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Wu J, Zhou Z, Huang Y, Deng X, Zheng S, He S, Huang G, Hu B, Shi M, Liao W, Huang N. Radiofrequency ablation: mechanisms and clinical applications. MedComm (Beijing) 2024; 5:e746. [PMID: 39359691 PMCID: PMC11445673 DOI: 10.1002/mco2.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
Radiofrequency ablation (RFA), a form of thermal ablation, employs localized heat to induce protein denaturation in tissue cells, resulting in cell death. It has emerged as a viable treatment option for patients who are ineligible for surgery in various diseases, particularly liver cancer and other tumor-related conditions. In addition to directly eliminating tumor cells, RFA also induces alterations in the infiltrating cells within the tumor microenvironment (TME), which can significantly impact treatment outcomes. Moreover, incomplete RFA (iRFA) may lead to tumor recurrence and metastasis. The current challenge is to enhance the efficacy of RFA by elucidating its underlying mechanisms. This review discusses the clinical applications of RFA in treating various diseases and the mechanisms that contribute to the survival and invasion of tumor cells following iRFA, including the roles of heat shock proteins, hypoxia, and autophagy. Additionally, we analyze the changes occurring in infiltrating cells within the TME after iRFA. Finally, we provide a comprehensive summary of clinical trials involving RFA in conjunction with other treatment modalities in the field of cancer therapy, aiming to offer novel insights and references for improving the effectiveness of RFA.
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Affiliation(s)
- Jianhua Wu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhiyuan Zhou
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yuanwen Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xinyue Deng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Siting Zheng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Shangwen He
- Department of Respiratory and Critical Care MedicineChronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Genjie Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Binghui Hu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Min Shi
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Wangjun Liao
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Na Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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Ümütlü MR, Öcal O, Puhr-Westerheide D, Fabritius MP, Wildgruber M, Deniz S, Corradini S, Rottler M, Walter F, Rogowski P, Seidensticker R, Philipp AB, Rössler D, Ricke J, Seidensticker M. Efficacy and Safety of Local Liver Radioablation in Hepatocellular Carcinoma Lesions within and beyond Limits of Thermal Ablation. Dig Dis 2024; 42:461-472. [PMID: 38781948 DOI: 10.1159/000538788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION CT-guided interstitial brachytherapy (iBT) radiotherapy has been established in the treatment of liver tumors. With iBT, hepatocellular carcinoma (HCC) lesions can be treated beyond the limits of thermal ablation (i.e., size and location). However, a comprehensive analysis of the efficacy of iBT in patients within and beyond thermal ablation limits is lacking. MATERIALS AND METHODS A total of 146 patients with 216 HCC lesions have been analyzed retrospectively. Clinical and imaging follow-up data has been collected. Lesions were evaluated in terms of suitability for thermal ablation or not. The correlation between local tumor control (LTC), time to progression (TTP), overall survival (OS), and clinical and imaging parameters have been evaluated using univariable and multivariable Cox regression analyses. RESULTS LTC rates at 12 months, 24 months, and 36 months were 87%, 75%, and 73%, respectively. 65% of lesions (n = 141) were not suitable for radiofrequency ablation (RFA). The median TTP was 13 months, and the median OS was not reached (3-year OS rate: 70%). No significant difference in LTC, TTP, or OS regarding RFA suitability existed. However, in the overall multivariable analysis, lesion diameter >5 cm was significantly associated with lower LTC (HR: 3.65, CI [1.60-8.31], p = 0.002) and shorter TTP (HR: 2.08, CI [1.17-3.70], p = 0.013). Advanced BCLC stage, Child-Pugh Stage, and Hepatitis B were associated with shorter OS. CONCLUSION iBT offers excellent LTC rates and OS in local HCC treatment regardless of the limits of thermal ablation, suggesting further evidence of its alternative role to thermal ablation in patients with early-stage HCC.
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Affiliation(s)
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sinan Deniz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Daniel Rössler
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Yang D, Zhuang B, Lin M, Xu M, Lv M, Kuang M, Xie X, Xie X. Primary tumour location is an important prognostic factor in colorectal cancer liver metastases following radiofrequency ablation. Clin Radiol 2020; 75:961.e1-961.e9. [PMID: 32859384 DOI: 10.1016/j.crad.2020.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/09/2020] [Indexed: 01/27/2023]
Abstract
AIM To examine the outcomes and different prognoses for colorectal cancer patients with liver metastases (CRCLM) treated with radiofrequency ablation (RFA) based on the origin of the primary tumour (rectum versus colon). MATERIALS AND METHODS Patients diagnosed with CRCLM from July 2011 to June 2018 were assessed in the study. The study included 114 patients with 176 lesions. All of the patients underwent RFA of their CRCLM. The overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier survival function estimate curves and Cox regression analysis between the group of patients with rectal cancer liver metastases (RCLM) and colon cancer liver metastases (CCLM). RESULTS Patients with RCLM exhibited worse OS and PFS than those with CCLM. The 1-, 2-, and 3-year OS rates were 87.5%, 75%, and 54.2% in the RCLM group and 93.9%, 87.8%, and 81.8% in the CCLM group (p=0.001), respectively. The 1-, 2-, and 3-year PFS rates were 43.7%, 22.9%, and 20.8% in the RCLM group and 57.6%, 45.4%, and 36.5% in the CCLM group (p=0.001), respectively. Multivariate analysis showed that primary tumour location, carcinoembryonic antigen (CEA), and response to pre-ablation chemotherapy were independent variables for OS and PFS. The N state of the primary tumour also had a significant impact on OS. CONCLUSION This study showed that patients with CCLM had better prognoses than those with RCLM following RFA treatment. If patients intend to undergo RFA for CRCLM, the location of the primary tumour should be considered in the assessment of long-term therapeutic effects.
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Affiliation(s)
- D Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - B Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - M Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - M Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - M Lv
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - M Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - X Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - X Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Camacho JC, Petre EN, Sofocleous CT. Thermal Ablation of Metastatic Colon Cancer to the Liver. Semin Intervent Radiol 2019; 36:310-318. [PMID: 31680722 DOI: 10.1055/s-0039-1698754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
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Affiliation(s)
- Juan C Camacho
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Constantinos T Sofocleous
- Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, New York
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Sotirchos VS, Fujisawa S, Vakiani E, Solomon SB, Manova-Todorova KO, Sofocleous CT. Fluorescent Tissue Assessment of Colorectal Cancer Liver Metastases Ablation Zone: A Potential Real-Time Biomarker of Complete Tumor Ablation. Ann Surg Oncol 2019; 26:1833-1840. [PMID: 30830537 DOI: 10.1245/s10434-018-07133-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to evaluate whether rapid fluorescent tissue examination immediately after colorectal cancer liver metastasis (CLM) ablation correlates with standard pathologic and immunohistochemical (IHC) assessments. METHODS This prospective, National Institutes of Health-supported study enrolled 34 consecutive patients with 53 CLMs ablated between January 2011 and December 2014. Immediately after ablation, core needle sampling of the ablation zone was performed. Tissue samples were evaluated with fluorescent viability (MitoTracker Red) and nuclear (Hoechst) stains. Confocal microscope imaging was performed within 30 min after ablation. The same samples were subsequently fixed and stained with hematoxylin and eosin (H&E). Identified tumor cells underwent IHC staining for proliferation (Ki67) and viability (OxPhos). The study pathologist, blinded to the H&E and IHC assessment, evaluated the fluorescent images separately to detect viable tumor cells. Sensitivity, specificity, and overall concordance of the fluorescent versus H&E and IHC assessments were calculated. RESULTS A total of 63 tissue samples were collected and processed. The overall concordance rate between the immediate fluorescent and the subsequent H&E and IHC assessments was 94% (59/63). The fluorescent assessment sensitivity and specificity for the identification of tumor cells were respectively 100% (18/18) and 91% (41/45). CONCLUSIONS The study showed a high concordance rate between the immediate fluorescent assessment and the standard H&E and IHC assessment of the ablation zone. Given the documented prognostic value of ablation zone tissue characteristics for outcomes after ablation of CLM, the fluorescent assessment offers a potential intra-procedural biomarker of complete tumor ablation.
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Affiliation(s)
- Vlasios S Sotirchos
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Sho Fujisawa
- Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sotirchos VS, Petrovic LM, Gönen M, Klimstra DS, Do RKG, Petre EN, Garcia AR, Barlas A, Erinjeri JP, Brown KT, Covey AM, Alago W, Brody LA, DeMatteo RP, Kemeny NE, Solomon SB, Manova-Todorova KO, Sofocleous CT. Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome. Radiology 2016; 280:949-59. [PMID: 27010254 DOI: 10.1148/radiol.2016151005] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 6.7) and positive biopsy results (P = .008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm. Conclusion Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. (©) RSNA, 2016.
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Affiliation(s)
- Vlasios S Sotirchos
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lydia M Petrovic
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Mithat Gönen
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - David S Klimstra
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Richard K G Do
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Elena N Petre
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Alessandra R Garcia
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Afsar Barlas
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Joseph P Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Karen T Brown
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Anne M Covey
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lynn A Brody
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Ronald P DeMatteo
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Nancy E Kemeny
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Stephen B Solomon
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Katia O Manova-Todorova
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Constantinos T Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
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Sofocleous CT, Violari EG, Sotirchos VS, Shady W, Gonen M, Pandit-Taskar N, Petre EN, Brody LA, Alago W, Do RK, D'Angelica MI, Osborne JR, Segal NH, Carrasquillo JA, Kemeny NE. Radioembolization as a Salvage Therapy for Heavily Pretreated Patients With Colorectal Cancer Liver Metastases: Factors That Affect Outcomes. Clin Colorectal Cancer 2015; 14:296-305. [PMID: 26277696 DOI: 10.1016/j.clcc.2015.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND In this study we assessed the efficacy and factors that affect outcomes of radioembolization (RE) using yttrium-90 resin microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastases (CLM). PATIENTS AND METHODS After an institutional review board waiver of approval, a review of a Health Insurance Portability and Accountability Act-registered, prospectively created and maintained database was performed. Data on patient demographic and disease characteristics, RE treatment parameters, and additional treatments were evaluated for significance in predicting overall survival (OS) and liver progression-free survival (LPFS). Complications were evaluated according to the National Cancer Institute Common Terminology Criteria for adverse events. RESULTS From September 2009 to September 2013, 53 patients underwent RE at a median of 35 months after CLM diagnosis. Median OS was 12.7 months. Multivariate analysis showed that carcinoembryonic antigen levels at the time of RE ≥ 90 ng/mL (P = .004) and microscopic lymphovascular invasion of the primary (P = .002) were independent predictors of decreased OS. Median LPFS was 4.7 months. At 4 to 8 and 12 to 16 weeks after RE, most patients (80% and 61%, respectively) according to Response Evaluation Criteria in Solid Tumors (RECIST) had stable disease; additional evaluation using PET Response Criteria in Solid Tumors (PERCIST) led to reclassification in 77% of these cases (response or progression). No deaths were noted within the first 30 days. Within the first 90 days after RE, 4 patients (8%) developed liver failure and 5 patients (9%) died, all with evidence of disease progression. CONCLUSION RE in the salvage setting was well-tolerated, and permitted the administration of additional therapies and led to a median OS of 12.7 months. Evaluation using PERCIST was more likely than RECIST to document response or progression compared with the baseline assessment before RE.
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Affiliation(s)
| | - Elena G Violari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Waleed Shady
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Joseph R Osborne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Fujisawa S, Romin Y, Barlas A, Petrovic LM, Turkekul M, Fan N, Xu K, Garcia AR, Monette S, Klimstra DS, Erinjeri JP, Solomon SB, Manova-Todorova K, Sofocleous CT. Evaluation of YO-PRO-1 as an early marker of apoptosis following radiofrequency ablation of colon cancer liver metastases. Cytotechnology 2013; 66:259-73. [PMID: 24065619 DOI: 10.1007/s10616-013-9565-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 04/10/2013] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED Radiofrequency (RF) ablation (RFA) is a minimally invasive treatment for colorectal-cancer liver metastases (CLM) in selected nonsurgical patients. Unlike surgical resection, RFA is not followed by routine pathological examination of the target tumor and the surrounding liver tissue. The aim of this study was the evaluation of apoptotic events after RFA. Specifically, we evaluated YO-PRO-1 (YP1), a green fluorescent DNA marker for cells with compromised plasma membrane, as a potential, early marker of cell death. YP1 was applied on liver tissue adherent on the RF electrode used for CLM ablation, as well as on biopsy samples from the center and the margin of the ablation zone as depicted by dynamic CT immediately after RFA. Normal pig and mouse liver tissues were used for comparison. The same samples were also immunostained for fragmented DNA (TUNEL assay) and for active mitochondria (anti-OxPhos antibody). YP1 was also used simultaneously with propidium iodine (PI) to stain mouse liver and samples from ablated CLM. Following RFA of human CLM, more than 90 % of cells were positive for YP1. In nonablated, dissected pig and mouse liver however, we found similar YP1 signals (93.1 % and 65 %, respectively). In samples of intact mouse liver parenchyma, there was a significantly smaller proportion of YP1 positive cells (22.7 %). YP1 and PI staining was similar for ablated CLM. However in dissected normal mouse liver there was initial YP1 positivity and complete absence of the PI signal and only later there was PI signal. CONCLUSION This is the first time that YP1 was applied in liver parenchymal tissue (rather than cell culture). The results suggest that YP1 is a very sensitive marker of early cellular events reflecting an early and widespread plasma membrane injury that allows YP1 penetration into the cells.
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Affiliation(s)
- Sho Fujisawa
- Molecular Cytology Core Facility, Memorial Sloan-Kettering Cancer, New York, NY, USA
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9
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Sofocleous CT, Garg S, Petrovic LM, Gonen M, Petre EN, Klimstra DS, Solomon SB, Brown KT, Brody LA, Covey AM, Dematteo RP, Schwartz L, Kemeny NE. Ki-67 is a prognostic biomarker of survival after radiofrequency ablation of liver malignancies. Ann Surg Oncol 2012; 19:4262-9. [PMID: 22752375 DOI: 10.1245/s10434-012-2461-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the predictive value of examinations of tissue adherent to multitined electrodes on local tumor progression-free survival (LPFS) and overall survival (OS) after liver tumor radiofrequency ablation (RFA). METHODS An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant review identified 68 liver tumors treated with RFA in 63 patients with at least 3 years' follow-up. Tissue adherent to the electrode after liver tumor RFA was evaluated with proliferation (Ki-67) and apoptotic (caspase-3) markers. LPFS and OS were evaluated by Kaplan-Meier methodology and the log-rank test. Multivariate analysis assessed the effect of tumor size, pathology, and post-RFA tissue characteristics on LPFS and OS. RESULTS Post-RFA tissue examination classified 55 of the 68 tumors as completely ablated with coagulation necrosis, with cells positive for caspase-3 and negative for Ki-67 (CN). Thirteen had viable Ki-67-positive tumor cells. Mean liver tumor size was larger in the viable (V) group versus the CN group (3.4 vs. 2.5 cm, respectively; P = .017). For the V and CN groups, respectively, local tumor progression occurred in 12 (92 %) of 13 and 23 (42 %) of 55 specimens. One, 3-, and 5-year LPFS was 8 %, 8 %, and 8 %, and 79 %, 47 %, and 47 % (P < .001) for the V and CN groups, respectively. During a 63-month median follow-up, 92 % of patients in the V group and 58 % in the CN group died, resulting in 1-, 3-, and 5-year OS of 92 %, 25 %, and 8 % vs. 92 %, 59 %, and 33 % (P = .032), respectively. CONCLUSIONS Ki-67-positive tumor cells on the electrode after liver tumor RFA is an independent predictor of LPFS and OS. Size, initially thought to be an independent risk factor for local tumor progression in tumors 3-5 cm, does not hold its significance at long follow-up.
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Affiliation(s)
- Constantinos T Sofocleous
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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10
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Gwak JH, Oh BY, Lee RA, Chung SS, Kim KH. Clinical applications of radio-frequency ablation in liver metastasis of colorectal cancer. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:202-10. [PMID: 21980591 PMCID: PMC3180601 DOI: 10.3393/jksc.2011.27.4.202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/18/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this study is to evaluate long-term survival and prognostic factors for radio-frequency ablation (RFA) in colorectal liver metastases. METHODS We retrospectively reviewed 35 colorectal liver metastases patients who underwent RFA between 2004 and 2008. We analyzed survival after RFA and prognostic factors for survival. RESULTS Of the 35 patients, 23 patients were male and 12 were female. Their mean age was 62.40 ± 12.52 years. Mean overall survival was 38.8 ± 4.6 months, and mean progression free survival was 19.9 ± 3.4 months. Three- and 5-year overall survival rates were 42.7 ± 0.1% and 26.0 ± 0.1%, respectively. Three- and 5-year progression-free survival rates were 19.6 ± 0.1% and 4.9 ± 0.04%, respectively. Overall survival and progression-free survival were significantly improved in male and in patients with carcinoembryonic antigen (CEA) ≤ 100 ng/mL, carbohydrate antigen (CA) 19-9 ≤ 100 ng/mL, absence of extrahepatic disease, and a unilobar hepatic lesion. In addition, progression-free survival was improved in patients with a solitary hepatic lesion. On the multivariate analysis, significant survival factors were the absence of extrahepatic disease and the presence of a unilobar hepatic lesion. CONCLUSION RFA for colorectal liver metastases is an effective treatment option in male patients and in patients with CEA or CA19-9 ≤ 100, absence of extrahepatic disease, a solitary hepatic lesion, and a unilobar hepatic lesion.
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Affiliation(s)
- Ji Hun Gwak
- Department of Surgery, Ewha Womans University School of Medicine, Seoul, Korea
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11
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Sofocleous CT, Petre EN, Gonen M, Brown KT, Solomon SB, Covey AM, Alago W, Brody LA, Thornton RH, D'Angelica M, Fong Y, Kemeny NE. CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy. J Vasc Interv Radiol 2011; 22:755-61. [PMID: 21514841 DOI: 10.1016/j.jvir.2011.01.451] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the clinical outcomes of percutaneous radiofrequency (RF) ablation of colorectal cancer liver metastases (CLMs) that recur after hepatectomy. MATERIALS AND METHODS From December 2002 to December 2008, 71 CLMs that developed after hepatectomy were ablated in 56 patients. Medical records and imaging were reviewed to determine technique effectiveness/complete ablation (ie, ablation defect covering the entire tumor on 4-6-week postablation computed tomography [CT]), complications, and local tumor progression (LTP) at the site of ablation. LTP-free and overall survival were calculated by using Kaplan-Meier methodology. A modified clinical risk score (CRS) including nodal status of the primary tumor, time interval between diagnoses of the primary tumor and liver metastases, number of tumors, and size of the largest tumor was assessed for its effect on overall survival and LTP. RESULTS Tumor size ranged between 0.5 and 5.7 cm. Complete ablation was documented in 67 of 71 cases (94%). Complications included liver abscess (n = 1) and pleural effusion (n = 1). Median overall survival time was 31 months. One-, 2- and 3-year overall survival rates were 91%, 66%, and 41%, respectively. CRS was an independent factor for overall survival (74% for CRS of 0-2 vs 42% for CRS of 3-4 at 2 y; P = .03) and for LTP-free survival (66% for CRS of 0-2 vs 22% for CRS of 3-4 at 1 y after a single ablation; P <.01). CONCLUSIONS CT-guided RF ablation can be used to treat recurrent CLM after hepatectomy. A low CRS is associated with better clinical outcomes.
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Affiliation(s)
- Constantinos T Sofocleous
- Department of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
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12
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Eisele RM, Zhukowa J, Chopra S, Schmidt SC, Neumann U, Pratschke J, Schumacher G. Results of liver resection in combination with radiofrequency ablation for hepatic malignancies. Eur J Surg Oncol 2009; 36:269-74. [PMID: 19726155 DOI: 10.1016/j.ejso.2009.07.188] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 07/12/2009] [Accepted: 07/23/2009] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Liver tumors should be surgically treated whenever possible. In the case of bilobar disease or coexisting liver cirrhosis, surgical options are limited. Radiofrequency ablation (RFA) has been successfully used for irresectable liver tumors. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with liver metastases and hepatocellular carcinoma (HCC). PATIENTS AND METHODS RFA was performed with two different monopolar devices using ultrasound guidance. Intraoperative use of RFA for the treatment of liver metastases or HCC was limited to otherwise irresectable tumors during open surgical procedures including hepatic resections. Irresectability was considered if bilobar disease was treated, the functional hepatic reserve was impaired or appraised marginal for allowing further resection. RESULTS Ten patients with both liver metastases and HCC, and two patients with cholangiocellular carcinoma were treated. Complete initial tumor clearance was achieved in all patients. Two patients of the metastases group and five patients of the HCC group suffered from local recurrence after a median of 12 months (1-26) (local recurrence rate 32%). Five patients of the metastases group and six patients of the HCC group developed recurrent tumors in different areas of the ablation site after a median time of 4 months (2-18) (distant intrahepatic recurrence in 55%). Survival at 31 months was 36%. CONCLUSION RFA extends the scope of surgery in some candidates with intraoperatively found irresectability.
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Affiliation(s)
- R M Eisele
- Department of General-, Visceral-, and Transplantation Surgery, Charité Virchow-Clinic, Augustenburger Platz 1, 13353 Berlin, Germany.
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13
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Sofocleous CT, Nascimento RG, Petrovic LM, Klimstra DS, Gonen M, Brown KT, Brody LA, Covey AM, Thornton RH, Fong Y, Solomon SB, Schwartz LH, DeMatteo RP, Getrajdman GI. Histopathologic and immunohistochemical features of tissue adherent to multitined electrodes after RF ablation of liver malignancies can help predict local tumor progression: initial results. Radiology 2008; 249:364-74. [PMID: 18796687 DOI: 10.1148/radiol.2491071752] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine whether histopathologic and immunohistochemical features of tissue adherent to electrodes after radiofrequency (RF) ablation of liver malignancies can help predict local tumor progression (LTP). MATERIALS AND METHODS Institutional review board waiver and informed consent were obtained. Histologic and immunohistochemical examinations of tissue adherent to electrodes after RF ablation of liver malignancies were performed, with application of proliferation (Ki-67) and apoptosis (caspase-3) markers. Clinical and technical information were prospectively collected for an HIPAA-registered database. Medical records and imaging were reviewed to determine LTP for treated tumors smaller than 5 cm in diameter. LTP-free and survival rates were assessed with Kaplan-Meier method; differences between groups assessed with permutation log-rank test. Multivariate analysis assessed with Cox regression for factors related to LTP. RESULTS Sixty-eight malignant tumors treated with RF ablation were identified. Fifty-five tissue specimens were classified as coagulation necrosis (CN), thermal artifact only, or tumor cells positive for caspase-3/negative for Ki-67; and 13 as viable tumor cells (Ki-67 positive). Mean tumor size was larger in viable (3.4 cm) than in CN (2.5 cm) group before treatment (P = .01). For viable and CN groups, LTP occurred in 12 (92%) of 13 and 16 (29%) of 55 specimens, respectively; 1-year LTP-free rates were 0% and 74%, respectively (P < .001). Multivariate analysis confirmed that viable cells comprise independent risk factor for LTP (P < .001). The odds of LTP is six times greater in viable group compared with CN group for tumors 3-5 cm (hazard ratio: 5.9, 95% confidence interval: 2.4, 14.5) and 10 times greater for tumors smaller than 3 cm (hazard ratio: 10.1, 95% confidence interval: 1.7, 57.5). Median survival was 32.7 months. CONCLUSION Evidence of Ki-67-positive tumor cells on the electrode after hepatic RF ablation is an independent predictor of LTP.
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Affiliation(s)
- Constantinos T Sofocleous
- Section of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065, USA.
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14
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Ritz JP, Lehmann KS, Mols A, Frericks B, Knappe V, Buhr HJ, Holmer C. Laser-induced thermotherapy for lung tissue—evaluation of two different internally cooled application systems for clinical use. Lasers Med Sci 2007; 23:195-202. [PMID: 17599236 DOI: 10.1007/s10103-007-0472-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
Thermal ablation techniques like radiofrequency or laser-induced thermotherapy (LITT) are increasingly used to treat tumors of parenchymatous organs. Minimal access, parenchymal preservation, and a low complication rate render them suitable for pulmonary tumors as well. Their successful clinical application depends on the induction of sufficiently large lesions and a knowledge of the energy parameters required for complete thermal ablation. The aim of this study was to establish a dose-response relationship for a percutaneous and an intraoperative system for LITT of lung tissue. Thermal lesions were induced in healthy porcine lungs using an Nd:YAG laser (1,064 nm). LITT was performed with a percutaneous application system in group I (n = 18) and an intraoperative application system in group II (n = 90). Laser energy was applied for 600-1,200 s in a power range of 20-32 W (12,000-38,400 J). The lesions were longitudinally and transversally measured, and the volume was calculated after the intervention. Furthermore, an open application system was used to perform LITT under in vivo conditions during lung perfusion and ventilation in domestic pigs. Lesion volumes in both groups showed a plateau-like curve when the laser power increased from an initial level of 25 W. With the percutaneous puncture system (group I), the application of 28 W (16,800 J) for 10 min generated the largest lesions with a volume of 12.54 +/- 1.33 cm(3), an axial diameter of 39.33 +/- 2.52 mm, and a diametrical diameter of 24.67 +/- 1.15 mm. A longer application time was not possible due to thermal instability of the applicator. Moreover, group I started developing extensive carbonizations at a laser power of 22 W (13,200 J). The intraoperative application system (group II) achieved the largest lesion volumes of 11.03 +/- 2.54 cm(3) with diameters of 34.6 +/- 4.22 mm (axial) and 25.6 +/- 2.51 mm (diametrical) by an exposure time of 20 min and a power of 32 W (38,400 J). Here extensive carbonizations only started to occur at 28 W (33,600 J). Under in vivo conditions, all pigs tolerated the LITT procedure well without complications. Besides a typical cooling effect in the vicinity of blood vessels, the thermal lesions were about three times smaller than the ex vivo lesions. Both the percutaneous and the open LITT application system induced reproducible, clinically relevant lung lesions. The percutaneous puncture set generated large relevant lesions, although its usability is limited by its restricted capacity and high carbonization risk. It is suitable for powers up to 22 W. The intraoperative application system allows higher energy exposure to induce larger lesion volumes. This study elucidates the dose-effect relation of two clinically relevant puncture sets.
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Affiliation(s)
- Joerg P Ritz
- Department of General, Vascular and Thoracic Surgery, Charité-University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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15
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Schumacher G, Eisele R, Spinelli A, Schmidt SC, Jacob D, Pratschke J, Neuhaus P. Indications for hand-assisted laparoscopic radiofrequency ablation for liver tumors. J Laparoendosc Adv Surg Tech A 2007; 17:153-9. [PMID: 17484640 DOI: 10.1089/lap.2006.0001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Radiofrequency ablation has established itself as the preferred treatment for irresectable liver tumors. It can be performed either percutaneously, laparoscopically, or by open surgery. The choice of approach depends on the patient and tumor-related variables. The laparoscopic approach appears to be the safest and most effective method for small tumors on the liver surface. It also provides additional information on the intrahepatic tumor burden with the use of intraoperative ultrasound and staging laparoscopy. Furthermore, the pneumoperitoneum reduces the flow of the portal vein and increases the efficacy of the ablation. Depending on the location of the tumor, mobilization of the liver or lysis of adhesions from previous surgery can require open surgery. Our aim was to study the combined use of laparoscopy and laparotomy by using hand-assisted laparoscopic radiofrequency ablation. MATERIALS AND METHODS We performed hand-assisted laparoscopy to ablate nine tumors in seven patients, enabling us to combine most of the advantages of laparoscopy and open surgery. The radiofrequency ablation was technically simple to perform. A laparoscopy of the entire abdominal cavity and a thorough examination of the entire liver via ultrasound was also performed. RESULTS The electrode was accurately placed in all patients. In four patients, a complete mobilization of the right lobe was performed to obtain the easiest possible access to the tumor. In three patients, severe adhesions from previous surgeries were removed prior to insertion of the laparoscopic tools. The ablation was completed safely and successfully in all patients. CONCLUSION Our overall impression of the hand-assisted laparoscopic approach is that it seems to have a major advantage in comparison with simple laparoscopy, specifically for adhesions from previous surgeries and when the right liver lobe requires mobilization. Also, needle placement seems to be far more accurate than with simple laparoscopy.
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Affiliation(s)
- Guido Schumacher
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany.
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Sato K, Lewandowski RJ, Bui JT, Omary R, Hunter RD, Kulik L, Mulcahy M, Liu D, Chrisman H, Resnick S, Nemcek AA, Vogelzang R, Salem R. Treatment of unresectable primary and metastatic liver cancer with yttrium-90 microspheres (TheraSphere): assessment of hepatic arterial embolization. Cardiovasc Intervent Radiol 2006; 29:522-9. [PMID: 16729228 DOI: 10.1007/s00270-005-0171-4] [Citation(s) in RCA: 180] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In Canada and Europe, yttrium-90 microspheres (TheraSphere); MDS Nordion, Ottawa, Canada) are a primary treatment option for primary and secondary hepatic malignancies. We present data from 30 patients with hepatocellular carcinoma (HCC) and metastatic liver disease treated with TheraSphere from a single academic institution to evaluate the angiographically evident embolization that follows treatment. Seven interventional radiologists from one treatment center compared pretreatment and posttreatment angiograms. The reviewers were blinded to the timing of the studies. The incidence of postembolization syndrome (PES) was determined as well as objective tumor response rates by the World Health Organization (WHO), Response Evaluation Criteria in Solid Tumors (RECIST), and European Association for the Study of the Liver (EASL) criteria. There were 420 independent angiographic observations that were assessed using the chi-squared statistic. The pretreatment and posttreatment angiograms could not be correctly identified on average more than 43% of the time (p = 0.0004). The postprocedure arterial patency rate was 100%. The objective tumor response rates for all patients were 24%, 31%, and 72% for WHO, RECIST, and EASL criteria, respectively. All of the patients tolerated the procedure without complications and were treated on an outpatient basis, and four patients had evidence of PES. This treatment method does not result in macroscopic embolization of the hepatic arteries, thereby maintaining hepatic tissue perfusion. These data support the principle that the favorable response rates reported with TheraSphere are likely due to radiation and microscopic embolization rather than flow-related macroscopic embolization and ischemia.
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Affiliation(s)
- Kent Sato
- Department of Radiology, Section of Interventional Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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