Статті в журналах: "Local ablation"

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Wada, Takuya, Katsutoshi Sugimoto, Kentaro Sakamaki, Hiroshi Takahashi, Tatsuya Kakegawa, Yusuke Tomita, Masakazu Abe, Yu Yoshimasu, Hirohito Takeuchi, and Takao Itoi. "Comparisons of Radiofrequency Ablation, Microwave Ablation, and Irreversible Electroporation by Using Propensity Score Analysis for Early Stage Hepatocellular Carcinoma." Cancers 15, no. 3 (January 25, 2023): 732. http://dx.doi.org/10.3390/cancers15030732.

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Background: Despite the diversity of thermal ablations, such as radiofrequency ablation (RFA) and microwave ablation (MWA), and non-thermal ablation, such as irreversible electroporation (IRE) cross-comparisons of multiple ablative modalities for hepatocellular carcinoma (HCC) treatment remain scarce. Thus, we investigated the therapeutic outcomes of different three ablation modalities in the treatment of early stage HCC. Methods: A total of 322 consecutive patients with 366 HCCs (mean tumor size ± standard deviation: 1.7 ± 0.9 cm) who underwent RFA (n = 216, 59.0%), MWA (n = 91, 28.3%), or IRE (n = 15, 4.7%) were included. Local tumor progression (LTP) rates for LTP were compared among the three modalities. Propensity score-matched analysis was used to reduce selection bias. Results: A significant difference in 2-year LTP rates between the IRE and RFA groups (IRE, 0.0% vs. RFA, 45.0%; p = 0.005) was found. There was no significant difference in 2-year LTP rates between the IRE and MWA groups (IRE, 0.0% vs. MWA, 25.0%; p = 0.103) as well as between the RFA and MWA groups (RFA, 18.2% vs. MWA, 20.6%; p = 0.586). Conclusion: IRE provides better local tumor control than RFA as a first-line therapeutic option for small perivascular HCC.

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Inoue, Tadahisa, and Masashi Yoneda. "Recent Updates on Local Ablative Therapy Combined with Chemotherapy for Extrahepatic Cholangiocarcinoma: Photodynamic Therapy and Radiofrequency Ablation." Current Oncology 30, no. 2 (February 9, 2023): 2159–68. http://dx.doi.org/10.3390/curroncol30020166.

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Although chemotherapy constitutes of the first-line standard therapy for unresectable extrahepatic cholangiocarcinoma, the treatment outcomes are unsatisfactory. In recent years, local ablative therapy, which is delivered to the cholangiocarcinoma lesion via the percutaneous or endoscopic approach, has garnered attention for the treatment of unresectable, extrahepatic cholangiocarcinoma. Local ablative therapy, such as photodynamic therapy and radiofrequency ablation, can achieve local tumor control. A synergistic effect may also be expected when local ablative therapy is combined with chemotherapy. However, it is a long way from being entrenched as an established therapeutic technique, and several unresolved problems persist, including the paucity of evidence comparing photodynamic therapy and radiofrequency ablation. Clinical application of photodynamic therapy and radiofrequency ablation requires sound comprehension and assimilation of the available evidence to truly benefit each individual patient. In this study, we reviewed the current status, issues, and future prospects of photodynamic therapy and radiofrequency ablation for extrahepatic cholangiocarcinoma, with a special focus on their combination with chemotherapy.

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Stone, Michael, and Bradford Wood. "Emerging Local Ablation Techniques." Seminars in Interventional Radiology 23, no. 1 (March 2006): 085–98. http://dx.doi.org/10.1055/s-2006-939844.

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Sparchez, Zeno, Tudor Mocan, Nadim All Hajjar, Adrian Bartos, Claudia Hagiu, Daniela Matei, Rares Craciun, Lavinia Patricia Mocan, Mihaela Sparchez, and Daniel Corneliu Leucuta. "Percutaneous ultrasound guided radiofrequency and microwave ablation in the treatment of hepatic metastases. A monocentric initial experience." Medical Ultrasonography 21, no. 3 (August 31, 2019): 217. http://dx.doi.org/10.11152/mu-1957.

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Aim: Percutaneous radiofrequency (RFA) and microwave ablation (MWA) are currently the best treatment options forpatients with liver metastases (LM) who cannot undergo a liver resection procedure. Presently, few studies have evaluated theefficacy of tumor ablation in beginner’s hands but none at all in hepatic metastasis. Our aim was to report the initial experiencewith ultrasound as a tool to guide tumor ablation in a low volume center with no experience in tumor ablation.Material and methods: We conducted a retrospective cohort study, on a series of 61 patients who had undergone percutaneous US-guided ablations for 82 LM between 2010 and 2015. Long term outcome predictors were assessed using univariate and multivariate analysis.Results: Complete ablation was achieved in 86.9% of cases (53/61). All MWA sessions (20/20) attained ablation margins >5mm, compared to 79% (49/62) for RFA sessions (p=0.031). Ablation time was significantly shorter for MWA, with a median duration of 10 minutes (range: 6-12) vs. 14 minutes (range: 10-19.5, p=0.003). There was no statistically significant difference in local tumor progression (LTP)-free survival rates between MWA and RFA (p=0.154). On univariate analysis, significant predictors for local recurrence were multiple metastases (p=0.013) and ablation margins <5 mm (p<.001), both retaining significance on multivariate analysis. Significant predictors for distant recurrence on both univariate and multivariate analysis were multiple metastases (p<0.001) and non-colorectal cancer metastases (p<0.05).Conclusion: A larger than 5 mm ablation size is critical for local tumor control. We favor the use of MWA due to its ability to achieve ablation in significantlyshorter times with less incomplete ablations.

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Kurup, A., Matthew Callstrom, and Michael Moynagh. "Thermal Ablation of Bone Metastases." Seminars in Interventional Radiology 35, no. 04 (October 2018): 299–308. http://dx.doi.org/10.1055/s-0038-1673422.

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AbstractImage-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.

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Frandon, Julien, Philippe Akessoul, Tarek Kammoun, Djamel Dabli, Hélène de Forges, Jean-Paul Beregi, and Joël Greffier. "Microwave Ablation of Liver, Kidney and Lung Lesions: One-Month Response and Manufacturer’s Charts’ Reliability in Clinical Practice." Sensors 22, no. 11 (May 24, 2022): 3973. http://dx.doi.org/10.3390/s22113973.

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Background: Microwave ablation systems allow for performing tumoral destruction in oncology. The objective of this study was to assess the early response and reliability of the microwave ablation zone size at one month for liver, kidney and lung lesions, as compared to the manufacturer’s charts. Methods: Patients who underwent microwave ablation with the EmprintTM ablation system for liver, kidney and lung lesions between June 2016 and June 2018 were retrospectively reviewed. Local response and ablation zone size (major, L, and minor, l, axes) were evaluated on the one-month follow-up imaging. Results were compared to the manufacturers’ charts using the Bland–Altman analysis. Results: Fifty-five patients (mean age 68 ± 11 years; 95 lesions) were included. The one-month complete response was 94%. Liver ablations showed a good agreement with subtle, smaller ablation zones (L: −2 ± 5.7 mm; l: −5.2 ± 5.6 mm). Kidney ablations showed a moderate agreement with larger ablations for L (L: 8.69 ± 7.94 mm; l: 0.36 ± 4.77 mm). Lung ablations showed a moderate agreement, with smaller ablations for l (L: −5.45 ± 4.5 mm; l: −9.32 ± 4.72 mm). Conclusion: With 94% of early complete responses, the system showed reliable ablations for liver lesions, but larger ablations for kidney lesions, and smaller for lung lesions.

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Sparchez, Zeno, Tudor Mocan, Pompilia Radu, Lavinia Patricia Mocan, Mihaela Sparchez, Daniel Corneliu Leucuta, and Nadim Al Hajjar. "Prognostic Factors after Percutaneous Radiofrequency Ablation in the Treatment of Hepatocellular Carcinoma. Impact of Incomplete Ablation on Recurrence and Overall Survival Rates." Journal of Gastrointestinal and Liver Diseases 27, no. 4 (December 31, 2018): 399–407. http://dx.doi.org/10.15403/jgld.2014.1121.274.pro.

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Aims: To report on the long-term impact of tumor and non-tumor related parameters on local recurrence, distant recurrence and survival in patients with naïve or recurrent type hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA).Methods: We performed 240 RFA sessions on 133 patients with 156 HCC nodules developed on a background of liver cirrhosis and analyzed the outcomes.Results: Contrast-enhanced ultrasound performed one month after RFA showed complete ablation in 119 out of 133 (89.65%) patients. With a median follow-up of 46 months, 3-, 5- and 7-year survival rates were 61.7%, 35.7%, and 22.6%, respectively. Previous ethanol injection and histological grade were significantly related to local tumor progression. Child-Pugh class, incomplete ablation, histological grade, previous ethanol injection, alpha-fetoprotein level before the treatment, and local recurrence were all significantly related to distant recurrence. Multivariate analysis demonstrated that age, Child-Pugh class, distant recurrence and multiple incomplete ablations were significantly related to survival.Conclusion: Radiofrequency ablation could be locally curative for HCC, resulting in a survival longer than 7 years. Previous ethanol injection and incomplete ablations were strongly associated with poor outcomes.

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Moskvicheva, L. I., D. V. Sidorov, M. V. Lozhkin, L. O. Petrov, and M. V. Zabelin. "Modern methods of ablation of malignant tumors of the liver." Research'n Practical Medicine Journal 5, no. 4 (December 22, 2018): 58–71. http://dx.doi.org/10.17709/2409-2231-2018-5-4-6.

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The purpose of this review is to demonstrate the possibility of performing various methods of thermal and non-thermal ablation in patients with primary and metastatic liver tumors on the basis of data available in the world medical literature.As conservative variants of local action in patients with non-resectable primary and secondary liver tumors and inoperable patients, various ablative techniques have been developed and used to achieve local control over the disease and increase the life expectancy of this group of patients. These include: radiofrequency ablation, microwave ablation, HIFU therapy, laser ablation, cryotherapy, chemical destruction of the tumor, irreversible electroporation, stereotactic radiation therapy.The effectiveness of these ablation methods depends on the size and localization of the tumor focus, and for thermal techniques — also on its location relative to large vessels. Ablative techniques have the maximum efficiency (in some cases, similar to surgical intervention) when exposed to early forms of primary cancer or secondary tumor formation of the liver in the presence of a solitary node with a maximum size up to 5 cm or 3 and less foci size up to 3 cm. The effectiveness of local destruction of tumor formations of the liver of larger diameter is increased by carrying out ablation by the second stage after performing chemoembolization of the hepatic artery or by combining various techniques of local action.The use of various modern methods of ablation of solid primary and secondary liver tumors in medical practice can expand the possibilities of antitumor treatment of this category of patients.

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Hui, Terrence CH, Justin Kwan, and Uei Pua. "Advanced Techniques in the Percutaneous Ablation of Liver Tumours." Diagnostics 11, no. 4 (March 24, 2021): 585. http://dx.doi.org/10.3390/diagnostics11040585.

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Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.

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Sweeney, Jennifer, Nainesh Parikh, Ghassan El-Haddad, and Bela Kis. "Ablation of Intrahepatic Cholangiocarcinoma." Seminars in Interventional Radiology 36, no. 04 (October 2019): 298–302. http://dx.doi.org/10.1055/s-0039-1696649.

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AbstractIntrahepatic cholangiocarcinoma is the second most common primary liver cancer but represents only a small portion of all primary liver cancers. At the time of diagnosis, patients are often not surgical candidates due to tumor burden of other comorbidities. In addition, there is a very high rate of tumor recurrence after resection. Local regional therapies, specifically ablative therapies of radiofrequency ablation, microwave ablation, cryoablation, and irreversible electroporation, have proven to be beneficial with other hepatic tumors. The purpose of this review is to provide an overview and update of the medical literature demonstrating ablative therapy as a treatment option for intrahepatic cholangiocarcinoma.

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Boyvat, Fatih. "Local Ablation for Hepatocellular Carcinoma." Experimental and Clinical Transplantation 12, Suppl 1 (March 2014): 55–59. http://dx.doi.org/10.6002/ect.25liver.l52.

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Hill, David J., Peter J. Maher, and David Lloyd. "Endometrial Ablation Under Local Analgesia." Australian and New Zealand Journal of Obstetrics and Gynaecology 32, no. 3 (February 13, 2008): 284–85. http://dx.doi.org/10.1111/j.1479-828x.1992.tb01969.x.

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Nakazawa, Takahide, Shigehiro Kokubu, Akitaka Shibuya, Koji Ono, Masaaki Watanabe, Hisashi Hidaka, Takeshi Tsuchihashi, and Katsunori Saigenji. "Radiofrequency Ablation of Hepatocellular Carcinoma: Correlation Between Local Tumor Progression After Ablation and Ablative Margin." American Journal of Roentgenology 188, no. 2 (February 2007): 480–88. http://dx.doi.org/10.2214/ajr.05.2079.

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Perrodin, Stéphanie F., Mariko M. Renzulli, Martin H. Maurer, Corina Kim-Fuchs, Daniel Candinas, Guido Beldi, and Anja Lachenmayer. "CAN MICROWAVE ABLATION BE AN ALTERNATIVE TO RESECTION FOR THE TREATMENT OF NEUROENDOCRINE LIVER METASTASES?" Endocrine Practice 26, no. 4 (April 2020): 378–87. http://dx.doi.org/10.4158/ep-2019-0394.

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Objective: Surgical resection of neuroendocrine tumor liver metastases has been proven to improve survival, but the benefit of microwave ablation as an alternative or adjunct to surgery has yet to be assessed. Our hypothesis is that ablation is equal to surgery in terms of local recurrence and survival. Methods: We conducted a retrospective analysis including all patients treated with microwave ablation and/or surgical resection for neuroendocrine liver metastases in our institution between 2008 and 2017. Results: A total of 47 patients and 68 treatments were analyzed, including 34 liver resections, 20 ablations, and 14 combined procedures. A total of 130 individual metastases were treated with ablation, representing a median of 4 per session (range 1–30). While no major complications occurred after ablation, we observed 11 minor and 3 major complications after open surgical resection ( P = .0135). Length of stay was significantly shorter after ablation ( P = .0008). The majority of patients (33/47, 70.2%) underwent curative procedures, 14 patients underwent (29.8%) debulking procedures. There was no difference in local recurrence rate between tumors treated with ablation or resection. Liver-only disease progression was detected in 29% of the patients and overall progression was detected in 66% of the patients. The mean survival was not significantly different between patients treated with ablation only versus resection with or without ablation ( P = .1570). Overall survival was mean 75.3 months (6 to 374 months). Conclusion: Depending on the extent of the liver metastases, microwave ablation might be a safe alternative or addition to resection for neuroendocrine tumor liver metastases with low morbidity and high local efficiency. Abbreviations: CT = computed tomography; MWA = microwave ablation; NET = neuroendocrine tumor; PET = positron emission tomography; RFA = radiofrequency ablation; RFS = recurrence-free survival; SMWA = stereotactic microwave ablation

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Vogel, Arndt, Oliver Waidmann, Tobias Müller, Gabriele Margareta Siegler, Thorsten Oliver Goetze, Enrico N. De Toni, Maria A. Gonzalez-Carmona, et al. "IMMULAB: A phase II trial of immunotherapy with pembrolizumab in combination with local ablation for patients with early-stage hepatocellular carcinoma (HCC)." Journal of Clinical Oncology 41, no. 4_suppl (February 1, 2023): 555. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.555.

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555 Background: Percutaneous ablation of neoplastic tissue by radiofrequency ablation (RFA), microwave ablation (MWA) or brachytherapy is considered a potentially curative treatment for early HCC, but recurrence rates are high. Local ablative therapies release immunogenic stimuli that can trigger an anti-tumoral immune response, which is, however, dampened by counter-regulatory mechanisms mediated through immune checkpoints, such as CTLA-4 and PD-1. Combining local therapies with immunotherapies may shift the balance to a more robust immunostimulatory response. We therefore hypothesized that peri-interventional treatment with pembrolizumab may synergize with and improve outcome of local ablative therapy. Methods: This single arm phase II trial investigates peri-interventional treatment with pembrolizumab combined with RFA/MWA or brachytherapy, or - as recommended for tumors larger than 3 cm – combined with TACE and RFA/MWA or brachytherapy in early-stage HCC with maintained liver function (Child Pugh A) who did not receive prior local or systemic therapy. Pembrolizumab (200mg, q3w) was administered intravenously for 2 cycles, followed by radiologic imaging and local therapy. Pembrolizumab was continued for up to 12 months. The primary efficacy endpoint was defined as overall response rate (ORR, RECIST 1.1) after 2 cycles of pembrolizumab and before local therapy while secondary endpoints are time to recurrence (TTR, defined as the length of time after performance of local ablation resulting in confirmed absence of viable tumor tissue until documented tumor recurrence), recurrence free survival and overall survival (OS) along with safety and tolerability. Results: 30 patients (pts, ECOG 0 or 1) were enrolled in 9 centers in Germany, with a median age of 70 years and a predominance of male pts (73.3%). All pts received at least 1 dose of study treatment and the median number of cycles was 13. ORR was 13.3%, with 6.7% complete responses (CR) and 6.7% partial responses (PR) after two cycles of pembrolizumab and before local ablation. Subsequent local ablation was performed in 25/30 pts. With ongoing follow-up median of 14 months (Sep 2022), provisional median overall survival time (mOS) was not reached and provisional median time to recurrence (TTR) was 17.41 months. No new safety signs were observed. Conclusions: The study did not meet its primary endpoint. The hypothesized ORR of 30% before local therapy was not reached. However, there is evidence for the efficacy of peri-interventional treatment with pembrolizumab combined with local ablative therapy without new safety signals. Our findings support further evaluation of this combination treatment in early-stage HCC. Clinical trial information: NCT03753659 .

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Ito, Toshikazu, Shoji Oura, Naohito Yamamoto, Shinji Nagamine, Masato Takahashi, Hirokazu Tanino, Noboru Yamamichi, et al. "Radiofrequency ablation (RFA) of breast cancer: A multicenter retrospective analysis." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 1119. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.1119.

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1119 Background: Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We performed a retrospective study of ultrasound-guided percutaneous radiofrequency ablation (RFA) of breast cancers to determine safety and complication related to this treatment. Methods: Four hundred and ninety-seven patients with core biopsy proven breast carcinoma in 10 institutions of non-surgical ablaton study group underwent RFA without surgical excision were enrolled in this study. Results: Mean patient age was 54 years (range 22 - 92 years). Mean tumor size was 1.6 cm. Four hundred and twenty-five tumors ( 86 %) were ≤ 2 cm. The median follow-up period was 50 months (range 3 – 92 months). The mean required for ablation was 19 minutes (range, 4- 72 minutes), and the average temperature of the tumor after ablation was 91 degrees Celsius. The local recurrence rate after RFA was higher in tumors of negative estrogen receptor (8 of 78, 10%) than in tumors of positive estrogen receptor (17 of 437, 4%; p<0.05), and was higher in tumors of positive HER2/neu than in tumors of negative HER2/neu (14.9% vs. 3.2%; p<0.01). The local recurrence rate after RFA was higher in tumors of positive node than in tumors of negative node (9.8% vs. 3.6%), and was higher in tumors without irradiation than in tumors with irradiation (18.2% vs. 3.2%; p<0.001). The local recurrence rate after RFA was higher in tumors of > 2 cm (13 of 72, 18%) than in tumors of ≤ 2 cm (11 of 425, 3%; p<0.001). RFA-relating adverse events were observed in 17 patients of local pain, 14 patients of skin burn and 4 patients of retraction of nipple. Conclusions: RFA is considered to be a safe and promising minimally invasive treatment of small breast cancer ≤ 2 cm in diameter. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.

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Vanagas, Tomas, Antanas Gulbinas, Juozas Pundzius, and Giedrius Barauskas. "Radiofrequency ablation of liver tumors (II): clinical application and outcomes." Medicina 46, no. 2 (February 10, 2010): 81. http://dx.doi.org/10.3390/medicina46020012.

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Radiofrequency ablation is one of the alternatives in the management of liver tumors, especially in patients who are not candidates for surgery. The aim of this article is to review applicability of radiofrequency ablation achieving complete tumor destruction, utility of imaging techniques for patients follow-up, indications for local ablative procedures, procedureassociated morbidity and mortality, and long-term results in patients with different tumors. The success of local thermal ablation consists in creating adequate volumes of tissue destruction with adequate clear margin, depending on improved delivery of radiofrequency energy and modulated tissue biophysiology. Different volumes of coagulation necrosis are achieved applying different types of electrodes, pulsing energy sources, utilizing sophisticated ablation schemes. Some additional methods are used to increase the overall deposition of energy through alterations in tissue electrical conductivity, to improve heat retention within the tissue, and to modulate tolerance of tumor tissue to hyperthermia. Contrast-enhanced computed tomography, magnetic resonance imaging, ultrasound or positron emission tomography are applied to control the effectiveness of radiofrequency ablation. The long-term results of radiofrequency ablation are controversial.

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ZHU, QINGYONG, CHENGGUANG ZHANG, and WEIBIN YANG. "THE INFLUENCE OF PERMEABILITY ON THE ABLATION PROCESS FOR AN ABLATIVE MATERIAL." Fractals 27, no. 06 (September 2019): 1950105. http://dx.doi.org/10.1142/s0218348x19501056.

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The heat and mass transfer in the ablation process is of great importance for the ablation protection engineering. Accurate temperature assessment can provide effective support for the design of thermal protection structure and ablative material of reentry hypersonic vehicle. In this work, we studied the effect of permeability on heat and mass transfer and ablation thermal protection of gases produced during ablation. Since the carbide formed by ablation of material is a typical porous medium, its structure has self-similarity and can be described by fractal theory. Taking into account the angle of global coordinates and the local coordinates, this paper derived the permeability in any direction as a function of three different fractal dimensions in [Formula: see text], [Formula: see text] and [Formula: see text] directions. In order to verify the correctness of this method, the new model is introduced into the ablation process. Aiming at the ablation process and the diffusion equation of pyrolysis gas in the carbide layer, the temperature, material density and pyrolysis gas density distribution of three-dimensional spherical head under different permeability were simulated numerically. It is found that the permeability of carbides formed by ablative reaction of ablative materials related to fractal structure has an effect on ablation process. From our preliminary results, the higher the permeability, the faster the ablation speed, and the more obvious the overall temperature rise is.

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Haider, Sameah, Jacob Pawloski, Hassan Fadel, Hesham Zakaria, Farhan Chaudhry, Seamus Bartlett, Michael Bazydlo, Steven Kalkanis, and Ian Lee. "SURG-16. PREDICTORS OF LOCAL CONTROL FOLLOWING LASER INTERSTITIAL THERMAL THERAPY FOR GLIAL TUMORS." Neuro-Oncology 22, Supplement_2 (November 2020): ii206—ii207. http://dx.doi.org/10.1093/neuonc/noaa215.863.

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Abstract INTRODUCTION Laser Interstitial thermal therapy (LITT) is a minimal-access procedure for intracranial tumors that are either refractory to standard treatment paradigms or difficult to access via conventional open surgery. OBJECTIVE To evaluate predictors of local disease control following LITT in patients with primary and secondary brain tumors. METHODS Single-center retrospective cohort study of all consecutive LITT ablations between 2014 and 2019. Demographic and procedural characteristics analyzed with respect to local disease control at 6 months. Chi-square tests for categorical variables, T-tests/Wilcoxon Rank-Sum tests for continuous variables for parametric and non-parametric data, respectively. Poisson regression models were used to approximate relative risk (RR) with 95% confidence intervals. RESULTS A total of 76 patients underwent LITT with a median follow up of 12.3 months; pathology at time of ablation was glioblastoma multiforme (GBM, 36%), WHO grade III primary CNS (24%), low grade CNS (20%), and metastatic lesions (19%) with respective local control rates of 26%, 20%, 29%, and 26%. Pathology of GBM (RR 0.46, 0.21-1.02, p=0.055) and a 5-year increase in age at the time of ablation (RR 0.91, 0.83-0.99, p=0.028) were associated with a lower likelihood of local control at 6 months. Preoperative Karnofsky performance status (KPS) of 100 (RR 2.04, 1.13-3.69, p=0.019) was associated with a higher likelihood of local control. Extent of ablation (EOA) demonstrated a direct relationship with local control; when EOA=100% local control was 59%, with this rate dropping down to 21% when EOA=90%. Tumor location, lesion volume, gender, BMI, ethnicity, or whether there existed multiple foci of disease at the time of ablation had no strong association with local control. CONCLUSION Our series demonstrates that preoperative performance status and age were strong predictors of local disease control following LITT. Incomplete ablation and histology of high-grade glioma portended a higher risk of local recurrence.

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Tsakok, Maria Theresa, Daniel Jones, Alice MacNeill, and Fergus Vincent Gleeson. "Is microwave ablation more effective than radiofrequency ablation in achieving local control for primary pulmonary malignancy?" Interactive CardioVascular and Thoracic Surgery 29, no. 2 (March 30, 2019): 283–86. http://dx.doi.org/10.1093/icvts/ivz044.

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Abstract A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘Is microwave ablation (MWA) more effective than radiofrequency ablation (RFA) in achieving local control for primary lung cancer?’. Altogether, 439 papers were found, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Both are thermal ablative techniques, with microwave ablation (MWA) the newer technique and radiofrequency ablation (RFA) with a longer track record. Lack of consensus with regard to definitions of technical success and efficacy and heterogeneity of study inclusions limits studies for both. The only direct comparison study does not demonstrate a difference with either technique in achieving local control. The quality of evidence for MWA is very limited by retrospective nature and heterogeneity in technique, power settings and tumour type. Tumour size and late-stage cancer were shown to be associated with higher rates of local recurrence in 1 MWA study. RFA studies were generally of a higher level of evidence comprising prospective trials, systematic review and meta-analysis. The recurrence rates for MWA and RFA overlapped, and for the included studies ranged between 16% and 44% for MWA and 9% and 58% for RFA. The current evidence, therefore, does not clearly demonstrate a benefit of MWA over RFA in achieving local control in primary lung cancer.

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Okada, Shuichi. "Local Ablation Therapy for Hepatocellular Carcinoma." Seminars in Liver Disease 19, no. 03 (1999): 323–28. http://dx.doi.org/10.1055/s-2007-1007121.

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Love, B., and R. McCorvey. "Office balloon ablation under local anesthesia." Journal of the American Association of Gynecologic Laparoscopists 5, no. 3 (August 1998): S27. http://dx.doi.org/10.1016/s1074-3804(05)80333-0.

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McCorvey, R., and BR Love. "Office hydrotherm ablation under local anesthesia." Journal of the American Association of Gynecologic Laparoscopists 6, no. 3 (August 1999): S35. http://dx.doi.org/10.1016/s1074-3804(99)80238-2.

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Mahnken, Andreas H., Philipp Bruners, and Rolf W. Günther. "Local Ablative Therapies in HCC: Percutaneous Ethanol Injection and Radiofrequency Ablation." Digestive Diseases 27, no. 2 (2009): 148–56. http://dx.doi.org/10.1159/000218347.

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Azegami, Koji, Shutarou Satake, Kaoru Okishige, Tetsuo Sasano, Hiroshi Ohira, Katsuhiro Yamashita, and Kazumasa Hiejima. "Local electrogram monitoring at the ablation site during radiofrequency catheter ablation." Japanese Journal of Electrocardiology 19, no. 4 (1999): 321–31. http://dx.doi.org/10.5105/jse.19.321.

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Bale, Reto, Daniel Putzer, and Peter Schullian. "Local Treatment of Breast Cancer Liver Metastasis." Cancers 11, no. 9 (September 11, 2019): 1341. http://dx.doi.org/10.3390/cancers11091341.

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Breast cancer represents a leading cause of death worldwide. Despite the advances in systemic therapies, the prognosis for patients with breast cancer liver metastasis (BCLM) remains poor. Especially in case of failure or cessation of systemic treatments, surgical resection for BCLMs has been considered as the treatment standard despite a lack of robust evidence of benefit. However, due to the extent and location of disease and physical condition, the number of patients with BCLM who are eligible for surgery is limited. Palliative locoregional treatments of liver metastases (LM) include transarterial embolization (TAE), transarterial chemoembolization (TACE), and selective internal radiotherapy (SIRT). Percutaneous thermal ablation methods, such as radiofrequency ablation (RFA) and microwave ablation (MWA), are considered potentially curative local treatment options. They are less invasive, less expensive and have fewer contraindications and complication rates than surgery. Because conventional ultrasound- and computed tomography-guided single-probe thermal ablation is limited by tumor size, multi-probe stereotactic radiofrequency ablation (SRFA) with intraoperative image fusion for immediate, reliable judgment has been developed in order to treat large and multiple tumors within one session. This review focuses on the different minimally invasive local and locoregional treatment options for BCLM and attempts to describe their current and future role in the multidisciplinary treatment setting.

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Campbell, Matthew T., Surena F. Matin, Rebecca Slack, Jing Jing Sun, Derek Ng Tang, Hong Chen, Jorge M. Blando, Li Zhang, Priya Rao, and Padmanee Sharma. "Ablative therapy to induce local and systemic immune changes in patients with metastatic renal cell carcinoma." Journal of Clinical Oncology 35, no. 6_suppl (February 20, 2017): 505. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.505.

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505 Background: Ablative therapy including cryoablation or radiofrequency ablation is a therapeutic option for small renal cell carcinomas (RCC) and provides effective palliation for symptomatic metastatic lesions, with reports of associated abscopal phenomenon in small numbers of patients. Pre-clinical animal modeling has suggested potential synergy with the use of ablative therapy and immune checkpoint blockade with ipilimumab. Methods: We performed retrospective analysis of 17 patients who underwent an ablative procedure followed later by nephrectomy. These samples were analyzed by IHC and gene expression studies. We also prospectively evaluated pre and post treatment blood samples from a different cohort of 13 patients. These samples were evaluated for immune cell subsets and cytokine profiles. Results: IHC studies revealed an increased frequency of PD-1 + immune cells in post-ablative tumor samples as compared to control samples. Gene expression studies also revealed higher expression of immune gene signatures as compared to control samples. Blood samples detected changes in regulatory T cell subsets and interleukin-6 cytokine levels in the short term, which normalized by 1 month post-ablation, suggested an active downregulation of the initial immune response. Based on these data, we initiated a clinical pilot study to treat patients with anti-CTLA-4 (tremelimumab) with or without cryoablation in patients with metastatic RCC. The primary endpoint of the trial will be safety. Secondary endpoints include objective response rate, progression free survival, and immune monitoring. A total of 30 patients, 15 in each arm, will be accrued. Initial data from the clinical trial will be presented. Conclusions: Ablative therapy causes immune changes that can be detected both at the tissue and systemic level. We hope to capitalize on these changes by combining immune checkpoint blockade and ablation in an ongoing prospective clinical trial.

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Bréhier, Germain, Louis Besnier, Anaïs Delagnes, Frédéric Oberti, Jérôme Lebigot, Christophe Aubé, and Anita Paisant. "Imaging after percutaneous thermal and non-thermal ablation of hepatic tumour: normal appearances, progression and complications." British Journal of Radiology 94, no. 1123 (July 1, 2021): 20201327. http://dx.doi.org/10.1259/bjr.20201327.

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The increasing number of liver tumours treated by percutaneous ablation leads all radiologists to be confronted with the difficult interpretation of post-ablation imaging. Radiofrequency and microwave techniques are most commonly used. Recently, irreversible electroporation treatments that do not induce coagulation necrosis but cellular apoptose and respect the collagen architecture of bile ducts and vessels have been introduced and lead to specific post-ablation features and evolution. Ablations cause ‘normal’ changes in ablation and periablation zones. It is necessary to know these post-ablation features to avoid the misinterpretation of recurrence or complication that would lead to unnecessary treatments. Another challenge for the radiologist is to detect as early as possible the residual unablated tumour or the disease progression (local progression and tumour seeding) that will require a new treatment. Finally, the complications, frequent or rarer, should be recognised to be managed adequately. The purpose of this article is therefore to describe the large spectrum of normal and pathological aspects related to the treatment of hepatic tumour by percutaneous thermal ablation and irreversible electroporation ablation.

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Ghahramani Z., Elmira, Peter D. Grimm, R. Cutler Quillin, Sameer H. Patel, Syed A. Ahmad, Shimul A. Shah, Nicholas S. Schoenleb, Ben Connolly, Bahar Saremi, and T. Douglas Mast. "In vivo thermal ablation control using three-dimensional echo decorrelation imaging in swine liver." Journal of the Acoustical Society of America 152, no. 4 (October 2022): A278. http://dx.doi.org/10.1121/10.0016262.

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In experiments modeling clinical thermal ablation of liver tumors, radiofrequency ablation (RFA) of swine liver was controlled using a three-dimensional (3D) ultrasound echo decorrelation imaging. Up to six ablations with target diameter 2 cm were done in each animal’s liver using a clinical RFA system (RITA/Angiodynamics, 50 W, 6–10 min). Paired sequential volumes of beamformed pulse-echo data (inter-frame time <50 ms) were acquired from a Siemens Acuson SC2000 scanner with a Z6Ms transesophageal matrix array and transferred via an Ethernet to a computer running a custom MATLAB program to compute 3D echo decorrelation images. When the average cumulative, motion-compensated echo decorrelation within the planned ablation zone exceeded a prespecified threshold determined from preliminary trials, ablation was ceased automatically. After each procedure, the animal’s liver was excised, uniformly sectioned, and optically scanned to reconstruct 3D ablation zones. Local ablation prediction was assessed using receiver operating characteristic (ROC) curve analysis comparing echo decorrelation images to co-registered ablation zones. To assess differences in outcomes, ablation zone volumes, ablation rates, Dice coefficients for measured versus targeted ablation zones, and ROC curves were statistically compared for controlled versus uncontrolled trials. The results indicate promise for control of in vivo thermal ablation using motion-corrected 3D echo decorrelation imaging.

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Nyamekye, Isaac K. "A practical approach to tumescent local anaesthesia in ambulatory endovenous thermal ablation." Phlebology: The Journal of Venous Disease 34, no. 4 (September 18, 2018): 238–45. http://dx.doi.org/10.1177/0268355518800191.

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Background Thermal ablation, usually performed with tumescent local anaesthesia (TLA), is the preferred method for varicose veins treatment. Tumescent local anaesthesia is always cited; however, little detail of the procedure is presented in publications. This retrospective audit of clinical tumescent local anaesthesia practice aims to provide detailed information on an important aspect of endovenous practice. Methods Patients who underwent three types of endothermal treatment (Venefit, Radiofrequency Induce Thermal Therapy and Endovenous Laser Ablation) to a single saphenous trunk using tumescent local anaesthesia were assessed. Differences in tumescent local anaesthesia volume per unit length of treated vein were assessed for the followings: type of saphenous trunk, length of vein treated, effect of additional phlebectomy and bilateral versus interval unilateral treatment for bilateral veins. Descriptive data are reported as mean and standard deviation, and groups were compared using the one-way ANOVA test. Results Between 2008 and 2014, single-saphenous-trunk ambulatory TLA thermal ablation was performed in 979 patients, mean age was 54 years. A total of 1229 limbs had truncal ablations and synchronous phlebectomy was performed in 470 limbs. No tumescent local anaesthesia-related complications occurred. There was no significant difference in standardised tumescent local anaesthesia volume per centimetre (ml) used for the three devices. Tumescent local anaesthesia volume per centimetre (ml) differed significantly between saphenous trunks. On average, a standard 10–12 ml/cm of tumescent local anaesthesia was used for saphenous trunks. Mean total tumescent local anaesthesia volume per patient, when treating the great saphenous vein alone, was 931 ml for bilateral and 425 ml for unilateral treatment. Conclusion This report of over 1000 endovenous procedures demonstrates safe performance of laser and radiofrequency treatments using tumescent local anaesthesia. Although no attempt was made to determine minimum volume requirements, a mean tumescent local anaesthesia volume of 10–12 ml/cm administered to the perivenous space provides adequate anaesthesia for truncal saphenous ablation.

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Slovak, Ryan, Junaid Raja, Meaghan Dendy Case, and Hyun S. Kim. "Interventional Oncology in Immuno-Oncology Part 1: Thermal Ablation." Digestive Disease Interventions 03, no. 02 (March 20, 2019): 143–54. http://dx.doi.org/10.1055/s-0039-1679935.

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AbstractThermal ablation occupies a unique position among the various modalities available to treat malignancies. Initially utilized as a minimally invasive form of palliation, ablative techniques are increasingly being recognized for their role in activating an immune response. Locally destructive, but not thoroughly extirpative, thermal ablation function to generate an in situ tumor vaccine capable of stimulating and enhancing both innate and adaptive immune responses. As monotherapy, the response engendered remains therapeutically insufficient, but newer data suggests that when used as an adjuvant or neoadjuvant, ablation may synergistically boost the anticancer immune response produced by other, sequentially acting immunotherapies. The purpose of this review is to discuss the local and systemic immunological effects induced by thermal ablation. Radio frequency, microwave, and cryoablation will all be considered in addition to focused ultrasound ablation.

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Chen, Angela, Nadine Abi-Jaoudeh, Min-Jung Lee, Jane B. Trepel, Udayan Guha, Elliot B. Levy, Venkatesh P. Krishnasamy, Bradford J. Wood, and Arun Rajan. "Thermal ablation for treatment of hepatic metastasis from thymic epithelial tumors (TETs)." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): e20000-e20000. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.e20000.

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e20000 Background: Thermal ablation [radiofrequency ablation (RFA), cryoablation, microwave ablation (MWA)] has been used effectively for control of hepatic metastases from various solid tumors. However, these interventions have not been systematically evaluated in patients (pts) with TETs. We present our experience of the safety and clinical efficacy of thermal ablation in pts with advanced TETs and limited sites of disease progression. Methods: Pts with metastatic TETs followed at the National Cancer Institute were considered for thermal ablation if extrathoracic disease progression was limited to 3 or fewer anatomic sites amenable to percutaneous thermal ablative techniques. Appropriate imaging studies were used to evaluate for recurrence, and recurrence-free survival (RFS) was calculated. Biopsies were performed prior to ablation to study mutational and signaling events that may predispose to benefit. Results: From November 2012 to June 2016, 11 metastases (9 liver, 2 chest wall) in 4 pts (3 male, 1 female; median age 59.5 (range, 59-67); 3 thymic carcinoma, 1 WHO B2 thymoma; all Masaoka stage IVB) were treated with thermal ablation (6 MWA, 3 RFA, 2 cryoablation). Median size of metastasis was 1.5 cm (range, 1-4 cm). Local recurrence occurred at 2 (18%) of 11 treated sites, 11.5 months and 10 months after thermal ablation. All pts experienced distant recurrence (1 mesenteric/pelvic mass, 1 lung, 1 malignant pleural effusion, 1 liver) with a median RFS of 7 months (range, 2.5-14). Treatment was well tolerated with no serious adverse events. One pt died due to disease progression 9 months after thermal ablation; 3 pts are alive at the time of reporting (23.5, 37.5 and 38 months after treatment). Conclusions: Thermal ablation is well tolerated and largely successful in achieving local control in pts with advanced, unresectable TETs. Further studies are needed to assess the clinical benefit of thermal ablation compared with systemic therapy and surgery in specific pts with recurrent, oligometastatic TETs. The exact role of thermal ablation tools remains to be defined in this population. The potential for local thermally-induced cell death to induce or augment immunogenic tumor cell death will be assessed and reported.

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Lang, Pencilla, Daniel R. Gomez, and David A. Palma. "Local Ablative Therapies in Oligometastatic NSCLC: New Data and New Directions." Seminars in Respiratory and Critical Care Medicine 41, no. 03 (May 25, 2020): 369–76. http://dx.doi.org/10.1055/s-0039-3400290.

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AbstractThe oligometastatic and oligoprogressive disease states have been recently recognized as common clinical scenarios in the management of non-small cell lung cancer (NSCLC). As a result, there has been increasing interest in treating these patients with locally ablative therapies including surgery, conventionally fractionated radiotherapy, stereotactic ablative radiotherapy, and radiofrequency ablation. This article provides an overview of oligometastatic and oligoprogressive disease in the setting of NSCLC and reviews the evidence supporting ablative treatment. Phase II randomized controlled trials and retrospective series suggest that ablative treatment of oligometastases may substantially improve progression-free survival and overall survival, and additional large randomized studies testing this hypothesis in a definitive context are ongoing. However, several challenges remain, including quantifying the possible benefits of ablative therapies for oligoprogressive disease and developing prognostic and predictive models to assist in clinical decision making.

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Pacella, Claudio Maurizio, Giampiero Francica, and Giovanni Giuseppe Di Costanzo. "Laser Ablation for Small Hepatocellular Carcinoma." Radiology Research and Practice 2011 (2011): 1–8. http://dx.doi.org/10.1155/2011/595627.

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Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and is increasingly detected at small size (<5 cm) owing to surveillance programmes in high-risk patients. For these cases, curative therapies such as resection, liver transplantation, or percutaneous ablation have been proposed. When surgical options are precluded, image-guided tumor ablation is recommended as the most appropriate therapeutic choice in terms of tumor local control, safety, and improvement in survival. Laser ablation (LA) represents one of currently available loco-ablative techniques: light is delivered via flexible quartz fibers of diameter from 300 to 600 μm inserted into tumor lesion through either fine needles (21g Chiba needles) or large-bore catheters. The thermal destruction of tissue is achieved through conversion of absorbed light (usually infrared) into heat. A range of different imaging modalities have been used to guide percutaneous laser ablation, but ultrasound and magnetic resonance imaging are most widely employed, according to local experience and resource availability. Available clinical data suggest that LA is highly effective in terms of tumoricidal capability with an excellent safety profile; the best results in terms of long-term survival are obtained in early HCC so that LA can be proposed not only in unresectable cases but, not differently from radiofrequency ablation, also as the first-line treatment.

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Minami, Yasunori, Tomohiro Minami, Kazuomi Ueshima, Yukinobu Yagyu, Masakatsu Tsurusaki, Takuya Okada, Masatoshi Hori, Masatoshi Kudo, and Takamichi Murakami. "Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration." Cancers 13, no. 6 (March 23, 2021): 1460. http://dx.doi.org/10.3390/cancers13061460.

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Background: We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. Methods: A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. Results: The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. Conclusion: Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy.

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Hui, Terrence Chi Hong, Ming Yann Lim, Amit Anand Karandikar, Siu Cheng Loke, and Uei Pua. "A Technical Guide to Palliative Ablation of Recurrent Cancers in the Deep Spaces of the Suprahyoid Neck." Seminars in Interventional Radiology 39, no. 02 (April 2022): 184–91. http://dx.doi.org/10.1055/s-0042-1745764.

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AbstractTreatment options for patients with recurrent head and neck cancer, whether locoregional recurrence of previously treated head and neck cancer or secondary primary malignancy, are limited. Percutaneous ablation is a minimally invasive procedure that can be used with palliative intent in the head and neck to achieve symptomatic relief and local tumor control, potentially fulfilling treatment gaps of current standard of care options. Image guidance is key when navigating the deep spaces of the neck with special attention paid to critical structures within the carotid sheath. This review article provides an overview and highlights the important nuances of performing percutaneous ablations in the head and neck. It covers general principles, ablative modalities, image guidance, procedural technique, expected outcomes, and possible complications.

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Yamashita, Shingo, Tohru Beppu, Satoshi katagiri, and Masakazu Yamamoto. "Current status of local ablation therapy for liver metastasis -Radiofrequency ablation therapy-." Journal of Microwave Surgery 37, no. 4 (2020): 1–7. http://dx.doi.org/10.3380/jmicrowavesurg.37.4.

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Chang, Stephen KY, Wah Wah Hlaing, Liangjing Yang, and Chee Kong Chui. "Current Technology in Navigation and Robotics for Liver Tumours Ablation." Annals of the Academy of Medicine, Singapore 40, no. 5 (May 15, 2011): 231–36. http://dx.doi.org/10.47102/annals-acadmedsg.v40n5p231.

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Radiofrequecy ablation is the most widely used local ablative therapy for both primary and metastatic liver tumours. However, it has limited application in the treatment of large tumours (tumours >3cm) and multicentric tumours. In recent years, many strategies have been developed to extend the application of radiofrequency ablation to large tumours. A promising approach is to take advantage of the rapid advancement in imaging and robotic technologies to construct an integrated surgical navigation and medical robotic system. This paper presents a review of existing surgical navigation methods and medical robots. We also introduce our current developed model — Transcutaneous Robot-assisted Ablation-device Insertion Navigation System (TRAINS). The clinical viability of this prototyped integrated navigation and robotic system for large and multicentric umors is demonstrated using animal experiments. Keywords: Computer aided surgery, Liver, Radiofrequency ablation

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Laimer, Gregor, Nikolai Jaschke, Peter Schullian, Daniel Putzer, Gernot Eberle, Marco Solbiati, Luigi Solbiati, S. Nahum Goldberg, and Reto Bale. "Volumetric assessment of the periablational safety margin after thermal ablation of colorectal liver metastases." European Radiology 31, no. 9 (January 14, 2021): 6489–99. http://dx.doi.org/10.1007/s00330-020-07579-x.

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Abstract Objectives To retrospectively assess the periablational 3D safety margin in patients with colorectal liver metastases (CRLM) referred for stereotactic radiofrequency ablation (RFA) and to evaluate its influence on local treatment success. Methods Forty-five patients (31 males; mean age 64.5 [range 31–87 years]) with 76 CRLM were treated with stereotactic RFA and retrospectively analyzed. Image fusion of pre- and post-interventional contrast-enhanced CT scans using a non-rigid registration software enabled a retrospective assessment of the percentage of predetermined periablational 3D safety margin and CRLM successfully ablated. Periablational safety zones (1–10 mm) and percentage of periablational zone ablated were calculated, analyzed, and compared with subsequent tumor growth to determine an optimal safety margin predictive of local treatment success. Results Mean overall follow-up was 36.1 ± 18.5 months. Nine of 76 CRLMs (11.8%) developed local tumor progression (LTP) with mean time to LTP of 18.3 ± 11.9 months. Overall 1-, 2-, and 3-year cumulative LTP-free survival rates were 98.7%, 90.6%, and 88.6%, respectively. The periablational safety margin assessment proved to be the only independent predictor (p < 0.001) of LTP for all calculated safety margins. The smallest safety margin 100% ablated displaying no LTP was 3 mm, and at least 90% of a 6-mm circumscribed 3D safety margin was required to achieve complete ablation. Conclusions Volumetric assessment of the periablational safety margin can be used as an intraprocedural tool to evaluate local treatment success in patients with CRLM referred to stereotactic RFA. Ablations achieving 100% 3D safety margin of 3 mm and at least 90% 3D safety margin of 6 mm can predict treatment success. Key Points • Volumetric assessment of the periablational safety margin can be used as an intraprocedural tool to evaluate local treatment success following thermal ablation of colorectal liver metastases. • Ablations with 100% 3D periablational safety margin of 3 mm and ablations with at least 90% 3D safety margin of 6 mm can be considered indications of treatment success. • Image fusion of pre- and post-interventional CT scans with the software used in this study is feasible and could represent a useful tool in daily clinical practice.

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Lin, Shi-Ming. "Local Ablation for Hepatocellular Carcinoma in Taiwan." Liver Cancer 2, no. 2 (2013): 73–83. http://dx.doi.org/10.1159/000343843.

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Bain, C., KC Cooper, and DE Parkin. "Microwave endometrial ablation performed under local anesthetic." Journal of the American Association of Gynecologic Laparoscopists 6, no. 3 (August 1999): S4. http://dx.doi.org/10.1016/s1074-3804(99)80128-5.

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Muiño, Coralia Bueno, José Ángel García-Sáenz, Ernesto Santos Martín, Javier Sastre, Julio Mayol, and Eduardo Díaz-Rubio. "Successful rectal cancer local recurrence radiofrequency ablation." Clinical and Translational Oncology 10, no. 5 (May 2008): 300–302. http://dx.doi.org/10.1007/s12094-008-0202-0.

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Bianchi, Lorenzo, Pietro Piazza*, Riccardo Schiavina, Francesco Chessa, Amelio Ercolino, Matteo Droghetti, Alessandro Colella, et al. "PD08-10 LOCAL ABLATION OF RENAL TUMORS." Journal of Urology 203 (April 2020): e172. http://dx.doi.org/10.1097/ju.0000000000000835.010.

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Andrews, Peter J., and Abdul Latif. "Outpatient laser tonsillar ablation under local anaesthetic." European Archives of Oto-Rhino-Laryngology 261, no. 10 (December 17, 2003): 551–54. http://dx.doi.org/10.1007/s00405-003-0718-4.

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Feng, Bing, and Ping Liang. "Local thermal ablation of renal cell carcinoma." European Journal of Radiology 81, no. 3 (March 2012): 437–40. http://dx.doi.org/10.1016/j.ejrad.2010.12.056.

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Vogel, Arndt, Thorsten Oliver Goetze, Guido Hausner, Michael Geißler, Gabriele Margareta Siegler, Ludwig Fischer von Weikersthal, Angelika M. R. Kestler, et al. "The IMMULAB trial: A phase II trial of immunotherapy with pembrolizumab in combination with local ablation for patients with early stage hepatocellular carcinoma (HCC)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): TPS4159. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.tps4159.

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TPS4159 Background: The investigator-initiated IMMULAB study investigates the clinical activity of peri-interventional treatment with the anti-PD1 antibody pembrolizumab in HCC patients who are candidates for local ablation via either radiofrequency ablation (RFA), microwave ablation (MWA) or brachytherapy, or - as recommended for tumor larger than 3 cm – by combination with TACE. Patients with extrahepatic disease are excluded. Local ablation is known to induce tumor destruction with subsequent antigen release resulting in host adaptive immune responses. However, tumors could quickly overcome the immune responses by upregulating PD-L1/PD-1 expression and inhibiting the function of CD8+ and CD4+ T cells. Thus, combination of local ablation with an anti-PD1 antibody might display interesting effects by activating immune cells and disabling immune inhibitory mechanisms at the same time. Methods: This is a prospective investigator initiated single-arm multicenter phase II trial investigating immunotherapy with the PD-1 inhibitor pembrolizumab in combination with local ablation in early stage hepatocellular carcinoma (HCC). Patients with a child-pugh classification score ≤ 6, including high risk candidates for local ablation (defined as patients having ≤ 5 tumor nodules with diameters ≤ 7cm [longest axis] each OR patients with vascular infiltration) receive 200mg pembrolizumab i.v. q3w for 2 cycles. Thereafter, radiologic imaging is followed by local ablation on day 1 of cycle 3. Further pembrolizumab (200mg) is applied 2 days after ablation and thereafter every 3 weeks (q3w) for a total treatment duration of up to 12 months. It is planned to enroll 30 pts. Primary efficacy endpoint is the overall response rate (RECIST 1.1) after 2 cycles of pembrolizumab and before performing local ablation aiming in the conversion / downstaging of borderline candidates by pre-interventional treatment with pembrolizumab. Overall recruitment has started; currently (Feb 2021) 18 of 30 planned patients have been enrolled. Clinical trial information: NCT03753659.

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Cho, Young Chul, Ki Baek Lee, Su Jung Ham, Jin Hwa Jung, Yubeen Park, Dong-Sung Won, Kyung Won Kim, and Jung-Hoon Park. "Feasibility of a Drug-Releasing Radiofrequency Ablation System in a Porcine Liver Model." Applied Sciences 11, no. 18 (September 7, 2021): 8301. http://dx.doi.org/10.3390/app11188301.

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The objective of this study was to investigate the feasibility of a newly developed anticancer drug-releasing radiofrequency ablation (RFA) system in a porcine liver model. A 15-gauge drug-releasing cooled wet electrode (DRCWE) was newly developed to improve the RFA efficacy for creating a large ablation as well as for simultaneously delivering an anticancer drug to the tumor margin. Nine ablations in three pigs were performed by the DRCWE. The sectioned liver specimens were evaluated by measuring the ablation zone by a positron emission tomography/magnetic resonance imaging examination to investigate whether 18F-fluorodeoxyglucose was exactly diffused. Volumes of the ablation zones released drug injection volumes, circularity, retention rate defined as the ratio between an estimated and injection dose, and the standard uptake value were assessed. The drug-releasing RFA was technically successful without procedural-related complications. During the procedure, the color changes of the ablated zones of the liver were observed in all specimens. The mean drug injection volume was higher than the ablated volumes (17.21 ± 2.85 vs. 15.22 ± 2.30 cm3) and the circularity was 0.72 ± 0.08. Moreover, the retention rate was 72.89% ± 4.22% and the mean standard uptake value was 0.44 ± 0.05. The drug-releasing RFA system was feasible not only for local ablation but also for the delivery of anticancer drugs. The results of this study indicate that this novel strategy of localized RFA with a drug delivery system could be a promising option for the prevention of local recurrence rates.

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Oosterveer, Timo T. M., Gonnie C. M. van Erp, Pim Hendriks, Alexander Broersen, Christiaan G. Overduin, Carla S. P. van Rijswijk, Arian R. van Erkel, et al. "Study Protocol PROMETHEUS: Prospective Multicenter Study to Evaluate the Correlation Between Safety Margin and Local Recurrence After Thermal Ablation Using Image Co-registration in Patients with Hepatocellular Carcinoma." CardioVascular and Interventional Radiology 45, no. 5 (March 1, 2022): 606–12. http://dx.doi.org/10.1007/s00270-022-03075-5.

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Abstract Purpose The primary objective is to determine the minimal ablation margin required to achieve a local recurrence rate of < 10% in patients with hepatocellular carcinoma undergoing thermal ablation. Secondary objectives are to analyze the correlation between ablation margins and local recurrence and to assess efficacy. Materials and Methods This study is a prospective, multicenter, non-experimental, non-comparative, open-label study. Patients > 18 years with Barcelona Clinic Liver Cancer stage 0/A hepatocellular carcinoma (or B with a maximum of two lesions < 5 cm each) are eligible. Patients will undergo dual-phase contrast-enhanced computed tomography directly before and after ablation. Ablation margins will be quantitatively assessed using co-registration software, blinding assessors (i.e. two experienced radiologists) for outcome. Presence and location of recurrence are evaluated independently on follow-up scans by two other experienced radiologists, blinded for the quantitative margin analysis. A sample size of 189 tumors (~ 145 patients) is required to show with 80% power that the risk of local recurrence is confidently below 10%. A two-sided binomial z-test will be used to test the null hypothesis that the local recurrence rate is ≥ 10% for patients with a minimal ablation margin ≥ 2 mm. Logistic regression will be used to find the relationship between minimal ablation margins and local recurrence. Kaplan–Meier estimates are used to assess local and overall recurrence, disease-free and overall survival. Discussion It is expected that this study will result in a clear understanding of the correlation between ablation margins and local recurrence. Using co-registration software in future patients undergoing ablation for hepatocellular carcinoma may improve intraprocedural evaluation of technical success. Trial registration The Netherlands Trial Register (NL9713), https://www.trialregister.nl/trial/9713.

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Paiella, Salvatore, Roberto Salvia, Marco Ramera, Roberto Girelli, Isabella Frigerio, Alessandro Giardino, Valentina Allegrini, and Claudio Bassi. "Local Ablative Strategies for Ductal Pancreatic Cancer (Radiofrequency Ablation, Irreversible Electroporation): A Review." Gastroenterology Research and Practice 2016 (2016): 1–10. http://dx.doi.org/10.1155/2016/4508376.

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Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis. Locally advanced pancreatic cancer (LAPC) accounts for the 40% of the new diagnoses. Current treatment options are based on chemo- and radiotherapy regimens. Local ablative techniques seem to be the future therapeutic option for stage-III patients with PDAC. Radiofrequency Ablation (RFA) and Irreversible Electroporation (IRE) are actually the most emerging local ablative techniques used on LAPC. Initial clinical studies on the use of these techniques have already demonstrated encouraging results in terms of safety and feasibility. Unfortunately, few studies on their efficacy are currently available. Even though some reports on the overall survival are encouraging, randomized studies are still required to corroborate these findings. This study provides an up-to-date overview and a thematic summary of the current available evidence on the application of RFA and IRE on PDAC, together with a comparison of the two procedures.

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van Amerongen, M. J., P. Mariappan, P. Voglreiter, R. Flanagan, S. F. M. Jenniskens, M. Pollari, M. Kolesnik, M. Moche, and J. J. Fütterer. "Software-based planning of ultrasound and CT-guided percutaneous radiofrequency ablation in hepatic tumors." International Journal of Computer Assisted Radiology and Surgery 16, no. 6 (May 11, 2021): 1051–57. http://dx.doi.org/10.1007/s11548-021-02394-1.

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Abstract Objectives Radiofrequency ablation (RFA) can be associated with local recurrences in the treatment of liver tumors. Data obtained at our center for an earlier multinational multicenter trial regarding an in-house developed simulation software were re-evaluated in order to analyze whether the software was able to predict local recurrences. Methods Twenty-seven RFA ablations for either primary or secondary hepatic tumors were included. Colorectal liver metastases were shown in 14 patients and hepatocellular carcinoma in 13 patients. Overlap of the simulated volume and the tumor volume was automatically generated and defined as positive predictive value (PPV) and additionally visually assessed. Local recurrence during follow-up was defined as gold standard. Sensitivity and specificity were calculated using the visual assessment and gold standard. Results Mean tumor size was 18 mm (95% CI 15–21 mm). Local recurrence occurred in 5 patients. The PPV of the simulation showed a mean of 0.89 (0.84–0.93 95% CI). After visual assessment, 9 incomplete ablations were observed, of which 4 true positives and 5 false positives for the detection of an incomplete ablation. The sensitivity and specificity were, respectively, 80% and 77% with a correct prediction in 78% of cases. No significant correlation was found between size of the tumor and PPV (Pearson Correlation 0.10; p = 0.62) or between PPV and recurrence rates (Pearson Correlation 0.28; p = 0.16). Conclusions The simulation software shows promise in estimating the completeness of liver RFA treatment and predicting local recurrence rates, but could not be performed real-time. Future improvements in the field of registration could improve results and provide a possibility for real-time implementation.

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