Статті в журналах: "Conformal ablation"

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Wang, Hongying, Shiqing Zhao, Jincheng Zou, and Aili Zhang. "A New Conformal Penetrating Heating Strategy for Atherosclerotic Plaque." Bioengineering 10, no. 2 (January 26, 2023): 162. http://dx.doi.org/10.3390/bioengineering10020162.

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(1) Background: A combination of radiofrequency (RF) volumetric heating and convection cooling has been proposed to realize plaque ablation while protecting the endothelial layer. However, the depth of the plaque and the thickness of the endothelial layer vary in different atherosclerotic lesions. Current techniques cannot be used to achieve penetrating heating for atherosclerosis with two targets (the specified protection depth and the ablation depth). (2) Methods: A tissue-mimicking phantom heating experiment simulating atherosclerotic plaque ablation was conducted to investigate the effects of the control parameters, the target temperature (Ttarget), the cooling water temperature (Tf), and the cooling water velocity (Vf). To further quantitatively analyze and evaluate the ablation depth and the protection depth of the control parameters, a three-dimensional model was established. In addition, a conformal penetrating heating strategy was proposed based on the numerical results. (3) Results: It was found that Ttarget and Tf were factors that regulated the ablation results, and the temperatures of the plaques varied linearly with Ttarget or Tf. The simulation results showed that the ablation depth increased with the Ttarget while the protection depth decreased correspondently. This relationship reversed with the Tf. When the two parameters Ttarget and Tf were controlled together, the ablation depth was 0.47 mm–1.43 mm and the protection depth was 0 mm–0.26 mm within 2 minutes of heating. (4) Conclusions: With the proposed control algorithm, the requirements of both the ablation depth and the endothelium protection depth can be met for most plaques through the simultaneous control of Ttarget and Tf.

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Sciubba, Daniel M., E. Clif Burdette, Jennifer J. Cheng, William A. Pennant, Joseph C. Noggle, Rory J. Petteys, Christopher Alix, et al. "Percutaneous computed tomography fluoroscopy–guided conformal ultrasonic ablation of vertebral tumors in a rabbit tumor model." Journal of Neurosurgery: Spine 13, no. 6 (December 2010): 733–79. http://dx.doi.org/10.3171/2010.5.spine09266.

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Object Radiofrequency ablation (RFA) has proven to be effective for treatment of malignant and benign tumors in numerous anatomical sites outside the spine. The major challenge of using RFA for spinal tumors is difficulty protecting the spinal cord and nerves from damage. However, conforming ultrasound energy to match the exact anatomy of the tumor may provide successful ablation in such sensitive locations. In a rabbit model of vertebral body tumor, the authors have successfully ablated tumors using an acoustic ablator placed percutaneously via computed tomography fluoroscopic (CTF) guidance. Methods Using CTF guidance, 12 adult male New Zealand White rabbits were injected with VX2 carcinoma cells in the lowest lumbar vertebral body. At 21 days, a bone biopsy needle was placed into the geographical center of the lesion, down which an acoustic ablator was inserted. Three multisensor thermocouple arrays were placed around the lesion to provide measurement of tissue temperature during ablation, at thermal doses ranging from 100 to 1,000,000 TEM (thermal equivalent minutes at 43°C), and tumor volumes were given a tumoricidal dose of acoustic energy. Animals were monitored for 24 hours and then sacrificed. Pathological specimens were obtained to determine the extent of tumor death and surrounding tissue damage. Measured temperature distributions were used to reconstruct volumetric doses of energy delivered to tumor tissue, and such data were correlated with pathological findings. Results All rabbits were successfully implanted with VX2 cells, leading to a grossly apparent spinal and paraspinal tissue mass. The CTF guidance provided accurate placement of the acoustic ablator in all tumors, as corroborated through gross and microscopic histology. Significant tumor death was noted in all specimens without collateral damage to nearby nerve tissue. Tissue destruction just beyond the margin of the tumor was noted in some but not all specimens. No neurological deficits occurred in response to ablation. Reconstruction of measured temperature data allowed accurate assessment of volumetric dose delivered to tissues. Conclusions Using a rabbit intravertebral tumor model, the authors have successfully delivered tumoricidal doses of acoustic energy via a therapeutic ultrasound ablation probe placed percutaneously with CTF guidance. The authors have thus established the first technical and preclinical feasibility study of controlled ultrasound ablation of spinal tumors in vivo.

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Milos, Frank S., Matthew J. Gasch, and Dinesh K. Prabhu. "Conformal Phenolic Impregnated Carbon Ablator Arcjet Testing, Ablation, and Thermal Response." Journal of Spacecraft and Rockets 52, no. 3 (May 2015): 804–12. http://dx.doi.org/10.2514/1.a33216.

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MacDonell, Jacquelyn, Niravkumar Patel, Sebastian Rubino, Goutam Ghoshal, Gregory Fischer, E. Clif Burdette, Roy Hwang, and Julie G. Pilitsis. "Magnetic resonance–guided interstitial high-intensity focused ultrasound for brain tumor ablation." Neurosurgical Focus 44, no. 2 (February 2018): E11. http://dx.doi.org/10.3171/2017.11.focus17613.

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Currently, treatment of brain tumors is limited to resection, chemotherapy, and radiotherapy. Thermal ablation has been recently explored. High-intensity focused ultrasound (HIFU) is being explored as an alternative. Specifically, the authors propose delivering HIFU internally to the tumor with an MRI-guided robotic assistant (MRgRA). The advantage of the authors’ interstitial device over external MRI-guided HIFU (MRgHIFU) is that it allows for conformal, precise ablation and concurrent tissue sampling. The authors describe their workflow for MRgRA HIFU delivery.

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Peng, Zhen-Wei, Hui-Hong Liang, Min-Shan Chen, Yao-Jun Zhang, Ya-Qi Zhang, and Wan Y. Lau. "Conformal radiofrequency ablation of hepatocellular carcinoma with a multi-pin bipolar system." Journal of Surgical Oncology 103, no. 1 (October 28, 2010): 69–74. http://dx.doi.org/10.1002/jso.21742.

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Sharma, Sunil, Ganesh Narayanasamy, Beata Przybyla, Jessica Webber, Marjan Boerma, Richard Clarkson, Eduardo G. Moros, Peter M. Corry, and Robert J. Griffin. "Advanced Small Animal Conformal Radiation Therapy Device." Technology in Cancer Research & Treatment 16, no. 1 (July 8, 2016): 45–56. http://dx.doi.org/10.1177/1533034615626011.

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We have developed a small animal conformal radiation therapy device that provides a degree of geometrical/anatomical targeting comparable to what is achievable in a commercial animal irradiator. small animal conformal radiation therapy device is capable of producing precise and accurate conformal delivery of radiation to target as well as for imaging small animals. The small animal conformal radiation therapy device uses an X-ray tube, a robotic animal position system, and a digital imager. The system is in a steel enclosure with adequate lead shielding following National Council on Radiation Protection and Measurements 49 guidelines and verified with Geiger-Mueller survey meter. The X-ray source is calibrated following AAPM TG-61 specifications and mounted at 101.6 cm from the floor, which is a primary barrier. The X-ray tube is mounted on a custom-made “gantry” and has a special collimating assembly system that allows field size between 0.5 mm and 20 cm at isocenter. Three-dimensional imaging can be performed to aid target localization using the same X-ray source at custom settings and an in-house reconstruction software. The small animal conformal radiation therapy device thus provides an excellent integrated system to promote translational research in radiation oncology in an academic laboratory. The purpose of this article is to review shielding and dosimetric measurement and highlight a few successful studies that have been performed to date with our system. In addition, an example of new data from an in vivo rat model of breast cancer is presented in which spatially fractionated radiation alone and in combination with thermal ablation was applied and the therapeutic benefit examined.

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Chami, Perla, William Jarnagin, Ghassan K. Abou-Alfa, James Harding, Neal Kim, Haibo Lin, Maria El Homsi, Christopher Crane, and Carla Hajj. "Non-Surgical Locoregional Therapies Alone or in Combination with Systemic Therapy in Patients with Hepatocellular Carcinoma." Cancers 15, no. 6 (March 14, 2023): 1748. http://dx.doi.org/10.3390/cancers15061748.

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Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the third-leading cause of cancer-related deaths worldwide. Curative intent treatment options for patients with HCC include liver transplantation, resection and ablation of small lesions. Other potentially curative therapies include cryoablation, microwave ablation and percutaneous alcohol injection. For locally advanced disease, different arterially directed therapies including transarterial chemoembolization and selective internal radiation therapy, plus external beam radiation including three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic body radiation therapy and proton beam therapy, are available or studied. Systemic therapies based on checkpoint inhibitors and tyrosine kinase inhibitors are available for the management of metastatic HCC and sometimes for locally advanced disease. Combinations of locoregional therapies with systemic drugs are currently the subject of several clinical trials.

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Kouloulias, Vassilis, Eftychia Mosa, John Georgakopoulos, Kalliopi Platoni, Ilias Brountzos, Anna Zygogianni, Christos Antypas, et al. "Three-Dimensional Conformal Radiotherapy for Hepatocellular Carcinoma in Patients Unfit for Resection, Ablation, or Chemotherapy: A Retrospective Study." Scientific World Journal 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/780141.

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Purpose. The purpose is to evaluate the feasibility, efficacy, and the toxicity of three-dimensional conformal radiotherapy (3DCRT) in patients with advanced hepatocelluar carcinoma (HCC) and inferior vena cava tumor thrombosis (IVCTT).Methods. Between 2007 and 2012, in a retrospective way, 9 patients (median age 69 years) with advanced HCC and IVCTT unfit for surgery, radiofrequency ablation, embolization, or chemotherapy were treated with three-dimensional conformal radiotherapy (3DCRT). The radiotherapy volume included both primary tumor and IVTT. The radiotherapy schedule was 50–52 Gy in 2 Gy fractions. Overall survival (OS), response to radiotherapy, visual analogue scale (VAS), and toxicity were assessed.Results. All patients demonstrated a response rate up to 60%. During radiotherapy, 3 patients experienced grade 1 nausea/vomit toxicity. All patients demonstrated an elevation of the liver enzymes (3 patients with grade 1 and 6 patients with grade 2). The mean VAS-score was decreased from 6.11 to 3.11, while the median overall survival was 24 months.Conclusion. 3DCRT achieves a very high local control rate and is suitable for patients with HCC and IVTT, while the documented radiation induced toxicity is moderate. It can be recommended for palliation in patients unable to undergo curative therapies.

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Chockalingam, Arun, Menelaos Konstantinidis, Brandon Koo, John Timothy Moon, Andrew Tran, Sahar Nourouzpour, Emily Lawson, et al. "Surgical resection, radiotherapy and percutaneous thermal ablation for treatment of stage 1 non-small cell lung cancer: protocol for a systematic review and network meta-analysis." BMJ Open 12, no. 6 (June 2022): e057638. http://dx.doi.org/10.1136/bmjopen-2021-057638.

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IntroductionNon-small cell lung cancer (NSCLC) makes up the majority of lung cancer cases. Currently, surgical resection is the gold standard of treatment. However, as patients are becoming medically more complex presenting with advanced disease, minimally invasive image-guided percutaneous ablations are gaining popularity. Therefore, comparison of surgical, ablative and second-line external beam therapies will help clinicians, as management of NSCLC changes. We will conduct a meta-analysis, reviewing literature investigating these therapies in adult patients diagnosed with stage 1 NSCLC, with neither hilar nor mediastinal nodal involvement, confirmed either through cytology or histology regardless of type.Methods and analysisWe will search electronic databases (MEDLINE, Embase, Web of Science, Scopus, ClinicalTrials.gov, Cochrane) from their inception to January 2021 to identify randomised controlled trials (RCTs), cluster RCTs and cohort studies comparing survival and clinical outcomes between any two interventions (lobectomy, wedge resection, video-assisted thoracoscopic surgery/robot-assisted thoracoscopic surgery, radiofrequency ablation, microwave ablation, cryoablation and consolidated radiation therapies (external beam radiation therapy, stereotactic body radiation therapy, and 3D conformal radiation therapy). The primary outcomes will include cancer-specific survival, lung disease-free survival, locoregional recurrence, death, toxicity and non-target organ injury. We will also search published and unpublished studies in trial registries and will review references of included studies for possible inclusion. Risk of bias will be assessed using tools developed by the Cochrane collaboration. Two reviewers will independently assess the eligibility of studies and conduct the corresponding risk of bias assessments. For each outcome, given enough studies, we will conduct a network meta-analysis. Finally, we will use the Confidence in Network Meta-Analysis tool to assess quality of the evidence for each of the primary outcomes.Ethics and disseminationWe aim to share our findings through high-impact peer review. As interventional techniques become more popular, it will be important for providers in multidisciplinary teams caring for these patients to receive continuing medical education related to these interventions. Data will be made available to readers.PROSPERO registration numberCRD42021276629.

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Kreidieh, Malek, Youssef H. Zeidan, and Ali Shamseddine. "The Combination of Stereotactic Body Radiation Therapy and Immunotherapy in Primary Liver Tumors." Journal of Oncology 2019 (April 28, 2019): 1–13. http://dx.doi.org/10.1155/2019/4304817.

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Treatment recommendations for primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), are complex and require a multidisciplinary approach. Despite surgical options that are potentially curative, options for nonsurgical candidates include systemic therapy, radiotherapy (RT), transarterial chemoembolization (TACE), and radiofrequency ablation (RFA). Stereotactic Body Radiation Therapy (SBRT) is now in routine use for the treatment of lung cancer, and there is growing evidence supporting its use in liver tumors. SBRT has the advantage of delivering ablative radiation doses in a limited number of fractions while minimizing the risk of radiation-induced liver disease (RILD) through highly conformal treatment plans. It should be considered in a multidisciplinary setting for the management of patients with unresectable, locally advanced primary liver malignancies and limited treatment options. Recently, the combination of immunotherapy with SBRT has been proposed to improve antitumor effects through engaging the immune system. This review aims at shedding light on the novel concept of the combination strategy of immune-radiotherapy in liver tumors by exploring the evidence surrounding the use of SBRT and immunotherapy for the treatment of HCC and CCA.

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Ma, Ge, Hao Chen, Jin Xu, Hong Pan, Muxin Yu, Yue Wang, Hui Xie, Wenbin Zhou, and Shui Wang. "Discontinuous moving shot technique for conformal thermal ablation in an ex vivo porcine liver model." Diagnostic and Interventional Radiology 27, no. 3 (May 7, 2021): 418–23. http://dx.doi.org/10.5152/dir.2021.20836.

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Gao, Hongjian, Xiaoru Wang, Shuicai Wu, Zhuhuang Zhou, Yanping Bai, and Weiwei Wu. "Conformal coverage of liver tumors by the thermal coagulation zone in 2450-MHz microwave ablation." International Journal of Hyperthermia 36, no. 1 (January 1, 2019): 590–604. http://dx.doi.org/10.1080/02656736.2019.1617437.

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Daunizeau, L., A. Nguyen, M. Le Garrec, J. Y. Chapelon, and W. A. N'Djin. "Robot-assisted ultrasound navigation platform for 3D HIFU treatment planning: Initial evaluation for conformal interstitial ablation." Computers in Biology and Medicine 124 (September 2020): 103941. http://dx.doi.org/10.1016/j.compbiomed.2020.103941.

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Raben, Adam, Jules Geltzeiler, Arnold Grebler, Ira Keselman, Samuel Litvin, Lawrence Coia, Joseph Lattanzi, Amy Rule, Michelle Fox, and Jack Yang. "179 Prospective study of androgen ablation, high dose rate temporary conformal brachytherapy and conformal external beam radiotherapy for locally advanced, organ confined, high risk prostate cancer." Radiotherapy and Oncology 55 (May 2000): 92. http://dx.doi.org/10.1016/s0167-8140(00)81497-8.

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Sciubba, D. M., C. Burdette, W. A. Pennant, J. C. Noggle, C. Alix, G. Fightinger, Z. L. Gokaslan, and K. P. J. Murphy. "Abstract No. 371: Percutaneous CT-Guided Conformal Ultrasonic Ablation of Vertebral Tumors Using a Rabbit Tumor Model." Journal of Vascular and Interventional Radiology 19, no. 2 (February 2008): S136. http://dx.doi.org/10.1016/j.jvir.2007.12.428.

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Mueller, Dirk, David Clark, Joris VanNunen, Ed Rea, and Hatim Haloui. "Laser-based Package Singulation and Trenching for SiP." Additional Conferences (Device Packaging, HiTEC, HiTEN, and CICMT) 2016, DPC (January 1, 2016): 002182–202. http://dx.doi.org/10.4071/2016dpc-tha43.

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Pulsed lasers are solving some packaging challenges for SiP applications. SiP devices designed for mobile devices with communication capability often have a need for EMI shielding. Nanosecond UV and picosecond green lasers are finding use in cutting these multi-compound packages as well as trench for exposing board contacts used for grounding. Mechanical cutting may not be an option if the perimeter of the package is not a simple rectangle. Water jet cutting may bear the risk of the package to fail to to water seeping in between the package layers during cutting. We will demonstrate how laser-based SiP package cutting and trenching can ameliorate both of those concerns and point toward limitations of laser-based processes. Today's high power nanosecond UV lasers are capable of cutting 1mm thick packages at an effective cutting speed of more than 10mm/s. The resulting cut surface shows no charring or melting. The surface roughness allows for excellent adhesion of EMI shielding paint on the cut conformal compound. Since the laser beam can be controlled with a programmable scanner, arbitrary shapes can be cut just as easily as simple rectangles. Difference ablation rates between polymer and copper allow the laser to trench the conformal coating and stop automatically when a metal layer is exposed. This self-terminating process leads to a precise exposure even when the conformal coating thickness differs from part to part. For the utmost in surface quality picosecond lasers can be employed. Their shorter pulse duration allows for an even lower surface roughness and less thermal impact on the package. Using an ultrafast laser, such as a 10ps laser, has the additional advantage that the process scales in speed with increased laser power. The excellent edge quality and possibility to cut random shapes allow laser-based processes to complement mechanical processes in high-end applications. We will present a full cost of ownership model that allows the designer to predict the exact singulation and trenching cost for a given package size.

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Chai, Zhiping, Liangxiong Lyu, Menghao Pu, Xianwen Chen, Jiaqi Zhu, Huageng Liang, Han Ding, and Zhigang Wu. "An Individually Controlled Multitined Expandable Electrode Using Active Cannula‐Based Shape Morphing for On‐Demand Conformal Radiofrequency Ablation Lesions." Advanced Intelligent Systems 4, no. 7 (July 2022): 2270035. http://dx.doi.org/10.1002/aisy.202270035.

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Wang, Tao, Gang Zhao, and Bensheng Qiu. "Theoretical evaluation of the treatment effectiveness of a novel coaxial multi-slot antenna for conformal microwave ablation of tumors." International Journal of Heat and Mass Transfer 90 (November 2015): 81–91. http://dx.doi.org/10.1016/j.ijheatmasstransfer.2015.06.030.

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Wolf, Dietrich, Maxime Lafond, and Cyril Lafon. "Ultrasound cycloplasty for refractory glaucoma treatment: The EyeTechCare Experience." Journal of the Acoustical Society of America 153, no. 3_supplement (March 1, 2023): A68. http://dx.doi.org/10.1121/10.0018191.

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In the 1980s, HIFU was successfully tested for treating refractory glaucoma (Lizzi et al.). A more recent device from EyeTechCare, made of six cylindrical transducers operating at 21MHz, can perform a conformal, partial, and fast thermal ablation of the ciliary bodies, a technique known as ultrasound cycloplasty (UCP). For the last 10 years, we investigated the safety and efficacy of UCP for reducing the production of aqueous humor and intraocular pressure (IOP). The primary outcomes that were validated (more than 55%) were therapeutic success (IOP reduction from baseline ≥20% and IOP >5 mm Hg without other surgical procedures) and vision-threatening complications. Secondary outcomes included mean IOP change from baseline at each follow-up visit, medication use, complications, and subsequent UCP and/or other postsurgical interventions. This technique was associated with a low complication rate and no cases of phthisis. In this presentation, we also highlight the remaining challenges in increasing the efficacy and reliability of UCP and its future developments. [Disclosure: Dietrich Wolf is CEO at EyeTechCare.]

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Zelefsky, M. J., O. Lyass, Z. Fuks, T. Wolfe, C. Burman, C. C. Ling, and S. A. Leibel. "Predictors of improved outcome for patients with localized prostate cancer treated with neoadjuvant androgen ablation therapy and three-dimensional conformal radiotherapy." Journal of Clinical Oncology 16, no. 10 (October 1998): 3380–85. http://dx.doi.org/10.1200/jco.1998.16.10.3380.

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PURPOSE To identify prognostic variables that predict for improved biochemical and local control outcome in patients with localized prostatic cancer treated with neoadjuvant androgen deprivation (NAAD) and three-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS Between 1989 and 1995, 213 patients with localized prostate cancer were treated with a 3-month course of NAAD that consisted of leuprolide acetate and flutamide before 3D-CRT. The purpose of NAAD in these patients was to reduce the preradiotherapy target volume so as to decrease the dose delivered to adjacent normal tissues and thereby minimize the risk of morbidity from high-dose radiotherapy. The median pretreatment prostate-specific antigen (PSA) level was 15.3 ng/mL (range, 1 to 560 ng/mL). The median 3D-CRT dose was 75.6 Gy (range, 64.8 to 81 Gy), and the median follow-up time was 3 years (range, 1 to 7 years). RESULTS The significant predictors for improved outcome as identified in a multivariate analysis included pretreatment PSA level < or = 10.0 ng/mL(P < .00), NAAD-induced preradiotherapy PSA nadir < or = 0.5 ng/mL (P < .001), and clinical stage < or = T2c (P < .04). The 5-year PSA relapse-free survival rates were 93%, 60%, and 40% for patients with pretreatment PSA levels < or = 10 ng/mL, 10 to 20 ng/mL, and greater than 20 ng/mL, respectively (P < .001). Patients with preradiotherapy nadir levels < or = 0.5 ng/mL after 3 months of NAAD experienced a 5-year PSA relapse-free survival rate of 74%, as compared with 40% for patients with higher nadir levels (P < .001). The incidence of a positive biopsy among 34 patients pretreated with androgen ablation was 12%, as compared with 39% for 117 patients treated with 3D-CRT alone who underwent a biopsy (P < .001). CONCLUSION For patients treated with NAAD and high-dose 3D-CRT, pretreatment PSA, preradiotherapy PSA nadir response, and clinical stage are important predictors of biochemical outcome. Patients with NAAD-induced PSA nadir levels greater than 0.5 ng/mL before radiotherapy are more likely to develop biochemical failure and may benefit from more aggressive therapies.

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Enomoto, Hirayuki, Masayuki Fujiwara, Hiroshi Kono, Yasukazu Kako, Motonori Takahagi, Junichi Taniguchi, Eri Ishikawa, et al. "Metastasis of Hepatocellular Carcinoma in the Pouch of Douglas Successfully Treated by Radiation Therapy: A Case Report." Life 13, no. 1 (January 13, 2023): 225. http://dx.doi.org/10.3390/life13010225.

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Metastasis of hepatocellular carcinoma (HCC) in the pouch of Douglas is relatively rare. A 65-year-old man with liver cirrhosis was admitted for detailed examination of a pelvic tumor. He had a previous history of ruptured HCC, and received emergent hemostasis with transcatheter arterial embolization followed by curative ablation. His blood tests showed an increase in des-gamma-carboxy prothrombin (DCP). Contrast-enhanced computed tomography (CE-CT) revealed a heterogeneously enhanced large pelvic tumor, but no additional tumorous lesions were detected in other organs, including the lungs, liver and abdominal lymph nodes. The colonoscopy showed compression by an extra-luminal/submucosal tumor, and computed tomography-guided percutaneous needle biopsy revealed that the pelvic tumor was metastasis of HCC. Because of the poor liver function, the solitary pelvic tumor was treated with three-dimensional conformal radiation therapy (3D-CRT). The tumor size and the DCP value were markedly decreased after radiation therapy. Nine months later, occasional mild bloody stool due to radiation proctitis was observed; however, no serious side effects occurred. Our case suggests that radiation therapy may be a therapeutic option for a solitary metastatic lesion of HCC in the pouch of Douglas.

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Vaskovskiy, V. A., I. A. Taymasova, D. V. Kalinin, N. A. Antipina, A. A. Nikolaeva, G. Y. Smirnov, A. V. Golanov, A. A. Potapov, and A. Sh Revishvili. "Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology." Journal of Arrhythmology 28 (October 26, 2021): 44–50. http://dx.doi.org/10.35336/va-2021-e-44-50.

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Purpose. The experimental study aimed to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Methods. The study comprised 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. A linear accelerator was used for the experiment. Each animal underwent radiation exposure in different areas: 1st animal - AV node (dose 35 Gy), 2nd animal - AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal - pulmonary veins (PV) and left atrium (dose 30 Gy), 4th - AV node and LV free wall (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in three projections: axial, frontal and sagittal. For electrocardiographic control, a loop recorder was implanted in each animal. The average exposure time was 11±7 minutes. After a follow-up period, morphological examination of the autopsy material was performed.Results. The average follow-up period after ablation was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, where AV-node was exposed: 2nd animal - 40 Gy on 108th day of observation and 4th animal - 45 Gy on 21st day of observation. No cardiac tachyarrhythmia was recorded in the animals. The results of myocardium macro- and microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern electrophysiology as an alternative ablation method.

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Zakondyrin, D. E., and A. A. Grin. "Spinal tumors: literature review." Russian journal of neurosurgery 24, no. 2 (June 13, 2022): 94–104. http://dx.doi.org/10.17650/1683-3295-2022-24-2-94-104.

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Problems epidemiology, classification, diagnosis, and treatment of spinal tumors are considered. Data on morbidity and characteristics of different histological forms of benign and malignant vertebral tumors are presented. Features of spinal tumor diagnosis, classic radiological signs, and current noninvasive visualization and invasive (biopsy) techniques are discussed. Literature data on techniques and capabilities of surgical treatment are analyzed. Current trends in selection of surgical intervention radicality level depending on the type of spinal tumor using staging classifications by Ennеking, Weinstein–Boriani–Biagini and Tomita are described. Current indications for radical en bloc resection performed in a limited number of cases is considered. Minimally invasive spine surgery is discussed: from vertebroplasty, radiofrequency ablation and intervention removal of metastatic tumor to separation surgery for epidural compression. Apart from surgical treatment, neoadjuvant and adjuvant radiotherapy of vertebral tumors are analyzed: conventional, conformal, including stereotaxic, beam therapy and radiosurgery. Data on current trends in treatment selection depending on histological nature of the tumor, its radiosensitivity and probability of post-radiation malignant transformation are presented. Drug treatment, in particular chemotherapy, is an indispensable in treatment of secondary and some primary spinal tumors. Data on chemosensitivity of various tumors and tactics of combination and complex treatment are presented. Evidently, the current trend is to decrease the level of surgical invasiveness and selection of minimally invasive methods of surgical treatment. Moreover, it is concluded that considering the biological nature of hemopoietic tumors and some sarcomas, currently surgical treatment is not the main method of treatment of these malignant tumors.

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Leal, Jeff S., Suzette K. Pangrle, Charles Whyte, Keith Barrie, Jeff Leff, Scott McGrath, and Gerardo Ayala. "Fine Pitch 3D Dispensable Electrical Interconnects for System In Package Solutions." International Symposium on Microelectronics 2010, no. 1 (January 1, 2010): 000559–65. http://dx.doi.org/10.4071/isom-2010-wp1-paper5.

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The use of dispensable conductive materials to create fine pitch 3D electrical interconnects has been proven by Vertical Circuits Inc. as a low cost, high reliability alternative to create System in Package (SIP) solutions. This paper discusses the benefits of dispensing the 3D electrical interconnects instead of using traditional wire bond or high cost TSV processes to create a System in Package. Pad pitches achieved are typically less than 65um. A conformal coating of a dielectric material with the subsequent selective laser ablation of the dielectric over the die pads allows all interconnect lines to be dispensed in a single application adjacent to each other. Compared to traditional wire bond applications, the overall interconnect inductance is lower with comparable capacitive and resistance values enabling higher frequencies to be achieved. Using this process, complex multi-step stacking and bonding applications that jeopardize known good die (KGD) and increase the XY footprint of the System in Package are eliminated. Furthermore, the entire die stacking process can be executed as a single step before the application of the electrical interconnect material. This method minimizes the overall material handling and repetitive die stack processes that increase the probability of defects leading to expensive yield losses. Methods for matching the Coefficient of Thermal Expansion (CTE) for the stacked components within a System in Package will be demonstrated as well as surface treatments to enable fine pitch dispense that result in increased product reliability. JEDEC L3 reliability data will be presented to demonstrate SIP robustness using this technology.

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Jankovic, Bojana, D. Andrew Loblaw, and Robert Nam. "Capsaicin may slow PSA doubling time: case report and literature review." Canadian Urological Association Journal 4, no. 1 (April 16, 2013): 9. http://dx.doi.org/10.5489/cuaj.784.

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Capsaicin is the main pungent component of chili peppers. Thisis the first case, to our knowledge, that describes prostatespecificantigen (PSA) stabilization in a patient with prostate cancer,who had biochemical failure after radiation therapy. A 66-year-old male underwent radiotherapy treatment for a T2b, Gleason7 (3+4) adenocarcinoma of the prostate, with a PSA level of13.3 ng/mL in April 2001. He had 3-dimensional conformal radiotherapyof 46 Gy in 23 fractions to the prostate and pelvis, and aprostate boost of 30 Gy in 15 fractions. Radiotherapy was completedin May 2001 and PSA nadired in January 2002 (0.57). Dueto the continued PSA rise, the patient was started on bicalutamide(50 mg orally, daily) and leuprolide acetate (1 dose of 22.5 mgintramuscularly) in July 2005 when PSA was 38.5 ng/mL. Due topoor tolerance of androgen ablation therapy, the patient discontinuedtreatment and started taking 2.5 mL of habaneros chilisauce, containing capsaicin, 1 to 2 times a week in April 2006.Prostate-specific antigen doubling time (PSAdt) increased from4 weeks before capsaicin to 7.3 months by October 2006. FromOctober 2006 until November 2007, the patient remained oncapsaicin (2.5 to 15 mL daily) and his PSA was stable (between11 to 14 ng/mL). By January 2008, his PSA rose to 22.3 and hehas maintained a PSAdt between 4 and 5 months, where it presentlyremains. Due to the patient’s continued PSA rise, he was restartedon bicalutamide (12.5 mg daily). Apart from PSA relapse, the patientremains free of signs or symptoms of recurrence.

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Zelefsky, Michael J., William K. Kelly, Howard I. Scher, Henry Lee, Tracy Smart, Erica Metz, Lawrence Schwartz, Zvi Fuks, and Steven A. Leibel. "Results of a Phase II Study Using Estramustine Phosphate and Vinblastine in Combination With High-Dose Three-Dimensional Conformal Radiotherapy for Patients With Locally Advanced Prostate Cancer." Journal of Clinical Oncology 18, no. 9 (May 9, 2000): 1936–41. http://dx.doi.org/10.1200/jco.2000.18.9.1936.

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PURPOSE: To assess the feasibility and tolerance of neoadjuvant and concomitant estramustine phosphate and vinblastine (EV) with high-dose three-dimensional conformal radiotherapy (3D-CRT) for patients with unfavorable-risk prostate cancer. PATIENTS AND METHODS: Twenty-seven patients with unfavorable-risk prostate cancer were enrolled onto a prospective study to determine the feasibility of combining EV with 3D-CRT. Patients were eligible if any of the following requirements were satisfied: (1) Gleason score ≥ 8 and prostate-specific antigen (PSA) > 10 ng/mL; (2) Gleason score of 7 and PSA > 20 ng/mL; (3) clinical stage T3N0M0 disease with PSA > 20 ng/mL; (4) any patient with T4N0M0 disease; or (5) patients with TXN1MO disease. Therapy consisted of three 8-week cycles of EV and 8 weeks of 3D-CRT. Estramustine phosphate was given orally beginning on week 1 and continued until the completion of 3D-CRT. Each 8-week cycle of vinblastine consisted of 6 weekly intravenous injections followed by a 2-week rest period. Radiation therapy was administered using a three-dimensional conformal approach to a prescription dose of 75.6 Gy. The median follow-up was 26 months (range, 6 to 40 months). RESULTS: Twenty-three (85%) of 27 patients completed the entire course of therapy and were assessable for toxicities and biochemical outcome. Two patients (7%) developed grade 3 hematologic toxicity that resolved, and two patients (7%) developed grade 3 hepatoxicity, manifesting as persistent elevation of serum transaminase levels, necessitating discontinuation of the chemotherapy and withdrawal from the treatment program. The most prominent adverse effects from this regimen were mild to moderate (grade 1 to 2) nausea and fatigue related to estramustine. Mild peripheral edema was seen in 15% of patients and was treated with diuresis. 3D-CRT was tolerated well in these patients. Medications were required for relief of acute grade 2 rectal (gastrointestinal [GI]) and urinary (genitourinary [GU]) symptoms in 35% and 48% of patients, respectively. Three patients developed acute grade 3 GU toxicities. The 2-year actuarial likelihood of late grade 2 GI toxicity was 20%. No late grade 3 or 4 GI toxicities were observed. The 2-year actuarial likelihoods of late grade 2 and 3 GU toxicities were 25% and 12%, respectively. No grade 4 GU toxicity was observed. CONCLUSION: Neoadjuvant and concomitant EV with high-dose 3D-CRT is well tolerated in patients with unfavorable-risk prostate cancer. Although the incidence of modest (grade 2) late GI and GU toxicities seem to be increased compared with 3D-CRT alone or in combination with androgen ablation therapy, no severe toxicities were encountered with this regimen.

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Greco, Carlo, Simona Castiglioni, Andrei Fodor, Chiara Mazzetta, Ottavio De Cobelli, and Roberto Orecchia. "Androgen Ablation Therapy Does not Increase the Risk of Late Morbidity following 3D-conformal Radiotherapy of Organ-confined Prostate Cancer: The Experience of the European Institute of Oncology." Tumori Journal 90, no. 6 (November 2004): 567–72. http://dx.doi.org/10.1177/030089160409000606.

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Zapatero, A., P. Alcantara, F. Valcarcel, A. de la Torre, F. A. Calvo, R. Algas, A. Bejar, J. Maldonado, and S. Villa. "Preliminary report of a multicenter spanish trial (GICOR 05) of risk-adapted androgen ablation combined with dose-escalation 3D conformal therapy for prostate cancer: impact on early toxicity." International Journal of Radiation Oncology*Biology*Physics 57, no. 2 (October 2003): S391—S392. http://dx.doi.org/10.1016/j.ijrobp.2003.08.015.

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Vaskovskiy, V. A., I. A. Taymasova, D. V. Kalinin, N. A. Antipina, A. A. Nikolaeva, G. Y. Smirnov, A. V. Golanov, A. A. Potapov, and A. Sh Revishvili. "Experimental use of stereotactic radiosurgery for non-invasive interventions in arrhythmology." Journal of Arrhythmology 28, no. 1 (May 1, 2021): 5–13. http://dx.doi.org/10.35336/va-2021-1-5-13.

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Purpose. The aim of the experimental study was to study the effects of stereotaxic radioablation of various doses on the myocardium of the atria, ventricles and atrioventricular (AV) node in the long term (up to 6 months); as well as assessment of collateral damage during radioablation.Material and methods. The research was carried out on 4 domestic pigs. The animals were 10-12 weeks old, the average weight was 30±2.7 kg. Linear accelerator «TrueBeam», Varian was used for the experiment. Animals were divided into groups according to the zones of planned radiation exposure: 1st animal AV node (dose 35 Gy), 2nd animal AV node and the apex of the left ventricle (LV) (dose 40/35 Gy, respectively), 3rd animal pulmonary veins (PV) and left atrium (dose 30 Gy), 4th AV node and free wall of the LV (dose 45/40 Gy). Under intravenous sedation with hemodynamic monitoring, contrast-based CT of the heart was performed to assess the degree of displacement of the heart chambers in one respiratory and cardiac cycle and to assess the anatomy of the chambers of the heart and adjacent organs. The allocation and the contouring of the target zones were carried out in 3 projections: axial, frontal and sagittal. For electrophysiological control, loop recorders were implanted in each animal. The average exposure time was 11±7 minutes. The long-term follow-up period was 6 months, followed by morphological examination of autopsy material.Results. The average follow-up period after the experiment was 134.75±77.34 days. The electrophysiological effect of the ablation was achieved in cases of complete AV-block development. This effect was developed in 2 out of 3 animals, whose AV-node was exposed: 2nd animal 40 Gy on 108th day of observation and 4th animal 45 Gy on 21st day of observation. No cardiac arrhythmias were recorded in all cases. The results of macroand microscopic examination showed significant changes in the target zones. These areas had precise but uneven damage boundaries, which were within the planned ones (conformal exposure with a high degree of precision). The transmural nature of the changes was noted as well. Massive fields of fibrous tissue of various degrees of maturity (with a predominance of subepicardial localization) with focal hemorrhages of various ages and granulations were detected, which were surrounded by cardiomyocytes with coagulated and vacuolated cytoplasm.Conclusion. The use of non-invasive stereotactic treatment of tachyarrhythmias has high prospects in modern arrhythmology as an alternative ablation method.

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Popov, Sergey, Aleksandr Pavlovskiy, Aleksey Polikarpov, Viktor Moiseenko, Andrey Moiseenko, A. Polekhin, A. Statsenko, and A. Granov. "NEW POSSIBILITIES OF COMPLEX TREATMENT FOR METASTATIC AND LOCALLY ADVANCED NEUROENDOCRINE TUMORS OF THE PANCREAS." Problems in oncology 64, no. 4 (April 1, 2018): 493–98. http://dx.doi.org/10.37469/0507-3758-2018-64-4-493-498.

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During the period 2006 to 2017 years 86 patients with neuroendocrine pancreatic tumors were observed and treated. 25 (29,1%) patients underwent only chemotherapy due to generalized tumor process or severe concomitant somatic status. 61 (70,9%) patients with neuroendocrine pancreatic tumors underwent surgical treatment. In 34 patients tumors were localized in the body and tail, in 27 - in the head of the pancreas. Women predominated among patients (n = 41), the average age of the patients was 51 ± 3.1 years. Synchronous metastatic liver metastases were detected in 33 (54,1%) of 61 patients, with the size of the primary tumor from 10 to 73 mm. In 47 (77%) neuroendocrine pancreatic tumors were regarded as non-functioning. Radical surgery was performed in 24 patients of 61 (39,3%) with tumor sizes from 11 to 128 mm (average 56 ± 21 mm), cytoreductive surgery was performed in 37 (60.7%) patients. Patients with locally advanced neuroendocrine pancreatic tumors (n = 13) and neuroendocrine pancreatic tumors with synchronous liver metastases (n = 33) undergone combined treatment (n = 46). Combined treatment was performed by means of intra-arterial selective oil chemoembolization and chemoinfusion, supplemented with one or several local methods effects: cytoreductive surgery and radiofrequency ablation (n = 8). 6 (12.2%) of patients with high, moderately and low-grade tumors died after the operation in period from 7 to 63 months from progression of disease. 43 (87.8%) patients survived in period from 4 to 112 months, 32 patients still alive without signs of disease progression. Because of recurrence in five patients (11.9%) repeated operations were performed. One patient (2.4%) underwent conformal radiation therapy. Life expectancy after surgery in patients with low-grade neuroendocrine cancer of the pancreas ranged from 3 to 16 months, and the median survival was 8.3 ± 1.2 months.

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Romero, Fabiola, Sandra Galeano, Francisco Cabrera, Liliana Vigo, Carlos Laterza, Oscar Codas Thompson, and Elizabeth Valinotti. "Utility of Stimulated Thyroglobulin in the Differentiate Thyroid Cancer." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A874. http://dx.doi.org/10.1210/jendso/bvab048.1786.

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Abstract Introduction: The treatment of differentiated thyroid cancer has changed considerably, total thyroidectomy and radioactive iodine ablation represented the initial treatment for these patients, currently with a great debate around the choice of which patient should undergo ablation with radioactive iodine in the post-surgical period. Objective: To determine the values of stimulated thyroglobulin (in hypothyroidism) in patients with differentiated thyroid carcinoma who have had surgery and its relationship with the ATA 2015 recurrence risk stratification and the presence of distant or locoregional metastasis in post ablative total body scan with I131 Methodology: Retrospective study, which included patients with differentiated thyroid carcinoma, patients who have had total thyroidectomy surgery and subsequent ablation with I131 in 45 days at the Central Hospital of Instituto de Prevision Social, from 2011 to 2018. There were evaluated: post-surgical thyroglobulin dosage in hypothyroidism, antithyroglobulin antibody measurement, and total body scan results at 72 hours post ablation with I131. There were excluded: Patients with positive antithyroglobulin antibodies, eu /hyperthyroidism, or incomplete data. Results: 100 patients conformed by women (88.0%), whose average age was 44.7 (± 16.1), intermediate risk 60%, high risk 31% and low risk 9%. According to the stimulated thyroglobulin values, 3 groups were classified: Group A thyroglobulin less than 1 ng/dl 32%, Group B 1 to 10 ng/dl 39%, Group C greater than 10 ng/dl 29%. Of the patients at intermediate risk n: 60, 23 (38%) belonged to group A, 27 (45%) to group B and 10 (17%) to group C. Of high-risk patients n: 31, 7 (22%) belonged to group A, 8 (26%) to group B, and 16 (52%) to group C. Of low risk patients n: 9, 2 (22%) belonged to group A, 4 (44%), group B, and 3 (33%) to group C. Post-ablative body scan detected locoregional or distant metastases in 23 (23%) patients, of which 2 (8.6%) belonged to group A, 6 (26%) to group B, 15 (65%) to group C. They were intermediate risk 10 (43%) and high risk 13 (57%) of them. No low-risk patient presented a positive RCT. There was found a relationship between thyroglobulin and high ATA risk (p <0.05) with positive RCT. Association between thyroglobulin> 10ng / dL and the presence of metastasis (p = 0.0001), Exp (B) 15.1 with R2 25 and 35%. Conclusion: A stimulated postoperative thyroglobulin dosage greater than 10 ng/ dL increases the chances of recurrence 15 times, with 25 to 37% chance of it. So, it would be important to consider ablation with iodine 131 in this type of patients.

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Sun, Xuyang, Zhi-Zhu He, Zhong-Shan Deng, Yi-Xin Zhou, and Jing Liu. "Liquid metal bath as conformable soft electrodes for target tissue ablation in radio-frequency ablation therapy." Minimally Invasive Therapy & Allied Technologies 27, no. 4 (November 23, 2017): 233–41. http://dx.doi.org/10.1080/13645706.2017.1393437.

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Sidor, Adam T., Graeme J. Kennedy, and Robert D. Braun. "Numerical Methodology for the Conceptual Design of Conformal Ablative Heat Shields." Journal of Spacecraft and Rockets 57, no. 4 (July 2020): 753–66. http://dx.doi.org/10.2514/1.a34442.

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Jacobson, Geraldine, and Valerie Galvan-Turner. "Rethinking the Role of Radiation Therapy in the Management of Epithelial Ovarian Cancer." Diagnostics 10, no. 4 (April 11, 2020): 211. http://dx.doi.org/10.3390/diagnostics10040211.

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Radiation has been relegated to a palliative role in the management of epithelial ovarian cancer (EOC). Contemporary radiation techniques, including intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and image-guided radiation therapy, enable conformal treatment that controls local disease with minimal morbidity. Recent studies from multiple institutions support the role of radiation in the ablative treatment of oligometastatic disease and control of locally recurrent and metastatic disease. Effective local treatment with radiation complements the role of systemic therapy in the management of EOC; reduces symptoms and disease burden, and may contribute to a prolonged drug free interval.

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Nazarenko, Alexey V., Sevil B. Alieva, Sergey I. Tkachev, S. V. Medvedev, Denis S. Romanov, V. V. Breder, I. V. Sagaydak, et al. "3D-CONFORMAL RADIATION THERAPY IN THE TREATMENT OF PATIENTS WITH HEPATOCELLULAR CANCER." Russian Journal of Oncology 24, no. 1-2 (April 15, 2019): 4–9. http://dx.doi.org/10.18821/1028-9984-2019-24-1-2-4-9.

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Despite the wide possibilities of applying various methods of local and systemic treatment and their continuous improvement, the results of treatment of patients with hepatocellular cancer in general remain unsatisfactory. Based on the latest achievements of science and technology, modern radiation therapy can be used as an effective method of local exposure to liver tumors because of its relative effectiveness and acceptable tolerability. Radiation treatment in the mode of stereotactic body radiation therapy is a promising direction in the complex treatment of patients with hepatocellular carcinoma. It makes it possible to apply ablative doses with a significant reduction of the doses on healthy organs and tissues in a short period of time and the combination of this technique with other approaches of antitumor treatment.

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Tham, Jodie L. M., Sweet Ping Ng, Richard Khor, Morikatsu Wada, Hui Gan, Alesha A. Thai, June Corry, et al. "Stereotactic Body Radiotherapy in Recurrent and Oligometastatic Head and Neck Tumours." Journal of Clinical Medicine 13, no. 11 (May 21, 2024): 3020. http://dx.doi.org/10.3390/jcm13113020.

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The treatment of head and neck cancers (HNCs) encompasses a complex paradigm involving a combination of surgery, radiotherapy, and systemic treatment. Locoregional recurrence is a common cause of treatment failure, and few patients are suitable for salvage surgery. Reirradiation with conventional radiation techniques is challenging due to normal tissue tolerance limits and the risk of significant toxicities. Stereotactic body radiotherapy (SBRT) has emerged as a highly conformal modality that offers the potential for cure while limiting the dose to surrounding tissue. There is also growing research that shows that those with oligometastatic disease can benefit from curative intent local ablative therapies such as SBRT. This review will look at published evidence regarding the use of SBRT in locoregional recurrent and oligometastatic HNCs.

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Toskich, Beau, and Sunil Krishnan. "Radiation Segmentectomy—Ablative and Conformal Radiation Therapy With High Rates of Complete Pathologic Response." International Journal of Radiation Oncology*Biology*Physics 115, no. 2 (February 2023): 279–80. http://dx.doi.org/10.1016/j.ijrobp.2022.08.062.

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Ju, Weizhu, Hongtao Liao, YUEGANG WANG, Zhongbao Ruan, CHENGZONG LI, Yuntong Zhang, and Minglong Chen. "PO-04-160 FIRST IN HUMAN CLINICAL USE OF A NOVEL PULSED FIELD ABLATION SYSTEM WITH A CONFORMABLE ABLATION CATHETER FOR ABLATION OF ATRIAL FIBRILLATION: NANO-AF CLINICAL REGISTRY." Heart Rhythm 21, no. 5 (May 2024): S450. http://dx.doi.org/10.1016/j.hrthm.2024.03.1190.

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Sacino, Amanda N., Hanbo Chen, Arjun Sahgal, Chetan Bettegowda, Laurence D. Rhines, Pejman Maralani, and Kristin J. Redmond. "Stereotactic body radiation therapy for spinal metastases: A new standard of care." Neuro-Oncology 26, Supplement_1 (March 1, 2024): S76—S87. http://dx.doi.org/10.1093/neuonc/noad225.

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Abstract Advancements in systemic therapies for patients with metastatic cancer have improved overall survival and, hence, the number of patients living with spinal metastases. As a result, the need for more versatile and personalized treatments for spinal metastases to optimize long-term pain and local control has become increasingly important. Stereotactic body radiation therapy (SBRT) has been developed to meet this need by providing precise and conformal delivery of ablative high-dose-per-fraction radiation in few fractions while minimizing risk of toxicity. Additionally, advances in minimally invasive surgical techniques have also greatly improved care for patients with epidural disease and/or unstable spines, which may then be combined with SBRT for durable local control. In this review, we highlight the indications and controversies of SBRT along with new surgical techniques for the treatment of spinal metastases.

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Lin, Haimin, Huiyong Wu, Ning Cong, Bo Liu, Chengxin Liu, and Dali Han. "Transarterial Chemoembolization Followed by Radiotherapy Versus Sandwich Treatment for Unresectable or Ablative Hepatocellular Carcinoma." Technology in Cancer Research & Treatment 19 (January 1, 2020): 153303382098379. http://dx.doi.org/10.1177/1533033820983799.

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Objective: Our objective is to assess whether the outcome of intrahepatic unresectable or ablative hepatocellular carcinoma (HCC) could be improved by supplemental transarterial chemoembolization (TACE) following initial treatment of TACE with 3-dimensional conformal radiotherapy (3DCRT), compared to TACE followed by 3DCRT alone. Methods: We retrospectively analyzed intrahepatic unresectable or ablative HCC patients who underwent TACE, followed by 3DCRT with or without additional TACE, from June 2010 to December 2016 at our institution. Survival was assessed using the Kaplan-Meier method and compared with the log-rank test. Cox regression analyses were used to identify factors that influenced prognosis. Toxicity profiles were evaluated using CTCAE 4.0. Results: 27 patients received TACE with 3DCRT (TR group) and 11 received additional TACE following TACE and 3DCRT (sandwich group), respectively. The median intrahepatic progression-free survival (IPFS), progression-free survival (PFS), and overall survival (OS) in the TR group and sandwich group were 5.4 months vs. 17 months (P = 0.018), 5.4 months vs. 17 months (P = 0.008), and 13.5 months vs. 29.2 months (P = 0.011), respectively. Multivariate Cox regression demonstrated that TACE followed by radiotherapy alone had a shorter IPFS (HR: 2.516, 95% CI (1.136-5.570), P = 0.023) and PFS (HR: 2.637, 95% CI (1.182-5.880), P = 0.018) compared with the sandwich treatment. Hepatitis B virus reactivation occurred in 1 patient in the sandwich group. Myleosuppresion was considered a grade 3/4 adverse event. Conclusion: Unresectable or ablative HCC patients possibly benefit from the combination of TACE and 3DCRT followed by additional TACE therapy, compared with TACE followed by 3DCRT alone.

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Kashyap, Varun, Alexandre Caprio, Tejas Doshi, Sun-Joo Jang, Christopher F. Liu, Bobak Mosadegh, and Simon Dunham. "Multilayer fabrication of durable catheter-deployable soft robotic sensor arrays for efficient left atrial mapping." Science Advances 6, no. 46 (November 2020): eabc6800. http://dx.doi.org/10.1126/sciadv.abc6800.

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Devices that perform cardiac mapping and ablation to treat atrial fibrillation provide an effective means of treatment. Current devices, however, have limitations that either require tedious point-by-point mapping of a cardiac chamber or have limited ability to conform to the complex anatomy of a patient’s cardiac chamber. In this work, a detailed, scalable, and manufacturable technique is reported for fabrication of a multielectrode, soft robotic sensor array. These devices exhibit high conformability (~85 to 90%) and are equipped with an array of stretchable electronic sensors for voltage mapping. The form factor of the device is intended to match that of the entire left atrium and has a hydraulically actuated soft robotic structure whose profile facilitates deployment from a 13.5-Fr catheter. We anticipate that the methods described in this paper will serve a new generation of conformable medical devices that leverage the unique characteristics of stretchable electronics and soft robotics.

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Sauer, E. Karl, and E. A. Christiansen. "Preconsolidation pressures in the Battleford Formation, southern Saskatchewan, Canada." Canadian Journal of Earth Sciences 28, no. 10 (October 1, 1991): 1613–23. http://dx.doi.org/10.1139/e91-144.

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Soft, surficial, unoxidized till of the Battleford Formation overlies hard, oxidized and unoxidized till of the Floral Formation. The difference in hardness between these two formations is the result of preconsolidation pressures that range from 1500 to 2200 kPa in the Floral Formation and from 350 to 750 kPa in the lower till unit of the Battleford Formation. The upper till and clay unit of the Battleford Formation, which represents a conformable contact between this formation and the overlying glaciolacustrine clay, is normally consolidated. Preconsolidation of the Floral Formation apparently took place upglacier where the potentiometric surface for subglacial beds was 170–240 m below the ice surface. The lower till unit of the Battleford Formation was deposited from and consolidated under stagnant ice. The upper normally consolidated till and clay unit of the Battleford Formation was let down upon the lower till unit by ablation. The calculated minimum stagnant ice thickness required for consolidation of the lower till unit of the Battleford Formation ranges from 51 to 81 m. The calculated time required for consolidation is less than 100 years.

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Ekanem, Emmanuel, Mohit Turagam, Jan Petru, Moritoshi Funasako, Jacob S. Koruth, Petr Neuzil, and Vivek Y. Reddy. "PO-01-187 FEASIBILITY OF FLUOROLESS PULMONARY VEIN ISOLATION USING A SINGLE-SHOT CONFORMABLE PULSED FIELD ABLATION CATHETER." Heart Rhythm 20, no. 5 (May 2023): S180—S181. http://dx.doi.org/10.1016/j.hrthm.2023.03.563.

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Olson, Robert A., Vincent LaPointe, Alex Benny, Matthew Chan, Shilo Lefresne, and Michael McKenzie. "Evaluation of Patient-Reported Outcome Differences by Radiotherapy Techniques for Bone Metastases in A Population-Based Healthcare System." Current Oncology 29, no. 3 (March 18, 2022): 2073–80. http://dx.doi.org/10.3390/curroncol29030167.

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We assessed whether advanced RT techniques were associated with differences in patient-reported outcomes (PROs). Patients with bone metastases who completed the brief pain inventory (BPI) before and after RT were identified, and RT technique was categorized as simple (e.g., parallel opposed pair) or advanced (e.g., 3D-conformal RT (3DCRT), intensity-modulated RT (IMRT), or stereotactic ablative RT (SABR)). Pain response and patient-reported interference on quality of life secondary to pain was compared. A total of 1712 patients completed the BPI. From 2017–2021, the rate of advanced RT technique increased significantly (p < 0.001; 2.4%, 2.4%, 9.7%, 5.5%, 9.3%), with most advanced techniques consisting of IMRT, and only 7% of advanced techniques were SABR. Comparing simple vs. advanced technique, neither the complete pain response (12.3% vs. 11.4%; p = 0.99) nor the partial pain response (50.0% vs. 51.8%; p = 0.42) was significantly different. There was no significant patient-reported difference in pain interfering with general activity, mood, walking ability, normal work, relationships, sleep, or enjoyment of life. Given that there is increasing utilization of advanced RT techniques, there is further need for randomized trials to assess their benefits given the increased cost and inconvenience to patients.

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Adler, John R., Federico Colombo, M. Peter Heilbrun, and Ken Winston. "Toward an Expanded View of Radiosurgery." Neurosurgery 55, no. 6 (December 1, 2004): 1374–76. http://dx.doi.org/10.1227/01.neu.0000143614.34986.5e.

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Abstract RADIOSURGERY AND RADIOTHERAPY were originally distinguished on the basis of the manner in which they protected normal tissues from radiation injury. Radiosurgery does so by precise targeting of cross-fired radiation beams to abnormal tissue, with abrupt falloff of radiation doses to surrounding normal tissue. Radiotherapy was historically less concerned with targeting accuracy and anatomic precision; normal tissues were protected by dividing doses into multiple fractions separated by time to allow recovery of normal tissues. By this means, radiotherapy applied radiobiological principles to disrupt dividing cells selectively. Despite the development of computer-based, image-guided frameless technology that eliminates the necessity to perform radiosurgery in a single session, there are some who still insist that radiosurgery be distinguished from radiotherapy on the basis of whether treatment is delivered in a single session. Here, we propose that this definition of radiosurgery is needlessly restrictive and that staging or hypofractionation of radiosurgical treatment permits the limited application of radiobiological principles of radiotherapy to improve radiosurgical treatment. We therefore define radiosurgery as a procedure that involves the active participation of a surgeon and in which spatially accurate and highly conformal doses of radiation are targeted at well-defined structures with an ablative intent.

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Holtz, S., and J. Bargon. "Laser-induced ablation of polymers using a patterned dopant generated from a leuco-dye precursor via flood exposure: A ?portable conformable mask? approach to laser ablation of PMMA at 351 nm." Applied Physics A Materials Science & Processing 60, no. 6 (June 1995): 529–35. http://dx.doi.org/10.1007/bf01538524.

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Pham, Daniel, Ann Thompson, Tomas Kron, Farshad Foroudi, Michal Schneider Kolsky, Thomas Devereux, Andrew Lim, and Shankar Siva. "Stereotactic Ablative Body Radiation Therapy for Primary Kidney Cancer: A 3-Dimensional Conformal Technique Associated With Low Rates of Early Toxicity." International Journal of Radiation Oncology*Biology*Physics 90, no. 5 (December 2014): 1061–68. http://dx.doi.org/10.1016/j.ijrobp.2014.07.043.

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Lehrer, Eric J., Henry Ruiz-Garcia, Anthony D. Nehlsen, Kunal K. Sindhu, Rachel Sarabia Estrada, Gerben R. Borst, Jason P. Sheehan, Alfredo Quinones-Hinojosa, and Daniel M. Trifiletti. "Preoperative Stereotactic Radiosurgery for Glioblastoma." Biology 11, no. 2 (January 26, 2022): 194. http://dx.doi.org/10.3390/biology11020194.

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Glioblastoma is a devastating primary brain tumor with a median overall survival of approximately 15 months despite the use of optimal modern therapy. While GBM has been studied for decades, modern therapies have allowed for a reduction in treatment-related toxicities, while the prognosis has largely been unchanged. Adjuvant stereotactic radiosurgery (SRS) was previously studied in GBM; however, the results were disappointing. SRS is a highly conformal radiation technique that permits the delivery of high doses of ionizing radiation in 1–5 sessions while largely sparing surrounding healthy tissues. Furthermore, studies have shown that the delivery of ablative doses of ionizing radiation within the central nervous system is associated with enhanced anti-tumor immunity. While SRS is commonly used in the definitive and adjuvant settings for other CNS malignancies, its role in the preoperative setting has become a topic of great interest due to the potential for reduced treatment volumes due to the treatment of an intact tumor, and a lower risk of nodular leptomeningeal disease and radiation necrosis. While early reports of SRS in the adjuvant setting for glioblastoma were disappointing, its role in the preoperative setting and its impact on the anti-tumor adaptive immune response is largely unknown. In this review, we provide an overview of GBM, discuss the potential role of preoperative SRS, and discuss the possible immunogenic effects of this therapy.

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Davda, Reena, Clement Orczyk, Mark Prentice, Aylin Sarova, Manit Arya, Hashim Ahmed, Mark Emberton, Caroline Moore, Anita Mitra, and Heather Ann Payne. "Late toxicity described using patient reported outcomes measures (PROMS) in men treated with salvage radiation following primary high intensity focal ultrasound (HIFU) for localized prostate cancer." Journal of Clinical Oncology 37, no. 7_suppl (March 1, 2019): 131. http://dx.doi.org/10.1200/jco.2019.37.7_suppl.131.

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131 Background: In primary treatment of localised prostate cancer, minimally invasive ablative therapies such as HIFU aim to achieve cancer control whilst offering a potentially favourable toxicity profile. At 5 years median follow up, 12% of patients treated with focal HIFU require salvage therapy. PROMS using Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC‐CP) provide a validated and clinically relevant tool to assess and quantify side effects from pelvic radiotherapy. There is limited data on late toxicity using PROMs with salvage radiotherapy in this setting. Methods: Retrospective analysis from prospectively collected data of 28 patients who received salvage radiotherapy at our institution 2010-2018 was performed. Late bowel and urinary toxicity measured by EPIC-CP is reported. Results: Gleason score at diagnosis: 3+3 4/28; 3+4 22/28; 4+3 2/28. HIFU treatment received: focal: 9/28; whole gland: 6/28; focal and redo focal: 7/28; focal and redo whole gland: 1/28; whole gland and redo: 5/28. All patients had mpMRI and biopsy proven recurrence with median PSA 6.6 ng/ml (0.57- 30.89). Median age at radiation was 67 years (55-80). Patients received 74 Gy to the prostate and 4 patients received additional pelvic lymph node irradiation. Three men received conformal radiotherapy (multiphase technique) and 25 arcing intensity modulated radiotherapy with hormone therapy as per risk stratification. Cumulative incidence of toxicity is reported at median follow-up of 43 months (7-99). Overall urinary function: no problem 8/28; very small problem 4/28; small problem 7/28; moderate problem 5/28; big problem 4/28 Urinary Incontinence Symptom Score: 2.5/12 (0-12) Urinary Irritation /Obstructive Symptom Score: 3.1/12 (0-12) Bowel Symptom Score: 3.5/12 (0-11) Biochemical relapse has occurred in 2/28 patients. Conclusions: Functional and oncological outcomes for a greater number of patients treated with minimally invasive ablative therapies followed by salvage radiation are required, however this data suggests radiation is a well-tolerated and effective salvage option following primary HIFU.

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Reddy, Vivek Y., Jacob S. Koruth, Jan Petru, Moritoshi Funasako, Pavel Hala, Jan Skoda, and Petr Neuzil. "PO-06-159 RAPID LEFT ATRIAL ANATOMICAL RENDERING AND PULMONARY VEIN ISOLATION USING A NOVEL CONFORMABLE “SINGLE-SHOT” PULSED FIELD ABLATION CATHETER." Heart Rhythm 21, no. 5 (May 2024): S647. http://dx.doi.org/10.1016/j.hrthm.2024.03.1602.

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