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Pezzulla D, Chiloiro G, Lima EM, Macchia G, Romano C, Reina S, Panza G, Cilla S, Morganti AG, Cellini F, Gambacorta MA, Deodato F. Stereotactic radiotherapy for liver oligometastases: a pooled analysis following the estro/eortc consensus recommendations. Clin Exp Metastasis 2024; 41:667-678. [PMID: 39017807 DOI: 10.1007/s10585-024-10301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Abstract
A large pooled analysis of liver oligometastases, classified accordingly to the ESTRO/EORTC recommendations, treated by stereotactic radiotherapy (SBRT) and Radiosurgery (SRS) was carried out. The clinical and dosimetric data of patients who underwent SBRT/SRS for liver metastases were analysed in terms of efficacy and toxicity profile. In particular, the Local Control (LC), the Distant Metastases Free Survival (DMFS), the Disease-Free Survival (DFS), the Overall Survival (OS), and the Next Systemic Therapy Free Survival (NEST-FS) rates were analysed. 113 patients (M/F: 49/64), accounting for a total of 150 hepatic lesions (March 2006-February 2023) in two Italian radiotherapy Institutions were evaluated. Median age was 67 years old (36-92) and 48 (42.5%) patients had at least one comorbidity. The majority of the lesions were induced (30.7%) or repeated oligoprogressive (12.7%) metastases. 98 lesions were treated with more than one daily fraction (mainly 50 Gy in 5 fractions), while 52 were radiosurgery treatments (mainly 32 Gy). The treatment response at 3-4 months was evaluable in 147 lesions: complete response was 32.0%, partial response 17.0%, and stable disease 32.0%. Actuarial LC, DMFS, DFS, OS, and NEST-FS at 1 year were 75.8%, 37.7%, 34.9%, 78.7%, and 59.4% respectively; while actuarial LC, DMFS, DFS, OS, and NEST-FS at 2 years were 52.1%, 24.9%, 21.9%, 51.3%, and 36.8%, respectively. The achievement of complete response, synchronous oligometastases, and no treatment interruptions correlated with a more favorable outcomes. As per the toxicity profile, we registered only two acute and one late toxicity cases higher than grade 2. Stereotactic treatment for liver metastases seems to be a safe and promising option in terms of local control. The best results in term of outcomes have been obtained in patients with complete response, synchronous oligometastases, favorable histology, and no treatment interruptions.
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Affiliation(s)
- D Pezzulla
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
| | - G Chiloiro
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - E M Lima
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Macchia
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy.
| | - C Romano
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - S Reina
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - G Panza
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
| | - S Cilla
- Medical Physics Unit, Responsible Research Hospital, Campobasso, Italy
| | - A G Morganti
- Radiation Oncology, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, IRCCS Azienda Ospedaliero, Universitaria di Bologna - Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - F Cellini
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - M A Gambacorta
- UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, San Giovanni Rotondo, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
| | - F Deodato
- Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Milano, Italy
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Zhao J, Zhong J, Chen Y, Chen Z, Yin H, He Y, Chen R, Guo R. Molecular features of NSCLC patients with liver metastasis. Ther Adv Med Oncol 2024; 16:17588359241275421. [PMID: 39346119 PMCID: PMC11437564 DOI: 10.1177/17588359241275421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/30/2024] [Indexed: 10/01/2024] Open
Abstract
Background Metastasis is the primary cause of lung cancer-related death. Primary cancer cells invade through the lymphatic or blood vessels to distant sites. Recently, it was proposed that lymphatic metastasis was more a hallmark of tumor aggressiveness or metastatic potential than a gateway to metastases. Therefore, the underlying molecular mechanism of metastasis is not entirely clear. Objectives This study aimed to explore the genetic mechanisms underlying liver metastases from lung cancer and to evaluate the efficacy of different therapies in these patients. Design We retrospectively analyzed the mutation spectrum of different biopsy samples including primary lung tumors, liver, lymph node metastasis, and circulating tumor DNA (ctDNA) from 1090 non-small-cell lung cancer (NSCLC) patients with liver metastasis between the years 2017 and 2022. Methods Demographic and disease characteristics were summarized using descriptive parameters. Time to treatment discontinuation was used to analyze the clinical outcome. Results More liquid biopsies were performed than tissue biopsies, especially in the treated advanced NSCLC patients. Liver metastasis before treatment was associated with poor response to immune checkpoint inhibitors and targeted therapy. Liver and lymph node metastasis had higher levels of single nucleotide variants and copy number variants than primary lung tumors. In paired lung and liver, lymph nodes, and simultaneous ctDNA, we found actionable mutations were always shared, while metastasis samples had multiple private mutations. Serial ctDNA analysis identifies potential resistant mutations and describes the evolution of tumor cells. Conclusion Liver and lymph node metastasis in NSCLC showed shared actionable mutations. Of note, the discrepancy of private mutations in liver and lymph node metastases indicated that liver metastases are mainly seeded by the primary tumor rather than the earlier colonized lymph node metastases.
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Affiliation(s)
- Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jia Zhong
- CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center
- National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China
| | - Yujie Chen
- Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
| | - Zipei Chen
- Medical Oncology Department 1, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Huan Yin
- Geneplus-Beijing, Beijing, China
| | | | - Rongrong Chen
- Geneplus-Beijing, 7 Science Road, Zhongguancun Life Science Park, Changping, Beijing 102206, China
| | - Renhua Guo
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China
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Satish V, Repaka R. The influence of microwave ablation parameters on the positioning of trocar in different cancerous tissues: a numerical study. Electromagn Biol Med 2024:1-10. [PMID: 38533761 DOI: 10.1080/15368378.2024.2333802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
The present study analyzed the microwave ablation of cancerous tumors located in six major cancer-prone organs and estimated the significance of input power and treatment time parameters in the apt positioning of the trocar into the tissue during microwave ablation. The present study has considered a three-dimensional two-compartment tumour-embedded tissue model. FEA based COMSOL Multiphysics software with inbuilt bioheat transfer, electromagnetic waves, heat transfer in solids and fluids, and laminar flow physics has been used to obtain the numerical results. Based on the mortality rates caused by cancer, the present study has considered six major organs affected by cancer, viz. lung, breast, stomach/gastric, liver, liver (with colon metastasis), and kidney for MWA analysis. The input power (100 W) and ablation times (4 minutes) with apt and inapt positioning of the trocar have been considered to compare the ablation volume of various cancerous tissues. The present study addresses one of the major problems clinicians face, i.e. the proper placement of the trocar due to poor imaging techniques and human error, resulting in incomplete tumor ablation and increased surgical procedures. The highest values of the ablation region have been observed for the liver, colon metastatic liver and breast cancerous tissues compared with other organs at the same operating conditions.
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Affiliation(s)
- Vellavalapalli Satish
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
| | - Ramjee Repaka
- Department of Mechanical Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, India
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Li R, An C, Wang S, Wang G, Zhao L, Yu Y, Wang L. A heuristic method for rapid and automatic radiofrequency ablation planning of liver tumors. Int J Comput Assist Radiol Surg 2023; 18:2213-2221. [PMID: 37145252 DOI: 10.1007/s11548-023-02921-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Preprocedural planning is a key step in radiofrequency ablation (RFA) treatment for liver tumors, which is a complex task with multiple constraints and relies heavily on the personal experience of interventional radiologists, and existing optimization-based automatic RFA planning methods are very time-consuming. In this paper, we aim to develop a heuristic RFA planning method to rapidly and automatically make a clinically acceptable RFA plan. METHODS First, the insertion direction is heuristically initialized based on tumor long axis. Then, the 3D RFA planning is divided into insertion path planning and ablation position planning, which are further simplified into 2D by projections along two orthogonal directions. Here, a heuristic algorithm based on regular arrangement and step-wise adjustment is proposed to implement the 2D planning tasks. Experiments are conducted on patients with liver tumors of different sizes and shapes from multicenter to evaluate the proposed method. RESULTS The proposed method automatically generated clinically acceptable RFA plans within 3 min for all cases in the test set and the clinical validation set. All RFA plans of our method achieve 100% treatment zone coverage without damaging the vital organs. Compared with the optimization-based method, the proposed method reduces the planning time by dozens of times while generating RFA plans with similar ablation efficiency. CONCLUSION The proposed method demonstrates a new way to rapidly and automatically generate clinically acceptable RFA plans with multiple clinical constraints. The plans of our method are consistent with the clinical actual plans on almost all cases, which demonstrates the effectiveness of the proposed method and can help reduce the burden on clinicians.
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Affiliation(s)
- Ruikun Li
- Department of Automation, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Chengyang An
- Department of Automation, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | | | - Guisheng Wang
- Department of Radiology, Third Medical Centre, Chinese PLA General Hospital, Beijing, 100036, China
| | - Lifeng Zhao
- Department of Radiology, Daqing Longnan Hospital, Daqing, 163453, China
| | - Yizhou Yu
- Deepwise AI Lab, Beijing, 100080, China.
| | - Lisheng Wang
- Department of Automation, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
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Li LQ, Su TS, Wu QY, Lin ZT, Liang SX. Therapeutic Outcome of Stereotactic Body Radiotherapy for Small Hepatocellular Carcinoma Lesions - A Systematic Review and Network Meta-analysis. Clin Oncol (R Coll Radiol) 2023; 35:652-664. [PMID: 37541936 DOI: 10.1016/j.clon.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023]
Abstract
Surgical resection, stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) have seldom been compared for small hepatocellular carcinoma (HCC). We explored the treatment outcomes of SBRT for small HCC by conducting a network meta-analysis (NMA). We compared the efficacy and safety of surgical resection, RFA and SBRT for liver-confined small HCC (three or fewer lesions with a diameter ≤5 cm). The study endpoint included the odds ratios of the 1-, 3- and 5-year progression/recurrence/disease-free survival (disease progression-free survival; DPFS) and overall survival rates, as well as severe complications. Forty-five studies included 21 468 patients. In the NMA with comparable data, SBRT had comparable 1-, 3- and 5-year DPFS but significantly worse pooled long-term overall survival (3- and 5-year overall survival) than surgical resection (odds ratio 1.39, 95% confidential interval 1.3-1.89; odds ratio 1.33, 95% confidence interval 1.06-1.69, respectively). SBRT was associated with significantly better pooled 1-year DPFS compared with RFA (odds ratio 0.39, 95% confidence interval 0.15-0.97), with the remaining outcomes being comparable. SBRT had significantly less incidence of severe complications compared with surgical resection (odds ratio 0.62, 95% confidence interval 0.42-0.88) and RFA (odds ratio 0.2, 95% confidence interval 0.03-0.94). In conclusion, for small HCCs (≤5 cm) with one to three nodules, SBRT may be favourable to reduce the risks of severe complications. In terms of DPFS, SBRT may be recommended as an alternative first-line therapy for RFA and surgical resection. The results regarding overall survival should be interpreted with caution, considering the potentially uneliminated bias. There is a clear need for well-designed randomised trials to conclusively identify real differences in efficacy between these treatments, especially SBRT and surgical resection.
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Affiliation(s)
- L-Q Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - T-S Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Q-Y Wu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Z-T Lin
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China
| | - S-X Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi Zhuang Autonomous Region, China.
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Yang ZL, Sun XQ, Tang YH, Xiong PY, Xu L. Comparison of stereotactic body radiation therapy with hepatic resection and radiofrequency ablation as initial treatment in patients with early-stage hepatocellular carcinoma. Front Oncol 2022; 12:948866. [PMID: 36479067 PMCID: PMC9719990 DOI: 10.3389/fonc.2022.948866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has emerged as a novel intervention for early-stage hepatocellular carcinoma (HCC). The outcomes of SBRT, liver resection (LR), and radiofrequency ablation (RFA) as the initial treatment for AJCC stage I HCC patients remain unclear. METHODS Patients with AJCC stage I HCC from the Surveillance, Epidemiology and End Results database were analyzed for survival rates using the Kaplan-Meier method and stratified according to tumor size: S subgroup (≤2 cm), M subgroup (>2-3 cm), and L subgroup (>3 cm). For factors including age, year of diagnosis, sex, race, grade, tumor size, AFP, and fibrosis score, propensity score matching was performed to eliminate the imbalance of baseline features and selection bias during groups. RESULTS A total of 4,002 patients were included; the difference in median overall survival (mOS) between the SBRT group and the LR or RFA group in the S subgroup was statistically insignificant (p=0.109 and p=0.744), while that of the RFA group was significantly worse than that of the LR group (p <0.001). In the M and L subgroups, the mOS of the SBRT group was worse than that of the RFA group (p=0.040 and p<0.001, respectively). The mOS of LR was the best when compared with either the SBRT or RFA group regardless of the subgroup M or L (all p<0.001). CONCLUSION For HCC ≤ 2 cm, SBRT can be used as an alternative treatment for RFA. For patients with HCC larger than 2 cm, RFA can provide better long-term survival than SBRT, while LR remains the best choice.
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Affiliation(s)
- Zi-liang Yang
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xu-qi Sun
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yu-hao Tang
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
- Department of Radiotherapy, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Pei-yao Xiong
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Li Xu
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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Vaidya N, Baragona M, Lavezzo V, Maessen R, Veroy K. Tuning the Pennes Perfusion Rate to Model Large Vessel Cooling Effects in Hepatic Radiofrequency Ablation. J Biomech Eng 2022; 144:1136903. [PMID: 35181786 DOI: 10.1115/1.4053909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 11/08/2022]
Abstract
Radio-frequency ablation (RFA) has become a popular method for the minimally invasive treatment of liver cancer. However, the success rate of these treatments depends heavily on the amount of experience the clinician possesses. Mathematical modelling can help mitigate this problem by providing an indication of the treatment outcome. Thermal lesions in RFA are affected by the cooling effect of both fine-scale and large-scale blood vessels. The exact model for large-scale blood vessels is advection-diffusion, i.e. a model capable of producing directional effects, which are known to occur in certain cases. In previous research, in situations where directional effects do not occur, the advection term in the blood vessel model has been typically replaced with the Pennes perfusion term, albeit with a higher-than usual perfusion rate. Whether these values of the perfusion rate appearing in literature are optimal for the particular vessel radii in question, has not been investigated so far. The present work aims to address this issue. An attempt has been made to determine, for values of vessel radius between 0.55 mm and 5 mm, best estimates for the perfusion rate which minimize the error in thermal lesion volumes between the perfusion-based model and the advection-based model. The results for the best estimate of the perfusion rate presented may be used in existing methods for fast estimation of RFA outcomes. Furthermore, the possible improvements to the presented methodology have been highlighted.
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Affiliation(s)
- Nikhil Vaidya
- Faculty of Civil Engineering, RWTH Aachen University, Germany
| | | | | | | | - Karen Veroy
- Center for Analysis, Scientific Computing, and Applications, Eindhoven University of Technology, 5600 MB Eindhoven, Netherlands
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RUSPI MARIALUISA, MARRAS DANIELE, CRISTOFOLINI LUCA. DOES CEMENT CURING CAUSE CONCERNING INCREASE OF THE TEMPERATURE WHEN DELIVERED IN THE HUMAN HUMERUS? J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
For the treatment of humeral fractures, numerous strategies exist to improve the clinical outcome of the reconstruction and to reduce the incidence of fixation failure. Injection of acrylic-based cements to reinforce the bone and/or augment the screws is one option. The heat generated during cement polymerization raises some concerns, as it could cause tissue damage. The first aim of this study was to measure the temperature over time during polymerization when acrylic cements are delivered inside the bone to treat fracture. The second aim was to assess if the ISO-5833:2002 standard can predict what happens in a real bone. Different tests were performed using two acrylic-based cements (Mendec and Cal-Cemex): (i) the ISO-5833:2002 standard (Annex C); (ii) tests on human bones (humeral diaphysis and humeral head) injected with cement to simulate fracture treatment. In the humeri, the highest temperature was measured in the diaphysis (68.6∘C for Mendec, 62.7∘C for Cal-Cemex). These values are comparable with the temperature reached in other consolidated applications (vertebroplasty). Exposure to high temperature was shorter for the diaphysis than for the head. For both cements, in both the diaphysis and the head, temperatures exceeded 48∘C for less than 10[Formula: see text]min. This is within the threshold for tissue necrosis. The ISO-5833:2002 yielded significantly different results in terms of maximum temperature (difference exceeding 15∘C) and exposure to temperature above 48∘C and 45∘C. This discrepancy is probably due to a combination of factors affecting the amount of heat produced and dissipated (e.g., amount and shape of the cement, thermal conductivity).
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Affiliation(s)
- MARIA LUISA RUSPI
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, University of Bologna, Via Umberto Terracini 24-28, 40131 Bologna, Italy
| | - DANIELE MARRAS
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, University of Bologna, Via Umberto Terracini 24-28, 40131 Bologna, Italy
| | - LUCA CRISTOFOLINI
- Department of Industrial Engineering, School of Engineering and Architecture, Alma Mater Studiorum, University of Bologna, Via Umberto Terracini 24-28, 40131 Bologna, Italy
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de la Peña C, Gonzalez MF, González C, Salazar JM, Cruz B. Stereotactic body radiation therapy for liver metastases: Clinical outcomes and literature review. Rep Pract Oncol Radiother 2020; 25:637-642. [DOI: 10.1016/j.rpor.2020.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 03/23/2020] [Accepted: 04/28/2020] [Indexed: 12/30/2022] Open
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Liang L, Cool D, Kakani N, Wang G, Ding H, Fenster A. Automatic Radiofrequency Ablation Planning for Liver Tumors With Multiple Constraints Based on Set Covering. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:1459-1471. [PMID: 31689185 DOI: 10.1109/tmi.2019.2950947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Radiofrequency ablation (RFA) is now a widely used minimally invasive treatment method for hepatic tumors. Preoperative planning plays a vital role in RFA therapy. With increasing tumor size, multiple overlapping ablations are needed, which are challenging to optimize while considering clinical constraints. In this paper, we present a new automatic RFA planning method. First, a 2-steps set cover-based model is formulated, which can integrate multiple clinical constraints for optimization of overlapping ablations. To ensure that the planning model can be solved in a reasonable time, a search space reducing strategy is then proposed. We also developed an algorithm for automatic RFA electrode selection, which provides a proper electrode ablation zone for the planning model. The proposed method was evaluated with 20 tumors of varying sizes (0.92 cm3 to 28.4 cm3). Results showed that the proposed method can generate clinical feasible RFA plans with a minimum number of RFA electrodes and ablations, complete tumor coverage and minimized ablation of normal tissue.
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Akbarizare M, Ofoghi H, Hadizadeh M, Moazami N. In vitro assessment of the cytotoxic effects of secondary metabolites from Spirulina platensis on hepatocellular carcinoma. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-0018-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Spirulina platensis, an edible cyanobacterium, is considered as a valuable and natural resource of novel anticancer agents. This study aimed to investigate the anticancer potential of major bioactive metabolites from Spirulina platensis on hepatocellular carcinoma cells. The total phenolic and alkaloid content of S. platensis were determined using spectrophotometric procedures and thin-layer chromatography. Cellular viability of HepG2 cancer cells and normal fibroblasts was evaluated using MTT assay after 24 h treatment with 0.02–2 mg/ml of alkaloids, phenolic compounds, aqueous, and methanol extracts from Spirulina platensis.
Results
Total phenolic and total alkaloid compounds were 150.5 ± 1.18 mg gallic acid equivalents/mg extract and 11.4 ± 0.05 mg atropine equivalents/mg extract, respectively. All tested extracts and compounds demonstrated the inhibitory effect on the viability of HepG2 cells in a dose-dependent manner without cytotoxicity on normal cells. The most potent anticancer activity was induced by alkaloids (2 ± 0.001 mg/ml) with 80% reduction in cell viability and an IC50 of 0.53 ± 0.08 mg/ml. IC50 values of the aqueous extract, the methanolic extract, and phenolic compounds were 1.7 ± 0.14, 1.28 ± 0.22, and 0.86 ± 0.14 mg/ml, respectively.
Conclusions
This is the first report to demonstrate anticancer effects of alkaloids and phenolic compounds of Spirulina platensis in relation to liver cancer.
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Carvalho VDO, Galastri FL, Affonso BB, Falsarella PM, Valle LGM, Ferraz-Neto BH, Rezende MBD, Motta-Leal-Filho JMD, Garcia RG, Nasser F. Transarterial radioembolization for liver tumors as neoadjuvant therapy: three case reports. EINSTEIN-SAO PAULO 2020; 18:eRC4990. [PMID: 32130329 PMCID: PMC7032884 DOI: 10.31744/einstein_journal/2020rc4990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/03/2019] [Indexed: 01/06/2023] Open
Abstract
Transarterial radioembolization (TARE) with yttrium-90 microspheres is a palliative locoregional treatment, minimally invasive for liver tumors. The neoadjuvant aim of this treatment is still controversial, however, selected cases with lesions initially considered unresectable have been enframed as candidates for curative therapy after hepatic transarterial radioembolization. We report three cases in which the hepatic transarterial radioembolization was used as neoadjuvant therapy in an effective way, allowing posterior potentially curative therapies.
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Anti-cancer, anti-biofilm, and anti-inflammatory properties of hen’s albumen: A photodynamic approach. Photodiagnosis Photodyn Ther 2019; 28:1-7. [DOI: 10.1016/j.pdpdt.2019.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/19/2022]
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Jiang BB, Yan K, Zhang ZY, Yang W, Wu W, Yin SS, Chen MH. The value of KRAS gene status in predicting local tumor progression of colorectal liver metastases following radiofrequency ablation. Int J Hyperthermia 2019; 36:211-219. [PMID: 30663903 DOI: 10.1080/02656736.2018.1556818] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We investigated the relationships between KRAS gene status and local tumor progression (LTP) of colorectal liver metastases (CLMs) after treatment with percutaneous ultrasound-guided radiofrequency ablation (RFA). MATERIALS AND METHODS Clinical and imaging data from 76 patients (154 lesions) with CLM who underwent percutaneous ultrasound-guided RFA and had KRAS gene test results between January 2012 and June 2016 were analyzed. The average lesion size was 2.3 ± 1.0 cm (range 0.9-5.7 cm); 38 cases (82 lesions) had wild-type KRAS, and 38 cases (72 lesions) had KRAS mutations. RESULTS The technique effectiveness was 98.1% (151/154), and the LTP rate was 18.2% (28/154) after RFA, which was performed between January 2012 and November 2017. The mean and median follow-up were 32.7 ± 2.5 and 32.0 ± 2.6 months (range 1-70 months), respectively. Cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA for all patients were 7.4, 14.5, 17.8 and 19.2%, respectively. The LTP rate for patients with mutant KRAS (27.8% [20/72]) was significantly higher than that in patients with wild-type KRAS (9.8% [8/82]; p = .004). The cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA were 4.0, 11.1, 11.1 and 11.1%, respectively, for patients with wild-type KRAS and 11.2, 18.4, 25.2 and 36.2%, respectively, for patient with mutant KRAS (p = .011). Univariate (p = .011) and multivariate analyses (p = .005) showed that KRAS genotype in liver metastases was predictive of LTP. Multivariate analysis also showed that ablation margin size (p< .001) and modified clinical risk score (CRS; p = .033) were independent prognostic factors for LTP. CONCLUSIONS KRAS gene status of liver metastatic lesions was associated with LTP rates after RFA of CLM. Ablation margin size and modified CRS were also independent prognostic factors for LTP.
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Affiliation(s)
- Bin-Bin Jiang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Kun Yan
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Zhong-Yi Zhang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Yang
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Wei Wu
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Shan-Shan Yin
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
| | - Min-Hua Chen
- a Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) , Peking University Cancer Hospital and Institute , Beijing , China
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Au KP, Chok KSH. Multidisciplinary approach for post-liver transplant recurrence of hepatocellular carcinoma: A proposed management algorithm. World J Gastroenterol 2018; 24:5081-5094. [PMID: 30568386 PMCID: PMC6288653 DOI: 10.3748/wjg.v24.i45.5081] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/21/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
A large number of liver transplants have been performed for hepatocellular carcinoma (HCC), and recurrence is increasingly encountered. The recurrence of HCC after liver transplantation is notoriously difficult to manage. We hereby propose multi-disciplinary management with a systematic approach. The patient is jointly managed by the transplant surgeon, physician, oncologist and radiologist. Immunosuppressants should be tapered to the lowest effective dose to protect against rejection. The combination of a mammalian target of rapamycin inhibitor with a reduced calcineurin inhibitor could be considered with close monitoring of graft function and toxicity. Comprehensive staging can be performed by dual-tracer positron emission tomography-computed tomography or the combination of contrast computed tomography and a bone scan. In patients with disseminated recurrence, sorafenib confers survival benefits but is associated with significant drug toxicity. Oligo-recurrence encompasses recurrent disease that is limited in number and location so that loco-regional treatments convey disease control and survival benefits. Intra-hepatic recurrence can be managed with graft resection, but significant operative morbidity is expected. Radiofrequency ablation and stereotactic body radiation therapy (SBRT) are effective alternative strategies. In patients with more advanced hepatic disease, regional treatment with trans-arterial chemoembolization or intra-arterial Yttrium-90 can be considered. For patients with extra-hepatic oligo-recurrence, loco-regional treatment can be considered if practical. Patients with more than one site of recurrence are not always contraindicated for curative treatments. Surgical resection is effective for patients with pulmonary oligo-recurrence, but adequate lung function is a pre-requisite. SBRT is a non-invasive and effective modality that conveys local control to pulmonary and skeletal oligo-recurrences.
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Affiliation(s)
- Kin Pan Au
- Department of Surgery, Queen Mary Hospital, Hong Kong, China
| | - Kenneth Siu Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China
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Chen R, Lu F, Wu F, Jiang T, Xie L, Kong D. An analytical solution for temperature distributions in hepatic radiofrequency ablation incorporating the heat-sink effect of large vessels. Phys Med Biol 2018; 63:235026. [PMID: 30511647 DOI: 10.1088/1361-6560/aaeef9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Fast prediction of the local thermal field induced by radiofrequency ablation (RFA) plays a critical role in hepatic RFA therapy. At present, it is still a challenging task to calculate and visualize the temperature distribution of RFA in real-time, especially when the heat-sink effect of adjacent large vessels is taken into account. To achieve this, the current investigation presented an analytical solution to calculate the temperature in RFA with an execution time of 0.05 s for three dimensional thermal field reconstruction. The presented temperature distribution is a combination of temperatures in homogeneous tissue and a quantification of the heat-sink effect of adjacent blood vessels. Temperatures in homogeneous tissue is calculated from a simplified Pennes bioheat equation, where several weighting parameters in the temperature expression are determined based on some reference point temperatures from the numerical simulation. The heat-sink effect is quantified based on a temperature factor, which measures the temperature difference between the vessel and the heated tissue, and a distance factor, which measures the distance to the vessel. The proposed method is validated to be able to gain similar temperature distributions to the numerical simulation but with its computational time being orders of magnitude smaller than that of numerical simulation, which improves the efficiency of interactive planning of RFA.
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Affiliation(s)
- Rendong Chen
- School of Mathematical Sciences, Zhejiang University, Hangzhou 310027, People's Republic of China
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17
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Abstract
BACKGROUND AND STUDY AIMS Percutaneous and intraoperative radiofrequency ablation (RFA) has become a valued tool in the management of primary and secondary hepatic lesions. A recent FDA-approved endoscopic ultrasound (EUS)-guided RFA probe now offers promise to help manage such lesions. However, there are no data to determine the ideal power setting and duration of ablation needed to effectively treat hepatic masses. The aim of the study was to evaluate the macroscopic zone of hepatic injury for EUS-RFA using a variety of settings within a fresh porcine hepatic specimen. METHODS RFA was performed using the Habib EUS-RFA needle (EMcision Ltd, London, UK) which is a 1-Fr wire (0.33 mm, 0.013 inch) with a working length of 190 cm. A step by step approach to deliver radiofrequency energy at 5, 10, 15, 20, and 50 W of power and 10, 30, 60, 90, 120, and 300 seconds, respectively, was followed. Macroscopic and microscopic findings of the ablation zone were evaluated at each setting. RESULTS The maximal zone (diameter, 8.2±0.14 mm; length, 20.85±0.21 mm) of coagulative necrosis was achieved using an ablation power of 10 W for duration of 90 seconds. Notably, increased power settings resulted in an unexpected and diminished effect on tissue destruction. CONCLUSIONS Our findings support the use of 10 W power for 90 seconds for maximum ablation in the liver. Our data also provide initial guidance and alternate settings to be considered when performing EUS-RFA to adjust the ablation power and duration to match the lesion size, shape, and risk of injury to adjacent structures.
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18
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Rajyaguru DJ, Borgert AJ, Smith AL, Thomes RM, Conway PD, Halfdanarson TR, Truty MJ, Kurup AN, Go RS. Radiofrequency Ablation Versus Stereotactic Body Radiotherapy for Localized Hepatocellular Carcinoma in Nonsurgically Managed Patients: Analysis of the National Cancer Database. J Clin Oncol 2018; 36:600-608. [PMID: 29328861 DOI: 10.1200/jco.2017.75.3228] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Data that guide selection of optimal local ablative therapy for the management localized hepatocellular carcinoma (HCC) are lacking. Because there are limited prospective comparative data for these treatment modalities, we aimed to compare the effectiveness of radiofrequency ablation (RFA) versus stereotactic body radiotherapy (SBRT) by using the National Cancer Database. Methods We conducted an observational study to compare the effectiveness of RFA versus SBRT in nonsurgically managed patients with stage I or II HCC. Overall survival was compared by using propensity score-weighted and propensity score-matched analyses based on patient-, facility-, and tumor-level characteristics. A sensitivity analysis was performed to evaluate the effect of severe fibrosis/cirrhosis. In addition, we performed exploratory analyses to determine the effectiveness of RFA and SBRT in clinically relevant patient subsets. Results Overall, 3,684 (92.6%) and 296 (7.4%) nonsurgically managed patients with stage I or II HCC received RFA or SBRT, respectively. After propensity matching, 5-year overall survival was 29.8% (95% CI, 24.5% to 35.3%) in the RFA group versus 19.3% (95% CI, 13.5% to 25.9%) in the SBRT group ( P < .001). Inverse probability-weighted analysis yielded similar results. The benefit of RFA was consistent across all subgroups examined and was robust to the effects of severe fibrosis/cirrhosis. Conclusion Our study suggests that treatment with RFA yields superior survival compared with SBRT for nonsurgically managed patients with stage I or II HCC. Even though our results are limited by the biases related to the retrospective study design, we believe that, in the absence of a randomized clinical trial, our findings should be considered when recommending local ablative therapy for localized unresectable HCC.
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Affiliation(s)
- Devalkumar J Rajyaguru
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Andrew J Borgert
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Angela L Smith
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Reggie M Thomes
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Patrick D Conway
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Thorvardur R Halfdanarson
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Mark J Truty
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - A Nicholas Kurup
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
| | - Ronald S Go
- Devalkumar J. Rajyaguru, Reggie M. Thomes, and Patrick D. Conway, Gundersen Health System; Andrew J. Borgert and Angela L. Smith, Gundersen Lutheran Medical Foundation, La Crosse, WI; and Thorvardur R. Halfdanarson, Mark J. Truty, A. Nicholas Kurup, and Ronald S. Go, Mayo Clinic, Rochester, MN
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Wang C, Wang Q, Zhang D, He Z, Chen W. Perfused hypertonic-saline-augmented needle enlarges ablation zones in ex vivo porcine livers. Oncol Lett 2018; 15:972-978. [PMID: 29391896 PMCID: PMC5769401 DOI: 10.3892/ol.2017.7352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/20/2017] [Indexed: 11/06/2022] Open
Abstract
There is a great clinical requirement to improve radiofrequency ablation (RFA) efficacy and create larger coagulation necrotic areas. The aim of the present study was to assess the ability of a hypertonic-saline (HS)-enhanced multipolar RFA technique using a perfused electrode to increase RF-created coagulation necrosis, and to compare that technique with natural saline-augmented needle and conventional multipolar RFA. A total of 18 ablations were performed in explanted porcine livers. A total of 6 thermal ablation zones were created in each of 3 groups treated with the conventional multipolar mode, the multipolar mode with 0.9% NaCl and the multipolar mode with 6% NaCl, respectively. During RFA, the dimensions and volumes of the ablation zones were compared, and gross and microscopic pathological evaluations were performed. Multipolar RFA with 6% NaCl created the largest short-axis diameters and volumes of coagulation necrosis (3.89±0.09 mm and 40.01±2.86 mm3, respectively) among the three groups (conventional group: 2.31±0.04 mm and 8.99±0.52 mm3, respectively; 0.9% NaCl solution group: 3.17±0.05 mm and 21.79±1.05 mm3, respectively). Overall, multipolar RFA with the instillation of 6% NaCl solution through an open perfusion system created a larger ablation zone compared with the conventional and 0.9% NaCl modes. Therefore, HS-enhanced multipolar RFA may be a promising approach for treating large liver tumors.
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Affiliation(s)
- Caoye Wang
- Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, P.R. China
| | - Qi Wang
- Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, P.R. China
| | - Dachuan Zhang
- Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, P.R. China
| | - Zhongming He
- Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, P.R. China
| | - Wenhua Chen
- Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, P.R. China
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20
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Chen Q, Müftü S, Meral FC, Tuncali K, Akçakaya M. Model-based optimal planning of hepatic radiofrequency ablation. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2017; 34:415-431. [PMID: 27436683 DOI: 10.1093/imammb/dqw011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/22/2016] [Indexed: 11/14/2022]
Abstract
This article presents a model-based pre-treatment optimal planning framework for hepatic tumour radiofrequency (RF) ablation. Conventional hepatic radiofrequency (RF) ablation methods rely on pre-specified input voltage and treatment length based on the tumour size. Using these experimentally obtained pre-specified treatment parameters in RF ablation is not optimal to achieve the expected level of cell death and usually results in more healthy tissue damage than desired. In this study we present a pre-treatment planning framework that provides tools to control the levels of both the healthy tissue preservation and tumour cell death. Over the geometry of tumour and surrounding tissue, we formulate the RF ablation planning as a constrained optimization problem. With specific constraints over the temperature profile (TP) in pre-determined areas of the target geometry, we consider two different cost functions based on the history of the TP and Arrhenius index (AI) of the target location, respectively. We optimally compute the input voltage variation to minimize the damage to the healthy tissue while ensuring a complete cell death in the tumour and immediate area covering the tumour. As an example, we use a simulation of a 1D symmetric target geometry mimicking the application of single electrode RF probe. Results demonstrate that compared to the conventional methods both cost functions improve the healthy tissue preservation.
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Affiliation(s)
- Qiyong Chen
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115-5000, USA
| | - Sinan Müftü
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115-5000, USA
| | - Faik Can Meral
- Focused Ultrasound Laboratory, Department of Radiology, Brigham and Women's Hospital/Harvard Medical School, Boston, MA 02115, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Murat Akçakaya
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA 15261, USA
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21
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Long-term outcomes of microwave versus radiofrequency ablation for hepatocellular carcinoma by surgical approach: A retrospective comparative study. Asian J Surg 2017; 40:301-308. [DOI: 10.1016/j.asjsur.2016.01.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/20/2015] [Accepted: 01/12/2016] [Indexed: 12/27/2022] Open
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Rustagi T, Chhoda A. Endoscopic Radiofrequency Ablation of the Pancreas. Dig Dis Sci 2017; 62:843-850. [PMID: 28160105 DOI: 10.1007/s10620-017-4452-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 01/10/2017] [Indexed: 12/18/2022]
Abstract
Radiofrequency ablation (RFA) is a well-established technique to ablate dysplastic and neoplastic tissue via local thermal coagulative necrosis. Despite the widespread use in management of several cancers, the application of RFA in pancreas has been limited due to the increased risks of complications from the increased sensitivity of pancreatic tissue to thermal injury and proximity to vascular and biliary structures. RFA has been successfully used during laparotomy for locally advanced pancreatic carcinoma but requires an invasive approach. Endoscopic ultrasound-guided RFA offers the best combination of excellent visualization, real-time imaging guidance, and precise localization with minimal invasiveness. Several animal and human studies have demonstrated the technical feasibility and safety of endoscopic RFA in the pancreas. This article provides a comprehensive review of endoscopic RFA in the management of pancreatic lesions.
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Affiliation(s)
- Tarun Rustagi
- Division of Gastroenterology and Hepatology, University of New Mexico, MSC10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Ankit Chhoda
- Department of Internal Medicine, Waterbury Hospital, Waterbury, CT, USA
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Park JG, Park SY, Tak WY, Kweon YO, Jang SY, Lee YR, Hur K, Lee HJ, Lee HW. Early complications after percutaneous radiofrequency ablation for hepatocellular carcinoma: an analysis of 1,843 ablations in 1,211 patients in a single centre: experience over 10 years. Clin Radiol 2017; 72:692.e9-692.e15. [PMID: 28364952 DOI: 10.1016/j.crad.2017.03.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/24/2017] [Accepted: 03/01/2017] [Indexed: 12/12/2022]
Abstract
AIM To evaluate the incidence of adverse events and associated factors after radiofrequency ablation (RFA) in patients with hepatocellular carcinoma within 30 days. MATERIALS AND METHODS The early complications that occurred within 30 days after RFA at a single institution from January 2000 to July 2010 were reviewed in order to evaluate the morbidity, mortality, and risk factors associated with the complications. In total, 1,211 patients (845 men, 70.5%) with a mean age of 68 years (range, 27-88 years) underwent 1,843 RFA procedures. RESULTS The overall incidence rate of complications was 6.8% (125 cases). Major complications (n=36, 2%) included liver abscess (n=15, 0.8%), intraperitoneal bleeding (n=8, 0.4%), liver failure (n=5, 0.3%), variceal bleeding (n=3, 0.2%), haemothorax (n=2, 0.1%), cholecystitis (n=2, 0.1%), and bowel perforation (n=1, 0.1%). Among the minor complications (n=89, 4.8%), the most common was the post RFA syndrome accompanied by pain and fever (n=75, 4.1%). Other minor complications included significant pleural effusion (n=7, 0.4%), skin wound infection (n=4, 0.2%), and thermal injuries to the skin (n=3, 0.2%). Procedural infections significantly increased with tumour size (OR=1.379; 95% confidence interval [CI], 1.191-1.579; p<0.001), and multiple overlapping ablations (OR=1.118; 95% CI, 1.019-1.227, p=0.018). Thrombocytopenia (<50,000/μl), prothrombin time, and serum albumin level were significantly associated with post-RFA bleeding episodes (p=0.041, p=0.021, and p=0.003, respectively). The overall mortality rate was 0.3% (three cases of hepatic failure, two case of sepsis, and one case of renal failure). CONCLUSIONS RFA is a safe and effective local treatment for hepatocellular carcinoma. Careful selection of patients and appropriate RFA planning could decrease procedural mortality and morbidity.
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Affiliation(s)
- J G Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - S Y Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - W Y Tak
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Y O Kweon
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - S Y Jang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Y R Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - K Hur
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - H J Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - H W Lee
- Department of Pathology, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Republic of Korea
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Žūkienė R, Naučienė Z, Šilkūnienė G, Vanagas T, Gulbinas A, Zimkus A, Mildažienė V. Contribution of mitochondria to injury of hepatocytes and liver tissue by hyperthermia. MEDICINA-LITHUANIA 2017; 53:40-49. [PMID: 28256298 DOI: 10.1016/j.medici.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 12/15/2016] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to investigate functional changes of liver mitochondria within the experimentally modeled transition zone of radiofrequency ablation and to estimate possible contribution of these changes to the energy status of liver cells and the whole tissue. MATERIALS AND METHODS Experiments were carried out on mitochondria isolated from the perfused liver and isolated hepatocytes of male Wistar rats. Hyperthermia was induced by changing the temperature of perfusion medium in the range characteristic for the transition zone (38-52°C). After 15-min perfusion, mitochondria were isolated to investigate changes in the respiration rates and the membrane potential. Adenine nucleotides extracted from isolated hepatocytes and perfused liver subjected to hyperthermic treatment were analyzed by HPLC. RESULTS Hyperthermic liver perfusion at 42-52°C progressively impaired oxidative phosphorylation in isolated mitochondria. Significant inhibition of the respiratory chain components was observed after perfusion at 42°C, irreversible uncoupling became evident after liver perfusion at higher temperatures (46°C and above). After perfusion at 50-52°C energy supplying function of mitochondria was entirely compromised, and mitochondria turned to energy consumers. Hyperthermia-induced changes in mitochondrial function correlated well with changes in the energy status and viability of isolated hepatocytes, but not with the changes in the energy status of the whole liver tissue. CONCLUSIONS In this study the pattern of the adverse changes in mitochondrial functions that are progressing with increase in liver perfusion temperature was established. Results of experiments on isolated mitochondria and isolated hepatocytes indicate that hyperthermic treatment significantly and irreversibly inhibits energy-supplying function of mitochondria under conditions similar to those existing in the radiofrequency ablation transition zone and these changes can lead to death of hepatocytes. However, it was not possible to estimate contribution of mitochondrial injury to liver tissue energy status by estimating only hyperthermia-induced changes in adenine nucleotide amounts on the whole tissue level.
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Affiliation(s)
- Rasa Žūkienė
- Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Zita Naučienė
- Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Giedrė Šilkūnienė
- Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania
| | - Tomas Vanagas
- Department of Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Antanas Gulbinas
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelijus Zimkus
- Institute of Biosciences, Vilnius University Life Sciences Center, Vilnius, Lithuania
| | - Vida Mildažienė
- Faculty of Natural Sciences, Vytautas Magnus University, Kaunas, Lithuania.
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Luu HM, Klink C, Niessen W, Moelker A, van Walsum T. Non-Rigid Registration of Liver CT Images for CT-Guided Ablation of Liver Tumors. PLoS One 2016; 11:e0161600. [PMID: 27611780 PMCID: PMC5017717 DOI: 10.1371/journal.pone.0161600] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 08/08/2016] [Indexed: 12/23/2022] Open
Abstract
CT-guided percutaneous ablation for liver cancer treatment is a relevant technique for patients not eligible for surgery and with tumors that are inconspicuous on US imaging. The lack of real-time imaging and the use of a limited amount of CT contrast agent make targeting the tumor with the needle challenging. In this study, we evaluate a registration framework that allows the integration of diagnostic pre-operative contrast enhanced CT images and intra-operative non-contrast enhanced CT images to improve image guidance in the intervention. The liver and tumor are segmented in the pre-operative contrast enhanced CT images. Next, the contrast enhanced image is registered to the intra-operative CT images in a two-stage approach. First, the contrast-enhanced diagnostic image is non-rigidly registered to a non-contrast enhanced image that is conventionally acquired at the start of the intervention. In case the initial registration is not sufficiently accurate, a refinement step is applied using non-rigid registration method with a local rigidity term. In the second stage, the intra-operative CT-images that are used to check the needle position, which often consist of only a few slices, are registered rigidly to the intra-operative image that was acquired at the start of the intervention. Subsequently, the diagnostic image is registered to the current intra-operative image, using both transformations, this allows the visualization of the tumor region extracted from pre-operative data in the intra-operative CT images containing needle. The method is evaluated on imaging data of 19 patients at the Erasmus MC. Quantitative evaluation is performed using the Dice metric, mean surface distance of the liver border and corresponding landmarks in the diagnostic and the intra-operative images. The registration of the diagnostic CT image to the initial intra-operative CT image did not require a refinement step in 13 cases. For those cases, the resulting registration had a Dice coefficient for the livers of 91.4%, a mean surface distance of 4.4 mm and a mean distance between corresponding landmarks of 4.7 mm. For the three cases with a refinement step, the registration result significantly improved (p<0.05) compared to the result of the initial non rigid registration method (DICE of 90.3% vs 71.3% and mean surface distance of 5.1 mm vs 11.3 mm and mean distance between corresponding landmark of 6.4 mm vs 10.2 mm). The registration of the preoperative data with the needle image in 16 cases yielded a DICE of 90.1% and a mean surface distance of 5.2 mm. The remaining three cases with DICE smaller than 80% were classified as unsuccessful registration. The results show that this is promising tool for liver image registration in interventional radiology.
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Affiliation(s)
- Ha Manh Luu
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam, The Netherlands
- * E-mail:
| | - Camiel Klink
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam, The Netherlands
| | - Wiro Niessen
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam, The Netherlands
| | - Theo van Walsum
- Biomedical Imaging Group Rotterdam, Departments of Radiology & Medical Informatics, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam, The Netherlands
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Luu HM, Klink C, Niessen W, Moelker A, van Walsum T, Klink C, Moelker A. An automatic registration method for pre- and post-interventional CT images for assessing treatment success in liver RFA treatment. Med Phys 2016; 42:5559-67. [PMID: 26329002 DOI: 10.1118/1.4927790] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE In image-guided radio frequency ablation for liver cancer treatment, pre- and post-interventional CT images are typically used to verify the treatment success of the therapy. In current clinical practice, the tumor zone in the diagnostic, preinterventional images is mentally or manually mapped to the ablation zone in the post-interventional images to decide success of the treatment. However, liver deformation and differences in image quality as well as in texture of the ablation zone and the tumor area make the mental or manual registration a challenging task. Purpose of this paper is to develop an automatic framework to register the pre-interventional image to the post-interventional image. METHODS The authors propose a registration approach enabling a nonrigid deformation of the tumor to the ablation zone, while keeping locally rigid deformation of the tumor area. The method was evaluated on CT images of 38 patient datasets from Erasmus MC. The evaluation is based on Dice coefficients of the liver segmentation on both the pre-interventional and post-interventional images, and mean distances between the liver segmentations. Additionally, residual distances after registration between corresponding landmarks and local mean surface distance in the images were computed. RESULTS The results show that rigid registration gives a Dice coefficient of 87.9%, a mean distance of the liver surfaces of 5.53 mm, and a landmark error of 5.38 mm, while non-rigid registration with local rigid deformation has a Dice coefficient of 92.2%, a mean distance between the liver segmentation boundaries near the tumor area of 3.83 mm, and a landmark error of 2.91 mm, where a part of this error can be attributed to the slice spacing in the authors' CT images. CONCLUSIONS This method is thus a promising tool to assess the success of RFA liver cancer treatment.
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Affiliation(s)
- Ha Manh Luu
- Departments of Radiology and Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Camiel Klink
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Wiro Niessen
- Departments of Radiology and Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Theo van Walsum
- Departments of Radiology and Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Camiel Klink
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
| | - Adriaan Moelker
- Department of Radiology, Erasmus MC, Dr. Molewaterplein 50/60, Rotterdam 3015 GE, The Netherlands
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Wahl DR, Stenmark MH, Tao Y, Pollom EL, Caoili EM, Lawrence TS, Schipper MJ, Feng M. Outcomes After Stereotactic Body Radiotherapy or Radiofrequency Ablation for Hepatocellular Carcinoma. J Clin Oncol 2015; 34:452-9. [PMID: 26628466 DOI: 10.1200/jco.2015.61.4925] [Citation(s) in RCA: 407] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Data guiding selection of nonsurgical treatment of hepatocellular carcinoma (HCC) are lacking. We therefore compared outcomes between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for HCC. PATIENTS AND METHODS From 2004 to 2012, 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors. We applied inverse probability of treatment weighting to adjust for imbalances in treatment assignment. Freedom from local progression (FFLP) and toxicity were retrospectively analyzed. RESULTS RFA and SBRT groups were similar with respect to number of lesions treated per patient, type of underlying liver disease, and tumor size (median, 1.8 v 2.2 cm in maximum diameter; P = .14). However, the SBRT group had lower pretreatment Child-Pugh scores (P = .003), higher pretreatment alpha-fetoprotein levels (P = .04), and a greater number of prior liver-directed treatments (P < .001). One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2% v 97.4% and 83.8% for SBRT. Increasing tumor size predicted for FFLP in patients treated with RFA (hazard ratio [HR], 1.54 per cm; P = .006), but not with SBRT (HR, 1.21 per cm; P = .617). For tumors ≥ 2 cm, there was decreased FFLP for RFA compared with SBRT (HR, 3.35; P = .025). Acute grade 3+ complications occurred after 11% and 5% of RFA and SBRT treatments, respectively (P = .31). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT. CONCLUSION Both RFA and SBRT are effective local treatment options for inoperable HCC. Although these data are retrospective, SBRT appears to be a reasonable first-line treatment of inoperable, larger HCC.
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Affiliation(s)
- Daniel R Wahl
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Matthew H Stenmark
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Yebin Tao
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Erqi L Pollom
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Elaine M Caoili
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Theodore S Lawrence
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Matthew J Schipper
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI
| | - Mary Feng
- Daniel R. Wahl, Matthew H. Stenmark, Yebin Tao, Erqi L. Pollom, Elaine M. Caoili, Theodore S. Lawrence, Matthew J. Schipper, and Mary Feng, University of Michigan Medical Center; and Matthew H. Stenmark, Veterans Affairs Medical Center, Ann Arbor, MI.
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Feng M, Brunner TB, Ben-Josef E. Stereotactic Body Radiation Therapy for Liver Cancer: Effective Therapy With Minimal Impact on Quality of Life. Int J Radiat Oncol Biol Phys 2015; 93:26-8. [PMID: 26279021 DOI: 10.1016/j.ijrobp.2015.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 05/11/2015] [Accepted: 06/29/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Mary Feng
- Department of Radiation Oncology, University of Michigan Hospitals, Ann Arbor, MI.
| | - Thomas B Brunner
- Department of Radiation Oncology, University Hospitals Freiburg, Freiburg, Germany
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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Nassef MA. Added value of diffusion weighted MRI in evaluation of treatment response: post radiofrequency ablation for hepatocellular carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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"Edgeboost": A Novel Technique to Extend the Ablation Zone Lateral to a Two-Probe Bipolar Radiofrequency Device. Cardiovasc Intervent Radiol 2015; 39:97-105. [PMID: 26155781 DOI: 10.1007/s00270-015-1168-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/23/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND The dual-electrode bipolar-RFA (B-RFA) is increasingly used to ablate large liver tumours (3-7 cm). However, the challenging aspect of B-RFA is the placement of the two electrodes around the tumour. Realignment often requires the electrodes to be extracted and reinserted. AIM The aim of this study is to examine "Edgeboost", a novel technique to increase the lateral ablation dimension without requiring any realignment of the electrodes. METHODS AND MATERIALS An egg-white model and an ex vivo calf liver model were used compare the standard bipolar mode ablation to Edgeboost-1 (reaching full impedance in bipolar mode initially, then cycling in unipolar mode between left and right probes) and Edgeboost-2 (similar to Edgeboost-1 but not reaching full impedance initially in bipolar mode in order to minimize charring and, thus, to increase total ablation time). RESULTS A significantly larger outer lateral ablation dimension to the probe was achieved with Edgeboost-1 compared to the standard method in the liver model (1.14 cm, SD: 0.16 vs. 0.44 cm, SD: 0.24, p = 0.04). Edgeboost-2 achieved the largest outer lateral ablation dimension of 1.75 cm (SD: 0.35). A similar association was seen in the egg model. Edgeboost-2 almost doubled the mass ablated with standard bipolar alone (mass ratio: 1:1.94 in egg white and 1:1.84 in liver). CONCLUSION This study demonstrates that the novel "Edgeboost" technique can increase the outer lateral ablation dimension without requiring the two inserted electrodes to be reinserted. This would be beneficial for interventionists who use the dual B-RFA.
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Audigier C, Mansi T, Delingette H, Rapaka S, Mihalef V, Carnegie D, Boctor E, Choti M, Kamen A, Ayache N, Comaniciu D. Efficient Lattice Boltzmann Solver for Patient-Specific Radiofrequency Ablation of Hepatic Tumors. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:1576-1589. [PMID: 30132760 DOI: 10.1109/tmi.2015.2406575] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Radiofrequency ablation (RFA) is an established treatment for liver cancer when resection is not possible. Yet, its optimal delivery is challenged by the presence of large blood vessels and the time-varying thermal conductivity of biological tissue. Incomplete treatment and an increased risk of recurrence are therefore common. A tool that would enable the accurate planning of RFA is hence necessary. This manuscript describes a new method to compute the extent of ablation required based on the Lattice Boltzmann Method (LBM) and patient-specific, pre-operative images. A detailed anatomical model of the liver is obtained from volumetric images. Then a computational model of heat diffusion, cellular necrosis, and blood flow through the vessels and liver is employed to compute the extent of ablated tissue given the probe location, ablation duration and biological parameters. The model was verified against an analytical solution, showing good fidelity. We also evaluated the predictive power of the proposed framework on ten patients who underwent RFA, for whom pre- and post-operative images were available. Comparisons between the computed ablation extent and ground truth, as observed in postoperative images, were promising (DICE index: 42%, sensitivity: 67%, positive predictive value: 38%). The importance of considering liver perfusion while simulating electrical-heating ablation was also highlighted. Implemented on graphics processing units (GPU), our method simulates 1 minute of ablation in 1.14 minutes, allowing near real-time computation.
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Yang GW, Zhao Q, Qian S, Zhu L, Qu XD, Zhang W, Yan ZP, Cheng JM, Liu QX, Liu R, Wang JH. Percutaneous microwave ablation combined with simultaneous transarterial chemoembolization for the treatment of advanced intrahepatic cholangiocarcinoma. Onco Targets Ther 2015; 8:1245-50. [PMID: 26060410 PMCID: PMC4454214 DOI: 10.2147/ott.s84764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim To retrospectively evaluate the safety and efficacy of ultrasound-guided percutaneous microwave ablation (MWA) combined with simultaneous transarterial chemoembolization (TACE) in the treatment of patients with advanced intrahepatic cholangiocarcinoma (ICC). Methods All patients treated with ultrasound-guided percutaneous MWA combined with simultaneous TACE for advanced ICC at our institution were included. Posttreatment contrast-enhanced computed tomography and/or magnetic resonance imaging were retrieved and reviewed for tumor response to the treatment. Routine laboratory studies, including hematology and liver function tests were collected and analyzed. Procedure-related complications were reviewed and survival rates were analyzed. Results From January 2011 to December 2014, a total of 26 advanced ICC patients were treated at our single institute with ultrasound-guided percutaneous MWA combined with simultaneous TACE. There were 15 males and eleven females with an average age of 57.9±10.4 years (range, 43–75 years). Of 26 patients, 20 (76.9%) patients were newly diagnosed advanced ICC without any treatment, and six (23.1%) were recurrent and treated with surgical resection of the original tumor. The complete ablation rate was 92.3% (36/39 lesions) for advanced ICC. There were no major complications observed. There was no death directly from the treatment. Median progression-free survival and overall survival were 6.2 and 19.5 months, respectively. The 6-, 12-, and 24-month survival rates were 88.5%, 69.2%, and 61.5%, respectively. Conclusion The study suggests that ultrasound-guided percutaneous MWA combined with simultaneous TACE therapy can be performed safely in all patients with advanced ICC. The complete ablation rate was high and there was no major complication. The overall 24-month survival was 61.5%.
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Affiliation(s)
- Guo-Wei Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qing Zhao
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Sheng Qian
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Liang Zhu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xu-Dong Qu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Wei Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jie-Min Cheng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Qing-Xin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Rong Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jian-Hua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Yamashita H, Onishi H, Murakami N, Matsumoto Y, Matsuo Y, Nomiya T, Nakagawa K. Survival outcomes after stereotactic body radiotherapy for 79 Japanese patients with hepatocellular carcinoma. JOURNAL OF RADIATION RESEARCH 2015; 56:561-7. [PMID: 25691453 PMCID: PMC4426924 DOI: 10.1093/jrr/rru130] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/24/2014] [Accepted: 12/24/2014] [Indexed: 05/17/2023]
Abstract
Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. Outcomes of SBRT for liver tumors unsuitable for ablation or surgical resection were evaluated. A total of 79 patients treated with SBRT for primary hepatocellular carcinoma (HCC) between 2004 and 2012 in six Japanese institutions were studied retrospectively. Patients treated with SBRT preceded by trans-arterial chemoembolization were eligible. Their median age was 73 years, 76% were males, and their Child-Pugh scores were Grades A (85%) and B (11%) before SBRT. The median biologically effective dose (α/β = 10 Gy) was 96.3 Gy. The median follow-up time was 21.0 months for surviving patients. The 2-year overall survival (OS), progression-free survival (PFS), and distant metastasis-free survival were 53%, 40% and 76%, respectively. Sex and serum PIVKA-II values were significant predictive factors for OS. Hypovascular or hypervascular types of HCC, sex and clinical stage were significant predictive factors for PFS. The 2-year PFS was 66% in Stage I vs 18% in Stages II-III. Multivariate analysis indicated that clinical stage was the only significant predictive factor for PFS. No Grade 3 laboratory toxicities in the acute, sub-acute, and chronic phases were observed. PFS after SBRT for liver tumor was satisfactory, especially for Stage I HCC, even though these patients were unsuitable for resection and ablation. SBRT is safe and might be an alternative to resection and ablation.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | | | - Naoya Murakami
- Department of Radiology, National Cancer Center Hospital
| | - Yasuo Matsumoto
- Department of Radiology, Niigata University School of Medicine
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuma Nomiya
- Department of Radiology, Yamagata University Hospital
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Schumann C, Rieder C, Haase S, Teichert K, Süss P, Isfort P, Bruners P, Preusser T. Interactive multi-criteria planning for radiofrequency ablation. Int J Comput Assist Radiol Surg 2015; 10:879-89. [PMID: 25903775 DOI: 10.1007/s11548-015-1201-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Image-guided radiofrequency ablation (RFA) is a broadly used minimally invasive method for the thermal destruction of focal liver malignancies using needle-shaped instruments. The established planning workflow is based on examination of 2D slices and manual definition of the access path. During that process, multiple criteria for all possible trajectories have to be taken into account. Hence, it demands considerable experience and constitutes a significant mental task. METHODS An access path determination method based on image processing and numerical optimization is proposed. Fast GPU-based simulation approximation is utilized to incorporate the heat distribution including realistic cooling effects from nearby blood vessels. A user interface for intuitive exploration of the optimization results is introduced. RESULTS The proposed methods are integrated into a clinical software assistant. To evaluate the suitability of the interactive optimization approach for the identification of meaningful therapy strategies, a retrospective study has been carried out. The system is able to propose clinically relevant trajectories to the target by incorporating multiple criteria. CONCLUSIONS A novel method for planning of image-guided radiofrequency ablation by means of interactive access path determination based on optimization is presented. A first retrospective study indicates that the method is suited to improve the classical planning of RFA.
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Affiliation(s)
- Christian Schumann
- Fraunhofer MEVIS, Fraunhofer-Gesellschaft, Universitätsallee 29, 28359, Bremen, Germany,
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Kanogawa N, Chiba T, Ogasawara S, Ooka Y, Suzuki E, Motoyama T, Saito T, Sekimoto T, Tawada A, Maruyama H, Yoshikawa M, Yokosuka O. Successful interventional treatment for arterioportal fistula caused by radiofrequency ablation for hepatocellular carcinoma. Case Rep Oncol 2014; 7:833-9. [PMID: 25685134 PMCID: PMC4307006 DOI: 10.1159/000370305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Radiofrequency ablation (RFA) is commonly used as a treatment for small hepatocellular carcinoma (HCC). Although several complications such as intraperitoneal bleeding are often observed after RFA, hepatic arterioportal fistula (APF) is a less frequently occurring complication. In this study, we describe two cases of APF caused by RFA, which was successfully occluded by an interventional approach. Case 1 involved a 68-year-old man with solitary HCC in segment VIII of the liver. Both contrast-enhanced computed tomography and color Doppler sonography indicated an APF between the anterosuperior branch of the right hepatic artery (A8) and the portal branch (P8). Concordant with these findings, digital subtraction angiography (DSA) revealed an APF in segment VIII of the liver. Subsequently, the APF was successfully occluded by transarterial embolization (TAE) using gelatin sponge particles. Case 2 involved a 67-year-old man with solitary HCC in segment VII of the liver. Although he developed obstructive jaundice because of hemobilia after RFA, it was improved by endoscopic nasobiliary drainage and the systemic administration of antibiotics. In addition, color Doppler sonography revealed a disturbed flow of the right branch of the portal vein. Similar to case 1, DSA showed an APF between A8 and P8. The APF was successfully embolized by TAE using microcoils. In conclusion, it appears that the formation of APF should be checked after RFA. It is preferable to treat RFA-induced APF promptly by an interventional approach to avoid secondary complications such as portal hypertension and liver dysfunction.
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Affiliation(s)
- Naoya Kanogawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tenyu Motoyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomoko Saito
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tadashi Sekimoto
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masaharu Yoshikawa
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tseng SE, Chiou YY, Lee YC, Perng RP, Jacqueline WP, Chen YM. Number of liver metastatic nodules affects treatment options for pulmonary adenocarcinoma patients with liver metastases. Lung Cancer 2014; 86:225-30. [DOI: 10.1016/j.lungcan.2014.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/03/2014] [Accepted: 09/03/2014] [Indexed: 12/18/2022]
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Rustagi T, Jamidar PA. Intraductal radiofrequency ablation for management of malignant biliary obstruction. Dig Dis Sci 2014; 59:2635-41. [PMID: 24906696 DOI: 10.1007/s10620-014-3237-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/29/2014] [Indexed: 12/12/2022]
Abstract
Self-expandable metal stents (SEMS) are the current standard of care for the palliative management of malignant biliary strictures. Recently, endoscopic ablative techniques with direct affect to local tumor have been developed to improve SEMS patency. Several reports have demonstrated the technical feasibility and safety of intraductal radiofrequency ablation (RFA), by both endoscopic and percutaneous approaches, in palliation of malignant strictures of the bile duct. Intraductal RFA has also been used in the treatment of occlusion of both covered and uncovered SEMS occlusion from tumor ingrowth or overgrowth. This article provides a comprehensive review of intraductal RFA in the management of malignant biliary obstruction.
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Affiliation(s)
- Tarun Rustagi
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA,
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Radiofrequency ablation of small breast tumours: Evaluation of a novel bipolar cool-tip application. Eur J Surg Oncol 2014; 40:1222-9. [DOI: 10.1016/j.ejso.2014.07.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 01/15/2023] Open
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Combined analysis of serum alpha-fetoprotein and MAGE-A3-specific cytotoxic T lymphocytes in peripheral blood for diagnosis of hepatocellular carcinoma. DISEASE MARKERS 2014; 35:915-23. [PMID: 24427779 PMCID: PMC3881391 DOI: 10.1155/2013/907394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We investigated the feasibility of the combined detection of HLA-A2/MAGE-A3 epitope-specific cytotoxic T lymphocytes (CTLs) and serum alpha-fetoprotein (AFP) for specific diagnosis of hepatocellular carcinoma (HCC). We detected the frequency of MAGE-A3 epitopes (p112–120, KVAELVHFL) in spontaneous CTLs in the peripheral blood of HCC patients, liver cirrhosis patients, and healthy subjects with HLA-A2/polypeptide complex (pentamer) detection technology. Eighty-five HCC cases, 38 liver cirrhosis cases, and 50 healthy cases who were HLA-A2-positive were selected from 175 HCC patients, 80 patients with liver cirrhosis, and 105 healthy volunteers, respectively. The frequency of HLA-A2-specific MAGE-A3+ CTLs in the HCC group was significantly higher than that in the other groups. Combined detection of MAGE-A3+ CTL frequency and serum AFP value had a higher specificity than either of the two indicators alone. The pentamer technique is helpful in distinguishing benign lesions and malignant lesions in the liver. Combined with serum AFP, it can improve the diagnosis performance for HCC, especially for AFP-negative cancer.
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Al-Alem I, Pillai K, Akhter J, Chua TC, Morris DL. Heat Sink Phenomenon of Bipolar and Monopolar Radiofrequency Ablation Observed Using Polypropylene Tubes for Vessel Simulation. Surg Innov 2014; 21:269-276. [PMID: 24132470 DOI: 10.1177/1553350613505713] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background. Radiofrequency ablation (RFA) is widely used for treating liver tumors; recurrence is common owing to proximity to blood vessels possibly due to the heat sink effect. We seek to investigate this phenomenon using unipolar and bipolar RFA on an egg white tumor tissue model and an animal liver model. Materials and methods. Temperature profiles during ablation (with and without vessel simulation) were studied, using both bipolar and unipolar RFA probes by 4 strategically placed temperature leads to monitor temperature profile during ablation. The volume of ablated tissue was also measured. Results. The volume ablated during vessel simulation confirmed the impact of the heat sink phenomenon. The heat sink effect of unipolar RFA was greater compared with bipolar RFA (ratio of volume affected 2:1) in both tissue and liver models. The volume ablated using unipolar RFA was less than the bipolar RFA (ratio of volume ablated = 1:4). Unipolar RFA achieved higher ablation temperatures (122°C vs 98°C). Unipolar RFA resulted in tissue damage beyond the vessel, which was not observed using bipolar RFA. Conclusion. Bipolar RFA ablates a larger tumor volume compared with unipolar RFA, with a single ablation. The impact of heat sink phenomenon in tumor ablation is less so with bipolar than unipolar RFA with sparing of adjacent vessel damage.
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Affiliation(s)
- Ihssan Al-Alem
- University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - Krishna Pillai
- University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - Javed Akhter
- University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - Terence C. Chua
- University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
| | - David L. Morris
- University of New South Wales, St George Hospital, Kogarah, New South Wales, Australia
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Yamashita H, Onishi H, Matsumoto Y, Murakami N, Matsuo Y, Nomiya T, Nakagawa K. Local effect of stereotactic body radiotherapy for primary and metastatic liver tumors in 130 Japanese patients. Radiat Oncol 2014; 9:112. [PMID: 24886477 PMCID: PMC4029909 DOI: 10.1186/1748-717x-9-112] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/21/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Stereotactic body radiotherapy (SBRT) is a relatively new treatment for liver tumor. The outcomes of SBRT for liver tumor unfit for ablation and surgical resection were evaluated. METHODS Liver tumor patients treated with SBRT in seven Japanese institutions were studied retrospectively. Patients given SBRT for liver tumor between 2004 and 2012 were collected. Patients treated with SBRT preceded by trans-arterial chemoembolization (TACE) were eligible. Seventy-nine patients with hepatocellular carcinoma (HCC) and 51 patients with metastatic liver tumor were collected. The median biologically effective dose (BED) (α/β = 10 Gy) was 96.3 Gy for patients with HCC and 105.6 Gy with metastatic liver tumor. RESULTS The median follow-up time was 475.5 days in patients with HCC and 212.5 days with metastatic liver tumor. The 2-year local control rate (LCR) for HCC and metastatic liver tumor was 74.8% ± 6.3% and 64.2 ± 9.5% (p = 0.44). The LCR was not different between BED10 ≥ 100 Gy and < 100 Gy (p = 0.61). The LCR was significantly different between maximum tumor diameter > 30 mm vs. ≤ 30 mm (64% vs. 85%, p = 0.040) in all 130 patients. No grade 3 laboratory toxicities in the acute, sub-acute and chronic phases were observed. CONCLUSIONS There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor. SBRT is safe and might be an alternative method to resection and ablation. SUMMARY There was no difference in local control after SBRT in the range of median BED10 around 100 Gy for between HCC and metastatic liver tumor and SBRT is safe and might be an alternative method to resection and ablation.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Yasuo Matsumoto
- Department of Radiology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Singapore, Singapore
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takuma Nomiya
- Department of Radiation Oncology, Yamagata University Hospital, Yamagata, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Apoptotic and inhibitory effects on cell proliferation of hepatocellular carcinoma HepG2 cells by methanol leaf extract of Costus speciosus. BIOMED RESEARCH INTERNATIONAL 2014; 2014:637098. [PMID: 24818148 PMCID: PMC4000957 DOI: 10.1155/2014/637098] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/01/2014] [Accepted: 02/04/2014] [Indexed: 12/24/2022]
Abstract
Costus speciosus is a medicinal plant commonly known as wild ginger distributed in South and Southeast Asian countries. Leaves of this plant are used for ayurvedic treatment regimes in malignancies and mental illness. Rhizome extract from the plant is used to treat malignancies, pneumonia, urinary disorders, jaundice, rheumatism, and diabetes. The goal of this study was to investigate the effects of methanol extract of leaves of C. speciosus on the growth of human hepatocellular carcinoma (HepG2) cells and understand possible mechanisms of its action. Viability of HepG2 cells were measured by MTS assay after 24 h and 48 h treatment with extracts of 1, 10, 50, 100, and 200 μg/mL concentrations. Cell cycle analysis and apoptosis were evaluated by flow cytometry and caspase-3 induction. HepG2 cells treated with 100 μg/mL methanol leaf extract for 24 h displayed a significant reduction in cell viability (P ≤ 0.05). The methanol extract perturbed cell cycle progression, modulated cell cycle and regulated, signal molecules were involved in induction of apoptosis in HepG2 cells. Our findings indicate that phytochemicals of leaves of C. speciosus shows potential for natural therapeutic product development for hepatocellular carcinoma. This is the first report to demonstrate in vitro anticancer activity of leaf extract of C. speciosus in relation to liver cancer.
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Evolution of surgical microwave ablation for the treatment of colorectal cancer liver metastasis: review of the literature and a single centre experience. Surg Today 2014; 45:407-15. [DOI: 10.1007/s00595-014-0879-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 02/03/2014] [Indexed: 02/07/2023]
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Jin C, He Z, Liu J. MRI-based finite element simulation on radiofrequency ablation of thyroid cancer. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 113:529-538. [PMID: 24411316 DOI: 10.1016/j.cmpb.2013.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/01/2013] [Accepted: 12/16/2013] [Indexed: 06/03/2023]
Abstract
In order to provide a quantitative disclosure on the RFA (radiofrequency ablation)-induced thermal ablation effects within thyroid tissues, this paper has developed a three-dimensional finite element simulation strategy based on a MRI (magnetic resonance imaging)-reconstructed model. The thermal lesion's growth was predicted and interpreted under two treatment conditions, i.e. single-cooled-electrode modality and two-cooled-electrode system. The results show that the thermal lesion's growth is significantly affected by two factors including the position of RF electrode and thermal-physiological behavior of the breathing airflow. Additional parametric studies revealed several valuable phenomena, e.g. with the electrode's movement, thermal injury with varying severity would happen to the trachea wall. Besides, the changes in airflow mass produced evident effects on the total heat flux of thyroid surface, while the changes in breathing frequency only generated minor effects that can be ignored. The present study provided a better understanding on the thermal lesions of RFA within thyroid domain, which will help guide future treatment of the thyroid cancer.
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Affiliation(s)
- Chao Jin
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, PR China
| | - Zhizhu He
- Beijing Key Laboratory of Cryo-Biomedical Engineering, and Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China
| | - Jing Liu
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, PR China; Beijing Key Laboratory of Cryo-Biomedical Engineering, and Key Laboratory of Cryogenics, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, PR China.
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Coronal reformatted CT images contribute to the precise evaluation of the radiofrequency ablative margin for hepatocellular carcinoma. ACTA ACUST UNITED AC 2013; 39:262-8. [DOI: 10.1007/s00261-013-0054-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Yoon JH, Lee JM, Han JK, Choi BI. Dual switching monopolar radiofrequency ablation using a separable clustered electrode: comparison with consecutive and switching monopolar modes in ex vivo bovine livers. Korean J Radiol 2013; 14:403-11. [PMID: 23690705 PMCID: PMC3655292 DOI: 10.3348/kjr.2013.14.3.403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/26/2012] [Indexed: 01/19/2023] Open
Abstract
Objective To compare the in-vitro efficiency of dual-switching monopolar (DSM) radiofrequency ablation (RFA) using a separable clustered electrode (Octopus® electrodes) with consecutive monopolar (CM) and switching monopolar (SM) RFA techniques to create an ablative zone in the explanted bovine liver. Materials and Methods For DSM-RFA, we used a prototype, three-channel, dual generator RFA Unit and Octopus® electrodes with three, 17 gauge internally cooled electrodes. The RFA Unit allowed simultaneous radiofrequency (RF) energy delivery to two electrodes of the Octopus® electrodes as well as automatic switching among the three electrode pairs according to the impedance changes. RF energy was sequentially applied to one of the three electrodes for 24 minutes (group A; CM mode, n = 10) or alternatively applied for 12 minutes (group B; SM mode, n = 10) or concurrently applied to a pair of electrodes for 12 minutes (group C; DSM mode, n = 10) in explanted bovine livers. Changes in the impedance and current during RFA as well as the dimensions of the thermal ablative zones were compared among the three groups. Results The mean, delivered RF energy amounts in groups A, B, and C were 63.15 ± 8.6 kJ, 72.13 ± 5.4 kJ, and 106.08 ± 13.4 kJ, respectively (p < 0.001). The DSM mode created a significantly larger ablation volume than did the other modes, i.e., 68.1 ± 10.2 cm3 (group A), 92.0 ± 19.9 cm3 (group B), and 115.1 ± 14.0 cm3 (group C) (p < 0.001). The circularity in groups A, B, and C were 0.84 ± 0.06, 0.87 ± 0.04 and 0.90 ± 0.03, respectively (p = 0.03). Conclusion DSM-RFA using Octopus® electrodes can help create large ablative zones within a relatively short time.
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Affiliation(s)
- Jeong-Hee Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul 110-744, Korea
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Scorsetti M, Arcangeli S, Tozzi A, Comito T, Alongi F, Navarria P, Mancosu P, Reggiori G, Fogliata A, Torzilli G, Tomatis S, Cozzi L. Is stereotactic body radiation therapy an attractive option for unresectable liver metastases? A preliminary report from a phase 2 trial. Int J Radiat Oncol Biol Phys 2013; 86:336-42. [PMID: 23433800 DOI: 10.1016/j.ijrobp.2012.12.021] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the feasibility of high-dose stereotactic body radiation therapy (SBRT) in the treatment of unresectable liver metastases. METHODS AND MATERIALS Patients with 1 to 3 liver metastases, with maximum individual tumor diameters less than 6 cm and a Karnofsky Performance Status of at least 70, were enrolled and treated by SBRT on a phase 2 clinical trial. Dose prescription was 75 Gy on 3 consecutive days. SBRT was delivered using the volumetric modulated arc therapy by RapidArc (Varian, Palo Alto, CA) technique. The primary end-point was in-field local control. Secondary end-points were toxicity and survival. RESULTS Between February 2010 and September 2011, a total of 61 patients with 76 lesions were treated. Among the patients, 21 (34.3%) had stable extrahepatic disease at study entry. The most frequent primary sites were colorectal (45.9%) and breast (18%). Of the patients, 78.7% had 1 lesion, 18.0% had 2 lesions, and 3.3% had 3 lesions. After a median of 12 months (range, 2-26 months), the in-field local response rate was 94%. The median overall survival rate was 19 months, and actuarial survival at 12 months was 83.5%. None of the patients experienced grade 3 or higher acute toxicity. No radiation-induced liver disease was detected. One patient experienced G3 late toxicity at 6 months, resulting from chest wall pain. CONCLUSIONS SBRT for unresectable liver metastases can be considered an effective, safe, and noninvasive therapeutic option, with excellent rates of local control and a low treatment-related toxicity.
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Affiliation(s)
- Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano, Italy
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Koda M, Murawaki Y, Hirooka Y, Kitamoto M, Ono M, Sakaeda H, Joko K, Sato S, Tamaki K, Yamasaki T, Shibata H, Shimoe T, Matsuda T, Toshikuni N, Fujioka SI, Ohmoto K, Nakamura S, Kariyama K, Aikata H, Kobayashi Y, Tsutsui A. Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: An analysis of 16 346 treated nodules in 13 283 patients. Hepatol Res 2012; 42:1058-64. [PMID: 22583706 DOI: 10.1111/j.1872-034x.2012.01025.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM We surveyed multiple centers to identify types and frequency of complications and mortality rate associated with radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). METHODS We distributed a questionnaire developed by members of the Chugoku-Shikoku Society for the Local Ablation Therapy of Hepatocellular Carcinoma to 20 centers and analyzed types and frequency of complications and mortality rate. RESULTS In total, 16 346 nodules were treated in 13 283 patients between January 1999 and November 2010. Five patients (0.038%) died: two from intraperitoneal hemorrhage, and one each from hemothorax, severe acute pancreatitis and perforation of the colon. In 16 346 treated nodules, 579 complications (3.54%) were observed, including 78 hemorrhages (0.477%), 276 hepatic injuries (1.69%), 113 extrahepatic organ injuries (0.691%) and 27 tumor progressions (0.17%). The centers that treated a large number of nodules and performed RFA modifications, such as use of artificial ascites, artificial pleural effusion and bile duct cooling, had low complication rates. CONCLUSION This study confirmed that RFA is a low-risk treatment for HCC and that sufficient experience and technical skill can reduce complications.
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Affiliation(s)
- Masahiko Koda
- Second Department of Internal Medicine Department of Pathobiological Science and Technology, Tottori University, Japan
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Kennedy TJ, Cassera MA, Khajanchee YS, Diwan TS, Hammill CW, Hansen PD. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol 2012; 107:324-8. [PMID: 22996143 DOI: 10.1002/jso.23268] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 08/27/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Published results addressing the treatment of colorectal liver metastases (CRLM) with radiofrequency ablation (RFA) vary widely with local recurrence rates of 2-40% and 5-year survival of 14-55%. The goal of this study was to analyze our 10-year experience with laparoscopic RFA. METHODS From January 2000 to July 2010, 130 patients underwent laparoscopic RFA for CRLM. Kaplan-Meier analysis was used to assess survival. Univariate and multivariate analysis were performed to identify factors associated with survival and recurrence. RESULTS In this cohort, median survival was 40.4 months with 5-year survival of 28.8%. Overall, 9.2% of patients had a local recurrence (3.6% for tumors 3 cm or less). On univariate analysis, factors associated with decreased survival were BMI (P = 0.045), rectal primary (P = 0.005), and increased tumor size (P = 0.002). On multivariate analysis, increased tumor size (HR 1.29 [95% CI: 1.04-1.59]; P = 0.020) and bilobar disease (HR 2.06 [95% CI: 1.02-4.15]; P = 0.044) were associated with decreased survival. On univariate analysis, only BMI was found to be associated with disease recurrence (P = 0.025). CONCLUSIONS Our data demonstrate that laparoscopic RFA can achieve a median survival of 40.4 months with a low local recurrence rate. Patients with tumors 3 cm or less have a decreased risk of local recurrence.
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Affiliation(s)
- Timothy J Kennedy
- Department of Surgery, Montefiore Medical Center, New York City, NY, USA
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