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1
Camacho, Juan C., Elena N. Petre, and Constantinos T. Sofocleous. "Thermal Ablation of Metastatic Colon Cancer to the Liver." Seminars in Interventional Radiology 36, no. 04 (October 2019): 310–18. http://dx.doi.org/10.1055/s-0039-1698754.
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AbstractColorectal cancer (CRC) is responsible for approximately 10% of cancer-related deaths in the Western world. Liver metastases are frequently seen at the time of diagnosis and throughout the course of the disease. Surgical resection is often considered as it provides long-term survival; however, few patients are candidates for resection. Percutaneous ablative therapies are also used in the management of this patient population. Different thermal ablation (TA) technologies are available including radiofrequency ablation, microwave ablation (MWA), laser, and cryoablation. There is growing evidence about the role of interventional oncology and image-guided percutaneous ablation in the management of metastatic colorectal liver disease. This article aims to outline the technical considerations, outcomes, and rational of TA in the management of patients with CRC liver metastases, focusing on the emerging role of MWA.
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Russotto, Fernanda, Vincenzo Fiorentino, Cristina Pizzimenti, Marina Gloria Micali, Mariausilia Franchina, Ludovica Pepe, Giuseppe Riganati, et al. "Histologic Evaluation of Thyroid Nodules Treated with Thermal Ablation: An Institutional Experience." International Journal of Molecular Sciences 25, no. 18 (September 22, 2024): 10182. http://dx.doi.org/10.3390/ijms251810182.
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Thyroid nodules are a common, benign condition with a higher prevalence in women, individuals with iodine deficiency, and radiation exposure. Treatment options for benign thyroid nodules include pharmaceutical therapy, thyroidectomy, and thermal ablation (TA). TA, including laser ablation (LA), radiofrequency ablation (RFA), and microwave ablation (MWA), is a procedure that uses heat to cause tissue necrosis. It is commonly used for large, firm, benign, non-functioning thyroid nodules that cause severe symptoms or pain when surgery is not recommended or desired. When thyroid nodules do not respond to TA, they undergo surgery to resolve the symptoms and clarify the diagnosis. This study aims to analyze the histological alterations found in surgically excised TA-treated thyroid nodules and to evaluate the morphological criteria of differential diagnosis between benign and malignant nodules, establishing whether the alterations observed on the histological sample are a consequence of TA or indicative of neoplastic disease. For this purpose, the adoption of ancillary methods, such as immunohistochemistry, is fundamental to distinguish the artifacts induced by TA from the typical morphological characteristics of malignant neoplasms.
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Evans, Audrey L., Susan C. Hagness, and Chu Ma. "The evolution of microwave-induced thermoacoustic signal characteristics generated during pulsed microwave ablation." Journal of the Acoustical Society of America 151, no. 4 (April 2022): A212. http://dx.doi.org/10.1121/10.0011079.
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Microwave-induced thermoacoustic (TA) signals are of emerging interest for monitoring microwave ablation (MWA) in real-time. TA signals can be generated using an interstitial ablation antenna with a pulsed microwave energy source. When a microsecond microwave pulse is absorbed by tissue, the tissue undergoes a small-scale temperature rise, inducing a thermoelastic expansion that leads to acoustic generation. TA signal characteristics are linked to the dielectric, thermal, and acoustic properties of the local ablation environment. These relevant properties evolve significantly during the ablation process. We conducted a simulation-based study to examine the evolution of microwave-induced TA signal characteristics generated during pulsed microwave ablation. We experimentally validated our multi-physics simulation model for a spatially uniform temperature profile. Then, using the validated simulation model, we investigated TA signals generated in tissue exhibiting spatially nonuniform temperature profiles that arise during MWA. We find that TA signal characteristics are highly influenced by the local environment temperature within the region of initial TA generation and, thus, contain rich information to be exploited for real-time ablation monitoring.
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Carriero, Serena, Gianmarco Della Pepa, Lorenzo Monfardini, Renato Vitale, Duccio Rossi, Andrea Masperi, and Giovanni Mauri. "Role of Fusion Imaging in Image-Guided Thermal Ablations." Diagnostics 11, no. 3 (March 19, 2021): 549. http://dx.doi.org/10.3390/diagnostics11030549.
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Thermal ablation (TA) procedures are effective treatments for several kinds of cancers. In the recent years, several medical imaging advancements have improved the use of image-guided TA. Imaging technique plays a pivotal role in improving the ablation success, maximizing pre-procedure planning efficacy, intraprocedural targeting, post-procedure monitoring and assessing the achieved result. Fusion imaging (FI) techniques allow for information integration of different imaging modalities, improving all the ablation procedure steps. FI concedes exploitation of all imaging modalities’ strengths concurrently, eliminating or minimizing every single modality’s weaknesses. Our work aims to give an overview of FI, explain and analyze FI technical aspects and its clinical applications in ablation therapy and interventional oncology.
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Odet, Julien, Julie Pellegrinelli, Olivier Varbedian, Caroline Truntzer, Marco Midulla, François Ghiringhelli, and David Orry. "Predictive Factors of Local Recurrence after Colorectal Cancer Liver Metastases Thermal Ablation." Journal of Imaging 9, no. 3 (March 10, 2023): 66. http://dx.doi.org/10.3390/jimaging9030066.
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Background: Identify risk factors for local recurrence (LR) after radiofrequency (RFA) and microwave (MWA) thermoablations (TA) of colorectal cancer liver metastases (CCLM). Methods: Uni- (Pearson’s Chi2 test, Fisher’s exact test, Wilcoxon test) and multivariate analyses (LASSO logistic regressions) of every patient treated with MWA or RFA (percutaneously and surgically) from January 2015 to April 2021 in Centre Georges François Leclerc in Dijon, France. Results: Fifty-four patients were treated with TA for 177 CCLM (159 surgically, 18 percutaneously). LR rate was 17.5% of treated lesions. Univariate analyses by lesion showed factors associated with LR: sizes of the lesion (OR = 1.14), size of nearby vessel (OR = 1.27), treatment of a previous TA site LR (OR = 5.03), and non-ovoid TA site shape (OR = 4.25). Multivariate analyses showed that the size of the nearby vessel (OR = 1.17) and the lesion (OR = 1.09) remained significant risk factors of LR. Conclusions: The size of lesions to treat and vessel proximity are LR risk factors that need to be considered when making the decision of thermoablative treatments. TA of an LR on a previous TA site should be reserved to specific situations, as there is an important risk of another LR. An additional TA procedure can be discussed when TA site shape is non-ovoid on control imaging, given the risk of LR.
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Chlorogiannis, David-Dimitris, Vlasios S. Sotirchos, Christos Georgiades, Dimitrios Filippiadis, Ronald S. Arellano, Mithat Gonen, Gregory C. Makris, Tushar Garg, and Constantinos T. Sofocleous. "The Importance of Optimal Thermal Ablation Margins in Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of 21 Studies." Cancers 15, no. 24 (December 12, 2023): 5806. http://dx.doi.org/10.3390/cancers15245806.
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Background: Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in the US. Thermal ablation (TA) can be a comparable alternative to partial hepatectomy for selected cases when eradication of all visible tumor with an ablative margin of greater than 5 mm is achieved. This systematic review and meta-analysis aimed to encapsulate the current clinical evidence concerning the optimal TA margin for local cure in patients with colorectal liver metastases (CLM). Methods: MEDLINE, EMBASE, and the CENTRAL databases were systematically searched from inception until 1 May 2023, in accordance with the PRISMA Guidelines. Measure of effect included the risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Results: Overall, 21 studies were included, comprising 2005 participants and 2873 ablated CLMs. TA with margins less than 5 mm were associated with a 3.6 times higher risk for LTP (n = 21 studies, RR: 3.60; 95% CI: 2.58–5.03; p-value < 0.001). When margins less than 5 mm were additionally confirmed by using 3D software, a 5.1 times higher risk for LTP (n = 4 studies, RR: 5.10; 95% CI: 1.45–17.90; p-value < 0.001) was recorded. Moreover, a thermal ablation margin of less than 10 mm but over 5 mm remained significantly associated with 3.64 times higher risk for LTP vs. minimal margin larger than 10 mm (n = 7 studies, RR: 3.64; 95% CI: 1.31–10.10; p-value < 0.001). Conclusions: This meta-analysis solidifies that a minimal ablation margin over 5 mm is the minimum critical endpoint required, whereas a minimal margin of at least 10 mm yields optimal local tumor control after TA of CLMs.
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Ali, Muhammad, Vanessa Acosta Ruiz, Sarah P. Psutka, David Liu, and Shankar Siva. "Ablative Therapies for Localized Primary Renal Cell Carcinoma." Société Internationale d’Urologie Journal 3, no. 6 (November 16, 2022): 437–49. http://dx.doi.org/10.48083/ueml5802.
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Surgery with either partial or radical nephrectomy remains the standard of care for localized primary renal cell carcinoma (RCC). However, most RCCs are detected in an older age group, and some may have multiple comorbidities that preclude surgery. Thermal ablation (TA) with radiofrequency ablation (RFA), cryoablation (CA), or microwave ablation (MWA) is considered an alternative to extirpative surgical procedures for select patients with small renal tumors. There is more than 90% post-ablation local control in carefully selected patients with reported complication rates of less than 10%. Most thermal ablation require only a single procedure. More recently, stereotactic ablative body radiotherapy (SABR) has emerged as an attractive noninvasive treatment modality for elderly patients with comorbidities and localized RCC. It has shown more than 90% local control rates for both small and relatively larger tumors (> 4 cm). Modest post-SABR renal function decline has been observed. Despite most patients presenting with mild or moderate chronic kidney disease there is less than a 5% chance of progression to end-stage renal disease. This article aims to summarize the key evidence and ablative treatment’s optimal patient selection, efficacy, and toxicity.
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Vasiniotis Kamarinos, Nikiforos, Efsevia Vakiani, Mithat Gonen, Nancy E. Kemeny, Anne M. Covey, Karen T. Brown, Lynn A. Brody, et al. "Immediate post-thermal ablation biopsy of colorectal liver metastases to predict oncologic outcomes." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 4602. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.4602.
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4602 Background: Thermal ablation (TA) is used as a local cure for selected colorectal liver metastases (CLM) with minimal risk. A critical limitation of TA has been early local tumor progression (LTP). The goal of this study is to establish the role of ablation zone (AZ) biopsy in predicting LTP. Methods: This institutional review board-approved prospective study included patients with CLM of 5cm or less in maximum diameter, with confined liver disease or stable, limited extrahepatic disease. Both radiofrequency(RF) and microwave(MW) ablation modalities were used. A biopsy of the center and margin of the AZ was performed immediately after ablation. The applicators were also examined for the presence of viable tumor cells. All samples containing morphologically identified tumor cells were further interrogated with immunohistochemistry to determine the proliferative and viability potential of the detected tumor cells. Ablation margin size was evaluated on the first CT scan performed 4–8 weeks after ablation and was confirmed by 3D assessment with Ablation Confirmation Software (Neuwave™). Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results: Between November 2009 and February 2019, 102 patients with 182 CLMs were enrolled. Mean tumor size was 2.0 cm (range, 0.6–4.8 cm). MW was used in 95/182 (52%) tumors and RF in 87/182 (48%). Median follow-up was 19 months. Technical effectiveness was evident in 178/182 (97%) ablated tumors on the first contrast material–enhanced CT at 4–8-weeks post-ablation. The cumulative incidence of LTP at 12 months was 19% (95% confidence interval [CI]: 14, 27). Samples from 64 (35%) of the 178 technically successful cases contained viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. In a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 4.3), and positive biopsy results (P = .02; HR, 1.8) remained significant. LTP within 12 months after TA was noted in 3% (95% CI: 1, 6) of tumor-negative biopsy CLMs with margins of at least 5 mm. Conclusions: Biopsy and pathologic examination of the AZ predicts LTP regardless of TA modality used. This can optimize ablation as a potential local cure for patients with limited CLM.
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Bernardi, Stella, Silvia Taccogna, Martina D’Angelo, Fabiola Giudici, Giovanni Mauri, Bruno Raggiunti, Doris Tina, Fabrizio Zanconati, Enrico Papini, and Roberto Negro. "Immunocytochemistry Profile of Benign Thyroid Nodules Not Responding to Thermal Ablation: A Retrospective Study." International Journal of Endocrinology 2023 (April 11, 2023): 1–7. http://dx.doi.org/10.1155/2023/7951942.
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Purpose. Thermal ablations (TA) are gaining ground as alternative options to conventional therapies for symptomatic benign thyroid nodules. Little is known about the impact of nodule biology on the outcomes of TA. The aim of our study was to evaluate the baseline immunocytochemistry profile of thyroid nodules that were poorly responsive to TA in order to identify potential predictors of the treatment response. Methods. From a cohort of 406 patients with benign thyroid nodules treated with TA and followed for 5 years, we retrospectively selected two groups of patients: NONRESPONDERS (patients who did not respond to TA and were later surgically treated) and RESPONDERS (patients who responded to TA). The fine-needle aspiration cytology (FNAC) slides obtained before TA were stained for Galectin-3, HBME-1, CK-19, and Ki-67. Results. Benign nodules of NONRESPONDERS (n = 19) did not express CK-19 ( p = 0.03 ), as compared to RESPONDERS (n = 26). We combined the absence of CK-19 and the presence of Ki-67 to obtain a composite biomarker of resistance to TA, which discriminated between likelihood of retreatment and no retreatment with an AUC of 0.68 (95%CI: 0.55-0.81) and a sensitivity, specificity, PPV, and NPV of 29%, 91%, 71%, and 64%, respectively. Conclusion. In benign thyroid nodules, the absence of CK-19 was associated with resistance to TA, while the presence of CK-19 was predictive of response to TA. If confirmed, this finding could provide rapid and inexpensive information about the potential outcome of TA on benign thyroid nodules. In addition, as CK-19 can be expressed in adenomatous hyperplasia, it could be speculated that these nodules, rather than follicular adenomas, might be better candidates for TA.
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Sim, Jung Suk, and Jung Hwan Baek. "Long-Term Outcomes of Thermal Ablation for Benign Thyroid Nodules: The Issue of Regrowth." International Journal of Endocrinology 2021 (July 21, 2021): 1–7. http://dx.doi.org/10.1155/2021/9922509.
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Thermal ablation (TA) for benign thyroid nodules (BTNs) is widely accepted as an effective and safe alternative to surgery. However, studies on the long-term outcomes of TA have reported problems with nodule regrowth and symptom recurrence, which have raised the need for adequate control of regrowth. Therefore, a more complete TA with a longer-lasting treatment effect may be required. In this study, we review and discuss long-term outcomes and regrowth of BTNs following TA and evaluate factors affecting the long-term outcomes. We also discuss the management of regrowth based on long-term outcomes.
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Cazzato, Roberto Luigi, Julien Garnon, Pierre De Marini, Pierre Auloge, Guillaume Koch, Danoob Dalili, Xavier Buy, et al. "Is percutaneous image-guided renal tumour ablation ready for prime time?" British Journal of Radiology 93, no. 1114 (October 1, 2020): 20200284. http://dx.doi.org/10.1259/bjr.20200284.
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In the last few decades, thermal ablation (TA) techniques have been increasingly applied to treat small localised renal cell carcinomas. Despite this trend, there is still an underuse of TA compared to surgery and a substantial lack of high-quality evidence derived from large, prospective, randomised controlled trials comparing the long-term oncologic outcomes of TA and surgery. Therefore, in this narrative review, we assess published guidelines and recent literature concerning the diagnosis and management of kidney-confined renal cell carcinoma to understand whether percutaneous image-guided TA is ready to be proposed as a first-line treatment.
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Xu, Kai, Yaning Zhang, Dong Wang, Xing Jin, and Xiang Ding. "Effect of TaC Content on Microstructure and Properties of W-TaC Composites." Materials 16, no. 1 (December 25, 2022): 186. http://dx.doi.org/10.3390/ma16010186.
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Transition metal carbide reinforcement can improve the performance of pure W. W-(10–50) vol% TaC composites were prepared by spark plasma sintering at 2100 °C. The effect of TaC content on the microstructure, mechanical properties, and thermal conductivity of the composites was studied. The ablation resistance of the W-TaC composites was evaluated under an air plasma torch. The addition of TaC into the W matrix enhanced the densification of W-TaC composites, the density of W-40 vol% TaC composite exceeded 93%. TaC particles inhibited the growth of W grains during sintering. Reactive diffusion occurred between W and TaC, forming the solid solutions of (W,Ta)ss and (Ta,W)Css. W and TaC react to form the W2C phase at a TaC content of 50 vol%. The Vickers hardness of the composite increases from 3.06 GPa for WTA1 to 10.43 GPa for WTA5. The flexural strength reached 528 MPa in the W-40 vol% TaC composite. The thermal conductivity of W-20 vol% TaC composite was 51.2 ± 0.2 W·m−1·K−1 at 750 °C. The addition of TaC improved the ablation resistance of W-TaC composites. The mass ablation rate of W-30 vol% TaC composite was 0.0678 g·s−1. The ablation products were mainly W oxides and complex oxides of W-Ta-O.
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Zirakchian Zadeh, Mahdi, Randy Yeh, Henry S. Kunin, Assen S. Kirov, Elena N. Petre, Mithat Gönen, Mikhail Silk, et al. "Real-Time Split-Dose PET/CT-Guided Ablation Improves Colorectal Liver Metastasis Detection and Ablation Zone Margin Assessments without the Need for Repeated Contrast Injection." Cancers 14, no. 24 (December 19, 2022): 6253. http://dx.doi.org/10.3390/cancers14246253.
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Background: Real-time split-dose PET can identify the targeted colorectal liver metastasis (CLM) and eliminate the need for repeated contrast administration before and during thermal ablation (TA). This study aimed to assess the added value of pre-ablation real-time split-dose PET when combined with non-contract CT in the detection of CLM for ablation and the evaluation of the ablation zone and margins. Methods: A total of 190 CLMs/125 participants from two IRB-approved prospective clinical trials using PET/CT-guided TA were analyzed. Based on detection on pre-TA imaging, CLMs were categorized as detectable, non-detectable, and of poor conspicuity on CT alone, and detectable, non-detectable, and low FDG-avidity on PET/CT after the initial dose. Ablation margins around the targeted CLM were evaluated using a 3D volumetric approach. Results: We found that 129/190 (67.9%) CLMs were detectable on CT alone, and 61/190 CLMs (32.1%) were undetectable or of poor conspicuity, not allowing accurate depiction and targeting by CT alone. Thus, the theoretical 5- and 10-mm margins could not be defined in these tumors (32.1%) using CT alone. When TA intraprocedural PET/CT images are obtained and inspected (fused PET/CT), only 4 CLM (2.1%) remained undetectable or had a low FDG avidity. Conclusions: The addition of PET to non-contrast CT improved CLM detection for ablation targeting, margin assessments, and continuous depiction of the FDG avid CLMs during the ablation without the need for multiple intravenous contrast injections pre- and intra-procedurally.
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Papini, Enrico, Hervé Monpeyssen, Andrea Frasoldati, and Laszlo Hegedüs. "2020 European Thyroid Association Clinical Practice Guideline for the Use of Image-Guided Ablation in Benign Thyroid Nodules." European Thyroid Journal 9, no. 4 (2020): 172–85. http://dx.doi.org/10.1159/000508484.
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Standard therapeutic approaches for benign thyroid lesions that warrant intervention are surgery for cold and either surgery or radioiodine for autonomously functioning thyroid nodules (AFTN). Image-guided thermal ablation (TA) procedures are increasingly proposed as therapy options for selected clinical conditions. Due to mounting scientific evidence and widening availability, ETA considered it appropriate to develop guidelines for the use of TA in adult patients. TA procedures are well tolerated, but a dedicated training of the operators is required and information on possible complications needs to be shared with the patients. The following factors should be considered when weighing between observation, surgery, and TA for benign thyroid nodules. In solid non-hyperfunctioning nodules, TA induces a decrease in thyroid nodule volume, paralleled by improvement in symptoms. Nodule re-growth is possible over time and may necessitate repeat treatment, or surgery, in a dialogue with the patient. In AFTN, radioactive iodine is the first-line treatment, but TA may be considered in young patients with small AFTN due to higher probability of restoring normal thyroid function and avoidance of irradiation. In cystic nodules, ethanol ablation (EA) is the most effective and least expensive treatment. TA may be considered for cystic lesions that relapse after EA or have a significant residual solid component following drainage and EA. TA should be restricted to benign lesions that cause symptoms or cosmetic concern. Presently, laser and radiofrequency ablation are the most thoroughly assessed techniques, with similar satisfactory clinical results. Microwaves and high-intensity focused ultrasound therapy options remain to be fully evaluated.
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Bodard, Sylvain, Idris Boudhabhay, Charles Dariane, Christophe Delavaud, Sylvain Guinebert, Dominique Joly, Marc-Olivier Timsit, et al. "Percutaneous Thermal Ablation for Renal Tumors in Patients with Birt–Hogg–Dubé Syndrome." Cancers 14, no. 20 (October 11, 2022): 4969. http://dx.doi.org/10.3390/cancers14204969.
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BHD syndrome is characterized by an increased risk of bilateral and multifocal renal cell carcinoma (RCCs), but is rarely metastatic. Our report aims to analyze the outcome of patients with BHD syndrome who underwent percutaneous thermal ablation (TA). The present report included six BHD syndrome patients (five men) with a mean age of 66 ± 11 (SD) years who had a proven germline FLCN gene mutation and underwent TA for a renal tumor. Nineteen renal tumors (median two tumors per patient; range: 1–3), including seven chromophobe RCCs, five clear-cell RCCs, four papillary RCCs, two clear-cell papillary RCC, and one hybrid oncocytic/chromophobe tumor were treated in 14 ablation sessions. The mean size of the tumors was 21 ± 11 (SD) mm (median: 20 mm; interquartile range (IQR): 14–25 mm) for a mean volume of 7 ± 11 (SD) mL (median: 3; IQR: 1–5 mL). Technical success was achieved in all ablation sessions (primary success rate, 100%). The procedure was well tolerated under conscious sedation with no significant Clavien–Dindo complication (grade 2, 3, 4). All patients were alive with no distant metastasis during a median follow-up period of 74 months (range: 33–83 months). No local tumor progression was observed. The mean decrease in estimated glomerular filtration rate was 8 mL/min/1.73 m2. No patients required dialysis or renal transplantation. In this case series, percutaneous TA appeared as a safe and efficient nephron-sparing treatment for treating RCCs associated with BHD syndrome, even in the case of advanced chronic kidney disease.
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Masch, Rachel, Gabriel Conzuelo-Rodriguez, Jameson A. Mitchell, Karla Alfaro, Montserrat Soler, Luis F. Chavez, Suhui Wu, et al. "Gynecologic infection rates after ablation treatment for cervical intraepithelial neoplasia grade 2 and higher (CIN2+): Secondary analysis of a non-inferiority randomized trial." PLOS Global Public Health 4, no. 7 (July 10, 2024): e0003333. http://dx.doi.org/10.1371/journal.pgph.0003333.
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Although concerns have been raised regarding potential infection and morbidity in women undergoing ablation treatment for cervical precancer in low- and middle-income countries (LMIC), there is extremely limited data to substantiate this claim. This is a secondary analysis of a randomized non-inferiority trial (id: NCT03084081) that compares the efficacy and safety of three ablation treatments for biopsy-confirmed cervical intraepithelial neoplasia grade 2 or higher (CIN2+): CO2 gas-based cryotherapy, non-gas cryotherapy, and thermal ablation (TA). Here, we present findings regarding the incidence of sexually transmitted infections (STI) and vaginitis post-treatment. Samples were collected at enrollment and again at 6 weeks post-treatment and assessed for STIs (Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and Trichomonas vaginalis (TV)) and vaginitis (Bacterial vaginosis (BV) and/or Candida albicans (Candida)). This analysis reflects 864 women with baseline and 6-week follow-up data. None of the ablative treatments put women at increased risk for STIs (CT, NG, TV) or vaginitis (BV, Candida). While most women adhered to post-treatment recommendations (97%) and no difference by treatment arm was observed, the incidence of STIs at follow-up in women that did not adhere with a given recommendation was higher compared to their adherent counterparts. The incidence of gynecologic infection did not increase with any of the ablation treatments from baseline to the six-week follow-up. Non-gas cryotherapy and TA emerge as safe alternatives to gas-based cryotherapy with respect to gynecologic infection rates.
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Mungo, Chemtai, Cyrillus Ogollah, Jennifer Ambaka, Jackton Omoto, and Craig Cohen. "Efficacy of Thermal Ablation for Treatment of High-Grade Cervical Dysplasia Among HIV-Positive Women: Preliminary Results From Western Kenya." JCO Global Oncology 8, Supplement_1 (May 2022): 34. http://dx.doi.org/10.1200/go.22.40000.
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PURPOSE In 2019, the World Health Organization (WHO) endorsed thermal ablation (TA) for use within “screen-and-treat” cervical cancer prevention programs in low- and middle-income countries (LMICs), including among women living with HIV (WLWH). We evaluated TA efficacy for treatment of biopsy-confirmed cervical intraepithelial neoplasia grades 2 and 3 (CIN2/3) among WLWH in western Kenya (ClinicalTrials.gov NCT04191967). METHODS Between August 2019 and November 2020, WLWH age 25-65 years underwent high-risk human papillomavirus (hrHPV) self-collection. hrHPV-positive women underwent colposcopy-directed biopsies, and thermal ablation treatment if eligible per WHO guidelines. Women with biopsy-confirmed CIN2/3 had colposcopy-directed biopsies at 12-months to determine treatment efficacy. RESULTS Sixty-eight hrHPV-positive WLWH with biopsy-confirmed CIN2/3 at baseline; 14 CIN2, 54 CIN3, underwent thermal ablation. Mean age and parity were 41.2 years and 4, respectively. The mean CD4 count was 473.98 cells/mm3 and 96.9% had HIV viral suppression. Fifty-eight women (83.8%) have been seen for a 12-month follow-up visit, and pathology results are available for 54 (79.4%). Of these, 35 (66.0%) had successful treatment, defined as biopsy-confirmed CIN1 or normal findings 12-months following treatment, while 18 (34.0%) had treatment failure - persistent biopsy-confirmed CIN2/3. Treatment failure was 23.1% 95% CI (13.0 to 45.9) and 37.5%, 95% CI (22.1 to 52.0) among women with CIN2 and CIN3 at baseline, respectively. CONCLUSION Hand-held thermal ablation devices are affordable, portable, easy to use, and hence highly scaleable within screen-and-treat programs in LMICs. However, our preliminary results, with rigorous disease status verification at both baseline and follow-up find higher than previously reported treatment failure rates for CIN3 among WLWH, a high-risk population for cervical cancer. If replicated by larger studies, this highlights a potential limitation of the current WHO cervical cancer elimination strategy, calling for better risk stratification in this population, and/or consideration of adjuvant therapy to prevent CIN2/3 recurrence following thermal ablation.
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Janić, Tamara, Mirjana Stojković, Sanja Klet, Bojan Marković, Biljana Nedeljković-Beleslin, Jasmina Ćirić, and Miloš Žarković. "Image-guided methods in the treatment of thyroid nodules and cancer." Medicinski glasnik Specijalne bolnice za bolesti štitaste žlezde i bolesti metabolizma 27, no. 85 (2022): 9–23. http://dx.doi.org/10.5937/mgiszm2285009j.
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Thyroid nodules (TN) are present in about half of the population. About 5% of all nodules are malignant. Image-guided methods for the treatment of TN are becoming a significant alternative to surgery. Percutaneous ethanol ablation (PEA) is effective in the treatment of thyroid cysts, and neck lymph node metastases. Percutaneous laser ablation (PLA) significantly reduces the size of the nodules and improves subjective symptoms. The adverse effects of PEA are rare, transitory, and mild. Radiofrequency ablation (RFA) is effective for nodules of all sizes and compositions. The major complications of RFA are rare and transient. Microwave ablation is also effective in the treatment of thyroid nodules with rare major complications. High-intensity focused ultrasound (HIFU) is a transcutaneous method. It is effective in the treatment of thyroid nodules, and complications are rare. Graves' hyperthyroidism was also treated with HIFU. As thermal ablation (TA ) methods are becoming more popular in 2020, the European Thyroid Association published clinical practice guidelines for the use of image-guided ablation in benign thyroid nodules. A meta-analysis showed that low-risk papillary thyroid microcarcinoma recurrences after TA treatment are rare, as are complications. As the TA methods are acceptable for the treatment of the low-risk papillary thyroid carcinoma European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe issued clinical practice guidelines for the use of minimally invasive treatments in malignant thyroid lesions. Image-guided treatments for thyroid nodules and cancer are here to stay. Their use will expand and become part of routine clinical practice.
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Rusinek, Michał, Marek Salagierski, Waldemar Różański, Bartłomiej Jakóbczyk, Michał Markowski, Marek Lipiński, and Jacek Wilkosz. "Comparison of the Results of Therapy for cT1 Renal Carcinoma with Nephron-Sparing Surgery (NSS) vs. Percutaneous Thermal Ablation (TA)." Journal of Personalized Medicine 12, no. 3 (March 18, 2022): 495. http://dx.doi.org/10.3390/jpm12030495.
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Implementation of ultrasonography (USG), computed tomography (CT) and magnetic resonance imaging (MRI) into abdominal cavity diagnostics enabled early detection of cT1 graded renal cancers. According to European Association of Urology (EAU) and Polish urological Association (PUA) recommended method of treatment is sparing resection of renal parenchyma with tumour—nephron-sparing surgery (NSS). In selected cases other methods such as thermal ablation (TA) or cryoablation can be introduced /1/. Objectives: To evaluate the results of treatment of cT1 renal tumours with the use of NSS and TA methods. Material and methods: 140 patients with cT1 renal carcinoma were treated in 2nd Department of Urology of Medical University of Lodz between 2014 and 2017. Neuron-sparing surgery was performed in 56 cases (40%), while percutane-ous thermal ablation (TA) in 84 cases (60%). Demographic data, clinical data (lab results, Charlson index), nephrometry data (tumour size, location, R.E.N.A.L. score) post-operative data (Clavien-Dindo classifica-tion) were investigated. Histopathology results, Fuhrman malignancy grading, as total three-year survival of patients were evaluated. The following methods were used for statistical evaluation: Chi2, Fisher, W Shapiro-Wilk, U Mann-Whitney tests, Kaplan-Meier’s curve and Cox model. The results were displayed in a form of median and upper and lower quartile values (25–75%). Results: No statistical differences in gender nor left/right kidney location were observed. Patients, who underwent TA were at average 10 years older and had multiple comorbidities (median age for TA was 79, for NSS 68; median Charlson index for TA was 5 and for NSS was 3). TA patients had lesser haematological values (Hb, Ht). R.E.N.A.L. scoring demonstrated comparable nephrometry in both groups. NSS procedure was open laparotomy without temporary clamping of renal vessels. Surgical margins of resected tumours were negative. TA was performed with Cool-Tip Covidienequipment with the use of Cluster electrode and was ultraso-nography-guided. Post-treatment complications evaluated with the use of Clavien-Dindo classification were slightly more frequent for NSS method. Patients after NSS were discharged at average after 8.5 days and after TA after 3 days. Histopathological type and Fuhrman malignancy grading were comparable in both groups. TA treated patients’ death risk was 9-fold of that observed in NSS treated patients. There was 1 death for each group in perioperative period. Conclusion: 1. NSS was associated with slightly higher side effect rate but resulted in prolonged survival. 2. TA was applied to elderly patients with comorbidities. Despite less invasive treatment this group had poorer/reduced survival. 3. Charlson Comorbidity Index (CCI) and the treatment method were relevant survival factors in patients treated due to cT1 renal cancer tumours.
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Filippiadis, Dimitrios K., Georgios Velonakis, Alexis Kelekis, and Constantinos T. Sofocleous. "The Role of Percutaneous Ablation in the Management of Colorectal Cancer Liver Metastatic Disease." Diagnostics 11, no. 2 (February 14, 2021): 308. http://dx.doi.org/10.3390/diagnostics11020308.
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Approximately 50% of colorectal cancer patients will develop metastases during the course of the disease. Local or locoregional therapies for the treatment of liver metastases are used in the management of oligometastatic colorectal liver disease, especially in nonsurgical candidates. Thermal ablation (TA) is recommended in the treatment of limited liver metastases as free-standing therapy or in combination with surgery as long as all visible disease can be eradicated. Percutaneous TA has been proven as a safe and efficacious therapy offering sustained local tumor control and improved patient survival. Continuous technological advances in diagnostic imaging and guidance tools, the evolution of devices allowing for optimization of ablation parameters, as well as the ability to perform margin assessment have improved the efficacy of ablation. This allows resectable small volume diseases to be cured with percutaneous ablation. The ongoing detailed information and increasing understanding of tumor biology, genetics, and tissue biomarkers that impact oncologic outcomes as well as their implications on the results of ablation have further allowed for treatment customization and improved oncologic outcomes even in those with more aggressive tumor biology. The purpose of this review is to present the most common indications for image-guided percutaneous ablation in colorectal cancer liver metastases, to describe technical considerations, and to discuss relevant peer-reviewed evidence on this topic. The growing role of imaging and image-guidance as well as controversies regarding several devices are addressed.
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Atri, Mostafa, Abdulmohsen Alrashed, Ahmad Hassan, Korosh Khalili, Tae Kyoung Kim, and Huynh Jung Jang. "Negative Predictive Value of Contrast-Enhanced Ultrasound of Liver and Kidney Thermal Ablation Sites for Local Tumour Progression during Long-term Follow-up: A Retrospective Consecutive Study." Canadian Association of Radiologists Journal 70, no. 4 (November 2019): 434–40. http://dx.doi.org/10.1016/j.carj.2019.06.011.
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Purpose To determine negative predictive value (NPV) of contrast-enhanced ultrasound (CEUS) to demonstrate local tumour progression (LTP) at thermal ablation (TA) sites. Methods Our institutional review board approved this retrospective study; acquisition of consent was waived. Consecutive CEUS examinations performed between 2004-2014 for TA site evaluation on patients who could not undergo enhanced computed tomography (CT) or magnetic resonance imaging (MRI), or had inconclusive CT or MRI, were retrospectively reviewed. Those reported as no abnormal enhancement in or surrounding TA site were included. CEUS examination was considered true-negative based on stability or lack of enhancement/washout on follow-up imaging for at least 1 year, and false-negative (FN), if there was an arterially enhancing focus with wash-out at or surrounding TA site on subsequent follow-up imaging. Results Study population included 56 tumours in 54 patients, 11 women, 43 men; mean age 71 years. Two patients had TA of two different hepatocellular carcinomas. Thirty-six examinations were for hepatic TA and twenty for renal TA. Lesion sizes ranged from 1 cm to 7 cm (mean 3.1 ± 1.2). Mean diameter of 7 recurrences was 13.8 mm. Overall FN rate was 12.5% (7/56). Corresponding numbers were 0% (0/20) for renal TA and 19.4% (7/36) for hepatic TA. Overall NPV of CEUS was 87.5% (49/56) (confidence interval [CI]: 78.8%–96.2%). NPV for renal TA was 100% (20/20) (CI: 100%–100%) and for hepatic TA 81.5% (29/36) (CI: 67.6 %–93.5%). Conclusion In this cohort, CEUS showed high NPV for exclusion of LTP at renal TA sites. NPV for hepatic TA sites was high but lower than renal TA.
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Macagno, Alban, Alexandre de Nonneville, Pierre Annede, Gilles Piana, Isabelle Pougnet, Nassima Daidj, Laurence Moureau-Zabotto, et al. "Repeated Multimodality Ablative Therapies for Oligorecurrent Pulmonary Metastatic Disease." Current Oncology 29, no. 3 (March 4, 2022): 1683–94. http://dx.doi.org/10.3390/curroncol29030140.
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Stereotactic body radiotherapy (SBRT) and percutaneous thermal ablation (TA) are alternatives to surgery for the management of pulmonary oligometastases. In this collaborative work, we retrospectively analyzed patients who had undergone iterative focal ablative treatments of pulmonary oligometastases. We hypothesized that repeated ablative therapies could benefit patients with consecutive oligometastatic relapses. Patients treated with SBRT and/or TA for pulmonary oligometastases in two French academic centers between October 2011 and November 2016 were included. A total of 102 patients with 198 lesions were included; 45 patients (44.1%) received repeated focal treatments at the pulmonary site for an oligorecurrent disease (the “multiple courses” group). Median follow-up was 22.5 months. The 3-year overall survival rates of patients who had a single treatment sequence (the “single course” group) versus the “multiple courses” were 73.9% and 78.8%, respectively, which was not a statistically significant difference (p = 0.860). The 3-year systemic therapy-free survival tended to be longer in the “multiple courses” group (50.4%) than in the “single course” group (44.7%) (p = 0.081). Tolerance of repeated treatments was excellent with only one grade 4 toxicity. Thereby, multimodality repeated ablative therapy is effective in patients with pulmonary oligorecurrent metastases. This strategy may delay the use of more toxic systemic therapy.
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An, Chao, Pei-Hong Wu, and Jin-Hua Huang. "Surgical resection versus thermal ablation: Comparison of sequential options after successful TACE downstaging therapy for unresectable hepatocellular carcinoma—A long-term multi-institutional study." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): e16258-e16258. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e16258.
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e16258 Background: Transarterial chemoembolization (TACE) is an effective and safe treatment for unresectable hepatocellular carcinoma (uHCC). However, the selection of sequential therapeutic modalities after TACE downstaging therapy is still controversial. The aim of this study is to compare the efficacy and safety of surgical resection (SR) and thermal ablation (TA) after successful TACE downstaging therapy for uHCC. Methods: In this real-world multi-institutional study from June 2008 to October 2022, 8,219 consecutive patients with HCC underwent conventional TACE at 12 hospitals. Patients underwent successful TACE downstaging therapy for uHCC beyond Milan criteria, who were assigned into SR group and TA group. The propensity score matching (PSM) was applied to reduce selection bias between groups. Cumulative overall survival (OS) and progression-free survival (PFS) were compared using the Kaplan‒Meier method with the log-rank test. A comparison analysis of major complications was performed using the c2 test. Results: 609 (7.4%) patients received SR or TA after TACE. After PSM 1:1, 185 patients in the SR group were matched with 185 in the TA group. After 4.5 years of median follow-up time, the cumulative 1-, 3-, 5- and 10-year OS rates were 98.8%, 89.3%, 82.9% and 64.4% in the SR group and 99.5%, 88.4%, 75.3% and 53.9% in the TA group, respectively, showing no significant difference ( P = .381). The cumulative 1-, 3-, 5- and 10-year PFS rates were 88.5%, 69.2%, 58.8% and 32.2% in the SR group and 90.6%, 71.4%, 53.1% and 32.0% in the TA group, respectively, showing no significant difference ( P = .855). The incidences of major complications were 6.5% in the SR group and 7.6% in the TA group, showing no significant difference ( P = .684). Conclusions: For uHCC patients beyond the Milan criteria received TACE downstaging therapy, TA might be acceptable as an alternative to SR in first-line sequential treatment scheme.
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Chen, Ching, Sergey Galitskiy, Avanish Mishra, and Avinash M. Dongare. "Modeling laser interactions with aluminum and tantalum targets using a hybrid atomistic-continuum model." Journal of Applied Physics 133, no. 10 (March 14, 2023): 105901. http://dx.doi.org/10.1063/5.0138389.
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A hybrid atomistic-continuum method can model the microstructure evolution of metals subjected to laser irradiation. This method combines classical molecular dynamics (MD) simulations with the two-temperature model (TTM) to account for the laser energy absorption and heat diffusion behavior. Accurate prediction of the temperature evolution in the combined MD-TTM method requires reliable accuracy in electron heat capacity, electron thermal conductivity, and electron–phonon coupling factor across the temperatures generated. This study uses the electronic density of states (DOS) obtained from first-principle calculations. The calculated electron temperature-dependent parameters are used in MD-TTM simulations to study the laser metal interactions in FCC and BCC metals and the phenomenon of laser shock loading and melting. This study uses FCC Al and BCC Ta as model systems to demonstrate this capability. When subjected to short pulsed laser shocks, the dynamic failure behavior predicted using temperature-dependent parameters is compared with the experimentally reported single-crystal and nanocrystalline Al and Ta systems. The MD-TTM simulations also investigate laser ablation and melting behavior of Ta to compare with the ablation threshold reported experimentally. This manuscript demonstrates that integrating the temperature-dependent parameters into MD-TTM simulations leads to the accurate modeling of the laser–metal interaction and allows the prediction of the kinetics of the solid–liquid interface.
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Meier, Thomas Oleg, Vincenzo Jacomella, Robert Karl Josef Clemens, and Beatrice Amann-Vesti. "Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation." Vasa 44, no. 6 (November 2015): 473–78. http://dx.doi.org/10.1024/0301-1526/a000471.
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Abstract. Background: Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. Patients and methods: Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0 = not at all, 10 = very much). Adverse events during the treatment were monitored. Results: 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0 - 6) compared to the controls (mean 4.3 points, range 1 - 9, p < 0.001). Overall, 64.5 % of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). Conclusions: N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA.
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Mauri, Giovanni, Laszlo Hegedüs, Steven Bandula, Roberto Luigi Cazzato, Agnieszka Czarniecka, Oliver Dudeck, Laura Fugazzola, et al. "European Thyroid Association and Cardiovascular and Interventional Radiological Society of Europe 2021 Clinical Practice Guideline for the Use of Minimally Invasive Treatments in Malignant Thyroid Lesions." European Thyroid Journal 10, no. 3 (2021): 185–97. http://dx.doi.org/10.1159/000516469.
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The growing detection of papillary thyroid microcarcinomas (PTMCs) is paralleled by an increase in surgical procedures. Due to the frequent indolent nature, cost, and risk of surgery, active surveillance (AS) and ultrasound-guided minimally invasive treatments (MITs) are in suitable cases of incidental PTMC proposed as alternatives to thyroidectomy. Surgery and radioiodine are the established treatments for relapsing cervical differentiated thyroid carcinoma (DTC) metastases. But radioiodine refractoriness, risk of surgical complications, adverse influence on quality of life, or declining repeat surgery have led to AS and MIT being considered as alternatives for slow-growing DTC nodal metastases. Also, for distant radioiodine-refractory metastases not amenable to surgery, MIT is proposed as part of a multimodality therapeutic approach. The European Thyroid Association and the Cardiovascular and Interventional Radiological Society of Europe commissioned these guidelines for the appropriate use of MIT. Based on a systematic PubMed search, an evidence-based approach was applied, and both knowledge and practical experience of the panelists were incorporated to develop the manuscript and the specific recommendations. We recommend that when weighing between surgery, radioiodine, AS, or MIT for DTC, a multidisciplinary team including members with expertise in interventional radiology assess the demographic, clinical, histological, and imaging characteristics for appropriate selection of patients eligible for MIT. Consider TA in low-risk PTMC patients who are at surgical risk, have short life expectancy, relevant comorbidities, or are unwilling to undergo surgery or AS. As laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective thermal ablation (TA) techniques, the choice should be based on the specific competences and resources of the centers. Use of ethanol ablation and high-intensity focused ultrasound is not recommended for PTMC treatment. Consider MIT as an alternative to surgical neck dissection in patients with radioiodine refractory cervical recurrences who are at surgical risk or decline further surgery. Factors that favor MIT are previous neck dissection, presence of surgical complications, small size metastases, and <4 involved latero-cervical lymph nodes. Consider TA among treatment options in patients with unresectable oligometastatic or oligoprogressive distant metastases to achieve local tumor control or pain palliation. Consider TA, in combination with bone consolidation and external beam radiation therapy, as a treatment option for painful bone metastases not amenable to other established treatments.
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Sheybani, Natasha Diba, Alexandra R. Witter, Aaron D. Stevens, Timothy N. Bullock, and Richard J. Price. "Focused ultrasound ablation as an immunomodulatory strategy for metastatic breast cancer therapy." Journal of Immunology 200, no. 1_Supplement (May 1, 2018): 178.39. http://dx.doi.org/10.4049/jimmunol.200.supp.178.39.
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Abstract Metastatic breast cancer (BrCa) is incurable, with a 5 year survival of only 22%. While immunotherapies are capable of generating durable responses in many forms of cancer, immune rejection of BrCa is very rare. Indeed, immunotherapies (e.g. checkpoint blockade) for BrCa are limited by poor functional CD8+ T cell infiltration and immunosuppression in the tumor microenvironment. Thus, adjunct strategies that render BrCa tumors responsive to immunotherapies are desperately needed. Focused ultrasound (FUS) mediates noninvasive acoustic energy deposition into tumors, conferring localized thermal and mechanical damage to targeted tissue. Here, we tested the hypothesis that FUS thermal ablation (TA) can serve as an auto-vaccine for treatment of BrCa with immunotherapy. Murine mammary carcinoma (4T1-HA) tumors were partially ablated with a 3 MHz ultrasound-guided FUS system. In tumor-draining lymph nodes, 1 week after FUS, we observed a ~3-fold increase in mature dendritic cells (CD11c-hi/CD86+), as well as an increasing trend in M1 macrophage representation by flow cytometry. While FUS did not confer changes in intratumoral CD8+ and CD4+ T cells, likely due to an overwhelming immunosuppressive burden imposed by myeloid derived suppressor cells (MDSCs), infiltrating T cells did express PD1. Therefore, we developed a combination treatment approach of FUS + gemcitabine and/or anti-PD1. This combination treatment elicited an ~50% reduction in 4T1-HA tumor growth at 5 days post-FUS ablation, suggesting that partial TA of BrCa tumors with FUS may represent a promising immunoadjuvant approach. Taken together, these results suggest immunoadjuvants abrogating immunosuppression may enable FUS to stimulate anti-tumor immunity in BrCa.
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Meivita, Maria P., Fitya S. Mozar, Shao-Xiang Go, Lunna Li, Natasa Bajalovic, and Desmond K. Loke. "Energy-Efficient and Effective MCF-7 Cell Ablation and Electrothermal Therapy Enabled by M13–WS2–PEG Nanostructures." Materials 17, no. 18 (September 20, 2024): 4624. http://dx.doi.org/10.3390/ma17184624.
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Thermal agents (TAs) have exhibited promise in clinical tests when utilized in cancer thermal therapy (TT). While rapid degradation of TAs may address safety concerns, it limits the thermal stability required for effective treatment. TAs, which possess exceptional thermal stability, experience gradual deterioration. There are few approaches that effectively address the trade-off between improving thermal stability and simultaneously boosting material deterioration. Here, we control the thermal character of tungsten disulfide (WS2)-based 2D materials by utilizing an M13 phage through Joule heating (the M13–WS2–PEG nanostructures were generated and termed a tripartite (T) nanostructure), and developed a T nanostructure-driven TT platform (we called it T-TT) for efficient thermal ablation of clinically relevant MCF-7 cells. A relative cell viability of ~59% was achieved, as well as onset time of degradation of ~0.5 week. The T-TT platform also discloses an energy density of 5.9 J/mL. Furthermore, the phage-conjugated WS2 can be utilized to achieve ultrasound imaging for disease monitoring. Therefore, this research not only presents a thermal agent that overcomes TA limitations, but also demonstrates a practical application of WS2-type material system in ultra-energy efficient and effective cancer therapy.
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Hegedüs, Laszlo, Andrea Frasoldati, Roberto Negro, and Enrico Papini. "European Thyroid Association Survey on Use of Minimally Invasive Techniques for Thyroid Nodules." European Thyroid Journal 9, no. 4 (2020): 194–204. http://dx.doi.org/10.1159/000506513.
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Objective: Image-guided interventional ultrasound (US) techniques represent diagnostic and therapeutic tools for non-surgical management of thyroid nodular disease. We sought to investigate the attitude of European Thyroid Association (ETA) members towards the use of minimally invasive techniques (MIT) in diagnosis/therapy of symptomatic nodular goitre. Methods: ETA members were invited to participate in an online survey investigating the use of MIT in benign and malignant thyroid nodular disease. Of 865 invited members, 221 (25.5%) completed the survey. The respondents were from 40 countries; 139 (74.7%) were from European countries. Results: Respondents personally performed thyroid US (91.6%), Fine needle aspiration (FNA; 75.3%), ethanol ablation (EA; 22.1%), core needle biopsy (CNB; 11%) and thermal treatments (4.8%). When skills and/or technology were unavailable, only 13.4% referred patients “often” or “always” to other centres with specific expertise in this field. Surgery was the preferred first option in patients with recurrent cysts, 4.0 cm benign nodules, local (radioiodine-avid or non-avid) lymph node metastases, or papillary cancers <1.0 cm. For autonomously functioning nodules radioactive iodine treatment was the preferred choice, followed by surgery. Thermal ablation (TA) was the preferred option only for a 4 cm benign nodule in old patients with comorbidities. Conclusions: US, US-guided FNA and surgery were available to nearly all respondents, while MIT was not. CNB and EA were employed only by about 1/3 of the respondents and TA procedures were available and personally performed only by a minority. For most thyroid lesions, surgery was the preferred option versus thermal therapies. The ETA needs to develop guidelines and establish teaching to overcome geographic inequality and promote the use of MIT as a valid therapy option in appropriate cases.
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Ashikbayeva, Zhannat, Arman Aitkulov, Alexey Wolf, Alexander Dostovalov, Aida Amantayeva, Aliya Kurbanova, Vassilis J. Inglezakis, and Daniele Tosi. "Investigation of Thermal Effects of Radiofrequency Ablation Mediated with Iron Oxide Nanoparticles Dispersed in Agarose and Chitosan Solvents." Applied Sciences 11, no. 5 (March 9, 2021): 2437. http://dx.doi.org/10.3390/app11052437.
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Thermal ablation (TA) is known as an alternative therapy to surgery to treat tumors. However, TA-based therapy requires advanced approaches in order to prevent causing damage to healthy tissue around the tumor and selectively target the desired area. Nanoparticles are considered as a promising tool in biomedicine to fulfill these requirements. This study was carried out in order to analyze the effect of iron oxide nanoparticles on the temperature increment during radiofrequency ablation therapy of porcine liver. In addition, this research aimed to experimentally evaluate the impact of two solvents such as agarose and chitosan on the temperature change, when magnetic nanoparticles were dispersed in them. The iron oxide nanoparticles were synthesized by the solvothermal method demonstrating the magnetic properties by acting to the external magnetic field. To increase the local heat superparamagnetic nanoparticles (iron oxide magnetic nanoparticle (IONPs)) of the average size of 20 nm in size and the concentrations from 1 to 10 mg/mL of MNPs with a step size of 1 mg/mL were tested in 10 replicates for each concentration and solvent. Moreover, the temperature changes for dry liver, and 0 mg/mL concentration was checked for calibration and reference purposes. As a sensing system, advanced 16-FBG optical fiber sensors connected to an interrogator were employed allowing the temperature change to be monitored accurately in real time. A maximum temperature of about 142 °C was recorded by a 5 mg/mL concentration of iron oxide nanoparticles dispersed in the agarose solvent.
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Hamel-Desnos, C., P. Desnos, F.-A. Allaert, and P. Kern. "Thermal ablation of saphenous veins is feasible and safe in patients older than 75 years: A prospective study (EVTA study)." Phlebology: The Journal of Venous Disease 30, no. 8 (June 18, 2014): 525–32. http://dx.doi.org/10.1177/0268355514540882.
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Objectives To investigate the tolerance and safety of thermal ablation (TA), consisting of radiofrequency or endovenous laser (EVLA) of saphenous veins (SV) in elderly (group 1 ≥75 years), compared with a control group (group 2 <75 years). Method An Observational multicenter-prospective study was conducted, under the aegis of the French and Swiss Societies of Phlebology (18 centers). Ninety patients were included in group 1, 617 in group 2 (mean age 80 years and 53 years; 69% women in both groups), representing 863 SV. Mean trunk diameters were similar in both groups (small SV: 6 mm; great SV: 7 mm). In group 1, comorbidities were more frequent, particularly cardiac insufficiency, diabetes, history of thrombosis, and CEAP clinical class was significantly higher. Results EVLA was used in 86% of cases. Settings used were similar in both groups for each technique. Only 6% of TA was performed in an operating room for group 1 (14% group 2). Tumescent local anaesthesia (TLA) alone was used in 91% of cases in group 1 (85% group 2). The mean pain score was only 1.6 for the procedure itself (VASP 0–10; 10 max.) and 1.4 for the 10 days following the procedure. Side effects were few, but rate of paraesthesia was higher when general anaesthesia was used (11.8%) compared with TLA alone (2.2%). At three months, 100% of SV was occluded in group 1 (99.5% group 2), with high satisfaction score (9.3/10). Conclusion TA is safe and effective in elderly; it should be performed strictly under TLA to minimize side effects.
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Castillo, Marlen Alejandra Alvarez, Luis Felipe Sãnchez Arriaga, and Antonio Segovia Palomo. "PSAT372 Percutaneous Polidocanol Injection as an Alternative Treatment Differentiated Thyroid Cancer Oligometastases." Journal of the Endocrine Society 6, Supplement_1 (November 1, 2022): A842—A843. http://dx.doi.org/10.1210/jendso/bvac150.1742.
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Abstract Introduction Differentiated thyroid cancer (DTC) presents central lymph node metastasis in 20-50% and lateral in 12-81% of patients and ipsilateral recurrence after lateral neck dissection occur in 8-26%. The treatment of choice is surgical reintervention with subsequent administration of radioiodine. Treatment with radioactive iodine together with surgical reintervention aimed at compartments dissection provides variable remission rates in some cases of only 30-50%. Surgical reintervention carries a greater risk of complications such as recurrent laryngeal nerve injury, secondary postoperative hypoparathyroidism and morbidity associated with fibrosis formation in the surgical bed. Due to the complications, minimal invasive techniques (MIT) have been described for the treatment of unresectable and/ or proliferative oligomestastases, such as percutaneous ethanol injection (PEI), radiofrequency ablation, microwave ablation and laser ablation. PEI is described for the ablation for thyroid cysts, thyroid and parathyroid adenomas and cervical lymph node metastases. It´s used in the treatment of lesions smaller than 10 mm2 and represents a berry picking type intervention. It requires multiple sessions and can cause pain due to extravasation, skin necrosis, laryngeal necrosis, and damage to the recurrent laryngeal nerve. PEI´s greatest limitation is the uneven and unpredictable ablation area. Guidelines don´t contemplate it as the first line of MIT, highlighting thermal ablation`s (TA) usefulness, however it´s mentioned to consider its selection according to resources availability. After stating the inconveniences with PEI and difficulties related to the TA availability, in our center we have used polidocanol as a safer and more effective alternative to ethanol. Percutaneous polidocanol injection (PPI) requires fewer sessions and lower dose, and its administration technique is like PEI. PPI is described only as an alternative treatment for PEI recurrent pure cysts. Objective Determine the efficacy of PPI for DTC oligometastasis treatment. Study Design: An experimental, prospective, comparative, and analytical study. Patients older than 18 years were selected, with oligometastasis due to DTC in whom ablation with polidocanol 3% was performed, considering therapeutic efficacy the disappearance of the treated node and reduction of thyroglobulin. Results 27 patients were studied, a total of 60 lymph nodes. 22 women and 5 men, age 47.0±14.2 years, all with papillary thyroid cancer and structural incomplete response, with a cumulative RAI dose of 50±176 mCi, Thyroglobulin without stimulation was 3.06±2.9 ng/dl. Number of sessions was 1 in 71.4%. Mean polidocanol 3% used was 1.9±1.28ml. Follow-up time was 7.8±4.9 months. Initial tumor volume 5.9±1.3 ml, tumor volume at follow-up 0.88± 0.21, (p=0.00), control thyroglobulin was 0.55±0.8.1 (p=0.10). Remission was modified in 52.4%, reduction in 42.9%, stability in 4.8% No patient documented progression. Conclusion Polidocanol is safe and effective so it should be considered for the treatment of oligometastasis in DTC, in selected cases when thermal ablation techniques are lacking. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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Dendy Case, Meaghan, Johannes Uhlig, Justin Blasberg, Daniel J. Boffa, Anne C. Chiang, Scott N. Gettinger, and Hyun S. Kim. "Benefit of combining local treatment and systemic therapy for stage IV NSCLC: Results from the National Cancer Database." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 8545. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.8545.
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8545 Background: To determine the potential benefit of combining local and systemic therapy in stage IV non-small cell lung cancer (NSCLC). Methods: Data from stage IV NSCLC patients receiving systemic therapy alone, surgical resection and systemic therapy, or external beam radiation therapy/thermal ablation (EBRT/TA) and systemic therapy were acquired from the 2010-2015 National Cancer Database (NCDB). EBRT and TA patients were combined to enhance the power of the study. Overall survival (OS) was evaluated via multivariable Cox proportional hazards models. Comparison was made between EBRT/TA and systemic therapy alone utilizing 1:1 propensity matching analysis. A multivariable logistic regression model was used to determine variables predictive of lung cancer treatment. Significant variables (p < 0.05) were used to calculate the propensity score, and patients receiving EBRT/TA and systemic therapy were 1:1 matched using a greedy (nearest-neighbor) approach. Results: 46,964 patients from the NCDB database fulfilled inclusion criteria (surgical resection n = 1,235; EBRT/TA n = 12,456; systemic therapy alone n = 33,273.) Treatment differed across patient demographics and disease characteristics. Surgical resection demonstrated superior OS compared to EBRT/TA and systemic therapy alone, even after multivariable adjustment (compared to systemic therapy alone HR = 0.54, 95% CI: 0.50-0.58, p < 0.001; compared to EBRT/TA HR = 0.56, 95% CI: 0.52-0.60, p < 0.001). EBRT/TA treatment demonstrated superior survival compared to systemic therapy alone after accounting for confounders via propensity score matching (HR = 0.95, 95% CI: 0.93-0.98, p = 0.002). Interaction analyses indicated heterogeneous effectiveness of EBRT/TA according to patient demographics and cancer factors: the survival benefit of EBRT/TA over systemic therapy alone was especially pronounced in stage IV squamous cell carcinoma patients with limited nodal and metastatic disease (HR = 0.78, 95% CI: 0.71-0.85, p < 0.001 compared to systemic therapy alone; OS rates at 1-year = 50.9% vs. 42.4%; 2-years = 26.6% vs. 19.8%; 3-years = 17.2% vs. 10.1%). Conclusions: Stage IV NSCLC patients who received EBRT/TA or surgical resection in addition to systemic therapy demonstrated prolonged survival. EBRT/TA in combination with systemic therapy should be preferred in selected patients that are ineligible surgical candidates.
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Uhlig, Annemarie, Johannes Uhlig, Lutz Trojan, and Hyun S. Kim. "Stereotactic radiotherapy for stage I renal cell carcinoma: Overall survival and treatment trends compared to thermal ablation and surgical resection." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e16111-e16111. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e16111.
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e16111 Background: Stereotactic radiotherapy (SRT) is a non-invasive treatment modality that is currently evaluated for use in renal cell cancer (RCC). We aimed to evaluate current utilization of SRT for stage I RCC and compare associated overall survival with thermal ablation (TA) and partial nephrectomy (PN). Methods: The 2004-2015 United States National Cancer Database was searched for histopathologically approved stage I RCC treated with PN, cryoablation (CRA), radiofrequency- or microwave-ablation (RFA/MWA) or SRT. Patients were propensity score matched to account for potential confounders. Overall survival (OS) was evaluated with Kaplan-Meier plots, log-rank tests and Cox proportional hazards models. Results: A total of 91,965 patients were included (SRT n = 174; PN n = 82,913; CRA n = 5,446; RFA/MWA n = 3,432).Stage I SRT patients tended to be older females with fewer comorbidities and treated at non-academic centers in New England states. After propensity score matching, a cohort of n = 660 patients was obtained with well-balanced distribution of confounders between the different treatment strategies. In the matched cohort, OS following SRT was inferior to PN and thermal ablation (PN vs. SRT HR = 0.33, 95% CI: 0.22-0.50, p < 0.001; CRA vs. SRT HR = 0.44, 95% CI: 0.30 – 0.66, p < 0.001; RFA/MWA vs. SRT HR = 0.53, 95% CI: 0.36-0.77, p < 0.001). OS following CRA was comparable to PN (HR = 1.35, 95% CI: 0.84-2.18, p = 0.216), while OS following RFA/MWA was inferior to PN (HR = 1.61, 95% CI: 1.01-2.56, p = 0.046). OS rates are summarized in table 1. Conclusions: Only a minority of RCC patients receive SRT. In stage I RCC, current renal SRT protocols yield lower overall survival compared to thermal ablation and resection, while CRA and PN show comparable outcomes. Based on the current body of evidence, SRT for RCC should be reserved for clinical trials or exceptional clinical circumstances.[Table: see text]
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Kimpel, Otilia, Barbara Altieri, Marta Laganà, Thomas J. Vogl, Hamzah Adwan, Tina Dusek, Vittoria Basile, et al. "The Value of Local Therapies in Advanced Adrenocortical Carcinoma." Cancers 16, no. 4 (February 7, 2024): 706. http://dx.doi.org/10.3390/cancers16040706.
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International guidelines recommend local therapies (LTs) such as local thermal ablation (LTA; radiofrequency, microwave, cryoablation), transarterial (chemo)embolisation (TA(C)E), and transarterial radioembolisation (TARE) as therapeutic options for advanced adrenocortical carcinoma (ACC). However, the evidence for these recommendations is scarce. We retrospectively analysed patients receiving LTs for advanced ACC. Time to progression of the treated lesion (tTTP) was the primary endpoint. The secondary endpoints were best objective response, overall progression-free survival, overall survival, adverse events, and the establishment of predictive factors by multivariate Cox analyses. A total of 132 tumoural lesions in 66 patients were treated with LTA (n = 84), TA(C)E (n = 40), and TARE (n = 8). Complete response was achieved in 27 lesions (20.5%; all of them achieved by LTA), partial response in 27 (20.5%), and stable disease in 38 (28.8%). For the LTA group, the median tTTP was not reached, whereas it was reached 8.3 months after TA(C)E and 8.2 months after TARE (p < 0.001). The median time interval from primary diagnosis to LT was >47 months. Fewer than four prior therapies and mitotane plasma levels of >14 mg/L positively influenced the tTTP. In summary, this is one of the largest studies on LTs in advanced ACC, and it demonstrates a very high local disease control rate. Thus, it clearly supports the guideline recommendations for LTs in these patients.
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Kumar, Abhishek, Joseph Kamel Salama, and Matthew J. Boyer. "Renal function and survival following treatment for cT1N0 renal cell carcinoma in a veteran population." Journal of Clinical Oncology 41, no. 6_suppl (February 20, 2023): 642. http://dx.doi.org/10.1200/jco.2023.41.6_suppl.642.
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642 Background: Radical nephrectomy (RN), nephron sparing surgery (NSS) and thermal ablation (TA) are associated with similar oncologic control for early-stage renal cell carcinoma (RCC). However, the potential protective role of nephron sparing treatments on renal function and its impact on non-cancer related mortality remains undetermined. Methods: We employed the national Veterans Affairs Corporate Data Warehouse (CDW) to identify patients diagnosed with cT1N0 RCC between 2000-2018. Laboratory and diagnosis data were used to calculate creatinine clearance and Charlson comorbidity score. Chronic kidney disease (CKD) was defined as creatinine clearance < 60 milliliters per minute. Kaplan-Meier analysis and multivariable Cox regression analysis were used to evaluate overall survival. Results: Overall, there were 8279 Veterans with cT1N0M0 renal cell carcinoma diagnosed between 2000-2018 who received either RN (2946, 36%), NSS (4846, 59%) or TA (487, 6%). Median follow up time was 8 years (90% CI 2-15 years). Patients receiving RN were older than those receiving NSS (median age 64.0 vs 62.6 years, p<0.01) but younger than those receiving TA (median age 67.9 years, p<0.01). Patients receiving RN and TA had more comorbidities than patients receiving NSS (mean Charlson scores 0.76 vs. 1.00 vs. 0.66, p<0.01. More patients among the RN group had CKD before RCC diagnosis than the NSS and TA groups (10% vs. 6% vs. 7%, p<0.01). Among the subset of patients without CKD before treatment, 17% of RN, 8% of NSS, and 11% of TA developed CKD at least 1 year after treatment, (p <0.01). Median OS was 11.5 years with RN, 14.2 years with NSS, and 10.3 years with TA. On multivariable analysis considering age, comorbidities, CKD, race, and year of treatment, compared to RN, NSS was associated with better OS (HR 0.75, p<0.01) with a trend to improved survival with TA (HR 0.88, p=0.08). Conclusions: NSS or TA are associated with less post-operative renal dysfunction than RN in patients treated for cT1N0 RCC in the VAHCS. NSS is associated with improved OS compared to RN. Further studies are warranted to assess the impact of renal dysfunction in this population in relation to oncologic and survival outcomes.
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Piret, Evelyne Marie, Beth A. Payne, Laurie W. Smith, Jessica Trawin, Jackson Orem, Gina Ogilvie, and Carolyn Nakisige. "Side effects and acceptability measures for thermal ablation as a treatment for cervical precancer in low-income and middle-income countries: a systematic review and meta-synthesis." Family Medicine and Community Health 10, no. 2 (May 2022): e001541. http://dx.doi.org/10.1136/fmch-2021-001541.
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ObjectiveUnderstanding the side effects and acceptability of thermal ablation (TA) is necessary before large-scale application in screen-and-treat programmes can be justified in low-income and middle-income countries (LMICs).DesignArticles were selected for inclusion by two independent reviewers. Risk of bias was assessed using the Downs and Black’s criteria. Summary data were extracted, and authors contacted for data when necessary. Proportions of interest and 95% CIs were estimated using a random effects model. Subgroup analysis was performed based on place of treatment and timing of post-treatment follow-up. Heterogeneity was estimated using the I2.Eligibility criteriaStudies that reported one or more side effects or patient acceptability measures after treatment of the cervix using TA in women living in LMICs who completed a cervical cancer screening test. Included articles were clinical trials or observational studies available in English and published before 18 December 2020.Information sourcesOvid MEDLINE, EMBASE, CINAHL, CAB Global Health and WHO Global Index Medicus were searched for this systematic review and meta-synthesis.ResultsA total of 1590 abstracts were screened, 84 full text papers reviewed and 15 papers selected for inclusion in the qualitative review, 10 for meta-synthesis (N=2039). Significant heterogeneity was found in screening tests used to identify women eligible for TA and in methods to ascertain side effects. The most commonly reported side effect during treatment was pain (70%, 95% CI 52% to 85%; I2=98.01%) (8 studies; n=1454). No women discontinued treatment due to pain. At treatment follow-up, common side effects included vaginal discharge (72%, 95% CI 18% to 100%; I2=99.55%) (5 studies; n=771) and bleeding (38%, 95% CI 15% to 64%; I2=98.14%) (4 studies; n=856). Satisfaction with treatment was high in 99% (95% CI 98% to 100%; I2=0.00%) of women (3 studies; n=679).ConclusionsTA results in a number of common side effects, though acceptability remains high among women treated in LMICs. Standardised side effect and acceptability reporting are needed as TA becomes more readily available.PROSPERO registration numberCRD42020197605.
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Psutka, Sarah P., Roman Gulati, Michael A. S. Jewett, Kamel Fadaak, Antonio Finelli, Todd Matthew Morgan, Phillip M. Pierorazio, et al. "A novel clinical decision aid to support personalized treatment selection for patients with CT1 renal cortical masses: Results from a multi-institutional competing risks analysis including performance status and comorbidity." Journal of Clinical Oncology 38, no. 6_suppl (February 20, 2020): 610. http://dx.doi.org/10.1200/jco.2020.38.6_suppl.610.
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610 Background: Personalized treatment for clinical T1 renal cortical masses (RCMs) should account for competing risks related to tumor and patient characteristics. Using a contemporary multi-institutional cohort, we developed treatment-specific prediction models for cancer-specific mortality (CSM), other-cause mortality (OCM), and 90-day complication rates for patients managed with surgery, thermal ablation (TA), and active surveillance (AS). Methods: Preoperative clinical and radiological features were collected for eligible patients aged 18-91 years treated at four academic centers from 2000-2016. Prediction models used competing risks regressions for CSM and OCM and logistic regressions for 90-day Clavien >3 complications, adjusting for tumor size as well as patient age, sex, ECOG performance status (PS), and Charlson comorbidity index (CCI). Predictions accounted for missing data using multiple imputation. Results: After excluding 25 patients with no follow-up, the cohort included 4995 patients treated with radical nephrectomy (RN, n=1270), partial nephrectomy (PN, n=2842), thermal ablation (n=479), or active surveillance (n=404). Median follow-up was 5.1 years (IQR 2.5-8.5). Predictions from the fitted model are shown in an online calculator ( https://rgulati.shinyapps.io/rcc-risk-calculator ). To illustrate the use of this calculator for a specific patient, a 70-year-old female with a 5.5 cm RCM, PS of 2, and CCI of 3 has a predicted 5-year CSM of 4-7% across treatments, 5-year OCM of 34-49%, and 90-day risk of Clavien ≥3 complications of 4%, 10%, and 6% for RN, PN, and TA respectively. Conclusions: Personalized treatment selection for cT1 RCM is challenging. We present a competing risk calculator that incorporates pretreatment features to quantify competing causes of mortality and treatment-associated complications. Pending validation, this tool may be used in clinical practice to provide patients with estimated individualized treatment-specific probabilities of competing causes of death and complication risks to facilitate shared decision-making.
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Blatteis, C. M., W. S. Hunter, J. M. Wright, R. A. Ahokas, J. Llanos-Q., and T. A. Mashburn Jr. "Thermoregulatory responses of guinea pigs with anteroventral third ventricle lesions." Canadian Journal of Physiology and Pharmacology 65, no. 6 (June 1, 1987): 1261–66. http://dx.doi.org/10.1139/y87-201.
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Guinea pigs with anteroventral third ventricle region (AV3V) lesions fail to develop fever and the associated rise in acute-phase plasma protein levels following systemic injections of lipopolysaccharide (LPS). Since endogenous pyrogen (EP) injected directly into the preoptic area of animals with AV3V lesions causes appropriate elevations in core temperature (Tco) and acute-phase plasma proteins levels, the blocked responses to LPS probably are not due to damage to the adjacent preoptic area. We proposed, therefore, that EP may pass from blood into brain in the AV3V, presumably through the organum vasculosum laminae terminalis. However, the possibility that a more generalized impairment due to damaged pathways within the AV3V could account for the observed effects was not examined. To investigate this possibility, guinea pigs were given AV3V lesions. Pending histological verification of the ablated sites, AV3V lesions were presumed to be placed correctly if the animals did not develop fever following LPS (Salmonella enteritidis, 2 μg/kg i.p., at ambient temperature (Ta) 22 °C); those failing to meet this criterion were designated as sham-operated. Two experiments were conducted. In the first, metabolic rates, Tco, and two skin temperatures (Tsk) were measured at Ta 12°, 22°, and 32 °C over an 8-month postlesion period during which failure to fever persisted; the data were collected during a 30-min period after thermal balance had been achieved at any given Ta. There were no differences in the variables measured between sham-operated and AV3V-lesioned animals at Ta 22 °C. At Ta 12° and 32 °C, the Tsk of both the sham-operated and the AV3V-lesioned guinea pigs were reduced and elevated, and metabolic rate increased and decreased, respectively. However, Tco at Ta 32 °C and metabolic rate at Ta 12° and 32 °C were significantly higher in the AV3V-lesioned than in the sham-operated animals. In the second experiment, only Tco was measured, but under more severe ambient conditions and over a briefer duration. Thus, 11 and 14 days postlesion, the animals were exposed to Ta 35.5 ± 1.8 °C (means ± SD) until their Tco stabilized between 40.5 and 41.5 °C, and to Ta 2.7 ± 1.5 °C for 2.5 h, respectively. In addition, as indices of the acute-phase plasma protein response, their plasma levels of copper (Cu) and N-acteylneuraminic acid (NANA) were assayed 28 h after the onset of these exposures. There were no significant differences in the Tco changes between sham-operated and AV3V-lesioned guinea pigs induced by each of these conditions. Plasma Cu and NANA levels also were not affected by the lesions or the environments. It would appear, therefore, that ablation of the AV3V causes enhanced metabolic responses to thermal stress; but since these changes lead to elevated rather than to depressed Tco and do not alter acute-phase plasma protein levels, they cannot account for the blocked febrile and acute-phase plasma protein responses to LPS.
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Caridi, F., L. Torrisi, D. Margarone, and A. Borrielli. "Investigations on low temperature laser-generated plasmas." Laser and Particle Beams 26, no. 2 (May 6, 2008): 265–71. http://dx.doi.org/10.1017/s0263034608000311.
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AbstractA nanosecond pulsed Nd-Yag laser, operating at an intensity of about 109 W/cm2, was employed to irradiate different metallic solid targets (Al, Cu, Ta, W, and Au) in vacuum. The measured ablation yield increases with the direct current (dc) electrical conductivity of the irradiated target. The produced plasma was characterized in terms of thermal and Coulomb interaction evaluating the ion temperature and the ion acceleration voltage developed in the non-equilibrium plasma core. The particles emission produced along the normal to the target surface was investigated measuring the neutral and the ion energy distributions and fitting the experimental data with the “Coulomb-Boltzmann-shifted” function. Results indicate that the mean energy of the distributions and the equivalent ion acceleration voltage of the non-equilibrium plasma increase with the free electron density of the irradiated element.
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Wang, Xuelin, and Lei Sheng. "Correlations between B-mode ultrasound image texture features and tissue temperatures in hyperthermia." PLOS ONE 17, no. 10 (October 6, 2022): e0266446. http://dx.doi.org/10.1371/journal.pone.0266446.
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Purpose The noninvasive monitoring of mild hyperthermia or thermal ablation is important to guarantee therapeutic safety and efficacy. The potential of ultrasound B-mode image texture features in monitoring temperature or coagulation zones studied in this article. Materials and methods The experiments carried out on eighteen in vitro porcine liver samples heated from 20°C to 60°C in the water bath. The ultrasound radiofrequency signal at different temperature collected to reconstruct B-mode ultrasound images. The texture features based on gray level histogram (GLH), gray level co-occurrence matrix (GLCM), and gray level-gradient co-occurrence matrix (GGCM) extracted, respectively. Accordingly, we analyze the correlations between these texture features and temperature based on the experiment results. Results The results showed that five texture feature parameters closely related to temperature, including mean gray scale of GLH, homogeneity of GLCM, hybrid entropy, inverse difference moment, and correlation of GGCM. Some of these feature parameters have correlation coefficients larger than 0.9 within the temperature range of 20°C to 60°C. Conclusions The above-mentioned five feature parameters expected to apply for noninvasive monitoring of MH or TA.
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Cassese, Gianluca, Ho-Seong Han, Jai Young Cho, Hae-Won Lee, Boram Lee, and Roberto Ivan Troisi. "Selecting the Best Approach for the Treatment of Multiple Non-Metastatic Hepatocellular Carcinoma." Cancers 14, no. 23 (December 5, 2022): 5997. http://dx.doi.org/10.3390/cancers14235997.
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According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the optimal strategy for patients with multiple HCC within the Milan Criteria is liver transplantation (LT). However, LT cannot be offered to all the patients due to organ shortages and long waiting lists, as well as because of the advanced disease carrying a high risk of poor outcomes. For early stages, liver resection (LR) or thermal ablation (TA) can be proposed, while trans-arterial chemoembolization (TACE) still remains the treatment of choice for intermediate stages (BCLC-B). Asian guidelines and the National Comprehensive Cancer Network suggest LR for resectable multinodular HCCs, even beyond Milan criteria. In this scenario, a growing body of evidence shows better outcomes after surgical resection when compared with TACE. Trans-arterial radioembolization (TARE) and stereotaxic body radiation therapy (SBRT) can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) specifically for patients with multiple HCC is still not clear. This review aims to summarize current knowledge about the best therapeutical strategy for multiple HCC while focusing on the role of minimally invasive surgery and on the most attractive future perspectives.
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Manga, Simon M., Yuanfan Ye, Kathleen L. Nulah, Florence Manjuh, Joel Fokom-Domgue, Isabel Scarinci, and Alan N. Tita. "Human Papillomavirus Types and Cervical Cancer Screening among Female Sex Workers in Cameroon." Cancers 16, no. 2 (January 5, 2024): 243. http://dx.doi.org/10.3390/cancers16020243.
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Background: Female sex workers (FSWs) are at high risk for sexually transmitted infections (STIs), including infection with human papillomavirus (HPV) and cervical cancer due to occupational exposure. The objective of this study was to estimate the prevalence of HPV, HPV types, and precancerous lesions of the cervix among FSWs in Cameroon. Material and Methods: In this cross-sectional study, FSWs in Cameroon aged 30 years and above were screened for cervical cancer using high-risk HPV testing and genotyping and visual inspection with acetic acid and Lugol’s iodine (VIA/VILI) enhanced using digital cervicography (DC) simultaneously. Those who were positive for VIA/VILI-DC were provided treatment with thermal ablation (TA) immediately for cryotherapy/TA-eligible lesions while lesions meeting the criteria for large loop excision of the transformation zone (LLETZ) were scheduled at an appropriate facility for the LLETZ procedure. HPV-positive FSWs without any visible lesion on VIA/VILI-DC were administered TA. Bivariate analyses were conducted to compare demographic and clinical characteristics. Crude and adjusted logistic regression models were computed for HPV infection status and treatment uptake as outcomes in separate models and their ORs and 95% confidence intervals (95% CI) were reported. Results: Among the 599 FSWs aged 30 years and older that were screened for HPV and VIA/VILI-DC, 62.1% (95% CI: (0.58–0.66)) were positive for one or more HPV types. HPV type 51 had the highest prevalence (14%), followed by types 53 (12.4%) and 52 (12.2%). Type 18 had the lowest prevalence of 2.8% followed by type 16 with 5.2%. In the multivariable model, HIV-positive FSWs were 1.65 times more likely to be infected with HPV compared to their HIV-negative counterparts (AOR: 1.65, CI: 1.11–2.45). A total of 9.9% of the 599 FSWs were positive for VIA/VILI-DC. Conclusion: The prevalence of HPV infection among FSWs in Cameroon is higher than the worldwide pooled FSW prevalence. HPV types 51 and 53 were the most prevalent, while types 18 and 16 were the least prevalent. HIV status was the only variable that was significantly associated with infection with HPV.
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Guimarães, Frederico Sousa, Rongqing Zhang, Bernd Lehmann, Alexandre Raphael Cabral, and Francisco Javier Rios. "CASSITERITE U-Pb GEOCHRONOLOGY OF THE SANTA BÁRBARA TIN DISTRICT, RONDÔNIA TIN PROVINCE, BRAZIL." Economic Geology 117, no. 3 (May 1, 2022): 719–29. http://dx.doi.org/10.5382/econgeo.4876.
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Abstract The Mesoproterozoic Rondônia Tin Province of the Amazonian craton records a protracted history of about 600 m.y. of successive rare-metal granite intrusions and hosts the youngest known event of tin-granite emplacement of the craton—a rare-metal granite suite known as the Younger Granites of Rondônia intrusive suite. The ~1 Ga suite is currently interpreted as intracratonic magmatism resulting from a Grenvillian-age orogeny during the assembly of Rodinia. The Santa Bárbara massif is a tin-granite system of the Younger Granites of Rondônia intrusive suite that hosts Sn-Nb-Ta-W–bearing endogreisen and stockwork, as well as important placer deposits. The Santa Bárbara mine produces about 800 to 1,000 t Sn/year from placers and weathered greisen and represents about 20% of the tin mine output of the Rondônia Tin Province. Here, we report laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) cassiterite U-Pb ages of 989 ± 3 and 987 ± 6 Ma for the Santa Bárbara greisen and the cassiterite-quartz vein system, respectively. Alluvial cassiterite from placer mining has a U-Pb age of 995 ± 4 Ma, which is, within uncertainty, indistinguishable from those of primary cassiterite. These ages agree well with the previously published zircon and monazite U-Pb ages for the Santa Bárbara granite (978 ± 13 and 989 ± 13 Ma), which indicate a coeval relationship between hydrothermal tin mineralization and granite magmatism. The previously suggested 20- to 30-m.y. time span between granite magmatism and hydrothermal tin mineralization, which was based on mica K-Ar and Ar-Ar age data, is likely due to younger thermal disturbance of the isotopic systems.
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Sandbergen, Laura, Muhammad Imran Omar, Lavin Othman, Faridi van Etten-Jamaludin, Mustafa Soytas, Jean J. de la Rosette, and M. Pilar Laguna. "Systematic Review of Comparative Patient Reported Outcomes and Health-Related Quality of Life After Management of Localized Renal Masses or Renal Cell Carcinomas." Société Internationale d’Urologie Journal 3, no. 4 (July 15, 2022): 209–39. http://dx.doi.org/10.48083/qode9040.
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Objective: To perform a systematic review assessing the impact of the different management options on health-related quality of life (HRQoL) of patients with localized renal masses or renal cell carcinomas (LRM/LRCC). Materials and Methods: Searches covering PubMed, Embase (Ovid), CENTRAL, PsycINFO (Ovid), CINAHL (EBSCO), and Cochrane Central Register of Controlled Trials (CENTRAL) databases was conducted for papers published up to 25 April 2021. Methods as per Cochrane Handbook were followed. “Modality” of treatment included radical nephrectomy (RN), nephron-sparing surgery (NSS), thermal ablation (TA), and active surveillance (AS). “Approach” was categorized as open incision and minimally invasive surgery (MIS). Risk of bias was assessed by ROBINS-I and Cochrane RoB 2 for observational studies and randomized controlled trials, respectively and certainty of the evidence by GRADE. Results: Sixteen observational studies and 1 randomized controlled trial (2.370 patients) met inclusion criteria. Fifteen different patient reported outcome measures (PROMs) were identified. Heterogeneity prevented quantitative analysis. Generic HRQoL decreases after RN and NSS, recovers within 6 to 12 months, and mostly overlaps with baseline values, irrespective of modality. Cancer-specific HRQoL improve faster after open-NSS than open-RN. The detrimental effect of RN may persist long-term in cross-evaluations. QoL scales significantly decrease after open surgery and MIS during the first weeks but improve faster after MIS. They are similar for both approaches at 1-year. Long-term cancer-specific QoL is similar for MIS and open procedures. Fear of recurrence is lower in older patients and affected by neither modality nor approach. Conclusions: Low quality evidence supports the use of MIS over the open approach when HRQoL is considered in the management of LRMs/LRCCs; data regarding the effect of the treatment modality of the LRM/LRCC show contradictory outcomes.
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CHERVYAKOVSKIY, Vasiliy Stanislavovich, Evgeniy Aleksandrovich SLOBODCHIKOV, Mariya Vladimirovna CHERVYAKOVSKAYA, Nadezhda Nikolaevna FARRAKHOVA, and Elena Nikolaevna VOLCHEK. "Geochemical characteristic of rocks and isotope dating of zircon from the andesite dyke of the rudyanskaya sequence (D2 rd) of the Middle Urals Eastern zone." NEWS of the Ural State Mining University, no. 4 (December 15, 2023): 69–80. http://dx.doi.org/10.21440/2307-2091-2023-4-69-80.
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Relevance. In the basin of the r. Pishma subvolcanic formations, localized in the fields of spreading of the Middle Devonian Rudyanskaya sequence, are presented by different on composition small bodies, sills and dykes, forming with volcanogenic rocks of the Rudyanskaya sequence a basalt-andesite-rhyolite complex, the formation of which is associated with volcanic activity, that took place in Middle Devonian in the environments close to the modern island arcs. Their isotope dating and geochemical characteristic are rather relevant for specification of the composition, volume and paleogeodynamic environment of the vulcanite formation. In the paper new data are presented on geochemistry of andesites of the dyke from the Diviy Kamen rock, considered as part of the Rudyanskaya sequence, as well as the age of zircon from them. Methods. Chemical analyses of vulcanites have been performed in the Centre of collective usage “Geoanalyst” of the Institute of Geology and Geochemistry of the UB of RAS (Ekaterinburg) by X-ray fluorescent method and ICP–MS method. Zircons were studied with scanning electron microscope JSM-6390L of the Jeol firm and with electrone-probe microanalyser Cameca SX100. The data on the U and Pb isotopes, as well as on elements-impurities in zircon grains were obtained by mass-spectrometry method with inductively coupled plasma with laser ablation (LA–ICP–MS) at the quadrupole ISP–MS NexION 300S with the attachment for laser ablation LA NWR 213. Purpose of researches. Getting new data on geochemical composition and age of the andesites of dyke in the section along the r. Pishma. Results. The andesite dyke intersects medium clastic unstratified tuffs and dipply occurring fragment of the lava flow of porphyry dacite. Andesites present themselves porphyry rocks with 20–30% of plagioclase phenocrysts. At the normalized many-component diagram the Ta–Nb minimum is displayed. For zircon grains are characteristic differentiated spectra, demonstrating the growth of compositions from light to heavy REE, positive Ce and negative Eu anomalies, typical of the zircon of magmatic genesis. For the first time geochronological study of zircons from andesites has been maded by method of LA–ICP–MS. 4 age groups of zircons, Ma: 390–387, 369–362, 337–345, 327–329 were revealed. Conclusions. The data obtained testify that andesites were formed under suprasubduction environments, and magmatic stage of rock formation corresponds to the upper Devonian varieties of zircons. Early Carboniferous datings can be associated with the thermal impact caused by the intrusion of a later dolerite dyke.
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Weber, Callie, Katy Graef, Marc Hagenimana, Elisabeth Mwiza, Justine Kuteesa, Therese Uwamariya, Cassandra Broadwin, Heather Davidson, and William Rutagengwa. "Training for Primary Care Providers: Case Study From Rwandan Cervical Cancer Educate, Screen, and Treat (EST) Program." JCO Global Oncology 8, Supplement_1 (May 2022): 28. http://dx.doi.org/10.1200/go.22.34000.
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PURPOSE Cervical cancer screening, triage, and treatment programs are expanding across Rwanda's districts. Screening for cervical cancer is needed at the local level, but health center nurses and midwives in the Bugesera district have not received formalized training. METHODS The RBC-BVGH Cervical Cancer Educate, Screen, and Treat (EST) Program introduced services in Bugesera district for the first time. In 4-week EST campaign (September 6-October 1], 4,013 women were screened for HPV, 2,056 for VIA, 282 received same-day TA, nine were treated with LEEP at Nyamata DH, and 26 were referred to a Kigali tertiary hospital (Rwanda Military Hospital; RMH) with suspected cervical cancer. Prior to launch of services, providers from 16 health facilities received training (52 nurses/midwives, 17 data managers, 15 lab technicians). The quality and sustainability impact of the training was determined through a pre- and post- course theory assessment (N = 52) and a post-EST survey (N = 15). On the post-EST survey, providers self-ranked their skill confidence across each service before vs. after the campaign on 5-point Likert scale (1 = low and 5 = high). RESULTS Following the training program, participants' cervical and breast cancer assessment scores increased by an average of 949% and 405% respectively ( P < .001). The participants' self-reported confidence in the following techniques also increased: HPV sample collection (206%), visual inspection with acetic acid (187%), thermal ablation (205%), breast examination (54%), and referral of cervical cancer cases (57%). One hundred percent of participants indicated their intent to apply the program learnings in their daily practice yet noted that a refresher training within 3-9 months would be valued. CONCLUSION The above results demonstrate that RBC's training programs effectively provide strong theoretical and hands-on training for primary providers. Continued mentorship and refresher trainings are critical for sustainability of high-quality cervical and breast cancer screening, triage, and treatment services in Rwanda.
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Gouesse, Rita-Josiane, Mathurin Dodo, Jean-Claude Kouassi, Simon Boni, Joel Setoh, Ida Zadi, Meg Bertram, et al. "Abstract 47: Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment." Cancer Epidemiology, Biomarkers & Prevention 32, no. 6_Supplement (June 1, 2023): 47. http://dx.doi.org/10.1158/1538-7755.asgcr23-abstract-47.
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Abstract Purpose: Cervical cancer is both preventable and curable, yet, in Côte d’Ivoire, it is the second deadliest cancer affecting women. The Unitaid-funded SUCCESS project is supporting the Ivorian Ministry of Health (MOH) to eliminate cervical cancer through a screen-and-treat strategy with primary Human papillomavirus (HPV) DNA testing for secondary prevention. However, little is known about the challenges and opportunities of HPV-testing in Côte d’Ivoire. Here, we aimed to analyze the time elapsed between testing and results reception to highlight critical implementation steps. Methods: We analyzed preliminary cohort study data of women aged 25-49 years who underwent HPV-testing at 10 health facilities, April-November 2022. After phone-call notification of result availability, results were delivered in-person by the healthcare provider, along with counseling. Visual acetic acid inspection (VIA) followed for HPV-positive, and treatment (same-day thermal ablation (TA) or loop electrical excision procedure) for VIA-positive women. Participants were followed through each step to document the test-to-treatment process and compute the expected testing-to-treatment time. Logistic regression was used to explore factors associated with VIA completion after an HPV-positive test. Results: 1868 women (median age 37 [Inter Quartile Range: 33-41]) years were enrolled by November 2022, of whom 1712 (91.6%) preferred self-sampling. Overall, 948 (50.7%) results were available at health facility level; 240 (25.3%) within 30 days, 322 (34%) within 30-60 days and 386 (40.7%) after 60 days. There were 189 (19.9%) HPV-positive women of whom 56 (30%) underwent VIA. The average duration from testing to TA was 70.1±42.1 days, with 61.4±41.8 days from sample collection to results reception, and 27.5±29.8 days from reception to VIA. Women encountering a duration of 30-60 (OR 0.33, 95%CI: [0.16-0.68]) or more than 60 (OR 0.52, 95%CI: [0.29-0.94]) days between testing and result reception were less likely to complete VIA compared with those with less than 30 days. Conclusion: Our findings suggest that test-to-treatment completion is likely to be affected by insufficiencies in sample/result processing and return to women. Hopefully, the upcoming deployment of 07 testing platforms under the MoH’s initiative to expand laboratory coverage along with advanced strategies to improve client follow-up and treatment, will help overcome these challenges. Citation Format: Rita-Josiane Gouesse, Mathurin Dodo, Jean-Claude Kouassi, Simon Boni, Joel Setoh, Ida Zadi, Meg Bertram, Tracey Shissler, Lisa Huang, Nemdia Daceney, Innocent Adoubi, Cindy Gauvreau, Mark Kabue. Human Papillomavirus (HPV) Cervical Cancer Screening and Secondary Prevention in Côte d’Ivoire: Time From Testing to Treatment [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 47.
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Crocetti, Laura, Paola Scalise, Elena Bozzi, Gianvito Candita, and Roberto Cioni. "Thermal ablation of hepatocellular carcinoma." Journal of Medical Imaging and Radiation Oncology, December 14, 2023. http://dx.doi.org/10.1111/1754-9485.13613.
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SummaryPercutaneous treatment of hepatocellular carcinoma (HCC) by means of thermal ablation (TA) has been introduced in clinical guidelines as a potentially curative treatment for the early stages of the disease since the early 2000s. Due to its safety profile and cost‐effectiveness, TA can be offered as a first‐line treatment for patients with HCC smaller than 3 cm. Thermal ablative techniques are in fact widely available at many centres worldwide and include radiofrequency (RF) and microwave (MW) ablation, with the latter increasingly applied in clinical practice in the last decade. Pre‐clinical studies highlighted, as potential advantages of MW‐based ablation, the ability to achieve higher temperatures (>100°C) and larger ablation zones in shorter times, with less susceptibility to blood flow‐induced heat sink effects. Despite these advantages, there is no evidence of superior overall survival in patients treated with MW as compared to those treated with RF ablation. Local control has been proven to be superior to MW ablation with a similar complication rate. It is expected that further improvement of TA results in the treatment of HCC will result from the refinement of guidance and monitoring tools and the careful assessment of ablation margins. Thermal ablative treatments may also be performed on nodules larger than 3 cm by applying multiple devices or combining percutaneous and intra‐arterial approaches. The role of novel immunotherapy regimens in combination with ablation is also currently under evaluation in clinical trials, with several potential benefits. In this review, indications, technical principles, results, and future prospects of TA for the treatment of HCC will be examined.
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Ali, Muhammad, Young Suk Kwon, Kendrick Koo, Anna Bruynzeel, David Pryor, Daniel G. Schep, Michael Huo, et al. "Salvage stereotactic ablative body radiotherapy after thermal ablation of primary kidney cancer." BJU International, August 26, 2024. http://dx.doi.org/10.1111/bju.16520.
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ObjectiveTo evaluate the effectiveness and safety of salvage stereotactic ablative body radiotherapy (SABR) for recurrent renal cell carcinoma (RCC) after thermal ablation (TA).Materials and MethodsThis study was a multi‐institutional retrospective analysis of patients with recurrent RCC following TA who received SABR between 2016 and 2020. The primary study outcome was freedom from local failure, evaluated radiographically based on Response Evaluation Criteria in Solid Tumours (RECIST) v1.1. Distant failure, cancer‐specific survival (CSS), overall survival (OS), treatment‐related toxicity and renal function changes following SABR were the secondary outcomes. The Kaplan–Meier method was used to estimate freedom from local and distant failure, CSS and OS.ResultsSeventeen patients with 18 biopsy‐confirmed RCCs were included, with a median (interquartile range [IQR]) age at time of SABR of 75.2 (72.6–68.7) years, a median (IQR) tumour size of 3.5 (1.9–4.1) cm and follow‐up (reverse Kaplan–Meier method) of 3.36 (95% confidence interval [CI] 1.6–4.1) years. Six of the 17 patients had a solitary kidney. Five patients had failed repeat TA prior to SABR. The median (IQR) time from TA procedure to SABR was 3.03 (1.5–5.1) years. No patient experienced local progression, with a local control rate of 100%. Four patients, two with baseline metastatic disease, experienced distant progression. The distant progression‐free survival, CSS and OS at 3 years were 72.1% (95% CI 51.9%–100%), 92.3% (95% CI 78.9%–100%) and 82.1% (95% CI 62.1%–100%), respectively. The median (IQR) glomerular filtration rate before SABR was 58 (40–71) mL/min, and at last follow‐up, it was 48 (33–57) mL/min. No patient experienced grade 3+ toxicity or went on to develop end‐stage renal disease.ConclusionThe results showed that SABR appears to be an effective and safe salvage strategy in patients with recurrent RCC following TA.