Pulmonary Radiofrequency Ablation: Long-term Safety and Efficacy in 153 Patients
Caroline J. SimonDamian E. DupuyThomas A. DiPetrilloHoward SafranCharlotte GriecoThomas NgWilliam W. Mayo-Smith
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To retrospectively evaluate long-term survival, local tumor progression, and complication rates for all percutaneous computed tomographic (CT)-guided lung tumor radiofrequency (RF) ablations performed at a tertiary care cancer hospital in patients who refused or who were not candidates for surgery.This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Between 1998 and 2005, 153 consecutive patients (mean age, 68.5 years; range, 17-94 years) with 189 primary or metastatic medically inoperable lung cancers underwent percutaneous fluoroscopic CT-guided RF ablation. Clinical outcomes were compiled on the basis of review of medical records, imaging follow-up reports, and any biopsy-proved residual or recurrent disease (when available). Kaplan-Meier method was used to estimate overall survival and disease-free survival (progression) as a function of time since RF ablation. Comparisons between survival functions were performed by using the log-rank statistic; P < .05 was considered to indicate a significant difference.The overall 1-, 2-, 3-, 4-, and 5-year survival rates, respectively, for stage I non-small cell lung cancer were 78%, 57%, 36%, 27%, and 27%; rates for colorectal pulmonary metastasis were 87%, 78%, 57%, 57%, and 57%. The 1-, 2-, 3-, 4-, and 5-year local tumor progression-free rates, respectively, were 83%, 64%, 57%, 47%, and 47% for tumors 3 cm or smaller and 45%, 25%, 25%, 25%, and 25% for tumors larger than 3 cm. The difference between the survival curves associated with large (>3 cm) and small (< or =3 cm) tumors was significant (P < .002). The overall pneumothorax rate was 28.4% (52 of 183 ablation sessions), with a 9.8% (18 of 183 ablation sessions) chest tube insertion rate. The overall 30-day mortality rate was 3.9% (six of 153 patients), with a 2.6% (four of 153 patients) procedure-specific 30-day mortality rate.Lung RF ablation appears to be safe and linked with promising long-term survival and local tumor progression outcomes, especially given the patient population treated.Keywords:
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Objectives The aim of this study was to compare the differences between the ablation region and hyperechoic zones in microwave and radio frequency ablation of different tissues. Methods Microwave and radio frequency ablation were performed on fresh porcine muscle and liver with different power levels for 90 seconds. These 2 ablation methods were then performed on rabbit liver in vivo using 20 W for 60 seconds. The volumes of the ablation and hyperechoic zones were compared following different ablation methods. Results The ablation zones were significantly greater than the hyperechoic zones ( P < .05) with the same power and duration when using 2 ablation methods. The differences of the ablation and hyperechoic zones between muscle and liver tissues were significantly different ( P < .05). The difference values of the ablation and hyperechoic zones were also significantly different ( P < .05) using 2 ablation methods. Conclusions The hyperechoic zone may have underestimated the extent of ablation using a specified ablation time. In the same tissue, the hyperechoic zone could more accurately estimate the ablation zones using microwave ablation.
Microwave ablation
Ablation zone
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Percutaneous radiofrequency ablation (RFA) has emerged as an alternative modality for treatment of small renal tumors. The increasing use of imaging studies has allowed for early detection of renal tumors and the advent of minimally invasive nephron-sparing approaches. The use of percutaneous RFA achieves acceptable oncologic and functional outcomes when compared to partial nephrectomy, the "gold standard" in managing small renal masses. Percutaneous RFA is safe and cost-effective in treating renal tumors.
Kidney cancer
Renal tumor
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Objective:To evaluate junction rhythm and atria pacemaking to show pathway conduction block as successful ablation indicatives applied in AVNRT of slow pathway ablation and compare the difference of discharge time and ablation targets to ablation endpoint.Methods:153 patients with AVNRT were performed slow pathway radiofrequency ablation. According to characteristics of X-ray image and local electrograms the dischargeing power of ablation target was ascertained for 10～40W.Regarding to different successful ablation monitoring indicatives,patients were divided into ablation group in traditional method(GroupⅠ)and ablation group with atria pacemaking showing slow pathway conduction block as successful ablation indicative(GroupⅡ).86of GroupⅠ presented junction rhythm in dischargeing 15s or early pacemade then consecutively discharged 60～90 seconds;In GroupⅡ 67 patients after dischargeing 15s showed junction rhythm or after early pacemaking delayed dischargeing to 20s then stopped dischargeing.Before procedure AV1︰1 the shortest interval atrium stimulation(S1S1)showed slow pathway block and stopped pacemaking then continuously delivered up to 60s.If not deliver to ablation end-point,continuing to select sites ablating till delivered to ablation end-point.Results: All patients in two groups delivered to ablation end-point.Ablation end-points and end-points types between two groups were no difference.In 86 of groupⅠ 306 targets were successfully ablated,3.59±1.21 targets per were ablated and dischargeing time was 208.94±89.26s;In 67 of groupⅡ all successful ablation targets were 150,2.24±0.94 targets per patient were ablated and dischargeing time was 114.83±38.97s.All parameter including all items per patients in groupⅠ were higher than in groupⅡ.The comparison between two groups lied in significant difference(P0.05).Within 15s no effective ablation did not involve in targets.Conclusions: To show slow pathway conduction block as successful ablation indicative can monitor objectively the efficiency of discharged ablation and attenuate myocardial injury of ineffective ablation.
Junctional rhythm
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To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in dangerous locations.One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study. The patients were divided into percutaneous RFA group and surgical RFA group. After the patients were regularly followed up for a long time, their curative rate, hospital stay time, postoperative complications and 5-year local tumor progression were compared and analyzed.No significant difference was observed in curative rate between the two groups (91.3% vs 96.8%, P=0.841). The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group (P<0.05). The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group (P=0.05). The relative risk of local tumor progression was 14.315 in percutaneous RFA group.The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.
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肝是主要、第二等的恶意的一个普通地点。为 unresectable 肝癌症，许多本地夺格的治疗被开发了。这些包括例如，经皮的乙醇注射(PEI ) ，经皮的醋酸注射， radiofrequency 脱离(RFA ) ， cryoablation，微波脱离，导致激光的 thermotherapy，和高紧张的集中的超声。RFA 最近获得了兴趣并且是最广泛地应用的 thermoablative 技术。RFA 与 PEI 相比在更少治疗会议允许更有效的肿瘤控制，但是与复杂并发症的更高的率。然而，有某些情形， PEI 治疗代表更好的策略比 RFA 控制肝肿瘤，特别处于 RFA 是困难的状况，例如当大容器包围肿瘤时。在 hepatocellular 癌(HCC ) 的上下文， RFA 和 PEI 是可行的并且在非合用的病人的利益。RFA 在 HCC 比 PEI 似乎优异 > 干预的 2 厘米，和联合可能具有在选择病人的利益。肝切除术比为有满足米兰标准的 HCC 的病人的 RFA 优异，但是 RFA 能在肿瘤被采用 3 厘米并且在有增加的期望的起作用的死亡的地方。另外，证据的一些线显示 RFA 和 PEI 能作为一座桥被采用到肝移植。在 colorectal 肝转移的 RFA 的使用当前被限制到 unresectable 疾病并且为为外科不适宜的病人。这篇文章的目的是在肝肿瘤的管理总结 RFA 的当前的地位并且把它比作 PEI 的便宜、容易地可得到的技术。
Cryoablation
Percutaneous ethanol injection
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Objective To assess whether combination of radiofrequency ablation and transcatheeter arterial chemoembolizalion can increase effectiveness compared with radiofrequency alone in the treament of hepatic cancer. Methods 23 nodules smaller than 3cm in diameter of 17 patients were treated with radiofrequency ablation. Of these, 12 nodules were treated with the combination of radiofrequency ablation and chemoembolization. Results The greatest diameter of the area coagulated by combined therapy (40.8±3.1mm) was significantly larger than by radiofrequency ablation alone (37.8±2.8mm). During the follow-up, one local recurrence(11.1%) was found in the nodules treated by combined therapy, one local recurrence(12.3%) was found in the nodules treated by radiofrequency alone. No significant differences in complications were observed between combined therapy and radiofrequency ablation alone. Conclusion The combination of radiofrequency ablation and transcatheter arterial chemoembolization can increase the effectiveness compared with radiofrequency alone.
Transcatheter arterial chemoembolization
Combination therapy
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BACKGROUND:This retrospective study aims to compare the efficacy of computed tomography-guided percutaneous excision and radiofrequency ablation in the treatment of osteoid osteoma. MATERIAL AND METHODS:We evaluated 40 patients with osteoid osteoma who underwent either percutaneous excision or radiofrequency ablation between 2012 and 2015. The cohort consisted of 10 female and 30 male patients, with a mean age of 15.1 years (range: 4-27 years) and a mean follow-up time of 19.02 months (range: 11-39 months). Percutaneous excision was performed in 20 patients, while radiofrequency ablation was performed in the remaining 20 patients. RESULTS:The success rates of percutaneous excision and radiofrequency ablation were comparable, with unsuccessful outcomes observed in 10% and 5% of patients, respectively. The reasons for failure in the percutaneous excision group were attributed to a marking error and incomplete excision of the wide-based nidus. Complications were limited to pathological fracture (n=1) and deep infection (n=1) in the percutaneous excision group, while no complications were encountered in the radiofrequency ablation group. CONCLUSIONS:Both percutaneous excision and radiofrequency ablation demonstrate high success rates in treating osteoid osteoma. However, radiofrequency ablation offers the advantage of a quicker return to daily activities without the need for activity restrictions or splints. While being a more cost-effective option, percutaneous excision should be considered cautiously to minimize potential complications.
Osteoid Osteoma
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Purpose Percutaneous radiofrequency ablation for renal tumor could be a useful modality as minimally invasive and palliative therapy. In this study we evaluated their feasibility and safety.Methods Between 2004 and 2011, real-time CT guided radiofrequency ablation was perfomed to ablate a total of 16 tumors in 13 patients. We recorded whether tumors were successfully ablated, major complications and changes of creatinine clearance before and after RFA.Results Overall 11 of 13 (84.6%) were successfully ablated with radiofrequency ablation but 2 had local recurrent tumors. There was no significant change in creatinine clearance between before and after RFA. Two minor complications as pararenal hemorrhage were observed.Conclusion Percutaneous radiofrequency is a feasible and safe modality as a minimally invasive therapy.
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Irreversible Electroporation
Tumor ablation
Ablation zone
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