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Qiu C, Ma Y, Xiao M, Wang Z, Wu S, Han K, Wang H. Nomogram to Predict Tumor Remnant of Small Hepatocellular Carcinoma after Microwave Ablation. Acad Radiol 2025; 32:1419-1430. [PMID: 39448339 DOI: 10.1016/j.acra.2024.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 09/11/2024] [Accepted: 09/29/2024] [Indexed: 10/26/2024]
Abstract
RATIONALE AND OBJECTIVES This investigation sought to create a nomogram to predict the ablation effect after microwave ablation in patients with hepatocellular carcinoma, which can guide the selection of microwave ablation for small hepatocellular carcinomas. METHODS In this two-center retrospective study, 233 patients with hepatocellular carcinoma treated with microwave ablation (MWA) between January 2016 and December 2023 were enrolled and analyzed for their clinical baseline data, laboratory parameters, and MR imaging characteristics. Logistic regression analysis was used to screen the features, and clinical and imaging feature models were developed separately. Finally, a nomogram was established. All models were evaluated using the area under the curve (AUC), accuracy, sensitivity, specificity, and decision curve analysis (DCA). RESULTS Two models and a nomogram were developed to predict ablation outcomes after MWA based on a training set (n = 182, including complete ablation: 136, incomplete ablation: 46) and an external validation set (n = 51, complete ablation: 36, incomplete ablation: 15). The clinical models and nomogram performed well in the external validation cohort. The AUC of the nomogram was 0.966 (95% CI: 0.944- 0.989), with a sensitivity of 0.935, a specificity of 0.882, and an accuracy of 0.896. CONCLUSIONS Combining clinical data and imaging features, a nomogram was constructed that could effectively predict the postoperative ablation outcome in hepatocellular carcinoma patients undergoing MWA, which could help clinicians provide treatment options for hepatocellular carcinoma patients.
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Affiliation(s)
- Chenyang Qiu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Yinchao Ma
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Mengjun Xiao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Zhipeng Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Shuzhen Wu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Kun Han
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
| | - Haiyan Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China (C.Q., Y.M., M.X., Z.W., S.W., K.H., H.W.).
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Sato M, Tateishi R, Zohar Y, Sato J, Watadani T, Moriyama M, Wake T, Nakagomi R, Kinoshita MN, Nakatsuka T, Minami T, Uchino K, Enooku K, Nakagawa H, Asaoka Y, Yamada R, Even N, Amitai I, Abu Y, Fujishiro M, Koike K. Retrospective evaluation of a novel ultrasound-based imaging analysis software for predicting radiofrequency ablation areas. PLoS One 2025; 20:e0317469. [PMID: 39823502 PMCID: PMC11741625 DOI: 10.1371/journal.pone.0317469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 12/27/2024] [Indexed: 01/19/2025] Open
Abstract
OBJECTIVE This study aimed to introduce and evaluate a novel software-based system, BioTrace, designed for real-time monitoring of thermal ablation tissue damage during image-guided radiofrequency ablation for hepatocellular carcinoma (HCC). METHODS BioTrace utilizes a proprietary algorithm to analyze the temporo-spatial behavior of thermal gas bubble activity during ablation, as seen in conventional B-mode ultrasound imaging. Its predictive accuracy was assessed by comparing the ablation zones it predicted with those annotated by radiologists using contrast-enhanced computed tomography (CECT) 24 hours post-treatment, considered the gold standard. The study included 20 liver tumors. RESULTS The median tumor measurement along the major axis was 1.2 cm. The median Dice coefficient, Sensitivity, and Precision between BioTrace and CECT were 0.90, 0.91, and 0.91, respectively. The intraclass correlation showed excellent agreement in volume size between BioTrace and CECT findings (0.98). CONCLUSION BioTrace effectively generates an ablation damage prediction map based on real-time ultrasound imaging, accurately predicting the ablation zone as confirmed by 24-hour post-procedural CECT. This system has the potential to enhance the safety and efficacy of ablation procedures in clinical settings.
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Affiliation(s)
- Masaya Sato
- Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yogev Zohar
- TechsoMed Medical Technologies Ltd., Rehovot, Israel
| | - Jiro Sato
- Department of Radiology, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | | | - Makoto Moriyama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taijiro Wake
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Takuma Nakatsuka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Gastroenterology and Hepatology Mie University Graduate School of Medicine, Mie, Japan
| | - Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryo Yamada
- Development Department 2, SCREEN Advanced System Solutions Co., Ltd, Kyoto, Japan
| | - Nitzan Even
- TechsoMed Medical Technologies Ltd., Rehovot, Israel
| | - Inbal Amitai
- TechsoMed Medical Technologies Ltd., Rehovot, Israel
| | - Yossi Abu
- TechsoMed Medical Technologies Ltd., Rehovot, Israel
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Doppegieter M, van Leeuwen TG, van Weert A, Aalders MCG, Bakker ENTP. Subminute thermal damage to cell types present in the skin. Int J Hyperthermia 2024; 41:2354435. [PMID: 38754976 DOI: 10.1080/02656736.2024.2354435] [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: 03/20/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
INTRODUCTION Psoriasis is characterized by an increase in the proliferation of keratinocytes and nerve fiber activity, contributing to the typical skin lesions. Pulsed Dye Laser (PDL) treatment is effective for the treatment of psoriatic lesions but its mechanism remains unclear. One hypothesis is that PDL causes thermal damage by the diffusion of heat to neighboring structures in lesional skin. There is limited information on the thermal sensitivity of these neighboring skin cells when exposed to hyperthermia for durations lasting less than a minute. Our study aimed to investigate the cell-specific responses to heat using sub-minute exposure times and moderate to ablative hyperthermia. MATERIALS AND METHODS Cultured human endothelial cells, smooth muscle cells, neuronal cells, and keratinocytes were exposed to various time (2-20 sec) and temperature (45-70 °C) combinations. Cell viability was assessed by measuring intracellular ATP content 24 h after thermal exposure and this data was used to calculate fit parameters for the Arrhenius model and CEM43 calculations. RESULTS Our results show significant differences in cell survival between cell types (p < 0.0001). Especially within the range of 50-60 °C, survival of neuronal cells and keratinocytes was significantly less than that of endothelial and smooth muscle cells. No statistically significant difference was found in the lethal dose (LT50) of thermal energy between neuronal cells and keratinocytes. However, CEM43 calculations showed significant differences between all four cell types. CONCLUSION The results imply that there is a cell-type-dependent sensitivity to thermal damage which suggests that neuronal cells and keratinocytes are particularly susceptible to diffusing heat from laser treatment. Damage to these cells may aid in modulating the neuro-inflammatory pathways in psoriasis. These data provide insight into the potential mechanisms of PDL therapy for psoriasis and advance our understanding of how thermal effects may play a role in its effectiveness.
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Affiliation(s)
- Meagan Doppegieter
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
| | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, the Netherlands
| | - Angela van Weert
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Maurice C G Aalders
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Amsterdam Public Health, Personalized Medicine, Amsterdam, the Netherlands
| | - Erik N T P Bakker
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Microcirculation, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Neurovascular Disorders, Amsterdam, the Netherlands
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Zhou F, Sun Y, Hou Y, Liu F, Yu X. Intratumoral perfusion may affect microwave ablation area of hepatocellular carcinoma. Int J Hyperthermia 2023; 40:2268892. [PMID: 37927295 DOI: 10.1080/02656736.2023.2268892] [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: 06/27/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of intratumoral perfusion on microwave ablation (MWA) area in hepatocellular carcinoma (HCC). METHODS Patients who underwent curative MWA for HCC between October 2013 and May 2015 were enrolled. Three days before MWA, contrast-enhanced ultrasound (CEUS) was performed to illustrate the perfusion characteristics of the target lesion. Using the Sonoliver quantification software, time-intensity curves of dynamic CEUS were obtained, and quantitative parameters were extracted. Two microwave antennae were inserted into the center of the tumor and MWA was performed with a continuous power output of 50 W for 5 min. A second CEUS was performed to measure the size of the ablated region. Thereafter, an additional MWA procedure was performed until complete ablation with a 5-10-mm safety margin was achieved. RESULTS A total of 38 patients who underwent curative MWA for 39 HCC nodules were enrolled. The mean age was 57 years (34-80 years), and the median maximum diameter of the HCC was 3.4 cm (interquartile range, 2-6.8 cm). Time-intensity curves were obtained and the area under the curve (AUC) was selected as a parameter for intratumoral perfusion. The AUC was inversely and linearly correlated with the size of the MWA area, including long- and short-axis diameters and ablation volume. A 1,000-dB·s change in the AUC produced an average change of 1.17 ± 0.44 mm, 0.725 ± 0.355 mm, and 2.4995 ± 0.6575 cm³ in the long- and short-axis diameters and ablation volume, respectively. CONCLUSIONS The intratumoral perfusion of HCC was inversely correlated with MWA area size.
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Affiliation(s)
- Fubo Zhou
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ya Sun
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yaxin Hou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Gordon AC, Lewandowski RJ. CBCT-guided TACE-MWA for HCC Measuring up to 5 cm. Acad Radiol 2021; 28 Suppl 1:S71-S72. [PMID: 34154903 DOI: 10.1016/j.acra.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
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Inoue A, Nitta N, Imai Y, Takaki K, Takahashi H, Ota S, Mukaisho KI, Watanabe Y. Effect of Portal Vein and Hepatic Artery Occlusion on Radiofrequency Ablation: Animal Experiment Comparing MR and Histology Measurements of the Ablation Zones. Cardiovasc Intervent Radiol 2021; 44:1790-1797. [PMID: 34231011 DOI: 10.1007/s00270-021-02822-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This animal experimental study evaluated how hepatic artery and portal vein transient occlusion affects the ablation zone of hepatic radiofrequency ablation (RFA). MATERIAL AND METHODS Twenty-one rabbits were divided into three groups of seven each: (1) control, (2) hepatic artery occlusion, and (3) portal vein occlusion by a balloon catheter. For each rabbit, two or three RFA sessions were performed using an electrode needle. Ablation time, temperature around the tip of RFA needle at the end of RFA, ablation volume on fat-suppressed T1-weighted image in the hepatobiliary phase, and coagulative necrosis area on histopathology were measured and compared between the three groups using the Kruskal-Wallis paired Mann-Whitney U tests. RESULTS In 43 RFA sessions (group 1, 15; group 2, 14; group 3, 14), mean tissue temperature in group 3 (77.0 °C ± 7.7 °C) was significantly higher compared to groups 1 (59.2 °C ± 18.8 °C; P = 0.010) and 2 (67.5 °C ± 9.9 °C; P = 0.010). In addition, mean ablation volume and coagulative necrosis in group 3 (2.10 ± 1.37 mm3 and 0.86 ± 0.28 mm2, respectively) were larger compared to groups 1 (0.84 ± 0.30 mm3; P < 0.001 and 0.55 ± 0.26 mm2; P = 0.020, respectively) and 2 (0.89 ± 0.59 mm3; P = 0.002 and 0.60 ± 0.22 mm2; P = 0.024, respectively). CONCLUSION Portal vein occlusion potentially boosts tissue temperature, ablation volume, and area of histopathologically proven coagulative necrosis during hepatic RFA in the non-cirrhotic liver.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Hiroaki Takahashi
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Ken-Ichi Mukaisho
- Division of Human Pathology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Afaghi P, Lapolla MA, Ghandi K. Percutaneous microwave ablation applications for liver tumors: recommendations for COVID-19 patients. Heliyon 2021; 7:e06454. [PMID: 33748501 PMCID: PMC7966996 DOI: 10.1016/j.heliyon.2021.e06454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
Microwave ablation (MWA) is an alternative locoregional therapy to surgical resection of solid tumors in the treatment of malignancies, and is widely used for hepatic tumors. It has a slightly higher overall survival (OS) rate compared to external beam radiation therapy (EBRT), and proton beam therapy (PBT), and better long-term recurrence-free OS rate compared to radiofrequency ablation (RFA). In this paper, current commercial devices, most recent noncommercial designs, and the principles behind them alongside the recently reported developments and issues of MWA are reviewed. The paper also provides microscopic insights on effects of microwave irradiation in the body. Our review shows that MWA is a safe and effective, minimally invasive method with high ablation completion rates. However, for large tumors, the completion rates slightly decrease, and recurrences increase. Thus, for large tumors we suggest using a cooled shaft antenna or multiple antenna placements. Comparisons of the two common ablation frequencies 915 MHz and 2.45 GHz have shown inconsistent results due to non-identical conditions. This review suggests that 915 MHz devices are more effective for ablating large tumors and the theory behind MWA effects corroborates this proposition. However, for small tumors or tumors adjacent to vital organs, 2.45 GHz is suggested due to its more localized ablation zone. Among the antenna designs, the double-slot antenna with a metallic choke seems to be more effective by localizing the radiation around the tip of the antenna, while also preventing backward radiation towards the skin. The review also pertains to the use of MWA in COVID-19 patients and risk factors associated with the disease. MWA should be considered for COVID-19 patients with hepatic tumors as a fast treatment with a short recovery time. As liver injury is also a risk due to COVID-19, it is recommended to apply liver function tests to monitor abnormal levels in alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, and other liver function indicators.
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Affiliation(s)
- Pooya Afaghi
- Department of Chemistry, University of Guelph, ON, Canada
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Zaitoun MMA, Elsayed SB, Zaitoun NA, Soliman RK, Elmokadem AH, Farag AA, Amer M, Hendi AM, Mahmoud NEM, Salah El Deen D, Alsowey AM, Shahin S, Basha MAA. Combined therapy with conventional trans-arterial chemoembolization (cTACE) and microwave ablation (MWA) for hepatocellular carcinoma >3-<5 cm. Int J Hyperthermia 2021; 38:248-256. [PMID: 33615957 DOI: 10.1080/02656736.2021.1887941] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare safety and efficacy of combined therapy with conventional transarterial chemoembolization (cTACE)+microwave ablation (MWA) versus only TACE or MWA for treatment of hepatocellular carcinoma (HCC) >3-<5 cm. METHODS This randomized controlled trial (NCT04721470) screened 278 patients with HCC >3-<5 cm. Patients were randomized into three groups: 90 underwent TACE (Group 1); 95 underwent MWA (Group 2); and 93 underwent combined therapy (Group 3). Patients were followed-up with contrast-enhanced CT or MRI. Images were evaluated and compared for treatment response and adverse events based on modified response evaluation criteria in solid tumor. Serum alpha-fetoprotein (AFP) concentration was measured at baseline and during every follow-up visit. RESULTS Final analysis included 265 patients (154 men, 111 women; mean age = 54.5 ± 11.8 years; range = 38-76 years). Complete response was achieved by 86.5% of patients who received combined therapy compared with 54.8% with only TACE and 56.5% with only MWA (p = 0.0002). The recurrence rate after 12 months was significantly lower in Group 3 (22.47%) than Groups 1 (60.7%) and 2 (51.1%) (p = 0.0001). The overall survival rate (three years after therapy) was significantly higher in Group 3 (69.6%) than Groups 1 (54.7%) and 2 (54.3%) (p = 0.02). The mean progression-free survival was significantly higher in Group 3 than groups 1 and 2 (p < 0.001). A decrease in AFP concentration was seen in 75%, 63%, and 48% patients of Group 3, 2, and 1, respectively. CONCLUSIONS Combined therapy with cTACE + MWA is safe, well-tolerated, and more effective than TACE or MWA alone for treatment of HCC >3-<5 cm.
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Affiliation(s)
- Mohamed M A Zaitoun
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Diagnostic Radiology Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Saeed B Elsayed
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nahla A Zaitoun
- Family Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Radwa K Soliman
- Diagnostic Radiology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ali H Elmokadem
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alaa A Farag
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mahmoud Amer
- Internal medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ali M Hendi
- Diagnostic Radiology Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Nader E M Mahmoud
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Dalia Salah El Deen
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed M Alsowey
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shahenda Shahin
- Diagnostic Radiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Influence of interapplicator distance on multibipolar radiofrequency ablation during physiological and interrupted liver perfusion in an in vivo porcine model. Sci Rep 2020; 10:16210. [PMID: 33004845 PMCID: PMC7529885 DOI: 10.1038/s41598-020-71512-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Radiofrequency ablation (RFA) is a curative treatment option for early stage hepatocellular carcinoma (HCC). Vascular inflow occlusion to the liver (Pringle manoeuvre) and multibipolar RFA (mbRFA) represent possibilities to generate large ablations. This study evaluated the impact of different interapplicator distances and a Pringle manoeuvre on ablation area and geometry of mbRFA. 24 mbRFA were planned in porcine livers in vivo. Test series with continuous blood flow had an interapplicator distance of 20 mm and 15 mm, respectively. For a Pringle manoeuvre, interapplicator distance was predefined at 20 mm. After liver dissection, ablation area and geometry were analysed macroscopically and histologically. Confluent and homogenous ablations could be achieved with a Pringle manoeuvre and an interapplicator distance of 15 mm with sustained hepatic blood flow. Ablation geometry was inhomogeneous with an applicator distance of 20 mm with physiological liver perfusion. A Pringle manoeuvre led to a fourfold increase in ablation area in comparison to sustained hepatic blood flow (p < 0.001). Interapplicator distance affects ablation geometry of mbRFA. Strict adherence to the planned applicator distance is advisable under continuous blood flow. The application of a Pringle manoeuvre should be considered when compliance with the interapplicator distance cannot be guaranteed.
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Xie L, Cao F, Qi H, Song Z, Shen L, Chen S, Hu Y, Chen C, Fan W. Efficacy and safety of CT-guided percutaneous thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis. Int J Hyperthermia 2019; 36:1122-1128. [DOI: 10.1080/02656736.2019.1684575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Ze Song
- Department of Oncology, The Seventh Affiliated Hospital,Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Yubin Hu
- Department of Interventional Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
| | - Chao Chen
- Department of Interventional Therapy, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Sun Yat-Sen University State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
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Lewis AR, Padula CA, McKinney JM, Toskich BB. Ablation plus Transarterial Embolic Therapy for Hepatocellular Carcinoma Larger than 3 cm: Science, Evidence, and Future Directions. Semin Intervent Radiol 2019; 36:303-309. [PMID: 31680721 DOI: 10.1055/s-0039-1697641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Thermal ablation is widely regarded as definitive therapy for early-stage hepatocellular carcinoma, but its efficacy decreases in tumors greater than 3 cm. Extensive clinical studies have supported improved outcomes provided through combining transarterial embolic therapy with ablation in the treatment of larger tumors. This article will provide a survey of the science and data for combination therapy in both thermal and nonthermal ablation modalities, as well as describe emerging applications.
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Affiliation(s)
- Andrew R Lewis
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Carlos A Padula
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - J Mark McKinney
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Beau B Toskich
- Division of Interventional Radiology, Department of Radiology, Mayo Clinic, Jacksonville, Florida
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Urbonas T, Anderson EM, Gordon-Weeks AN, Kabir SI, Soonawalla Z, Silva MA, Gleeson FV, Reddy S. Factors predicting ablation site recurrence following percutaneous microwave ablation of colorectal hepatic metastases. HPB (Oxford) 2019; 21:1175-1184. [PMID: 30777696 DOI: 10.1016/j.hpb.2019.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microwave ablation (MWA) is a recognised treatment option for liver metastases. The size of the tumour is a well-established factor that influences the success of MWA. However, the effect of "heat sink" on the success of MWA for hepatic metastases is unclear. The aim of this study was to determine whether heat sink effect is a factor that contributes to ablation site recurrence (ASR). METHODS A prospectively maintained database of patients who underwent percutaneous MWA for treatment of colorectal liver metastases was analysed. Imaging and demographic characteristics were compared between metastases that recurred following ablation and those that did not. Proximity to a large hepatic vein was defined as <10 mm. RESULTS 126 ablations in 87 patients met the inclusion criteria and were studied over a median follow-up period of 28 (12-75) months. ASR was detected in 43 ablations (34%) and was associated with clinical risk score (CRS) ≥2 (OR 2.2 95% CI 1.3-3.3, p = 0.029), metastasis size (OR 0.953 95% CI (0.929-0.978), p < 0.001) and proximity to a large hepatic vein (OR 7.5 95%CI 2.4-22.8, p < 0.001). Proximity to a large hepatic vein was not associated with reduced overall survival (OS) but was associated with liver-specific recurrence (HR 4.7 95%CI 1.7-12.5, p = 0.004). CONCLUSIONS In addition to tumour size proximity to large hepatic venous structures is an independent predictor of ASR and liver-specific recurrence following MWA. However, this was not associated with overall survival.
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Affiliation(s)
- Tomas Urbonas
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust.
| | - Ewan M Anderson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Alex N Gordon-Weeks
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Syed I Kabir
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Zahir Soonawalla
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Michael A Silva
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Fergus V Gleeson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Srikanth Reddy
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
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13
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Vahldiek JL, Erxleben C, Bressem KK, Gemeinhardt O, Poch F, Hiebl B, Lehmann KS, Hamm B, Niehues SM. Multipolar RFA of the liver: Influence of intrahepatic vessels on ablation zones and appropriateness of CECT in detecting ablation dimensions - Results of an in-vivo porcine liver model. Clin Hemorheol Microcirc 2019; 70:467-476. [DOI: 10.3233/ch-189313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Janis L. Vahldiek
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Christoph Erxleben
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Keno Kyrill Bressem
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Ole Gemeinhardt
- Department of Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Franz Poch
- Department of Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Bernhard Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Foundation, Hannover, Germany
| | - Kai S. Lehmann
- Department of Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - B. Hamm
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
| | - Stefan M. Niehues
- Department of Radiology, Charité-University Medicine Berlin, Berlin, Germany
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14
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Kang TW, Lim HK, Cha DI. Percutaneous ablation for perivascular hepatocellular carcinoma: Refining the current status based on emerging evidence and future perspectives. World J Gastroenterol 2018; 24:5331-5337. [PMID: 30598578 PMCID: PMC6305531 DOI: 10.3748/wjg.v24.i47.5331] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/24/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023] Open
Abstract
Various therapeutic modalities including radiofrequency ablation, cryoablation, microwave ablation, and irreversible electroporation have attracted attention as energy sources for effective locoregional treatment of hepatocellular carcinoma (HCC); these are accepted non-surgical treatments that provide excellent local tumor control and favorable survival. However, in contrast to surgery, tumor location is a crucial factor in the outcomes of locoregional treatment because such treatment is mainly performed using a percutaneous approach for minimal invasiveness; accordingly, it has a limited range of ablation volume. When the index tumor is near large blood vessels, the blood flow drags thermal energy away from the targeted tissue, resulting in reduced ablation volume through a so-called “heat-sink effect”. This modifies the size and shape of the ablation zone considerably. In addition, serious complications including infarction or aggressive tumor recurrence can be observed during follow-up after ablation for perivascular tumors by mechanical or thermal damage. Therefore, perivascular locations of HCC adjacent to large intrahepatic vessels can affect post-treatment outcomes. In this review, we primarily focus on physical properties of perivascular tumor location, characteristics of perivascular HCC, potential complications, and clinical outcomes after various locoregional treatments; moreover, we discuss the current status and future perspectives regarding percutaneous ablation for perivascular HCC.
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Affiliation(s)
- Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 135-710, South Korea
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
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15
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Zhang B, Yang Y, Ding L, Moser MAJ, Zhang EM, Zhang W. Tumor Ablation Enhancement by Combining Radiofrequency Ablation and Irreversible Electroporation: An In Vitro 3D Tumor Study. Ann Biomed Eng 2018; 47:694-705. [PMID: 30565007 DOI: 10.1007/s10439-018-02185-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/06/2018] [Indexed: 02/08/2023]
Abstract
We hypothesized and demonstrated for the first time that significant tumor ablation enhancement can be achieved by combining radiofrequency ablation (RFA) and irreversible electroporation (IRE) using a 3D cervical cancer cell model. Three RFA (43, 50, and 60 °C for 2 min) and IRE protocols (350, 700, and 1050 V/cm) were used to study the combining effect in the 3D tumor cell model. The in vitro experiment showed that both RFA enhanced IRE and IRE enhanced RFA can lead to a significant increase in the size of the ablation zone compared to IRE and RFA alone. It was also noted that the sequence of applying ablation energy (RFA → RE or IRE → RFA) affected the efficacy of tumor ablation enhancement. The electrical conductivity of 3D tumor was found to be increased after preliminary RFA or IRE treatment. This increase in tumor conductivity may explain the enhancement of tumor ablation. Another explanation might be that there is repeat injury to the transitional zone of the first treatment by the second one. The promising results achieved in the study can provide us useful clues about the treatment of large tumors abutting large vessels or bile ducts.
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Affiliation(s)
- Bing Zhang
- Tumor Ablation Group, Biomedical Science and Technology Research Center, School of Mechatronic Engineering and Automation, Shanghai University, 99 Shangda Road, Baoshan, Shanghai, 200444, China.
| | - Yongji Yang
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Lujia Ding
- School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, 200237, China
| | - Michael A J Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, S7N 0W8, Canada
| | - Edwin M Zhang
- Division of Vascular & Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, ON, M5T 1W7, Canada
| | - Wenjun Zhang
- Tumor Ablation Group, Biomedical Science and Technology Research Center, School of Mechatronic Engineering and Automation, Shanghai University, 99 Shangda Road, Baoshan, Shanghai, 200444, China.,Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, SK, S7N 5A9, Canada
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16
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Li Y, Stevenson M, Rostas JW, Pandit H, Li SP, Wolf FJ, Dupuy DE, Martin RCG. Evaluation of Probe Angles for Synchronous Waveform 915-MHz Microwave Ablation. J Surg Res 2018; 232:1-6. [PMID: 30463704 DOI: 10.1016/j.jss.2018.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study is to compare the ablation performance between a synchronous microwave ablation (MWA) system and a commercially available asynchronous system in ex vivo bovine liver and evaluate the efficacy of ablation at varying entrance angles. MATERIALS AND METHODS Two 915-MHz MWA systems were used in bench top ex vivo bovine livers with various conditions (synchronous versus asynchronous). Using synchronous technology ablations to liver, kidney, or lung at angles of 0, 15, 30, and 90° were evaluated. RESULTS Synchronous and asynchronous MWA systems created mean ablation zone volumes of 26.4 and 15.8 cm3, 62.9 and 45.4 cm3, 90.8 and 56.4, and 75.7 and 54.8 cm3 with single, double (2 microwave probes in use simultaneous) (2 cm spacing), and triple (three probes in use simultaneously) (2 cm and 3 cm spacing) antennae configurations, respectively; adjusted P-values ≤ 0.006. Ablation defects were similar across all groups when evaluated for entrance angle. Specifically, when comparing 0-degree angle to all other angles, achieved zones of ablation (ZA) were similar (mean ± standard deviation for 0-degree versus all other angles: 8.72 ± 4.84 versus 9.38 ± 4.11 cm2, P = 0.75). The use of the long-tip probe resulted in a statistically significant increase in the achieved ZA when compared to the short tip probe (10.9 ± 4.3 versus 6.5 ± 2.4, respectively; P = 0.01). CONCLUSIONS Newly developed synchronous microwave technology creates significantly larger ablation zones when compared to an existing asynchronous commercially available system. The angle of approach does not affect the resulting ZA. This is clinically relevant as true 0-degree angle is often difficult to obtain.
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Affiliation(s)
- Yan Li
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Megan Stevenson
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Jack W Rostas
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Harshul Pandit
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Su Ping Li
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Farrah J Wolf
- Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Damian E Dupuy
- Rhode Island Hospital/Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
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17
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Smolock AR, Cristescu MM, Hinshaw A, Woo KM, Wells SA, Ziemlewicz TJ, Lubner MG, Dalvie PS, Louis Hinshaw J, Brace CL, Ozkan OS, Lee FT, Laeseke P. Combination transarterial chemoembolization and microwave ablation improves local tumor control for 3- to 5-cm hepatocellular carcinoma when compared with transarterial chemoembolization alone. Abdom Radiol (NY) 2018; 43:2497-2504. [PMID: 29450606 DOI: 10.1007/s00261-018-1464-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare transarterial chemoembolization (TACE) monotherapy to combination TACE and microwave ablation (MWA) for local control of 3- to 5-cm hepatocellular carcinoma (HCC). METHODS Patients with HCC between 3 and 5 cm treated with TACE monotherapy or combination TACE + MWA at a single institution between 2007 and 2016 were retrospectively reviewed. Twenty-four HCCs (median diameter 3.8 cm) in 16 patients (13 males; median age 64 years) were treated using TACE monotherapy. Combination TACE + MWA was used to treat 23 HCCs (median diameter 4.2 cm) in 22 patients (18 males; median age 61 years). Microwave ablation was performed at a target time of two weeks following TACE. Individual tumors were followed by serial contrast-enhanced CT or MR. Response to treatment was evaluated on a tumor-by-tumor basis using mRECIST criteria with the primary outcome being local tumor progression (LTP). Data were analyzed using Fisher's exact test for categorical variables and Wilcoxon rank sum test for continuous variables. Time to LTP was estimated with the Kaplan-Meier method. RESULTS Relative to TACE monotherapy, TACE + MWA provided a trend toward both a lower rate of LTP (34.8% vs. 62.5%, p = 0.11) and a higher complete response rate (65.2% vs. 37.5%; p = 0.12). Time to LTP (22.3 months vs. 4.2 months; p = 0.001) was significantly longer in the TACE + MWA group compared to TACE monotherapy. CONCLUSIONS Combination therapy with TACE and microwave ablation improves local control and increases time to LTP for 3-5 cm HCC.
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Affiliation(s)
- Amanda R Smolock
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Mircea M Cristescu
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Audrey Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Kaitlin M Woo
- Departments of Biostatistics and Medical Informatics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Shane A Wells
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Timothy J Ziemlewicz
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Meghan G Lubner
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Prasad S Dalvie
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Christopher L Brace
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Medical Physics, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Orhan S Ozkan
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Fred T Lee
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
- Departments of Biomedical Engineering, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA
| | - Paul Laeseke
- Departments of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Ave., MC 3252, Madison, WI, 53792, USA.
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18
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Combination Therapies: Quantifying the Effects of Transarterial Embolization on Microwave Ablation Zones. J Vasc Interv Radiol 2018; 29:1050-1056. [DOI: 10.1016/j.jvir.2018.01.785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023] Open
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19
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Poch FGM, Neizert CA, Gemeinhardt O, Geyer B, Eminger K, Rieder C, Niehues SM, Vahldiek J, Thieme SF, Lehmann KS. Intermittent Pringle maneuver may be beneficial for radiofrequency ablations in situations with tumor-vessel proximity. Innov Surg Sci 2018; 3:245-251. [PMID: 31579788 PMCID: PMC6604585 DOI: 10.1515/iss-2018-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/11/2018] [Indexed: 12/15/2022] Open
Abstract
Background Radiofrequency ablation (RFA) represents a treatment option for non-resectable liver malignancies. Larger ablations can be achieved with a temporary hepatic inflow occlusion (Pringle maneuver - PM). However, a PM can induce dehydration and carbonization of the target tissue. The objective of this study was to evaluate the impact of an intermittent PM on the ablation size. Methods Twenty-five multipolar RFAs were performed in porcine livers ex vivo. A perfused glass tube was used to simulate a natural vessel. The following five test series (each n=5) were conducted: (1) continuous PM, (2-4) intermittent PM, and (5) no PM. Ablations were cut into half. Ablation area, minimal radius, and maximal radius were compared. Results No change in complete ablation size could be measured between the test series (p>0.05). A small rim of native liver tissue was observed around the glass tube in the test series without PM. A significant increase of ablation area could be measured on the margin of the ablations with an intermittent PM, starting without hepatic inflow occlusion (p<0.05). Conclusion An intermittent PM did not lead to smaller ablations compared to a continuous or no PM ex vivo. Furthermore, an intermittent PM can increase the ablation area when initial hepatic inflow is succeeded by a PM.
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Affiliation(s)
- Franz G M Poch
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Christina A Neizert
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Ole Gemeinhardt
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Beatrice Geyer
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Katharina Eminger
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Rieder
- Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany
| | - Stefan M Niehues
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Janis Vahldiek
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan F Thieme
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Kai S Lehmann
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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20
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Hue YK, Guimaraes AR, Cohen O, Nevo E, Roth A, Ackerman JL. Magnetic Resonance Mediated Radiofrequency Ablation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:417-427. [PMID: 28922117 PMCID: PMC5813696 DOI: 10.1109/tmi.2017.2753739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To introduce magnetic resonance mediated radiofrequency ablation (MR-RFA), in which the MRI scanner uniquely serves both diagnostic and therapeutic roles. In MR-RFA scanner-induced RF heating is channeled to the ablation site via a Larmor frequency RF pickup device and needle system, and controlled via the pulse sequence. MR-RFA was evaluated with simulation of electric and magnetic fields to predict the increase in local specific-absorption-rate (SAR). Temperature-time profiles were measured for different configurations of the device in agar phantoms and ex vivo bovine liver in a 1.5 T scanner. Temperature rise in MR-RFA was imaged using the proton resonance frequency method validated with fiber-optic thermometry. MR-RFA was performed on the livers of two healthy live pigs. Simulations indicated a near tenfold increase in SAR at the RFA needle tip. Temperature-time profiles depended significantly on the physical parameters of the device although both configurations tested yielded temperature increases sufficient for ablation. Resected livers from live ablations exhibited clear thermal lesions. MR-RFA holds potential for integrating RF ablation tumor therapy with MRI scanning. MR-RFA may add value to MRI with the addition of a potentially disposable ablation device, while retaining MRI's ability to provide real time procedure guidance and measurement of tissue temperature, perfusion, and coagulation.
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21
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Primavesi F, Swierczynski S, Klieser E, Kiesslich T, Jäger T, Urbas R, Hutter J, Neureiter D, Öfner D, Stättner S. Thermographic real-time-monitoring of surgical radiofrequency and microwave ablation in a perfused porcine liver model. Oncol Lett 2017; 15:2913-2920. [PMID: 29435018 PMCID: PMC5778864 DOI: 10.3892/ol.2017.7634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 11/21/2017] [Indexed: 12/22/2022] Open
Abstract
Radiofrequency ablation (RFA) and microwave ablation (MWA) are currently the dominant modalities to treat unresectable liver tumors. Monitoring the ablation process with b-mode-sonography is often hampered by artefacts. Furthermore, vessels may cause cooling in the adjacent tumor target (heat-sink-effect) with risk of local recurrence. The present study evaluated infrared-thermography to monitor surgical RFA/MWA and detect heat-sink-effects in real-time. RFA and MWA of perfused porcine livers was conducted at peripheral and central-vessel-adjacent locations, and monitored by real-time thermography. Ablation was measured and evaluated by gross pathology. The mean time for ablation was significantly longer in RFA compared with MWA (8 vs. 2 min). Although mean macroscopic ablation diameter was similar (RFA, 3.17 cm; MWA, 3.38 cm), RFA showed a significant heat-sink-effect compared with MWA. The surface temperature during central RFA near vessels was 1/3 lower compared with peripheral RFA (47.11±8.35°C vs. 68.72±12.70°C; P<0.001). There was no significant difference in MWA (50.52±8.35°C vs. 50.18±10.35°C; P=0.74). In conclusion, thermography is suitable to monitor the correct ablation with MWA and RFA. The results of the current study demonstrated a significant heat-sink-effect for RFA, but not MWA near vessels. MWA reaches consistent surface temperatures much faster than RFA. With further in vivo validation, thermography may be useful to ensure appropriate ablation particularly near vulnerable or vascular structures.
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Affiliation(s)
- Florian Primavesi
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria.,Department of Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Stefan Swierczynski
- Department of Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Eckhard Klieser
- Institute of Pathology, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Tobias Kiesslich
- Department of Internal Medicine I, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Tarkan Jäger
- Department of Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Romana Urbas
- Institute of Pathology, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Jörg Hutter
- Department of Surgery, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Daniel Neureiter
- Institute of Pathology, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University Innsbruck, A-6020 Innsbruck, Austria
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22
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Dodd GD, Lanctot AC, Lind KE. Effect of Change in Portal Vein Flow Rates on Hepatic Ablations Created with a Bipolar Radiofrequency Ablation Device. Radiology 2017; 283:399-407. [DOI: 10.1148/radiol.2016152562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Gerald D. Dodd
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
| | - Anthony C. Lanctot
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
| | - Kimberly E. Lind
- From the Department of Radiology, School of Medicine, University of Colorado, Mail Stop L954, 12401 E 17th Ave, PO Box 6510, Aurora, CO 80045
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23
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Gemeinhardt O, Poch FG, Hiebl B, Kunz-Zurbuchen U, Corte GM, Thieme SF, Vahldiek JL, Niehues SM, Kreis ME, Klopfleisch R, Lehmann KS. Comparison of bipolar radiofrequency ablation zones in an in vivo porcine model: Correlation of histology and gross pathological findings. Clin Hemorheol Microcirc 2017; 64:491-499. [DOI: 10.3233/ch-168123] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ole Gemeinhardt
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Franz G.M. Poch
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Bernhard Hiebl
- Institute for Animal Hygiene, Animal Welfare and Farm Animal Behaviour, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Urte Kunz-Zurbuchen
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Giuliano M. Corte
- Institute of Veterinary Anatomy, Freie Universität Berlin, Berlin, Germany
| | - Stefan F. Thieme
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Janis L. Vahldiek
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Stefan M. Niehues
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Martin E. Kreis
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Robert Klopfleisch
- Institute of Veterinary Pathology, Freie Universität Berlin, Berlin, Germany
| | - Kai S. Lehmann
- Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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Chang S, Lanctot AC, McCarter MD, Roberts KM, Glueck DH, Dodd GD. The prediction of radiofrequency ablation zone volume using vascular indices of 3-dimensional volumetric colour Doppler ultrasound in an in vitro blood-perfused bovine liver model. Br J Radiol 2016; 90:20160661. [PMID: 27925468 DOI: 10.1259/bjr.20160661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To determine the most reliable predictor of radiofrequency (RF) ablation zone volume among three-dimensional (3D) volumetric colour Doppler vascular indices in an in vitro blood-perfused bovine liver model. METHODS 3D colour Doppler volume data of the local hepatic parenchyma were acquired from 37 areas of 13 bovine livers connected to an in vitro oxygenated blood perfusion system. Doppler vascular indices of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained from the volume data using 3D volume analysis software. 37 RF ablations were performed at the same locations where the ultrasound data were obtained from. The relationship of these vascular indices and the ablation zone volumes measured from gross specimens were analyzed using a general linear mixed model fit with random effect for liver and backward stepwise regression analysis. RESULTS FI was significantly associated with ablation zone volumes measured on gross specimens (p = 0.0047), but explained little of the variance (Rβ2 = 0.21). Ablation zone volume decreased by 0.23 cm3 (95% confidence interval: -0.38, -0.08) for every 1 increase in FI. Neither VI nor VFI was significantly associated with ablation zone volumes (p > 0.05). CONCLUSION Although FI was associated with ablation zone volumes, it could not sufficiently explain their variability, limiting its clinical applicability. VI, FI and VFI are not clinically useful in the prediction of RF ablation zone volume in the liver. Advances in knowledge: Despite a significant association of FI with ablation zone volumes, VI, FI and VFI cannot be used for their prediction. Different Doppler vascular indices need to be investigated for clinical use.
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Affiliation(s)
- Samuel Chang
- 1 Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anthony C Lanctot
- 1 Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin D McCarter
- 2 Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine M Roberts
- 3 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Deborah H Glueck
- 3 Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Gerald D Dodd
- 1 Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
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Xu C, Huang XE, Lv PH, Wang SX, Sun L, Wang FA. Radiofrequency Ablation in Treating Colorectal Cancer Patients with Liver Metastases. Asian Pac J Cancer Prev 2016; 16:8559-61. [PMID: 26745116 DOI: 10.7314/apjcp.2015.16.18.8559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To evaluate efficacy of radiofrequency ablation (RFA) in treating colorectal cancer patients with liver metastases. METHODS During January 2010 to April 2012, 56 colorectal cancer patients with liver metastases underwent RFA. CT scans were obtained one month after RFA for all patients to evaluate tumor response. (CR+PR+SD)/n was used to count the disease control rates (DCR). Survival data of 1, 2 and 3 years were obtained from follow up. RESULTS Patients were followed for 10 to 40 months after RFA (mean time, 25±10 months). Median survival time was 27 months. The 1, 2, 3 year survival rate were 80.4%, 71.4%, 41%, 1 % respectively. 3-year survival time for patients with CR or PR after RFA was 68.8% and 4.3% respectively, the difference was statistically significant. The number of CR, PR, SD and PD in our study was 13, 23, 11 and 9 respectively. CONCLUSIONS RFA could be an effective method for treating colorectal cancer patients with liver metastases, and prolong survival time, especially for metastatic lesions less than or equal to 3 cm. But this result should be confirmed by randomized controlled studies.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail : ;
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Trujillo M, Bon J, José Rivera M, Burdío F, Berjano E. Computer modelling of an impedance-controlled pulsing protocol for RF tumour ablation with a cooled electrode. Int J Hyperthermia 2016; 32:931-939. [PMID: 27452352 DOI: 10.1080/02656736.2016.1190868] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To develop computer models to mimic the impedance-controlled pulsing protocol implemented in radiofrequency (RF) generators used for clinical practice of radiofrequency ablation (RFA), and to assess the appropriateness of the models by comparing the computer results with those obtained in previous experimental studies. METHODS A 12-min RFA was modelled using a cooled electrode (17G, 3 cm tip) inserted in hepatic tissue. The short (transverse) diameter of the coagulation zone was assessed under in vivo (with blood perfusion (BP) and considering clamping) and ex vivo (at 21 °C) conditions. The computer results obtained by programming voltage pulses were compared with current pulses. RESULTS The differences between voltage and current pulses were noticeable: using current instead of voltage allows larger coagulation zones to be created, due to the higher energy applied by current pulses. If voltage pulses are employed the model can accurately predict the number of roll-offs, although the waveform of the applied power is clearly not realistic. If current voltages are employed, the applied power waveform matches well with those reported experimentally, but there are significantly fewer roll-offs. Our computer results were overall into the ranges of experimental ones. CONCLUSIONS The proposed models reproduce reasonably well the electrical-thermal performance and coagulation zone size obtained during an impedance-controlled pulsing protocol.
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Affiliation(s)
- Macarena Trujillo
- a Instituto Universitario de Matemática Pura y Aplicada, Universitat Politècnica de València , Spain
| | - Jose Bon
- b Food Technology Department , Universitat Politècnica de València , Spain
| | - María José Rivera
- c Applied Mathematics Department , Universitat Politècnica de València , Spain
| | - Fernando Burdío
- d Department of Surgery , Hospital del Mar , Barcelona , Spain
| | - Enrique Berjano
- e Biomedical Synergy, Department of Electronic Engineering , Universitat Politècnica de València , Spain
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Paul A, Narasimhan A, Das SK, Sengupta S, Pradeep T. Subsurface thermal behaviour of tissue mimics embedded with large blood vessels during plasmonic photo-thermal therapy. Int J Hyperthermia 2016; 32:765-77. [PMID: 27404093 DOI: 10.1080/02656736.2016.1196831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
PURPOSE The purpose of this study was to understand the subsurface thermal behaviour of a tissue phantom embedded with large blood vessels (LBVs) when exposed to near-infrared (NIR) radiation. The effect of the addition of nanoparticles to irradiated tissue on the thermal sink behaviour of LBVs was also studied. MATERIALS AND METHODS Experiments were performed on a tissue phantom embedded with a simulated blood vessel of 2.2 mm outer diameter (OD)/1.6 mm inner diameter (ID) with a blood flow rate of 10 mL/min. Type I collagen from bovine tendon and agar gel were used as tissue. Two different nanoparticles, gold mesoflowers (AuMS) and graphene nanostructures, were synthesised and characterised. Energy equations incorporating a laser source term based on multiple scattering theories were solved using finite element-based commercial software. RESULTS The rise in temperature upon NIR irradiation was seen to vary according to the position of the blood vessel and presence of nanoparticles. While the maximum rise in temperature was about 10 °C for bare tissue, it was 19 °C for tissue embedded with gold nanostructures and 38 °C for graphene-embedded tissues. The axial temperature distribution predicted by computational simulation matched the experimental observations. CONCLUSIONS A different subsurface temperature distribution has been obtained for different tissue vascular network models. The position of LBVs must be known in order to achieve optimal tissue necrosis. The simulation described here helps in predicting subsurface temperature distributions within tissues during plasmonic photo-thermal therapy so that the risks of damage and complications associated with in vivo experiments and therapy may be avoided.
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Affiliation(s)
- Anup Paul
- a Heat Transfer and Thermal Power Laboratory, Department of Mechanical Engineering , Indian Institute of Technology Madras , Chennai , India ;,b Department of Mechanical Engineering , NIT Arunachal Pradesh , Yupia , Arunachal Pradesh , India
| | - Arunn Narasimhan
- a Heat Transfer and Thermal Power Laboratory, Department of Mechanical Engineering , Indian Institute of Technology Madras , Chennai , India
| | - Sarit K Das
- a Heat Transfer and Thermal Power Laboratory, Department of Mechanical Engineering , Indian Institute of Technology Madras , Chennai , India
| | - Soujit Sengupta
- c DST Unit on Nanoscience, Department of Chemistry , Indian Institute of Technology Madras , Chennai , India
| | - Thalappil Pradeep
- c DST Unit on Nanoscience, Department of Chemistry , Indian Institute of Technology Madras , Chennai , India
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Xu C, Lv PH, Huang XE, Wang SX, Sun L, Wang FA. Efficacy of Transarterial Chemoembolization Combined with Radiofrequency Ablation in Treatment of Hepatocellular Carcinoma. Asian Pac J Cancer Prev 2016; 16:6159-62. [PMID: 26320512 DOI: 10.7314/apjcp.2015.16.14.6159] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treatment of patients with hepatocellular carcinoma. MATERIALS AND METHODS During January 2009 to March 2012, 80 patients with hepatocellular carcinoma underwent TACE, with or without RFA. Alfa- fetoprotein (AFP) was checked before and after procedure. CT scans were obtained one month after TACE or RFA for all patients to evaluate tumor changes. Complete response+partial response+stable disease (CR+PR+SD)/n were used to assess the disease control rate (DCR). Survival at 3, 6 and 12 months was compared in both groups. RESULTS AFP levels in TACE + RFA group dropped rapidly, becoming obviously lower than that of the TACE group. In the TACE + RFA group DCR was 93.8%, while only 76.8% in the TACE group. The treatment effect between the two groups was statistically significant (P<0.05) by Ridit analysis. 1 year survival rate in the TACE + RFA group was 92.5%, significantly higher than that of the TACE group at 77.5% (P<0.05). CONCLUSIONS TACE and RFA as combined therapy method for patients with middle and terminal stage HCC gives full play to synergy between the two and improves the therapeutic effect.
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Affiliation(s)
- Chuan Xu
- Department of Interventional Radiology, Subei People's Hospital of Jiangsu Province, Clinical Hospital of Yangzhou University, Yangzhou, China E-mail : why777sina.com;
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Abstract
PURPOSE To demonstrate and quantify the heat sink effect in hepatic microwave ablation (MWA) in a standardized ex vivo model, and to analyze the influence of vessel distance and blood flow on lesion volume and shape. MATERIALS AND METHODS 108 ex vivo MWA procedures were performed in freshly harvested pig livers. Antennas were inserted parallel to non-perfused and perfused (700,1400 ml/min) glass tubes (diameter 5mm) at different distances (10, 15, 20mm). Ablation zones (radius, area) were analyzed and compared (Kruskal-Wallis Test, Dunn's multiple comparison Test). Temperature changes adjacent to the tubes were measured throughout the ablation cycle. RESULTS Maximum temperature decreased significantly with increasing flow and distance (p<0.05). Compared to non-perfused tubes, ablation zones were significantly deformed by perfused tubes within 15 mm distance to the antenna (p<0.05). At a flow rate of 700 ml/min ablation zone radius was reduced to 37.2% and 80.1% at 10 and 15 mm tube distance, respectively; ablation zone area was reduced to 50.5% and 89.7%, respectively. CONCLUSION Significant changes of ablation zones were demonstrated in a pig liver model. Considerable heat sink effect was observed within a diameter of 15 mm around simulated vessels, dependent on flow rate. This has to be taken into account when ablating liver lesions close to vessels.
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Yu MH, Lee JY, Jun SR, Kim KW, Kim SH, Han JK, Choi BI. Radiofrequency Ablation with an Internally Cooled Monopolar Directional Electrode: Ex Vivo and in Vivo Experimental Studies in the Liver. Radiology 2015; 278:395-404. [PMID: 26172531 DOI: 10.1148/radiol.2015142269] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the feasibility of using an internally cooled directional electrode (ICDE) to create sufficient directional ablation in the desired area and to investigate whether use of the ICDE reduces thermal injury to the adjacent organs. MATERIALS AND METHODS The animal care and use committee approved this animal study. In ex vivo studies of bovine livers and colons, temperature was measured in both ablation and nonablation directions with the ICDE, temperature at the liver-colon interface and the presence of burns on the colon were evaluated with each ICDE and internally cooled conventional electrode (ICCE), and the ablation area with the use of three ICDEs in the switching multichannel mode was evaluated. In an in vivo study of 10 pigs, 11 ablations were performed by using three ICDEs in the switching multichannel mode. In addition, the difference in thermal injury to the gallbladder and stomach was compared between use of the ICDE and the ICCE. Mann-Whitney test and the Fisher exact test were used for statistical analysis. RESULTS In the ex vivo study, the hepatic temperature in the nonablation direction was lower than 50°C; temperature higher than 47°C was maintained for less than 3 minutes, even 0.5 cm away from the ICDE; and the temperature at the liver-colon interface did not increase above 50°C. In the switching multichannel mode, a fused coagulation zone was created. In the in vivo study, confluent ablation was created in the inner circle of three ICDEs with a mean interelectrode distance of less than 2.6 cm. Use of the ICDE did not create a moderate-to-severe gallbladder wall injury in any of the pigs, but use of the ICCE caused injury in three of the five pigs (P > .05). The ICDE caused moderate-to-severe gastric wall injury at one of eight ablations, and the ICCE caused injury at eight of nine ablations (P < .05). CONCLUSION Use of an ICDE can create a sufficient ablation in the desired direction and can decrease thermal injury to the adjacent organs.
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Affiliation(s)
- Mi Hye Yu
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Jae Young Lee
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Su Ryoung Jun
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Kyung Won Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Se Hyung Kim
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Joon Koo Han
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
| | - Byung Ihn Choi
- From the Department of Radiology, KonKuk University Medical Center, Seoul, Korea (M.H.Y.); Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (J.Y.L., S.H.K., J.K.H., B.I.C.); Department of Radiology, Human Medical Imaging and Intervention Center, Seoul, Korea (S.R.J.); and Department of Radiology, Asan Medical Center, Seoul, Korea (K.W.K.)
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Dodd GD, Kreidler SM, Lanctot AC, Glueck DH. Effect of Change in Portal Venous Blood Flow Rates on the Performance of a 2.45-GHz Microwave Ablation Device. Radiology 2015; 277:727-32. [PMID: 26030660 DOI: 10.1148/radiol.2015150102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the effect of change in portal venous blood flow rates on the size and shape of ablations created by a 2.45-GHz microwave ablation device. MATERIALS AND METHODS This study was exempt from review by the institutional animal care and use committee. An in vitro bovine liver model perfused with autologous blood via the portal vein at five flow rates (60, 70, 80, 90, and 100 mL/min per 100 g of liver) was used to evaluate the effect of change in flow rates on the size and shape of coagulation created by a 2.45-GHz, 140-W microwave ablation device operated for 5 and 10 minutes. Three ablations per ablation time were conducted in each of 10 livers, with two livers perfused at each flow rate. Short- and long-axis diameters were measured from gross specimens, and volume and sphericity index were calculated. General linear mixed models that accounted for correlations within the liver were used to evaluate the effects of lobe, flow, and ablation time on size and sphericity index of ablations. RESULTS Flow did not have a significant effect on the size or shape of coagulation created at 5 or 10 minutes (P > .05 for all tests). The mean short- and long-axis diameters and volume were 3.2 cm (95% confidence interval [CI]: 3.1, 3.3), 5.6 cm (95% CI: 5.4, 5.8), and 30.2 cm(3) (95% CI: 28.4, 32.1) for the 5-minute ablations and 3.8 cm (95% CI: 3.7, 3.9), 6.5 cm (95% CI: 6.3, 6.7), and 49.3 cm(3) (95% CI: 47.5, 51.2), for the 10-minute ablations, respectively. The mean sphericity index for both 5- and 10-minute ablations was 34.4% (95% CI: 32%, 36.7%). CONCLUSION Change in portal venous blood flow rates did not have an effect on the size and shape of ablations created by a 2.45-GHz microwave ablation device.
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Affiliation(s)
- Gerald D Dodd
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Sarah M Kreidler
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Anthony C Lanctot
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
| | - Deborah H Glueck
- From the Department of Radiology, School of Medicine (G.D.D., S.M.K., A.C.L.), and School of Public Health (D.H.G.), University of Colorado, 12401 E 17th Ave, Mail Stop L954, PO Box 6510, Aurora, CO 80045
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Fukushima T, Ikeda K, Kawamura Y, Sorin Y, Hosaka T, Kobayashi M, Saitoh S, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Arase Y, Kumada H. Randomized Controlled Trial Comparing the Efficacy of Impedance Control and Temperature Control of Radiofrequency Interstitial Thermal Ablation for Treating Small Hepatocellular Carcinoma. Oncology 2015; 89:47-52. [DOI: 10.1159/000375166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/09/2015] [Indexed: 11/19/2022]
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Willatt J, Hannawa KK, Ruma JA, Frankel TL, Owen D, Barman PM. Image-guided therapies in the treatment of hepatocellular carcinoma: A multidisciplinary perspective. World J Hepatol 2015; 7:235-244. [PMID: 25729478 PMCID: PMC4342605 DOI: 10.4254/wjh.v7.i2.235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/26/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
A multidisciplinary approach to the treatment of patients with unresectable hepatocellular carcinoma (HCC) has led to improvements in screening, detection, and treatments. Interventional techniques include thermal ablation, transarterial chemoembolization, and radioembolization whilst stereotactic body radiation therapy also uses imaging to target the radiation. Both survival rates and cure rates have improved markedly since the introduction of these techniques. This review article describes the image guided techniques used for the treatment of HCC.
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Duan X, Zhou G, Han X, Ren J, Zheng C, Liang H, Feng G. Radiofrequency ablation combined with transcatheter therapy in rabbit VX2 liver tumors: effects and histopathological characteristics. Acta Radiol 2015; 56:87-96. [PMID: 24425792 DOI: 10.1177/0284185113520266] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) treatment (TACE-RFA) has been confirmed superior to TACE or RFA alone in animal liver tumors. TACE before RFA was shown to increase hepatocellular damage. Further optimization of the combination strategy for transcatheter arterial embolization (TAE) or TACE combined with RFA is warranted. PURPOSE To determine the optimal strategy for radiofrequency ablation combined with transcatheter therapies in VX2 liver tumors in a rabbit model. MATERIAL AND METHODS Twenty-four Japanese White rabbits with VX2 liver tumors were randomly divided into four groups: TACE-RFA (TACE-RFA group), transcatheter arterial embolization (TAE) combined with RFA treatment (TAE-RFA group), RFA only group, and TACE only group. Blood samples were collected 1 day before the operation and at 3 and 7 days postoperatively. Seven days after the operation, maximal diameters of coagulation or infarcted zones in the gross specimens, CT images, histopathological characteristics, tumor necrotic rate, and growth rate were compared. RESULTS Significantly larger mean long-axis (P < 0.05) and short-axis (P < 0.05) diameters of coagulation and infarction were observed in the TACE-RFA group compared with the TAE-RFA, RFA, and TACE groups on day 7; and the TAE-RFA group showed a significant (P < 0.05) increase versus the RFA and TACE groups on day 7. There were no significant differences in tumor growth rate (109.3 ± 37.5 vs. 119.0 ± 43.1%, P = 0.45) and necrotic rate (89.5 ± 12.0 vs. 83.5 ± 9.3%, P = 0.73) between the TACE-RFA and TAE-RFA groups. TACE-RFA was more effective for achieving tumor destruction than the other treatment strategies, but led to increased rabbits discomfort and more severe liver dysfunction compared with TAE-RFA. CONCLUSION TAE-RFA appears to be a beneficial therapeutic modality for treating VX2 liver tumors in a rabbit model.
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Affiliation(s)
- XuHua Duan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - GuoFeng Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - XinWei Han
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - JianZhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan Province, People’s Republic of China
| | - ChuanSheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - HuiMin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - GanSheng Feng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Enhancement of radiofrequency ablation of the liver combined with transarterial embolization using various embolic agents. ACTA ACUST UNITED AC 2014; 40:1821-8. [PMID: 25526685 DOI: 10.1007/s00261-014-0332-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Reducing blood flow in the liver during radiofrequency ablation causes enlargement of the ablation area. In this animal study, we evaluated the extended effects of radiofrequency ablation combined with transarterial embolization using various embolic agents. METHODS We treated 38 radiofrequency ablation lesions after embolization in 13 pigs using the following embolic agents: gelatin sponge (Group A); iodized oil followed by gelatin sponge (Group B); 700-900 µm calibrated microspheres (Group C); and 100-300 µm calibrated microspheres (Group D). Lesion size and pathological evaluations of these ablation lesions were compared with those receiving radiofrequency ablation alone (control). RESULTS Both the long- and short-axis diameters of the ablation lesions for Groups A, B, C, and D were significantly longer than those of controls (long axis/short axis for Groups A, B, C, D, and controls were 27.2/23.2, 30.2/26.0, 28.2/22.2, 32.0/24.4, and 23.2 mm/18.5 mm, respectively) (P < 0.05). The long-axis of the ablation lesion for Group D was significantly longer than those for both Groups A and C (P < 0.05). At pathological examination, the central ablation lesions showed coagulative necrosis with a surrounding hemorrhagic rim, and the microspheres were fitted to occlude the small arteries in peripheral liver parenchyma in Groups C and D. CONCLUSIONS The extended effects of embolization with small microspheres may be stronger than those with large microspheres and were equal to those with iodized oil followed by gelatin sponge.
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Yokoyama K, Ikeda O, Kawanaka K, Nakasone Y, Inoue S, Tamura Y, Yamashita Y. Pain control in patients with hepatocellular carcinoma treated by percutaneous radiofrequency ablation: comparison of the efficacy of one-shot and continuous intravenous fentanyl delivery. Acta Radiol 2014; 55:1219-25. [PMID: 24413224 DOI: 10.1177/0284185113519623] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hepatic percutaneous radiofrequency ablation (RFA) is usually performed with the patient under deep intravenous (i.v.) sedation or general anesthesia. Nonetheless, many patients report pain during and/or after the procedure. PURPOSE To perform a prospective study of pain control obtained by the i.v. one-shot delivery and the continuous i.v. infusion of fentanyl in patients with hepatocellular carcinoma (HCC) treated by RFA. MATERIAL AND METHODS Between April 2007 and March 2010, 83 patients with 106 HCCs underwent percutaneous RFA. All HCCs were addressed by computed tomography (CT)-guided percutaneous RFA performed within 5 h of embolization of the tumor vessels with iodized oil and gelatin sponges. Standard anesthesia consisted of 10 mL of 1% lidocaine injected locally. For conscious sedation, group one patients (n = 41) were injected i.v. with 100 µg of fentanyl before and 100 µg of fentanyl 30 min after percutaneous RFA. In group two (n = 42) we delivered fentanyl by continuous i.v. infusion at 100 µg/h during RFA. Upon request, patients in both groups also received 5 mg of diazepam i.v. for pain during the RFA procedure. The severity of pain experienced by all patients was evaluated on a visual analogue scale (VAS) and complications elicited by the anesthesia regimens were recorded. We also assessed the effectiveness of the treatment on sequential follow-up CT and/or magnetic resonance imaging (MRI) at 3-month intervals. RESULTS Percutaneous RFA was technically successful in all 83 patients. Two patients in group one (4.8%) and one patient in group two (2.4%) manifested residual enhancement 3 months post RFA. There was no significant difference in the local recurrence rate between the two groups. At 4.0 ± 1.8 for group one and 3.4 ± 1.9 for group two, the VAS score was not significantly different. Major fentanyl or diazepam toxicity was recorded in 11 patients (24.4%) in group one and two patients (4.8%) in group two; the difference was statistically significant (P < 0.01). CONCLUSION The continuous infusion of fentanyl provided effective and safe analgesia in HCC patients undergoing percutaneous RFA.
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Affiliation(s)
- Koichi Yokoyama
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Osamu Ikeda
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Koichi Kawanaka
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yutaka Nakasone
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Seijiro Inoue
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yoshitaka Tamura
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Kumamoto University Graduate School of Medical and Pharmaceutical Sciences, Kumamoto, Japan
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Fukuda H, Numata K, Moriya S, Shimoyama Y, Ishii T, Nozaki A, Kondo M, Morimoto M, Maeda S, Sakamaki K, Morita S, Tanaka K. Hepatocellular carcinoma: concomitant sorafenib promotes necrosis after radiofrequency ablation--propensity score matching analysis. Radiology 2014; 272:598-604. [PMID: 24689883 DOI: 10.1148/radiol.14131640] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
PURPOSE To retrospectively compare radiofrequency ablation (RFA) combined with the multikinase inhibitor sorafenib (hereafter, sorafenib-RFA) and RFA alone in the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS Institutional review board approval and informed consent were obtained. Between January 2007 and December 2011, 16 patients (mean age, 72.8 years; age range 52-84 years; 10 men, six women) with HCC tumors less than 3 cm in diameter were included in the sorafenib-RFA group, and 136 patients (mean age, 72.1 years; age range, 51-86 years; 92 men, 44 women) with HCC tumors less than 3 cm in diameter were included in the RFA alone (control) group. Mean diameters of the greatest long-axis dimensions of HCC were 22.8 mm ± 4.6 (standard deviation) in the sorafenib-RFA group and 18.1 mm ± 4.4 in the control group. RFA was performed immediately after the 7-day administration of sorafenib. Propensity score matching analysis was used to adjust for potential biases. RESULTS Fifteen of the 16 patients in the sorafenib-RFA group and 30 of the 136 patients in the control group were selected during propensity score matching. No significant differences between the sorafenib-RFA group (n = 15) and the control group (n = 30) were observed with regard to age, sex, etiology, Child-Pugh class, tumor size, puncture number, needle size, location at the liver margin, or location adjacent to a main vessel. The respective mean diameters of the greatest long- and short-axis dimensions of the RFA-induced ablated area were 46.3 mm ± 10.3 and 33.0 mm ± 6.9 in the sorafenib-RFA group and 32.9 mm ± 7.6 and 25.6 mm ± 5.7 in the control group; both of these dimensions were significantly larger in the sorafenib-RFA group (both P < .001). CONCLUSION Sorafenib-RFA may be superior to standard RFA alone in the treatment of HCC tumors smaller than 3 cm in diameter.
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Affiliation(s)
- Hiroyuki Fukuda
- From the Gastroenterological Center (H.F., K.N., S. Moriya, Y.S., T.I., A.N., M.K., M.M., K.T.), Department of Gastroenterology (S. Maeda), Department of Biostatistics and Epidemiology (K.S., S. Morita), and Clinical Research Coordinating Center (K.S., S. Morita, K.T.), Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
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Reataza M, Imagawa DK. Advances in managing hepatocellular carcinoma. Front Med 2014; 8:175-89. [PMID: 24810646 DOI: 10.1007/s11684-014-0332-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/28/2014] [Indexed: 12/13/2022]
Abstract
Multiple modalities for treatment of hepatocellular carcinoma are available, depending on tumor size and number. Surgical resection remains the gold standard, so long as the residual liver function reserve is sufficient. In patients with advanced cirrhosis, liver transplantation is the preferred option, as these patients may not have adequate hepatic reserve after resection. Salvage liver transplantation has also become an option for a select few patients who recur after surgical resection. Ablative techniques have been used for palliation as well as to either completely destroy the tumor, act as an adjunct to resection, or downstage the tumor to meet Milan criteria such that a patient may be a candidate for liver transplantation. Radiofrequency ablation, microwave ablation, chemoembolization, radioembolization, and irreversible electroporation have all been used in this capacity. Currently, sorafenib is the only US Food and Drug Administration-approved chemotherapeutic for hepatocellular carcinoma. The efficacy of sorafenib, in combination with other agents, transarterial chemoembolization, and surgical resection is currently being investigated. Sunitinib and brivanib, tyrosine kinase inhibitors, have failed as potential first- or second-line options for chemotherapy. Bevacizumab in combination with erlotinib is also currently being studied. Final analysis for ramucirumab and axitinib are pending. Tivantinib, a selective mesenchymal-epithelial transition factor (MET) inhibitor, is also undergoing clinical trials for efficacy in MET-high tumors. This review serves to emphasize the current and new technologies emerging in the treatment of hepatocellular carcinoma.
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Affiliation(s)
- Marielle Reataza
- Irvine Medical Center, University of California, Orange, CA, 92868, USA
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Zhang B, Moser MAJ, Luo Y, Zhang EM, Zhang W. Evaluation of the current radiofrequency ablation systems using axiomatic design theory. Proc Inst Mech Eng H 2014; 228:397-408. [PMID: 24705341 DOI: 10.1177/0954411914530104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article evaluates current radiofrequency ablation systems using axiomatic design theory. Due to its minimally invasive procedure, short-time hospital stay, low cost, and tumour metastasis treatment, the radiofrequency ablation technique has been playing an important role in tumour treatment in recent decades. Although the radiofrequency ablation technique has many advantages, some issues still need to be addressed. Among these issues, the two most important are as follows: (1) the size of tumours to be removed (has to be larger than 3 cm in diameter) and (2) cleanness of the removal. Many device solutions have been proposed to address the two issues. However, there is a lack of knowledge regarding the systematic evaluation of these solutions. This article evaluates these systems in terms of their solution principles (or simply called conceptual design in general product design theory) using a design theory called axiomatic design theory. In addition, with the axiomatic design theory, a better conceptual design in terms of its feasibility to cope with incomplete target tissue necrosis from the large size of tumours has been found. The detailed analysis and simulation of the new conceptual design are conducted using finite element approach. The results in this article are proved by the information of animal experiments and clinical practices obtained from the literature. This study thus contributes to the current knowledge to further developments in radiofrequency ablation systems and procedure guidelines for physicians to perform the radiofrequency ablation operation more effectively.
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Affiliation(s)
- Bing Zhang
- Complex and Intelligent Systems Center, School of Mechanical and Power Engineering, East China University of Science and Technology, Shanghai, China
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Shah KN, Clary BM. Endoscopic and Percutaneous Approaches to the Treatment of Biliary Tract and Primary Liver Tumors. Surg Oncol Clin N Am 2014; 23:207-30. [DOI: 10.1016/j.soc.2013.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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SARIFUDDIN. SIMULATION OF CASSON FLUID FLOW AND HEAT TRANSPORT IN DIFFERENTLY SHAPED STENOSES. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414500249] [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
The present investigation deals with a mathematical model representing the response of heat transfer to blood streaming through the arteries under stenotic condition. The flowing blood is represented as the suspension of all erythrocytes assumed to be Casson fluid and the arterial wall is considered to be rigid having differently shaped stenoses in its lumen arising from various types of abnormal growth or plaque formation. The governing equations of motion accompanied by the appropriate choice of the boundary conditions are solved numerically by Marker and Cell (MAC) method. The necessary checking for numerical stability has been incorporated into the algorithm for better precision of the results computed. The quantitative analysis carried out finally includes the respective profiles of the flow-field and the temperature along with their individual distributions over the entire arterial segment as well. The key factors like the pressure drop, wall shear stress, flow separation, Nusselt number and streamlines are examined for qualitative insight into the blood flow and heat transport phenomena through arterial stenosis. In conformity with other several existing findings the present simulation predicts that the pressure drop and Nusselt number diminishes with increasing yield stress values, and significant enhancement in values of Nusselt number is observed with increasing severity of the stenosis. However, the effect of the shapes of the stenoses on flow separation cannot be ruled out from the present investigation.
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Affiliation(s)
- SARIFUDDIN
- Department of Mathematics, Raiganj Surendranath College, Raiganj – 733134, Uttar Dinajpur, W.B., INDIA
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Huang HW. Influence of blood vessel on the thermal lesion formation during radiofrequency ablation for liver tumors. Med Phys 2014; 40:073303. [PMID: 23822457 DOI: 10.1118/1.4811135] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The major obstacles of radiofrequency ablation (RFA) heat treatments are nonuniform heating in the thermal lesion and heat sinks caused by large blood vessels during treatments which could lead to high tumor recurrence in patients. The objective of this study is to help comprehend RFA heat treatment through thermal lesion formation using computer simulation, and thus to provide helpful assistance in planning RFA. METHODS RFA heat treatment is a popular "minimally invasive" treatment method for both primary and metastatic liver tumors, and the heat treatment is studied by numerical calculation. A finite difference model is used to solve all partial differential equations for a simple three-dimensional cubic geometry model. Maximum tissue temperature is used as a critical index for reaching thermal lesion during RFA. Cylindrical RF cool-tip electrode is internally cooled at constant water temperature. RFA thermal lesion is studied at various impacts by single and countercurrent blood vessel(s) traversing the thermal lesion. Several factors are considered, such as location, diameter, and orientation of the blood vessel(s) to the electrode. RESULTS Results show the thermal lesion size decreases as the lesion blood perfusion rate increases. And, single large blood vessel which is orthogonal to RF electrode will cause less undercooled volume in the thermal lesion than one which is parallel to RF electrode. Furthermore, convective energy may easily damage parallel vessel and its surrounding normal tissues during RFA. Small blood vessels (or larger vessels with slow blood flow rate) during RFA could form "tail-like" thermal lesion formation, which could damage vessel downstream spots. CONCLUSIONS Studies suggested that incomplete RF tumor ablation still exists within 1 cm distance between large blood vessel and RF electrode in a liver. This could have significant impact on local tumor recurrence rates. Second, if thermally significant vessel existed inevitably within the lesion, avoiding the RF cool-tip electrode placement next to the parallel large blood vessel would have a better heat treatment during RF heating. Additionally, reduced blood flow rate could help reduce significant cooling by large blood vessel.
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Affiliation(s)
- Huang-Wen Huang
- Department of Innovative Information and Technology, Langyang Campus, Tamkang University, Ilan 26247, Taiwan.
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Salas N, Castle SM, Leveillee RJ. Radiofrequency ablation for treatment of renal tumors: technological principles and outcomes. Expert Rev Med Devices 2014; 8:695-707. [DOI: 10.1586/erd.11.51] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Radiofrequency Ablation After Arterial Injection of Miriplatin–Iodized Oil Suspension Into Swine Liver: Ablative Zone Size and Tissue Platinum Concentration. Cardiovasc Intervent Radiol 2013; 37:1047-52. [DOI: 10.1007/s00270-013-0779-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 10/10/2013] [Indexed: 12/16/2022]
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Hirakawa M, Ikeda K, Kobayashi M, Kawamura Y, Hosaka T, Sezaki H, Akuta N, Suzuki F, Suzuki Y, Saitoh S, Arase Y, Kumada H. Randomized controlled trial of a new procedure of radiofrequency ablation using an expandable needle for hepatocellular carcinoma. Hepatol Res 2013; 43:846-52. [PMID: 23282227 DOI: 10.1111/hepr.12033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 11/21/2012] [Accepted: 11/26/2012] [Indexed: 02/08/2023]
Abstract
AIM To evaluate the efficacy of a new ablation procedure for the stepwise hook extension technique using a SuperSlim needle for radiofrequency ablation (RFA) treatment of hepatocellular carcinoma (HCC), a randomized controlled trial was performed. METHODS Thirty patients with HCC measuring 20 mm or less were randomly treated with a conventional four stepwise expansion technique (group 1) and the new stepwise expansion technique (group 2; the electrode was closed in the shaft after the same three steps of the conventional procedure and then fully extended). All patients underwent the RFA procedure using a 10-hook expandable electrode of 17-G diameter (LeVeen SuperSlim 30 mm). We compared the ablation time, required energy and ablated lesions in the two groups. RESULTS The long and short diameters of RFA-induced necrosis were significantly larger in group 2 (37 and 28 mm) than group 1 (30 and 26 mm, P = 0.001 and =0.045, respectively). Irregular and small needle expansion resulting in the parachute-like or irregularly shaped ablated zone was observed in more cases in group 1 than in group 2. The new technique made all tines expand uniformly and largely, which produced a near-oval ablated zone of which the long axis is perpendicular to the needle shaft. CONCLUSION The two kinds of stepwise procedures allow the selection of a more suitable procedure according to the tumor size and shape in each RFA.
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Zhang B, Moser M, Zhang E, Zhang WJ. Radiofrequency ablation technique in the treatment of liver tumours: review and future issues. J Med Eng Technol 2013; 37:150-9. [PMID: 23360198 DOI: 10.3109/03091902.2012.754510] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Thermal ablation is increasingly being used for treatment of liver tumours. Among the techniques of thermal ablation, radiofrequency ablation (RF) is undoubtedly being used most frequently because of its advantages, such as morbidity and mortality rates, effective tumour ablation, as well as being less time-consuming. This paper presents the state of the art of RF ablation technique. This includes the theoretical development, experimental study and clinical application of the radiofrequency ablation technique. First, it introduces the principle of this technique. Second, it shows the development of this technique and valuable achievements. These achievements include the device, strategy of operation and extension to other diseases. Third, it concludes future issues to be addressed in order to further advance this technique.
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Affiliation(s)
- B Zhang
- Department of Biomedical Engineering, University of Saskatchewan, Saskatoon, SK, Canada
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Swan RZ, Sindram D, Martinie JB, Iannitti DA. Operative microwave ablation for hepatocellular carcinoma: complications, recurrence, and long-term outcomes. J Gastrointest Surg 2013; 17:719-29. [PMID: 23404173 DOI: 10.1007/s11605-013-2164-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 01/30/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of hepatocellular carcinoma (HCC) in the setting of cirrhosis is limited by tumor size/location and underlying liver disease. Radiofrequency ablation is utilized in selected patients; however, local recurrence remains a concern. Microwave ablation (MWA) delivers energy to tissue in a unique fashion, reducing local recurrence. A minimally invasive operative approach allows for mobilization/protection of adjacent structures, intra-operative ultrasound, and assessment of ablation progress. STUDY DESIGN Retrospective review of operative MWA performed for HCC in patients with cirrhosis over a 4-year period at a single center. Complications were stratified by Clavien-Dindo classification. Incomplete ablation and local, regional, and metastatic recurrence was assessed on follow-up imaging. Survival was assessed in months. RESULTS Fifty-four patients with 73 tumors underwent MWA. Median tumor size was 2.6 cm (range 0.5-8.5 cm). Cirrhosis was present in 92.6 % of patients, with a Child-Pugh score of B/C in 27.8 % and hepatitis C present in 59.3 %. A minimally invasive approach was used in 94.5 % of patients. There were no deaths within 30 days. Thirty-day morbidity was 28.9 %, with grade III complications present in 11.5 %. Delayed complications occurred in 7.8 % of patients, with a 5.6 % 90-day mortality. Incomplete ablation was identified in 5.9 % of tumors with local recurrence of 2.9 % at 9 months median follow-up. Regional and metastatic recurrence occurred in 27.5 and 11.8 % at 9 months median follow-up. Median survival was not reached at 11 months median follow-up. One- and 2-year survival was 72.3 and 58.8 %. CONCLUSION Operative, preferably minimally invasive, MWA can be performed in cirrhotic patients with HCC with acceptable morbidity and low recurrence rates. High regional and metastatic recurrence rates in these patients underscore the need for minimally invasive, low morbidity approaches to liver-directed therapy.
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Affiliation(s)
- Ryan Z Swan
- Hepato-Pancreato-Biliary Surgery, Department of General Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204, USA
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El-Gendi A, El-Shafei M, Abdel-Aziz F, Bedewy E. Intraoperative ablation for small HCC not amenable for percutaneous radiofrequency ablation in Child A cirrhotic patients. J Gastrointest Surg 2013. [PMID: 23179908 DOI: 10.1007/s11605-012-2085-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiofrequency ablation (RFA) was initially started by radiologists as a percutaneous treatment, but surgeons started to use RFA by surgical approach for patients with tumors at locations difficult for the percutaneous procedure. The aim was to evaluate the results of intraoperative RFA for small hepatocellular carcinomas (HCCs) (<3 cm) in locations difficult for a percutaneous approach. METHODS Two hundred forty-seven patients with small solitary HCC (<3 cm) were treated; 196 via percutaneous RFA while 51 patients presented at sites not amenable for percutaneous route. Twenty-seven out of 51 patients underwent surgical resection, while 24/51 patients underwent intraoperative RFA. RESULTS The location and depth of the tumor from the liver capsule was the only significant factors in the choice of the surgeon between resection and RFA. RFA was successful in all tumors (complete ablation rate of 100 %). In the surgery group, all patients achieved R0 resection. Complication rate was comparable (p = 1.0). After a median follow-up of 37 months (range, 10-45 months), no tumors showed neither local progression nor local recurrence and no significant difference was observed between two groups as regards early recurrence and number of de novo lesions (p = 0.49). One-year and 3-year survival rates were 93 % and 81 %, respectively, in the resection group comparable to the corresponding rates of 92 % and 74 % in the RFA group (p = 0.9). CONCLUSION For small HCC in locations difficult for a percutaneous approach, intraoperative RFA can be an alternative option for deep-seated tumors necessitating more than one segmentectomy achieving similar tumor control, and overall and disease-free survival.
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Affiliation(s)
- Ahmed El-Gendi
- Department of Surgery, Faculty of Medicine, Alexandria University, El Sultan Hussein Street, El-Azarita, Khartom Square, Alexandria, 21131, Egypt.
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Dodd GD, Dodd NA, Lanctot AC, Glueck DA. Effect of Variation of Portal Venous Blood Flow on Radiofrequency and Microwave Ablations in a Blood-perfused Bovine Liver Model. Radiology 2013; 267:129-36. [DOI: 10.1148/radiol.12120486] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Park MH, Cho JS, Shin BS, Jeon GS, Lee B, Lee K. Comparison of internally cooled wet electrode and hepatic vascular inflow occlusion method for hepatic radiofrequency ablation. Gut Liver 2012; 6:471-5. [PMID: 23170152 PMCID: PMC3493728 DOI: 10.5009/gnl.2012.6.4.471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 12/03/2011] [Accepted: 12/30/2011] [Indexed: 01/28/2023] Open
Abstract
Background/Aims Various strategies to expand the ablation zone have been attempted using hepatic radiofrequency ablation (RFA). The optimal strategy, however, is unknown. We compared hepatic RFA with an internally cooled wet (ICW) electrode and vascular inflow occlusion. Methods Eight dogs were assigned to one of three groups: only RFA using an internally cooled electrode (group A), RFA using an ICW electrode (group B), and RFA using an internally cooled electrode with the Pringle maneuver (group C). The ablation zone diameters were measured on the gross specimens, and the volume of the ablation zone was calculated. Results The ablation zone volume was greatest in group B (1.82±1.23 cm3), followed by group C (1.22±0.47 cm3), and then group A (0.48±0.33 cm3). The volumes for group B were significantly larger than the volumes for group A (p=0.030). There was no significant difference in the volumes between groups A and C (p=0.079) and between groups B and C (p=0.827). Conclusions Both the usage of an ICW electrode and hepatic vascular occlusion effectively expanded the ablation zone. The use of an ICW electrode induced a larger ablation zone with easy handling compared with using hepatic vascular occlusion, although this difference was not statistically significant.
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Affiliation(s)
- Mi-Hyun Park
- Department of Radiology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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