Development Status of Irreversible Electric Perforated Tumor Ablation Device / 中国医疗器械杂志

This study firstly introduced the mechanism, benefits and applications of irreversible electroporation(IRE) for tumor ablation. In addition, this study also introduced the most advanced IRE systems cleared by FDA or CFDA and IRE research equipment. The clinically licensed IRE systems include the Nanoknife 3.0 of Angiodynamics, the Dophi

Therapy of Pancreatic Neuroendocrine Tumors: Fine Needle Intervention including Ethanol and Radiofrequency Ablation

Pancreatic neuroendocrine tumors (PNETs) are increasingly being detected, though usually as incidental findings. Majority of the PNETs are non-functional and surgical resection is the standard of care for most of them. However, in patients with small PNETs localized within the pancreas, who are unfit or unwilling for surgery, alternate methods of treatment are needed. Direct methods of ablation of PNETs, using either ethanol injection or radiofrequency ablation (RFA), are emerging as effective methods. The limited literature available as case reports or case series on endoscopic ultrasound (EUS)-guided local ablation using either ethanol or RFA has demonstrated safety and efficacy along with short- to medium-term sustained relief. Long-term benefits with these local ablative therapies are awaited. Comparative studies are needed to show which of these two competing technologies is superior. Finally, comparative trials of EUS-guided ablation with surgical resection in terms of efficacy and safety will ensure their place in the management algorithm.

Total reconstruction of mandible by transport distraction after complete resection for benign and malignant tumors.

Background: Distraction osteogenesis (DO) is a recognized technique for the bone lengthening and correction of various mandibular deformities. It has an aided advantage of both osteogenesis and histiogenesis in achieving a bone supported mandibular ridge covered with attached gingiva, forming an appropriate vestibule. Aim: The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects following tumor ablation in both benign and malignant tumor cases. Materials and Methods: This is a retrospective analysis of patients who underwent mandibular TDO for the correction of mandibular segmental defect at authors’ center from 2000 to 2014 with the inclusion criteria of segmental bony defect in the mandible with moderate soft tissue defect. After the latency period of 10 days, the distraction was initiated at a rate of 0.25–1 mm/day. The distraction period continued until the segment with the transport disc reached the distal base. The total consolidation periods ranged from 6 to 14 weeks. Results: The study group consists of 9 cases of TDO for reconstruction of segmental defect following tumor resection, of which 5 cases of benign and 4 cases of malignant tumor resection. The mean (standard deviation [SD]) bony defect length was 48 mm (9.8). The mean (SD) distracted bone lengthening was 43 mm (9.7), with a mean (SD) consolidation period of 17.9 (3.4) weeks. The bony defect involved the hemimandibular angle in four patients, hemimandibular body in three patients, with greater involvement of the body, symphysis in two patients, and of the bilateral mandibular body in two patients. Except for two patients who required additional bone grafting to complete union with the residual bone, other seven patients in the distraction zone showed the complete ossification by radiological evaluation. The mean (SD) consolidation period of 13.56 (1.5) weeks ranging from 12-15 weeks with the mean (SD) follow‑up years is about 8.7 years (2.95) for the cases. Out of the 9 cases, one case had recurrence in the follow‑up period and underwent resection with reconstruction using reconstruction plate in the created bone. The overall success rate of TDO was 88.9% (8 out of 9) in spite of adequate case selection and TDO protocol. Conclusions: TDO potentially benefits patients with segmental bony defects following tumor ablation in mandible. It is an unswerving tool to achieve sufficient bone in mandible in patients who cannot undergo aggressive surgery or poor general health. Bone resorption remains a critical issue for this reconstruction technique, though blood supply is continuously maintained in TDO.

Radiofrequency Ablation of Hepatocellular Carcinoma: Pros and Cons

Among locoregional treatments for hepatocellular carcinoma (HCC), radiofrequency ablation (RFA) has been accepted as the most popular alternative to curative transplantation or resection, and it shows an excellent local tumor control rate and acceptable morbidity. The benefits of RFA have been universally validated by the practice guidelines of international societies of hepatology. The main advantages of RFA include 1) it is minimally invasive with acceptable morbidity, 2) it enables excellent local tumor control, 3) it has promising long-term survival, and 4) it is a multimodal approach. Based on these pros, RFA will play an important role in managing the patient with early HCC (smaller than 3 cm with fewer than four tumors). The main limitations of current RFA technology in hepatic ablation include 1) limitation of ablation volume, 2) technically infeasible in some tumors due to conspicuity and dangerous location, and 3) the heat-sink effect. Many technical approaches have been introduced to overcome those limitations, including a novel guiding modality, use of artificial fluid or air, and combined treatment strategies. RFA will continue to play a role as a representative ablative modality in the management of HCC, even in the era of targeted agents.