Clinical diagnosis and treatment of multiple pulmonary nodules / 中华肿瘤杂志

CT screening has markedly reduced the lung cancer mortality in high-risk population and increased the detection of early-stage pulmonary neoplasms, including multiple pulmonary nodules, especially those with a ground-glass appearance on CT. Multiple primary lung cancer (MPLC) constitutes a specific subtype of lung cancer with indolent biological behaviors, which is predominantly early-stage adenocarcinoma. Although MPLC progresses slowly with rare lymphatic metastasis, existence of synchronous lesions and distributed location of these nodules still pose difficulty for the management of such patients. One single operation is usually insufficient to eradicate all neoplastic lesions, whereas repeated surgical procedures bring about another dilemma: whether clinical benefits of surgical treatment outweigh loss of pulmonary function following multiple operations. Therefore, despite the anxiety for treatment among MPLC patients, whether and how to treat the patient should be assessed meticulously. Currently there is a heated discussion upon the timing of clinical intervention, operation mode and the application of local therapy in MPLC. Based on clinical experience of our multiple disciplinary team, we have summarized and commented on the evaluation, surgical treatment, non-surgical local treatment, targeted therapy and immunotherapy of MPLC in this article to provide further insight into this field.

CSCO ablation expert workshop report: Recommendations for the management of tumor ablation during the coronavirus disease 2019 epidemic

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel

Contrast-enhanced ultrasound and acoustic radiation force impulse elastography in evaluating efficacy of microwave ablation on hepatic alveolar echinococcosis in rats / 中国介入影像与治疗学

Objective: To observe the value of contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) elastography in evaluating efficacy of microwave ablation (MWA) on hepatic alveolar echinococcosis in rats. Methods: Totally 40 HAE rat models were divided into experimental group (n=30) and control group (n=10). Rats in experimental group underwent ultrasound-guided MWA, while those in control group received routine feeding. Routine 2D ultrasound, CEUS and ARFI were used to measure the maximum diameter of lesions before and 1 month later. The changes of mean gray scale ratio and shear wave velocity (SWV) in marginal zone of lesions in experimental group were compared with pathologic findings. Then the rats were all scarified, and routine HE staining, CD34 immunohistochemical staining and Masson staining were performed to count the microvessel density (MVD) and fibrosis area at the edge of lesions. Results: There were 19 rats (21 lesions) in experimental group and 10 rats (10 lesions) in control group. One month after MWA, the maximum diameter of lesions obtained with 2D ultrasound, CEUS and ARFI became smaller in experimental group (all P0.05). One month after MWA, the mean gray scale ratio of ablation edge in experimental group was lower, while SWV value was higher than that before (both P<0.001). MVD of the ablation edge in experimental group was lower than that in control group (P<0.001), and the fibrosis area of experimental group was higher than that of control group (P<0.001). MVD was positively correlated with the gray scale ratio at the ablation edge (r=0.541, P=0.011), and SWV was positively correlated with the fibrosis area of Masson (r=0.494, P=0.023). Conclusion: Both CEUS and ARFI had certain application value for evaluation on efficacy of microwave ablation for treatment of HAE in rat models.

Safety and Effectiveness Analysis of Percutaneous Microwave Thermal Ablation Therapy Combined Brachytherapy for Lung Malignant Lesion / 中国肺癌杂志

BACKGROUND@#Microwave ablation and radioactive seed implantation are therapeutic options for patients with advanced lung cancer and lung metastases lesion who are not surgical candidates. However, reports on therapeutic effectiveness and safety of the two combination treatments methods have been limited to small case series. This research was to assess the clinical outcome and safety of radioactive seed implantation combined with computed tomography (CT)-guided microwave ablation for the treatment of advanced lung cancer and lung metastases lesion.@*METHODS@#The clinical data of 21 advanced lung cancer and lung metastases patients who received treatment at author hospital during the period from May 2018 to December 2018 were retrospectively analyzed. The patients were divided into two groups by whether received extra percutaneous microwave thermal ablation therapy. The short-term effectiveness and safety were analyzed.@*RESULTS@#The efficacy of control group was 28.75%, and the efficacy of experiment group was 14.28%. The rate of adverse reaction between two groups has no significantly difference (P>0.05).@*CONCLUSIONS@#Seed implantation combined with CT-guided microwave ablation for advanced lung cancer and lung metastases is safety and effective.

Research status and progress of ablation therapy for locally advanced pancreatic cancer / 中华肝胆外科杂志

Locally advanced pancreatic cancer remains to be a disease with dismal prognosis,despite the improvements in chemotherapy or chemoradiotherapy,which was recognized as standard treatment.A heterogeneous armamentarium of locoregional ablative therapeutic options has been successfully applied for other solid organ malignancies.Recently,they were gradually applied in pancreas and commenced to show benefits.However,there are still many problems to be discussed.Here we reviewed the recent publications on the feasibility,safety and efficiency of various ablation treatments that have been applied to pancreatic cancer.

Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study

OBJECTIVE: To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group. MATERIALS AND METHODS: This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA. RESULTS: There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm³/min vs. 3.03 ± 1.99 cm³/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15). CONCLUSION: DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.

Clinical application of high-intensity focused ultrasound ablation for uterine fibroids

HIFU (high-intensity focused ultrasound) ablation is an emerging therapeutic modality that induces thermal coagulative necrosis of biological tissues by focusing high-energy ultrasound waves onto one small spot. This technique is at various stages of clinical applications in several organs. However, it has increasingly been used in the treatment of symptomatic uterine fibroids, a common condition affecting women. Since its first clinical use for symptomatic uterine fibroids, this technique has been recognized for safety, satisfactory therapeutic efficacy in symptom control, uterus-preserving ability, radiation-free nature, and because of the fact that it does not require hospitalization. Owing to its numerous benefits, HIFU ablation is currently one of the major therapeutic options for symptomatic uterine fibroids. In this review, several aspects ranging from the physical principle of HIFU to the long-term outcomes are summarized from the perspective of the clinical application for uterine fibroids.

Effect of a Low Iodine Diet vs. Restricted Iodine Diet on Postsurgical Preparation for Radioiodine Ablation Therapy in Thyroid Carcinoma Patients

PURPOSE: The radioiodine ablation therapy is required for patients who underwent a total thyroidectomy. Through a comparative review of a low iodine diet (LID) and a restricted iodine diet (RID), the study aims to suggest guidelines that are suitable for the conditions of Korea. MATERIALS AND METHODS: The study was conducted with 101 patients. With 24-hour urine samples from the patients after a 2-week restricted diet and after a 4-week restricted diet, the amount of iodine in the urine was estimated. The consumed radioiodine amounts for 2 hours and 24 hours were calculated. RESULTS: This study was conducted with 47 LID patients and 54 RID patients. The amounts of iodine in urine, the 2-week case and 4-week case for each group showed no significant differences. The amounts of iodine in urine between the two groups were both included in the range of the criteria for radioiodine ablation therapy. Also, 2 hours and 24 hours radioiodine consumption measured after 4-week restrictive diet did not show statistical differences between two groups. CONCLUSION: A 2-week RID can be considered as a type of radioiodine ablation therapy after patients undergo a total thyroidectomy.

Application of hydro-dissection technique in percutaneous thermal ablation of neck nodular lesions / 第二军医大学学报

Objective To introduce the hydro-dissection technique and its application in ultrasound-guided percutaneous thermal ablation therapy of neck nodular lesions. Methods A total of 1 126 patients suffering from neck nodular diseases received percutaneous thermal therapy using radiofrequency ablation or microwave ablation from May 2005 to April 2013. As a part of the treatment procedure, ultrasound-guided injection of separating liquid was performed into between the target nodules and surrounding structures to form a separating zone prior to ablation. The roles of hydro-dissection technique in improving the safety of puncture route, reducing the thermal injury to normal tissues, and enhancing the curative effects of ablation were analyzed. Results Hydro-dissection technique was successfully performed in as many as fourteen parts related to the thyroids, parathyroids, submandibular glands and lymph nodes. The key points and ultrasonic characteristics of this maneuver were well established and understood. Compared with those not receiving the technique, those receiving the technique had significantly reduced heat damage to lesion-adjacent structures (0.7% vs 15%, P < 0.01) and decreased incomplete ablation rate of the lirst try (0.29% vs 7.4%, P < 0.01). Conclusion Hydro-dissection technique under ultrasound-guidance is easy to perform, has good repeatability and reliable effect; it may serve as a safe and effective supplementary measure for thermal ablation of various neck nodular lesions.

Radiofrequency ablation therapy for breast cancer:case report and reference review / 实用肿瘤学杂志

Objective To evaluate the effect of ultrasound guided percutaneous radiofrequent ablation treatment on breast cancer .Methods Two patients,were pathologically confirmed as breast cancer ,underwent percutaneous ultrasound guided radiofrequency ablation of breast lesions ,followed with radical excision of breast within 3 months after the ablation .Postoperative pathological examination was conducted .Patients were followed up for over 12 months by now.Results The postoperative pathology of case No .1,in which the original breast le-sion was within 2 cm in diameter,found no tumor cells left but filled with inflammatory cells instead .Case No.2 with the longer diameter as 27 mm showed majority necrotic tissues but the tissue around left with some ductal carcinoma in-situ components .One-year′s follow up found no local recurrence or distant metastasis of tumor . Conclusion Radiofrequency ablation is a promising therapy with minimally invasion and better outlooking for early breast cancer within 2 cm in diameter .

Photodynamic Therapy for Barrett's Esophagus and Esophageal Carcinoma

This paper reviews the use of photodynamic therapy (PDT) in patients with Barrett's esophagus and esophageal carcinoma. We describe the history of PDT, mechanics, photosensitizers for PDT in patients with esophageal disease. Finally, we discuss its utility and limitations in this setting.

Androgen receptor levels during progression of prostate cancer in the transgenic adenocarcinoma of mouse prostate model.

Aim To construct tissue microarrays (TMAs) that consisted of prostate tumours from the transgenic adenocarcinoma of mouse prostate (TRAMP) mice and non-transgenic murine prostates and to assess androgen receptor (AR) levels during progression of prostate cancer in TRAMP mice by immunohistochemistry. Methods Haematoxylin and eosin (H&E) sections from the ventral and dorso-lateral prostate lobes of non-transgenic, intact TRAMP and castrated TRAMP were used to demarcate regions of interest for TMAs construction. The samples on TMAs were used to evaluate AR expression using video image analysis (VIA). Results AR was expressed during cancer progression, but AR levels were reduced or absent in late stage disease. Furthermore, when AR levels were compared in tumours from intact and castrate animals, a significant increase in AR levels was observed following androgen ablation. Conclusion Similar to clinical prostate cancer, in the TRAMP model, prostate tumours evolve mechanisms to maintain AR expression and AR responsive gene pathways following castration to facilitate continued tumour growth.

Is Percutaneous Ethanol Injection Therapy Still Effective for Hepatocellular Carcinoma in the Era of Radiofrequency Ablation?

Percutaneous ethanol injection (PEI) therapy has been replaced by more-effective thermal ablation techniques that have lower local recurrence rates. However, PEI therapy remains useful in certain settings. Since PEI can be performed in any portion of the liver, PEI therapy can be valuable when tumors are located in close proximity to intestinal loops or other positions that are risky for thermal local ablative techniques. PEI therapy is also valuable in other situations where radiofrequency ablation (RFA) is difficult, including technically difficult masses that are not detected with ultrasound (US), are located in the hepatic dome, in the subcapsular area, and exophytically, or are surrounded by large vessels. PEI therapy contributes to combination therapy with transcatheter arterial chemoembolization or RFA in advanced-stage hepatocellular carcinoma (HCC), and also to the treatment of large HCC or extrahepatic metastasis from HCC. These roles of PEI therapy should be stressed for the treatment of HCCs in appropriate clinical situations. This comprehensive review of articles related to PEI therapy illustrates the recent role and indications of this therapy, which is currently valuable for HCC in the era of RFA.

Alternative Energy Sources for Surgical Treatment of Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery: Microwave Ablation vs Cryoablation

The study aim was to compare maze outcomes using microwave ablation or cryoablation in patients with mitral disease and atrial fibrillation (AF). Between 1999 and 2005, 340 patients underwent mitral valve surgery and concomitant maze procedure involving either microwave ablation (n=96, MW group) or cryoablation (n=244, Cryo group). Mean age at operation was 50.0+/-12.5 yr. Follow-up period was 46.1+/-28.2 months. The Cryo group showed a longer aortic clamping time than the MW group (P=0.005). There were no differences in operative mortality and morbidity rates. The unadjusted 5-yr AF free rate was 61.3+/-1.2% in the MW group and 79.9+/-3.2% in the Cryo group (P=0.089). After adjustment, the MW group only showed a tendency toward more frequent AF recurrence than the Cryo group (Hazard ration 1.66, 95% confidence interval 0.89 to 3.07). Multivariate analysis revealed that older patient age (P<0.001) and greater left atrial size (P<0.001) were independent risk factors for AF recurrence. Although the use of microwave ablation results in shorter aortic clamping time, it has a tendency toward more frequent late AF recurrence than with cryoablation.

Metástasis intraabdominal y pélvica en cáncer de próstata: resistente a terapia de bloqueo androgénico total / Pelvic and intraabdominal metastases in prostate cancer: resistant to total androgenic blockade therapy

Los sitios habituales para metástasis de cáncer de próstata son en ganglios linfáticos regionales, vejiga, hueso, pulmón, hígado, un escaso porcentaje en otras localizaciones, como retroperitoneo y mediastínicas. Cirugía y radioterapia constituyen el tratamiento estándar de la enfermedad localizada. El uso de la terapia hormonal ha sido el principal abordaje oncológico en el tumor hormono sensible. La quimioterapia recientemente ha arrojado una alternativa terapéutica para estos tumores. Deprivación androgénica produce una disminución en niveles del antígeno prostático específico, regresión de masas tumorales medibles y período de estabilidad clínica. Paciente masculino de 60 años de edad, con adenocarcinoma poco diferenciado infiltrante de próstata Gleason 10, localmente avanzado, bajo tratamiento con bloqueo androgénico total, quien refirió dolor abdominal, aumento de volumen progresivo en hipogastrio y estreñimiento. Biopsia de tumor abdominal: adenocarcinoma de próstata poco diferenciado metastásico. Quimioterapia con docetaxel provee un mejor soporte para los pacientes con cáncer de próstata metastásico, andrógeno independiente.

The common sites for metastasis of prostate cancer are lymphatic’s regional nodule, bladder, bones, lung, liver, a small percentile of cases are present in other localizations how retro peritoneum, mediastinum. The surgery and radiation therapy are the standard treatment for disease localizes lesions. The use of hormonal therapy is the principal oncological treatment for hormone sensitive tumors. Recently chemotherapy treatment are and therapeutic alternative for this kind of tumors. Androgenic suppression produces a decrease of the levels for specifically prostate antigen, regression of the measure mass tumors anda clinical stable period. Masculine patient of 60 years old with less differentiated prostate adenocarcinoma Gleason 10, locally advanced, underwent suppression androgenic treatment, which refer abdominal pain and increase of the hipogastric volume. The biopsy of the abdominal tumor: Metastatic less differentiated adenocarcinoma of the prostate. Chemotherapy with docetaxel improves the support for the patients with metastatic prostate cancer metastásic androgenic independence.

The effectiveness of thermal uterine balloon therapy in patients with abnormal uterine bleeding / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness and safety of uterine thermal balloon ablation therapy (UBT) for the treatment of abnormal uterine bleeding . METHODS: From May 2005 to June 2007, a total of 40 women who visited to our hospital and Wallace memorial baptist had their charts and telephones reviewed for demographics, procedure data, clinical history, and follow up. RESULTS: The mean age was 43.5+/-4.7 years old. A decrease in days per cycle (7.2+/-2.5 vs 5.2+/-2.7 days, P<0.0001), and in pads per day (9.9+/-2.3 vs 5.8+/-3.1 pads/d, P<0.0001) and an increase in hemoglobin (g/dL, mean+/-SD) /hematocrit (%, mean+/-SD) (7.2+/-0.5/29.4+/-2.7 vs 10.3+/- 1.7/36.4+/-4.4, P<0.0001) and an improvement in self-reported quality of life scores (discomfort score: 7.1+/-2.1 vs 2.5+/-1.7, P<0.0001, limitation of life: 1.9+/-1.5 vs 0.6+/-1.5, P<0.0001) were observed after UBT. Assessment of the level of satisfaction showed that 76% of patients were satisfied with the procedure. No major complications or deaths were found. The prognostic factors of UBT were age, parity, uterine pressure and depth, position. But age and uterine pressure had no significant difference statistically. CONCLUSION: UBT is a safe and efficient method to treat abnormal uterine bleeding. It reduces the menstrual flow, improves the quality of life, and remarkably satisfies patients with a desire to preserve a uterus.

Are Medical Personnel Safe from Radiation Exposure from Patient Receiving Radioiodine Ablation Therapy? / 핵의학분자영상

Radioiodine ablation therapy has been considered to be a standard treatment for patient with differentiated thyroid cancer after total thyroidectomy. Patients may need to be hospitalized to reduce radiation exposure of other people and relatives from radioactive patients receiving radioiodine therapy. Medical staffs, nursing staffs and technologists sometimes hesitate to contact patients in radioiodine therapy ward. The purpose of this paper is to introduce radiation dosimetry, estimate radiation dose from patients and emphasize the safety of radiation exposure from patients treated with high dose radioiodine in therapy ward. The major component of radiation dose from patient is external exposure. However external radiation dose from these patients treated with typical therapeutic dose of 4 to 8 GBq have a very low risk of cancer induction compared with other various risks occurring in daily life. The typical annual radiation dose without shielding received by patient is estimated to be 5 to 10 mSv, which is comparable with 100 to 200 times effective dose received by chest PA examination. Therefore, when we should keep in mind the general principle of radiation protection, the risks of radiation exposure from patients are low and the medical personnel are considered to be safe from radiation exposure.

The efficacy of uterine balloon ablation therapy in patient with menorrhagia / 대한산부인과학회지

OBJECTIVE: Menorrhagia is defined as a complaint of heavy cyclical menstrual bleeding occurring over several consecutive cycles and approximately 30% of women suffer from it. Recently uterine balloon ablation therapy (UBT) system has been used widely as a safe and easy surgical option for this cumbersome symptom. The aims of this study were to determine the safety and the efficacy of UBT system in the management of menorrhagia, and to identify the possible factors for a successful outcome. METHODS: From August 2003 to May 2004, 77 patients with menorrhagia were enrolled. Demographic information, diary score for menorrhagia, and size of uterus were checked before treatment. All patients were treated with UBT system under IV anesthesia at day-surgery unit and followed up post-operatively. The change of diary score, and the change of hemoglobin/hematocrit were recorded. And the change of quality of life was assessed. RESULTS: Medical records of 73 patients who completed scheduled follow up were analyzed. Mean age was 43.7 years old, pre-operative mean diary score was 255.9+/-98.0 and pre-operative mean hemoglobin was 10.67+/-1.67. After the operation, the diary score significantly decreased to 53.3+/-27.5, and the hemoglobin significantly increased to 12.67+/-1.53. Multiple logistic regression analysis showed that success of treatment was influenced by the indication of UBT, patient age, uterine depth, and adequate intra-operative balloon pressure. An improvement in self-reported quality of life scores was also observed. CONCLUSION: The UBT system is a safe and effective method to treat menorrhagia and can be easily done under outpatient basis. Thus, it is a good alternative to hysterectomy or hysteroscopic endometrial ablation with a comparable success rate and minimal risk.

A Case of Condyloma Acuminatum Treated by Argon Plasma Coagulation / 대한소화기내시경학회지

Condyloma acuminatum (CA) is a common sexually transmitted disease caused by the human papillomavirus. In gastrointestinal practice, we generally encounter this disease in the anal canal but rarely in the rectum during a colonoscopy. There are many therapeutic options for CA including chemical or physical destruction, immunological therapy, or a surgical excision. All these procedures have some degree of limitations such as limited clearance rate, high recurrence rate, long duration of therapy, bleeding, release of potentially infectious aerosols, scarring etc. With argon plasma coagulation (APC), which is more available than lasers in gastrointestinal practice, a high frequency current flows through the argon plasma to the tissue, allowing well-controlled superficial tissue destruction without any direct contact between the probe and the tissue. We present a case of anal CA that was treated successfully with APC during a colonoscopy with no recurrence during the follow up.