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The Oncologist Oct 2019This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only... (Review)
Review
This article provides an overview of radiofrequency ablation (RFA) and microwave ablation (MWA) for treatment of primary liver tumors and hepatic metastasis. Only studies reporting RFA and MWA safety and efficacy on liver were retained. We found 40 clinical studies that satisfied the inclusion criteria. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive to treat hepatic tumors. According to the literature, the overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with hepatocellular carcinoma (HCC) treated with RFA vary between 53.2 ± 3.0 months and 66 months, between 59.8% and 63.1%, between 2% and 10.5%, between 22.0 ± 2.6 months and 39 months, and between 0% and 1.2%, respectively. According to the literature, overall survival, local recurrence, complication rates, disease-free survival, and mortality in patients with HCC treated with MWA (compared with RFA) vary between 22 months for focal lesion >3 cm (vs. 21 months) and 50 months for focal lesion ≤3 cm (vs. 27 months), between 5% (vs. 46.6%) and 17.8% (vs. 18.2%), between 2.2% (vs. 0%) and 61.5% (vs. 45.4%), between 14 months (vs. 10.5 months) and 22 months (vs. no data reported), and between 0% (vs. 0%) and 15% (vs. 36%), respectively. According to the literature, the overall survival, local recurrence, complication rates, and mortality in liver metastases patients treated with RFA (vs. MWA) are not statistically different for both the survival times from primary tumor diagnosis and survival times from ablation, between 10% (vs. 6%) and 35.7% (vs. 39.6), between 1.1% (vs. 3.1%) and 24% (vs. 27%), and between 0% (vs. 0%) and 2% (vs. 0.3%). MWA should be considered the technique of choice in selected patients, when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size. IMPLICATIONS FOR PRACTICE: Although technical features of the radiofrequency ablation (RFA) and microwave ablation (MWA) are similar, the differences arise from the physical phenomenon used to generate heat. RFA has become an established treatment modality because of its efficacy, reproducibility, low complication rates, and availability. MWA has several advantages over RFA, which may make it more attractive than RFA to treat hepatic tumors. The benefits of MWA are an improved convection profile, higher constant intratumoral temperatures, faster ablation times, and the ability to use multiple probes to treat multiple lesions simultaneously. MWA should be considered the technique of choice when the tumor is ≥3 cm in diameter or is close to large vessels, independent of its size.
Topics: Female; Humans; Liver Neoplasms; Male; Microwaves; Radiofrequency Ablation; Survival Analysis
PubMed: 31217342
DOI: 10.1634/theoncologist.2018-0337 -
Techniques in Vascular and... Jun 2020
Topics: Ablation Techniques; Cryosurgery; Electroporation; Humans; Medical Oncology; Microwaves; Neoplasms; Radiofrequency Ablation; Radiology, Interventional
PubMed: 32591187
DOI: 10.1016/j.tvir.2020.100671 -
Radiology May 2023Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However,...
Background Microwave ablation (MWA) has achieved favorable results in the treatment of papillary thyroid microcarcinoma (PTMC) confined in glandular parenchyma. However, studies on the outcome of MWA for PTMC with US-detected capsular invasion remain unclarified in the literature. Purpose To compare the feasibility, effectiveness, and safety of MWA in the treatment of PTMC with and without US-detected capsular invasion. Materials and Methods Participants from 12 hospitals with a PTMC maximal diameter of 1 cm or less without US- or CT-detected lymph node metastasis (LNM) who planned to undergo MWA were enrolled in this prospective study between December 2019 and April 2021. All tumors were evaluated with preoperative US and were divided into those with and those without capsular invasion. The participants were observed until July 1, 2022. The primary end points, including technical success and disease progression, and the secondary end points, including treatment parameters, complications, and tumor shrinkage during follow-up, were compared between the two groups, and multivariable regression was performed. Results After exclusion, 461 participants (mean age, 43 years ± 11 [SD]; 337 women) were included: 83 with and 378 without capsular invasion. After one participant with capsular invasion aborted MWA because of technical failure, 82 participants with and 378 participants without capsular invasion (mean tumor volume, 0.1 mL ± 0.1 vs 0.1 mL ± 0.1; = .07) were analyzed with a mean follow-up period of 20 months ± 4 (range, 12-25 months) and 21 months ± 4 (range, 11-26 months), respectively. In those with and those without capsular invasion, comparable technical success rates were achieved (99% [82 of 83] vs 100% [378 of 378], = .18), with one and 11 complications, respectively (1% [one of 82] vs 3% [11 of 378], = .38). There was no evidence of differences in disease progression (2% [one of 82] vs 1% [four of 378]; = .82) or tumor shrinkage (mean, 97% ± 8 [SD] vs 96% ± 13; = .58). Conclusion Microwave ablation was feasible in the treatment of papillary thyroid microcarcinoma with US-detected capsular invasion and showed comparable short-term efficacy with or without the presence of capsular invasion. © RSNA, 2023 Clinical trial registration no. NCT04197960
Topics: Humans; Female; Adult; Prospective Studies; Microwaves; Thyroid Neoplasms; Radiofrequency Ablation; Retrospective Studies
PubMed: 36880949
DOI: 10.1148/radiol.220661 -
Advanced Drug Delivery Reviews 2020Local application of hyperthermia has a myriad of effects on the tumor microenvironment as well as the host's immune system. Ablative hyperthermia... (Review)
Review
Local application of hyperthermia has a myriad of effects on the tumor microenvironment as well as the host's immune system. Ablative hyperthermia (typically > 55 °C) has been used both as monotherapy and adjuvant therapy, while mild hyperthermia treatment (39-45 °C) demonstrated efficacy as an adjuvant therapy through enhancement of both chemotherapy and radiation therapy. Clinical integration of hyperthermia has especially great potential in pediatric oncology, where current chemotherapy regimens have reached maximum tolerability and the young age of patients implies significant risks of late effects related to therapy. Furthermore, activation of both local and systemic immune response by hyperthermia suggests that hyperthermia treatments could be used to enhance the anticancer effects of immunotherapy. This review summarizes the state of current applications of hyperthermia in pediatric oncology and discusses the use of hyperthermia in the context of other available treatments and promising pre-clinical research.
Topics: DNA Repair-Deficiency Disorders; Drug Delivery Systems; High-Intensity Focused Ultrasound Ablation; Humans; Hyperthermia, Induced; Immune System; Liposomes; Microsatellite Instability; Microwaves; Neoplasms; Pediatrics; Tumor Microenvironment; Ultrasonography
PubMed: 33203538
DOI: 10.1016/j.addr.2020.10.016 -
Advanced Science (Weinheim,... Jun 2022Minimally invasive thermal therapies have been attempted in the treatment of breast cancer, and the immune response induced by these therapies has not been fully... (Clinical Trial)
Clinical Trial
Minimally invasive thermal therapies have been attempted in the treatment of breast cancer, and the immune response induced by these therapies has not been fully reported. A clinical trial is performed to determine the effect of microwave ablation (MWA) in the treatment of early-stage breast cancer. The authors perform single-cell RNA sequencing on peripheral blood mononuclear cells (PBMCs) from six patients before and after ablation. NK and CD8 T cells are activated by MWA of breast cancer, with the increased inhibitory signature of CD8 T cells but not dysfunctional. Enhanced co-stimulatory signature of CD4 T cells is observed and increased frequency of ICOS CD4 T cells after MWA is confirmed by flow cytometric analysis. After ablation, T-cell clones expand with increased T-cell receptor diversities. Activated antigen receptor-mediated signaling pathways are found in B cells. Enhanced interactions between B cells and CD4 T cells are found, indicating that B cells are important antigen-presenting cells that initiate CD4 T cells in MWA-induced immune response. Blockade of CTLA-4 or PD-1 of post-MWA PBMCs show higher T-cell activity than that of pre-MWA PBMCs. This study provide global characteristics of MWA-induced systemic immune response and pave a way for the identification of potential targets to improve the immune response.
Topics: Breast Neoplasms; CD8-Positive T-Lymphocytes; Female; Humans; Immunity; Leukocytes, Mononuclear; Microwaves
PubMed: 35403824
DOI: 10.1002/advs.202200033 -
Techniques in Vascular and... Jun 2020Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for... (Review)
Review
Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for small renal masses. However, given the comorbidities in this elderly population, not all patients are candidates for surgery. The development of minimally invasive ablative therapies has solved the surgical dilemma in this patient population. Furthermore, the 2017 American Urological Association guidelines recommends consideration of percutaneous image guided thermal ablation as a treatment option for masses smaller than 3 cm even in healthy individuals. Percutaneous image guided thermal ablation is an attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay. Various ablative modalities are available in clinical practice. This includes radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation. In this review, we focus on the most commonly used modalities including radiofrequency ablation and cryoablation and to a lesser extent microwave ablation and irreversible electroporation.
Topics: Carcinoma, Renal Cell; Cryosurgery; Electroporation; Humans; Kidney Neoplasms; Microwaves; Postoperative Complications; Radiofrequency Ablation; Risk Factors; Surgery, Computer-Assisted; Treatment Outcome; Tumor Burden
PubMed: 32591194
DOI: 10.1016/j.tvir.2020.100674 -
International Journal of Molecular... Jun 2020Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and its incidence is rising. Percutaneous locoregional therapies, such... (Review)
Review
Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide and its incidence is rising. Percutaneous locoregional therapies, such as radiofrequency ablation and microwave ablation, are widely used as curative treatment options for patients with small HCC, but their effectiveness remains restricted because of the associated high rate of recurrence, occurring in about 70% of patients at five years. These thermal ablation techniques have the particularity to induce immunomodulation by destroying tumours, although this is not sufficient to raise an effective antitumour immune response. Ablative therapies combined with immunotherapies could act synergistically to enhance antitumour immunity. This review aims to understand the different immune changes triggered by radiofrequency ablation and microwave ablation as well as the interest in using immunotherapies in combination with thermal ablation techniques as a tool for complementary immunomodulation.
Topics: Carcinoma, Hepatocellular; Clinical Trials as Topic; Combined Modality Therapy; Humans; Immunotherapy; Liver Neoplasms; Microwaves; Neoplasm Recurrence, Local; Radiofrequency Ablation; Treatment Outcome
PubMed: 32575734
DOI: 10.3390/ijms21124398 -
Der Radiologe Mar 2022Hepatocellular carcinoma (HCC) is fifth most common cancer worldwide. The German S3 guideline on the diagnosis and the treatment of hepatocellular and biliary carcinoma... (Review)
Review
BACKGROUND
Hepatocellular carcinoma (HCC) is fifth most common cancer worldwide. The German S3 guideline on the diagnosis and the treatment of hepatocellular and biliary carcinoma was recently revised.
OBJECTIVE
Determination of the current status of thermal ablation in HCC according to the German S3 guideline.
MATERIALS AND METHODS
Based on the current guideline and a selective literature search, the current status on indication and application of thermal ablation in HCC was revisited.
RESULTS
Radiofrequency ablation (RFA) and microwave ablation (MWA) provide similar survival when compared with surgery. Accordingly, RFA und MWA are considered first-line treatments for HCCs ≤ 3 cm in cirrhotic livers. For HCCs with diameters of 3-5 cm, a combination of transarterial chemoembolization and thermal ablation is recommended.
CONCLUSION
The current S3 guideline on diagnosis and treatment of HCC comprises relevant changes regarding thermal ablation in HCC. The overall role of interventional oncology procedures in the treatment of HCC was reinforced.
Topics: Carcinoma, Hepatocellular; Catheter Ablation; Chemoembolization, Therapeutic; Humans; Liver Neoplasms; Microwaves; Radiofrequency Ablation; Retrospective Studies; Treatment Outcome
PubMed: 35037979
DOI: 10.1007/s00117-021-00960-x -
Journal of Cancer Research and... Dec 2022Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of... (Review)
Review
Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases.
Topics: Humans; Catheter Ablation; Microwaves; Radiofrequency Ablation; Spinal Neoplasms
PubMed: 36647941
DOI: 10.4103/jcrt.jcrt_655_22 -
Cancer Radiotherapie : Journal de La... Aug 2020Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful... (Review)
Review
Therapeutic advances in oncology have led to longer survival in many forms of cancer, including those complicated by bone metastases. When a bone metastasis is painful or when there is a risk of fracture, interventional radiology procedures can be carried out for pain control and/or stabilisation. All of these techniques can be performed under local anaesthesia. Cementoplasty and vertebroplasty are stabilisation procedures consisting in the percutaneous injection of acrylic cement into a lytic bone lesion. The effect on pain can be explained by the consolidation of weakened, fractured or pre-fractured bone, but also to a lesser extent by the toxic, chemical and thermal effect of the cement. Tumour ablation techniques include alcoholisation or thermal ablation (by heat with radiofrequency and microwave or cold by cryoablation). Percutaneous thermal ablation of bone tumours is most often performed as a palliative measure resulting in a significant and lasting reduction in symptoms. Radiofrequency ablation consists in placing needles through which an electrical current passes. Microwave ablation acts by causing very high frequency vibrations of water molecules. Cryoablation releases argon gas at the tip of the needle, forming an "ice ball" effectively destroying tumour cells. Any of these techniques can be combined to radiation therapy, performed before or after radiation. Finally, tumour embolisation can have a goal of pain control, or preparation of surgery to reduce the risk of peroperative haemorrhage.
Topics: Anesthesia, Local; Bone Cements; Bone Neoplasms; Cancer Pain; Catheter Ablation; Cementoplasty; Cryosurgery; Embolization, Therapeutic; Ethanol; Fractures, Spontaneous; Hemorrhage; Humans; Microwaves; Nerve Block; Palliative Care; Radiofrequency Ablation; Radiology, Interventional; Solvents; Vertebroplasty
PubMed: 32527694
DOI: 10.1016/j.canrad.2020.04.006