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Wu J, Zhou Z, Huang Y, Deng X, Zheng S, He S, Huang G, Hu B, Shi M, Liao W, Huang N. Radiofrequency ablation: mechanisms and clinical applications. MedComm (Beijing) 2024; 5:e746. [PMID: 39359691 PMCID: PMC11445673 DOI: 10.1002/mco2.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 10/04/2024] Open
Abstract
Radiofrequency ablation (RFA), a form of thermal ablation, employs localized heat to induce protein denaturation in tissue cells, resulting in cell death. It has emerged as a viable treatment option for patients who are ineligible for surgery in various diseases, particularly liver cancer and other tumor-related conditions. In addition to directly eliminating tumor cells, RFA also induces alterations in the infiltrating cells within the tumor microenvironment (TME), which can significantly impact treatment outcomes. Moreover, incomplete RFA (iRFA) may lead to tumor recurrence and metastasis. The current challenge is to enhance the efficacy of RFA by elucidating its underlying mechanisms. This review discusses the clinical applications of RFA in treating various diseases and the mechanisms that contribute to the survival and invasion of tumor cells following iRFA, including the roles of heat shock proteins, hypoxia, and autophagy. Additionally, we analyze the changes occurring in infiltrating cells within the TME after iRFA. Finally, we provide a comprehensive summary of clinical trials involving RFA in conjunction with other treatment modalities in the field of cancer therapy, aiming to offer novel insights and references for improving the effectiveness of RFA.
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Affiliation(s)
- Jianhua Wu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Zhiyuan Zhou
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Yuanwen Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Xinyue Deng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Siting Zheng
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Shangwen He
- Department of Respiratory and Critical Care MedicineChronic Airways Diseases Laboratory, Nanfang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - Genjie Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Binghui Hu
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Min Shi
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Wangjun Liao
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
| | - Na Huang
- Department of Oncology, Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongChina
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2
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State-of-the-art surgery for hepatocellular carcinoma. Langenbecks Arch Surg 2021; 406:2151-2162. [PMID: 34405284 DOI: 10.1007/s00423-021-02298-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the most commonly diagnosed primary liver tumor with an increasing incidence worldwide. Management of patients with HCC is largely dictated by the presence of cirrhosis, disease stage, underlying liver function, and patient performance status. PURPOSE We provide an update on key aspects of surgical treatment options for patients with HCC. RESULTS & CONCLUSIONS: Liver resection and transplantation remain cornerstone treatment options for patients with early-stage disease and constitute the only potentially curative options for HCC. Selection of patients for surgical treatment should include a thorough evaluation of tumor characteristics and biology, as well as evidence-based use of various available treatment options to achieve optimal long-term outcomes for patients with HCC.
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Catania R, Dasyam AK, Miller FH, Borhani AA. Noninvasive Imaging Prior to Biliary Interventions. Semin Intervent Radiol 2021; 38:263-272. [PMID: 34393336 DOI: 10.1055/s-0041-1731268] [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]
Abstract
Noninvasive imaging is a crucial and initial step in the diagnostic algorithm of patients with suspected biliary pathology and directs the subsequent diagnostic and therapeutic workup, including the endoluminal and percutaneous biliary interventions. This article reviews the current noninvasive imaging methods for the evaluation of biliary system and further discusses their roles in the diagnostic workup of different biliary disease.
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Affiliation(s)
- Roberta Catania
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anil K Dasyam
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Cheung TT, Ma KW, She WH. A review on radiofrequency, microwave and high-intensity focused ultrasound ablations for hepatocellular carcinoma with cirrhosis. Hepatobiliary Surg Nutr 2021; 10:193-209. [PMID: 33898560 DOI: 10.21037/hbsn.2020.03.11] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Hepatocellular carcinoma (HCC) is usually accompanied by liver cirrhosis, which makes treatment of this disease challenging. Liver transplantation theoretically provides an ultimate solution to the disease, but the maximal surgical stress and the scarcity of liver graft make this treatment option impossible for some patients. In an ideal situation, a treatment that is safe and effective should provide a better outcome for patients with the dilemma. Objective This article aims to give a comprehensive review of various types of loco-ablative treatment for HCC. Evidence Review Loco-ablative treatment bridges the gap between surgical resection and transarterial chemotherapy. Various types of ablative therapy have their unique ability, and evidence-based outcome analysis is the most important key to assisting clinicians to choose the most suitable treatment modality for their patients. Findings Radiofrequency ablation (RFA) has a relatively longer history and more evidence to support its effectiveness. Microwave ablation (MWA) is gaining momentum because of its shorter ablation time and consistent ablation zone. High-intensity focused ultrasound (HIFU) ablation is a relatively new technology that provides non-invasive treatment for patients with HCC. It has been carried out at centers of excellence and it is a safe and effective treatment option for selected patients with HCC and liver cirrhosis. Conclusion and Relevance Selective use of different loco-ablative therapies will enhance clinicians' treatment options for treatment of HCC.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China
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Ou S, Xu R, Li K, Chen Y, Kong Y, Liu H, Li J, Ouyang Y, Yu X. Radiofrequency ablation with systemic chemotherapy in the treatment of colorectal cancer liver metastasis: a 10-year single-center study. Cancer Manag Res 2018; 10:5227-5237. [PMID: 30464620 PMCID: PMC6217171 DOI: 10.2147/cmar.s170160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective To retrospectively evaluate the long-term efficacy and safety of radiofrequency ablation (RFA) with systemic chemotherapy (CT) in treatment of solitary liver metastasis after surgery for colorectal cancer (CRC). Methods This single-center study was conducted at the Hunan Provincial Cancer Hospital from June 2006 to December 2015 with median follow-up time of 26 months. Percutaneous ultrasound-guided RFA was carried out on eligible patients with solitary liver metastasis after surgery for CRC. After a week, ablation status was confirmed by MRI. Post MRI, all patients received systemic CT with or without molecular-targeted therapy. Survival rate was evaluated and survival curve was constructed with Kaplan-Meier analysis. Log-rank test and Cox regression model were used for univariate and multivariate analysis, respectively, to determine the independent prognostic factors for survival rate. Results A total of 109 eligible patients (mean age, 53.84±11.71; mean tumor mass diameter, 3.4+2.01 cm) were enrolled in this 10-year study. After RFA, 95 patients achieved complete ablation, and 14 patients achieved partial ablation, with median ablation time of 26 minutes (range: 12-120 minutes). The median survival time required for achieving complete and partial ablation was 56.0 and 19.0 months, respectively (P<.01). After RFA and adjuvant systemic CT, the 1-, 3-, and 5-year survival rates were 92.3%, 50.7%, and 41.6%, respectively, with the median (mean) survival time of 39.0 (56.5) months. Age was the only significant independent prognostic factor with better survival rate observed in patients aged ≥50 years than those aged <50 years (P<0.05). The incidence of complications was minimal (1.8%) with only two cases: one biliary fistula and one liver hemorrhage. Conclusion RFA combination with systemic CT was safe; it showed long-term efficacy in patients with solitary liver metastasis after surgery for CRC and can be a preferred treatment.
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Affiliation(s)
- Shuangyan Ou
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Ruocai Xu
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Ke Li
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Yong Chen
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Yi Kong
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Hanchun Liu
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Jianliang Li
- Department of Hepatobiliary and Pancreatic Medicine, Hunan Cancer Hospital, Changsha City, Hunan Province, China,
| | - Yongzhong Ouyang
- Department of Gastroduodenal Surgery, Hunan Provincial Cancer Hospital, Changsha City, Hunan Province, China
| | - Xiaoping Yu
- Department of Radiology, Hunan Cancer Hospital, Changsha City, Hunan Province, China
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Seidensticker R, Damm R, Enge J, Seidensticker M, Mohnike K, Pech M, Hass P, Amthauer H, Ricke J. Local ablation or radioembolization of colorectal cancer metastases: comorbidities or older age do not affect overall survival. BMC Cancer 2018; 18:882. [PMID: 30200921 PMCID: PMC6131876 DOI: 10.1186/s12885-018-4784-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background Local ablative techniques are emerging in patients with oligometastatic disease from colorectal carcinoma, commonly described as less invasive than surgical methods. This single arm cohort seeks to determine whether such methods are suitable in patients with comorbidities or higher age. Methods Two hundred sixty-six patients received radiofrequency ablation (RFA), CT-guided high-dose rate brachytherapy (HDR-BT) or Y90-radioembolization (Y90-RE) during treatment of metastatic colorectal cancer (mCRC). This cohort comprised of patients with heterogenous disease stages from single liver lesions to multiple organ systems involvement commonly following multiple chemotherapy lines. Data was reviewed retrospectively for patient demographics, previous therapies, initial or disease stages at first intervention, comorbidities and mortality. Comorbidity was measured using the Charlson Comorbidity Index (CCI) and age-adjusted Charlson Index (CACI) excluding mCRC as the index disease. Kaplan-Meier survival analysis and Cox regression were used for statistical analysis. Results Overall median survival of 266 patients was 14 months. Age ≥ 70 years did not influence survival after local therapies. Similarly, CCI or CACI did not affect the patients prognoses in multivariate analyses. Moderate or severe renal insufficiency (n = 12; p = 0.005) was the only single comorbidity identified to negatively affect the outcome after local therapy. Conclusion Interventional procedures for mCRC may be performed safely even in elderly and comorbid patients. In severe renal insufficiency, the use of invasive techniques should be limited to selected cases.
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Affiliation(s)
- Ricarda Seidensticker
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Julia Enge
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Max Seidensticker
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Konrad Mohnike
- Diagnostic and Treatment Center Frankfurter Tor, Berlin, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Peter Hass
- Department of Radiation Oncology, Otto-von-Guericke-University Magdeburg, Berlin, Germany
| | - Holger Amthauer
- Department of Nuclear Medicine, Charite, Berlin, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology, Ludwig-Maximilians-University Munich, Munich, Germany.,Deutsche Akademie für Mikrotherapie e.V, Magdeburg, Germany
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Cassinotto C, Denys A, Gay F, Duran R, Hocquelet A, Piron L, Guiu B. Radiofrequency Ablation of Liver Tumors: No Difference in the Ablation Zone Volume Between Cirrhotic and Healthy Liver. Cardiovasc Intervent Radiol 2018; 41:905-911. [PMID: 29484466 DOI: 10.1007/s00270-018-1898-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 02/07/2018] [Indexed: 01/20/2023]
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Kotewall CN, Cheung TT, She WH, Ma KW, Tsang SHY, Dai JWC, Chan ACY, Chok KSH, Lo CM. The role of radiofrequency ablation to liver transection surface in patients with close tumor margin of HCC during hepatectomy-a case matched study. Transl Gastroenterol Hepatol 2017; 2:33. [PMID: 28529987 PMCID: PMC5420546 DOI: 10.21037/tgh.2017.03.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/10/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To review the outcome of using radiofrequency ablation (RFA) for patients with close resection margin during hepatectomy. METHODS From Oct 2004 to Sept 2013, 862 patients received hepatectomy for hepatocellular carcinoma (HCC) in the Department of Surgery, Queen Mary Hospital in Hong Kong. Fourteen patients received additional RFA because of close resection margin (<1 cm) during the operation for HCC. The result of 28 patients with close liver resection margin was selected for comparison. The two groups of patients were matched in terms of tumor size, tumor number, stage of disease and magnitude of resection. RESULTS In the RFA group (n=14), the median age of the patients was 58.5 (range, 25-78 years). The median tumor size was 2.25 cm (range, 1.2-12 cm). In the resection alone group (n=28), the median age for the patients was 61 (range, 36-79 years). The median tumor size was 2.7 cm (range, 1-11 cm). There was no difference in terms of liver function assessment between the two groups. There was no RFA related complication recorded during the study period. There was no hospital mortality in both groups. The 1- and 3-year disease free survival was 38.3% and 25.5% respectively in the RFA group vs. 57.4% and 39.3% respectively in the liver resection alone group (P=0.563). The 1- and 3-year overall survival was 81.5% and 69.8% respectively in the RFA group vs .88.4% and 59.9% respectively in the liver resection alone group (P=0.83). CONCLUSIONS RFA to hepatectomy resection surface in patients with close margin is a safe treatment option but its effectiveness on prevention of local recurrence has yet to be confirmed.
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Affiliation(s)
- C. Nicholas Kotewall
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Wong Hoi She
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Ka Wing Ma
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Simon Hing Ying Tsang
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | - Jeff Wing Chiu Dai
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | | | | | - Chung Mau Lo
- Departments of Pathology and Surgery, State Key Laboratory for Liver Research, University of Hong Kong, Hong Kong 999077, China
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Radiofrequency ablation vs. hepatic resection for resectable colorectal liver metastases. ACTA ACUST UNITED AC 2016; 36:514-518. [PMID: 27465325 DOI: 10.1007/s11596-016-1617-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 04/13/2016] [Indexed: 01/16/2023]
Abstract
The treatments of resectable colorectal liver metastases (CRLM) are controversial. This study aimed to evaluate the relative efficacy and safety of hepatic resection (HR) and radiofrequency ablation (RFA) for treating resectable CRLM. Between January 2004 and May 2010, the enrolled patients were given hepatic resection (HR group; n=32) or percutaneous RFA (RFA group; n=21) as a first-line treatment for CRLM. All the tumors had a maximum diameter of 3.5 cm and all patients had five or less tumors. The patient background, tumor characteristics, cumulative survival rate and recurrence-free survival rate were assessed in both groups. There were significantly more patients with comorbidities in the RFA group than those in the HR group (17 in RFA group vs. 10 in HR group; P<0.000). The mean maximum tumor diameter in the HR group and RFA group was 2.25±0.68 and 1.89±0.62 cm (P=0.054), and the mean number of tumors was 2.28±1.05 and 2.38±1.12 (P=0.744), respectively. The 1-, 3- and 5-year cumulative survival rates in the HR group were 87.5%, 53.1% and 31.3%, respectively, and those in the RFA group were 85.7%, 38.1% and 14.2%, respectively with the differences being not significant between the two groups (P=0.062). The 1-, 3- and 5-year recurrence-free survival rates in the HR group were 90.6%, 56.3% and 28.1%, respectively, and those in the RFA group were 76.1%, 23.8% and 4.8%, respectively, with the differences being significant between the two groups (P=0.036). In conclusion, as HR has greater efficacy than RFA in the treatment of resectable CRLM, we recommend it as the first option for this malignancy.
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Egger J, Busse H, Brandmaier P, Seider D, Gawlitza M, Strocka S, Voglreiter P, Dokter M, Hofmann M, Kainz B, Hann A, Chen X, Alhonnoro T, Pollari M, Schmalstieg D, Moche M. Interactive Volumetry Of Liver Ablation Zones. Sci Rep 2015; 5:15373. [PMID: 26482818 PMCID: PMC4612735 DOI: 10.1038/srep15373] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 09/24/2015] [Indexed: 12/14/2022] Open
Abstract
Percutaneous radiofrequency ablation (RFA) is a minimally invasive technique that destroys cancer cells by heat. The heat results from focusing energy in the radiofrequency spectrum through a needle. Amongst others, this can enable the treatment of patients who are not eligible for an open surgery. However, the possibility of recurrent liver cancer due to incomplete ablation of the tumor makes post-interventional monitoring via regular follow-up scans mandatory. These scans have to be carefully inspected for any conspicuousness. Within this study, the RF ablation zones from twelve post-interventional CT acquisitions have been segmented semi-automatically to support the visual inspection. An interactive, graph-based contouring approach, which prefers spherically shaped regions, has been applied. For the quantitative and qualitative analysis of the algorithm's results, manual slice-by-slice segmentations produced by clinical experts have been used as the gold standard (which have also been compared among each other). As evaluation metric for the statistical validation, the Dice Similarity Coefficient (DSC) has been calculated. The results show that the proposed tool provides lesion segmentation with sufficient accuracy much faster than manual segmentation. The visual feedback and interactivity make the proposed tool well suitable for the clinical workflow.
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Affiliation(s)
- Jan Egger
- Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2 C, 02150 Espoo, Finland.,Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria.,BioTechMed-Graz, Austria
| | - Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - Philipp Brandmaier
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - Daniel Seider
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - Steffen Strocka
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
| | - Philip Voglreiter
- Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Mark Dokter
- Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Michael Hofmann
- Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Bernhard Kainz
- Department of Computing, Imperial College London, Huxley Building, 180 Queen's Gate, London SW7 2AZ, UK
| | - Alexander Hann
- Department of Internal Medicine and Gastroenterology, Katharinenhospital, Kriegsbergstraße 60, 70174 Stuttgart, Germany
| | - Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, School of Mechanical Engineering, Shanghai Jiao Tong University, Dong Chuan Road 800, Shanghai Post Code: 200240, China
| | - Tuomas Alhonnoro
- Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2 C, 02150 Espoo, Finland
| | - Mika Pollari
- Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2 C, 02150 Espoo, Finland
| | - Dieter Schmalstieg
- Institute for Computer Graphics and Vision, Faculty of Computer Science and Biomedical Engineering, Graz University of Technology, Inffeldgasse 16, 8010 Graz, Austria
| | - Michael Moche
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany
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Han K, Ko HK, Kim KW, Won HJ, Shin YM, Kim PN. Radiofrequency Ablation in the Treatment of Unresectable Intrahepatic Cholangiocarcinoma: Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2015; 26:943-8. [DOI: 10.1016/j.jvir.2015.02.024] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/14/2015] [Accepted: 02/24/2015] [Indexed: 12/16/2022] Open
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12
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Babawale SN, Jensen TM, Frøkjær JB. Long-term survival following radiofrequency ablation of colorectal liver metastases: A retrospective study. World J Gastrointest Surg 2015; 7:33-38. [PMID: 25848490 PMCID: PMC4381154 DOI: 10.4240/wjgs.v7.i3.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 12/28/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively evaluate the long-term survival of patients that received radiofrequency ablation (RFA) therapies of colorectal liver metastases.
METHODS: In 2005 to 2008, RFA of 105 colorectal liver metastases (CRLM) were performed on 49 patients in our institution. The liver metastases were evaluated, both before and after ablation therapies, with contrast enhanced computerised tomography and contrast enhanced ultrasonography. Histological evidence of malignant liver metastases was obtained in the few instances where contrast enhanced ultrasonography gave equivocal results. Accesses to the CRLM were guided ultrasonically in all patients. The data obtained from records of these ablations were retrospectively analysed and survival data were compared with existing studies in the literature.
RESULTS: 1-, 2-, 3-, 4- and 5-year survival rates, when no stringent selection criteria were applied, were 92%, 65%, 51%, 41% and 29% respectively. To explore the impact of the number and size of CRLM on patients’ survival, an exclusion of 13 patients (26.5%) with number of CRLM ≥ 5 and tumour size ≥ 40 mm resulted in 1-, 2-, 3-, 4- and 5-year survival rates improving to 94%, 69%, 53%, 42% and 31% respectively. It is of note that 9 of 49 patients developed extra-hepatic metastases, not visible or seen on pre-treatment scans, just after RFA treatment. These patients had poorer survival. The development of extra-hepatic metastases in nearly 20% of the patients included in our study can partly account for modestly lower survival rates as compared with earlier studies in the literature.
CONCLUSION: Our study underscores the fact that optimum patients’ selection before embarking on RFA treatment is vitally important to achieving a superior outcome.
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13
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Egger J, Busse H, Brandmaier P, Seider D, Gawlitza M, Strocka S, Voglreiter P, Dokter M, Hofmann M, Kainz B, Chen X, Hann A, Boechat P, Yu W, Freisleben B, Alhonnoro T, Pollari M, Moche M, Schmalstieg D. RFA-cut: Semi-automatic segmentation of radiofrequency ablation zones with and without needles via optimal s-t-cuts. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:2423-2429. [PMID: 26736783 DOI: 10.1109/embc.2015.7318883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this contribution, we present a semi-automatic segmentation algorithm for radiofrequency ablation (RFA) zones via optimal s-t-cuts. Our interactive graph-based approach builds upon a polyhedron to construct the graph and was specifically designed for computed tomography (CT) acquisitions from patients that had RFA treatments of Hepatocellular Carcinomas (HCC). For evaluation, we used twelve post-interventional CT datasets from the clinical routine and as evaluation metric we utilized the Dice Similarity Coefficient (DSC), which is commonly accepted for judging computer aided medical segmentation tasks. Compared with pure manual slice-by-slice expert segmentations from interventional radiologists, we were able to achieve a DSC of about eighty percent, which is sufficient for our clinical needs. Moreover, our approach was able to handle images containing (DSC=75.9%) and not containing (78.1%) the RFA needles still in place. Additionally, we found no statistically significant difference (p<;0.423) between the segmentation results of the subgroups for a Mann-Whitney test. Finally, to the best of our knowledge, this is the first time a segmentation approach for CT scans including the RFA needles is reported and we show why another state-of-the-art segmentation method fails for these cases. Intraoperative scans including an RFA probe are very critical in the clinical practice and need a very careful segmentation and inspection to avoid under-treatment, which may result in tumor recurrence (up to 40%). If the decision can be made during the intervention, an additional ablation can be performed without removing the entire needle. This decreases the patient stress and associated risks and costs of a separate intervention at a later date. Ultimately, the segmented ablation zone containing the RFA needle can be used for a precise ablation simulation as the real needle position is known.
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Yin G, Chen M, Yang S, Li J, Zhu T, Zhao X. Treatment of uterine myomas by radiofrequency thermal ablation: a 10-year retrospective cohort study. Reprod Sci 2014; 22:609-14. [PMID: 25355802 DOI: 10.1177/1933719114556481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients' selection criteria, effectiveness, and safety of radiofrequency thermal ablation (RFTA) therapy for uterine myomas (UM) were assessed using a 10-year retrospective cohort study. From July 2001 to July 2011, a total of 1216 patients treated for UM were divided into 2 groups. Group A consisted of 476 premenopause patients, average age 36.5 ± 8.5 years, average number of myomas 1.7 ± 0.9, and average diameter of myomas 4.5 ± 1.5 cm, and group B consisted of 740 menopause patients, average age 48.5 ± 3.5 years, average number of myomas 2.6 ± 1.3, and average diameter of myomas 5.0 ± 2.5 cm. Average follow-up period was 36.5 ± 11.5 months. At 1, 3, 6, 12, and 24 months after RFTA, average diameters of myomas in group A were 3.8, 3.0, 2.7, 2.4, and 2.2 cm, respectively, and 47.7% (227 of 476) of patients had tumor trace at 12 months after RFTA. In group B, the results were 4.7, 3.7, 3.3, 2.3, and 2.3 cm, respectively, and 58.8% (435 of 740) of patients had tumor trace at 12 months after RFTA. Three months after treatment, myoma volumes were significantly reduced in both the groups (P < .01), and group B had higher rate of tumor trace at 12 months after RFTA than group A (P < .05). Clinical symptoms and health-related quality-of-life outcome (HRQL) were significantly improved after RFTA in both groups and the postoperative recurrence rate of UM was significantly higher in group A at 10.7% (51 of 476) than group B at 2.4% (18 of 740; P < .05). Radiofrequency thermal ablation is an excellent minimally invasive treatment for UM smaller than 5.0 cm in diameter.
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Affiliation(s)
- Geping Yin
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Ming Chen
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Shujun Yang
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Juan Li
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Tongyu Zhu
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
| | - Xiaoli Zhao
- Department of Obstetrics & Gynecology, Jinan Military General Hospital, Jinan, China
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Iida H, Aihara T, Ikuta S, Yamanaka N. Comparative study of percutaneous radiofrequency ablation and hepatic resection for small, poorly differentiated hepatocellular carcinomas. Hepatol Res 2014; 44:E156-62. [PMID: 24164784 DOI: 10.1111/hepr.12264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Revised: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 02/08/2023]
Abstract
AIM Histologically, poorly differentiated hepatocellular carcinomas (HCC) are considered highly malignant. Here, we aimed to evaluate the relative efficacy and safety of hepatic resection or radiofrequency ablation (RFA) for treating this malignancy. METHODS Between April 2004 and May 2011, we enrolled 48 patients who had poorly differentiated HCC that had been diagnosed postoperatively by pathological assessment. All the tumors had a maximum diameter of 3 cm and all patients had three or less tumors. Fifteen of these patients underwent hepatic resection (HR group) and 33 patients underwent RFA (RF group). The patient background, tumor characteristics, overall survival rate and recurrence-free survival rate were assessed in both groups. RESULTS The mean maximum tumor diameter was 2.5 and 2.0 cm in the HR and RF groups, respectively. The prothrombin activity level was 94% and 86% in the HR and RF groups, respectively. The 1-, 3- and 5-year cumulative survival rates were 89.1%, 68.7% and 68.7%, respectively, in the HR group, and 59.2%, 40.9% and 32.7%, respectively, in the RF group. The 1-, 3- and 5-year recurrence-free survival rates were 85.1%, 64.8% and 48.6%, respectively, in the HR group, and 29.0%, 7.2% and 7.2%, respectively, in the RF group. There was a significant difference between these groups (P < 0.05). CONCLUSION As hepatic resection has greater efficacy than RFA in the treatment of poorly differentiated HCC, even in cases with a small tumor size, we recommend its use for this malignancy.
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Affiliation(s)
- Hiroya Iida
- Department of Surgery, Meiwa Hospital, Nishinomiya, Japan
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Yu H, Burke CT. Comparison of percutaneous ablation technologies in the treatment of malignant liver tumors. Semin Intervent Radiol 2014; 31:129-37. [PMID: 25071303 PMCID: PMC4078184 DOI: 10.1055/s-0034-1373788] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tumor ablation is a minimally invasive technique used to deliver chemical, thermal, electrical, or ultrasonic damage to a specific focal tumor in an attempt to achieve substantial tumor destruction or complete eradication. As the technology continues to advance, several image-guided tumor ablations have emerged to effectively manage primary and secondary malignancies in the liver. Percutaneous chemical ablation is one of the oldest and most established techniques for treating small hepatocellular carcinomas. However, this technique has been largely replaced by newer modalities including radiofrequency ablation, microwave ablation, laser-induced interstitial thermotherapy, cryoablation, high-intensity-focused ultrasound ablation, and irreversible electroporation. Because there exist significant differences in underlying technological bases, understanding each mechanism of action is essential for achieving desirable outcomes. In this article, the authors review the current state of each ablation method including technological and clinical considerations.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T. Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Zhang M, Liang P, Cheng ZG, Yu XL, Han ZY, Yu J. Efficacy and safety of artificial ascites in assisting percutaneous microwave ablation of hepatic tumours adjacent to the gastrointestinal tract. Int J Hyperthermia 2014; 30:134-41. [DOI: 10.3109/02656736.2014.891765] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Kim JW, Shin SS, Kim JK, Choi SK, Heo SH, Lim HS, Hur YH, Cho CK, Jeong YY, Kang HK. Radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of single hepatocellular carcinoma of 2 to 5 cm in diameter: comparison with surgical resection. Korean J Radiol 2013; 14:626-35. [PMID: 23901320 PMCID: PMC3725357 DOI: 10.3348/kjr.2013.14.4.626] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/06/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) with surgical resection in patients with a single hepatocellular carcinoma (HCC) ranging from 2 to 5 cm. MATERIALS AND METHODS The study participants were enrolled over a period of 29 months and were comprised of 37 patients in a combined therapy group and 47 patients in a surgical resection group. RFA was performed the day after TACE, and surgical resection was performed by open laparotomy. The two groups were compared with respect to the length of hospital stay, rates of major complication, and rates of recurrence-free and overall survival. RESULTS Major complications occurred more frequently in the surgical resection group (14.9%) than in the combined therapy group (2.7%). However, there was no statistical significance (p = 0.059). The rates of recurrence-free survival at 1, 2, 3 and 4 years were similar between the combined therapy group (89.2%, 75.2%, 69.4% and 69.4%, respectively) and the surgical resection group (81.8%, 68.5%, 68.5% and 65%, respectively) (p = 0.7962, log-rank test). The overall survival rates at 1, 2, 3 and 4 years were also similar between groups (97.3%, 86.5%, 78.4% and 78.4%, respectively, in the combined therapy group, and 95.7%, 89.4%, 84.3% and 80.3%, respectively, in the surgical resection group) (p = 0.6321, log-rank test). CONCLUSION When compared with surgical resection for the treatment of a single HCC ranging from 2 to 5 cm, RFA combined with TACE shows similar results in terms of recurrence-free and overall survival rates.
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Affiliation(s)
- Jin Woong Kim
- Department of Radiology, Chonnam National University Hwasun Hospital, Hwasun 519-763, Korea
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Stintzing S, Grothe A, Hendrich S, Hoffmann RT, Heinemann V, Rentsch M, Fuerweger C, Muacevic A, Trumm CG. Percutaneous radiofrequency ablation (RFA) or robotic radiosurgery (RRS) for salvage treatment of colorectal liver metastases. Acta Oncol 2013; 52:971-7. [PMID: 23409768 DOI: 10.3109/0284186x.2013.766362] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stereotactic radiation therapy is an evolving modality to treat otherwise unresectable liver metastases. In this analysis, two local therapies: 1) single session robotic radiosurgery (RRS) and 2) percutaneous radiofrequency ablation (RFA) were compared in a total of 60 heavily pretreated colorectal cancer patients. METHODS Thirty patients with a total of 35 colorectal liver metastases not qualifying for surgery that were treated in curative intent with RRS were prospectively followed. To compare efficacy of both treatment modalities, patients treated with RFA during the same period of time were matched according to number and size of the treated lesions. Local tumor control, local disease free survival (DFS), and freedom from distant recurrence (FFDR) were analyzed for efficacy. Treatment-related side effects were recorded for comparison. RESULTS The median diameter of the treated lesions was 33 mm (7-53 mm). Baseline characteristics did not differ significantly between the groups. One- and two-year local control rates showed no significant difference but favored RRS (85% vs. 65% and 80% vs. 61%, respectively). A significantly longer local DFS of patients treated with RRS compared to RFA (34.4 months vs. 6.0 months; p < 0.001) was found. Both, median FFDR (11.4 months for RRS vs. 7.1 months for RFA p = 0.25) and the recurrence rate (67% for RRS and 63% for RFA, p > 0.99) were comparable. CONCLUSION Single session RRS is a safe and effective method to treat colorectal liver metastases. In this analysis, a trend towards longer DFS was seen in patients treated with RRS when compared to RFA.
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Affiliation(s)
- Sebastian Stintzing
- Department of Medical Oncology and Comprehensive Cancer Center, Klinikum Grosshadern, LMU, Munich, Germany.
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Pretreatment microbubble-induced enhancement in hepatocellular carcinoma predicts intrahepatic distant recurrence after radiofrequency ablation. AJR Am J Roentgenol 2013; 200:570-7. [PMID: 23436846 DOI: 10.2214/ajr.12.8999] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this study is to examine whether pretreatment findings in hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound can predict local or distant recurrence after radiofrequency ablation (RFA). SUBJECTS AND METHODS Subjects of the prospective study were 54 patients with HCC lesions treated by RFA. Intensity differences between lesion and liver parenchyma at early arterial (4 seconds) and peak enhancement times and washout at late phase were provided on contrast-enhanced sonograms with perflubutane microbubble agent. The pretreatment findings were examined with respect to intrahepatic local and distant recurrence. RESULTS Univariate analysis showed that intensity differences at the early arterial time (hazard ratio [HR], 2.2; 95% CI, 1.0-4.6; p = 0.042) and lesion frequency (HR, 2.3; 95% CI, 1.0-5.0; p = 0.044) were risk factors for distant recurrence. Multivariate analysis showed that intensity differences at the early arterial time (HR, 2.7; 95% CI, 1.2-5.8; p = 0.014) and lesion frequency (HR, 2.9; 95% CI, 1.3-6.5; p = 0.015) were risk factors for distant recurrence. The cumulative distant recurrence rate for patients with intensity differences at the early arterial time was greater at less than 10 dB than at 10 dB or higher (33.3% and 91.3% vs 23.9% and 65.1% at 1 and 2 years, respectively; p = 0.035). The cumulative distant recurrence rate was 16.5% and 61.1% at 1 and 2 years, respectively, in patients with solitary lesions and 54.7% and 77.4% at 1 and 2 years, respectively, in patients with multiple lesions (p = 0.0296). No pretreatment findings were predictive for local recurrence. CONCLUSION HCC lesions with gradual enhancement in the early arterial time displayed potential distant recurrence risk after RFA, requiring careful posttreatment surveillance.
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Computed tomography-guided interstitial high dose rate brachytherapy for centrally located liver tumours: a single institution study. Eur Radiol 2013; 23:2264-70. [PMID: 23515917 DOI: 10.1007/s00330-013-2816-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/15/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the clinical outcome of computed tomography (CT)-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the treatment of unresectable primary and secondary liver malignancies. This report updates and expands our previously described experience with this treatment technique. METHODS Forty-one patients with 50 tumours adjacent to the liver hilum and bile duct bifurcation were treated in 59 interventions of CT-guided IRT HDR BRT. The tumours were larger than 4 cm with a median volume of 84 cm(3) (38-1,348 cm(3)). The IRT HDR BRT delivered a median total physical dose of 20.0 Gy (7.0-32.0 Gy) in twice daily fractions of median 7.0 Gy (4.0-10.0 Gy) in 19 patients and in once daily fractions of median 8.0 Gy (7.0-14.0 Gy) in 22 patients. RESULTS With a median follow-up of 12.4 months, the local control for metastatic hepatic tumours was 89 %, 73 % and 63 % at 6, 12 and 18 months respectively. The local control for primary hepatic tumours was 90 %, 81 % and 50 % at 6, 12 and 18 months respectively. Severe side effects occurred in 5.0 % of interventions with no treatment-related deaths. CONCLUSIONS CT-guided IRT HDR BRT is a promising procedure for the radiation treatment of centrally located liver malignancies. KEY POINTS • Interstitial high-dose-rate brachytherapy (IRT HDR BRT) is a promising treatment for central liver tumours • CT-guided IRT HDR BRT is safe for treating extensive tumours • CT-guided IRT HDR BRT could play a role in managing unresectable hepatic malignancies.
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Hypofractionated radiotherapy with Tomotherapy for patients with hepatic oligometastases: retrospective analysis of two institutions. Clin Exp Metastasis 2013; 30:643-50. [DOI: 10.1007/s10585-013-9568-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 01/18/2013] [Indexed: 12/25/2022]
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Passera K, Selvaggi S, Scaramuzza D, Garbagnati F, Vergnaghi D, Mainardi L. Radiofrequency ablation of liver tumors: quantitative assessment of tumor coverage through CT image processing. BMC Med Imaging 2013; 13:3. [PMID: 23324557 PMCID: PMC3626768 DOI: 10.1186/1471-2342-13-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) is one of the most promising non-surgical treatments for hepatic tumors. The assessment of the therapeutic efficacy of RFA is usually obtained by visual comparison of pre- and post-treatment CT images, but no numerical quantification is performed. METHODS In this work, a novel method aiming at providing a more objective tool for the evaluation of RFA coverage is described. Image registration and segmentation techniques were applied to enable the visualization of the tumor and the corresponding post-RFA necrosis in the same framework. In addition, a set of numerical indexes describing tumor/necrosis overlap and their mutual position were computed. RESULTS After validation of segmentation step, the method was applied on a dataset composed by 10 tumors, suspected not to be completed treated. Numerical indexes showed that only two tumors were totally treated and the percentage of a residual tumor was in the range of 5.12%-35.92%. CONCLUSIONS This work represents a first attempt to obtain a quantitative tool aimed to assess the accuracy of RFA treatment. The possibility to visualize the tumor and the correspondent post-RFA necrosis in the same framework and the definition of some synthetic numerical indexes could help clinicians in ameliorating RFA treatment.
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Affiliation(s)
- Katia Passera
- Istituto di Ricerche Farmacologiche Mario Negri – IRCCS, Bergamo, Italy
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Iida H, Aihara T, Ikuta S, Yamanaka N. Effectiveness of impedance monitoring during radiofrequency ablation for predicting popping. World J Gastroenterol 2012; 18:5870-8. [PMID: 23139602 PMCID: PMC3491593 DOI: 10.3748/wjg.v18.i41.5870] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/30/2012] [Accepted: 08/04/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively evaluate the effectiveness of impedance monitoring for predicting popping during radiofrequency ablation (RFA) using internally cooled electrodes.
METHODS: We reviewed 140 patients (94 males, 46 females; age range 73.0 ± 11.1 year) who underwent RFA between February 2006 and November 2008 with a modified protocol using a limited power delivery rather than a conventional one to avoid popping. All the patients provided their written informed consent, and the study was approved by the institutional review board. Intraprocedural impedances were measured for the study subjects, and the tumors were classified into three types according to the characteristics of their impedance curves: increasing, flat, or decreasing. The tumors were further sorted into seven subtypes (A-G) depending on the curvature of the impedance curve’s increase or decrease. Relative popping rates were determined for the three types and seven subtypes. A chi-square test was performed to estimate statistical significance.
RESULTS: A total of 148 nodules treated by RFA were analyzed. The study samples included 132 nodules of hepatocellular carcinoma, 14 nodules of metastatic liver cancer, and two nodules of intrahepatic cholangiocarcinoma. The numbers of nodules with each impedance curve type were as follows: 37 increasing-type nodules, 43 flat-type nodules, and 68 decreasing-type nodules. Popping occurrence rates were 24.3%, 46.5% and 64.7%, respectively. Flat-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P = 0.039). Decreasing-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P < 0.0001). Notably, nodules that showed a sharp decrease in impedance in the latter ablation period (subtype E) exhibited a significantly higher rate of popping compared to other subtypes.
CONCLUSION: Intraprocedural impedance monitoring can be a useful tool to predict the occurrence of popping during liver tumor RFA performed with internally cooled electrodes.
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Tselis N, Chatzikonstantinou G, Kolotas C, Milickovic N, Baltas D, Chung TL, Zamboglou N. Hypofractionated accelerated computed tomography–guided interstitial high-dose-rate brachytherapy for liver malignancies. Brachytherapy 2012; 11:507-14. [DOI: 10.1016/j.brachy.2012.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 01/03/2012] [Accepted: 02/16/2012] [Indexed: 01/20/2023]
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Kamei S, Matsuda J, Hagihara M, Kitagawa A, Izumi Y, Katsuda E, Oshima Y, Ikeda S, Kimura J, Ota T, Kawamura T, Ishiguchi T. Oblique approach for CT-guided liver radiofrequency ablation using multiplanar reformation images in hepatocellular carcinoma. Jpn J Radiol 2012; 30:533-9. [PMID: 22528338 DOI: 10.1007/s11604-012-0074-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/13/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of CT-guided radiofrequency (RF) ablation by caudal-cranial oblique insertion using multiplanar reformation (MPR) images for hepatocellular carcinomas (HCCs). MATERIALS AND METHODS Twenty-two HCCs in 19 patients that were difficult to demonstrate on ultrasound (mean tumor diameter was 17.5 mm) were treated with CT-guided RF ablation by caudal-cranial oblique insertion to avoid pneumothorax, using MPR images after transcatheter arterial chemoembolization. The insertion point and direction of insertion, avoiding aerated lung parenchyma, bones, large vessels, and intestine, were sought on the MPR images. Technical success was defined as complete eradication of tumor enhancement in the contrast-enhanced CT. Local tumor progression was defined by the appearance of enhanced tumor adjacent to the zone of ablation. The technical success rate, local tumor progression, and complications were investigated. RESULTS The coronal plane was used for insertion in 18 tumors, the sagittal plane in 3 tumors, and the oblique plane in 1 tumor. RF electrode placement was successful and complete necrosis was obtained in all cases. During the mean follow-up period of 38.0 months, local tumor progression was not detected in any of the patients. There were no major complications, including pneumothorax. CONCLUSION CT-guided RF ablation by caudal-cranial oblique insertion using MPR images is a feasible and safe therapeutic option.
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Affiliation(s)
- Seiji Kamei
- Department of Radiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan.
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Veltri A, Guarnieri T, Gazzera C, Busso M, Solitro F, Fora G, Racca P. Long-term outcome of radiofrequency thermal ablation (RFA) of liver metastases from colorectal cancer (CRC): size as the leading prognostic factor for survival. Radiol Med 2012; 117:1139-51. [PMID: 22430677 DOI: 10.1007/s11547-012-0803-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 07/14/2011] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to review some prognostic factors for survival after radiofrequency ablation (RFA) of metastases from colorectal cancer (CRC). MATERIALS AND METHODS From 1996 to 2009, 262 patients with metastases from CRC were treated with RFA. Fourteen were lost to follow-up. The following predictors were analysed in the remaining 248: synchronous/metachronous metastases, single/multiple metastases, diameter of largest metastasis and absence/presence of extrahepatic metastases. Survival was measured from the date of metastasis diagnosis and from the date of RFA. RESULTS Survival at 1, 2, 3 and 5 years was 93%, 78%, 62% and 35% from metastasis diagnosis, and 84%, 59%, 43% and 23% from the date of RFA. Median survival was 41 months in patients with largest metastasis ≤3 cm and 21.7 months for those with metastases >3 cm (p=0.0001); survival increased to 45.2 months in patients with largest metastasis ≤2.5 cm and fell to 18.5 months in those with metastasis >3.5 cm. Median survival of patients with extrahepatic metastases was significantly lower than that of patients without extrahepatic disease (23.3 vs. 32.6 months, p=0.018). CONCLUSIONS In light of our long-term results obtained with commonly used equipment, small lesion size (diameter of largest lesion ≤3 or 2.5 cm) proved to be the most favourable prognostic factor for survival in patients with CRC metastases to the liver treated with RFA. This conclusion is probably related to the possibility of obtaining radical ablation and points to the usefulness of devices allowing ablation of larger volumes. In the presence of extrahepatic metastases, RFA has less impact on survival, even though it is potentially useful in patients at a higher risk of death due to hepatic rather than extrahepatic metastases.
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Affiliation(s)
- A Veltri
- Istituto di Radiologia, Università di Torino, Facoltà San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano Torino, Italy.
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Minimally invasive evaluation and treatment of colorectal liver metastases. Int J Surg Oncol 2012; 2011:686030. [PMID: 22312518 PMCID: PMC3263653 DOI: 10.1155/2011/686030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 05/05/2011] [Indexed: 12/07/2022] Open
Abstract
Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
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Brunello F, Carucci P, Gaia S, Rolle E, Brunocilla PR, Castiglione A, Ciccone G, Rizzetto M. Local Tumor Progression of Hepatocellular Carcinoma After Microwave Percutaneous Ablation: A Preliminary Report. Gastroenterology Res 2012; 5:28-32. [PMID: 27785175 PMCID: PMC5051038 DOI: 10.4021/gr401w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 01/17/2023] Open
Abstract
Background Microwaves (MW) technology is an ablative treatment alternative to radiofrequency (RF) for early stages of hepatocellular carcinoma (HCC) in cirrhotic patients not suitable for surgical resection. It is well known that HCC lesions ≥ 30 mm treated by RF show a high rate of local tumor progression because of residual of unablated neoplastic tissue. Methods Aim of this study was to describe a limited experience of MW ablation (9 cirrhotic patients with medium size HCC: 11 lesions, 31 - 50 mm in diameter) treated from June 2009 to May 2010 by one of currently marketed western MW ablation systems and followed up for 2 years. Primary end-point was the probability of local tumor progression at 24 months; secondary end-point was the safety of the procedure. Results Radiological response after a single session and re-evaluation of local tumor progression along the time were performed by contrast enhanced computed-tomography at months 1-8-12-24. Early effectiveness rate was 90.1 %. The cumulative incidence of local tumor progression at 1 and 2 years were 36.4% (95% CI 11.2 - 62.7) and 57.6% (95% CI 23.6 - 81.0). We observed a single minor complication of the procedure. Conclusions In conclusion, MW ablation system “Amica” has a high rate of primary effectiveness rate but residual of unablated neoplastic tissue induce local tumor progression in about half of the cases during the following 2 years.
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Affiliation(s)
- Franco Brunello
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Patrizia Carucci
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Silvia Gaia
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Emanuela Rolle
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Paola Rita Brunocilla
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Anna Castiglione
- Departement of Tumor Epidemiology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Giovannino Ciccone
- Departement of Tumor Epidemiology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
| | - Mario Rizzetto
- Department of Gastro-Hepatology, Azienda Ospedaliera San Giovanni Battista della Citta di Torino, corso Bramante, 88 Turin, Italy
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Tiong LU, Field JBF, Maddern GJ. Bimodal electric tissue ablation (BETA) compared with the Cool-Tip RFA system. ANZ J Surg 2012; 82:269-74. [PMID: 22510186 DOI: 10.1111/j.1445-2197.2011.05990.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bimodal electric tissue ablation (BETA) incorporates the process of electrolysis into radiofrequency ablation (RFA) to increase the size of tissue ablation. This study investigated whether BETA could increase the efficacy of the Cool-Tip RF system (Covidien, Boulder, CO, USA) to produce larger ablations. It also investigated whether applying electrolysis only during the pretreatment phase (called electrochemical treatment (ECT)/RFA group) is as effective as BETA (where electrolysis was used during both the pretreatment and RFA phases). METHODS A Cool-Tip RF system (Covidien) was used to test three types of ablations (RFA, BETA, and ECT/RFA) in a pig liver model. In BETA, 9 V of direct current was provided for 10 min, after which the RF generator was started and both electrical circuits were allowed to run concurrently. In ECT/RFA, however, the direct current circuit was switched off after 10 min of pretreatment and only RFA was performed as described above. Ablation sizes were measured in three dimensions. RESULTS The size of ablations (transverse diameter A and B) produced by BETA and ECT/RFA was significantly larger compared with standard RFA (P < 0/001). BETA also created larger ablations compared with ECT/RFA (P < 0.001). CONCLUSION BETA could improve the efficacy of the Cool-Tip RF system (Covidien) to achieve larger ablations. The increased tissue hydration improved delivery of electrical energy to the tissues and delayed the process of desiccation, thus allowing the ablation process to continue for longer periods of time to produce larger ablations. BETA could be used to treat larger liver tumours more effectively than standard RFA.
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Affiliation(s)
- Leong Ung Tiong
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Lee J, Lee JM, Yoon JH, Lee JY, Kim SH, Lee JE, Han JK, Choi BI. Percutaneous radiofrequency ablation with multiple electrodes for medium-sized hepatocellular carcinomas. Korean J Radiol 2011; 13:34-43. [PMID: 22247634 PMCID: PMC3253401 DOI: 10.3348/kjr.2012.13.1.34] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 08/26/2011] [Indexed: 12/29/2022] Open
Abstract
Objective To prospectively evaluate the safety and short-term therapeutic efficacy of switching monopolar radiofrequency ablation (RFA) with multiple electrodes to treat medium-sized (3.1-5.0 cm), hepatocellular carcinomas (HCC). Materials and Methods In this prospective study, 30 patients with single medium-sized HCCs (mean, 3.5 cm; range, 3.1-4.4 cm) were enrolled. The patients were treated under ultrasonographic guidance by percutaneous switching monopolar RFA with a multichannel RF generator and two or three internally cooled electrodes. Contrast-enhanced CT scans were obtained immediately after RFA, and the diameters and volume of the ablation zones were then measured. Follow-up CT scans were performed at the first month after ablation and every three months thereafter. Technical effectiveness, local progression and remote recurrence of HCCs were determined. Results There were no major immediate or periprocedural complications. However, there was one bile duct stricture during the follow-up period. Technical effectiveness was achieved in 29 of 30 patients (97%). The total ablation time of the procedures was 25.4 ± 8.9 minutes. The mean ablation volume was 73.8 ± 56.4 cm3 and the minimum diameter was 4.1 ± 7.3 cm. During the follow-up period (mean, 12.5 months), local tumor progression occurred in three of 29 patients (10%) with technical effectiveness, while new HCCs were detected in six of 29 patients (21%). Conclusion Switching monopolar RFA with multiple electrodes in order to achieve a sufficient ablation volume is safe and efficient. This method also showed relatively successful therapeutic effectiveness on short-term follow up for the treatment of medium-sized HCCs.
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Affiliation(s)
- Jung Lee
- Seoul National University Hospital, Seoul 110-744, Korea
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Radiofrequency ablation for treatment of symptomatic uterine fibroids. Obstet Gynecol Int 2011; 2012:194839. [PMID: 21961009 PMCID: PMC3180825 DOI: 10.1155/2012/194839] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 07/21/2011] [Indexed: 11/30/2022] Open
Abstract
The use of thermal energy-based systems to treat uterine fibroids has resulted in a plethora of devices that are less invasive and potentially as effective in reducing symptoms as traditional options such as myomectomy. Most thermal ablation devices involve hyperthermia (heating of tissue), which entails the conversion of an external electromagnetic or ultrasound waves into intracellular mechanical energy, generating heat. What has emerged from two decades of peer-reviewed research is the concept that hyperthermic fibroid ablation, regardless of the thermal energy source, can create large areas of necrosis within fibroids resulting in reductions in fibroid volume, associated symptoms and the need for reintervention. When a greater percentage of a fibroid's volume is ablated, symptomatic relief is more pronounced, quality of life increases, and it is more likely that such improvements will be durable. We review radiofrequency ablation (RFA), one modality of hyperthermic fibroid ablation.
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Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011; 98:1210-24. [PMID: 21766289 DOI: 10.1002/bjs.7669] [Citation(s) in RCA: 202] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite being one of the commonest causes of cancer-related death around the world, only 20 per cent of hepatocellular carcinomas (HCCs) are amenable to curative treatment (surgical resection or liver transplantation). Radiofrequency ablation (RFA) has emerged as a popular therapy for unresectable HCC. There is evidence that the disparity in survival after curative RFA and surgery for HCC, especially tumours smaller than 3 cm in diameter, is narrowing. This review examined the survival and disease recurrence rates after RFA for HCC over the past decade. METHODS A systematic review was conducted using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register and the Database of Abstracts of Reviews of Effects from January 2000 until November 2010. Papers reporting on patients with HCC who were treated with RFA, either in comparison or in combination with other interventions, such as surgery or percutaneous ethanol injection (PEI), were eligible for inclusion. Outcome data collected were overall survival, disease-free survival and disease recurrence rates. Only randomized controlled trials (RCTs), quasi-RCTs and non-randomized comparative studies with more than 12 months' follow-up were included. RESULTS Forty-three articles, including 12 RCTs, were included in the review. The majority of the articles reported the use of RFA for unresectable HCC, often in combination with other treatments such as PEI, transarterial chemoembolization and/or surgery. Overall and disease-free survival rates continue to improve, despite an increase in the size and numbers of tumours treated. More recently some clinicians have used RFA to treat selected patients with resectable HCC, with good outcomes. CONCLUSION RFA provides a valuable treatment option for patients with unresectable HCC. It improves survival in those previously considered to have advanced disease. As progress continues to be made, RFA is gradually being used to treat resectable HCC.
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Affiliation(s)
- L Tiong
- University of Adelaide Department of Surgery, Queen Elizabeth Hospital, Woodville, Adelaide, South Australia 5011, Australia
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Kim KH, Yoon YS, Yu CS, Kim TW, Kim HJ, Kim PN, Ha HK, Kim JC. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:25-34. [PMID: 22066097 PMCID: PMC3204557 DOI: 10.4174/jkss.2011.81.1.25] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 04/23/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection for the treatment of colorectal liver metastasis (CRLM). METHODS Between 1996 and 2008, 177 patients underwent RFA, 278 underwent hepatic resection and 27 underwent combination therapy for CRLM. Comparative analysis of clinical outcomes was performed including number of liver metastases, tumor size, and time of CRLM. RESULTS Based on multivariate analysis, overall survival (OS) correlated with the number of liver metastases and the use of combined chemotherapy (P < 0.001, respectively). Disease-free survival (DFS) also correlated with the number of liver metastases (P < 0.001). In the 226 patients with solitary CRLM < 3 cm, OS and DFS rates did not differ between the RFA group and the resection group (P = 0.962 and P = 0.980). In the 70 patients with solitary CRLM ≥ 3 cm, DFS was significantly lower in the RFA group as compared with the resection group (P = 0.015). CONCLUSION The results indicate that RFA may be a safe alternative treatment for solitary CRLM less than 3 cm, with outcomes equivalent to those achieved with hepatic resection. A randomized controlled study comparing RFA and resection for patients with single small metastasis would help to determine the most efficient treatment modalities for CRLM.
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Affiliation(s)
- Kyung Ho Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Jin Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pyo Nyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Kwon Ha
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Winkler I, Adam D. Monitoring radio-frequency thermal ablation with ultrasound by low frequency acoustic emissions--in vitro and in vivo study. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:755-767. [PMID: 21497718 DOI: 10.1016/j.ultrasmedbio.2010.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 11/05/2010] [Accepted: 11/12/2010] [Indexed: 05/30/2023]
Abstract
The object of this study was to evaluate the monitoring of thermal ablation therapy by measuring the nonlinear response to ultrasound insonation at the region being treated. Previous reports have shown that during tissue heating, microbubbles are formed. Under the application of ultrasound, these microbubbles may be driven into nonlinear motion that produces acoustic emissions at sub-harmonic frequencies and a general increase of emissions at low frequencies. These low frequency emissions may be used to monitor ablation surgery. In this study, a modified commercial ultrasound system was used for transmitting ultrasound pulses and for recording raw RF-lines from a scan plane in porcine (in vitro) and rabbit (in vivo) livers during radio-frequency ablation (RFA). The transmission pulse was 15 cycles in length at 4 MHz (in vitro) and 3.6 MHz (in vivo). Thermocouples were used for monitoring temperatures during the RFA treatment.In the in vitro experiments, recorded RF signals (A-lines) were segmented, and the total energy was measured at two different frequency bands: at a low frequency band (LFB) of 1-2.5 MHz and at the transmission frequency band (TFB) of 3.5-4.5 MHz. The mean energy at the LFB and at the TFB increased substantially in areas adjacent to the RF needle. These energies also changed abruptly at higher temperatures, thus, producing great variance in the received energy. Mean energies in areas distant from RF needle showed little change and variation during treatment. It was also shown that a 3 dB increase of energy at the low frequency band was typically obtained in regions in which temperature was above 53.3 ± 5° C. Thus, this may help in evaluating regions undergoing hyperthermia. In the in vivo experiments, an imaging algorithm based on measuring the LFB energy was used. The algorithm performs a moving average of the LFB energies measured at segments within the scan plane.Results show that a colored region is formed on the image and that it is similar in size to a measurement of the lesion from gross pathology, with a correlation coefficient of 0.743.
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Affiliation(s)
- Itai Winkler
- Biomedical Engineering, Technion City, Haifa, Israel.
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Luo RG, Gao F, Gu YK, Huang JH, Li CL. Radioablation settings affecting the size of lesions created ex vivo in porcine livers with monopolar perfusion electrodes. Acad Radiol 2010; 17:980-4. [PMID: 20599156 DOI: 10.1016/j.acra.2010.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 12/04/2009] [Accepted: 03/29/2010] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVES To explore the morphological characteristics of ablated lesions and find which combination of duration, temperature, and power was preferable to create largest lesion size with monopolar perfusion electrodes. MATERIALS AND METHODS Using monopolar perfusion electrodes to create 72 lesions in 30 excised porcine livers with radiofrequency radiation at different durations (5, 10, 15, and 20 minutes), temperatures (83 degrees C, 93 degrees C, 103 degrees C, and 113 degrees C), and powers (20, 30, and 40 W). Lesion volumes were calculated from longitudinal diameters and transverse diameters. Morphological characteristics were assessed microscopically from slides stained with hematoxylin and eosin. RESULTS Positive correlations were found between duration and longitudinal diameter (r = 0.66; P < .001), transverse diameter (r = 0.66; P < .001), distance of ablation beyond the electrode tip (r = 0.56; P < .001), and volume of lesions (r = 0.66; P < .001). Temperature was also positively correlated with longitudinal diameter (r = 0.70; P < .001), transverse diameter (r = 0.72; P < .001), distance of ablation beyond the electrode tip (r = 0.61; P < .001), and lesion volume (r = 0.711; P < .001). Lesion size did not increase when duration was longer than 15 minutes and temperature was higher than 103 degrees C. Power was not correlated with lesion size. Lesion size did not increase with increasing power. Macroscopically, all lesions were elliptical in cross section and appeared three zones: a central zone (I), a coagulated necrotic zone (II), and a hemorrhagic and edematous zone (III) from inside to outside. Microscopically, cells morphology and the nucleus were irregular or even disappeared in zone I. In zone II and III, cells did not appear deformation. CONCLUSION Duration and temperature, not power, affected lesion size. The largest lesion size was about 3.5 cm x 2.5 cm x 2.5 cm as temperature and duration was 15 minutes/103 degrees C.
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Leveillee RJ, Ramanathan R. Optimization of Image-Guided Targeting in Renal Focal Therapy. J Endourol 2010; 24:729-44. [DOI: 10.1089/end.2009.0622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Raymond J. Leveillee
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Rajan Ramanathan
- Department of Urology, University of Miami, Miller School of Medicine, Miami, Florida
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Stintzing S, Hoffmann R, Heinemann V, Kufeld M, Muacevic A. Frameless single-session robotic radiosurgery of liver metastases in colorectal cancer patients. Eur J Cancer 2010; 46:1026-32. [DOI: 10.1016/j.ejca.2010.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 12/23/2009] [Accepted: 01/14/2010] [Indexed: 12/20/2022]
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Luo W, Numata K, Morimoto M, Oshima T, Ueda M, Okada M, Takebayashi S, Zhou X, Tanaka K. Role of Sonazoid-enhanced three-dimensional ultrasonography in the evaluation of percutaneous radiofrequency ablation of hepatocellular carcinoma. Eur J Radiol 2009; 75:91-7. [PMID: 19361941 DOI: 10.1016/j.ejrad.2009.03.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Accepted: 03/13/2009] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We investigated contrast-enhanced three-dimensional ultrasonography (CE 3D US) with contrast agent Sonazoid for evaluating the effect of percutaneous radiofrequency (RF) ablation of hepatocellular carcinomas (HCCs). METHODS 63 HCCs were treated by US-guided percutaneous RF ablation. CE 3D US after bolus injection of 0.2 mL of Sonazoid was performed 5-7 days before and 1 day after RF ablation. CE 3D computed tomography (CT) was performed 5-7 days before and 1 month after the ablation, and during the follow-up period. Multiplanar images in three orthogonal planes and US/CT angiograms were reconstructed on both modalities. Two blinded observers reviewed the images on both modalities to evaluate the ablation effects. RESULTS After RF ablation, the evaluation on CE 3D US and that on CE 3D CT achieved concordance in 61 lesions. Among them, 59 lesions were detected with the absence of tumor vessels and tumor enhancement and evaluated as adequate ablation, and the remaining two lesions were detected with residual tumors. The kappa value for agreement between the findings on the two modalities was 0.65. When 1-month CE 3D CT scans were used as reference standard, the sensitivity, specificity, and accuracy of 1-day CE 3D US for detecting adequate ablation were 97%, 100%, and 97%, respectively. CONCLUSION By demonstrating the ablated areas and residual tumors in three dimensions, CE 3D US with Sonazoid was shown to be useful for evaluating the effect of RF ablation of HCCs, and there was good concordance with the results obtained by CE 3D CT.
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Affiliation(s)
- Wen Luo
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
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Frich L, Halvorsen PS, Skulstad H, Damås JK, Gladhaug IP. Microbubbles in the pulmonary artery generated during experimental hepatic radiofrequency ablation is correlated with increased pulmonary arterial pressure. J Vasc Interv Radiol 2008; 18:437-42. [PMID: 17377191 DOI: 10.1016/j.jvir.2006.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Microbubbles in hepatic veins during hepatic radiofrequency (RF) ablation is a well-known observation. In this experimental study, we examined the association between microbubbles in the pulmonary artery and alterations in mean pulmonary arterial pressure (MPAP) during hepatic RF ablation with a perfusion electrode system. MATERIALS AND METHODS Sixteen domestic pigs were included in the study. Twelve animals were randomly assigned to RF ablation with maintained (n = 6) or interrupted (n = 6) hepatic inflow. Four animals were assigned to a control group where interruption of hepatic inflow but no RF ablation was performed. Microbubbles in the pulmonary artery were recorded by transesophageal echocardiography and scored according to the number of bubbles per heart cycle. Mean pulmonary arterial pressure was continuously registered by a pulmonary artery catheter. The association between the microbubble score and increase in MPAP during ablation was examined using Spearman's rank correlation coefficient. RESULTS Echocardiographic recordings were acquired in 9 of 12 animals in the two treatment groups. Microbubbles in the pulmonary artery were present in four animals in each treatment group. Mean pulmonary arterial pressure increased from a baseline value of 17.7 mm Hg +/- 2.3 to a maximum value of 29.7 mm Hg +/- 7.7 during ablation (P = .018). A significant association was found between the microbubble score and increase in MPAP (P = .001). CONCLUSIONS Microbubbles were detected in the pulmonary artery during hepatic RF ablation both during maintained and interrupted hepatic inflow. A strong association was found between microbubbles in the pulmonary artery and increased MPAP. The clinical implications of our findings are to be determined.
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Affiliation(s)
- Lars Frich
- Interventional Centre, Rikshospitalet University Hospital, N-0027 Oslo, Norway.
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Thabet A, Kalva S, Gervais DA. Percutaneous image-guided therapy of intra-abdominal malignancy: imaging evaluation of treatment response. ACTA ACUST UNITED AC 2008; 34:593-609. [DOI: 10.1007/s00261-008-9448-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Bartolotta TV, Taibbi A, Midiri M, De Maria M. Hepatocellular cancer response to radiofrequency tumor ablation: contrast-enhanced ultrasound. ACTA ACUST UNITED AC 2008; 33:501-11. [PMID: 17786507 DOI: 10.1007/s00261-007-9294-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Radiofrequency ablation (RFA) is increasingly being used as percutaneous treatment of choice for patients with early stage hepatocellular carcinoma (HCC). An accurate assessment of the RFA therapeutic response is of crucial importance, considering that a complete tumor ablation significantly increases patient survival, whereas residual unablated tumor calls for additional treatment. Imaging modalities play a pivotal role in accomplishing this task, but ultrasound (US) is not considered a reliable modality for the evaluation of the real extent of necrosis, even when color/power Doppler techniques are used. Recently, newer microbubble-based US contrast agents used in combination with grey-scale US techniques, which are very sensitive to non-linear behavior of microbubbles, have been introduced. These features have opened new prospects in liver ultrasound and may have a great impact on daily practice, including cost-effective assessment of therapeutic response of percutaneous ablative therapies. Technical evolution of CEUS focusing on findings after RFA are illustrated. These latter are detailed, cross-referenced with the literature and discussed on the basis of our personal experience. Timing of CEUS posttreatment assessment among with advantages and limitations of CEUS are also described with a perspective on further technologic refinement.
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"Dual-scopic" intraoperative radiofrequency ablation for the treatment of a hepatic metastatic tumor located beneath the diaphragm. Surg Laparosc Endosc Percutan Tech 2008; 18:202-6. [PMID: 18427343 DOI: 10.1097/sle.0b013e31815ccb0c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Surgical resection leaving negative margins provides the only chance for a cure in hepatic metastasis of colorectal cancer. Tumor ablation techniques are known for their reliability and effectiveness in the treatment of primary and metastatic hepatic tumors. Among these treatment modalities, radiofrequency ablation (RFA) is commonly used for local control of primary and metastatic hepatic tumors with acceptable complication rates. Although the percutaneous approach is the usual route for RFA application, both laparoscopic approach and laparotomy can also be used. Hepatic tumors, located immediately beneath the diaphragm (segment VIII), are not suitable for percutaneous RFA due to the risks of injuring the diaphragm, and poor visualization by ultrasonography. Herein, we present a case of hepatic metastatic tumor located immediately beneath the diaphragm successfully treated by "dual-scopic" approach. A 50-year-old female patient had previously undergone an extended right hemicolectomy for transverse colon cancer, and she visited our department for hepatic metastasis on the dome of liver. She successfully underwent percutaneous transthoracic transdiaphragmatic intraoperative RFA under the guidance of a combination of thoracoscopic and laparoscopic approaches.
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Zhai B, Xu AM, Sheng YH, Liu S, Li XY, Chen Y. Prevention and treatment of needle-tract bleeding after percutaneous radiofrequency ablation for liver cancer: an analysis of 21 cases. Shijie Huaren Xiaohua Zazhi 2008; 16:2423-2427. [DOI: 10.11569/wcjd.v16.i21.2423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the risk factors, prevention and treatment of needle-tract bleeding after percutaneous image-guided radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC).
METHODS: A total of 1567 patients with liver cancer received PRFA therapy for 2035 sessions between December, 1999 and October, 2007. The data of patients suffered from needle-tract bleeding were recorded.
RESULTS: Needle-tract bleeding developed in 21 patients, who firstly received medicine therapy to control bleeding. Of 6 patients only used medicine therapy, 4 cases were successful and 2 cases died. In the other 15 patients, 3 cases directly received surgery and 12 cases received transcatheter embolization. Thirteen patients were treated successfully and 2 cases died. The rate of success for controlling bleeding was 81.0% (17/21), and the rate of bleeding-induced death was 19.0% (4/21). The rate of needle-tract bleeding significantly correlated with the degree of liver cirrhosis, lower platelet count, obvious prolongation of prothrombin time and subcapsular HCC (OR = 4.33, 6.31, 7.66, 7.91; P = 0.008, 0.32, 0.000, 0.027).
CONCLUSION: This study demonstrates that obvious prolongation of prothrombin time, lower platelet count, subcapsular HCC and pattern of RF needle electrode influence the needle-tract bleeding after PRFA for HCC. The most effective method to control the bleeding is transcatheter embolization.
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Radiofrequency ablation of colorectal liver metastases: small size favorably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol 2008; 31:948-56. [PMID: 18506519 DOI: 10.1007/s00270-008-9362-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 05/03/2008] [Accepted: 05/07/2008] [Indexed: 01/02/2023]
Abstract
The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases (MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine nonresectable MTS (0.5-8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during surgery. The technique was "simple" or "combined" with vascular occlusion. The mean follow-up time was 24.2 months. Complications, technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions < or = 3 cm versus 33.3% of lesions > 3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%, and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS < or = 3 cm and 23.2 in those with at least one lesion > 3 cm (p = 0.006). We conclude that "simple" RFA is safe and successful for MTS < or = 3 cm, contributing to prolong survival when patients can be completely treated.
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Arellano RS. Invited Commentary. Radiographics 2008. [DOI: 10.1148/radiographics.28.2.0280390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Krücker J, Xu S, Glossop N, Viswanathan A, Borgert J, Schulz H, Wood BJ. Electromagnetic tracking for thermal ablation and biopsy guidance: clinical evaluation of spatial accuracy. J Vasc Interv Radiol 2007; 18:1141-50. [PMID: 17804777 PMCID: PMC2555977 DOI: 10.1016/j.jvir.2007.06.014] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To evaluate the spatial accuracy of electromagnetic needle tracking and demonstrate the feasibility of ultrasonography (US)-computed tomography (CT) fusion during CT- and US-guided biopsy and radiofrequency ablation procedures. MATERIALS AND METHODS The authors performed a 20-patient clinical trial to investigate electromagnetic needle tracking during interventional procedures. The study was approved by the institutional investigational review board, and written informed consent was obtained from all patients. Needles were positioned by using CT and US guidance. A commercial electromagnetic tracking device was used in combination with prototype internally tracked needles and custom software to record needle positions relative to previously obtained CT scans. Position tracking data were acquired to evaluate the tracking error, defined as the difference between tracked needle position and reference standard needle position on verification CT scans. Registration between tracking space and image space was obtained by using reference markers attached to the skin ("fiducials"), and different registration methods were compared. The US transducer was tracked to demonstrate the potential use of real-time US-CT fusion for imaging guidance. RESULTS One patient was excluded from analysis because he was unable to follow breathing instructions during the acquisition of CT scans. Nineteen of the 20 patients were evaluable, demonstrating a basic tracking error of 5.8 mm +/- 2.6, which improved to 3.5 mm +/- 1.9 with use of nonrigid registrations that used previous internal needle positions as additional fiducials. Fusion of tracked US with CT was successful. Patient motion and distortion of the tracking system by the CT table and gantry were identified as sources of error. CONCLUSIONS The demonstrated spatial tracking accuracy is sufficient to display clinically relevant preprocedural imaging information during needle-based procedures. Virtual needles displayed within preprocedural images may be helpful for clandestine targets such as arterial phase enhancing liver lesions or during thermal ablations when obscuring gas is released. Electromagnetic tracking may help improve imaging guidance for interventional procedures and warrants further investigation, especially for procedures in which the outcomes are dependent on accuracy.
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Affiliation(s)
- Jochen Krücker
- Philips Research North America, Briarcliff Manor, NY, USA.
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Nishie A, Yoshimitsu K, Irie H, Tajima T, Asayama Y, Hirakawa M, Nakayama T, Kakihara D, Honda H. Spectrum of hepatic surface enhancement on contrast-enhanced CT in various abdominal conditions. Clin Imaging 2007; 31:329-34. [PMID: 17825741 DOI: 10.1016/j.clinimag.2007.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 03/26/2007] [Indexed: 11/21/2022]
Abstract
Hepatic surface enhancement on CT can represent particular clinical significance in various abdominal conditions, at times being the only abnormality found. Detecting hepatic surface enhancement, together with the other ancillary diagnostic techniques as well, may lead to grasp of the underlying condition and to early or timely diagnosis and treatment of abdominal disorders. This manuscript describes the spectrum of hepatic surface enhancement on CT, and the importance of focusing on the hepatic surface during interpretation is emphasized.
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Affiliation(s)
- Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
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van Dalen JA, Hoffmann AL, Dicken V, Vogel WV, Wiering B, Ruers TJ, Karssemeijer N, Oyen WJG. A novel iterative method for lesion delineation and volumetric quantification with FDG PET. Nucl Med Commun 2007; 28:485-93. [PMID: 17460540 DOI: 10.1097/mnm.0b013e328155d154] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The determination of lesion boundaries on FDG PET is difficult due to the point-spread blurring and unknown uptake of activity within a lesion. Standard threshold-based methods for volumetric quantification on PET usually neglect any size dependence and are biased by dependence on the signal-to-background ratio (SBR). A novel, model-based method is hypothesized to provide threshold levels independent f the SBR and to allow accurate measurement of volumes down to the resolution of the PET scanner. METHODS A background-subtracted relative-threshold level (RTL) method was derived, based on a convolution of the point-spread function and a sphere with diameter D. Validation of the RTL method was performed using PET imaging of a Jaszczak phantom with seven hollow spheres (D=10-60 mm). Activity concentrations for the background and spheres (signal) were varied to obtain SBRs of 1.5-10. An iterative procedure was introduced for volumetric quantification, as the optimal RTL depends on a priori knowledge of the volume. The feasibility of the RTL method was tested in two patients with liver metastases and compared to a standard method using a fixed percentage of the signal. RESULTS Phantom data validated that the theoretically optimal RTL depends on the sphere size, but not on the SBR. Typically, RTL=40% (D=15-60 mm), and RTL>50% for small spheres (D<12 mm). The RTL method is better applicable to patient data than the standard method. CONCLUSIONS Based on an iterative procedure, the RTL method has been shown to provide optimal threshold levels independent of the SBR and to be applicable in phantom and in patient studies. It is a promising tool for lesion delineation and volumetric quantification of PET lesions.
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Affiliation(s)
- Jorn A van Dalen
- Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, the Netherlands.
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