Microwave ablation: an effective treatment for mild-to-moderate secondary hyperparathyroidism in patients undergoing haemodialysis

Abstract

Background: Microwave ablation (MWA) is an effective treatment for severe secondary hyperparathyroidism (SHPT), but it can also be used for mild-to-moderate secondary hyperparathyroidism (SHPT). In this randomised, controlled study, the efficacy of MWA in the treatment of mild-to-moderate hyperparathyroidism is investigated.

Materials and methods: We assessed outcomes 12?months after the randomisation of 28 patients with mild-to-moderate SHPT. The subjects received either MWA plus calcitriol or calcitriol alone. The primary end-points were the rate of achieving target levels of intact parathyroid hormone (iPTH), changes in iPTH levels and the rate of patients developing severe SHPT.

Results: Primary end points: the overall rates of achieving target levels of iPTH were comparable between the MWA and calcitriol alone groups (24% vs. 22%, p?=?0.85). However, the rate of iPTH <150?pg/mL (lower limit of the target range) in the MWA group was higher than that in the calcitriol alone group (23% vs. 8%, p?=?0.02). The mean iPTH level in the MWA group after MWA was lower than that in the calcitriol alone group (373.09?±?322.31 vs. 552.28?±?361.87?pg/mL, p?<?0.001). There was a significant difference in the change in iPTH levels over time within the MWA group (p?<?0.001) but not in the calcitriol alone group. Only one patient developed severe SHPT in the MWA group, while six patients in the calcitriol alone group developed severe SHPT (p?=?0.04).

Conclusions: Compared with calcitriol alone, MWA plus calcitriol decreases iPTH levels and prevents the progression of mild-to-moderate SHPT.     

Safety and efficiency of microwave ablation for recurrent and persistent secondary hyperparathyroidism after parathyroidectomy: A retrospective pilot study

Background: Recurrent and persistent secondary hyperparathyroidism (SHPT) nodules have an incidence of 10–70% after surgery. The treatment of recurrent and persistent SHPT nodules is a challenge, and surgical resection of difficult-to-reach or post-operative adhesions often fails. Purpose: The aim of this research was to study the safety and effectiveness of microwave ablation (MWA) for recurrent and persistent SHPT. Materials and methods: This was a retrospective study of 11 patients enrolled with a total of 16 nodules, and MWA was employed to manage SHPT. The laboratory test results, including the intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels, improvement of SHPT-related symptoms after ablation, and complications during and after MWA were recorded and analysed. Results: After ablation the value of iPTH was markedly decreased from 1570?±?1765?pg/mL to 287?±?239?pg/mL 1 day after MWA (p?<?0.05). The levels of serum calcium and phosphorus decreased from 2.51?±?0.23?mmol/L to 2.06?±?0.27?mmol/L (p?<?0.001) and 1.80?±?0.43?mmol/L to 1.48?±?0.32?mmol/L (p?<?0.05), respectively, 1 day after MWA. There was no significant difference in the ALP value before and after MWA (p?>?0.05). The clinical symptoms, including ostalgia, pruritus, disability, and restless legs, improved after MWA. Minor complications and side effects encountered during or after MWA include haematoma (1/11, 9%), transient hoarseness (2/11, 18.2%), hypocalcemia (6/11, 54.5%). No major complication occurred. Conclusion: MWA may be safe and effective to manage recurrent and persistent SHPT nodules; a definite conclusion needs to expand the sample size with a longer follow-up time.     

Microwave ablation versus hepatic resection for the treatment of hepatocellular carcinoma and oesophageal variceal bleeding in cirrhotic patients

Purpose: The aim of this study was to compare the results of microwave ablation (MWA) and hepatic resection (HR) when combined with pericardial devascularisation plus splenectomy (PCDV) for the treatment of patients with cirrhosis complicated by small hepatocellular carcinoma (HCC) and oesophageal variceal bleeding (EVB).

Materials and methods: Between 2001 and 2013, 73 patients (median age 53.2 years, 67% male) with small HCC and concomitant EVB who underwent MWA or HR for HCC and PCDV for cirrhotic portal hypertension were selected retrospectively for inclusion in this study. The overall survival curves and recurrence-free survival curves were calculated using the Kaplan–Meier method and compared using log-rank tests. Multivariate analysis was performed using the Cox regression model.

Results: The 1-, 3- and 5-year overall survival rates were 95.2%, 71.4% and 38.1% and 96.7%, 53.3% and 43.3% for the HR and MWA groups, respectively; these did not differ significantly between the two groups. However, patients in the HR group had more post-operative complications (52.3% vs. 13.7%; p?=?0.002). Multivariate analysis identified albumin and bilirubin levels and tumour size to be statistically significant and independent prognostic factors for overall survival, while BCLC stage was associated with poor recurrence-free survival. Furthermore, albumin levels were shown to be an independent predictive factor for post-operative complications.

Conclusions: For patients with small HCC and concomitant EVB, MWA plus PCDV may reduce the incidence of post-operative complications relative to and provide similar therapeutic benefits as HR plus PCDV, especially for patients with low albumin levels.     

Feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma: a first evaluation

Aim: The aim of this study was to first assess the feasibility of bipolar radiofrequency ablation in patients with parathyroid adenoma.

Material and methods: Bipolar RFA was performed in 9 patients with primary parathyroid adenoma in one single session. Measured parameters were PTH and calcium serum levels prior to and after bRFA. Furthermore, using an NRS pain scale (1–10), the individual, subjective maximum sensation of pain was documented.

Results: The bRFA resulted in a highly significant (p?=?.003906) decrease of serum PTH levels (median 67?ng/l) in comparison to those prior to the intervention (median 199?ng/l). Regarding calcium levels, there was no statistical significance (p?=?.460938), with a decrease of median serum levels comparing pre- and post-bRFA values from 2.82?mmol/l to 2.66?mmol/l. The evaluation of the individual pain sensation during the procedure was assessed by the patients with a median of 5/10 on the NRS scale. In none of the 9 cases complications such as infections, persisting pain or nerve injury occurred.

Conclusion: For the first time, it was possible to depict the successful therapy of parathyroid adenoma by means of bRFA. This work thus proves bRFA to be an effective, safe, applicable and, concerning sensation of pain, very well tolerable thermoablative technique in the treatment of parathyroid adenoma.     

Microwave ablation versus radiofrequency ablation for the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Purpose: Radiofrequency ablation (RFA) and microwave ablation (MWA) are the two main percutaneous techniques for the treatment of unresectable hepatocellular carcinoma (HCC). However, to date, studies comparing the two therapies have provided discordant results. The aim of this meta-analysis is to evaluate the efficacy and safety of the two treatments for HCC patients. Materials and methods: A computerised bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. The rates of complete response (CR), local recurrence (LRR), 3-year survival (SR) and major complications were compared between the two treatment groups by using the Mantel-Haenszel test in cases of low heterogeneity or the DerSimonian and Laird test in cases of high heterogeneity. Sources of heterogeneity were investigated using subgroup analyses. In order to confirm our finding, sensitivity analysis was performed restricting the analysis to high-quality studies. Results: One randomised controlled trial (RCT) and six retrospective studies with 774 patients were included in the meta-analysis. A non-significant trend of higher CR rates in the patients treated with MWA was found (odds ratio (OR)?=?1.12, 95% confidence interval (CI) 0.67–1.88, p?=?0.67]. Overall LRR was similar between the two treatment groups (OR 1.01, 95% CI 0.53–1.87, p?=?0.98) but MWA outperformed RFA in cases of larger nodules (OR 0.46, 95% CI 0.24–0.89, p?=?0.02). 3-year SR was higher after RFA without statistically significant difference (OR 0.95, 95% CI 0.58–1.57, p?=?0.85). Major complications were more frequent, although not significantly, in MWA patients (OR 1.63, 95% CI 0.88–3.03, p?=?0.12). Conclusions: Our results indicate a similar efficacy between the two percutaneous techniques with an apparent superiority of MWA in larger neoplasms.     

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.     

Microwave ablation vs. surgical resection for treatment naïve hepatocellular carcinoma within the Milan criteria: a follow-up of at least 5 years

Objective:Thermal ablation poses challenges in the surgical resection (SR) of small hepatocellular carcinoma (HCC), and its therapeutic outcomes for larger lesions remain debated.Methods:This retrospective study evaluated 729 patients with HCC meeting the Milan criteria, who were treated with curative SR or microwave ablation (MWA) between 2008 and 2014. Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS), and local tumor progression (LTP) were compared after propensity score matching (PSM). Co-variates associated with OS, CSS, LTP, and DFS were identified. The risk of death and tumor progression were compared.Results:During the median follow-up of 78.6 months, 253 patients were included in each group after PSM. For tumors ≤ 3.0 cm and 3.1–4.0 cm, MWA achieved comparable results in terms of OS, CSS, DFS, and LTP. For tumors 4.1–5.0 cm, MWA had lower OS, CSS, and DFS rates (all P < 0.05) than SR. Higher LTP rates were observed in the MWA group for tumors 4.1–5.0 cm, although the difference was not significant (P = 0.18). Complication rates (P = 0.41) were similar, but MWA led to less estimated blood loss (P < 0.01) and shorter postoperative hospitalization times (P < 0.01).Conclusions:MWA achieved comparable long-term oncologic outcomes with SR for ≤ 4 cm HCC, with lower complication rates and faster recovery.     

微波消融治疗肝癌187例的临床疗效评价研究

目的 本文旨在研究微波消融治疗原发性肝癌的安全性、局部控制率及近期疗效。方法 从2006年1月—2013年1月收集了187例肝癌患者,共209个病灶。其中有112个为邻近肺、膈肌、腹壁、结肠、胃和胆囊区的病灶。对以上209个病灶进行微波消融治疗,病灶平均直径为3.92cm。消融治疗后一个月行增强CT检查,术后每三个月对患者的影像学资料、肝功能、AFP水平及生活质量进行随访,评价其有效性。结果 186个病灶达到完全消融,完全消融率为88.99%。对于＜3cm的病灶完全消融率可达100%。23个病灶消融后出现局部肿瘤进展。17例患者出现临床轻度并发症,轻微并发症发生率约为5.82%。在本研究中未出现死亡及其他严重并发症。结论 对于＜5cm的肝癌病灶,包括对位于特殊危险区域的肝癌病灶进行微波消融是安全可行的;尤其是对于＜3cm的小肝癌患者,微波消融可以显著延长患者生存期。     

Microwave ablation induces a lower systemic stress response in patients than open surgery for treatment of benign thyroid nodules

Objective: In this study, we compared the systemic stress response induced by microwave ablation with that induced by conventional open surgery for treatment of benign thyroid nodules.

Methods: A total of 108 patients with benign thyroid nodules were randomly assigned to receive ultrasound-guided thyroid microwave ablation (microwave group, n?=?57) and conventional open thyroid surgery (open group, n?=?51). Body temperature, white blood cell (WBC) counts, visual analogue scale (VAS) scores for pain, and serum levels of high sensitive C-reactive protein (hs-CRP), interleukin 6 (IL-6) and cortisol were measured at 24?h before operation and at 8?h, 24?h and 48?h after operation.

Results: No significant between-group differences were observed with respect to preoperative body temperature, VAS scores, WBC counts, serum hs-CRP, IL-6 and cortisol levels. Patients in the open group exhibited higher body temperature at 24?h after operation and higher WBC counts at both 24?h and 48?h after operation, as compared to those in the microwave group. As compared with microwave ablation, open surgery was associated with significantly higher VAS scores, and significantly higher serum levels of hs-CRP, IL-6 and cortisol at all postoperative time-points (8?h, 24?h and 48?h).

Conclusion: Microwave ablation induces a lower systemic stress response than open surgery for treatment of benign thyroid nodules.     

31例胃癌肝转移微波消融疗效分析

目的 探讨微波消融治疗对胃癌肝转移患者的治疗效果.方法 回顾性分析行微波消融治疗的31例胃癌肝转移患者的疗效及预后,并对患者的总体生存情况进行分析.结果 患者的中位随访时间为26个月(4～44个月),中位生存期为25个月(95％CI:11.5～38.5).1、2、3年总体生存率分别为80.3％、50.9％、25.4％.结论 微波消融可作为胃癌肝转移患者局部控制的安全、有效手段.     

早期肝细胞癌射频消融联合肝动脉化疗栓塞与手术切除疗效Meta分析

目的通过Meta分析比较射频消融(radiofrequency ablation,RFA)联合肝动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)与手术切除(surgical resection,SR)治疗早期原发性肝细胞癌(hepatocellular carcinoma,HCC)的临床疗效。方法通过PubMed、Embase和Medline等外文数据库,及CNKI、维普和万方数据库等中文数据库,检索国内外2013-12-31以前关于比较RFA+TACE与SR治疗早期HCC的病例对照临床试验的文献,根据纳入标准对总体生存率(overall survival rate,OS)、无病生存率(disease-free survival rate,DFS)及术后主要并发症发生率均有详细的分析描述。利用评价指标优势比(OR)及95%可信区间(95%CI)在固定效应模式或随机效应模式下对数据进行合并分析,所有数据均采用Cochrance协作网提供的Revman 4.2软件及Stata 12.0软件进行分析。结果纳入4篇病例对照研究,共697例患者。Meta分析结果显示,手术治疗组5年OS及3和5年DFS明显高于联合治疗组,OR及95%CI分别为0.50(0.32~0.79)、0.66(0.45~0.97)和0.37(0.19~0.72),P值分别为0.003、0.03和0.003;而1、3年OS及1年DFS差异无统计学意义,OR及95%CI分别为1.50(0.77~2.92)、0.94(0.64~1.37)和1.23(0.79~1.90),P值分别为0.23、0.74和0.36。联合治疗组的主要术后并发症发生率低于手术治疗组,OR=0.29,95%CI:0.10~0.78,P=0.01。结论对于早期肝细胞癌,虽然联合治疗术后并发症明显小于手术治疗,但手术治疗的总体疗效仍优与联合治疗。     

Ultrasound-guided percutaneous laser ablation is safe and effective in the treatment of small renal tumors in patients at increased bleeding risk

Purpose: The aim of this retrospective study was to assess the safety and effectiveness of laser ablation (LA) in patients with small renal cell carcinomas (RCC) and increased risk of bleeding.

Material and methods: From 2013 to 2017, nine patients (six males, three females, aged 68.5?±?12.2 years) at high risk of bleeding underwent ultrasonography-guided LA for an RCC. Patients were considered at increased risk of bleeding because of impairment of coagulation parameters, concomitant antiplatelet therapy, or at-risk location of the tumor (one, five, and three patients, respectively). RCC diameter ranged from 11 to 23?mm. According to tumor size, two or three laser fibers were introduced through 21-gauge needles and 1800 J per fiber were delivered in 6?min with a fixed power of 5 W. Major and minor complications, technical success, and primary and secondary technical effectiveness and tumor recurrence were recorded.

Results: Just one Grade 1 complication was observed: a small asymptomatic hematoma that spontaneously resolved. Technical success was 100%, 1 month technical efficacy was 88.9% (8/9 patients). One patient with residual tumor was successfully retreated 1 month later, and secondary efficacy rate was 100%. No local tumor recurrence occurred during a median follow-up of 26 months (range 11–49 months).

Conclusions: LA is safe and effective in the treatment of small RCC and might represent a valid option in patients with increased risk of bleeding.     

Radiofrequency ablation versus surgical resection for hepatocellular carcinoma within the Milan criteria: A study of 281 Western patients

Abstract

Objectives: The aim of this study was to compare survival between radiofrequency ablation (RFA) and surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within Milan criteria. Methods: From January 2004 to December 2013 we consecutively and retrospectively included all patients with first occurrence of HCC within Milan criteria receiving SR or RFA as first-line treatment. The cumulative overall survival (OS) and disease-free survival (DFS) were compared after inverse probability weighting (including confounding factor). Results: A total of 281 patients (RFA 178, SR 103) were enrolled. In multivariate Cox regression RFA and SR were not independent predictors of survival or recurrence. The respective weighted 5 years OS and DFS for patients with propensity scores between 0.1–0.9 in the SR and RFA groups were 54–33% and 60–16.9%, P?=?0.695 and P?=?0.426, respectively. Local tumour progression rate did not differ according to treatment (P?=?0.523). Major complication rate was higher in the SR group, P?=?0.001. Hospitalisation duration was lower in the RFA group (mean 2.19 days, range 2–7) than in the SR group (mean 10.2 days, range 3–30), P?<?0.001. Conclusion: This large Western study has shown that OS and DFS did not differ after RFA (using mainly multipolar devices) and SR, for HCC within the Milan criteria in a European population, with a shorter hospitalisation time and a lower complication rate for RFA.     

Hospital volume of percutaneous radiofrequency ablation is closely associated with treatment outcomes for patients with hepatocellular carcinoma

BACKGROUND:

Hospital volume for several major operations is associated with treatment outcomes. In this study, the authors explored the influence of hospital radiofrequency ablation (RFA) volume on the prognosis of patients who received RFA for hepatocellular carcinoma (HCC).

METHODS:

The authors searched for all patients who were diagnosed with stage I or stage II HCC from 2004 to 2006 and who received RFA as first‐line therapy in a population‐based cohort. Overall survival (OS) and liver cancer‐specific survival (CSS) were compared according to hospital volume. A Cox proportional hazards model was used for multivariate analysis.

RESULTS:

In total, 661 patients received first‐line RFA for stage I and II HCC in 28 hospitals. Among these, there were 480 patients (72.6%) in the high‐volume group (those who received RFA at hospitals that treated >10 first‐line patients per year), and there were 181 patients (27.4%) in the low‐volume group (those who received RFA at hospitals that treated ≤10 first‐line patients per year). The sex, age, stage, tumor size, and year of diagnosis for patients in the 2 groups did not differ significantly. Patients in the high‐volume group demonstrated significantly longer OS and CSS than those in the low‐volume group (5‐year OS rate, 58.7% vs 47.2%; P = .001; 5‐year CSS rate, 67.1% vs 57.1%; P = .009). After adjusting for covariates, high‐volume hospitals remained an independent predictor of longer OS (hazard ratio, 0.57; P < .001) and CSS (hazard ratio, 0.57; P = .003).

CONCLUSIONS:

Patients who received first‐line RFA for HCC in high‐volume hospitals demonstrated better survival outcomes. Cancer 2013. © 2012 American Cancer Society.     

Review of current thermal ablation treatment for lung cancer and the potential of electrochemotherapy as a means for treatment of lung tumours

Lung cancer remains the most common cancer diagnosed worldwide and has one of the lowest survival rates of all cancers. Surgery remains the only curative treatment option but because most patients are either diagnosed at advanced stages or are unfit for surgery, less than a third of all lung cancer patients will undergo a surgical resection. Thermal ablation has emerged as an alternative option in patients who are unfit to undergo surgery. Thermal ablative therapies used in clinical practice to date include Radiofrequency Ablation (RFA), Microwave Ablation (MWA) and Cryoablation This article will focus on the advantages and limitations of thermal ablative therapy and investigates the potential of a relatively new treatment modality, Electrochemotherapy (ECT), as a novel treatment for lung cancer.     

Gefitinib as a last treatment option for non-small-cell lung cancer: durable disease control in a subset of patients.

BACKGROUND: We describe 16 months' single-institution experience with gefitinib ("Iressa", ZD1839) used as "ultimum refugium" for pretreated non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Toxicity, response and survival data of NSCLC patients participating in a compassionate-use program with gefitinib were reviewed. Documented disease progression and confirmation of the absence of other treatment options were requested. Oral gefitinib at a dose of 250 mg/day was given until disease progression, unacceptable toxicity or death. Cox's proportional hazards model was used to analyze relationships between factors and probability of survival. RESULTS: Rapid disease precluded treatment in eight cases. Of 92 evaluable patients, one-third had a baseline performance status (PS) of > or =2. The main side-effects of gefitinib were grade 1-2 diarrhea and skin rash. A disease control rate of 46% (objective response rate 8.7%) and 1-year survival of 29% were documented. Histology (adenocarcinoma) and a "never-smoking" history were predictive of response. Number of previous chemotherapy regimens, gender, time since diagnosis and time since last chemotherapy lacked such an association. Radiotherapy during gefitinib treatment was well tolerated and was associated with prolonged survival in a patient with multiple brain metastases. Multivariate analyses revealed a significant impact of PS on survival. A "never-smoking" history, adenocarcinoma/bronchoalveolar-cell carcinoma and female gender showed a trend towards better survival outcomes. CONCLUSION: Gefitinib's single-agent activity in a group consisting of pretreated NSCLC patients is confirmed. Side-effects of gefitinib were mild. Prolonged survival was associated with good PS and less significantly with a never-smoking history, female gender and histology. Additional studies on mechanisms of tumor control and selection of target populations for this remarkable new drug are warranted.