Comparison of microwave ablation and radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: Microwave ablation (MWA) has several advantages over radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). We aimed to compare the efficacy and safety of MWA with those of RFA for HCC from the perspectives of percutaneous and laparoscopic approaches.

Methods: PubMed/MEDLINE, Embase, the Cochrane library, and China Biology Medicine databases were searched. Studies comparing the efficacy and safety of MWA with those of RFA in patients with HCC were considered eligible. Complete ablation (CA), local recurrence (LR), disease-free survival (DFS), overall survival (OS), and the major complication rate were compared between MWA and RFA.

Results: Four randomized controlled trials and 10 cohort studies were included. For percutaneous ablation, no significant difference was found between MWA and RFA regarding CA, LR, DFS, OS, and the major complication rate. A subgroup analysis of tumors measuring ≥3?cm revealed no difference in CA and LR for percutaneous ablation. For laparoscopic ablation, a significantly lower LR rate and a non-significant trend toward a higher major complication rate were observed for the MWA group (odds ratio [OR] 2.16, 95% confidence interval [CI] 1.16–4.02, p?=?.01 for LR; OR 0.21, 95% CI 0.04–1.03, p?=?.05 for major complication rate). CA, DFS, and OS were similar between the two groups.

Conclusions: Percutaneous (P)-MWA had similar therapeutic effects compared with P-RFA for HCC. Patients undergoing laparoscopic MWA had a lower LR rate; however, their major complication rate appeared to be higher. The superiority of MWA over RFA remains unclear and needs to be confirmed by high-quality evidence.     

Predictive value of the albumin-bilirubin grade on long-term outcomes of CT-guided percutaneous microwave ablation in intrahepatic cholangiocarcinoma

Purpose: To assess the efficacy of the albumin-bilirubin (ALBI) grade on assessing long-term outcomes of computed tomography (CT)-guided percutaneous microwave ablation (CT-PMWA) in the treatment of patients with intrahepatic cholangiocarcinoma (ICC).

Methods: Between April 2011 and March 2018, 78 patients who underwent CT-PMWA were enrolled in this study. Overall survival (OS) and recurrence-free survival (RFS) were compared in the groups stratified by the ALBI grade and Child–Pugh score. Cox proportional hazard regression analyses were performed to determine independent predictors of OS and RFS.

Results: After a median follow-up of 22.7?months (range 1–86.7?months), 67 patients had died. The cumulative 1-, 3-, and 5-year OS rates were 89.5%, 52.2%, and 35.0%, respectively. Stratified by the ALBI grade, the cumulative 1-, 3-, and 5-year OS rates were 100%, 69.2%, and 25.6% for patients with the grade 1, respectively. For patients with the ALBI grade 2, the cumulative 1-, 3-, and 5-year OS rates were 41.0%, 10.3%, and 10.3%, respectively. Patients with a hepatic function of the ALBI grade 1 had significantly higher OS rates than patients with the ALBI grade 2 (p?<?.001). The multivariate analysis showed tumor size (Hazard Ratio[HR] 95% Confidence Interval[CI]:9.03[1.01–80.52], p?=?.049) and the ALBI grade (HR[95%CI]:9.56[1.58–58.00], p?=?.014) were associated with OS, and tumor size (HR: 2.03[0.69–8.04], p?=?.049) was associated with RFS.

Conclusions: The preliminary data of this study showed the ALBI grade was effective to predict long-term outcomes of CT-PMWA in ICCs. Further study is necessary to validate our results by a large, multi-center patient cohort.     

US-guided microwave ablation for secondary hyperparathyroidism in patients after renal transplantation: a pilot study

Objective: To assess the safety and efficacy of ultrasound-guided microwave ablation (MWA) in the treatment of patients who develop secondary hyperparathyroidism (SHPT) after renal transplantation (RT).

Methods: In total, nine patients, each with symptomatic SHPT caused by RT and at least one enlarged parathyroid gland, underwent MWA via hydrodissection. Intact parathyroid hormone (i-PTH), serum calcium, serum phosphorus, creatinine and blood urea nitrogen concentrations, before and after MWA, were assessed and compared.

Results: Complete ablation was achieved in all patients for a total of 14 ablated parathyroid glands. The mean follow-up time was 17.2?±?1.7?months post-operation. The mean maximum diameter of the parathyroid glands was 1.3?±?0.4?cm (range: 0.4–2.0?cm). The ablation power implemented was 30?W and the mean time for each parathyroid gland to achieve complete ablation was 287.5?±?83.4?s. The mean i-PTH, serum calcium and phosphorus concentrations at one day post-MWA (69.6?pg/mL, 2.23?±?0.29?mmol/L, 1.2 2?±?0.48?mmol/L, respectively) were significantly lower than those before MWA (780.0?pg/mL, 2.62?±?0.32?mmol/L, 1.39?±?0.61?mmol/L, respectively; p?<?.01), whereas the creatinine and blood urea nitrogen concentrations before and after MWA did not differ significantly from each other (p?>?.05). No significant differences were found between the biomarker concentrations observed at one day post-MWA and at the follow-ups (p?>?.05). No major operation-related complications occurred.

Conclusion: Ultrasound-guided MWA is a safe and effective technique for destroying parathyroid gland tissue in patients who develop SHPT after RT and its clinical effects are long-lasting.     

An assessment of the survival impact of multimodal anesthesia/analgesia technique in adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a propensity score matched analysis

Background: Studies suggest volatile anesthetics and opioids may enhance the malignant potential of cancer cells. The objective of this single institution retrospective study was to evaluate the survival impact of a multimodal opioid-sparing nonvolatile anesthetic technique (MA) in a group of patients who had undergone cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for appendiceal carcinomatosis.

Methods: Propensity score matching (PSM) and Cox proportional hazard models were used to compare the survivals of patients who received MA (MA group), to those who received volatile-opioid anesthesia (volatile-opioid group).

Results: Of the 373 patients, 110 (29%) were in the MA group and 263 (71%) in the volatile-opioid group. The MA group was older (mean?±?standard deviation (SD): 55?±?11 versus 53?±?10?years, p?=?.035) and had more patients with ASA scores 3 or 4 (90% versus 81%, p?=?.032), and those with high grade tumors (18% versus 12%, p?=?.009). Intraoperative opioid consumption was lower in the MA group (mean morphine equivalents?±?SD: 13?±?10 versus 194?±?789, p?<?.0001). After PSM, 107 patients remained in each group. In the adjusted Cox proportional hazards model after PSM, MA was not associated with improved progression free survival (PFS) (HR 1.45, 95% CI [0.94–2.22], p?=?.093) or overall survival (OS) (HR 1.66, 95% CI [0.86–3.20], p?=?.128), when compared to volatile-opioid anesthesia.

Conclusions: In this retrospective study, a multimodal opioid-sparing nonvolatile anesthetic approach was not associated with improved survival.

Precis’ statement: In this study of patients undergoing major cancer surgery, the use of multimodal anesthetic and analgesic agents, while avoiding volatile anesthetics and minimizing opioid use was not associated with improved survival.     

High intensity focused ultrasound (HIFU) ablation of benign thyroid nodule is safe and efficacious in patients who continue taking an anti-coagulation or anti-platelet agent in the treatment period

Background: High intensity focused ultrasound (HIFU) ablation is a promising treatment for benign thyroid nodules but because bleeding complications can occur following any intervention to the thyroid gland, the safety and efficacy of HIFU ablation were evaluated in patients who continued taking an anti-coagulation or anti-platelet agent during treatment.

Methods: From 2015 to 2017, 303 patients who underwent a single-session ablation for a benign thyroid nodule were analyzed. The primary study endpoint was thyroid bleeding, intra-lesional or peri-thyroidal hematoma or neck bruising diagnosed within 4?days of the treatment. Other endpoints included treatment-related complications, extent of nodule shrinkage and symptom score. Nodule volume was estimated by ultrasound. Extent of nodule shrinkage (by volume reduction ratio) (VRR)=?[Baseline volume – volume at 6-month]/[Baseline volume]?×?100. Obstructive symptom score (by 0– 10 visual analog scale, VAS) was evaluated after treatment.

Results: Twelve patients continued taking an anti-coagulation or anti-platelet agent while the other 291 patients did not during treatment. No patients in either group suffered active thyroid bleeding, intralesional/pericapsular hematoma or subcutaneous neck bruising in the first 4?days of treatment. Complication rate and the 6-month VRR were comparable between the two groups (0.0% vs. 1.7%, p?=?1.000 and 55.96% vs. 61.29%, respectively, p?=?.073).

Conclusions: HIFU ablation is a feasible treatment in patients who continue to take an anti-coagulation or anti-platelet agent during treatment and might be preferable in patients who continuously require an anti-coagulation or anti-platelet agent for one reason or another during treatment.     

The local efficacy and influencing factors of ultrasound-guided percutaneous microwave ablation in colorectal liver metastases: a review of a 4-year experience at a single center

Purpose: To investigate the clinical effectiveness and safety of ultrasound (US)-guided percutaneous microwave ablation (MWA) for colorectal liver metastasis (CRLM) and evaluate the influencing factors of local efficacy.

Methods: From January 2013 to January 2017, 137 CRLM patients accepting US-guided percutaneous MWA were included. The 2450-MHz microwave ablation system and a cooled-shaft antenna were used. All patients were regularly followed up for at least 6?months. Technical success, complete ablation, local tumor progression (LTP), complications and side effects were assessed. Logistic regression analysis was used to identify the independent prognostic factors for LTP.

Results: In total, 411 lesions (mean diameter 15.4?±?7.2?mm, range 5–67?mm) were treated. Complete ablation was achieved in 99.27% (408/411) of lesions and 97.81% (134/137) of patients. LTP occurred in 5.35% (22/411) of lesions and 16.06% (22/137) of patients. LTP was more likely to occur in lesions larger than 3?cm in diameter (OR: 14.71; p?<?.001; 95% CI: 3.7 3–57.92), near a large vascular structure (OR: 7.04; p?<?.001; 95% CI: 2.41–20.60), near the diaphragm (OR: 4.02; p?=?.049; 95% CI: 1.05–16.11) and in patients with no response to chemotherapy before MWA (OR: 3.25; p?=?.032; 95% CI: 1.14–15.30). MWA was well tolerated, with a major complication rate of 3.65%, a minor complication rate of 8.03% and a mortality rate of 0%. Fever and pain were the most common side effects after MWA.

Conclusions: US-guided percutaneous MWA of CRLM is a safe and effective method that is expected to become a routine treatment for local tumor control of CRLM.     

Real-time monitoring radiofrequency ablation using tree-based ensemble learning models

Background: Radiofrequency ablation is a minimally-invasive treatment method that aims to destroy undesired tissue by exposing it to alternating current in the 100?kHz–800?kHz frequency range and heating it until it is destroyed via coagulative necrosis. Ablation treatment is gaining momentum especially in cancer research, where the undesired tissue is a malignant tumor. While ablating the tumor with an electrode or catheter is an easy task, real-time monitoring the ablation process is a must in order to maintain the reliability of the treatment. Common methods for this monitoring task have proven to be accurate, however, they are all time-consuming or require expensive equipment, which makes the clinical ablation process more cumbersome and expensive due to the time-dependent nature of the clinical procedure.

Methods: A machine learning (ML) approach is presented that aims to reduce the monitoring time while keeping the accuracy of the conventional methods. Two different hardware setups are used to perform the ablation and collect impedance data at the same time and different ML algorithms are tested to predict the ablation depth in 3 dimensions, based on the collected data.

Results: Both the random forest and adaptive boosting (adaboost) models had over 98% R² on the data collected with the embedded system-based hardware instrumentation setup, outperforming Neural Network-based models.

Conclusions: It is shown that an optimal pair of hardware setup and ML algorithm (Adaboost) is able to control the ablation by estimating the lesion depth within a test average of 0.3mm while keeping the estimation time within 10ms on a ×86–64 workstation.     

Heat shock protein expression and autophagy after incomplete thermal ablation and their correlation

Objective: To establish a model of incomplete ablation in nude mice with hepatocellular carcinoma (HCC) and to evaluate heat shock protein (HSP) expression and autophagy and their correlation.

Materials and methods: In the first stage, 12 nude mice with HCC were randomly divided into two groups (n?=?6). A sham puncture operation was performed for one group, and palliative laser ablation was performed for the other group. All mice were sacrificed after 18?h, and HSP expression, autophagy, and apoptosis were assessed. In the second stage, 16 nude mice with HCC were randomly divided into two groups (n?=?8). One group was given an HSP90 inhibitor before the operation, and the other group was given dimethyl sulfoxide (DMSO) as a control. HSP expression, autophagy and apoptosis were assessed for the two groups after palliative laser ablation.

Results: In the incomplete ablation model, using nude mice with HCC, HSP90, HSP70, and HSP27 expression was up-regulated, Akt and mTOR phosphorylation was enhanced, autophagy was decreased, and apoptosis was increased. After administration of the HSP90 inhibitor, HSP90, P-Akt, and P-mTOR expression was decreased, autophagy was increased, and apoptosis was further increased.

Conclusion: Autophagy was decreased in the incomplete ablation model and might be inversely correlated with HSP expression. It is suggested that the HSP90/Akt/mTOR pathway is involved in signal transmission between autophagy and HSPs.     

Local tumor progression after ultrasound-guided percutaneous microwave ablation of stage T1a renal cell carcinoma: risk factors analysis of 171 tumors

Purpose: To retrospectively review long-term oncologic outcomes after ultrasound (US)-guided percutaneous microwave ablation (MWA) of T1a renal cell carcinoma (RCC) and to identify the incidence and risk factors that predict local tumor progression (LTP) after MWA of RCC.

Materials and methods: The present study was approved by the institutional review board. A total of 162 patients with 171 RCC nodules (mean size, 2.6?±?0.8?cm; range, 0.6–4.0?cm) were treated by MWA between April 2006 and January 2017. The influence of eight factors (age; sex; longest tumor diameter; tumor number, location and pathology type; ablation power and time) affecting the risk of LTP was assessed. Univariate Kaplan–Meier and Cox proportional hazard models were used for statistical analysis.

Results: LTP occurred in five patients (5 tumors) after US-guided percutaneous MWA of stage T1a RCC. The overall occurrence of LTP was 2.9% per tumor and 3.0% per patient with a median follow-up of 45.5?months. Among the 162 patients, there were no instances of LTP-related deaths; however, 20 patients died of other diseases. All patients with LTP survived through follow-up. The survival rate of LTP-free patients at 1, 3 and 5?years were 98.7%, 89.5% and 82.1%, respectively (p?=?.38). Univariate and multivariate analysis identified tumor location to be the only independent predictor of LTP.

Conclusions: US-guided percutaneous MWA for T1a RCC achieved a relatively low LTP incidence rate. Tumors adjacent to the renal pelvis or bowel increased the potential of LTP occurrence.     

A novel software platform for volumetric assessment of ablation completeness

Purpose: To retrospectively evaluate the accuracy of a novel software platform for assessing completeness of percutaneous thermal ablations.

Materials & methods: Ninety hepatocellular carcinomas (HCCs) in 50 patients receiving percutaneous ultrasound-guided microwave ablation (MWA) that resulted in apparent technical success at 24-h post-ablation computed tomography (CT) and with ≥1-year imaging follow-up were randomly selected from a 320 HCC ablation database (2010–2016). Using a novel volumetric registration software, pre-ablation CT volumes of the HCCs without and with the addition of a 5?mm safety margin, and corresponding post-ablation necrosis volumes were segmented, co-registered and overlapped. These were compared to visual side-by-side inspection of axial images.

Results: At 1-year follow-up, CT showed absence of local tumor progression (LTP) in 69/90 (76.7%) cases and LTP in 21/90 (23.3%). For HCCs classified by the software as “incomplete tumor treatments”, LTP developed in 13/17 (76.5%) and all 13 (100%) of these LTPs occurred exactly where residual non-ablated tumor was identified by retrospective software analysis. HCCs classified as “complete ablation with <100% 5?mm ablative margins” had LTP in 8/49 (16.3%), while none of 24 HCCs with “complete ablation including 100% 5?mm ablative margins” had LTP. Differences in LTP between both partially ablated HCCs vs completely ablated HCCs, and ablated HCCs with <100% vs with 100% 5?mm margins were statistically significant (p?<?.0001 and p?=?.036, respectively). Thus, 13/21 (61.9%) incomplete tumor treatments could have been detected immediately, were the software available at the time of ablation.

Conclusions: A novel software platform for volumetric assessment of ablation completeness may increase the detection of incompletely ablated tumors, thereby holding the potential to avoid subsequent recurrences.     

The value of KRAS gene status in predicting local tumor progression of colorectal liver metastases following radiofrequency ablation

Purpose: We investigated the relationships between KRAS gene status and local tumor progression (LTP) of colorectal liver metastases (CLMs) after treatment with percutaneous ultrasound-guided radiofrequency ablation (RFA).

Materials and methods: Clinical and imaging data from 76 patients (154 lesions) with CLM who underwent percutaneous ultrasound-guided RFA and had KRAS gene test results between January 2012 and June 2016 were analyzed. The average lesion size was 2.3?±?1.0?cm (range 0.9–5.7?cm); 38 cases (82 lesions) had wild-type KRAS, and 38 cases (72 lesions) had KRAS mutations.

Results: The technique effectiveness was 98.1% (151/154), and the LTP rate was 18.2% (28/154) after RFA, which was performed between January 2012 and November 2017. The mean and median follow-up were 32.7?±?2.5 and 32.0?±?2.6 months (range 1–70 months), respectively. Cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA for all patients were 7.4, 14.5, 17.8 and 19.2%, respectively. The LTP rate for patients with mutant KRAS (27.8% [20/72]) was significantly higher than that in patients with wild-type KRAS (9.8% [8/82]; p?=?.004). The cumulative LTP rates at 6 months and 1, 2 and 3 years post-RFA were 4.0, 11.1, 11.1 and 11.1%, respectively, for patients with wild-type KRAS and 11.2, 18.4, 25.2 and 36.2%, respectively, for patient with mutant KRAS (p?=?.011). Univariate (p?=?.011) and multivariate analyses (p?=?.005) showed that KRAS genotype in liver metastases was predictive of LTP. Multivariate analysis also showed that ablation margin size (p< .001) and modified clinical risk score (CRS; p?=?.033) were independent prognostic factors for LTP.

Conclusions: KRAS gene status of liver metastatic lesions was associated with LTP rates after RFA of CLM. Ablation margin size and modified CRS were also independent prognostic factors for LTP.     

Ultrasound-guided percutaneous microwave ablation versus surgical resection for recurrent intrahepatic cholangiocarcinoma: intermediate-term results

Objective: The aims of this study were to compare the clinical outcomes between ultrasound-guided percutaneous microwave ablation (US-PMWA) and surgical resection (SR) in patients with recurrent intrahepatic cholangiocarcinoma (ICC) and to identify the prognostic factors associated with the two treatment methods.

Methods: This retrospective study was institutional review board approved. A total of 121 patients (102 men and 19 women) with 136 ICCs after hepatectomy from April 2011 to January 2017 were reviewed. Fifty-six patients underwent US-PMWA and 65 patients underwent SR. Survival, recurrence and liver function were compared between the two groups. Effect of changes in key parameters [i.e., overall survival (OS) and recurrence-free survival (RFS)] was statistically analyzed with the log-rank test. Univariate and multivariate analysis were performed on clinicopathological variables to identify factors affecting long-term outcome.

Results: The OS and RFS after MWA were comparable to that of SR (p?=?.405, and p?=?.589, respectively). Estimated 5-year OS rates were 23.7% after MWA and 21.8% after SR; for RFS, estimated 3-year RFS rates were 33.1% after MWA and 30.6% after SR. Major complication rates in SR group were higher than that in MWA (p?<?.001) (SR, 13.8% vs. MWA, 5.3%). Multivariate analysis showed tumor number (p?=?.012), ALBI grade (p?=?.007), and metastasis (p?=?.016), may become OS rate predictors.

Conclusions: US-PMWA had comparable oncologic outcomes with SR and could be a safe and effective treatment for recurrent ICC after hepatectomy.     

Microwave ablation of hyperplastic parathyroid glands is a treatment option for end-stage renal disease patients ineligible for surgical resection

Background: Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in patients with end-stage renal disease (ESRD). Some patients with severe SHPT could not be managed by medical treatment and are ineligible for surgical resection.

Purpose: Our objective was to evaluate the efficacy, safety of microwave ablation (MWA) on these patients.

Materials and Methods: Between 1 April 2015 and 28 February 2017, 35 patients (M/F 19/16, age 49.8?±?12.9?years) were enrolled. All patients were treated with MWA. Levels of intact parathyroid hormone (iPTH) and of serum calcium and phosphorus were compared pre- and post-ablation. Repeated-measures ANOVA was used to compare treatment outcomes pre- and post-ablation.

Results: Complete ablation was achieved in all 63 glands in the 35 patients with SHPT. The mean follow-up time was 15.9?±?2.2?months. The maximum gland diameter was 6–31?mm (mean, 14.9?±?5.5?mm). The trends of the changes in iPTH and calcium levels showed a curve: the level of iPTH and calcium at 6?months post-ablation were lower than those pre-ablation (both p?<?.0001); after then iPTH remained relatively stable and the end of follow up, with no rebound (p?<?.0001), while instead of calcium at the end of follow up was not significantly lower than pre-ablation (p?=?.462). The trend in the change in phosphate levels showed a straight line; the level of phosphate at 6?months post-ablation and at the end of follow up both were significantly lower than pre-MWA (p?<?.001). There was no major complication.

Conclusions: In this series, MWA was used successfully to treat SHPT patients who are ineligible for surgical resection.     

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

Purpose: This study aimed to assess the safety and technical feasibility of percutaneous ablation therapy for lymph node (LN) metastases of hepatocellular carcinoma (HCC).

Material and Methods: A total of 31 consecutive HCC patients with LN metastases who were treated with ablation were included in this retrospective study. Percutaneous ablation was performed under local anesthesia and computed tomography–guidance. The primary endpoint was technique success; secondary endpoints were overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS). Survival curves were constructed using Kaplan-Meier method.

Results: The median diameter of metastatic LNs was 30?mm (range, 10–77?mm). The 1-, 3-, and 5-year OS rates were 74.6%, 50.3%, and 50.3%, respectively. The 1-, 3-, and 5-year PFS rates were 24.7%, 0%, and not available for calculation (NA), respectively. The 1-, 3-, and 5-year LPFS rates were 78.7%, 69.9%, and 69.9%, respectively. The technique success and technical effectiveness rates were 100% and 64.5%, respectively. The technical effectiveness rates were 65.4% (17/26) and 60% (3/5) in abdominal LN metastases and distant LN metastases, respectively. Only one patient (1/31, 3.2%) had major complications (massive pleural effusion and severe pneumonia) related to ablation. Minor complications related to ablation included mild abdominal pain (10/31, 32.3%) and self-limiting hematoma (2/31, 6.5%). No ablation-related death occurred.

Conclusion: Percutaneous ablation appears to be a safe and feasible method for treatment of metastatic LNs in patients with HCC.     

Factors influencing MR changes associated with sacral injury after high-intensity focused ultrasound ablation of uterine fibroids

Purpose: We investigated the risk factors influencing MR changes associated with sacral injury from ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation for uterine fibroids.

Methods: We retrospectively analyzed a total of 346 patients with symptomatic uterine fibroids who received USgHIFU ablation. All of the patients underwent contrast-enhanced magnetic resonance imaging (CE-MRI) before and after treatment. Injury to the sacrum was set as the dependent variable, while fibroid features and the treatment parameters were set as independent variables. These variables were used to assess respectively their correlation with sacral injury by using univariate and multivariate analyses.

Results: The results of univariate analysis revealed that the volume, distance from the fibroid to the skin, maximal diameter, distance from the fibroid to the sacrum, fibroid types, degree of enhancement, therapeutic dosimetry (TD), energy efficiency factor (EEF) and non-perfused volume (NPV) ratio manifested significant correlations with the sacral injury (p?<?.05). Multivariate analysis showed that the degree of enhancement, TD and EEF were independent risk factors for sacral injury (p?<?.05), while the distance from fibroid to sacrum and intramural or subserosal types were protective factors (p?<?.05). The incidence of sacral tail pain and leg pain showed a significant positive correlation with sacral injury (p?<?.05).

Conclusion: As important affecting factors, the degree of enhancement, distance from fibroid to sacrum and fibroid types all possess significant correlations with MR changes associated with sacral injury.     

Management strategy for nerve damage during radiofrequency ablation of thyroid nodules

Objective: The aim of this study was to introduce a management strategy for nerve damage occurring during radiofrequency ablation (RFA).

Methods: From January 2016 to October 2017, 17 patients who experienced the symptoms of nerve damage during RFA were enrolled in this study. If damage to nerves was suspected during RFA, ablation was stopped immediately, and a cold solution of 5% dextrose was injected directly into the space where the nerves were located until symptoms improved. Patients were followed up after the procedure until symptoms had resolved. The clinical data of patients who received a cold dextrose solution injection for nerve damage were compared with those who did not receive such an injection.

Results: Of 17 patients who experienced nerve damage, 12 received an injection of cold dextrose solution shortly after the emergence of symptoms. While resolution of symptoms was seen in all 17 patients, the mean time to recovery was significantly faster in the 12 patients who received treatment with an injection of cold dextrose solution than in those patients who did not receive such a treatment (p value = .041).

Conclusions: In the event of thermal damage to adjacent nerve structures during RFA, the direct injection of a cold dextrose solution is a simple and effective treatment that can result in rapid symptom resolution.     

The impact of epidermal growth factor receptor mutations on the efficacy of definitive chemoradiotherapy in patients with locally advanced unresectable stage III non-small cell lung cancer: a systematic review and meta-analysis

Objectives: To investigate the impact of EGFR mutations on the efficacy of definitive chemoradiotherapy (CRT) in patients with locally advanced unresectable stage III NSCLC.

Methods: PubMed and EMBASE were searched for eligible studies. Efficacy outcomes included objective response rate (ORR), overall disease progression, local-regional recurrence (LRR), distant progression (DP), brain metastasis, progression-free survival (PFS) and overall survival (OS). Meta-analysis was performed when relevant data were available.

Results: The authors identified seven eligible studies including 695 patients. No significant difference was detected in ORR (Risk Ratio [RR] 1.13, 95% confidence interval [CI] 0.91–1.39, P = 0.28) and overall disease progression (RR 1.06, 95% CI 0.95–1.19, P = 0.29) between EGFR-mutant and EGFR-wild-type groups. EGFR-mutant group had significantly lower LRR (RR 0.49, 95% CI 0.33–0.72, P < 0.01), higher DP (RR 1.36, 95% CI 1.18–1.55, P < 0.01) and higher brain metastasis (RR 2.48, 95% CI 1.46–4.20, P < 0.01) than the EGFR-wild-type group. No sufficient data were available to perform pooled analysis regarding PFS and OS.

Conclusion: For patients with locally advanced unresectable stage III NSCLC treated with definitive CRT, the presence of EGFR mutations may be indicative of lower locoregional recurrence and higher distant progression, especially brain metastasis.     

Prostate cancer: the influence of stigma on quality of life and relationship satisfaction for survivors and their partners

Objectives: Prostate cancer (PCa) stigma and its relationship to quality of life (QoL) is a relatively new finding. As the experiences of couples facing PCa are shared, the study examined the relationship between of PCa stigma, QoL, and relationship satisfaction of PCa survivors and their spouses.

Design: A correlational design with dyadic data was used.

Sample: Participants (N?=?80 dyads) were PCa survivors and their spouses sampled from an oncology center and PCa support groups.

Methods: Structural equation modeling was used to assess how stigma related to the QoL and relationship satisfaction of participants.

Findings: Stigma had a negative association with QoL, but not relationship satisfaction. There were no significant demographic differences in regards to stigma.

Conclusion: Overall, stigma has a relationship with the experience of couples, but not with every aspect of their experience.

Implications for psychosocial providers: Implications for clinicians in regards to addressing PCa stigma with clients and areas for future research are discussed.     

Family dynamics in young adult cancer caregiving: “It should be teamwork”

Purpose/Objectives: Young adult cancer patients undergo stress at a time when their primary source of psychosocial support may be changing. Our goal was to provide insight into the expectations young adult patients and their family caregivers for types of psychosocial support.

Research Approach: Semi-structured interviews.

Participants: Fifteen patients, 9 caregivers recruited from an AYA clinic.

Methodological Approach: Thematic content analysis using the constant comparison method.

Findings: Two themes were identified. First, families described coordinating support around strengths to determine who would take on caregiving roles/tasks. Second, families described the importance of patient-caregiver relationship status/history in determining trust and expectations.

Interpretation: Family strengths and existing relationships can impact caregiving roles and expectations for families of young adult cancer patients.

Implications for Psychosocial Providers: Cancer clinics may need to involve members of the psychosocial provider team to better understand the family dynamics of their patients and how these relate to support.     

Activated hepatic stellate cells promote progression of post-heat residual hepatocellular carcinoma from autophagic survival to proliferation

Background: Microscopic residual tumor often occurs after thermal ablation for medium-large hepatocellular carcinoma (HCC), leading to early aggressive recurrence or late relapse during follow-up. The mechanism how microscopic residual HCC cells survive sublethal heat stress and develop rapid outgrowth remains poorly understood.

Methods: HCC cells were exposed to sublethal heat treatment and co-cultured with conditioned media from activated HSCs (HSC-CM). Changes of cell proliferation, parameters of cell autophagy and activation of signaling pathways in heat-treated residual HCC cells were analyzed. An HCC orthotopic model was subjected to partial thermal ablation and antitumor effects of a combined treatment regimen were studied.

Results: HCC cells survived sublethal heat stress via activation of autophagy. HSC-CM enhanced autophagic survival within 24?h and then promoted proliferation of heat-treated residual HCC cells through HGF/c-Met signaling. Inhibition of autophagy or c-Met increased apoptosis of heat-treated residual HCC cells and reversed the protective effect of HSC-CM. HGF modulated biological status in autophagic survival or proliferation of heat-treated residual HCC through HGF/c-Met/ERK signaling and downstream components of ATG5/Beclin1 or cyclinD1. In an animal model, inhibiting autophagy in combination with c-Met inhibitor significantly thwarted tumor progression of residual HCC after incomplete thermal ablation via the suppressed autophagy, the decreased proliferation and the increased apoptosis.

Conclusions: Activated HSCs promote progression of residual HCC cells after sublethal heat treatment from autophagic survival to proliferation via HGF/c-Met signaling. A combined treatment regimen of inhibiting autophagy and c-Met signaling could be used to suppress tumor progression of residual HCC after incomplete thermal ablation.