Open-configuration MR-guided microwave thermocoagulation therapy for metastatic liver tumors from breast cancer

BACKGROUND: Liver metastases from breast cancer are associated with a poor prognosis, however, local control with microwave thermocoagulation therapy has been used in certain subgroups of these patients in the past decade. In this study, open-configuration magnetic resonance (MR) -guided microwave thermocoagulation therapy was used for metastatic liver tumors from breast cancer, and the efficacy of this treatment was assessed. METHODS: Between June 2000 and April 2004, we used MR-guided microwave thermocoagulation therapy on 11 nodules in 8 patients with metastatic liver tumors from breast cancer. The procedure was carried out under general anesthesia. A 0.5 T open-configuration MR system and a microwave coagulator were used. Near-real-time MR images and real-time temperature images were collected and displayed on the monitor. The MR-compatible thoracoscope was used and combined with MR imaging guidance. Navigation software, a 3D Slicer, was installed and customized. RESULTS: The customized navigation software displayed near-real-time MR images. The percutaneous puncture into the tumors was successful in all cases. No mortality or major complications occurred as a result of the procedures. Five of the 8 patients are alive with new metastatic foci with a mean observation period of 25.9 months. CONCLUSIONS: We developed several devices to allow safe, easy, and accurate MR-guided microwave thermocoagulation therapy of liver tumors. Open-configuration MR-guided microwave thermocoagulation therapy appears to be a feasible method for tumor ablation of metastatic liver tumors from breast cancer.     

Tumor ablation with MRI navigation--a novel method of microwave coagulation therapy for hepatic tumor]

Fifty-eight patients with hepatic tumor which consisted of 22 hepatocellular carcinomas and 36 metastatic liver tumors were treated by microwave coagulation therapy with MRI navigation. The tumors were located in all segments of liver except S1. In 24 cases among them, the abdominal approach was difficult, because the tumors were located just below the diaphragm. These cases were selected for thoracoscope-assisted microwave ablation under MR-guidance across the diaphragm. All MR data were collected on a vertically oriented open MRI system (0.5 T SIGNA SP/i system: GE Medical Systems). The microwave electrode was introduced into the liver through a 14G needle via a percutaneous puncture with real-time MR image navigation. Microwave ablations at 60 W for 60 seconds were repeated several times depending on the tumor size. MR imaging may be employed as a reliable guide for percutaneous puncture. Moreover, sufficient safety margin could be obtained for hepatic tumor ablation. MR-guided microwave thermoablation therapy is a feasible method of treatment for hepatic tumors.     

MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data

MR-guided laser-induced interstitial thermotherapy (LITT) is a percutaneous, minimally invasive treatment modality for treating liver lesions/metastases, soft tissue tumours and musculoskeletal lesions. In this group, MR-guided LITT is currently performed under local anaesthesia on an out-patient basis with a specially designed saline-cooled laser application system. Nd:YAG laser (1064?nm wave length) was used for tumour ablation. Magnetic resonance imaging (MRI) using both open and closed MR units has proven clinically effective in validating the exact positioning of optical fibres. It also allows for real time-monitoring of thermal effects and the evaluation of treatment-induced coagulation necrosis. In liver tumours, percutaneous MR-guided LITT achieves a local tumour control rate of 98.7% at 3 months post-therapy and 97.3% at 6 months with metastases smaller than 5?cm in diameter. The mean survival rate for 1259 patients with 3440 metastases treated with 14 694 laser applications at the institute (calculated with the Kaplan-Meier method) was 4.4 years (95% confidence interval: 4.1–4.8?years) and median survival was 3.00 years. No statistically significant difference in survival rates was observed in patients with liver metastases from colorectal cancer vs metastases from other primary tumours. The rate of clinically relevant side effects and complications requiring secondary treatment was 2.2%. The clinical use of MR guided LITT (size<5?cm, number<5) is justified in patients with liver metastases of colorectal and/or breast cancers if the inclusion criteria are carefully observed. Further indications for MR guided LITT include recurrent cancer lesions in the head and neck, lung metastases and bone and soft tissue lesions.     

MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data.

MR-guided laser-induced interstitial thermotherapy (LITT) is a percutaneous, minimally invasive treatment modality for treating liver lesions/metastases, soft tissue tumours and musculoskeletal lesions. In this group, MR-guided LITT is currently performed under local anaesthesia on an out-patient basis with a specially designed saline-cooled laser application system. Nd:YAG laser (1064 nm wave length) was used for tumour ablation. Magnetic resonance imaging (MRI) using both open and closed MR units has proven clinically effective in validating the exact positioning of optical fibres. It also allows for real time-monitoring of thermal effects and the evaluation of treatment-induced coagulation necrosis. In liver tumours, percutaneous MR-guided LITT achieves a local tumour control rate of 98.7% at 3 months post-therapy and 97.3% at 6 months with metastases smaller than 5 cm in diameter. The mean survival rate for 1259 patients with 3440 metastases treated with 14 694 laser applications at the institute (calculated with the Kaplan-Meier method) was 4.4 years (95% confidence interval: 4.1-4.8 years) and median survival was 3.00 years. No statistically significant difference in survival rates was observed in patients with liver metastases from colorectal cancer vs metastases from other primary tumours. The rate of clinically relevant side effects and complications requiring secondary treatment was 2.2%. The clinical use of MR guided LITT (size < 5 cm, number < 5) is justified in patients with liver metastases of colorectal and/or breast cancers if the inclusion criteria are carefully observed. Further indications for MR guided LITT include recurrent cancer lesions in the head and neck, lung metastases and bone and soft tissue lesions.     

MR引导微波治疗肝癌的临床初步研究

目的研究利用MR导引微波治疗肝癌的可行性.方法利用0.23TMR导引微波热凝固治疗肝癌患者.结果在MR引导下,微波天线可以准确、安全地置入肿瘤内,而且没有严重并发症.结论MR导引微波治疗是可行的,而且它可以准确的显示毁损区的形状和边缘.     

超声引导经皮气冷微波固化在活体猪肝的实验研究

背景与目的:超声引导经皮微波固化术创伤小且疗效确实,目前已广泛运用于治疗小肝癌,但微波天线高杆温阻碍了该治疗方法的发展。本研究探讨新式气冷微波固化仪在肝癌微波固化治疗的应用前景。方法:应用ECO-100增强型气冷微波固化仪,在超声引导下对6头猪的肝脏进行活体微波凝固试验。结果:实验显示,运用气冷却技术进行微波固化可以降低微波天线杆温,从而可以通过增大微波输出功率及延长固化时间来增大固化范围;当微波功率为80W,辐射时间为10min时,单点凝固范围达到4.0cm×4.3cm;当微波功率为80W,辐射时间为20min时,凝固范围可达到4.7cm×5.2cm。而且气冷微波固化组织无“拖尾”现象。结论:气冷微波固化术可以降低微波天线杆温,增大微波功率和延长辐射时间,提高固化效果。     

超声引导下经皮微波凝固治疗肝癌的临床应用

目的探讨超声引导下经皮微波凝固治疗肝癌的临床应用价值。方法治疗３２例肝癌５７个结节。每个点的凝固治疗采用输出功率６０Ｗ,作用时间２４０～３００秒。５７个结节进行９２次１８２个点的治疗。结果随访５～１８个月,平均１０．４个月,２９例健在,３例死亡。治疗后８５．９％（４９／５７）的肿块缩小,超声显示７８．２％（３６／４６）的肿块内血流消失,增强ＣＴ显示７６．４％（２５／３４）的肿瘤内无强化。原血ＡＦＰ升高１３例,治疗后１１例降至正常。２７例患者全身情况改善,１９例体重增加。１４例治疗后再次活检,１２例肿瘤呈完全性坏死,代之以纤维结缔组织增生。结论超声引导下经皮微波凝固肝肿瘤,在大部分病例可以达到使肿瘤完全性坏死的较好疗效,可望成为肝癌非手术治疗的重要途径。     

经皮微波凝固疗法治疗肺癌的临床应用

目的　探讨经皮经肺微波凝固治疗周围型肺癌的临床疗效、CT影像的变化及不良反应。方法　使用针式单极微波辐射天线 ,CT引导下经皮经肺穿刺周围型肺癌 ,以 2 4 5 0MHz的微波 ,6 5W辐射 6 0s,对原发性肺癌 8例、转移性肺癌 12例 ,共 2 0例患者的 2 8个病灶进行治疗。结果　随访 3～ 2 4个月 ,16例患者健在。全部肿块均缩小 ,缩小 5 0 %以上 13个病灶 ,病灶消失 3例 ,有效率5 7.1%。CT表现为即刻凝固灶呈约 3.5cm× 2 .5cm的软组织影 ,1周后凝固区域内见气化灶 ,外周有高密度反应区 ,1个月后凝固区进一步缩小 ,3个月后实变 ,1年后几乎消失 ,治疗后细胞学证实肿瘤组织坏死。此治疗方法无副作用及并发症。结论　经皮微波凝固疗法治疗周围型肺癌是高效、微创、安全的新方法。     

超声引导下微波凝固治疗肝癌前后患者免疫指标的动态变化

 目的　观察超声引导下微波凝固治疗肝癌前后患者免疫指标的动态变化。方法　分别于微波治疗前1周及治疗后1、2、3、4周采集患者外周静脉血,用Cr51释放法检测自然杀伤细胞活性,放射免疫法测定白细胞介素-2水平,酶联免疫法测定可溶性白介素2受体水平。结果　肝癌患者存在严重免疫功能低下,与正常人比NK细胞活性与IL-2水平下降;SIL-2R水平上升,均有统计学意义(P<0.01)。微波凝固治疗肝癌后,NK细胞活性明显上升(P<0.05),SIL-2R水平明显降低(P<0.01)。结论　微波热疗后机体免疫功能增强,提高了抗肿瘤能力。     

超声引导经皮微波消融对紧邻胆囊肝癌的临床研究

目的探讨超声引导下经皮微波消融（PMCT）紧邻胆囊肝癌的有效性和安全性。方法2006年6月～2007年9月,31例患者的37个紧邻胆囊的恶性肿瘤行PMCT,本组病灶直径为0．8～5．9cm,平均3．2±1．7cm。随访患者2—16个月,平均随访期为7．1±4．3个月。并观察肿瘤灭活情况、肝功能、副作用及并发症。结果所有患者均未出现与操作相关的较严重并发症。其中术后17例患者发热,7例出现腹痛,17例出现发热,3例出现恶心、呕吐。肿瘤完全灭活率为89．1％;2例患者的3个结节分别于治疗后1个月、3个月、12个月出现肿瘤局部复发。结论PMCT对紧邻胆囊的肝癌病灶是一种安全、可行、有效的非手术治疗手段。     

MR-guided microwave ablation for malignancies

Since we first successfully performed magnetic resonance (MR)-guided microwave coagulation therapy for liver tumors in January 2000, we have developed new MR-compatible instruments, laparoscopy and thoracoscopy, which have enabled us to approach liver tumors located just below the diaphragm and in contact with other organs. We have customized software for an MR gradient-based tracking system for the easy detection of the location and orientation of treatment area and for the real-time display of MR temperature maps with a scale bar. Navigation software was customized to enable real-time image navigation. The reformatted images in the two perpendicular planes complemented the limitations of real-time MR imaging. Evaluation software, “FootPrint,” was useful for distinguishing treated areas from untreated areas and improved the evaluation of treatment accuracy. These newly developed MR-guided systems that utilize microwave have played important roles in more accurate, safer, and easier treatment for liver tumors. We have treated 184 patients using these new techniques without major complications.     

经皮微波固化联合肝动脉化疗栓塞治疗碘油存留较少的原发性肝癌

目的观察经皮微波固化治疗联合肝动脉化疗栓塞治疗碘油存留较少的原发性肝癌的疗效。方法60例曾经进行肝动脉化疗栓塞且碘油存留较少肝癌的患者随机分为两组。联合治疗组30例患者在进行肝动脉化疗栓塞后给予经皮穿刺微波固化治疗,对照组30例患者仅行肝动脉化疗栓塞治疗。结果联合治疗组和对照组的近期有效率分别为70%和53.3%,联合治疗组没有增加严重并发症。结论经皮微波固化联合肝动脉化疗栓塞治疗可提高碘油存留较少的原发性肝癌的近期疗效。     

经皮微波热凝治疗原发性和转移性肝癌

目的 经皮微波肝穿刺热凝损毁肝癌是个新的治疗方法,使用该法观察其对肝癌的作用疗效和安全性。方法 100例患者在局麻或硬膜外麻醉下,接受了经皮微波肝穿刺热凝损毁肝癌治疗,其中原发性和复发性肝癌79例,转移性肝癌21例。肿瘤总数186个,被分成瘤体直径<3cm的A组和瘤体直径≥3 cm-<5cm的B组。在局部麻醉或硬膜外麻醉下,单针或双针阵列的微波天线在B超的引导下直接经皮肝穿刺插入瘤体中对其行热凝损毁。结果 100例患者的186个瘤体中,直径<3cm A组的肿块123个(66％)能1次手术热凝损毁,其中112个(91％)经CT或MRI检查,并随访6-12个月,提示瘤体热损毁后未见复发;直径≥3 cm-<5cm B组的肿块63个(33.87％),被分2次手术,术后6个月 CT或MRI检查提示,31个热凝损毁(49％),32个大部分热凝损毁(51％)。经皮微波热凝治疗(PMCT)的患者均未见明显的不良反应和其他严重并发症。结论 PMCT治疗肝癌,尤其对直径<3cm的瘤体疗效可靠,对直径≥3cm-<5cm的瘤体仍具有大部分或完全热损毁的作用。它是一种微创、有效、安全的治疗方法,对肝功能较差的患者也可使用。     

Treatment of liver tumours adjacent to hepatic hilum with percutaneous microwave ablation combined with ethanol injection: A pilot study

Purpose: To evaluate the feasibility, safety and efficacy of ultrasound-guided percutaneous microwave ablation combined with percutaneous ethanol injection in the treatment of liver tumours adjacent to the hepatic hilum.

Materials and methods: From December 2005 to April 2008, 18 consecutive patients with 18 pathologically proven or clinically diagnosed liver tumours (15 HCCs, three metastatic tumours) adjacent to the hepatic hilum underwent ultrasound-guided percutaneous microwave ablation combined with percutaneous ethanol injection. One or two microwave antennae were inserted and placed at designated places in the tumour. One or two ethanol needles were placed at the tumour periphery near the hepatic hilum. An aliquot of 2–10?mL of absolute ethanol was injected into the tumour at the same time as microwave emission. A thermocouple was placed directly abutting the bile ducts of the hepatic hilum to monitor temperature in real time during ablation to avoid thermal injury.

Results: No more than two sessions were performed to complete the treatment (one session for 10 patients, two sessions for eight, mean 1.4 sessions per patient). Complete ablation was achieved in 94.4% (17 out of 18 cases). In a median follow up of 15 months (range 4 to 27 months, mean 13.5 months), no mortality or complications occurred. Local tumour progression was noted in one patient 12 months after treatment.

Conclusion: A combination of ultrasound-guided percutaneous microwave ablation and percutaneous ethanol injection assisted with real-time temperature monitoring appears to be feasible and effective in the treatment of liver tumours adjacent to the hepatic hilum, and initial experience with safety is promising.     

A case of postoperative multiple hepatic metastasis from gastric cancer successfully treated by percutaneous microwave coagulation therapy and hepatic arterial infusion chemotherapy

A 61-year-old male who underwent radical resection for gastric cancer was diagnosed with multiple hepatic metastasis 2 years and 2 months after the surgery. He first underwent percutaneous microwave hepatic coagulation therapy with segmental hepatic blood flow occlusion and obtained complete coagulation of the main tumor. Consecutively, he received hepatic arterial infusion chemotherapy (FAP: 5-FU, cisplatin, adriamycin) against residual multiple hepatic tumors. These hepatic recurrent lesions disappeared completely after 3 sessions of arterial infusion chemotherapy. At present, this patient is alive with no recurrent lesions, 1 year and 6 months from the beginning of treatment for hepatic metastasis. Recently, we tried hepatic arterial infusion chemotherapy (FAP) in four cases in which the recurrence from gastric cancer was not only in the liver but elsewhere. The response rate (CR and PR) was 75% and no major side effects were observed. In conclusion, some cases can obtain longer survival if the multimoderate therapy including hepatic arterial infusion chemotherapy (FAP) and microwave coagulation therapy are effective.     

A long-term surviving case of multiple metastatic liver tumors from rectal cancer treated with microwave coagulation therapy (MCT)

We experienced a long-term surviving case from excellent control of a multiple metastatic liver tumor from rectal cancer. The patient was a 38-year-old male, and his chief complaint was pain at defecation. The primary lesion was diagnosed as rectal cancer (Rb), and it was histologically found to be well-differentiated adenocarcinoma. The preoperative enhanced CT demonstrated 8 metastatic lesions in bilateral lobes of the liver. Low anterior resection for rectum and open microwave coagulation therapy (MCT) for liver metastasis were synchronously performed. The coagulated areas after MCT revealed no enhancement. The serum CEA levels returned to normal for 9 months. Nine months after the first operation, we detected 6 recurrent lesions in the other sites of the remnant liver. We used second open MCT because the hepatic arterial chemotherapy was ineffective. We performed percutaneous MCT for the next new lesions. The patient was diagnosed with lung metastasis 2 years after the first operation, and died of cancer growth 2 years and 9 months after the first operation. This long-term surviving case of nine metastatic liver tumors achieved adequate quality of life by a combination therapy mainly consisting of MCT.     

Indication of percutaneous microwave coagulation therapy for hepatocellular carcinoma

Multifocal carcinogenesis is caused by a persistent infection of hepatitis viruses, and is considered to be the main cause of post-operational recurrences of hepatocellular carcinoma. It has been generally believed that a single therapeutic modality (including resection therapy) cannot improve the survival rate. In this paper, we describe the efficacy of microwave coagulation therapy and its indications based on an analysis of cases experienced at our institution over a 10-year period. We compared the background factors, recurrence rate, and survival rate of various therapies, and concluded that microwave coagulation therapy is highly effective for tumor coagulation and necrosis. Microwave coagulation therapy is also technically easier than a surgical operation, has fewer complications, and results in an equally good survival rate when compared to hepatectomy. Due to these intrinsic advantages, microwave therapy is useful not only as a treatment after recurrence, but also as a primary therapy of small liver tumors. When the detection rate for small liver tumors increases, microwave coagulation therapy will start to play an even more important role in the treatment strategy for hepatocellular carcinomas as a less invasive option, in addition to laparotomic and percutaneous/laparoscopic surgeries.     

Percutaneous microwave coagulation therapy for patients with primary and metastatic hepatic tumors during interruption of hepatic blood flow

BACKGROUND: Although percutaneous microwave coagulation is relatively noninvasive therapy for patients with hepatic tumors, coagulation of tumors is sometimes incomplete and local recurrence occurs. The authors hypothesized that the cause of incomplete coagulation was a cooling effect in surrounding hepatic blood flow. To prove this hypothesis and to improve the efficacy of this therapy, they interrupted hepatic blood flow during the treatment and measured the amount of tumor tissue coagulated by microwave. METHODS: The authors first performed an animal experiment on pigs. After laparotomy, the liver of an anesthetized pig was coagulated by microwave with or without interruption of hepatic blood flow; the interruption was achieved by squeezing hepatic blood vessels. Next, the authors applied the microwave coagulation percutaneously to 25 human patients with primary or metastatic carcinoma in the liver with or without intraoperative temporary interruption of hepatic blood flow; the interruption was achieved by inflating balloon catheters inserted in the hepatic blood vessels through femoral vessels. RESULTS: The greatest dimension of area of normal liver tissue coagulated by microwave with blood flow interruption was significantly (P < 0.001) larger (18.8 +/- 1.0 mm, n = 4) than without it (9.8 +/- 1.7 mm, n = 4) in the experiment with pigs. In human hepatic tumors, the greatest dimension of the area coagulated by microwave with blood flow interruption was also significantly (P < 0.001) larger (41.1 +/- 9.3 mm, n = 14) than without it (26.9 +/- 8.5 mm, n = 11). The local recurrence rate of the tumor during a period of 6 months after the treatment was lower (P < 0.05) with blood flow interruption (7%) than without it (45%). CONCLUSIONS: Intraoperative interruption of hepatic blood flow increases the areas of primary and metastatic hepatic tumors coagulated by microwave. It is expected to increase the efficacy of percutaneous microwave coagulation therapy for patients with hepatic tumors.     

Radiofrequency ablation for hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related mortality worldwide. Unfortunately, only 20% of HCC patients are amenable to curative therapy (liver transplantation or surgical resection). Locoregional therapies such as radiofrequency ablation (RFA), percutaneous ethanol injection, microwave coagulation therapy, and transcatheter arterial chemoembolisation play a key role in the management of HCC. The choice of the treatment modality depends on the size of the tumour, tumour location, anatomic considerations and the number of tumours present and liver function. RFA therapy for HCC can be performed safely using a percutaneous, laparoscopic, or an open approach, even in patients with poor functional reserve. Since the introduction of RFA, several randomised controlled trials and non-randomised studies comparing RFA and other therapies for HCC have been conducted. In addition, in the last decade there have been technical advances in RFA therapy for HCC, resulting in significant improvement in the prognosis of HCC patients treated with this modality. In this review, we primarily focus on percutaneous RFA therapy for HCC and refer to current knowledge and future perspectives for this therapy. We also discuss new emerging ablation techniques.     

肝动脉化疗栓塞分别联合经皮微波凝固治疗与^125I放射性粒子植入治疗原发性大肝癌的疗效观察

目的评价和比较肝动脉化疗栓塞（TACE）联合经皮微波凝固治疗（PMCT）与TACE联合^125I放射性粒子植入治疗原发性大肝癌的效果。方法46例原发性大肝癌患者接受TACE联合PMCT治疗,20例接受TACE联合^125I放射性粒子植入治疗。术后2个月、3个月分别行动态增强CT复查。观察并比较两组疗效、毒副反应及并发症发生的情况。结果综合治疗后3个月,TACE联合PMCT组的有效率为82．61％,明显高于TACE联合^125I放射性粒子植入组的有效率55．00％（P〈0．05）。两组的临床总控制率分别为93．47％、85．00％（P〉0．05）。两组发生的毒副反应无明显差异,均未出现严重并发症。结论TACE联合PMCT及TACE联合^125I放射性粒子植入均为原发性大肝癌安全、有效的治疗方法,两组毒副反应及并发症的发生率相当,前者治疗效果较为理想,值得临床应用。