactness, modularity, overall efficiency, and operational flexibility. Full-wave electromagnetic (EM) and thermal (TH) simulations have been made to confirm the expected performances of the FSS technology. Here we provide an overview of technical details and early ex-vivo experiments carried out with a full functional β-prototype of the system.
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Abstract
Tumor ablation is a minimally invasive technique that is commonly used in the treatment of tumors of the liver, kidney, bone, and lung. During tumor ablation, thermal energy is used to heat or cool tissue to cytotoxic levels (less than -40°C or more than 60°C). An additional technique is being developed that targets the permeability of the cell membrane and is ostensibly nonthermal. Within the classification of tumor ablation, there are several modalities used worldwide: radiofrequency, microwave, laser, high-intensity focused ultrasound, cryoablation, and irreversible electroporation. Each technique, although similar in purpose, has specific and optimal indications. This review serves to discuss general principles and technique, reviews each modality, and discusses modality selection.
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Affiliation(s)
- Erica M Knavel
- Department of Radiology, University of Wisconsin Madison, Clinical Sciences Center, Madison, WI.
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Bai JF, Liu P, Xu LX. Recent Advances in Thermal Treatment Techniques and Thermally Induced Immune Responses Against Cancer. IEEE Trans Biomed Eng 2014; 61:1497-505. [DOI: 10.1109/tbme.2014.2314357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chiang J, Hynes KA, Bedoya M, Brace CL. A dual-slot microwave antenna for more spherical ablation zones: ex vivo and in vivo validation. Radiology 2013; 268:382-9. [PMID: 23579048 PMCID: PMC3721053 DOI: 10.1148/radiol.13122128] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare the performance of a microwave antenna design with two annular slots to that of a monopole antenna design in creating a more spherical ablation zone. MATERIALS AND METHODS Animal care and use committee approval was obtained before in vivo experiments were performed. Microwave ablation zones were created by using dual-slot and monopole control antennas for 2, 5, and 10 minutes at 50 and 100 W in ex vivo bovine livers. Dual-slot and monopole antennas were then used to create ablation zones at 100 W for 5 minutes in in vivo porcine livers, which also underwent intraprocedural imaging. Ablation diameter, length, and aspect ratio (diameter ÷ length) were measured at gross pathologic examination and compared at each combination of power and time by using the paired Student t test. A P value less than .05 was considered to indicate a significant difference. Aspect ratios closer to 1 reflected a more spherical ablation zone. RESULTS The dual-slot antenna created ablation zones with a higher aspect ratio at 50 W for 2 minutes (0.75 vs 0.53, P = .003) and 5 minutes (0.82 vs 0.63, P = .053) than did the monopole antenna in ex vivo liver tissue, although the difference was only significant at 2 minutes. At 100 W, the dual-slot antenna had a significantly higher aspect ratio at 2 minutes (0.52 vs 0.42, P = .002). In vivo studies showed significantly higher aspect ratios at 100 W for 5 minutes (0.63 vs 0.53, respectively, P = .029). Intraprocedural imaging confirmed this characterization, showing higher rates of ablation zone growth and heating primarily at the early stages of the ablation procedure when the dual-slot antenna was used. CONCLUSION The dual-slot microwave antenna created a more spherical ablation zone than did the monopole antenna both in vivo and ex vivo liver tissue. Greater control over power delivery can potentially extend the advantages of the dual-slot antenna design to higher power and longer treatment times.
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Affiliation(s)
- Jason Chiang
- Departments of Radiology, Biomedical Engineering, and Chemistry, University of Wisconsin, 1111 Highland Ave, WIMR 1303-O, Madison, WI 53705, USA
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Hoffmann R, Rempp H, Erhard L, Blumenstock G, Pereira PL, Claussen CD, Clasen S. Comparison of four microwave ablation devices: an experimental study in ex vivo bovine liver. Radiology 2013; 268:89-97. [PMID: 23440327 DOI: 10.1148/radiol.13121127] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare volume, sphericity, and short-axis diameter of the coagulation zone of four commercially available microwave ablation systems with three technical concepts in an ex vivo setting and to formulate mathematical models to predict these quantities. MATERIALS AND METHODS Two high-power systems (systems A and B), a system that enables simultaneous use of three antennas (system C), and a non-perfusion-cooled system that automatically adapts power and frequency (system D) were tested in ex vivo bovine livers (108 ablations). Coagulation volume, sphericity, and mean short-axis diameter were assessed, and mathematical functions were fitted for each system and assessed with the coefficient of determination (R(2)). Analysis of variance and Tukey post hoc tests were used for interdevice comparison after 5 and 10 minutes and after maximum recommended ablation time. RESULTS Volume and short-axis diameter were determined by using a mathematical model for every system, with coefficients of determination of 0.75-0.98 and 0.70-0.97, respectively. Correlation for determination of sphericity was lower (R(2) = 0.01-0.68). Mean results with ablation performed according to manufacturer recommendations were as follows: Volume, sphericity, and short-axis diameter were 57.5 cm(3), 0.75, and 43.4 mm, respectively, for system A; 72.3 cm(3), 0.68, and 45.5 mm, respectively, for system B; 17.1 cm(3), 0.58, and 26.8 mm, respectively, for system C (one antenna); 76.5 cm(3), 0.89, and 50.6 mm, respectively, for system C (three antennas); and 56.0 cm(3), 0.64, and 40.9 mm, respectively, for system D. Systems A (mean volume, 52.4 cm(3) ± 4.5 [standard deviation]) and B (39.4 cm(3) ± 1.7) reach large ablation zones with 5-minute ablation. CONCLUSION The largest ablation zone is obtained with systems B and C (three antennas) under maximum recommended ablation duration and with system A under short ablation time. The most spherical zone is obtained with system C (three antennas).
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Affiliation(s)
- Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology and Department of Medical Biometry, Eberhard-Karls-University, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Abstract
Microwave ablation is an emerging treatment option for many cancers, cardiac arrhythmias, and other medical conditions. During treatment, microwaves are applied directly to tissues to produce rapid temperature elevations sufficient to produce immediate coagulative necrosis. The engineering design criteria for each application differ, with individual consideration for factors such as desired ablation zone size, treatment duration, and procedural invasiveness. Recent technological developments in applicator cooling, power control, and system optimization for specific applications promise to increase the utilization of microwave ablation in the future. This article reviews the basic biophysics of microwave tissue heating, provides an overview of the design and operation of current equipment, and outlines areas for future research.
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