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Jin X, Jiang M, Qian L, Tao L, Yang Y, Xing L, Qian Z, Li W. Effect of 433 MHz double-slot microwave antennas for double-zone ablation in ex vivo swine liver experiment. PLoS One 2025; 20:e0315678. [PMID: 39933011 PMCID: PMC11813083 DOI: 10.1371/journal.pone.0315678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/29/2024] [Indexed: 02/13/2025] Open
Abstract
PURPOSE To evaluate the effects of axial length and slot-to-slot distance of double-slot microwave antenna (DSMA) with frequency of 433 MHz on the size and shape of ablation zones created under different input microwave powers. MATERIALS AND METHODS The design of double slot microwave antennas (DSMAs) with axial lengths (70 mm, 30 mm) and slot-to-slot distance (49 mm, 10 mm) were optimized by numerical simulation and ex vivo liver experiments. Finite-element method simulations and forty ablations of swine liver were employed to obtain the temperature distributions within liver tissue using DSMAs at the 433 MHz operating frequency in a range of heating powers (20, 30, 40 and 50W) for 600 s. The dependence of the effectiveness of MWA on the axial length and slot-to-slot distance of antenna as well as the input power was further evaluated by analyzing morphologic characteristics of ablated zone. RESULTS Two-zone ablation was achieved by two types of double-slot antennas in our study with frequency of 433 MHz, and the observed shapes of ex vivo experimental ablation zones were in good agreement with patterns predicted by simulation models. The ablation zone exhibited a 'gourd' shape after the treatment using the antenna with longer axial length and slot-to-slot distance, while the short antenna caused a guitar-shape ablation in liver tissue after MWA. CONCLUSION The dedicated design of our DSMAs with a frequency of 433 MHz could enable new ablation shapes with controllable dimensions, which can be applied to the clinical treatment of MWA for gourd-shaped liver tumors and other long-shaped tumors. Furthermore, research can be conducted on how to design the antenna as flexible and use it for the treatment of pulmonary nodules or varicose veins.
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Affiliation(s)
- Xiaofei Jin
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Key Laboratory of Multi-modal Brain-Computer Precision Drive, Industry and Information Technology Ministry, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Mengwei Jiang
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Ling Tao
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Key Laboratory of Brain-Machine Intelligence Technology, Ministry of Education, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Yamin Yang
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Key Laboratory of Multi-modal Brain-Computer Precision Drive, Industry and Information Technology Ministry, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Lidong Xing
- Key Laboratory of Multi-modal Brain-Computer Precision Drive, Industry and Information Technology Ministry, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Zhiyu Qian
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Key Laboratory of Multi-modal Brain-Computer Precision Drive, Industry and Information Technology Ministry, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Weitao Li
- Department of Biomedical Engineering, College of Automation Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
- Key Laboratory of Multi-modal Brain-Computer Precision Drive, Industry and Information Technology Ministry, Nanjing University of Aeronautics and Astronautics, Nanjing, China
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Bošković N, Nikolić S, Radjenović B, Radmilović-Radjenović M. Safety and Effectiveness of Triple-Antenna Hepatic Microwave Ablation. Bioengineering (Basel) 2024; 11:1133. [PMID: 39593793 PMCID: PMC11591611 DOI: 10.3390/bioengineering11111133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 11/05/2024] [Accepted: 11/07/2024] [Indexed: 11/28/2024] Open
Abstract
Microwave ablation is becoming a standard procedure for treating tumors based on heat generation, causing an elevation in the tissue temperature level from 50 to 60 °C, causing tissue death. Microwave ablation is associated with uniform cell killing within ablation zones, multiple-antenna capability, low complication rates, and long-term survival. Several reports have demonstrated that multiple-antenna microwave ablation is a promising strategy for safely, rapidly, and effectively treating large tumors. The key advantage of multi-antenna tumor microwave ablation is the creation of a large, well-defined ablation zone without excessively long treatment times or high power that can damage healthy tissue. The strategic positioning of multiple probes provides a fully ablated volume, even in regions where individual probe damage is incomplete. Accurate modeling of the complex thermal and electromagnetic behaviors of tissue is critical for optimizing microwave ablation because material parameters and tissue responses can change significantly during the procedure. In the case of multi-antenna microwave ablation, the calculation complexity increases significantly, requiring significant computational resources and time. This study aimed to evaluate the efficacy and safety of liver percutaneous microwave ablation using the simultaneous activation of three antennas for the treatment of lesions larger than 3 cm. Based on the known results from a single-probe setup, researchers can estimate and evaluate various spatial configurations of the three-probe array to identify the optimal arrangement. Due to the synergistic effects of the combined radiation from the three antennas, the resulting ablation zone can be significantly larger, leading to better outcomes in terms of treatment time and effectiveness. The obtained results revealed that volumetric damage and the amount of damaged healthy tissue are smaller for a three-antenna configuration than for microwave ablation using a single-antenna and two-antenna configurations.
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Affiliation(s)
- Nikola Bošković
- Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Belgrade, Serbia; (N.B.); (B.R.)
| | - Srdjan Nikolić
- Department of Surgery, Institute of Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia;
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia
| | - Branislav Radjenović
- Institute of Physics, University of Belgrade, Pregrevica 118, 11080 Belgrade, Serbia; (N.B.); (B.R.)
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Tang Z, Deng L, Zhang J, Jiang T, Xiang H, Chen Y, Liu H, Cai Z, Cui W, Xiong Y. Intelligent Hydrogel-Assisted Hepatocellular Carcinoma Therapy. RESEARCH (WASHINGTON, D.C.) 2024; 7:0477. [PMID: 39691767 PMCID: PMC11651419 DOI: 10.34133/research.0477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 12/19/2024]
Abstract
Given the high malignancy of liver cancer and the liver's unique role in immune and metabolic regulation, current treatments have limited efficacy, resulting in a poor prognosis. Hydrogels, soft 3-dimensional network materials comprising numerous hydrophilic monomers, have considerable potential as intelligent drug delivery systems for liver cancer treatment. The advantages of hydrogels include their versatile delivery modalities, precision targeting, intelligent stimulus response, controlled drug release, high drug loading capacity, excellent slow-release capabilities, and substantial potential as carriers of bioactive molecules. This review presents an in-depth examination of hydrogel-assisted advanced therapies for hepatocellular carcinoma, encompassing small-molecule drug therapy, immunotherapy, gene therapy, and the utilization of other biologics. Furthermore, it examines the integration of hydrogels with conventional liver cancer therapies, including radiation, interventional therapy, and ultrasound. This review provides a comprehensive overview of the numerous advantages of hydrogels and their potential to enhance therapeutic efficacy, targeting, and drug delivery safety. In conclusion, this review addresses the clinical implementation of hydrogels in liver cancer therapy and future challenges and design principles for hydrogel-based systems, and proposes novel research directions and strategies.
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Affiliation(s)
- Zixiang Tang
- Department of Hepatobiliary Surgery, Academician (Expert) Workstation, Sichuan Digestive System Disease Clinical Medical Research Center,
Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P. R. China
| | - Lin Deng
- Department of Clinical Medicine,
North Sichuan Medical College, Nanchong 637000, P. R. China
| | - Jing Zhang
- Department of Gastroenterology,
Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P. R. China
| | - Tao Jiang
- Department of Hepatobiliary Surgery, Academician (Expert) Workstation, Sichuan Digestive System Disease Clinical Medical Research Center,
Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P. R. China
| | - Honglin Xiang
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China
| | - Yanyang Chen
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China
| | - Huzhe Liu
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China
| | - Zhengwei Cai
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China
| | - Wenguo Cui
- Department of Orthopaedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P. R. China
| | - Yongfu Xiong
- Department of Hepatobiliary Surgery, Academician (Expert) Workstation, Sichuan Digestive System Disease Clinical Medical Research Center,
Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, P. R. China
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Lucatelli P, Rocco B, Argirò R, Semeraro V, Lai Q, Bozzi E, Crociati S, Barone M, Posa A, Catalano C, Crocetti L, Iezzi R. Percutaneous thermal segmentectomy for liver malignancies over 3 cm: mid-term oncological performance and predictors of sustained complete response from a multicentric Italian retrospective study. LA RADIOLOGIA MEDICA 2024; 129:1543-1554. [PMID: 39285023 PMCID: PMC11480182 DOI: 10.1007/s11547-024-01877-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/09/2024] [Indexed: 10/16/2024]
Abstract
INTRODUCTION Percutaneous thermal segmentectomy is a single-step combination of microwave ablation, performed during arterial occlusion obtained with a balloon micro catheter, followed in the same session by balloon-occluded TACE. The aim of this multicenter retrospective study is to report the mid-term oncological performance of this technique for liver malignancies > 3.0 cm and to identify risk factors for the loss of sustained complete response. METHODS Oncological results were evaluated with CT or MRI according to m-RECIST (HCC) and RECISTv1.1 (metastasis/intra-hepatic cholangiocarcinoma, iCC) at 1-month, 3-6-month and then at regular-6-month intervals. To identify predictive variables associated with not achieving or losing complete response two mixed-effects multivariable logistic regression models were constructed. RESULTS Sixty-three patients (40/23, male/female) with primary liver malignancies (HCC = 49; iCC = 4) and metastasis (n = 10) were treated. Median diameter of target lesion was 4.5 cm (range 3.0-7.0 cm). The median follow-up time was 9.2 months. At one-month follow-up, 79.4% of patients presented with a complete response and the remaining 20.6% were partial responders. At the 3-6-month follow-up, reached by 59 of the initial 63 patients, 83.3% showed a sustained complete response, while 10.2% had a partial response and 8.5% a local recurrence. At the last follow-up, 69.8% of the lesions showed a complete response. The initial diameter of the target lesion ≥ 5.0 cm was the only independent variable associated with the risk of failure in maintaining a complete response at 6 months (OR = 8.58, 95% CI 1.38-53.43; P = 0.02). CONCLUSION Percutaneous thermal segmentectomy achieves promising oncological results in patients with tumors > 3.0 cm, with tumor dimension ≥ 5.0 cm being the only risk factor associated with the failure of a sustained complete response.
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Affiliation(s)
- Pierleone Lucatelli
- Interventional Radiology Unit, Department of Diagnostic Medicine and Radiology, UOC Radiology, Sapienza University of Rome, Rome, Italy
| | - Bianca Rocco
- Interventional Radiology Unit, Department of Diagnostic Medicine and Radiology, UOC Radiology, Sapienza University of Rome, Rome, Italy.
| | - Renato Argirò
- Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Vittorio Semeraro
- SSD Radiologia Interventistica POC SS Annunziata - ASL Taranto, Taranto, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Elena Bozzi
- Department of Radiology and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Sara Crociati
- Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Michele Barone
- SSD Radiologia Interventistica POC SS Annunziata - ASL Taranto, Taranto, Italy
| | - Alessandro Posa
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Area Di Diagnostica per Immagini, UOC Radiologia d'Urgenza ed Interventistica, L.go A Gemelli 8, 00168, Rome, Italy
| | - Carlo Catalano
- Interventional Radiology Unit, Department of Diagnostic Medicine and Radiology, UOC Radiology, Sapienza University of Rome, Rome, Italy
| | - Laura Crocetti
- Department of Radiology and Interventional Radiology, University of Pisa, Pisa, Italy
| | - Roberto Iezzi
- Fondazione Policlinico Universitario "A. Gemelli" - IRCCS, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Area Di Diagnostica per Immagini, UOC Radiologia d'Urgenza ed Interventistica, L.go A Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, L.go F Vito 1, 00168, Rome, Italy
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Ju S, Duan X, Wang Y, Zhang M, Bai Y, He X, Wang C, Liu J, Yao W, Zhou C, Xiong B, Zheng C. Blocking TGFβR synergistically enhances anti-tumor effects of anti-PD-1 antibody in a mouse model of incomplete thermal ablation. Int Immunopharmacol 2024; 138:112585. [PMID: 38950456 DOI: 10.1016/j.intimp.2024.112585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/20/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
The mechanism of early tumor recurrence after incomplete microwave ablation (iMWA) is poorly understood. The anti-programmed cell death protein 1 (anti-PD-1) monotherapy is reported to be ineffective to prevent the progression of residual tumor resulted from iMWA. Transforming growth factor-β (TGFβ) signaling pathway plays an important role in tumorigenesis and development. We assume blocking transforming growth factor-β receptor (TGFβR) after incomplete iMWA may synergistically enhance the effect of anti-PD-1 antibody to prevent the progression of residual tumor. We construct an iMWA model with mice harboring Hepa1-6 derived xenograft. The Tgfb1 expression and phosphorylated-Smad3 protein expression is upregulated in the residual tumor after iMWA. With the application of TGFβR inhibitor SB431542, the cell proliferation potential, the tumor growth, the mRNA expression of epithelial mesenchymal transition (EMT) markers including Cdh2, and Vim, and cancer stem cell marker Epcam, and the infiltrating Treg cells are reduced in the residual tumor tissue. In addition, iMWA combined with TGFβR blocker and anti-PD-1 antibody further decreases the cell proliferation, tumor growth, expression of EMT markers and cancer stem cell marker, and the infiltrating Treg cells in the residual tumor tissue. Blocking TGFβR may alleviate the pro-tumoral effect of tumor microenvironment thereby significantly prevents the progression of residual tumor tissue. Our study indicates that blocking TGFβR may be a novel therapeutic strategy to enhance the effect of anti-PD-1 antibody to prevent residual hepatocellular carcinoma (HCC) progression after iMWA.
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Affiliation(s)
- Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xuhua Duan
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mengfan Zhang
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou 450000, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xuelian He
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Bin Xiong
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China.
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Zhu ZY, Qian Z, Qin ZQ, Xie B, Wei JZ, Yang PP, Yuan M. Effectiveness and safety of sequential transarterial chemoembolization and microwave ablation for subphrenic hepatocellular carcinoma: A comprehensive evaluation. World J Gastrointest Oncol 2024; 16:2941-2951. [PMID: 39072162 PMCID: PMC11271768 DOI: 10.4251/wjgo.v16.i7.2941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/11/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Subphrenic carcinoma has been identified as a significant risk factor for the thermal ablation of intrahepatic tumors, resulting in a high rate of residual tumor recurrence. Some studies have proposed that combination treatment with transarterial chemoembolization (TACE) followed by radiofrequency ablation is both feasible and safe for tumors in the subphrenic region. However, research specifically examining the therapeutic outcomes of combination therapy using TACE and microwave ablation (TACE-MWA) in subphrenic tumors is lacking. AIM To evaluate the efficacy and safety of TACE-MWA in patients with subphrenic hepatocellular carcinoma (HCC). METHODS Between December 2017 and December 2021, 49 patients diagnosed with HCC ≤ 6 cm, who received TACE-MWA, were included in this retrospective cohort study. These patients were classified into subphrenic and non-subphrenic groups based on the distance between the diaphragm and the tumor margin. The rates of local tumor progression (LTP), progression-free survival (PFS), and overall survival (OS) were compared between the two groups. Complications were evaluated by using a grading system developed by the Society of Interventional Radiology. RESULTS After a median follow-up time of 38 mo, there were no significant differences in LTP between the subphrenic and non-subphrenic groups (27.3% and 22.2% at 5 years, respectively; P = 0.66), PFS (55.5% at 5 years in both groups; P = 0.91), and OS (85.0% and 90.9% in the subphrenic and non-subphrenic groups at 5 years; P = 0.57). However, a significantly higher rate of LTP was observed in subphrenic HCC > 3 cm compared to those ≤ 3 cm (P = 0.085). The dosage of iodized oil [hazard ratio (HR): 1.52; 95% confidence interval (CI): 1.11-2.08; P = 0.009] and multiple tumors (HR: 13.22; 95%CI: 1.62-107.51; P = 0.016) were independent prognostic factors for LTP. There were no significant differences in complication rates between the two groups (P = 0.549). CONCLUSION Combined TACE and MWA was practical and safe for managing subphrenic HCC. The efficacy and safety levels did not vary significantly when tumors outside the subphrenic region were treated.
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Affiliation(s)
- Zi-Yi Zhu
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Zhen Qian
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Zhong-Qiang Qin
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Bo Xie
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Jian-Zhu Wei
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Pei-Pei Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
| | - Mu Yuan
- Department of Interventional Radiology, The First Affiliated Hospital of Bengbu Medical University, Bengbu 233004, Anhui Province, China
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Tang L, Hou Y, Huang Z, Huang J. Transarterial Chemoembolization Combined with Lenvatinib Plus Sequential Microwave Ablation for Large Hepatocellular Carcinoma Beyond Up-to-Seven Criteria: A Retrospective Cohort Study. Acad Radiol 2024; 31:2795-2806. [PMID: 38290885 DOI: 10.1016/j.acra.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to investigate the efficacy and safety of transarterial chemoembolization (TACE) combined with Lenvatinib plus sequential microwave ablation (MWA) for the treatment of patients with large hepatocellular carcinoma (HCC) beyond up-to-seven criteria. MATERIALS AND METHODS This retrospective cohort study assessed the medical records of patients with large HCC who underwent TACE combined with Lenvatinib plus sequential MWA (TLM) or TACE plus sequential MWA (TM). Lenvatinib was administered to patients within 3-5 days after TACE and sequential MWA was performed once they met the criteria for curative ablation after TACE or the combination therapy. The progression-free survival (PFS), overall survival (OS) and treatment-related complications were compared between two groups. RESULTS Of the 81 patients who underwent TLM or TM, 64 who met the eligibility criteria were included in this study. Among them, 28 patients underwent TLM and 36 underwent TM. The inverse probability weighting method (IPTW) was used to balance differences between two groups. The TLM group had longer PFS than the TM group (median, before IPTW: 18.53 vs. 5.62 months, p < 0.001; median, after IPTW: 28.27 vs. 5.30 months, p < 0.001). Univariate and multivariate analyses revealed that TLM and the maximum tumor diameter were independent prognostic factors for PFS. The overall incidence rate of minor complications related to TACE or MWA was lower in the TLM group (32.1% vs. 66.7%, p = 0.006). CONCLUSION TACE combined with Lenvatinib plus sequential MWA can prolong the progression-free survival of patients with large HCC beyond up-to-seven criteria.
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Affiliation(s)
- Lu Tang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Yingwen Hou
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Zhimei Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.)
| | - Jinhua Huang
- Department of Minimally Invasive Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China (L.T., Y.H., Z.H., J.H.); State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Guangdong Provincial Clinical Research Center for Cancer, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.); Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong, China (L.T., Y.H., Z.H., J.H.).
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Mathy RM, Giannakis A, Franke M, Winiger A, Kauczor HU, Chang DH. Factors Impacting Microwave Ablation Zone Sizes: A Retrospective Analysis. Cancers (Basel) 2024; 16:1279. [PMID: 38610957 PMCID: PMC11011160 DOI: 10.3390/cancers16071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/01/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE Evaluation of the influence of intrinsic and extrinsic conditions on ablation zone volumes (AZV) after microwave ablation (MWA). METHODS Retrospective analysis of 38 MWAs of therapy-naïve liver tumours performed with the NeuWave PR probe. Ablations were performed either in the 'standard mode' (65 W, 10 min) or in the 'surgical mode' (95 W, 1 min, then 65 W, 10 min). AZV measurements were obtained from contrast-enhanced computed tomography immediately post-ablation. RESULTS AZVs in the 'standard mode' were smaller than predicted by the manufacturer (length 3.6 ± 0.6 cm, 23% below 4.7 cm; width 2.7 ± 0.6, 23% below 3.5 cm). Ablation zone past the tip was limited to 6 mm in 28/32 ablations. Differences in AZV between the 'surgical mode' and 'standard mode' were not significant (15.6 ± 7.8 mL vs. 13.9 ± 8.8 mL, p = 0.6). AZVs were significantly larger in case of hepatocellular carcinomas (HCCs) (n = 19) compared to metastasis (n = 19; 17.8 ± 9.9 mL vs. 10.1 ± 5.1 mL, p = 0.01) and in non-perivascular tumour location (n = 14) compared to perivascular location (n = 24, 18.7 ± 10.4 mL vs. 11.7 ± 6.1 mL, p = 0.012), with both factors remaining significant in two-way analysis of variance (HCC vs. metastasis: p = 0.02; perivascular vs. non-perivascular tumour location: p = 0.044). CONCLUSION Larger AZVs can be expected in cases of HCCs compared with metastases and in non-perivascular locations. Using the 'surgical mode' does not increase AZV significantly.
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Affiliation(s)
- René Michael Mathy
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- 2nd Department of Radiology, University General Hospital, “ATTIKON” Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Mareike Franke
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Alain Winiger
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
| | - De-Hua Chang
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, 69120 Heidelberg, Germany; (A.G.)
- Department of Radiology, Cantonal Hospital of Lucerne, 6000 Lucerne, Switzerland
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9
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Servin F, Collins JA, Heiselman JS, Frederick-Dyer KC, Planz VB, Geevarghese SK, Brown DB, Jarnagin WR, Miga MI. Simulation of Image-Guided Microwave Ablation Therapy Using a Digital Twin Computational Model. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:107-124. [PMID: 38445239 PMCID: PMC10914207 DOI: 10.1109/ojemb.2023.3345733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Abstract
Emerging computational tools such as healthcare digital twin modeling are enabling the creation of patient-specific surgical planning, including microwave ablation to treat primary and secondary liver cancers. Healthcare digital twins (DTs) are anatomically one-to-one biophysical models constructed from structural, functional, and biomarker-based imaging data to simulate patient-specific therapies and guide clinical decision-making. In microwave ablation (MWA), tissue-specific factors including tissue perfusion, hepatic steatosis, and fibrosis affect therapeutic extent, but current thermal dosing guidelines do not account for these parameters. This study establishes an MR imaging framework to construct three-dimensional biophysical digital twins to predict ablation delivery in livers with 5 levels of fat content in the presence of a tumor. Four microwave antenna placement strategies were considered, and simulated microwave ablations were then performed using 915 MHz and 2450 MHz antennae in Tumor Naïve DTs (control), and Tumor Informed DTs at five grades of steatosis. Across the range of fatty liver steatosis grades, fat content was found to significantly increase ablation volumes by approximately 29-l42% in the Tumor Naïve and 55-60% in the Tumor Informed DTs in 915 MHz and 2450 MHz antenna simulations. The presence of tumor did not significantly affect ablation volumes within the same steatosis grade in 915 MHz simulations, but did significantly increase ablation volumes within mild-, moderate-, and high-fat steatosis grades in 2450 MHz simulations. An analysis of signed distance to agreement for placement strategies suggests that accounting for patient-specific tumor tissue properties significantly impacts ablation forecasting for the preoperative evaluation of ablation zone coverage.
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Affiliation(s)
- Frankangel Servin
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jarrod A. Collins
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
| | - Jon S. Heiselman
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | | | - Virginia B. Planz
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | | | - Daniel B. Brown
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
| | - William R. Jarnagin
- Department of Surgery, Hepatopancreatobiliary ServiceMemorial Sloan Kettering Cancer CenterNew YorkNY10065USA
| | - Michael I. Miga
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTN37235USA
- Vanderbilt Institute for Surgery and EngineeringVanderbilt UniversityNashvilleTN37235USA
- Department of RadiologyVanderbilt University Medical CenterNashvilleTN37235USA
- Department of Neurological SurgeryVanderbilt University Medical CenterNashvilleTN37235USA
- Department of OtolaryngologyVanderbilt University Medical CenterNashvilleTN37235USA
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10
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Han X, Wang X, Li Z, Dou W, Shi H, Liu Y, Sun K. Risk prediction of intraoperative pain in percutaneous microwave ablation of lung tumors under CT guidance. Eur Radiol 2023; 33:8693-8702. [PMID: 37382619 DOI: 10.1007/s00330-023-09874-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 04/05/2023] [Accepted: 05/04/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To evaluate the effect of intraoperative pain in microwave ablation of lung tumors (MWALT) on local efficacy and establish the pain risk prediction model. METHODS It was a retrospectively study. Consecutive patients with MWALT from September 2017 to December 2020 were divided into mild and severe pain groups. Local efficacy was evaluated by comparing technical success, technical effectiveness, and local progression-free survival (LPFS) in two groups. All cases were randomly allocated into training and validation cohorts at a ratio of 7:3. A nomogram model was established using predictors identified by logistics regression in training dataset. The calibration curves, C-statistic, and decision curve analysis (DCA) were used to evaluate the accuracy, ability, and clinical value of the nomogram. RESULTS A total of 263 patients (mild pain group: n = 126; severe pain group: n = 137) were included in the study. Technical success rate and technical effectiveness rate were 100% and 99.2% in the mild pain group and 98.5% and 97.8% in the severe pain group. LPFS rates at 12 and 24 months were 97.6% and 87.6% in the mild pain group and 91.9% and 79.3% in the severe pain group (p = 0.034; HR: 1.90). The nomogram was established based on three predictors: depth of nodule, puncture depth, and multi-antenna. The prediction ability and accuracy were verified by C-statistic and calibration curve. DCA curve suggested the proposed prediction model was clinically useful. CONCLUSIONS Severe intraoperative pain in MWALT reduced the local efficacy. An established prediction model could accurately predict severe pain and assist physicians in choosing a suitable anesthesia type. CLINICAL RELEVANCE STATEMENT This study firstly provides a prediction model for the risk of severe intraoperative pain in MWALT. Physicians can choose a suitable anesthesia type based on pain risk, in order to improve patients' tolerance as well as local efficacy of MWALT. KEY POINTS • The severe intraoperative pain in MWALT reduced the local efficacy. • Predictors of severe intraoperative pain in MWALT were the depth of nodule, puncture depth, and multi-antenna. • The prediction model established in this study can accurately predict the risk of severe pain in MWALT and assist physicians in choosing a suitable anesthesia type.
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Affiliation(s)
- Xujian Han
- Department of Medical Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China.
| | - Zhenjia Li
- Department of Medical Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China.
| | - Weitao Dou
- Department of Medical Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China
| | - Honglu Shi
- Department of Medical Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China
| | - Yuanqing Liu
- Department of Medical Intervention, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China
| | - Kui Sun
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No. 324 Jingwu Road, Jinan, Shandong, China
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11
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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] [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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12
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Hui TCH, How GY, Chim MSM, Pua U. Comparative Study of Ablation Zone of EMPRINT HP Microwave Device with Contemporary 2.4 GHz Microwave Devices in an Ex Vivo Porcine Liver Model. Diagnostics (Basel) 2023; 13:2702. [PMID: 37627962 PMCID: PMC10453042 DOI: 10.3390/diagnostics13162702] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
(1) Background: Percutaneous microwave ablation (MWA) is an accepted treatment of non-operative liver cancer. This study compares the ablation zones of four commercially available 2.45 GHz MWA systems (Emprint, Eco, Neuwave, and Solero) in an ex vivo porcine liver model. (2) Methods: Ex vivo porcine livers (n = 85) were obtained. Two ablation time setting protocols were evaluated, the manufacturer's recommended maximum time and a 3 min time, performed at the manufacturer-recommended maximum power setting. A total of 236 ablation samples were created with 32 (13.6%) samples rejected. A total of 204 samples were included in the statistical analysis. (3) Results: For single-probe protocols, Emprint achieved ablation zones with the largest SAD. Significant differences were found in all comparisons for the 3 min time setting and for all comparisons at the 10 min time setting except versus Neuwave LK15 and Eco. Emprint produced ablation zones that were also significantly more spherical (highest SI) than the single-probe ablations from all other manufacturers. No statistical differences were found for ablation shape or SAD between the single-probe protocols for Emprint and the three-probe protocols for Neuwave. (4) Conclusions: The new Emprint HP system achieved large and spherical ablation zones relative to other 2.45 GHz MWA systems.
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Affiliation(s)
- Terrence C. H. Hui
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Guo Yuan How
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Michelle S. M. Chim
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
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13
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Varble NA, Bakhutashvili I, Reed SL, Delgado J, Tokoutsi Z, Frackowiak B, Baragona M, Karanian JW, Wood BJ, Pritchard WF. Morphometric characterization and temporal temperature measurements during hepatic microwave ablation in swine. PLoS One 2023; 18:e0289674. [PMID: 37540658 PMCID: PMC10403086 DOI: 10.1371/journal.pone.0289674] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE Heat-induced destruction of cancer cells via microwave ablation (MWA) is emerging as a viable treatment of primary and metastatic liver cancer. Prediction of the impacted zone where cell death occurs, especially in the presence of vasculature, is challenging but may be achieved via biophysical modeling. To advance and characterize thermal MWA for focal cancer treatment, an in vivo method and experimental dataset were created for assessment of biophysical models designed to dynamically predict ablation zone parameters, given the delivery device, power, location, and proximity to vessels. MATERIALS AND METHODS MWA zone size, shape, and temperature were characterized and monitored in the absence of perfusion in ex vivo liver and a tissue-mimicking thermochromic phantom (TMTCP) at two power settings. Temperature was monitored over time using implanted thermocouples with their locations defined by CT. TMTCPs were used to identify the location of the ablation zone relative to the probe. In 6 swine, contrast-enhanced CTs were additionally acquired to visualize vasculature and absence of perfusion along with corresponding post-mortem gross pathology. RESULTS Bench studies demonstrated average ablation zone sizes of 4.13±1.56cm2 and 8.51±3.92cm2, solidity of 0.96±0.06 and 0.99±0.01, ablations centered 3.75cm and 3.5cm proximal to the probe tip, and temperatures of 50 ºC at 14.5±13.4s and 2.5±2.1s for 40W and 90W ablations, respectively. In vivo imaging showed average volumes of 9.8±4.8cm3 and 33.2±28.4cm3 and 3D solidity of 0.87±0.02 and 0.75±0.15, and gross pathology showed a hemorrhagic halo area of 3.1±1.2cm2 and 9.1±3.0cm2 for 40W and 90W ablations, respectfully. Temperatures reached 50ºC at 19.5±9.2s and 13.0±8.3s for 40W and 90W ablations, respectively. CONCLUSION MWA results are challenging to predict and are more variable than manufacturer-provided and bench predictions due to vascular stasis, heat-induced tissue changes, and probe operating conditions. Accurate prediction of MWA zones and temperature in vivo requires comprehensive thermal validation sets.
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Affiliation(s)
- Nicole A. Varble
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Philips, Best, The Netherlands
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Sheridan L. Reed
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Jose Delgado
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, United States of America
| | | | | | | | - John W. Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
| | - Bradford J. Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
- Bioengineering and National Cancer Institute Center, Bethesda, Maryland, United States of America
| | - William F. Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National, Institutes of Health, Bethesda, Maryland, United States of America
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14
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Satish V, Repaka R. Safety and efficacy of intracavitary microwave ablation in hepatic gland tumours: Numerical and in vitro studies. Proc Inst Mech Eng H 2023:9544119231179136. [PMID: 37300398 DOI: 10.1177/09544119231179136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The microwave ablation (MWA) of large hepatic gland tumour using multiple trocars operated at 2.45/6 GHz frequencies has been analysed. The ablation region (in vitro) obtained using parallel and non-parallel insertion of multiple trocars into the tissue has been analysed and compared with the numerical studies. The present study has considered a typical triangular-shaped hepatic gland model for experimental and numerical analysis. COMSOL Multiphysics software with inbuilt bioheat transfer, electromagnetic waves, heat transfer in solids and fluids and laminar flow physics has been used to obtain the numerical results. Experimental analysis has been conducted on egg white using a market-available microwave ablation device. It has been found from the present study that MWA operated at 2.45/6 GHz with the non-parallel position of multiple trocars into the tissue leads to a considerable increase in the ablation region as compared to the parallel insertion of trocars. Hence, non-parallel insertion of trocars is suitable to treat irregular-shaped large cancerous tumours (>3 cm). The non-parallel simultaneous insertion of trocars can overcome the healthy tissue ablation issue as well as the problem associated with indentation. Further, reasonable accuracy (with the difference being nearly ±0.1 cm in ablation diameter) has been achieved in comparing the ablation region and temperature variation between experimental and numerical studies. The present study may create a new path in the ablation of large size tumours (>3 cm) with multiple trocars of all shapes by sparing the healthy tissue.
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Affiliation(s)
- Vellavalapalli Satish
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Ramjee Repaka
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
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Cong R, Ma XH, Wang S, Feng B, Cai W, Chen ZW, Zhao XM. Application of ablative therapy for intrahepatic recurrent hepatocellular carcinoma following hepatectomy. World J Gastrointest Surg 2023; 15:9-18. [PMID: 36741068 PMCID: PMC9896493 DOI: 10.4240/wjgs.v15.i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/20/2022] [Accepted: 12/21/2022] [Indexed: 01/17/2023] Open
Abstract
The post-hepatectomy recurrence rate of hepatocellular carcinoma (HCC) is persistently high, affecting the prognosis of patients. An effective therapeutic option is crucial for achieving long-term survival in patients with postoperative recurrences. Local ablative therapy has been established as a treatment option for resectable and unresectable HCCs, and it is also a feasible approach for recurrent HCC (RHCC) due to less trauma, shorter operation times, fewer complications, and faster recovery. This review focused on ablation techniques, description of potential candidates, and therapeutic and prognostic implications of ablation for guiding its application in treating intrahepatic RHCC.
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Affiliation(s)
- Rong Cong
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao-Hong Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shuang Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bing Feng
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Cai
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhao-Wei Chen
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin-Ming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Andresciani F, Pacella G, Vertulli D, Altomare C, Bitonti MT, Bruno A, Cea L, Faiella E, Beomonte Zobel B, Grasso RF. Microwave ablation using two simultaneous antennas for the treatment of liver malignant lesions: a 3 year single-Centre experience. Int J Hyperthermia 2023; 40:2163309. [PMID: 36599421 DOI: 10.1080/02656736.2022.2163309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND sequential or simultaneous applications of multiple antennas have been proposed to create larger ablation zone; however, there is a lack of data in patients affected by liver tumors, with potentially different results from animal liver models. The purpose of this study was to evaluate efficacy and safety of liver percutaneous microwave ablation using simultaneous activation of two antennas to treat lesions bigger than 2,5 cm; particularly the focus was assessing whether the ratio of ablation zone volume in millimeters to applied energy in kilojoules [R(AZ:E)] differs between hepatocellular carcinoma in a cirrhotic liver and liver metastasis and if it is correlated to complications incidence or recurrence of disease. METHODS Fifty-five liver microwave ablation performed with two simultaneous antennas from March 2017 to June 2021 were retrospectively reviewed; 9 procedures were excluded due to the association with Chemoembolization. Size, shape, volume of lesions and ablation zones were recorded. Technical success was defined as complete devascularization of the treated area at the post-procedural CT. R(AZ:E) was determined dividing the ablation zone volume in mm3 by the amount of energy in kilojoules applied in each procedure and complications were reported. RESULTS Technical success was achieved in all the procedures. Mean R(AZ:E) was 0,75 ± 0,58. T-student test for patients with HCC and patients with metastasis about R(AZ:E) was significant (p = 0.03). The incidence of bilomas was lower for HCC (p = 0.022). One-month follow-up showed Complete Response (CR) in 44/46 (95,6%) patients; Three-six months follow-up demonstrated: CR in 43/46 (93.5%) cases and 12 months follow-up highlighted CR in 40/45 (88,9%) cases. CONCLUSIONS These results provide preliminary evidence of efficacy and safety of simultaneous liver MWA using two antennas, highlighting the importance of procedural indications.
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Affiliation(s)
- Flavio Andresciani
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giuseppina Pacella
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Daniele Vertulli
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Carlo Altomare
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Maria Teresa Bitonti
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Amalia Bruno
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Laura Cea
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | | | - Bruno Beomonte Zobel
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Rosario Francesco Grasso
- Diagnostic and Interventional Radiology Department; Departmental Faculty of Medicine and Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
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Stereotactic Microwave Ablation of Hepatocellular Carcinoma: The Impact of Tumor Size and Minimal Ablative Margin on Therapeutic Success. Tomography 2022; 9:50-59. [PMID: 36648992 PMCID: PMC9844395 DOI: 10.3390/tomography9010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Microwave ablation (MWA) has gained relevance in the treatment of hepatic malignancies and especially in hepatocellular carcinoma (HCC), and it is an important alternative to surgery. The purpose of the study was to evaluate whether the minimal ablative margin (MAM) or the initial tumor size has a greater effect on the success of stereotactic MWA of HCC regarding the time to local tumor progression (LTP) and overall survival (OS). METHODS 88 patients, who received stereotactic MWA of 127 tumor lesions with a curative intention were included in this single-center, retrospective study. The MAM was evaluated in a side-by-side comparison of pre- and post-ablative, contrast-enhanced slice imaging. A Cox proportional hazard model with a frailty term was computed to assess the influence of the MAM and the maximum tumor diameter on the time to LTP and the OS. RESULTS The maximum tumor diameter was identified as a significant positive predictor for LTP (hazard ratio 1.04, 95% CI 1.00-1.08, p = 0.03), but it was not a significant positive predictor for the OS (p = 0.20). The MAM did not have a significant influence on LTP-free survival (p = 0.23) and OS (p = 0.67). CONCLUSION For the successful stereotactic MWA of HCC, the MAM and maximum tumor diameter might not have an influence on the OS, but the maximum tumor diameter seems to be an independent predictor of the time to LTP.
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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: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [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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Vogel A, Meyer T, Sapisochin G, Salem R, Saborowski A. Hepatocellular carcinoma. Lancet 2022; 400:1345-1362. [PMID: 36084663 DOI: 10.1016/s0140-6736(22)01200-4] [Citation(s) in RCA: 1123] [Impact Index Per Article: 374.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma is one of the most common cancers worldwide and represents a major global health-care challenge. Although viral hepatitis and alcohol remain important risk factors, non-alcoholic fatty liver disease is rapidly becoming a dominant cause of hepatocellular carcinoma. A broad range of treatment options are available for patients with hepatocellular carcinoma, including liver transplantation, surgical resection, percutaneous ablation, and radiation, as well as transarterial and systemic therapies. As such, clinical decision making requires a multidisciplinary team that longitudinally adapts the individual treatment strategy according to the patient's tumour stage, liver function, and performance status. With the approval of new first-line agents and second-line agents, as well as the establishment of immune checkpoint inhibitor-based therapies as standard of care, the treatment landscape of advanced hepatocellular carcinoma is more diversified than ever. Consequently, the outlook for patients with hepatocellular carcinoma has improved. However, the optimal sequencing of drugs remains to be defined, and predictive biomarkers are urgently needed to inform treatment selection. In this Seminar, we present an update on the causes, diagnosis, molecular classification, and treatment of hepatocellular carcinoma.
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Affiliation(s)
- Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
| | - Tim Meyer
- Research Department of Oncology, UCL Cancer Institute, University College London, Royal Free Hospital, London, UK
| | - Gonzalo Sapisochin
- Abdominal Transplant & HPB Surgical Oncology, University Health Network, University of Toronto, ON, Canada
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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20
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da Fonseca LG, Araujo RLC. Combination approaches in hepatocellular carcinoma: How systemic treatment can benefit candidates to locoregional modalities. World J Gastroenterol 2022; 28:3573-3585. [PMID: 36161045 PMCID: PMC9372805 DOI: 10.3748/wjg.v28.i28.3573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/19/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
The management of hepatocellular carcinoma (HCC) is challenging because most patients have underlying cirrhosis, and the treatment provides, historically, a limited impact on the natural history of patients with advanced-stage disease. Additionally, recurrence rates are high for those patients who receive local and locoregional modalities, such as surgical (resection and transplantation) or image-guided (ablation and intra-arterial) therapies. Translational research has led to new concepts that are reshaping the current clinical practice. Substantial advancements were achieved in the understanding of the hallmarks that drive hepatocarcinogenesis. This has primed a successful incorporation of novel agents with different targets, such as anti-angiogenic drugs, targeted-therapies, and immune-checkpoint inhibitors. Although clinical trials have proven efficacy of systemic agents in advanced stage disease, there is no conclusive evidence to support their use in combination with loco-regional therapy. While novel local modalities are being incorporated (e.g., radioembolization, microwave ablation, and irreversible electroporation), emerging data indicate that locoregional treatments may induce tumor microenvironment changes, such as hyperexpression of growth factors, release of tumor antigens, infiltration of cytotoxic lymphocytes, and modulation of adaptative and innate immune response. Past trials that evaluated the use of antiangiogenic drugs in the adjuvant setting after ablation or chemoembolization fail to demonstrate a substantial improvement. Current efforts are directed to investigate the role of immunotherapy-based regimens in this context. The present review aims to describe the current landscape of systemic and locoregional treatments for HCC, present evidence to support combination approaches, and address future perspectives.
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Affiliation(s)
- Leonardo Gomes da Fonseca
- Department of Medical Oncology, Instituto do Cancer do Estado de Sao Paulo, University of Sao Paulo, São Paulo 01246-000, São Paulo, Brazil
- Hospital e Maternidade Brasil - Rede D'Or São Luiz, Santo André 09030-590, São Paulo, Brazil
| | - Raphael L C Araujo
- Department of Digestive Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo 04023-062, São Paulo, Brazil
- Hospital e Maternidade Brasil - Rede D'Or São Luiz, Santo André 09030-590, São Paulo, Brazil
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21
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Huang X, Zhou Y, Wang C, Qi F, Luo P, Du H, Zhang Q, Liu Z, Yuan K, Qiu B. Development of a novel MR-conditional microwave needle for MR-guided interventional microwave ablation at 1.5T. Magn Reson Med 2022; 88:1886-1900. [PMID: 35775830 DOI: 10.1002/mrm.29289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop an MR-conditional microwave needle that generates a spherical ablation zone and clear MRI visibility for MR-guided microwave ablation. METHODS An MR-conditional microwave needle consisting of zirconia tip and TA18 titanium alloy tube was investigated. The numerical model was created to optimize the needle's geometry and analyze its performance. A geometrically optimized needle was produced using non-magnetic materials based on the electromagnetics simulation results. The needle's mechanical properties were tested per the Chinese pharmaceutical industry standard YY0899-2013. The MRI visibility performance and ablation characteristics of the needle was tested both in vitro (phantom) and in vivo (rabbit) at 1.5T. The RF-induced heating was evaluated in ex vivo porcine liver. RESULTS The needle's mechanical properties met the specified requirements. The needle susceptibility artifact was clearly visible both in vitro and in vivo. The needle artifact diameter (A) was small in in vivo (Ashaft: 4.96 ± 0.18 mm for T1W-FLASH, 3.13 ± 0.05 mm for T2-weighted fast spin-echo (T2W-FSE); Atip: 2.31 ± 0.09 mm for T1W-FLASH, 2.29 ± 0.08 mm for T2W-FSE; tip location error [TLE]: -0.94 ± 0.07 mm for T1W-FLASH, -1.10 ± 0.09 mm for T2W-FSE). Ablation zones generated by the needle were nearly spherical with an elliptical aspect ratio ranging from 0.79 to 0.90 at 30 W, 50 W for 3, 5, 10 min duration ex vivo ablations and 0.86 at 30 W for 10 min duration in vivo ablations. CONCLUSION The designed MR-conditional microwave needle offers excellent mechanical properties, reliable MRI visibility, insignificant RF-induced heating, and a sufficiently spherical ablation zone. Further clinical development of MR-guided microwave ablation appears warranted.
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Affiliation(s)
- Xiaoyan Huang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Yufu Zhou
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Changliang Wang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Fulang Qi
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Penghui Luo
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Huiyu Du
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Qing Zhang
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Zhengrong Liu
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Kecheng Yuan
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
| | - Bensheng Qiu
- Hefei National Lab for Physical Science at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, AnHui Province, China
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22
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Lee CW, Chiang MH, Wei WC, Liao SS, Liu YB, Huang KC, Chen KL, Kuo WC, Sung YC, Chen TY, Liu JF, Chiang YC, Shih HN, Peng KT, Chieh JJ. Highly efficient magnetic ablation and the contrast of various imaging using biocompatible liquid-metal gallium. Biomed Eng Online 2022; 21:38. [PMID: 35715781 PMCID: PMC9205100 DOI: 10.1186/s12938-022-01003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 05/23/2022] [Indexed: 01/01/2023] Open
Abstract
Background Although the powerful clinical effects of radiofrequency and microwave ablation have been established, such ablation is associated with several limitations, including a small ablation size, a long ablation time, the few treatment positioning, and biosafety risks. To overcome these limitations, biosafe and efficient magnetic ablation was achieved in this study by using biocompatible liquid gallium as an ablation medium and a contrast medium for imaging. Results Magnetic fields with a frequency (f) lower than 200 kHz and an amplitude (H) × f value lower than 5.0 × 109 Am−1 s−1 were generated using the proposed method. These fields could generate an ablation size of 3 cm in rat liver lobes under a temperature of approximately 300 °C and a time of 20 s. The results of this study indicate that biomedical gallium can be used as a contrast medium for the positioning of gallium injections and the evaluation of ablated tissue around a target site. Liquid gallium can be used as an ablation medium and imaging contrast medium because of its stable retention in normal tissue for at least 3 days. Besides, the high anticancer potential of gallium ions was inferred from the self-degradation of 100 µL of liquid gallium after around 21 days of immersion in acidic solutions. Conclusions The rapid wireless ablation of large or multiple lesions was achieved through the simple multi-injection of liquid gallium. This approach can replace the currently favoured procedure involving the use of multiple ablation probes, which is associated with limited benefits and several side effects. Methods Magnetic ablation was confirmed to be highly efficient by the consistent results obtained in the simulation and in vitro tests of gallium and iron oxide as well as the electromagnetic specifics and thermotherapy performance comparison detailed in this study Ultrasound imaging, X-ray imaging, and magnetic resonance imaging were found to be compatible with the proposed magnetic ablation method. Self-degradation analysis was conducted by mixing liquid gallium in acidic solutions with a pH of approximately 5–7 (to imitate a tumour-containing microenvironment). X-ray diffraction was used to identify the gallium oxides produced by degraded gallium ions. Supplementary Information The online version contains supplementary material available at 10.1186/s12938-022-01003-9.
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Affiliation(s)
- Chiang-Wen Lee
- Department of Nursing, Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi County, Taiwan.,Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Ming-Hsien Chiang
- Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chun Wei
- Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Shu-Shien Liao
- Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Yen-Bin Liu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Chih Huang
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuen-Lin Chen
- Department of Physics, National Chung Hsing University, Taichung, Taiwan
| | - Wen-Cheng Kuo
- Department of Mechanical and Automation Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Yuan-Ching Sung
- Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Ting-Yuan Chen
- Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei, Taiwan
| | - Ju-Fang Liu
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Chang Chiang
- Department of Nursing, Division of Basic Medical Sciences, and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi County, Taiwan.,Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopaedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Ti Peng
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Jen-Jie Chieh
- Institute of Electro-Optical Engineering, National Taiwan Normal University, Taipei, Taiwan.
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23
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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24
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Zanus G, Tagliente G, Rossi S, Bonis A, Zambon M, Scopelliti M, Brizzolari M, Grossi U, Romano M, Finotti M. Pulsed Microwave Liver Ablation: An Additional Tool to Treat Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:748. [PMID: 35159014 PMCID: PMC8833939 DOI: 10.3390/cancers14030748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/26/2022] [Accepted: 01/29/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to analyze the outcomes of HCC patients treated with a novel technique-pulsed microwave ablation (MWA)-in terms of safety, local tumor progression (LTP), intrahepatic recurrence (IHR), and overall survival (OS). A total of 126 pulsed microwave procedures have been performed in our center. We included patients with mono- or multifocal HCC (BCLC 0 to D). The LTP at 12 months was 9.9%, with an IHR rate of 27.8% at one year. Survival was 92.0% at 12 months with 29.4% experiencing post-operative complications (28.6% Clavien-Dindo 1-2, 0.8% Clavien-Dindo 3-4). Stratifying patients by BCLC, we achieved BCLC 0, A, B, C, and D survival rates of 100%, 93.2%, 93.3%, 50%, and 100%, respectively, at one year, which was generally superior to or in line with the expected survival rates among patients who are started on standard treatment. The pulsed MWA technique is safe and effective. The technique can be proposed not only in patients with BCLC A staging but also in the highly selected cases of BCLC B, C, and D, confirming the importance of the concept of stage migration. This procedure, especially if performed with a minimally invasive technique (laparoscopic or percutaneous), is repeatable with a short postoperative hospital stay.
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Affiliation(s)
- Giacomo Zanus
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Giovanni Tagliente
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Serena Rossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Alessandro Bonis
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Mattia Zambon
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Scopelliti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Marco Brizzolari
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Ugo Grossi
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Maurizio Romano
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
| | - Michele Finotti
- 4th Surgery Unit, Regional Hospital Treviso, University of Padua, DISCOG, 31100 Padua, Italy; (G.Z.); (G.T.); (S.R.); (A.B.); (M.Z.); (M.S.); (M.B.); (U.G.); (M.R.)
- Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX 75204, USA
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25
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Knott EA, Ziemlewicz TJ, Lubner SJ, Swietlik JF, Weber SM, Zlevor AM, Longhurst C, Hinshaw JL, Lubner MG, Mulkerin DL, Abbott DE, Deming D, LoConte NK, Uboha N, Couillard AB, Wells SA, Laeseke PF, Alexander ML, Lee FT. Microwave ablation for colorectal cancer metastasis to the liver: a single-center retrospective analysis. J Gastrointest Oncol 2021; 12:1454-1469. [PMID: 34532102 DOI: 10.21037/jgo-21-159] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study is to evaluate the safety and intermediate-term efficacy of percutaneous microwave (MW) ablation for the treatment of colorectal liver metastases (CRLM) at a single institution. Methods A retrospective review was performed of all CRLM treated with MW ablation from 3/2011 to 7/2020 (102 tumors; 72 procedures; 57 patients). Mean age was 60 years (range, 36-88) and mean tumor size was 1.8 cm (range, 0.5-5.0 cm). The patient population included 19 patients with extra-hepatic disease. Chemotherapy (pre- and/or post-ablation) was given in 98% of patients. Forty-five sessions were preceded by other focal CRLM treatments including resection, ablation, radiation, and radioembolization. Kaplan-Meier curves were used to estimate local tumor progression-free survival (LTPFS), disease-free survival (DFS), and overall survival (OS) and multivariate analysis (Cox Proportional Hazards model) was used to test predictors of OS. Results Technical success (complete ablation) was 100% and median follow-up was 42 months (range, 1-112). There was a 4% major complication rate and an overall complication rate of 8%. Local tumor progression (LTP) rate during the entire study period was 4/98 (4%), in which 2 were retreated with MW ablation for a secondary LTP-rate of 2%. LTP-free survival at 1, 3, and 5 years was 93%, 58%, and 39% and median LTP-free survival was 48 months. OS at 1, 3, and 5 years was 96%, 66%, 47% and median OS was 52 months. There were no statistically significant predictors of OS. Conclusions MW ablation of hepatic colorectal liver metastases appears safe with excellent local tumor control and prolonged survival compared to historical controls in selected patients. Further comparative studies with other local treatment strategies appear indicated.
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Affiliation(s)
- Emily A Knott
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Sam J Lubner
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - John F Swietlik
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Sharon M Weber
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Colin Longhurst
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Urology, University of Wisconsin-Madison, Madison, WI, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel L Mulkerin
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel E Abbott
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA
| | - Dustin Deming
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Noelle K LoConte
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Nataliya Uboha
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Shane A Wells
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul F Laeseke
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Marci L Alexander
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Urology, University of Wisconsin-Madison, Madison, WI, USA.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Huang Z, Pan Y, Zhou P, Li S, Li K. Long-term outcomes of ultrasound-guided percutaneous microwave ablation versus resection for colorectal cancer liver metastases: a propensity-score matched study. Int J Hyperthermia 2021; 38:1276-1284. [PMID: 34423716 DOI: 10.1080/02656736.2021.1968511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND AIMS Many previous studies comparing liver resection versus thermal ablation for colorectal cancer liver metastases (CRCLM) are subject to severe selection bias. This study aimed to compare the long-term clinical efficacy of ultrasonography-guided percutaneous microwave ablation (PMWA) with resection for CRCLM using propensity score analysis to reduce confounding by indication. METHODS This retrospective study included 184 patients with CRCLM from January 2012 to June 2017. Treatment effect was estimated after propensity score matching, Descriptive, regression and survival statistics were applied. RESULTS A lower American Society of Anesthesiologists classification score and higher performance status were found positively associated with resection (p < 0.05). After propensity score matching, the 1-, 2-, and 3-year local tumor progression free survival rates were found to be 60.3%, 19.1%, and 17.6% in the PMWA group, and 72.1%, 35.3%, 26.5% in the resection group, respectively (p = 0.049). The 1-, 3-, 5-, and 7-year overall survival rates in two groups were similar (p = 0.943). In the PMWA group and resection group, the median hospital stay was 1 (0-12) days and 7 (1-27) days (p = 0.005), respectively; major complications occurred in two patients (2%) and 11 patients (12.9%) (p = 0.009), respectively. CONCLUSIONS After adjusting for factors known to affect treatment choice, no significant difference in overall survival rates was shown after ultrasound-guided PMWA versus resection for CRCLM. The LTPFS rate of the resection group were better than those of the ultrasound-guided PMWA group. However, the ultrasound-guided PMWA group had fewer complications and shorter hospital stay.
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Affiliation(s)
- Zhe Huang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - YongLong Pan
- Institute of Hepato-Pancreato-Bililary Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - PingPing Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - ShanShan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kaiyan Li
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Prud'homme C, Teriitehau C, Adam J, Kyaw Tun J, Roux C, Hakime A, Delpla A, Deschamps F, de Baere T, Tselikas L. Lung microwave ablation - an in vivo swine tumor model experiment to evaluate ablation zones. Int J Hyperthermia 2021; 37:879-886. [PMID: 32689829 DOI: 10.1080/02656736.2020.1787530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate microwave ablation (MWA) algorithms, comparing pulsed and continuous mode in an in vivo lung tumor mimic model. MATERIALS AND METHODS A total of 43 lung tumor-mimic models of 1, 2 or 3 cm were created in 11 pigs through an intra-pulmonary injection of contrast-enriched minced muscle. Tumors were ablated under fluoroscopic and 3D-CBCT-guidance using a single microwave antenna. Continuous (CM) and pulsed mode (PM) were used. According to tumor size, 3 different algorithms for both continuous and pulsed mode were used. The ablation zones were measured using post-procedural 3D-CBCT and on pathologic specimens. RESULTS Two radiologists measured the ablation zones on CBCT and they significantly correlated with macroscopic and microscopic pathological findings: r = 0.75 and 0.74 respectively (p < 0.0001) (inter-observer correlation r = 0.9). For 1, 2 and 3 cm tumors mimics lesions (TMLs), mean maximal and transverse ablation diameters were 3.6 [Formula: see text] 0.3 × 2.2 [Formula: see text] 0.3 cm; 4.1 [Formula: see text] 0.5 × 2.6 [Formula: see text] 0.3 cm and 4.8 [Formula: see text] 0.3 × 3.2 [Formula: see text] 0.3 cm respectively using CM; And, 3.0 [Formula: see text] 0.2 × 2.1 [Formula: see text] 0.2 cm; 4.0 [Formula: see text] 0.4 × 2.7 [Formula: see text] 0.4 cm and 4.6 [Formula: see text] 0.4 × 3.2 [Formula: see text] 0.4 cm respectively for PM, without any significant difference except for 1 cm TMLs treated by PM ablation which were significantly smaller (p = 0.009) The sphericity index was 1.6, 1.6, 1.5 and 1.4, 1.5, 1.4 at 1, 2 and 3 cm for CM and PM respectively, p = 0.07, 0.14 and 0.13 for 1, 2 and 3 cm tumors mimics. CONCLUSION Microwave ablation for 1-3 cm lung tumors were successfully realized but with a moderate reproducibility rate, using either CM or PM. Immediate post ablation CBCT can accurately evaluate ablation zones.
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Affiliation(s)
- Clara Prud'homme
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Christophe Teriitehau
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Julien Adam
- Department of Pathology, Gustave Roussy, Villejuif, France
| | - Jimmy Kyaw Tun
- Interventional Radiology Department, Barts Health NHS Trust, London, UK
| | - Charles Roux
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Antoine Hakime
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Alexandre Delpla
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Fréderic Deschamps
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
| | - Thierry de Baere
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, Saint-Aubin, France
| | - Lambros Tselikas
- Département d' Anesthésie, Chirurgie et Interventionel, Gustave Roussy, Villejuif, France
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Garnon J, Delmas L, De Marini P, Dalili D, Koch G, Auloge P, Cazzato RL, Gangi A. Triple-Antenna Microwave Ablation with Repositioning for the Creation of a Reliable 6-cm Ablation Zone in the Liver. Cardiovasc Intervent Radiol 2021; 44:1291-1295. [PMID: 33948698 DOI: 10.1007/s00270-021-02854-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/17/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France.
| | - Louis Delmas
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Pierre De Marini
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, King's College Hospital NHS Foundation Trust, Strand, London, WC2R 2LS, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France
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Llovet JM, De Baere T, Kulik L, Haber PK, Greten TF, Meyer T, Lencioni R. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol 2021; 18:293-313. [PMID: 33510460 DOI: 10.1038/s41575-020-00395-0] [Citation(s) in RCA: 556] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related mortality and has an increasing incidence worldwide. Locoregional therapies, defined as imaging-guided liver tumour-directed procedures, play a leading part in the management of 50-60% of HCCs. Radiofrequency is the mainstay for local ablation at early stages and transarterial chemoembolization (TACE) remains the standard treatment for intermediate-stage HCC. Other local ablative techniques (microwave ablation, cryoablation and irreversible electroporation) or locoregional therapies (for example, radioembolization and sterotactic body radiation therapy) have been explored, but have not yet modified the standard therapies established decades ago. This understanding is currently changing, and several drugs have been approved for the management of advanced HCC. Molecular therapies dominate the adjuvant trials after curative therapies and combination strategies with TACE for intermediate stages. The rationale for these combinations is sound. Local therapies induce antigen and proinflammatory cytokine release, whereas VEGF inhibitors and tyrosine kinase inhibitors boost immunity and prime tumours for checkpoint inhibition. In this Review, we analyse data from randomized and uncontrolled studies reported with ablative and locoregional techniques and examine the expected effects of combinations with systemic treatments. We also discuss trial design and benchmarks to be used as a reference for future investigations in the dawn of a promising new era for HCC treatment.
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Affiliation(s)
- Josep M Llovet
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Translational Research in Hepatic Oncology, Liver Unit, IDIBAPS, Hospital Clinic, University of Barcelona, Catalonia, Spain. .,Institució Catalana d'Estudis Avançats (ICREA), Barcelona, Catalonia, Spain.
| | - Thierry De Baere
- Radiology Department Gustave Roussy Cancer Center, Vilejuif, France.,University Paris-Saclay, Saint-Aubin, France
| | - Laura Kulik
- Division of Gastroenterology and Hepatology, Surgery and Interventional Radiology in Northwestern University, Chicago, IL, USA
| | - Philipp K Haber
- Mount Sinai Liver Cancer Program, Division of Liver Diseases, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tim F Greten
- Gastrointestinal Malignancy Section, Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tim Meyer
- Deptartment of Oncology, University College London Cancer Institute, London, UK.,Deptartment of Oncology, Royal Free Hospital, London, UK
| | - Riccardo Lencioni
- Department of Radiology, University of Pisa School of Medicine, Pisa, Italy.,Miami Cancer Institute, Miami, FL, USA
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Kuroda H, Nagasawa T, Fujiwara Y, Sato H, Abe T, Kooka Y, Endo K, Oikawa T, Sawara K, Takikawa Y. Comparing the Safety and Efficacy of Microwave Ablation Using Thermosphere TM Technology versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Propensity Score-Matched Analysis. Cancers (Basel) 2021; 13:cancers13061295. [PMID: 33803926 PMCID: PMC7998443 DOI: 10.3390/cancers13061295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Microwave ablation using ThermosphereTM technology is a novel locoregional treatment for hepatocellular carcinoma. This study compared the safety and efficacy outcomes of this microwave ablation strategy versus radiofrequency ablation using propensity score-matched analysis. Microwave ablation led to a high rate of curative ablation (94.7%) and a low rate of local recurrence (3.3%), with an overall survival rate of 99.3% at 1 year (recurrence-free survival: 81.1%) and 88.4% at 2 years (recurrence-free survival: 60.5%). There were no significant differences in survival outcomes after microwave and radiofrequency ablation. However, microwave ablation required significantly fewer insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). Based on the similar survival outcomes, we recommend microwave ablation using ThermosphereTM technology for hepatocellular carcinoma with a diameter of >2 cm because of the lower number of insertions. Abstract There is limited information regarding the oncological benefits of microwave ablation using ThermosphereTM technology for hepatocellular carcinoma. This study compared the overall survival and recurrence-free survival outcomes among patients with hepatocellular carcinoma after microwave ablation using ThermosphereTM technology and after radiofrequency ablation. Between December 2017 and August 2020, 410 patients with hepatocellular carcinoma (a single lesion that was ≤5 cm or ≤3 lesions that were ≤3 cm) underwent ablation at our institution. Propensity score matching identified 150 matched pairs of patients with well-balanced characteristics. The microwave ablation and radiofrequency ablation groups had similar overall survival rates at 1 year (99.3% vs. 98.2%) and at 2 years (88.4% vs. 87.5%) (p = 0.728), as well as similar recurrence-free survival rates at 1 year (81.1% vs. 76.2%) and at 2 years (60.5% vs. 62.1%) (p = 0.492). However, the microwave ablation group had a significantly lower mean number of total insertions (1.22 ± 0.49 vs. 1.59 ± 0.94; p < 0.0001). This retrospective study revealed no significant differences in the overall survival and recurrence-free survival outcomes after microwave ablation or radiofrequency ablation. However, we recommend microwave ablation for hepatocellular carcinoma tumors with a diameter of >2 cm based on the lower number of insertions.
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Filippiadis D, Mazioti A, Velonakis G, Tsochantzis A, Tosoratti N, Kelekis A, Kelekis N. Continuous versus pulsed microwave ablation in the liver: any difference in intraoperative pain scores? Ann Gastroenterol 2021; 34:80-84. [PMID: 33414626 PMCID: PMC7774668 DOI: 10.20524/aog.2020.0557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
Background This study prospectively compared intraoperative pain scores during percutaneous microwave ablation of the liver in patients randomized between continuous and pulsed energy delivery algorithms. Methods During a 12-month period, 20 patients who underwent microwave liver ablation were prospectively randomized between 2 different energy delivery modes: “continuous mode” (CM, n=10) and “pulsed mode” (PM, n=10). All ablation sessions were performed using the same microwave ablation platform under computed tomographic guidance and intravenous analgesia. Within 30 min post ablation, all patients completed a questionnaire assigning a numeric pain intensity score from 0 (no pain) to 10. Results Mean pain scores were 8.17±1.850 in the CM group and 4.50±1.567 in the PM group, with a statistically significant difference of 3.667±2.807 pain units (P=0.001). The mean procedure time was 53.5±20.90 min in the PM group vs. 58.5±17.44 min in the CM group (P=0.279). The mean size of the lesions was 2.81±0.95 cm in the PM group and 2.81±0.85 cm in the CM group (P=0.984). On a per-lesion basis, technical success was achieved in all evaluable tumors in both groups. No difference was noted in the local tumor control on the 6-month imaging evaluation. No complications were observed in the CM arm, while small perihepatic hemorrhagic fluid collections were reported in the PM group. Conclusions Both algorithms for microwave energy delivery have comparable treatment effects in terms of 6-month local tumor control for liver lesions <3 cm in diameter. PM treatments compared to CM appear to induce significantly less pain in patients undergoing percutaneous liver ablation under intravenous analgesia.
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Affiliation(s)
- Dimitrios Filippiadis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Argyro Mazioti
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - George Velonakis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Athanasios Tsochantzis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nevio Tosoratti
- R&D Manager, HS Hospital Service SpA, Aprilia (LT), Italy (Nevio Tosoratti)
| | - Alexis Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
| | - Nikolaos Kelekis
- 2 Department of Radiology, "Attikon" University General Hospital, Medical School, National and Kapodistrian University of Athens, Greece (Dimitrios Filippiadis, Argyro Mazioti, George Velonakis, Athanasios Tsochantzis, Alexis Kelekis, Nikolaos Kelekis)
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Deng H, Zhang T, Jiang X, Huang S, Jiang NN, Lau WY, Jinhua H. Comparison of hydrochloric acid infusion radiofrequency ablation with microwave ablation in an ex vivo liver model. Int J Hyperthermia 2020; 37:600-607. [PMID: 32484363 DOI: 10.1080/02656736.2020.1772995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objectives: To compare sizes and shapes of ablation zones resulting from hydrochloric acid infusion radiofrequency ablation (HRFA) and microwave ablation (MWA), using normal saline infusion radiofrequency ablation (NSRFA) as a control, at a variety of matched power settings and ablation durations, in an ex vivo bovine liver model.Methods: A total of 90 ablation procedures were performed, using each of three modalities: NSRFA, HRFA, and MWA. For each modality, five ablation procedures were performed for each combination of power (80 W, 100 W, or 120 W) and duration (5, 10, 20, 30, 45, or 60 min). The size of ablation zones were compared using ANOVA, the Kruskal-Wallis test, or generalized linear regression.Results: For ablation durations up to 30 min, mean transverse diameter (TD) after HRFA and MWA did not differ significantly (β = 0.13, p = .20). For ablation durations greater than 30 min, mean TD was significantly larger after HRFA than after MWA (β = 1.657, p < .001). The largest TD (9.46 cm) resulted from HRFA performed with 100 W power for 60 min.Conclusions: Compared to MWA, monopolar HRFA with power settings of 80 W-120 W and durations of less than 30 min showed no significant difference. When duration of more than 30 min, HRFA created larger ablation zones than MWA.
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Affiliation(s)
- Hanxia Deng
- 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
| | - Tianqi 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
| | - Xiongying Jiang
- Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Senmiao Huang
- Department of Oncology, Panyu Central Hospital, Guangzhou, People's Republic of China
| | - Nan Nancy Jiang
- Department of Diagnostic Radiology, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Wan-Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, Hong Kong, PR China
| | - Huang Jinhua
- 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
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Pohlman RM, Varghese T. Physiological Motion Reduction Using Lagrangian Tracking for Electrode Displacement Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:766-781. [PMID: 31806499 PMCID: PMC7241290 DOI: 10.1016/j.ultrasmedbio.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/19/2019] [Accepted: 11/04/2019] [Indexed: 05/03/2023]
Abstract
Minimally invasive treatments such as microwave ablation (MWA) have been growing in popularity for extending liver cancer survival rates in patients, when surgery is not an option. As a non-ionizing, real-time alternative to contrast-enhanced computed tomography, electrode displacement elastography (EDE) has shown promise as an imaging modality for MWA. Despite imaging efficacy, motion artifacts caused by physiological motion result in unintended speckle pattern variance, thereby inhibiting consistent and accurate ablated region visualization. To combat these unavoidable motion artifacts, a Lagrangian deformation tracking (LDT) approach based on freehand EDE was developed to track tissue movement and better define tissue properties. For validating LDT efficacy, a spherical inclusion phantom as well as seven in vivo data sets were processed, and strain tensor images were compared with identical time sampled images estimated using a traditional Eulerian approach. In vivo results revealed greater consistency among visualized LDT strain tensor images, with segmented ablated regions exhibiting standard deviation reductions of up to 98% when compared with Eulerian strain tensor images. Additionally, Lagrangian strain tensor images provided Dice coefficient improvements up to 25%, and success rates improved from approximately 50% to nearly 100% for ablated region visualization.
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Affiliation(s)
- Robert M Pohlman
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - Tomy Varghese
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Microwave Ablation (MWA) of Pulmonary Neoplasms: Clinical Performance of High-Frequency MWA With Spatial Energy Control Versus Conventional Low-Frequency MWA. AJR Am J Roentgenol 2019; 213:1388-1396. [PMID: 31593520 DOI: 10.2214/ajr.18.19856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE. The objective of our study was to evaluate the clinical performance of a new high-frequency (HF) microwave ablation (MWA) technology with spatial energy control for treatment of lung malignancies in comparison with a conventional low-frequency (LF) MWA technology. MATERIALS AND METHODS. In this retrospective study, 59 consecutive patients (mean age, 58.9 ± 12.6 [SD] years) were treated in 71 sessions using HF spatial-energy-control MWA. Parameters collected were technical success and efficacy, tumor diameter, tumor and ablation volumes, ablation time, output energy, complication rate, 90-day mortality, local tumor progression (LTP), ablative margin size, and ablation zone sphericity. Results were compared with the same parameters retrospectively collected from the last 71 conventional LF-MWA sessions. This group consisted of 56 patients (mean age, 60.3 ± 10.8 years). Statistical comparisons were performed using the Wilcoxon-Mann-Whitney test. RESULTS. Technical success was 98.6% for both technologies; technical efficacy was 97.2% for HF spatial-energy-control MWA and 95.8% for LF-MWA. The 90-day mortality rate was 5.1% (3/59) in the HF spatial-energy-control MWA group and 5.4% (3/56) in the LF-MWA group; for both groups, there were zero intraprocedural deaths. The median ablation time was 8.0 minutes for HF spatial-energy-control MWA and 10.0 minutes for LF-MWA (p < 0.0001). Complications were recorded in 21.1% (15/71) of HF spatial-energy-control MWA sessions and in 31.0% (22/71) of LF-MWA sessions (p = 0.182); of these complications, 4.2% (3/71) were major complications in the HF spatial-energy-control MWA group, and 9.9% (7/71) were major complications in the LF-MWA group. The median deviation from ideal sphericity (1.0) was 0.195 in the HF spatial-energy-control MWA group versus 0.376 in the LF-MWA group (p < 0.0001). Absolute minimal ablative margins per ablation were 7.5 ± 3.6 mm (mean ± SD) in the HF spatial-energy-control MWA group versus 4.2 ± 3.0 mm in the LF-MWA group (p < 0.0001). In the HF spatial-energy-control MWA group, LTP at 12 months was 6.5% (4/62). LTP at 12 months in the LF-MWA group was 12.5% (7/56). Differences in LTP rate (p = 0.137) and time point (p = 0.833) were not significant. CONCLUSION. HF spatial-energy-control MWA technology and conventional LFMWA technology are safe and effective for the treatment of lung malignancies independent of the MWA system used. However, HF spatial-energy-control MWA as an HF and high-energy MWA technique achieves ablation zones that are closer to an ideal sphere and achieves larger ablative margins than LF-MWA (p < 0.0001).
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Grimm A, Winkelmann M, Weiß J, Gohla G, Blumenstock G, Nikolaou K, Clasen S, Hoffmann R. Artefact and ablation performance of an MR-conditional high-power microwave system in bovine livers: an ex vivo study. Eur Radiol Exp 2019; 3:39. [PMID: 31549338 PMCID: PMC6757083 DOI: 10.1186/s41747-019-0115-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background We evaluated a magnetic resonance (MR)-conditional high-power microwave ablation system. Methods An exvivo 1.5-T evaluation was conducted by varying the sequence (T1-weighted volume interpolated breath-hold examination, T1w-VIBE; T1-weighted fast low-angle shot, T1w-FLASH; T2-weighted turbo spin-echo, T2w-TSE), applicator angulation to B0 (A-to-B0), slice orientation, and encoding direction. Tip location error (TLE) and artefact diameters were measured, and influence of imaging parameters was assessed with analysis of variance and post hoc testing. Twenty-four exvivo ablations were conducted in three bovine livers at 80 W and 120 W. Ablation durations were 5, 10, and 15 min. Ablation zones were compared for short-axis diameter (SAD), volume, and sphericity index (SI) with unpaired t test. Results The artefact pattern was similar for all sequences. The shaft artefact (4.4 ± 2.9 mm, mean ± standard deviation) was dependent on the sequence (p = 0.012) and the A-to-B0 (p < 0.001); the largest shaft diameter was measured with T1w-FLASH (6.3 ± 3.4 mm) and with perpendicular A-to-B0 (6.7 ± 2.4 mm). The tip artefact (1.6 ± 0.7 mm) was dependent on A-to-B0 (p = 0.001); TLE was -2.6 ± 1.0 mm. Ablation results at the maximum setting (15 min, 120 W) were SAD = 42.0 ± 1.41 mm; volume = 56.78 ± 3.08 cm3, SI = 0.68 ± 0.05. In all ablations, SI ranged 0.68–0.75 with the smallest SI at 15 min and 120 W (p = 0.048). Conclusion The system produced sufficiently large ablation zones and the artefact was appropriate for MR-guided interventions.
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Affiliation(s)
- Antonia Grimm
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Moritz Winkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jakob Weiß
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Georg Gohla
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Gunnar Blumenstock
- Institute for Clinical Epidemiology and Applied Biometry, University Hospital of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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Cazzato RL, De Marini P, Leclerc L, Dalili D, Koch G, Rao P, Auloge P, Garnon J, Gangi A. Large nearly spherical ablation zones are achieved with simultaneous multi-antenna microwave ablation applied to treat liver tumours. Eur Radiol 2019; 30:971-975. [PMID: 31529251 DOI: 10.1007/s00330-019-06431-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022]
Abstract
AIM To investigate the shape and the volume of ablation zones obtained with microwave ablation (MWA) performed with multiple antennas in liver tumours. MATERIALS AND METHODS Tumour volume, number of antennas, size (long diameter (Dl), along the antenna axis; short diameter (Ds), perpendicular to the antenna axis; vertical diameter (Dv), vertical to both Dl and Ds) and shape (roundness index (RI); 1 corresponds to a sphere) of the ablation zone, ablation volume, and complications were evaluated. RESULTS Mean Dl, Ds, and Dv were 4.7 ± 1.4 cm, 3.9 ± 1.4 cm, and 3.8 ± 1.0 cm, respectively. Mean RIs (Ds/Dl, Dv/Dl, and Dv/Ds) were 0.83 ± 0.13, 0.83 ± 0.17, and 1.02 ± 0.23, respectively, without any difference between the mean RI obtained with the double (0.84 ± 0.01) and that with the triple-antenna (0.93 ± 0.13) approach (p = 0.25). Mean ablation volume was 41 ± 32 cm3 (vs. mean tumour volume 13 ± 10 cm3; range 1-40; p < 0.001). No complications were noted. CONCLUSIONS Simultaneous multi-antenna MWA of liver tumours results in large nearly spherical ablation zones. KEY POINTS • Simultaneous multi-antenna microwave ablation of liver tumours results in nearly spherical ablation zones. • The multi-antenna approach generates oversized ablation volumes compared with the target tumour volume. • The multi-antenna approach is safe.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France.
| | - Pierre De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Loïc Leclerc
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Danoob Dalili
- Department of Diagnostic and Interventional Radiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
- Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Pramod Rao
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
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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: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [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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Glassberg MB, Ghosh S, Clymer JW, Qadeer RA, Ferko NC, Sadeghirad B, Wright GW, Amaral JF. Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis. Onco Targets Ther 2019; 12:6407-6438. [PMID: 31496742 PMCID: PMC6698169 DOI: 10.2147/ott.s204340] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose Percutaneous ablation techniques, including microwave ablation (MWA) and radiofrequency ablation (RFA), have become important minimally invasive treatment options for liver cancer. This systematic review compared MWA with RFA for treatment of liver cancer. Methods The systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted for randomized and observational studies published from 2006 onwards. A random-effects model was used for meta-analyses and local tumor progression (LTP), technique efficacy, overall survival (OS), disease-free survival (DFS), intrahepatic de novo lesions (IDL), extrahepatic metastases (EHM), length of stay (LOS), and complications were analyzed. Subgroup and sensitivity analyses were also conducted. Results Of 1379 studies identified, 28 randomized and observational studies met inclusion criteria. The main analysis demonstrated that LTP was significantly reduced by 30% with MWA versus RFA (RR=0.70; P=0.02) (all studies) and by 45% with MWA versus RFA (RR=0.55; P=0.007) (randomized studies only). There were no significant differences between MWA and RFA for other efficacy and safety outcomes. Higher frequency (2450 MHz) and larger tumor size (≥2.5 cm) are amongst variables that may be associated with improved outcomes for MWA. Sensitivity analyses were generally congruent with the main results. Conclusion MWA is at least as safe and effective as RFA for treating liver cancer and demonstrated significantly reduced LTP rates. Future studies should assess time and costs associated with these two treatment modalities.
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Affiliation(s)
| | - Sudip Ghosh
- Health Economics and Market Access, Ethicon Inc, Cincinnati, OH, USA
| | | | | | | | | | | | - Joseph F Amaral
- Health Economics and Market Access, Ethicon Inc, Cincinnati, OH, USA
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Ruiter SJS, Heerink WJ, de Jong KP. Liver microwave ablation: a systematic review of various FDA-approved systems. Eur Radiol 2019; 29:4026-4035. [PMID: 30506218 PMCID: PMC6611060 DOI: 10.1007/s00330-018-5842-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/18/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of the present study is to analyze preclinical and clinical data on the performance of the currently US Food and Drug Administration (FDA)-approved microwave ablation (MWA) systems. METHODS A review of the literature, published between January 1, 2005, and December 31, 2016, on seven FDA-approved MWA systems, was conducted. Ratio of ablation zone volume to applied energy R(AZ:E) and sphericity indices were calculated for ex vivo and in vivo experiments. RESULTS Thirty-four studies with ex vivo, in vivo, and clinical data were summarized. In total, 14 studies reporting data on ablation zone volume and applied energy were included for comparison R(AZ:E). A significant correlation between volume and energy was found for the ex vivo experiments (r = 0.85, p < 0.001) in contrast to the in vivo experiments (r = 0.54, p = 0.27). CONCLUSION Manufacturers' algorithms on microwave ablation zone sizes are based on preclinical animal experiments with normal liver parenchyma. Clinical data reporting on ablation zone volume in relation to applied energy and sphericity index during MWA are scarce and require more adequate reporting of MWA data. KEY POINTS • Clinical data reporting on the ablation zone volume in relation to applied energy during microwave ablation are scarce. • Manufacturers' algorithms on microwave ablation zone sizes are based on preclinical animal experiments with normal liver parenchyma. • Preclinical data do not predict actual clinical ablation zone volumes in patients with liver tumors.
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Affiliation(s)
- Simeon J S Ruiter
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
| | - Wouter J Heerink
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Center for Medical Imaging, University of Groningen, Groningen, Netherlands
| | - Koert P de Jong
- Department of HPB Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Center for Medical Imaging, University of Groningen, Groningen, Netherlands
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Longo KC, Knott EA, Watson RF, Swietlik JF, Vlaisavljevich E, Smolock AR, Xu Z, Cho CS, Mao L, Lee FT, Ziemlewicz TJ. Robotically Assisted Sonic Therapy (RAST) for Noninvasive Hepatic Ablation in a Porcine Model: Mitigation of Body Wall Damage with a Modified Pulse Sequence. Cardiovasc Intervent Radiol 2019; 42:1016-1023. [PMID: 31041527 PMCID: PMC7456499 DOI: 10.1007/s00270-019-02215-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/31/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE Robotically assisted sonic therapy (RAST) is a nonthermal, noninvasive ablation method based on histotripsy. Prior animal studies have demonstrated the ability to create hepatic ablation zones at the focal point of an ultrasound therapy transducer; however, these treatments resulted in thermal damage to the body wall within the path of ultrasound energy delivery. The purpose of this study was to evaluate the efficacy and safety of a pulse sequence intended to mitigate prefocal body wall injury. MATERIALS AND METHODS Healthy swine (n = 6) underwent hepatic RAST (VortxRx software version 1.0.1.3, HistoSonics, Ann Arbor MI) in the right hepatic lobe. A 3.0 cm spherical ablation zone was prescribed for each. Following treatment, animals underwent MRI which was utilized for ablation zone measurement, evaluation of prefocal injury, and assessment of complications. Each animal was euthanized, underwent necropsy, and the tissue was processed for histopathologic analysis of the ablation zone and any other sites concerning for injury. RESULTS No prefocal injury was identified by MRI or necropsy in the body wall or tissues overlying the liver. Ablation zones demonstrated uniform cell destruction, were nearly spherical (sphericity index = 0.988), and corresponded closely to the prescribed size (3.0 × 3.1 × 3.4 cm, p = 0.70, 0.36, and 0.01, respectively). Ablation zones were associated with portal vein (n = 3, one occlusive) and hepatic vein thrombosis (n = 4, one occlusive); however, bile ducts remained patent within ablation zones (n = 2). CONCLUSIONS Hepatic RAST performed with a modified ultrasound pulse sequence in a porcine model can mitigate prefocal body wall injuries while maintaining treatment efficacy. Further study of hepatic RAST appears warranted, particularly in tumor models.
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Affiliation(s)
- Katherine C Longo
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI, 53705, USA.
| | - Emily A Knott
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI, 53705, USA
| | - Rao F Watson
- Department of Pathology, University of Wisconsin, Madison, USA
| | - John F Swietlik
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI, 53705, USA
| | - Eli Vlaisavljevich
- Department of Biomedical Engineering and Mechanics, Virginia Polytechnic and State University, Blacksburg, USA
| | - Amanda R Smolock
- Division of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, USA
| | - Clifford S Cho
- Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, USA
- Department of Urology, University of Wisconsin, Madison, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave, Madison, WI, 53705, USA
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Dong LN, Yu XL, Cheng ZG, Han ZY, Liu FY, Chen G, Luo YC, Yu J, Liang P. Comparison of parallel and crossed placement of antennas in microwave ablation of 3-5 cm hepatocellular carcinoma. Abdom Radiol (NY) 2019; 44:2293-2300. [PMID: 30919040 DOI: 10.1007/s00261-019-01959-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the effects of ablation strategies on local tumor progression (LTP) after microwave ablation (MWA) of hepatocellular carcinomas (HCCs) measuring 3-5 cm. MATERIALS AND METHODS Between December 2011 and May 2017, 71 HCC patients with 71 nodules treated by ultrasound(US)-guided percutaneous MWA were divided into parallel (group A) and crossed (group B) antenna placement groups. All patients underwent MWA using two antennas with four insertions. LTP and overall survival (OS) rates were compared between the two groups. RESULTS The median follow-up time was 16.8 months. There was no significant difference in the complete ablation rate and treatment sessions between the two groups. LTP was diagnosed in 8 of 48 nodules (16.7%) in group A and 1 of 23 nodules (4.3%) in group B, with no significant difference between two groups (P = 0.115). The 1-, 2-, and 3-year OS rates were 88.5%, 79%, and 71.8% in group A and 93.8%, 87.5%, and 87.5% in group B, respectively (P = 0.236). Multivariate analysis showed that the tumor diameter (P = 0.017), the distance between the antennas (P = 0.032), and the total emission time (P = 0.015) were associated with LTP. CONCLUSIONS There were trends with lower LTP and improved OS in group B, despite the lack of statistically significant differences between the two strategies at a level of P < 0.05. The increase of distance between antennas and total emission time will facilitate reductions in LTP rate.
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Affiliation(s)
- Li-Nan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Gang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fang-Yi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Gang Chen
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Pohlman RM, Turney MR, Wu P, Brace CL, Ziemlewicz TJ, Varghese T. Two-dimensional ultrasound-computed tomography image registration for monitoring percutaneous hepatic intervention. Med Phys 2019; 46:2600-2609. [PMID: 31009079 PMCID: PMC6758542 DOI: 10.1002/mp.13554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Deformable registration of ultrasound (US) and contrast enhanced computed tomography (CECT) images are essential for quantitative comparison of ablation boundaries and dimensions determined using these modalities. This comparison is essential as stiffness-based imaging using US has become popular and offers a nonionizing and cost-effective imaging modality for monitoring minimally invasive microwave ablation procedures. A sensible manual registration method is presented that performs the required CT-US image registration. METHODS The two-dimensional (2D) virtual CT image plane that corresponds to the clinical US B-mode was obtained by "virtually slicing" the 3D CT volume along the plane containing non-anatomical landmarks, namely points along the microwave ablation antenna. The initial slice plane was generated using the vector acquired by rotating the normal vector of the transverse (i.e., xz) plane along the angle subtended by the antenna. This plane was then further rotated along the ablation antenna and shifted along with the direction of normal vector to obtain similar anatomical structures, such as the liver surface and vasculature that is visualized on both the CT virtual slice and US B-mode images on 20 patients. Finally, an affine transformation was estimated using anatomic and non-anatomic landmarks to account for distortion between the colocated CT virtual slice and US B-mode image resulting in a final registered CT virtual slice. Registration accuracy was measured by estimating the Euclidean distance between corresponding registered points on CT and US B-mode images. RESULTS Mean and SD of the affine transformed registration error was 1.85 ± 2.14 (mm), computed from 20 coregistered data sets. CONCLUSIONS Our results demonstrate the ability to obtain 2D virtual CT slices that are registered to clinical US B-mode images. The use of both anatomical and non-anatomical landmarks result in accurate registration useful for validating ablative margins and comparison to electrode displacement elastography based images.
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Affiliation(s)
- Robert M. Pohlman
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Michael R. Turney
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Po‐Hung Wu
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Christopher L. Brace
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Timothy J. Ziemlewicz
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
| | - Tomy Varghese
- Department of Medical PhysicsUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWI53706USA
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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: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Oramas A, Case JB, Toskich BB, Fox-Alvarez WA, Boston SE, Giglio RF, Dark MJ. Laparoscopic access to the liver and application of laparoscopic microwave ablation in 2 dogs with liver neoplasia. Vet Surg 2019; 48:O91-O98. [DOI: 10.1111/vsu.13153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Alberto Oramas
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - J. Brad Case
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Beau B. Toskich
- Department of Interventional Radiology; Mayo Clinic; Jacksonville Florida
| | - W. Alexander Fox-Alvarez
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Sarah E. Boston
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Robson F. Giglio
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
| | - Michael J. Dark
- Department of Small Animal Clinical Sciences, Veterinary Medical Center; University of Florida; Gainesville Florida
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Pohlman RM, Varghese T. Dictionary Representations for Electrode Displacement Elastography. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:2381-2389. [PMID: 30296219 PMCID: PMC6400457 DOI: 10.1109/tuffc.2018.2874181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Ultrasound electrode displacement elastography (EDE) has demonstrated the potential to monitor ablated regions in human patients after minimally invasive microwave ablation procedures. Displacement estimation for EDE is commonly plagued by decorrelation noise artifacts degrading displacement estimates. In this paper, we propose a global dictionary learning approach applied to denoising displacement estimates with an adaptively learned dictionary from EDE phantom displacement maps. The resulting algorithm is one that represents displacement patches sparsely if they contain low noise and averages remaining patches thereby denoising displacement maps while retaining important edge information. The results of dictionary-represented displacements presented with a higher signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) with improved contrast, as well as improved phantom inclusion delineation when compared to initial displacements, median-filtered displacements, and spline smoothened displacements, respectively. In addition to visualized noise reduction, dictionary-represented displacements presented with the highest SNR, CNR, and improved contrast with values of 1.77, 4.56, and 4.35 dB, respectively, when compared to axial strain tensor images estimated using the initial displacements. Following EDE phantom imaging, we utilized dictionary representations from in vivo patient data, further validating efficacy. Denoising displacement estimates are a newer application for dictionary learning producing strong ablated region delineation with little degradation from denoising.
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46
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Francica G, Altiero M, Laccetti E, Pezzullo F, Tanga M, Avitabile G, Elameer M, Scaglione M. Long-term follow-up of unresectable medium-large hepatocellular carcinoma nodules treated with radiofrequency ablation using a multiple-electrode switching system. Br J Radiol 2018; 92:20180625. [PMID: 30272482 DOI: 10.1259/bjr.20180625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat unresectable medium-large (3.1-6.0 cm) HCC nodules. METHODS RFA using a multiple-electrode switching system was performed for HCC nodules with size > 3.0 < 6.0 cm in nonsurgical candidates. Two electrodes were consecutively placed for 3.1-4.0 cm tumours, and three electrodes for 4.1-5.9 cm tumours, with a 2.0-2.5 cm spacing. The power was switched from one electrode to the next automatically when the impedance reached 30 Ω above the baseline level. 25 patients (M/F = 9/16; median age 76 years, range 61-84) with liver cirrhosis (20 HCV-positive) in Child's Class A (22 cases) and B (3 cases) and 26 HCC nodules (median diameter 4.0 cm; range 3.2-5.5 cm) underwent treatment in 25 sessions from 2013 and 2018. Therapeutic effectiveness was assessed through CT or MRI exam at 30-40 days post-ablation. RESULTS No procedure-related death or major complications occurred. Complete ablation was obtained in all nodules (100%). At a median follow up of 30 months, local tumor progression occurred in five out of 26 nodules (19.2%). Overall survival at 4 years was 49%. CONCLUSION RFA with a multiple-electrode switching system may be a safe, quick and effective therapeutic option for treatment of 3.1-6.0 cm unresectable HCC tumours. ADVANCES IN KNOWLEDGE RFA with multiple electrodes provides favourable clinical results in patients with medium-large HCC nodules who are not suitable for surgery.
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Affiliation(s)
- Giampiero Francica
- Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Altiero
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Ettore Laccetti
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Filomena Pezzullo
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michela Tanga
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Mathew Elameer
- Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy.,Department of Radiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
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Kim C. Understanding the nuances of microwave ablation for more accurate post-treatment assessment. Future Oncol 2018; 14:1755-1764. [DOI: 10.2217/fon-2017-0736] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Microwave ablation (MWA) is a relatively new thermal modality for minimally invasive procedures compared with radiofrequency ablation. Although MWA and radiofrequency ablation are thermal modalities, their underlying physics and principles greatly differ. Consequently, it is imperative that clinicians be aware of how these differences impact realized ablation volumes to consistently ensure technical success and better patient outcomes. This paper will review the nuances specific to MWA technology (i.e., tissue properties, perfusion/heat sink effect, ablation assessment, imaging accuracy and tissue contraction) that are often overlooked based on familiarity with conventional thermal modalities to guide more accurate assessment of post-treatment MWA volumes.
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Affiliation(s)
- Christy Kim
- Angio Dynamics, Inc., 1850 Mt Diablo Blvd, Ste 660, Walnut Creek, CA 94596, 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: 0.9] [Reference Citation Analysis] [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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Yang W, Varghese T, Ziemlewicz T, Alexander M, Lubner M, Hinshaw JL, Wells S, Lee FT. Delineation of Post-Procedure Ablation Regions with Electrode Displacement Elastography with a Comparison to Acoustic Radiation Force Impulse Imaging. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1953-1962. [PMID: 28595851 PMCID: PMC5523876 DOI: 10.1016/j.ultrasmedbio.2017.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 05/03/2023]
Abstract
We compared a quasi-static ultrasound elastography technique, referred to as electrode displacement elastography (EDE), with acoustic radiation force impulse imaging (ARFI) for monitoring microwave ablation (MWA) procedures on patients diagnosed with liver neoplasms. Forty-nine patients recruited to this study underwent EDE and ARFI with a Siemens Acuson S2000 system after an MWA procedure. On the basis of visualization results from two observers, the ablated region in ARFI images was recognizable on 20 patients on average in conjunction with B-mode imaging, whereas delineable ablation boundaries could be generated on 4 patients on average. With EDE, the ablated region was delineable on 40 patients on average, with less imaging depth dependence. Study of tissue-mimicking phantoms revealed that the ablation region dimensions measured on EDE and ARFI images were within 8%, whereas the image contrast and contrast-to-noise ratio with EDE was two to three times higher than that obtained with ARFI. This study indicated that EDE provided improved monitoring results for minimally invasive MWA in clinical procedures for liver cancer and metastases.
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Affiliation(s)
- Wenjun Yang
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA.
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Timothy Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Marci Alexander
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Meghan Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - James Louis Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shane Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Zhou Q, Wu S, Gong N, Li X, Dou J, Mu M, Yu X, Yu J, Liang P. Liposomes loading sodium chloride as effective thermo-seeds for microwave ablation of hepatocellular carcinoma. NANOSCALE 2017; 9:11068-11076. [PMID: 28741635 DOI: 10.1039/c7nr02955a] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Microwave ablation (MWA) is a promising minimally invasive therapy that has been widely used to treat hepatocellular carcinoma (HCC). However, the efficiency of MWA in treating HCC is evidently limited by the incomplete ablation of large tumors and tumors in high-risk locations. Here, we report the value of using liposomes packed with sodium chloride (NaCl-LPs) as effective thermo-seeds for MWA of HCC. The prepared liposomes exhibited excellent heat conversion ability by showing a more rapid temperature increase than free NaCl medium, blank liposomes or water under microwave irradiation. The high efficiency of this new microwave sensitization strategy was fully demonstrated in vitro in subcutaneous and orthotopic tumors. The results showed that MWA combined with NaCl-LPs clearly enhanced the ablation efficiency, leading to apparent tumor inhibition and low recurrence. What's more, we verified the susceptibility of NaCl-LPs on orthotopic tumors. Based on the unique properties of NaCl-LPs, sublethal MWA was used to mimic the transitional zone, and large-scale necrosis was observed in tumors combined with NaCl-LPs. In addition, HE staining and blood hematology analysis revealed no noticeable toxicity of NaCl-LPs in vivo, which confirmed that NaCl-LPs possessed good biocompatibility. CONCLUSION The effective nanoparticles could play a valuable role in enhancing the thermo-sensitizing effect of MWA for achieving better therapeutic efficacy.
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Affiliation(s)
- Qunfang Zhou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
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