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Viozzi I, Overduin CG, Rijpma A, Rovers MM, Laan MT. MR-guided LITT therapy in patients with primary irresectable glioblastoma: a prospective, controlled pilot study. J Neurooncol 2023; 164:405-412. [PMID: 37505379 PMCID: PMC10522506 DOI: 10.1007/s11060-023-04371-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/10/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE Laser interstitial thermal therapy (LITT) is increasingly being used in the treatment of brain tumors, whereas high-quality evidence of its effectiveness is lacking. This pilot examined the feasibility of conducting a randomized controlled trial (RCT) in patients with irresectable newly diagnosed glioblastoma (nGBM), and generated data on technical feasibility and safety. METHODS We included patients with irresectable nGBM with KPS ≥ 70 and feasible trajectories to ablate ≥ 70% of the tumor volume. Patients were initially randomized to receive either biopsy combined with LITT or biopsy alone, followed by chemoradiation (CRT). Randomization was stopped after 9 patients as the feasibility endpoint with respect to willingness to be randomized was met. Main endpoints were feasibility of performing an RCT, technical feasibility of LITT and safety. Follow-up was 3 months. RESULTS A total of 15 patients were included, of which 10 patients received a biopsy followed by LITT and 5 patients a biopsy. Most patients were able to complete the follow-up procedures (93% clinical, 86% questionnaires, 78% MRI). Patients were planned within 3 weeks after consultation (median 12 days, range 8-16) and no delay was observed in referring patients for CRT (median 37 days, range 28-61). Two CD ≥ 3 complications occurred in the LITT arm and none in the biopsy arm. CONCLUSION An RCT to study the effectiveness of LITT in patients with an irresectable nGBM seems feasible with acceptable initial safety data. The findings from this pilot study helped to further refine the design of a larger full-scale multicenter RCT in the Netherlands. Protocol and study identifier: The current study is registered at clinicaltrials.gov (EMITT pilot study, NTR: NCT04596930).
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Affiliation(s)
- Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Radiology, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Anne Rijpma
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Maroeska M Rovers
- Department of Health Evidence, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
- Department of Operating Rooms, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
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Neutel CLG, Viozzi I, Overduin CG, Rijpma A, Grutters JPC, Hannink G, van Eijsden P, Robe PA, Rovers MM, Ter Laan M. Study protocol for a multicenter randomised controlled trial on the (cost)effectiveness of biopsy combined with same-session MR-guided LITT versus biopsy alone in patients with primary irresectable glioblastoma (EMITT trial). BMC Cancer 2023; 23:788. [PMID: 37612610 PMCID: PMC10463911 DOI: 10.1186/s12885-023-11282-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common primary, malignant brain tumour with a 5-year survival of 5%. If possible, a glioblastoma is resected and further treated with chemoradiation therapy (CRT), but resection is not feasible in about 30% of cases. Current standard of care in these cases is a biopsy followed by CRT. Magnetic resonance (MR) imaging-guided laser interstitial thermal therapy (LITT) has been suggested as a minimally invasive alternative when surgery is not feasible. However, high-quality evidence directly comparing LITT with standard of care is lacking, precluding any conclusions on (cost-)effectiveness. We therefore propose a multicenter randomized controlled study to assess the (cost-)effectiveness of MR-guided LITT as compared to current standard of care (EMITT trial). METHODS AND ANALYSIS The EMITT trial will be a multicenter pragmatic randomized controlled trial in the Netherlands. Seven Dutch hospitals will participate in this study. In total 238 patients will be randomized with 1:1 allocation to receive either biopsy combined with same-session MR-guided LITT therapy followed by CRT or the current standard of care being biopsy followed by CRT. The primary outcomes will be health-related quality of life (HR-QoL) (non-inferiority) using EORTC QLQ-C30 + BN20 scores at 5 months after randomization and overall survival (superiority). Secondary outcomes comprise cost-effectiveness (healthcare and societal perspective) and HR-QoL of life over an 18-month time horizon, progression free survival, tumour response, disease specific survival, longitudinal effects, effects on adjuvant treatment, ablation percentage and complication rates. DISCUSSION The EMITT trial will be the first RCT on the effectiveness of LITT in patients with glioblastoma as compared with current standard of care. Together with the Dutch Brain Tumour Patient association, we hypothesize that LITT may improve overall survival without substantially affecting patients' quality of life. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT05318612).
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Affiliation(s)
- Céline L G Neutel
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne Rijpma
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke P C Grutters
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pieter van Eijsden
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pierre A Robe
- Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maroeska M Rovers
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
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Wimper Y, Overduin CG, Sedelaar JPM, Veltman J, Jenniskens SFM, Bomers JGR, Fütterer JJ. MRI-Guided Salvage Focal Cryoablation: A 10-Year Single-Center Experience in 114 Patients with Localized Recurrent Prostate Cancer. Cancers (Basel) 2023; 15:4093. [PMID: 37627122 PMCID: PMC10452144 DOI: 10.3390/cancers15164093] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Patients with localized recurrent prostate cancer (PCa) are eligible for androgen-deprivation therapy, salvage radical prostatectomy (RP) or radiation therapy. These treatments are associated with serious side-effects, illustrating the need for alternative local treatment options with lower morbidity rates. All patients who underwent magnetic resonance imaging (MRI)-guided salvage focal cryoablation (SFC) with localized recurrent PCa between 2011-2021 (n = 114) were included. Two subgroups were formed: patients without (n = 99) and with prior RP (n = 15). We assessed the recurrence- (RFS) and treatment-free survival (TFS), measured from date of treatment to date of recurrence or initiation of additional salvage treatment, using Kaplan-Meier plots. Complications were reported using the Clavien-Dindo (CD) scale. Overall 1-year and 5-year RFS were 76.0% and 25.1%, and overall 1-year and 5-year TFS were 91.5% and 58.2%, respectively. Patients without prior RP showed a significantly higher 1-year (78.5% vs. 52.5%) and 5-year RFS (28.1% vs. 0.0%; p = 0.03), and a trend towards a higher 1-year (92.6% vs. 79.0%) and 5-year TFS (60.2% vs. 23.0%; p = 0.10) compared to those with prior RP. A total of 46 complications occurred in 37 patients, and the overall complication rate was 32.4% (37/114 patients). The majority (41/46; 89.1%) of complications were minor (CD 1-2). Overall (31.3 vs. 40.0%) and major (3.0 vs. 13.3%) complication rates were lower in patients without compared to those with prior RP, respectively. MRI-guided SFC is an effective and safe therapy for patients with recurrent PCa, and has proved to delay and potentially prevent the initiation of salvage treatments. Patients with locally recurrent PCa after prior RP had an increased risk of recurrence, a shortened time to additional treatment, and more complications compared to those without prior RP, which should be considered when selecting patients for SFC.
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Affiliation(s)
- Yvonne Wimper
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Christiaan G. Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - J. P. Michiel Sedelaar
- Department of Urology, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Jeroen Veltman
- Department of Radiology, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands;
| | - Sjoerd F. M. Jenniskens
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Joyce G. R. Bomers
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
| | - Jurgen J. Fütterer
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.G.O.); (S.F.M.J.); (J.G.R.B.); (J.J.F.)
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Verdonschot KHM, Arts S, Van den Boezem PB, de Wilt JHW, Fütterer JJ, Stommel MWJ, Overduin CG. Ablative margins in percutaneous thermal ablation of hepatic tumors: a systematic review. Expert Rev Anticancer Ther 2023; 23:977-993. [PMID: 37702571 DOI: 10.1080/14737140.2023.2247564] [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: 02/28/2023] [Accepted: 08/09/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION This study aims to systematically review current evidence on ablative margins and correlation to local tumor progression (LTP) after thermal ablation of hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM). METHODS A systematic search was performed in PubMed (MEDLINE) and Web of Science to identify all studies that reported on ablative margins (AM) and related LTP rates. Studies were assessed for risk of bias and synthesized separately per tumor type. Where possible, results were pooled to calculate risk differences (RD) as function of AM. RESULTS In total, 2910 articles were identified of which 43 articles were eligible for final analysis. There was high variability in AM measurement methodology across studies in terms of measurement technique, imaging modalities, and timing. Most common margin stratification was < 5 mm and > 5 mm, for which data were available in 25/43 studies (58%). Of these, all studies favored AM > 5 mm to reduce the risk of LTP, with absolute RD of 16% points for HCC and 47% points for CRLM as compared to AM < 5 mm. CONCLUSIONS Current evidence supports AM > 5 mm to reduce the risk of LTP after thermal ablation of HCC and CRLM. However, standardization of AM measurement and reporting is critical to allow future meta-analyses and improved identification of optimal threshold value for clinical use.
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Affiliation(s)
- K H M Verdonschot
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Arts
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P B Van den Boezem
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J H W de Wilt
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J J Fütterer
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
- The Robotics and Mechatronics research group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - M W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C G Overduin
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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Viozzi I, Rovers MM, Overduin CG, ter Laan M. Stereotactic laser ablation in neuro-oncology - A survey among European neurosurgeons. Brain Spine 2023; 3:101749. [PMID: 37383437 PMCID: PMC10293215 DOI: 10.1016/j.bas.2023.101749] [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] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 06/30/2023]
Abstract
Introduction In the last decades, the application of stereotactic laser ablation (SLA) for the treatment of intracranial tumours has been growing, even though comparative trials are lacking. Our aim was to investigate the familiarity with SLA of neurosurgeons in Europe and their opinion regarding potential neuro-oncological indications. Furthermore, we investigated treatment preferences and variability for three exemplar neuro-oncological cases and willingness to refer for SLA. Material and methods A 26-questions survey was mailed to members of the EANS neuro-oncology section. We presented three clinical cases of respectively deep-seated glioblastoma, recurrent metastasis and recurrent glioblastoma. Descriptive statistics was applied to report results. Results 110 respondents completed all questions. Recurrent glioblastoma and recurrent metastases were regarded as the most feasible indications for SLA (chosen by 69% and 58% of the respondents) followed by newly diagnosed high-grade gliomas (31%). Seventy percent of respondents would refer patients for SLA. The majority of respondents would consider SLA as a treatment option for all three presented cases: 79% for the deep-seated glioblastoma case, 65% for the recurrent metastasis case and 76% for the recurrent glioblastoma case. Among respondents who wouldn't consider SLA, preference for standard treatment and lack of clinical evidence were reported as the main reasons. Conclusions Most of respondents considered SLA as a treatment option for recurrent glioblastoma, recurrent metastases and newly diagnosed deep-seated glioblastoma. At the moment the current evidence to support such a treatment is very low. Comparative prospective trials are needed to support the use of SLA and determine proper indications.
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Affiliation(s)
- Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Maroeska M. Rovers
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Christiaan G. Overduin
- Department of Medical Imaging, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
| | - Mark ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA, Nijmegen, The Netherlands
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de Jager NS, van Oostenbrugge TJ, Pätz T, Jenniskens SFM, Fütterer JJ, Langenhuijsen JF, Overduin CG. Intraoperative MRI-derived volumetric ablation margins and initial correlation with local outcome after MRI-guided cryoablation of renal tumors. Cancer Imaging 2023; 23:31. [PMID: 36998028 PMCID: PMC10064595 DOI: 10.1186/s40644-023-00546-x] [Citation(s) in RCA: 1] [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: 06/28/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To assess volumetric ablation margins derived from intraoperative pre- and post-ablation MRI after magnetic resonance imaging (MRI)-guided percutaneous cryoablation of renal tumors and explore its correlation with local treatment success. METHODS Retrospective analysis was performed on 30 patients (mean age 69y) who underwent percutaneous MRI-guided cryoablation between May 2014 and May 2020 for 32 renal tumors (size: 1.6-5.1 cm). Tumor and ice-ball volumes were segmented on intraprocedural pre- and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI co-registration, the software automatically quantified the minimal treatment margin (MTM),defined as the smallest 3D distance between the tumor and ice-ball surface. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. RESULTS Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 26 cases (81%) while LTP occurred in 6 (19%). The intended MTM of ≥5 mm was achieved in 3/32 (9%) cases. Median MTM was significantly smaller for cases with (- 7 mm; IQR:-10 to - 5) vs. without LTP (3 mm; IQR:2 to 4) (P < .001). All cases of LTP had a negative MTM. All negative treatment margins occurred in tumors > 3 cm. CONCLUSIONS Determination of volumetric ablation margins from intraoperative MRI was feasible and may be useful in predicting local outcome after MRI-guided renal cryoablation. In our preliminary data, an intraoperative MRI-derived minimal margin extending at least 1 mm beyond the MRI-visible tumor led to local control and this was more difficult to achieve in tumors > 3 cm. Ultimately, online margin analysis may be a valuable tool to intraoperatively assess therapy success, but larger prospective studies are needed to establish a reliable threshold for clinical use.
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Affiliation(s)
- Nienke S de Jager
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Tim J van Oostenbrugge
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine, Max-von-Laue-Str. 2, 28359, Bremen, Germany
| | - Sjoerd F M Jenniskens
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands.
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Roosen J, van Wijk MWM, Westlund Gotby LEL, Arntz MJ, Janssen MJR, Lobeek D, van de Maat GH, Overduin CG, Nijsen JFW. Improving MRI-based dosimetry for holmium-166 transarterial radioembolization using a nonrigid image registration for voxelwise Δ R 2 ∗ $\Delta R_2^*$ calculation. Med Phys 2023; 50:935-946. [PMID: 36202392 DOI: 10.1002/mp.16014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/16/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Transarterial radioembolization (TARE) is a treatment modality for liver tumors during which radioactive microspheres are injected into the hepatic arterial system. These microspheres distribute throughout the liver as a result of the blood flow until they are trapped in the arterioles because of their size. Holmium-166 (166 Ho)-loaded microspheres used for TARE can be visualized and quantified with MRI, as holmium is a paramagnetic metal and locally increases the transverse relaxation rate R 2 ∗ $R_2^*$ . The current 166 Ho quantification method does not take regional differences in baseline R 2 ∗ $R_2^*$ values (such as between tumors and healthy tissue) into account, which intrinsically results in a systematic error in the estimated absorbed dose distribution. As this estimated absorbed dose distribution can be used to predict response to treatment of tumors and potential toxicity in healthy tissue, a high accuracy of absorbed dose estimation is required. PURPOSE To evaluate pre-existing differences in R 2 ∗ $R_2^*$ distributions between tumor tissue and healthy tissue and assess the feasibility and accuracy of voxelwise subtraction-based Δ R 2 ∗ $\Delta R_2^*$ calculation for MRI-based dosimetry of holmium-166 transarterial radioembolization (166 Ho TARE). METHODS MRI data obtained in six patients who underwent 166 Ho TARE of the liver as part of a clinical study was retrospectively evaluated. Pretreatment differences in R 2 ∗ $R_2^*$ distributions between tumor tissue and healthy tissue were characterized. Same-day pre- and post-treatment R 2 ∗ $R_2^*$ maps were aligned using a deformable registration algorithm and subsequently subtracted to generate voxelwise Δ R 2 ∗ $\Delta R_2^*$ maps and resultant absorbed dose maps. Image registration accuracy was quantified using the dice similarity coefficient (DSC), relative overlay (RO), and surface dice (≤4 mm; SDSC). Voxelwise subtraction-based absorbed dose maps were quantitatively (root-mean-square error, RMSE) and visually compared to the current MRI-based mean subtraction method and routinely used SPECT-based dosimetry. RESULTS Pretreatment R 2 ∗ $R_2^*$ values were lower in tumors than in healthy liver tissue (mean 36.8 s-1 vs. 55.7 s-1 , P = 0.004). Image registration improved the mean DSC of 0.83 (range: 0.70-0.88) to 0.95 (range: 0.92-0.97), mean RO of 0.71 (range 0.53-0.78) to 0.90 (range: 0.86-0.94), and mean SDSC ≤4 mm of 0.47 (range: 0.28-0.67) to 0.97 (range: 0.96-0.98). Voxelwise subtraction-based absorbed dose maps yielded a higher tumor-absorbed dose (median increase of 9.0%) and lower healthy liver-absorbed dose (median decrease of 13.8%) compared to the mean subtraction method. Voxelwise subtraction-based absorbed dose maps corresponded better to SPECT-based absorbed dose maps, reflected by a lower RMSE in three of six patients. CONCLUSIONS Voxelwise subtraction presents a robust alternative method for MRI-based dosimetry of 166 Ho microspheres that accounts for pre-existing R 2 ∗ $R_2^*$ differences, and appears to correspond better with SPECT-based dosimetry compared to the currently implemented mean subtraction method.
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Affiliation(s)
- Joey Roosen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Meike W M van Wijk
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lovisa E L Westlund Gotby
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daphne Lobeek
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Christiaan G Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Hogenes AM, Overduin CG, Slump CH, van Laarhoven CJHM, Fütterer JJ, ten Broek RPG, Stommel MWJ. The Influence of Irreversible Electroporation Parameters on the Size of the Ablation Zone and Thermal Effects: A Systematic Review. Technol Cancer Res Treat 2023; 22:15330338221125003. [PMID: 36598035 PMCID: PMC9830580 DOI: 10.1177/15330338221125003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction: The aim of this study was to review the effect of irreversible electroporation parameter settings on the size of the ablation zone and the occurrence of thermal effects. This insight would help to optimize treatment protocols and effectively ablate a tumor while controlling the occurrence of thermal effects. Methods: Various individual studies report the influence of variation in electroporation parameters on the ablation zone size or occurrence of thermal effects. However, no connections have yet been established between these studies. With the aim of closing the gap in the understanding of and personalizing irreversible electroporation parameter settings, a systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A quality assessment was performed using an in-house developed grading tool based on components of commonly used grading domains. Data on the electroporation parameters voltage, number of electrodes, inter-electrode distance, active needle length, pulse length/number/protocol/frequency, and pulse interval were extracted. Ablation zone size and temperature data were grouped per parameter. Spearman correlation and linear regression were used to define the correlation with outcome measures. Results: A total of 7661 articles were screened, of which 18 preclinical studies (animal and phantom studies) met the inclusion criteria. These studies were graded as moderate (4/18) and low (14/18) quality. Only the applied voltage appeared to be a significant linear predictor of ablation zone size: length, surface, and volume. The pulse number was moderately but nonlinearly correlated with the ablation zone length. Thermal effects were more likely to occur for higher voltages (≥2000 V), higher number of electrodes, and increased active needle length. Conclusion: Firm conclusions are limited since studies that investigated and precisely reported the influence of electroporation parameters on the ablation zone size and thermal effects were scarce and mostly graded low quality. High-quality studies are needed to improve the predictability of the combined effect of variation in parameter combinations and optimize irreversible electroporation treatment protocols.
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Affiliation(s)
- Annemiek M Hogenes
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Annemiek M Hogenes, MSc, Department of Medical Imaging, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, P.O. box 9101 (766), 6500 HB Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | | | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands,Department of Robotics and Mechatronics, University of Twente, Enschede, the Netherlands
| | | | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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Nijsink H, Overduin CG, Willems LH, Warlé MC, Fütterer JJ. Current State of MRI-Guided Endovascular Arterial Interventions: A Systematic Review of Preclinical and Clinical Studies. J Magn Reson Imaging 2022; 56:1322-1342. [PMID: 35420239 PMCID: PMC9790618 DOI: 10.1002/jmri.28205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND MRI guidance of arterial endovascular interventions could be beneficial as it does not require radiation exposure, allows intrinsic blood-tissue contrast, and enables three-dimensional and functional imaging, however, clinical applications are still limited. PURPOSE To review the current state of MRI-guided arterial endovascular interventions and to identify the most commonly reported challenges. STUDY TYPE Systematic review. POPULATION Pubmed, Embase, Web of Science, and The Cochrane Library were systematically searched to find relevant articles. The search strategy combined synonyms for vascular pathology, endovascular therapy, and real-time MRI guidance. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions were applied. ASSESSMENT Two reviewers independently identified and reviewed the original articles and extracted relevant data. STATISTICAL TESTS Results of the included original articles are reported. RESULTS A total of 24,809 studies were identified for screening. Eighty-eight studies were assessed for eligibility, after which data were extracted from 43 articles (6 phantom, 33 animal, and 4 human studies). Reported technical success rates for animal and human studies ranged between 42% to 100%, and the average complication rate was 5.8% (animal studies) and 8.8% (human studies). Main identified challenges were related to spatial and temporal resolution as well as safety, design, and scarcity of current MRI-compatible endovascular devices. DATA CONCLUSION MRI guidance of endovascular arterial interventions seems feasible, however, included articles included mostly small single-center case series. Several hurdles remain to be overcome before larger trials can be undertaken. Main areas of research should focus on adequate imaging protocols with integrated tracking of dedicated endovascular devices.
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Affiliation(s)
- Han Nijsink
- Department of Medical ImagingRadboudumcNijmegenNetherlands
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10
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Roosen J, Westlund Gotby LEL, Arntz MJ, Fütterer JJ, Janssen MJR, Konijnenberg MW, van Wijk MWM, Overduin CG, Nijsen JFW. Intraprocedural MRI-based dosimetry during transarterial radioembolization of liver tumours with holmium-166 microspheres (EMERITUS-1): a phase I trial towards adaptive, image-controlled treatment delivery. Eur J Nucl Med Mol Imaging 2022; 49:4705-4715. [PMID: 35829749 DOI: 10.1007/s00259-022-05902-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Transarterial radioembolization (TARE) is a treatment for liver tumours based on injection of radioactive microspheres in the hepatic arterial system. It is crucial to achieve a maximum tumour dose for an optimal treatment response, while minimizing healthy liver dose to prevent toxicity. There is, however, no intraprocedural feedback on the dose distribution, as nuclear imaging can only be performed after treatment. As holmium-166 (166Ho) microspheres can be quantified with MRI, we investigate the feasibility and safety of performing 166Ho TARE within an MRI scanner and explore the potential of intraprocedural MRI-based dosimetry. METHODS Six patients were treated with 166Ho TARE in a hybrid operating room. Per injection position, a microcatheter was placed under angiography guidance, after which patients were transported to an adjacent 3-T MRI system. After MRI confirmation of unchanged catheter location, 166Ho microspheres were injected in four fractions, consisting of 10%, 30%, 30% and 30% of the planned activity, alternated with holmium-sensitive MRI acquisition to assess the microsphere distribution. After the procedures, MRI-based dose maps were calculated from each intraprocedural image series using a dedicated dosimetry software package for 166Ho TARE. RESULTS Administration of 166Ho microspheres within the MRI scanner was feasible in 9/11 (82%) injection positions. Intraprocedural holmium-sensitive MRI allowed for tumour dosimetry in 18/19 (95%) of treated tumours. Two CTCAE grade 3-4 toxicities were observed, and no adverse events were attributed to treatment in the MRI. Towards the last fraction, 4/18 tumours exhibited signs of saturation, while in 14/18 tumours, the microsphere uptake patterns did not deviate from the linear trend. CONCLUSION This study demonstrated feasibility and preliminary safety of a first in-human application of TARE within a clinical MRI system. Intraprocedural MRI-based dosimetry enabled dynamic insight in the microsphere distribution during TARE. This proof of concept yields unique possibilities to better understand microsphere distribution in vivo and to potentially optimize treatment efficacy through treatment personalization. REGISTRATION Clinicaltrials.gov, identifier NCT04269499, registered on February 13, 2020 (retrospectively registered).
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Affiliation(s)
- Joey Roosen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Lovisa E L Westlund Gotby
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark J Arntz
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel J R Janssen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W M van Wijk
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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11
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Oosterveer TTM, van Erp GCM, Hendriks P, Broersen A, Overduin CG, van Rijswijk CSP, van Erkel AR, van der Meer RW, Tushuizen ME, Moelker A, Meijerink MR, van Delden OM, de Jong KP, van der Leij C, Smits MLJ, Urlings TAJ, Braak JPBM, Meershoek-Klein Kranenbarg E, van Duijn-de Vreugd B, Zeijdner E, Goeman JJ, Fütterer JJ, Coenraad MJ, Dijkstra J, Burgmans MC. Study Protocol PROMETHEUS: Prospective Multicenter Study to Evaluate the Correlation Between Safety Margin and Local Recurrence After Thermal Ablation Using Image Co-registration in Patients with Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2022; 45:606-612. [PMID: 35233662 PMCID: PMC9018632 DOI: 10.1007/s00270-022-03075-5] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
Purpose The primary objective is to determine the minimal ablation margin required to achieve a local recurrence rate of < 10% in patients with hepatocellular carcinoma undergoing thermal ablation. Secondary objectives are to analyze the correlation between ablation margins and local recurrence and to assess efficacy. Materials and Methods This study is a prospective, multicenter, non-experimental, non-comparative, open-label study. Patients > 18 years with Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (or B with a maximum of two lesions < 5 cm each) are eligible. Patients will undergo dual-phase contrast-enhanced computed tomography directly before and after ablation. Ablation margins will be quantitatively assessed using co-registration software, blinding assessors (i.e. two experienced radiologists) for outcome. Presence and location of recurrence are evaluated independently on follow-up scans by two other experienced radiologists, blinded for the quantitative margin analysis. A sample size of 189 tumors (~ 145 patients) is required to show with 80% power that the risk of local recurrence is confidently below 10%. A two-sided binomial z-test will be used to test the null hypothesis that the local recurrence rate is ≥ 10% for patients with a minimal ablation margin ≥ 2 mm. Logistic regression will be used to find the relationship between minimal ablation margins and local recurrence. Kaplan–Meier estimates are used to assess local and overall recurrence, disease-free and overall survival. Discussion It is expected that this study will result in a clear understanding of the correlation between ablation margins and local recurrence. Using co-registration software in future patients undergoing ablation for hepatocellular carcinoma may improve intraprocedural evaluation of technical success. Trial registration The Netherlands Trial Register (NL9713), https://www.trialregister.nl/trial/9713.
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Affiliation(s)
- Timo T M Oosterveer
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Gonnie C M van Erp
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Pim Hendriks
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alexander Broersen
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla S P van Rijswijk
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Arian R van Erkel
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martijn R Meijerink
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Koert P de Jong
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Maarten L J Smits
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs A J Urlings
- Department of Radiology, Haaglanden Medical Center, Hague, The Netherlands
| | - Jeffrey P B M Braak
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bianca van Duijn-de Vreugd
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Jelle J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jouke Dijkstra
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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12
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Nijsink H, Overduin CG, Brand P, De Jong SF, Borm PJA, Warlé MC, Fütterer JJ. Optimised passive marker device visibility and automatic marker detection for 3-T MRI-guided endovascular interventions: a pulsatile flow phantom study. Eur Radiol Exp 2022; 6:11. [PMID: 35199259 PMCID: PMC8866618 DOI: 10.1186/s41747-022-00262-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive paramagnetic markers on magnetic resonance imaging (MRI)-compatible endovascular devices induce susceptibility artifacts, enabling MRI-visibility and real-time MRI-guidance. Optimised visibility is crucial for automatic detection and device tracking but depends on MRI technical parameters and marker characteristics. We assessed marker visibility and automatic detection robustness for varying MRI parameters and marker characteristics in a pulsatile flow phantom. METHODS Guidewires with varying iron(II,III) oxide nanoparticle (IONP) concentration markers were imaged using gradient-echo (GRE) and balanced steady-state free precession (bSSFP) sequences at 3 T. Furthermore, echo time (TE), slice thickness (ST) and phase encoding direction (PED) were varied. Artifact width was measured and contrast-to-noise ratios were calculated. Marker visibility and image quality were scored by two MRI interventional radiologists. Additionally, a deep learning model for automatic marker detection was trained and the effects of the parameters on detection performance were evaluated. Two-tailed Wilcoxon signed-rank tests were used (significance level, p < 0.05). RESULTS Medan artifact width (IQR) was larger in bSSFP compared to GRE images (12.7 mm (11.0-15.2) versus 8.4 mm (6.5-11.0)) (p < 0.001) and showed a positive relation with TE and IONP concentration. Switching PED and doubling ST had limited effect on artifact width. Image quality assessment scores were higher for GRE compared to bSSFP images. The deep learning model automatically detected the markers. However, the model performance was reduced after adjusting PED, TE, and IONP concentration. CONCLUSION Marker visibility was sufficient and a large range of artifact sizes was generated by adjusting TE and IONP concentration. Deep learning-based marker detection was feasible but performance decreased for altered MR parameters. These factors should be considered to optimise device visibility and ensure reliable automatic marker detectability in MRI-guided endovascular interventions.
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Affiliation(s)
- Han Nijsink
- Department of Medical Imaging, Radboudumc, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands.
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboudumc, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands
| | - Patrick Brand
- Department of Medical Imaging, Radboudumc, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands
| | - Sytse F De Jong
- Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | | | - Michiel C Warlé
- Department of Vascular and Transplant Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboudumc, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, The Netherlands
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13
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Roosen J, Klaassen NJM, Westlund Gotby LEL, Overduin CG, Verheij M, Konijnenberg MW, Nijsen JFW. To 1000 Gy and back again: a systematic review on dose-response evaluation in selective internal radiation therapy for primary and secondary liver cancer. Eur J Nucl Med Mol Imaging 2021; 48:3776-3790. [PMID: 33839892 PMCID: PMC8484215 DOI: 10.1007/s00259-021-05340-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/25/2021] [Indexed: 12/21/2022]
Abstract
Purpose To systematically review all current evidence into the dose-response relation of yttrium-90 and holmium-166 selective internal radiation therapy (SIRT) in primary and secondary liver cancer. Methods A standardized search was performed in PubMed (MEDLINE), Embase, and the Cochrane Library in order to identify all published articles on dose-response evaluation in SIRT. In order to limit the results, all articles that investigated SIRT in combination with other therapy modalities (such as chemotherapy) were excluded. Results A total of 3038 records were identified of which 487 were screened based on the full text. Ultimately, 37 studies were included for narrative analysis. Meta-analysis could not be performed due to the large heterogeneity in study and reporting designs. Out of 37 studies, 30 reported a ‘mean dose threshold’ that needs to be achieved in order to expect a response. This threshold appears to be higher for hepatocellular carcinoma (HCC, 100–250 Gy) than for colorectal cancer metastases (CRC, 40–60 Gy). Reported thresholds tend to be lower for resin microspheres than when glass microspheres are used. Conclusion Although the existing evidence demonstrates a dose-response relationship in SIRT for both primary liver tumours and liver metastases, many pieces of the puzzle are still missing, hampering the definition of standardized dose thresholds. Nonetheless, most current evidence points towards a target mean dose of 100–250 Gy for HCC and 40–60 Gy for CRC. The field would greatly benefit from a reporting standard and prospective studies designed to elucidate the dose-response relation in different tumour types. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05340-0.
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Affiliation(s)
- Joey Roosen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nienke J M Klaassen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lovisa E L Westlund Gotby
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel Verheij
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mark W Konijnenberg
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - J Frank W Nijsen
- Department of Medical Imaging, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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14
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Viozzi I, Guberinic A, Overduin CG, Rovers MM, ter Laan M. Laser Interstitial Thermal Therapy in Patients with Newly Diagnosed Glioblastoma: A Systematic Review. J Clin Med 2021; 10:jcm10020355. [PMID: 33477796 PMCID: PMC7832350 DOI: 10.3390/jcm10020355] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Laser interstitial thermal therapy (LITT) is a minimal invasive neurosurgical technique for the treatment of brain tumors. Results of LITT have been reported in a case series of patients with deep seated and/or recurrent glioblastoma or cerebral metastases. With this review we aim to summarize the currently available evidence regarding safety and effectiveness of LITT in patients with newly diagnosed glioblastoma (nGBM). METHODS A literature search was performed using electronic databases (PubMed and Embase). Papers were assessed for the methodological quality using the Risk Of Bias In Non- randomised Studies - of Interventions (ROBINS-I) tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of the evidence. RESULTS We identified 835 papers of which only 11 articles were eligible for our review. All papers suffered from serious or critical risk of bias, and the quality of evidence was graded as very low according to the GRADE criteria. None of the studies was randomized and reporting of confounders and other parameters was poor. Median overall survival (OS) ranged from 4.1 to 32 months and progression free survival (PFS) from 2 to 31 months. The mean complication rate was 33.7%. No quality of life or cost-effectiveness data were reported. CONCLUSIONS Due to the low quality of the studies, it is not possible to draw firm conclusions regarding the (cost) effectiveness of LITT in patients with newly diagnosed glioblastoma. The low quality of evidence shows the need for a well-designed prospective multicenter randomized controlled trial.
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Affiliation(s)
- Ilaria Viozzi
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
| | - Alis Guberinic
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
| | - Christiaan G. Overduin
- Department of Radiology, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands;
| | - Maroeska M. Rovers
- Departments of Health Evidence and Operating Rooms, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands;
| | - Mark ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Radboud Institute for Health Sciences, 6525 GA Nijmegen, The Netherlands; (I.V.); (A.G.)
- Correspondence:
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15
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Hogenes AM, Slump CH, Te Riet O G Scholten GA, Meijerink MR, Fütterer JJ, van Laarhoven CJHM, Overduin CG, Stommel MWJ. Effect of irreversible electroporation parameters and the presence of a metal stent on the electric field line pattern. Sci Rep 2020; 10:13517. [PMID: 32782339 PMCID: PMC7421881 DOI: 10.1038/s41598-020-70308-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/24/2020] [Indexed: 12/25/2022] Open
Abstract
The final ablation zone created with irreversible electroporation (IRE) depends on the size, shape and strength of the electric field that is influenced by several parameters. A profound understanding of the effect of IRE parameter alterations on the electric field are a prerequisite for a safe and effective treatment. Here, we demonstrate a semolina in castor oil model that enables visualization of the static electric field developed by a high-voltage generator between two needle-electrodes. We intuitively visualize the variation in electric field line pattern for selected IRE parameters; active needle length, inter-needle distance, applied voltage and presence of a nearby metal stent, by cameras in three dimensions. The observations were compared to and supported by two-dimensional numerical simulations of the electric field. Our semolina model visualizes the disturbance of the electric field by a metal stent, potentially leading to an incomplete tumour ablation between the needles. The reduction in electric field strength and the area at risk for incomplete tumour ablation are confirmed by the numerical simulations. The semolina model provides insight in the fundamental physics of the electric field, the effect of alterations in IRE parameter combinations and presence of a metal stent within the ablation zone.
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Affiliation(s)
- Annemiek M Hogenes
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands.
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | | | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, Vrije Universiteit-Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | | | - Christiaan G Overduin
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Centre, P.O. box 9101 (766), 6500 HB, Nijmegen, The Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Venderink W, Bomers JG, Overduin CG, Padhani AR, de Lauw GR, Sedelaar MJ, Barentsz JO. Multiparametric Magnetic Resonance Imaging for the Detection of Clinically Significant Prostate Cancer: What Urologists Need to Know. Part 3: Targeted Biopsy. Eur Urol 2020; 77:481-490. [DOI: 10.1016/j.eururo.2019.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/18/2019] [Indexed: 02/02/2023]
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17
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Bomers JGR, Overduin CG, Jenniskens SFM, Cornel EB, van Lin ENJT, Sedelaar JPM, Fütterer JJ. Focal Salvage MR Imaging-Guided Cryoablation for Localized Prostate Cancer Recurrence after Radiotherapy: 12-Month Follow-up. J Vasc Interv Radiol 2019; 31:35-41. [PMID: 31735483 DOI: 10.1016/j.jvir.2019.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate safety, quality of life (QoL), and local cancer control after focal salvage MR imaging-guided cryoablation in patients with local recurrence of prostate cancer (PCa) after radiotherapy. MATERIALS AND METHODS A retrospective, single-center study was performed in 62 patients with radiorecurrent PCa who underwent MR imaging-guided cryoablation since May 2011 with a follow-up ≥12 months in December 2017. Rates and descriptions of adverse events were reported. Ablation complications were classified according to the Clavien and SIR systems. Validated questionnaires were used to observe functional outcomes and QoL before therapy and 6 and 12 months after therapy. Cancer control was defined as no biochemical failure according to Phoenix criteria and no other clinical evidence for local or metastatic disease. RESULTS All procedures were technically feasible. The number of complications requiring major therapy (Clavien grade 3b/4 or SIR grade D/E/F) was low (2 [3.2%] and 1 [1.6%], respectively). After 12 months, the International Consultation of Incontinence Questionnaire-Short Form (P < .001) and 5-item International Index of Erectile Function (P = .001) scores became significantly worse, indicating increased symptoms of incontinence and diminished erectile function, without compromising QoL. Six patients developed metastases within 6 months. After 12 months, 36 patients (63%) were disease-free. CONCLUSIONS Focal salvage MR imaging-guided cryoablation is safe and is associated with a high technical success rate, preservation of QoL, and local PCa control. This treatment can be a reasonable alternative to salvage radical prostatectomy in properly selected patients with low morbidity and preservation of QoL; however, longer follow-up is needed.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Christiaan G Overduin
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sjoerd F M Jenniskens
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik B Cornel
- Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | | | - J P Michiel Sedelaar
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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18
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Venderink W, van Luijtelaar A, van der Leest M, Barentsz JO, Jenniskens SF, Sedelaar MJ, Hulsbergen-van de Kaa C, Overduin CG, Fütterer JJ. Multiparametric magnetic resonance imaging and follow-up to avoid prostate biopsy in 4259 men. BJU Int 2019; 124:775-784. [DOI: 10.1111/bju.14853] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Wulphert Venderink
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Marloes van der Leest
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jelle O. Barentsz
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Sjoerd F.M. Jenniskens
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | | | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
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19
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Heidkamp J, Zusterzeel PL, van Engen‐van Grunsven AC, Overduin CG, Veltien A, Maat A, Rovers MM, Fütterer JJ. MRI evaluation of vulvar squamous-cell carcinoma in fresh radical local excision specimens for cancer localization and prediction of surgical tumor-free margins. NMR Biomed 2019; 32:e4025. [PMID: 30431192 PMCID: PMC6587990 DOI: 10.1002/nbm.4025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/30/2018] [Accepted: 09/19/2018] [Indexed: 06/09/2023]
Abstract
In the surgical treatment of vulvar squamous-cell carcinoma (VSCC), tumor-free margins of 8 mm or more are considered adequate. However, limited perioperative information on the tumor-free margins other than the surgeon's own estimation is available. The purpose of this study was therefore to investigate the feasibility of ex vivo MRI in localizing VSCC and to assess the surgical tumor-free margins in fresh radical local excision (RLE) specimens to guide the surgeon during resections. Nine patients with biopsy-proven VSCC scheduled for RLE were prospectively included. Intact fresh specimens were scanned using a 7 T preclinical MR-scanner. Whole mount H&E-stained slides were obtained every 3 mm and correlated with ex vivo MRI. A pathologist annotated VSCC and minimal tumor-free margins (3 o'clock, 9 o'clock, basal) on the digitalized histological slides. An observer with knowledge of histology (the non-blinded annotation) and a radiologist blinded to histology (the blinded annotation) separately performed annotation of the same features on ex vivo MRI. Linear correlation and agreement of the ex vivo MRI measurements with histology were assessed. Diagnostic performance for VSCC localization and identification of margins less than 8 mm was expressed as positive and negative predictive values (PPV, NPV). In 153 matched ex vivo MRI slices, the observer correctly identified 79/91 margins as less than 8 mm (PPV 87%) and 110/124 margins as 8 mm or greater (NPV 89%). The radiologist correctly annotated absence of VSCC in 73/81 (NPV 90%) and presence in 65/72 (PPV 90%) slices. Sixty-four of 90 margins were correctly identified as less than 8 mm (PPV 71%) and 83/102 margins as 8 mm or greater (NPV 81%). Both non-blinded and blinded annotations were linearly correlated and demonstrated good agreement with histology. Accurate localization of VSCC and measurements of the surgical tumor-free margins in fresh RLE specimens using ex vivo MRI seems feasible. High diagnostic performance in VSCC localization and identification of margins less than 8 mm suggest ex vivo MRI to be clinically applicable.
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Affiliation(s)
- Jan Heidkamp
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Petra L.M. Zusterzeel
- Department of Obstetrics and GynaecologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | - Christiaan G. Overduin
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Andor Veltien
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - Arie Maat
- Department of PathologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Maroeska M. Rovers
- Department of Operating RoomsRadboud University Medical CenterNijmegenThe Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear MedicineRadboud University Medical CenterNijmegenThe Netherlands
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20
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Overduin CG, Heidkamp J, Rothgang E, Barentsz JO, de Lange F, Fütterer JJ. Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study. Eur Radiol 2018; 28:4824-4831. [PMID: 29789909 PMCID: PMC6182740 DOI: 10.1007/s00330-018-5497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/16/2018] [Revised: 04/07/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy. METHODS Twenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded. RESULTS Needle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min. CONCLUSIONS Use of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction. KEY POINTS • Performing MR-guided prostate biopsy using an in-room tablet device is feasible. • CSRs could be sampled after a single alignment step in 19/20 patients. • The mean procedure time for biopsy with the tablet device was 23.7 min.
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Affiliation(s)
- Christiaan G Overduin
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.
| | - Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | | | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands
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21
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van Oostenbrugge TJ, Langenhuijsen JF, Overduin CG, Jenniskens SF, Mulders PF, Fütterer JJ. Percutaneous MR Imaging–Guided Cryoablation of Small Renal Masses in a 3-T Closed-Bore MR Imaging Environment: Initial Experience. J Vasc Interv Radiol 2017; 28:1098-1107.e1. [DOI: 10.1016/j.jvir.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022] Open
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Overduin CG, Fütterer JJ, Scheenen TW. 3D MR thermometry of frozen tissue: Feasibility and accuracy during cryoablation at 3T. J Magn Reson Imaging 2016; 44:1572-1579. [DOI: 10.1002/jmri.25301] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/21/2016] [Accepted: 04/21/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Christiaan G. Overduin
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
| | - Jurgen J. Fütterer
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
- MIRA Institute for Biomedical Engineering and Technical Medicine; University of Twente; Enschede the Netherlands
| | - Tom W.J. Scheenen
- Department of Radiology and Nuclear Medicine; Radboud University Medical Center; Nijmegen the Netherlands
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23
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Overduin CG, Bomers JGR, Jenniskens SFM, Hoes MF, ten Haken B, de Lange F, Fütterer JJ, Scheenen TWJ. T1-weighted MR image contrast around a cryoablation iceball: A phantom study and initial comparison within vivofindings. Med Phys 2014; 41:112301. [DOI: 10.1118/1.4896824] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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Overduin CG, Fütterer JJ, Barentsz JO. MRI-guided biopsy for prostate cancer detection: a systematic review of current clinical results. Curr Urol Rep 2014; 14:209-13. [PMID: 23568624 DOI: 10.1007/s11934-013-0323-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In-bore magnetic resonance-guided biopsy (MRGB) has been increasingly used in clinical practice to detect prostate cancer (PCa). This review summarizes the current clinical results of this biopsy method. A systematic literature search was performed in the PubMed and Embase databases. Of 2,035 identified records, 49 required full review. In all, ten unique studies reporting clinical results of MRGB could be included. Reported PCa detection rates ranged from 8 to 59 % (median 42 %). The majority of tumors detected by MRGB were clinically significant (81-93 %). Most frequent complications of MRGB are transient hematuria (1-24 %) and short-term perirectal bleeding (11-17 %). Major complications are rare. Based on the reviewed literature, MRGB can be regarded an accurate and safe diagnostic tool to detect clinically significant PCa. However, as general availability is limited, this procedure should be reserved for specific patients. Appropriate indications will have to be determined.
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Affiliation(s)
- Christiaan G Overduin
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, P.O. Box 9101 (766), 6500 HB, Nijmegen, the Netherlands.
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Bomers JGR, Yakar D, Overduin CG, Sedelaar JPM, Vergunst H, Barentsz JO, de Lange F, Fütterer JJ. MR imaging-guided focal cryoablation in patients with recurrent prostate cancer. Radiology 2013; 268:451-60. [PMID: 23525206 DOI: 10.1148/radiol.13121291] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [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 assess the feasibility of magnetic resonance (MR) imaging-guided focal cryoablation in patients with locally recurrent prostate cancer after radiation therapy. MATERIALS AND METHODS This was a prospective study, and informed consent was obtained from all patients. Ten consecutive patients with histopathologically proved recurrent prostate cancer after radiation therapy, without evidence of distant metastases, were treated while under general anesthesia in a 1.5-T MR unit. A urethral warmer was inserted. Cryoneedles were transperineally inserted under real-time MR imaging. Then, a rectal warmer was inserted. Ice ball growth was continuously monitored under MR imaging guidance. Two freeze-thaw cycles were performed. Follow-up consisted of a visit to the urologist, measurement of prostate-specific antigen level, and multiparametric MR imaging at 3, 6, and 12 months. Potential complications were recorded. RESULTS All patients were successfully treated. In one patient, the urethral warmer could not be inserted and the procedure was cancelled. Two months later, the procedure was successfully repeated. Another patient had urinary retention. Follow-up data were available for all patients. A local recurrence or remnant tumor was found in two patients after 6 months and in another patient after 12 months. These three patients underwent successful retreatment with MR imaging-guided focal cryoablation. CONCLUSION MR imaging-guided focal cryoablation of recurrent prostate cancer after radiation therapy is feasible and safe. Initial results are promising; however, longer follow-up is needed and more patients must be studied.
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Affiliation(s)
- Joyce G R Bomers
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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