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Chelales E, von Windheim K, Banipal AS, Siebeneck E, Benham C, Nief CA, Crouch B, Everitt JI, Sag AA, Katz DF, Ramanujam N. Determining the Relationship between Delivery Parameters and Ablation Distribution for Novel Gel Ethanol Percutaneous Therapy in Ex Vivo Swine Liver. Polymers (Basel) 2024; 16:997. [PMID: 38611255 PMCID: PMC11013462 DOI: 10.3390/polym16070997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/22/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Ethyl cellulose-ethanol (ECE) is emerging as a promising formulation for ablative injections, with more controllable injection distributions than those from traditional liquid ethanol. This study evaluates the influence of salient injection parameters on forces needed for infusion, depot volume, retention, and shape in a large animal model relevant to human applications. Experiments were conducted to investigate how infusion volume (0.5 mL to 2.5 mL), ECE concentration (6% or 12%), needle gauge (22 G or 27 G), and infusion rate (10 mL/h) impacted the force of infusion into air using a load cell. These parameters, with the addition of manual infusion, were investigated to elucidate their influence on depot volume, retention, and shape (aspect ratio), measured using CT imaging, in an ex vivo swine liver model. Force during injection increased significantly for 12% compared to 6% ECE and for 27 G needles compared to 22 G. Force variability increased with higher ECE concentration and smaller needle diameter. As infusion volume increased, 12% ECE achieved superior depot volume compared to 6% ECE. For all infusion volumes, 12% ECE achieved superior retention compared to 6% ECE. Needle gauge and infusion rate had little influence on the observed depot volume or retention; however, the smaller needles resulted in higher variability in depot shape for 12% ECE. These results help us understand the multivariate nature of injection performance, informing injection protocol designs for ablations using gel ethanol and infusion, with volumes relevant to human applications.
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Affiliation(s)
- Erika Chelales
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Katriana von Windheim
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Arshbir Singh Banipal
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Elizabeth Siebeneck
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Claire Benham
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Corrine A. Nief
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Brian Crouch
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Jeffrey I. Everitt
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Alan Alper Sag
- Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC 27710, USA
| | - David F. Katz
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
| | - Nirmala Ramanujam
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA; (K.v.W.); (A.S.B.); (C.A.N.)
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Crocetti L, Scalise P, Bozzi E, Candita G, Cioni R. Thermal ablation of hepatocellular carcinoma. J Med Imaging Radiat Oncol 2023; 67:817-831. [PMID: 38093656 DOI: 10.1111/1754-9485.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 11/29/2023] [Indexed: 01/14/2024]
Abstract
Percutaneous treatment of hepatocellular carcinoma (HCC) by means of thermal ablation (TA) has been introduced in clinical guidelines as a potentially curative treatment for the early stages of the disease since the early 2000s. Due to its safety profile and cost-effectiveness, TA can be offered as a first-line treatment for patients with HCC smaller than 3 cm. Thermal ablative techniques are in fact widely available at many centres worldwide and include radiofrequency (RF) and microwave (MW) ablation, with the latter increasingly applied in clinical practice in the last decade. Pre-clinical studies highlighted, as potential advantages of MW-based ablation, the ability to achieve higher temperatures (>100°C) and larger ablation zones in shorter times, with less susceptibility to blood flow-induced heat sink effects. Despite these advantages, there is no evidence of superior overall survival in patients treated with MW as compared to those treated with RF ablation. Local control has been proven to be superior to MW ablation with a similar complication rate. It is expected that further improvement of TA results in the treatment of HCC will result from the refinement of guidance and monitoring tools and the careful assessment of ablation margins. Thermal ablative treatments may also be performed on nodules larger than 3 cm by applying multiple devices or combining percutaneous and intra-arterial approaches. The role of novel immunotherapy regimens in combination with ablation is also currently under evaluation in clinical trials, with several potential benefits. In this review, indications, technical principles, results, and future prospects of TA for the treatment of HCC will be examined.
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Affiliation(s)
- Laura Crocetti
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Paola Scalise
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Gianvito Candita
- Department of Translational Research, Academic Radiology, University of Pisa, Pisa, Italy
| | - Roberto Cioni
- Division of Interventional Radiology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Koza A, Bhogal RH, Fotiadis N, Mavroeidis VK. The Role of Ablative Techniques in the Management of Hepatocellular Carcinoma: Indications and Outcomes. Biomedicines 2023; 11:biomedicines11041062. [PMID: 37189680 DOI: 10.3390/biomedicines11041062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/18/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
The management of hepatocellular carcinoma (HCC) remains complex and will continue to rely on the multidisciplinary input of hepatologists, surgeons, radiologists, oncologists and radiotherapists. With the appropriate staging of patients and selection of suitable treatments, the outcomes for HCC are improving. Surgical treatments encompassing both liver resection and orthotopic liver transplantation (OLT) are the definitive curative-intent options. However, patient suitability, as well as organ availability, pose essential limitations. Consequently, non-surgical options, such as ablative techniques, play an increasingly important role, especially in small HCCs, where overall and disease-free survival can be comparable to surgical resection. Ablative techniques are globally recommended in recognised classification systems, showing increasingly promising results. Recent technical refinements, as well as the emerging use of robotic assistance, may expand the treatment paradigm to achieve improved oncological results. At present, in very early stage and early stage unresectable disease, percutaneous thermal ablation is considered the treatment of choice. Owing to their different features, various ablative techniques, including radiofrequency ablation, microwave ablation, cryotherapy ablation and irreversible electroporation, have been shown to confer different comparative advantages and applicability. We herein review the role of available ablative techniques in the current complex multidisciplinary management of HCC, with a main focus on the indications and outcomes, and discuss future perspectives.
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Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:54-63. [PMID: 36041973 DOI: 10.1016/j.hbpd.2022.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail. DATA SOURCES The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using "minimally invasive" and "hepatocellular carcinoma" or "liver cancer" as the keywords. RESULTS Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC. CONCLUSIONS A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.
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Affiliation(s)
- Ya-Wen Zou
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhen-Guo Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Bo Hu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hai-Yu Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Han Y, Zhao W, Wu M, Qian Y. Efficacy and safety of single- and multiple-antenna microwave ablation for the treatment of hepatocellular carcinoma and liver metastases: A systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e32304. [PMID: 36595779 PMCID: PMC9794220 DOI: 10.1097/md.0000000000032304] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is a myriad of microwave ablation (MWA) systems used in clinical settings worldwide for the management of liver cancer that offer a variety of features and capabilities. However, an analysis on which features and capabilities result in the most favorable efficacy and safety results has never been completed due to a lack of head-to-head comparisons. The aim of this study is to compare single-antenna and multiple-antenna MWA using radiofrequency ablation (RFA) as a common comparator in the treatment of very-early, early hepatocellular carcinoma (HCC) and ≤5 cm liver metastases. METHODS This network meta-analysis was performed according to PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were searched for comparative studies. Complete ablation (CA) rate, local tumor progression-free (LTPF) rate, overall survival (OS), and major complication rate were assessed. Subgroup analyses were further performed based on synchronous or asynchronous MWA generators and tumor size (<2 cm or ≥2 cm). RESULTS Twenty-one studies (3424 patients), including 3 randomized controlled trials (RCTs) and 18 observational studies, met eligibility criteria. For CA, LTPF and major complications, as compared to single-antenna MWA, multiple-antenna MWA had relative risks (RRs) of 1.051 (95% CI: 0.987-1.138), 1.099 (95% CI: 0.991-1.246), and 0.605 (95% CI: 0.193-1.628), respectively. For 1-year and 3-year OS, as compared to single-antenna MWA, multiple-antenna MWA had odds ratios (ORs) of 0.9803 (95% CI: 0.6772-1.449) and 1.046 (95% CI: 0.615-1.851), respectively. Subgroup analysis found synchronized multi-antenna MWA was associated with significantly better LTPF by 22% (RR: 1.22, 95% CI 1.068, 1.421), and 21.4% (RR: 1.214, 95% CI 1.035, 1.449) compared with single-antenna MWA, and asynchronous multiple-antenna MWA, respectively, with more evident differences in larger tumors (≥2 cm). CONCLUSION Multi-antenna and single-antenna MWA showed similar effectiveness for local treatment of liver tumors, but synchronous multi-antenna MWA exhibited better LTPF compared to other MWA approaches, particularly for larger liver tumors (≥2 cm). Large-scale RCTs should be further conducted.
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Affiliation(s)
- Yi Han
- Health Economics Research Institute, Sun Yat-Sen University, Guangdong, China
| | | | - Min Wu
- Shanghai VMLY&Rx Co., Ltd., Shanghai, China
| | - Yingjun Qian
- Johnson & Johnson Medical (Shanghai) Ltd., Shanghai, China
- * Correspondence: Yingjun Qian, Johnson & Johnson Medical (Shanghai) Ltd., 65 Guiqing Road, Shanghai 200233, China (e-mail: )
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Zhu W, Zhong Z, Yan H, Guo H, Xiao M, He X, Gao F, Zhang F. Clinical efficacy of CT-guided 125I brachytherapy in patients with local residual or recurrent hepatocellular carcinoma after thermal ablation. Insights Imaging 2022; 13:185. [PMID: 36471084 PMCID: PMC9723008 DOI: 10.1186/s13244-022-01327-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation. METHODS A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model. RESULTS After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable. CONCLUSIONS CT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.
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Affiliation(s)
- Wenliang Zhu
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Zhihui Zhong
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Huzheng Yan
- grid.12981.330000 0001 2360 039XDepartment of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630 People’s Republic of China
| | - Huanqing Guo
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Meigui Xiao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Xu He
- grid.452930.90000 0004 1757 8087ZhuHai Interventional Medical Center, ZhuHai People’s Hospital (ZhuHai Hospital Affiliated With Jinan University), Jinan University, ZhuHai, 519000 Guangdong People’s Republic of China
| | - Fei Gao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Fujun Zhang
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
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Trujillo-Romero CJ, Dionisio Merida J, Ramírez-Guzmán TJ, Martínez-Valdez R, Leija-Salas L, Vera-Hernández A, Rico-Martínez G, Flores-Cuautle JJA, Gutiérrez-Martínez J, Sacristán-Rock E. Thermal Evaluation of Multi-Antenna Systems Proposed to Treat Bone Tumors: Finite Element Analysis. Sensors (Basel) 2022; 22:7604. [PMID: 36236709 PMCID: PMC9571680 DOI: 10.3390/s22197604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Microwave ablation is commonly used in soft tissue tumors, but its application in bone tumors has been barely analyzed. Antennas to treat bone tissue (~3 cm2), has been lately designed. Bone tumors at pathological stage T1 can reach 8 cm wide. An antenna cannot cover it; therefore, our goal is to evaluate the thermal performance of multi-antenna arrays. Linear, triangular, and square configurations of double slot (DS) and monopole (MTM) antennas were evaluated. A parametric study (finite element method), with variations in distance between antennas (ad) and bone thickness (bt) was implemented. Array feasibility was evaluated by SWR, ablated tissue volume, etc. The linear configuration with DS and MTM antennas showed SWR ≤ 1.6 for ad = 1 mm−15 mm and bt = 20 mm−40 mm, and ad = 10 mm−15 mm and bt = 25 mm−40 mm, respectively; the triangular showed SWR ≤ 1.5 for ad = 5 mm−15 mm and bt = 20 mm−40 mm and ad = 10 mm−15 mm and bt = 25 mm−40 mm. The square configuration (DS) generated SWR ≤ 1.5 for ad = 5 mm−20 mm and bt = 20 mm−40 mm, and the MTM, SWR ≤ 1.5 with ad = 10 mm and bt = 25 mm−40 mm. Ablated tissue was 4.65 cm3−10.46 cm3 after 5 min. According to treatment time and array configuration, maximum temperature and ablated tissue is modified. Bone tumors >3 cm3 can be treated by these antenna-arrays.
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Affiliation(s)
- Citlalli Jessica Trujillo-Romero
- Division of Medical Engineering Research, National Institute of Rehabilitation-LGII, Calz. México Xochimilco No. 289, Arenal de Guadalupe, Mexico City 14389, Mexico
| | - Juan Dionisio Merida
- Department of Electrical Engineering, Universidad Autonoma Metropolitana, UAM-Iztapalapa, Av. Ferrocarril San Rafael Atlixco, 186, Leyes de Reforma, Mexico City 09310, Mexico
| | - Texar Javier Ramírez-Guzmán
- Electrical Engineering Department, Bioelectronics Section, CINVESTAV-IPN, Instituto Politécnico Nacional 2508, San Pedro Zacatenco, Mexico City 07360, Mexico
| | - Raquel Martínez-Valdez
- Biomedical Engineering Program, Universidad Politécnica de Chiapas, Suchiapa 29150, Mexico
| | - Lorenzo Leija-Salas
- Electrical Engineering Department, Bioelectronics Section, CINVESTAV-IPN, Instituto Politécnico Nacional 2508, San Pedro Zacatenco, Mexico City 07360, Mexico
| | - Arturo Vera-Hernández
- Electrical Engineering Department, Bioelectronics Section, CINVESTAV-IPN, Instituto Politécnico Nacional 2508, San Pedro Zacatenco, Mexico City 07360, Mexico
| | - Genaro Rico-Martínez
- Bone Tumors Service, National Institute of Rehabilitation-LGII, Calz. México Xochimilco No. 289, Arenal de Guaudalupe, Mexico City 14389, Mexico
| | - José Jesús Agustín Flores-Cuautle
- CONACYT-National Technological Institute of Mexico/I.T. Orizaba, Posgraduate Studies and Research Division, Oriente 9, No. 852, Orizaba 94320, Mexico
| | - Josefina Gutiérrez-Martínez
- Division of Medical Engineering Research, National Institute of Rehabilitation-LGII, Calz. México Xochimilco No. 289, Arenal de Guadalupe, Mexico City 14389, Mexico
| | - Emilio Sacristán-Rock
- National Center for Research in Instrumentation and Medical Imaging, UAM-Iztapalapa, Av. Ferrocarril San Rafael Atlixco, 186, Leyes de Reforma, Mexico City 09310, Mexico
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Sgalambro F, Zugaro L, Bruno F, Palumbo P, Salducca N, Zoccali C, Barile A, Masciocchi C, Arrigoni F. Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:3265. [PMID: 35743336 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
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Ringe KI. [Percutaneous local ablation of small renal cell cancer]. Aktuelle Urol 2021; 52:445-451. [PMID: 33860478 DOI: 10.1055/a-1364-4633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Renal cell carcinoma (RCC) is a cancer that mainly occurs in elderly patients. Percutaneous image-guided ablation of small RCC (< 4 cm) is a validated therapeutic option, especially as many patients are no candidates for surgery due to comorbidities. This article presents and discusses established local ablative techniques such as radiofrequency (RFA), microwave (MWA) and cryoablation for the treatment of small RCC based on current literature and in the context of the latest guidelines.
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Affiliation(s)
- Kristina Imeen Ringe
- Medizinische Hochschule Hannover, Institut für Diagnostische und Interventionelle Radiologie, Hannover
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10
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Fujimori M, Kimura Y, Ueshima E, Dupuy DE, Adusumilli PS, Solomon SB, Srimathveeravalli G. Lung Ablation with Irreversible Electroporation Promotes Immune Cell Infiltration by Sparing Extracellular Matrix Proteins and Vasculature: Implications for Immunotherapy. Bioelectricity 2021; 3:204-214. [PMID: 34734168 DOI: 10.1089/bioe.2021.0014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: This study investigated the sparing of the extracellular matrix (ECM) and blood vessels at the site of lung irreversible electroporation (IRE), and its impact on postablation T cell and macrophage populations. Materials and Methods: Normal swine (n = 8) lung was treated with either IRE or microwave ablation (MWA), followed by sacrifice at 2 and 28 days (four animals/timepoint) after treatment. En bloc samples of ablated lung were stained for blood vessels (CD31), ECM proteins (Collagen, Heparan sulfate, and Decorin), T cells (CD3), and macrophages (Iba1). Stained slides were analyzed with an image processing software (ImageJ) to count the number of positive staining cells or the percentage area of tissue staining for ECM markers, and the statistical difference was evaluated with Student's t-test. Results: Approximately 50% of the blood vessels and collagen typically seen in healthy lung were evident in IRE treated samples at Day 2, with complete destruction within MWA treated lung. These levels increased threefold by Day 28, indicative of post-IRE tissue remodeling and regeneration. Decorin and Heparan sulfate levels were reduced, and it remained so through the duration of observation. Concurrently, numbers of CD3+ T cells and macrophages were not different from healthy lung at Day 2 after IRE, subsequently increasing by 2.5 and 1.5-fold by Day 28. Similar findings were restricted to the peripheral inflammatory rim of MWA samples, wherein the central necrotic regions remained acellular through Day 28. Conclusion: Acute preservation of blood vessels and major ECM components was observed in IRE treated lung at acute time points, and it was associated with the increased infiltration and presence of T cells and macrophages, features that were spatially restricted in MWA treated lung.
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Affiliation(s)
- Masashi Fujimori
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Mie University, Mie, Japan
| | - Yasushi Kimura
- Department of Mechanical & Industrial Engineering, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - Damian E Dupuy
- Department of Radiology, Cape Cod Healthcare, Hyannis, Massachusetts, USA
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Radiology, Mie University, Mie, Japan
| | - Govindarajan Srimathveeravalli
- Department of Mechanical & Industrial Engineering, University of Massachusetts, Amherst, Massachusetts, USA.,Institute for Applied Life Sciences, University of Massachusetts, Amherst, Massachusetts, USA
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11
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Luerken L, Doppler M, Brunner SM, Schlitt HJ, Uller W. Stereotactic Percutaneous Electrochemotherapy as Primary Approach for Unresectable Large HCC at the Hepatic Hilum. Cardiovasc Intervent Radiol 2021; 44:1462-1466. [PMID: 34036404 PMCID: PMC8382613 DOI: 10.1007/s00270-021-02841-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/05/2021] [Indexed: 12/21/2022]
Abstract
Electrochemotherapy (ECT) is a novel non-thermal ablative technique that combines chemotherapy and the application of electric pulses for reversible cell membrane electroporation. This method was recently performed in the treatment of deep-seated liver tumors during open surgery but experience about percutaneous ECT is rare and further developments like combination of percutaneous ECT with stereotactic navigated devices may be very promising. We report on a case of a 4.7 × 4.5 × 3.5 cm unresectable HCC at the hepatic hilum adjacent to the major vessels and the bile duct that was successfully treated using percutaneous ECT in combination with stereotactic navigation. Follow-up imaging 6 weeks and 6 months after ECT showed complete response.
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Affiliation(s)
- L Luerken
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - M Doppler
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - S M Brunner
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - H J Schlitt
- Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - W Uller
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. .,Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Medical Center, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
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12
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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13
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Zaitoun MMA, Elsayed SB, Zaitoun NA, Soliman RK, Elmokadem AH, Farag AA, Amer M, Hendi AM, Mahmoud NEM, Salah El Deen D, Alsowey AM, Shahin S, Basha MAA. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm. Int J Hyperthermia 2021; 38:248-256. [PMID: 33615957 DOI: 10.1080/02656736.2021.1887941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. METHODS This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. RESULTS Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. CONCLUSIONS Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.
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Affiliation(s)
- Mohamed M A Zaitoun
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Diagnostic Radiology Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saeed B Elsayed
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla A Zaitoun
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa K Soliman
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ali H Elmokadem
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa A Farag
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Amer
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali M Hendi
- Diagnostic Radiology Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Nader E M Mahmoud
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Salah El Deen
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shahenda Shahin
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Ateş ÖF. Effectiveness and reliability of percutaneous microwave ablation therapy in early stage renal cell cancer: Intermediate term results. Journal of Surgery and Medicine 2020; 4:1068-1072. [DOI: 10.28982/josam.821632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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15
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Verpaalen VD, Case JB, Dark MJ, Cardenas-Goicoechea SJ, Winter MD, Boston SE, Garcia-Pereira F, Rhoton-Vlasak AS, Toskich BB. Feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation of clinically normal canine ovaries. Am J Vet Res 2020; 81:747-754. [PMID: 33112170 DOI: 10.2460/ajvr.81.9.747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the optimal energy profile for and to assess the feasibility and efficacy of ultrasonographic and laparoscopic guidance for microwave ablation (MWA) of clinically normal canine ovaries. SAMPLE 44 extirpated ovaries from 22 healthy dogs. PROCEDURES In the first of 2 trials, 13 dogs underwent oophorectomy by routine laparotomy. Extirpated ovaries underwent MWA at 45 W for 60 (n = 11) or 90 (12) seconds; 3 ovaries did not undergo MWA and served as histologic controls. Ovaries were histologically evaluated for cell viability. Ovaries without viable cells were categorized as completely ablated. Histologic results were used to identify the optimal MWA protocol for use in the subsequent trial. In the second trial, the ovaries of 9 dogs underwent MWA at 45 W for 90 seconds in situ. Ultrasonographic guidance for MWA was deemed unfeasible after evaluation of 1 ovary. The remaining 17 ovaries underwent MWA with laparoscopic guidance, after which routine laparoscopic oophorectomy was performed. Completeness of ablation was histologically assessed for all ovaries. RESULTS 2 ovaries were excluded from the trial 1 analysis because of equivocal cell viability. Six of 11 ovaries and 10 of 10 ovaries that underwent MWA for 60 and 90 seconds, respectively, were completely ablated. In trial 2, laparoscopic-guided MWA resulted in complete ablation for 12 of 17 ovaries. Dissection of the ovarian bursa for MWA probe placement facilitated complete ablation. CONCLUSIONS AND CLINICAL RELEVANCE Laparoscopic-guided MWA at 45 W for 90 seconds was feasible, safe, and effective for complete ablation of clinically normal ovaries in dogs.
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Darweesh SK, Gad AA. Percutaneous microwave ablation for HCV-related hepatocellular carcinoma: Efficacy, safety, and survival. Turk J Gastroenterol 2020; 30:445-453. [PMID: 31060999 DOI: 10.5152/tjg.2019.17191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Hepatocellular carcinoma (HCC) has a poor prognosis if managed late. Percutaneous microwave ablation (MWA) emerged as one of the top therapeutic decisions for non-surgical patients. The aim of the present study aim was to evaluate the efficacy, side effects, and survival after MWA of hepatitis C virus (HCV)-related HCC tumors with spectrum sizes up to 5 cm. MATERIALS AND METHODS Fifty-nine patients with early HCC were treated in the Hepatology Department using percutaneous MWA. Patients were assessed for side effects and efficacy that includes the rate of complete ablation, primary or de novo recurrence, and survival. RESULTS Complete ablation was achieved in 57 (96.6%) patients treated by MWA, with a minor complication rate of 3.3% (n=2) including liver abscess formation and abdominal skin burn. The ablation rates in lesions <3 versus 3-5 cm were not different. Of the patients, 3 (5%) had primary recurrence in the treated HCC tumors, de novo lesions (secondary recurrence) developed in 8 (13.5%, 5 of them >3 cm), and 2 (3.3%) had malignant portal vein thrombosis. The survival rates were 95.4% and 69% at 1 and 2 years, respectively. CONCLUSION Percutaneous MWA had achieved a safe and effective treatment with good overall survival in patients with HCV-related HCC.
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Affiliation(s)
- Samar K Darweesh
- Department of Hepato-gastroenterology and Tropical Medicine, Cairo University School of Medicine, Egypt
| | - Amal A Gad
- Department of Internal Medicine, Suez Canal University School of Medicine, Ismailia, Egypt
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17
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Xie L, Cao F, Qi H, Song Z, Shen L, Chen S, Hu Y, Chen C, Fan W. Efficacy and safety of CT-guided percutaneous thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis. Int J Hyperthermia 2019; 36:1122-1128. [DOI: 10.1080/02656736.2019.1684575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ze Song
- Department of Oncology, The Seventh Affiliated Hospital,Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yubin Hu
- Department of Interventional Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
| | - Chao Chen
- Department of Interventional Therapy, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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18
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Zhang TQ, Huang ZM, Shen JX, Chen GQ, Shen LJ, Ai F, Gu YK, Yao W, Zhang YY, Guo RP, Chen MS, Huang JH. Safety and effectiveness of multi-antenna microwave ablation-oriented combined therapy for large hepatocellular carcinoma. Therap Adv Gastroenterol 2019; 12:1756284819862966. [PMID: 31489030 PMCID: PMC6709441 DOI: 10.1177/1756284819862966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/14/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND In patients with a large, unresectable hepatocellular carcinoma (HCC), the primary recommendation is for transarterial chemoembolization (TACE) but used alone TACE is not typically curative. Combinations of TACE followed in a delayed fashion by single-applicator thermal ablation have also been suboptimal. As an alternative, we investigated the combination of TACE followed within 1-3 days by multi-antenna microwave ablation (MWA) in patients with a large HCC, to determine the feasibility, safety, local control, and short-term survival rates of this approach. METHODS We retrospectively studied 43 patients with a large HCC (mean diameter, 8.8 cm; SD, 2.8 cm) treated between July 2015 and July 2018, who underwent TACE followed within 3 days by multi-antenna simultaneous MWA. We measured the liver and renal function before and after treatment, recorded complications, used three-dimensional software and imaging to calculate tumor necrosis rates at 1 month after therapy, and calculated overall survival (OS) and progression-free survival (PFS) using the Kaplan-Meier method. RESULTS Mean follow up was 12.2 (range, 3.5-35.6) months. All patients completed the treatment protocol. At 1 month after combined therapy, tumor necrosis was complete in 16 (37.2%), nearly complete in 19 (44.2%), and partial in 8 (18.6%) patients. The 1- and 2-year OS rates were 64.0% and 46.8%, respectively, with a median OS of 23.0 months; and the 1- and 2-year PFS rates were 19.9% and 4.4%, respectively, with a median PFS of 4.2 months. A transient change in liver function occurred 3 days after MWA but resolved within 1 month. Only two patients had major complications, which were treatable and resolved. CONCLUSION Multi-antenna MWA-oriented combined therapy is feasible and well tolerated, and it results in satisfactory initial local control and short-term survival in some but not all patients with a large HCC.
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Affiliation(s)
- Tian-qi Zhang
- Department of Minimally Invasive Interventional
Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China,State Key Laboratory of Oncology in South China,
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhi-mei Huang
- Department of Minimally Invasive Interventional
Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China,State Key Laboratory of Oncology in South China,
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jing-xian Shen
- State Key Laboratory of Oncology in South China,
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China,Department of Imaging, Sun Yat-sen University
Cancer Center, Guangzhou, China
| | - Gui-qun Chen
- Department of Minimally Invasive Interventional
Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China,State Key Laboratory of Oncology in South China,
Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lu-jun Shen
- Department of Minimally Invasive Interventional
Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China,State Key Laboratory of Oncology in South
China, Collaborative Innovation Center for Cancer Medicine, Guangzhou,
China
| | - Fei Ai
- State Key Laboratory of Oncology in South
China, Collaborative Innovation Center for Cancer Medicine, Guangzhou,
China,Department of Imaging, Sun Yat-sen University
Cancer Center, Guangzhou, China
| | - Yang-kui Gu
- Department of Minimally Invasive Interventional
Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China,State Key Laboratory of Oncology in South
China, Collaborative Innovation Center for Cancer Medicine, Guangzhou,
China
| | - Wang Yao
- Department of Oncology Interventional
Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou,
China
| | - Yan-yang Zhang
- Department of Interventional Radiology, The
Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rong-ping Guo
- State Key Laboratory of Oncology in South
China, Collaborative Innovation Center for Cancer Medicine, Guangzhou,
China,Department of Hepatobiliary and Pancreatic
Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Min-shan Chen
- State Key Laboratory of Oncology in South
China, Collaborative Innovation Center for Cancer Medicine, Guangzhou,
China,Department of Hepatobiliary and Pancreatic
Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
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Zhang TQ, Huang SM, Gu YK, Jiang XY, Huang ZM, Deng HX, Huang JH. Sequential and Simultaneous 4-Antenna Microwave Ablation in an Ex Vivo Bovine Liver Model. Cardiovasc Intervent Radiol 2019; 42:1466-1474. [DOI: 10.1007/s00270-019-02241-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Smolock AR, Cristescu MM, Hinshaw A, Woo KM, Wells SA, Ziemlewicz TJ, Lubner MG, Dalvie PS, Louis Hinshaw J, Brace CL, Ozkan OS, Lee FT, Laeseke P. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom Radiol (NY) 2018; 43:2497-2504. [PMID: 29450606 DOI: 10.1007/s00261-018-1464-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC). METHODS Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.8 cm) in 16 patients (13 males; median age 64 years) were treated using TACE monotherapy. Combination TACE + MWA was used to treat 23 HCCs (median diameter 4.2 cm) in 22 patients (18 males; median age 61 years). Microwave ablation was performed at a target time of two weeks following TACE. Individual tumors were followed by serial contrast-enhanced CT or MR. Response to treatment was evaluated on a tumor-by-tumor basis using mRECIST criteria with the primary outcome being local tumor progression (LTP). Data were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Time to LTP was estimated with the Kaplan-Meier method. RESULTS Relative to TACE monotherapy, TACE + MWA provided a trend toward both a lower rate of LTP (34.8% vs. 62.5%, p = 0.11) and a higher complete response rate (65.2% vs. 37.5%; p = 0.12). Time to LTP (22.3 months vs. 4.2 months; p = 0.001) was significantly longer in the TACE + MWA group compared to TACE monotherapy. CONCLUSIONS Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3-5 cm HCC.
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Affiliation(s)
- Amanda R Smolock
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Mircea M Cristescu
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Audrey Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Kaitlin M Woo
- Departments of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Shane A Wells
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Prasad S Dalvie
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Christopher L Brace
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Medical Physics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Orhan S Ozkan
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Paul Laeseke
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA.
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Marcelin C, Leiner J, Nasri A, Petitpierre F, Le Bras Y, Yacoub M, Grenier N, Bernhard JC, Cornelis F. In vivo percutaneous microwave ablation in kidneys: Correlation with ex vivo data and ablation work. Diagn Interv Imaging 2017; 99:3-8. [PMID: 29066127 DOI: 10.1016/j.diii.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/29/2017] [Accepted: 09/13/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare diameters of in vivo microwave ablation (MWA) performed in swine kidneys with ex vivo diameters, and to correlate with ablation work (AW), a new metric reflecting total energy delivered. MATERIAL AND METHODS Eighteen in vivo MWA were performed in 6 swine kidneys successively using one or two antennas (MicroThermX®). Ablation consisted in delivering power (45-120W) for 5-15minutes. Ex vivo diameters were provided by the vendors and obtained on bovine liver tissue. AW was defined as the sum of (power)*(time)*(number of antennas) for all phases of an ablation (in kJoules). Kidneys were removed laparoscopically immediately after ablation. After sacrifice, ablations zones were evaluated macroscopically, and maximum diameters of the zones were recorded. Wilcoxon sum rank test and Pearson's correlation were used for comparisons. RESULTS For a single antenna (n=12), the in vivo diameters ranged from 12 to 35mm, and 15-49mm for 2 antennas (n=6). The in vivo diameters remained shorter than ex vivo diameters by 8.6%±30.1 on 1 antenna and 11.7%±26.5 on 2 antennas (P=0.31 and 0.44, respectively). AW ranged from 13.5 to 108kJ. Diameters increased linearly with AW both with 1 and 2 antennas, but only moderate correlations were observed (r=0.43 [95% confidence interval: -0.19; 0.81], P=0.16; and 0.57 [-0.44; 0.95], P=0.24, respectively). CONCLUSION Although diameters after in vivo renal MWA increased linearly with AW, the moderate correlation and wide standard deviations observed may justify a careful imaging monitoring during treatment delivery and settings adaptation, if needed, for optimal ablation.
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Affiliation(s)
- C Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - J Leiner
- Service d'anatomopathologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - A Nasri
- Service d'anatomopathologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Petitpierre
- Service d'imagerie diagnostique et thérapeutique de l'adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - Y Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M Yacoub
- Service d'anatomopathologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - N Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J C Bernhard
- Service de chirurgie urologique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Cornelis
- Service d'imagerie diagnostique et thérapeutique de l'adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France; Service de radiologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
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Dodd GD, Lanctot AC, Lind KE. Effect of Change in Portal Vein Flow Rates on Hepatic Ablations Created with a Bipolar Radiofrequency Ablation Device. Radiology 2017; 283:399-407. [DOI: 10.1148/radiol.2016152562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gerald D. Dodd
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
| | - Anthony C. Lanctot
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
| | - Kimberly E. Lind
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
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Revel-Mouroz P, Otal P, Jaffro M, Petermann A, Meyrignac O, Rabinel P, Mokrane FZ. Other non-surgical treatments for liver cancer. Rep Pract Oncol Radiother 2017; 22:181-192. [PMID: 28490991 DOI: 10.1016/j.rpor.2017.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 01/11/2017] [Accepted: 02/25/2017] [Indexed: 02/08/2023] Open
Abstract
Interventional radiology plays a major role in the modern management of liver cancers, in primary hepatic malignancies or metastases and in palliative or curative situations. Radiological treatments are divided in two categories based on their approach: endovascular treatment and direct transcapsular access. Endovascular treatments include mainly three applications: transarterial chemoembolization (TACE), transarterial radioembolization (TARE) and portal vein embolization (PVE). TACE and TARE share an endovascular arterial approach, consisting of a selective catheterization of the hepatic artery or its branches. Subsequently, either a chemotherapy (TACE) or radioembolic (TARE) agent is injected in the target vessel to act on the tumor. PVE raises the volume of the future liver remnant in extended hepatectomy by embolizing a portal vein territory which results in hepatic regeneration. Direct transcapsular access treatments involve mainly three techniques: radiofrequency thermal ablation (RFA), microwave thermal ablation (MWA) and percutaneous ethanol injection (PEI). RFA and MWA procedures are almost identical, their clinical applications are similar. A probe is deployed directly into the tumor to generate heat and coagulation necrosis. PEI has known implications based on the chemical toxicity of intra-tumoral injection with highly concentrated alcohol by a thin needle.
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Affiliation(s)
- Paul Revel-Mouroz
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Philippe Otal
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Marion Jaffro
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Antoine Petermann
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Olivier Meyrignac
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Pierre Rabinel
- Department of Digestive Surgery and Liver Transplantation, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
| | - Fatima-Zohra Mokrane
- Department of Radiology, Rangueil Hospital, 1, avenue du Pr Jean Poulhès TSA 50032, 31059 Toulouse Cedex, France
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Cornelis FH, Marcelin C, Bernhard JC. Microwave ablation of renal tumors: A narrative review of technical considerations and clinical results. Diagn Interv Imaging 2016; 98:287-297. [PMID: 28011104 DOI: 10.1016/j.diii.2016.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/01/2016] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this review was to identify the specific technical considerations to adequately perform microwave ablations (MWA) of renal tumors and analyze the currently available clinical results. METHODS Using Medline, a systematic review was performed including articles published between January 2000 and September 2016. English language original articles, reviews and editorials were selected based on their clinical relevance. RESULTS MWA has several theoretical advantages over radiofrequency ablation in consistently providing higher intratumoral temperatures. MWA is less dependent of electrical conductivities of tissues and the delivered energy is less limited by desiccation of heated tissues. While there are insufficient data, especially because of a lack of studies with mid- to long-term follow-up, to determine the oncologic effectiveness of MWA, this technique appears safe and effective for the ablation of T1 renal tumors. There is evidence for using mid-level settings based on experimental and clinical data. Power set at 50-65W for 5-15min appears adequate in kidney but close clinical and imaging follow-up have to be performed. CONCLUSION Renal MWA offers theoretical advantages by comparison with other available techniques to treat renal tumors. However, MWA suffers of less cumulative data compared to radiofrequency ablation or cryoablation. Moreover, microwaves still require further studies to identify the optimal tumor characteristics and device settings leading to predictable ablation.
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Affiliation(s)
- F H Cornelis
- Department of radiology, Tenon hospital, 4, rue de la Chine, 75020 Paris, France.
| | - C Marcelin
- Department of radiology, Pellegrin hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J-C Bernhard
- Department of urology, Pellegrin hospital, place Amélie-Raba-Léon, 33076 Bordeaux, France
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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: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Meloni MF, Chiang J, Laeseke PF, Dietrich CF, Sannino A, Solbiati M, Nocerino E, Brace CL, Lee FT. Microwave ablation in primary and secondary liver tumours: technical and clinical approaches. Int J Hyperthermia 2016; 33:15-24. [PMID: 27416729 DOI: 10.1080/02656736.2016.1209694] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Thermal ablation is increasingly being utilised in the treatment of primary and metastatic liver tumours, both as curative therapy and as a bridge to transplantation. Recent advances in high-powered microwave ablation systems have allowed physicians to realise the theoretical heating advantages of microwave energy compared to other ablation modalities. As a result there is a growing body of literature detailing the effects of microwave energy on tissue heating, as well as its effect on clinical outcomes. This article will discuss the relevant physics, review current clinical outcomes and then describe the current techniques used to optimise patient care when using microwave ablation systems.
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Affiliation(s)
- Maria Franca Meloni
- a Department of Radiology , Interventional Ultrasound, Institute of Care IGEA , Milan , Italy
| | - Jason Chiang
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Paul F Laeseke
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Christoph F Dietrich
- c Department of Internal Medicine , Caritas Krankenhas Bad Mergentheim , Bad Mergentheim , Germany
| | - Angela Sannino
- d Department of Clinical Medicine and Surgery , University of Naples Federico II , Naples , Italy
| | - Marco Solbiati
- e Department of Electronics, Information and Bioengineering , Politecnico Milano , Milan , Italy
| | - Elisabetta Nocerino
- f Department of Radiology , San Paolo Hospital, University of Milan , Milan , Italy
| | - Christopher L Brace
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
| | - Fred T Lee
- b Department of Radiology , University of Wisconsin , Madison , Wisconsin , USA
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Chiang J, Cristescu M, Lee MH, Moreland A, Hinshaw JL, Lee FT, Brace CL. Effects of Microwave Ablation on Arterial and Venous Vasculature after Treatment of Hepatocellular Carcinoma. Radiology 2016; 281:617-624. [PMID: 27257951 DOI: 10.1148/radiol.2016152508] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To characterize vessel occlusion rates and their role in local tumor progression in patients with hepatocellular carcinoma (HCC) who underwent microwave tumor ablation. Materials and Methods This institutional review board approved, HIPAA-compliant retrospective review included 95 patients (75 men and 20 women) with 124 primary HCCs who were treated at a single center between January 2011 and March 2014. Complete occlusion of the portal veins, hepatic veins, and hepatic arteries within and directly abutting the ablation zone was identified with postprocedure contrast material-enhanced computed tomography. For each vessel identified in the ablation zone, its size and antenna spacing were recorded and correlated with vascular occlusion with logistic regression analysis. Local tumor progression rates were then compared between patent and occluded vessels for each vessel type with Fisher exact test. Results Occlusion was identified in 39.7% of portal veins (29 of 73), 15.0% of hepatic veins (six of 40), and 14.2% of hepatic arteries (10 of 70) encompassed within the ablation zone. Hepatic vein occlusion was significantly correlated with a smaller vessel size (P = .036) and vessel-antenna spacing (P = .006). Portal vein occlusion was only significantly correlated with a smaller vessel size (P = .001), particularly in vessels that were less than 3 mm in diameter. Local tumor progression rates were significantly correlated with patent hepatic arteries within the ablation zone (P = .02) but not with patent hepatic (P = .57) or portal (P = .14) veins. Conclusion During microwave ablation of HCC, hepatic veins and arteries were resistant to vessel occlusion compared with portal veins, and only arterial patency within an ablation zone was related to local tumor progression. © RSNA, 2016.
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Affiliation(s)
- Jason Chiang
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Mircea Cristescu
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Matthew H Lee
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Anna Moreland
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - J Louis Hinshaw
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Fred T Lee
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
| | - Christopher L Brace
- From the Departments of Radiology (J.C., M.C., M.H.L., A.M., J.L.H., F.T.L., C.L.B.) and Biomedical Engineering (J.C., F.T.L., C.L.B.), University of Wisconsin-Madison, 1111 Highland Ave, WIMR 1310-O, Madison, WI 53705
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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: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Lee JK, Siripongsakun S, Bahrami S, Raman SS, Sayre J, Lu DS. Microwave ablation of liver tumors: degree of tissue contraction as compared to RF ablation. Abdom Radiol (NY) 2016; 41:659-66. [PMID: 27039193 DOI: 10.1007/s00261-016-0725-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the amount of tissue contraction after microwave (MW) versus radiofrequency (RF) ablation of liver tumors. MATERIALS AND METHODS Seventy-five hepatic tumors in 65 patients who underwent percutaneous MW or RF ablations were included in this retrospective study. All patients underwent MRI within 6 months before the ablation and 24 h after the procedure. Two blinded radiologists, by consensus, performed measurements on the corresponding series of pre and post-ablation MRI. Absolute and relative contraction of liver, tumor, and control were calculated and compared. RESULTS Thirty-one patients underwent MW ablations, and 44 patients underwent RF ablations. The absolute and relative contraction of the ablation zone were significantly greater with MW than RF ablation (p = 0.003 to <0.001). Thirty-two lesions were visible on both pre- and post-ablation MRI. MW ablation had significantly more tumor contraction as compared to RF ablation (p = 0.003 to 0.009). The control measurements demonstrated no significant difference in normal tissue variation between MW and RF groups. CONCLUSIONS MW ablation of hepatic tumors produced significantly more contraction of tumor and ablated hepatic tissue compared to RF ablation. Tissue contraction should be taken into account during pre-procedural planning and assessing treatment response by comparing pre- and post-ablation images.
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Affiliation(s)
- Jeong Kyong Lee
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Radiology, Ewha Womans University, Seoul, Korea
| | - Surachate Siripongsakun
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Radiology, Chalubhorn Hospital, Bangkok, Thailand
| | - Simin Bahrami
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Biostatistics, School of Public Health, UCLA, Los Angeles, CA, USA
| | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Harari CM, Magagna M, Bedoya M, Lee FT, Lubner MG, Hinshaw JL, Ziemlewicz T, Brace CL. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems. Radiology 2015; 278:95-103. [PMID: 26133361 DOI: 10.1148/radiol.2015142151] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare microwave ablation zones created by using sequential or simultaneous power delivery in ex vivo and in vivo liver tissue. MATERIALS AND METHODS All procedures were approved by the institutional animal care and use committee. Microwave ablations were performed in both ex vivo and in vivo liver models with a 2.45-GHz system capable of powering up to three antennas simultaneously. Two- and three-antenna arrays were evaluated in each model. Sequential and simultaneous ablations were created by delivering power (50 W ex vivo, 65 W in vivo) for 5 minutes per antenna (10 and 15 minutes total ablation time for sequential ablations, 5 minutes for simultaneous ablations). Thirty-two ablations were performed in ex vivo bovine livers (eight per group) and 28 in the livers of eight swine in vivo (seven per group). Ablation zone size and circularity metrics were determined from ablations excised postmortem. Mixed effects modeling was used to evaluate the influence of power delivery, number of antennas, and tissue type. RESULTS On average, ablations created by using the simultaneous power delivery technique were larger than those with the sequential technique (P < .05). Simultaneous ablations were also more circular than sequential ablations (P = .0001). Larger and more circular ablations were achieved with three antennas compared with two antennas (P < .05). Ablations were generally smaller in vivo compared with ex vivo. CONCLUSION The use of multiple antennas and simultaneous power delivery creates larger, more confluent ablations with greater temperatures than those created with sequential power delivery.
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Affiliation(s)
- Colin M Harari
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Michelle Magagna
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Mariajose Bedoya
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Fred T Lee
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Meghan G Lubner
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - J Louis Hinshaw
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Timothy Ziemlewicz
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
| | - Christopher L Brace
- From the Departments of Radiology (C.M.H., M.M., M.B., F.T.L., M.G.L., J.L.H., T.Z., C.L.B.), Biomedical Engineering (F.T.L., C.L.B.), and Medical Physics (M.B., C.L.B.), University of Wisconsin, Wisconsin Institutes for Medical Research, 1111 Highland Ave, WIMR 1141, Madison, WI 53705
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Dodd GD, Kreidler SM, Lanctot AC, Glueck DH. Effect of Change in Portal Venous Blood Flow Rates on the Performance of a 2.45-GHz Microwave Ablation Device. Radiology 2015; 277:727-32. [PMID: 26030660 DOI: 10.1148/radiol.2015150102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the effect of change in portal venous blood flow rates on the size and shape of ablations created by a 2.45-GHz microwave ablation device. MATERIALS AND METHODS This study was exempt from review by the institutional animal care and use committee. An in vitro bovine liver model perfused with autologous blood via the portal vein at five flow rates (60, 70, 80, 90, and 100 mL/min per 100 g of liver) was used to evaluate the effect of change in flow rates on the size and shape of coagulation created by a 2.45-GHz, 140-W microwave ablation device operated for 5 and 10 minutes. Three ablations per ablation time were conducted in each of 10 livers, with two livers perfused at each flow rate. Short- and long-axis diameters were measured from gross specimens, and volume and sphericity index were calculated. General linear mixed models that accounted for correlations within the liver were used to evaluate the effects of lobe, flow, and ablation time on size and sphericity index of ablations. RESULTS Flow did not have a significant effect on the size or shape of coagulation created at 5 or 10 minutes (P > .05 for all tests). The mean short- and long-axis diameters and volume were 3.2 cm (95% confidence interval [CI]: 3.1, 3.3), 5.6 cm (95% CI: 5.4, 5.8), and 30.2 cm(3) (95% CI: 28.4, 32.1) for the 5-minute ablations and 3.8 cm (95% CI: 3.7, 3.9), 6.5 cm (95% CI: 6.3, 6.7), and 49.3 cm(3) (95% CI: 47.5, 51.2), for the 10-minute ablations, respectively. The mean sphericity index for both 5- and 10-minute ablations was 34.4% (95% CI: 32%, 36.7%). CONCLUSION Change in portal venous blood flow rates did not have an effect on the size and shape of ablations created by a 2.45-GHz microwave ablation device.
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Affiliation(s)
- Gerald D Dodd
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Sarah M Kreidler
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Anthony C Lanctot
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Deborah H Glueck
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
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Biffi Gentili G, Ignesti C. Dual applicator thermal ablation at 2.45 GHz: a numerical comparison and experiments on synchronous versus asynchronous and switched-mode feeding. Int J Hyperthermia 2015; 31:528-37. [DOI: 10.3109/02656736.2015.1032369] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Guido Biffi Gentili
- Department of Information Engineering, University of Florence, Florence, Italy
| | - Cosimo Ignesti
- Department of Information Engineering, University of Florence, Florence, Italy
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Yoon JH, Lee JM, Woo S, Hwang EJ, Hwang I, Choi W, Han JK, Choi BI. Switching bipolar hepatic radiofrequency ablation using internally cooled wet electrodes: comparison with consecutive monopolar and switching monopolar modes. Br J Radiol 2015; 88:20140468. [PMID: 25873479 DOI: 10.1259/bjr.20140468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To evaluate whether switching bipolar radiofrequency ablation (SB-RFA) using three internally cooled wet (ICW) electrodes can induce coagulations >5 cm in porcine livers with better efficiency than consecutive monopolar (CM) or switching monopolar (SM) modes. METHODS A total of 60 coagulations were made in 15 in vivo porcine livers using three 17-gauge ICW electrodes and a multichannel radiofrequency (RF) generator. RF energy (approximately 200 W) was applied in CM mode (Group A, n = 20) for 24 min, SM mode for 12 min (Group B, n = 20) or switching bipolar (SB) mode for 12 min (Group C, n = 20) in in vivo porcine livers. Thereafter, the delivered RFA energy, as well as the shape and dimension of coagulations were compared among the groups. RESULTS Spherical- or oval-shaped ablations were created in 30% (6/20), 85% (17/20) and 90% (18/20) of coagulations in the CM, SM and SB groups, respectively (p = 0.003). SB-RFA created ablations >5 cm in minimum diameter (Dmin) in 65% (13/20) of porcine livers, whereas SM- or CM-RFA created ablations >5 cm in only 25% (5/20) and 20% (4/20) of porcine livers, respectively (p = 0.03). The mean Dmin of coagulations was significantly larger in Group C than in Groups A and B (5.1 ± 0.9, 3.9 ± 1.2 and 4.4 ± 1.0 cm, respectively, p = 0.002) at a lower delivered RF energy level (76.8 ± 14.3, 120.9 ± 24.5 and 114.2 ± 18.3 kJ, respectively, p < 0.001). CONCLUSION SB-RFA using three ICW electrodes can create coagulations >5 cm in diameter with better efficiency than do SM- or CM-RFA. ADVANCES IN KNOWLEDGE SB-RFA can create large, regular ablation zones with better time-energy efficiency than do CM- or SM-RFA.
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Affiliation(s)
- J H Yoon
- 1 Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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Winokur RS, Du JY, Pua BB, Talenfeld AD, Sista AK, Schiffman MA, Trost DW, Madoff DC. Characterization of In Vivo Ablation Zones Following Percutaneous Microwave Ablation of the Liver with Two Commercially Available Devices: Are Manufacturer Published Reference Values Useful? J Vasc Interv Radiol 2014; 25:1939-1946.e1. [DOI: 10.1016/j.jvir.2014.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/04/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022] Open
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Ziemlewicz TJ, Hinshaw JL, Lubner MG, Brace CL, Alexander ML, Agarwal P, Lee FT. Percutaneous microwave ablation of hepatocellular carcinoma with a gas-cooled system: initial clinical results with 107 tumors. J Vasc Interv Radiol 2014; 26:62-8. [PMID: 25446425 DOI: 10.1016/j.jvir.2014.09.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/05/2014] [Accepted: 09/17/2014] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To retrospectively review the results of hepatocellular carcinoma (HCC) treatment with a high-power, gas-cooled, multiantenna-capable microwave device. MATERIALS AND METHODS A total of 107 HCCs in 75 patients (65 men) with a mean age of 61 years (range, 44-82 y) were treated via percutaneous approach. Combination microwave ablation and transarterial chemoembolization was performed for 22 tumors in 19 patients with tumors larger than 4 cm (n = 10), tumors larger than 3 cm with ill-defined margins (n = 7), or lesions not identified with ultrasonography (n = 5). Mean tumor size was 2.1 cm (range, 0.5-4.2 cm), with median follow-up of 14 months, for ablation alone; compared with 3.7 cm (range, 1.0-7.0 cm) and 12 months, respectively, for combination therapy. All procedures were performed with a single microwave system (Certus 140) with one to three 17-gauge antennas. RESULTS Mean ablation time was 5.3 minutes (range, 1-11.5 min). All treatments were considered technically successful in a single session. Primary technique effectiveness rates were 91.6% (98 of 107) overall, 93.7% (89 of 95) for tumors 4 cm or smaller, and 75.0% (nine of 12) for tumors larger than 4 cm; and 91.8% (78 of 85) for ablation alone and 90.9% (20 of 22) for combination therapy. There was no major complication or procedure-related mortality. The overall survival rate was 76.0% at a median 14-month clinical follow-up, with most deaths related to end-stage liver disease (n = 11) or multifocal HCC (n = 5). CONCLUSIONS Treating HCC with a gas-cooled, multiantenna-capable microwave ablation device is safe, with promising treatment effectiveness.
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Affiliation(s)
- Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792..
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792.; Department of Biomedical Engineering, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792.; Department of Medical Physics, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
| | - Marci L Alexander
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
| | - Parul Agarwal
- Section of Hepatology, Department of Medicine, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave., E3/366 CSC, Madison, WI 53792
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. J Vasc Interv Radiol 2014; 25:1691-705.e4. [PMID: 25442132 PMCID: PMC7660986 DOI: 10.1016/j.jvir.2014.08.027] [Citation(s) in RCA: 332] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 02/11/2014] [Accepted: 03/26/2014] [Indexed: 12/12/2022] Open
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes.
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215.
| | - Luigi Solbiati
- Department of Radiology, Ospedale Generale, Busto Arsizio, Italy
| | - Christopher L Brace
- Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David J Breen
- Department of Radiology, Southampton University Hospitals, Southampton, England
| | | | | | - Min-Hua Chen
- Department of Ultrasound, School of Oncology, Peking University, Beijing, China
| | - Byung Ihn Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Thierry de Baère
- Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - Gerald D Dodd
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Damian E Dupuy
- Department of Diagnostic Radiology, Rhode Island Hospital, Providence, Rhode Island
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Gianfelice
- Medical Imaging, University Health Network, Laval, Quebec, Canada
| | | | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Edward Leen
- Department of Radiology, Royal Infirmary, Glasgow, Scotland
| | - Riccardo Lencioni
- Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy
| | - Peter J Littrup
- Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Michigan
| | | | - David S Lu
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - John P McGahan
- Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, California
| | | | - Boris Nikolic
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Philippe L Pereira
- Clinic of Radiology, Minimally-Invasive Therapies and Nuclear Medicine, Academic Hospital Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Hyunchul Rhim
- Department of Diagnostic Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Steven C Rose
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael C Soulen
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Bradford J Wood
- Radiology and Imaging Science, National Institutes of Health, Bethesda, Maryland
| | - S Nahum Goldberg
- Department of Radiology, Image-Guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Abstract
OBJECTIVE The purposes of this article are to review the indications for and technical aspects of various percutaneous strategies available for the treatment of intrathoracic metastases involving the parenchyma, pleura, and chest wall and to describe the relative merits of one of these strategies over another to determine the best approach to use. CONCLUSION The thorax is a common site of metastatic disease with frequent involvement of the lungs, pleura, and osseous structures. A variety of interventional procedures and techniques are available for treatment and for palliative care of patients with this disease. Imaging-guided interventions include thermal ablation of metastatic disease of the lungs and pleura, catheter placement and sclerosis of malignant pleural effusions, and palliative pain management for osseous and soft-tissue metastases.
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Biffi Gentili G, Ignesti C, Tesi V. Development of a Novel Switched-Mode 2.45 GHz Microwave Multiapplicator Ablation System. ACTA ACUST UNITED AC 2014; 2014:1-12. [DOI: 10.1155/2014/973736] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Lubner MG, Ziemlewicz TJ, Hinshaw JL, Lee FT, Sampson LA, Brace CL. Creation of short microwave ablation zones: in vivo characterization of single and paired modified triaxial antennas. J Vasc Interv Radiol 2014; 25:1633-40. [PMID: 25156644 DOI: 10.1016/j.jvir.2014.06.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/29/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To characterize modified triaxial microwave antennas configured to produce short ablation zones. MATERIALS AND METHODS Fifty single-antenna and 27 paired-antenna hepatic ablations were performed in domestic swine (N = 11) with 17-gauge gas-cooled modified triaxial antennas powered at 65 W from a 2.45-GHz generator. Single-antenna ablations were performed at 2 (n = 16), 5 (n = 21), and 10 (n = 13) minutes. Paired-antenna ablations were performed at 1-cm and 2-cm spacing for 5 (n = 7 and n = 8, respectively) and 10 minutes (n = 7 and n = 5, respectively). Mean transverse width, length, and aspect ratio of sectioned ablation zones were measured and compared. RESULTS For single antennas, mean ablation zone lengths were 2.9 cm ± 0.45, 3.5 cm ± 0.55, and 4.2 cm ± 0.40 at 2, 5, and 10 minutes, respectively. Mean widths were 1.8 cm ± 0.3, 2.0 cm ± 0.32, and 2.5 cm ± 0.25 at 2, 5, and 10 minutes, respectively. For paired antennas, mean length at 5 minutes with 1-cm and 2-cm spacing and 10 minutes with 1-cm and 2-cm spacing was 4.2 cm ± 0.9, 4.9 cm ± 1.0, 4.8 cm ± 0.5, and 4.8 cm ± 1.3, respectively. Mean width was 3.1 cm ± 1.0, 4.4 cm ± 0.7, 3.8 cm ± 0.4, and 4.5 cm ± 0.7, respectively. Paired-antenna ablations were more spherical (aspect ratios, 0.72-0.79 for 5-10 min) than single-antenna ablations (aspect ratios, 0.57-0.59). For paired-antenna ablations, 1-cm spacing appeared optimal, with improved circularity and decreased clefting compared with 2-cm spacing (circularity, 0.85 at 1 cm, 0.78 at 2 cm). CONCLUSIONS Modified triaxial antennas can generate relatively short, spherical ablation zones. Paired-antenna ablations were rounder and larger in transverse dimension than single antenna ablations, with 1-cm spacing optimal for confluence of the ablation zone.
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Affiliation(s)
- Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792.
| | - Tim J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792
| | - Lisa A Sampson
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792
| | - Christopher L Brace
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792; Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave., Madison, WI 53792
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Abstract
Image-guided thermal ablation is a widely accepted tool in the treatment of a variety of solid organ neoplasms. Among the different techniques of ablation, radiofrequency ablation, cryoablation, and microwave ablation have been most commonly used and investigated in the treatment of liver and kidney neoplasms. This article will review complications following thermal ablation of tumors in the liver and kidney, and discuss the risks and clinical presentation of each complication as well as how to treat and potentially avoid complications.
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Affiliation(s)
- Kyung Rae Kim
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Thomas
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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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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Moreland AJ, Ziemlewicz TJ, Best SL, Hinshaw JL, Lubner MG, Alexander ML, Brace CL, Kitchin DR, Hedican SP, Nakada SY, Lee FT, Abel EJ. High-powered microwave ablation of t1a renal cell carcinoma: safety and initial clinical evaluation. J Endourol 2014; 28:1046-52. [PMID: 24846329 DOI: 10.1089/end.2014.0190] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Percutaneous radiofrequency ablation and cryoablation are accepted alternative treatments for small renal cell carcinomas (RCC) in high-risk patients. The recent development of high-powered microwave (MW) ablation offers theoretical advantages over existing ablation systems, including higher tissue temperatures, more reproducible ablation zones, and shorter procedural times. The purpose of this study is to review the feasibility, safety, and early efficacy of a novel high-powered percutaneous MW ablation system to treat RCC. METHODS An institutional database identified 53 consecutive patients with biopsy-proven RCC ≤4 cm (55 tumors) who were treated with percutaneous MW ablation using a novel MW ablation system. All patients had percutaneous renal mass biopsy, which identified RCC before ablation. Postprocedure follow-up imaging was performed by contrast-enhanced computed tomography or magnetic resonance imaging. RESULTS Mean patient age was 66 years and 81% of patients were male. RCC subtypes included clear cell (n=25), papillary (n=12), and unspecified (n=18) and Fuhrman grades 1, 2, 3, and ungraded in 15, 25, 1, and 14 patients, respectively. The mean tumor diameter was 2.6 cm (range 0.8-4.0 cm). Six low-grade complications were recorded during 53 (11.3%) procedures: five Clavien Grade 1 (urine retention, fluid overload, and atrial fibrillation) and one Grade 2 (hemorrhage requiring transfusion). The postprocedure estimated glomerular filtration rate was not significantly changed from preprocedure levels (median: -1.1%, p=0.10). Median follow-up was 8 months (interquartile range [IQR] 5-18.25) with 0/38 (0%) patients demonstrating evidence of local recurrence or metastasis during surveillance imaging. CONCLUSIONS Use of a high-powered MW ablation system for the treatment of T1a RCC is feasible, safe, and efficacious with short-term follow-up. A longer follow-up is warranted to evaluate oncologic outcomes.
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Affiliation(s)
- Anna J Moreland
- 1 Department of Radiology, University of Wisconsin , Madison, Wisconsin
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Abstract
Microwave ablation is an extremely promising heat-based thermal ablation modality that has particular applicability in treating hepatic malignancies. Microwaves can generate very high temperatures in very short time periods, potentially leading to improved treatment efficiency and larger ablation zones. As the available technology continues to improve, microwave ablation is emerging as a valuable alternative to radiofrequency ablation in the treatment of hepatic malignancies. This article reviews the current state of microwave ablation including technical and clinical considerations.
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Affiliation(s)
| | - Christopher L Brace
- Department of Radiology ; Department of Biomedical Engineering ; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin
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45
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Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, Chen MH, Choi BI, de Baère T, Dodd GD, Dupuy DE, Gervais DA, Gianfelice D, Gillams AR, Lee FT, Leen E, Lencioni R, Littrup PJ, Livraghi T, Lu DS, McGahan JP, Meloni MF, Nikolic B, Pereira PL, Liang P, Rhim H, Rose SC, Salem R, Sofocleous CT, Solomon SB, Soulen MC, Tanaka M, Vogl TJ, Wood BJ, Goldberg SN. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014; 273:241-60. [PMID: 24927329 DOI: 10.1148/radiol.14132958] [Citation(s) in RCA: 768] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided tumor ablation has become a well-established hallmark of local cancer therapy. The breadth of options available in this growing field increases the need for standardization of terminology and reporting criteria to facilitate effective communication of ideas and appropriate comparison among treatments that use different technologies, such as chemical (eg, ethanol or acetic acid) ablation, thermal therapies (eg, radiofrequency, laser, microwave, focused ultrasound, and cryoablation) and newer ablative modalities such as irreversible electroporation. This updated consensus document provides a framework that will facilitate the clearest communication among investigators regarding ablative technologies. An appropriate vehicle is proposed for reporting the various aspects of image-guided ablation therapy including classification of therapies, procedure terms, descriptors of imaging guidance, and terminology for imaging and pathologic findings. Methods are addressed for standardizing reporting of technique, follow-up, complications, and clinical results. As noted in the original document from 2003, adherence to the recommendations will improve the precision of communications in this field, leading to more accurate comparison of technologies and results, and ultimately to improved patient outcomes. Online supplemental material is available for this article .
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Affiliation(s)
- Muneeb Ahmed
- Department of Radiology, Beth Israel Deaconess Medical Center 1 Deaconess Rd, WCC-308B, Boston, MA 02215 (M.A.); Department of Radiology, Ospedale Generale, Busto Arsizio, Italy (L.S.); Departments of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B.); Department of Radiology, Southampton University Hospitals, Southampton, England (D.J.B.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C., J.W.C.); Department of Ultrasound, School of Oncology, Peking University, Beijing, China (M.H.C.); Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea (B.I.C.); Department of Imaging, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colo (G.D.D.); Department of Diagnostic Radiology, Rhode Island Hospital, Providence, RI (D.E.D.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (D.A.G.); Medical Imaging, University Health Network, Laval, Quebec, Canada (D.G.); Imaging Department, the London Clinic, London, England (A.R.G.); Department of Radiology, University of Wisconsin Hospital and Clinics, Madison, Wis (F.T.L.); Department of Radiology, Royal Infirmary, Glasgow, Scotland (E.L.); Department of Diagnostic Imaging and Intervention, Cisanello Hospital, Pisa University Hospital and School of Medicine, University of Pisa, Pisa, Italy (R.L.); Department of Radiology, Karmonos Cancer Institute, Wayne State University, Detroit, Mich (P.J.L.); Busto Arsizio, Italy (T.L.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (D.S.L.); Department of Radiology, Ambulatory Care Center, UC Davis Medical Center, Sacramento, Calif (J.P.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, Albert Einstein Medical Center, Phil
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Kastler A, Alnassan H, Pereira PL, Alemann G, Barbé DA, Aubry S, Tiberghien F, Kastler B. Analgesic Effects of Microwave Ablation of Bone and Soft Tissue Tumors Under Local Anesthesia. Pain Med 2013; 14:1873-81. [DOI: 10.1111/pme.12242] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Carrafiello G, Mangini M, Fontana F, Ierardi AM, De Marchi G, Rotolo N, Chini C, Cuffari S, Fugazzola C. Microwave ablation of lung tumours: single-centre preliminary experience. Radiol Med 2013; 119:75-82. [PMID: 24234180 DOI: 10.1007/s11547-013-0301-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/21/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE This study was done to evaluate the feasibility, effectiveness and safety of microwave (MW) ablation of lung tumours. MATERIALS AND METHODS Twenty-four patients underwent percutaneous MW ablation of 26 intraparenchymal pulmonary masses. All patients were judged to be inoperable on the basis of tumour stage, comorbidities, advanced age and/or refusal to undergo surgery. Ablation was performed using a microwave generator (Evident Microwave Ablation System, Covidien Ltd., Dublin). Lesions with a diameter ≤ 3 cm were treated with a single antenna, lesions with a diameter >3 cm were treated by positioning two or more antennae, simultaneously. All patients underwent computed tomography (CT) follow-up with and without contrast administration at 1, 3 and 6 months and then yearly in combination with complete blood and metabolic tests. RESULTS Technical success was 100 %. No major complications were recorded. Asymptomatic grade-1 pneumothorax was recorded in 9 patients (37.5 %). One case of asymptomatic pleural effusion and one of haemoptysis, not requiring transfusion, were observed. No patients were diagnosed with a post-ablation syndrome. Complete necrosis was observed in 16 of 26 lesions (61.6 %). Partial necrosis was obtained in 30.8 % (8/26 lesions); in one case (3.8 %) a progression of the disease was recorded and in another case (3.8 %) a stability was observed. CONCLUSIONS Our preliminary experience may be considered in accordance with literature dates, in terms of efficacy and safety.
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Karampatzakis A, Kühn S, Tsanidis G, Neufeld E, Samaras T, Kuster N. Heating characteristics of antenna arrays used in microwave ablation: A theoretical parametric study. Comput Biol Med 2013; 43:1321-7. [DOI: 10.1016/j.compbiomed.2013.07.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/18/2013] [Accepted: 07/13/2013] [Indexed: 12/22/2022]
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Chiang J, Hynes K, Brace CL. Flow-dependent vascular heat transfer during microwave thermal ablation. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:5582-5. [PMID: 23367194 DOI: 10.1109/embc.2012.6347259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Microwave tumor ablation is an attractive option for thermal ablation because of its inherent benefits over radiofrequency ablation (RFA) in the treatment of solid tumors such as hepatocellular carcinoma (HCC). Microwave energy heats tissue to higher temperatures and at a faster rate than RFA, creating larger, more homogenous ablation zones. In this study, we investigate microwave heating near large vasculature using coupled fluid-flow and thermal analysis. Low-flow conditions are predicted to be more likely to cause cytotoxic heating and, therefore, vessel thrombosis and endothelial damage of downstream tissues. Such conditions may be more prevalent in patient with severe cirrhosis or compromised blood flow. High-flow conditions create the more familiar heat-sink effect that can protect perivascular tissues from the intended thermal damage. These results may help guide placement and use of microwave ablation technologies in future studies.
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Affiliation(s)
- Jason Chiang
- Department of Radiology and BiomedicalEngineering, University of Wisconsin, Madison, 53705 USA.
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Abstract
Microwave tissue heating is being increasingly utilised in several medical applications, including focal tumour ablation, cardiac ablation, haemostasis and resection assistance. Computational modelling of microwave ablations is a precise and repeatable technique that can assist with microwave system design, treatment planning and procedural analysis. Advances in coupling temperature and water content to electrical and thermal properties, along with tissue contraction, have led to increasingly accurate computational models. Developments in experimental validation have led to broader acceptability and applicability of these newer models. This review will discuss the basic theory, current trends and future direction of computational modelling of microwave ablations.
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Affiliation(s)
- Jason Chiang
- Department of Radiology, University of Wisconsin – Madison, Madison WI
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison WI
| | - Peng Wang
- Department of Radiology, University of Wisconsin – Madison, Madison WI
| | - Christopher L. Brace
- Department of Radiology, University of Wisconsin – Madison, Madison WI
- Department of Biomedical Engineering, University of Wisconsin – Madison, Madison WI
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