Research advances in thermal ablation for lung cancer / 中国胸心血管外科临床杂志

@#Although surgical resection remains to be the best treatment strategy for stageⅠnon-small cell lung cancer (NSCLC), percutaneous thermal ablation offers an important option for patients who are unable to undergo surgical resection. Currently, there are three main thermal ablation methods used in the treatment of lung cancer, including radiofrequency ablation (RFA), microwave ablation (MWA) and argon-helium cryoablation (AHC). With the improvement of technique and the accumulation of experience in the treatment of lung cancer, some limitations are disclosed in the initial application of RFA, such as heat sink effect, skin burns and rapid carbonization. These shortcomings have been overcome in the development of MWA and AHC. The feasibility and safety of thermal ablation for the treatment of lung cancer has been demonstrated and its efficacy has been significantly improved (especially for the tumour diameter≤3 cm). This article will focus on the application and recent research developments of these ablation techniques in the treatment of lung cancer.

Effects of Amarogentin on Residual Liver Cancer Stem Cells After Insufficient Thermal Ablation and Related Mechanism / 肿瘤防治研究

Objective To observe the effects of amarogentinon liver cancer stem cells (LCSCs) after insufficient thermal ablation and its mechanism. Methods A insufficient thermal ablation model of HepG2 cells was established by water bath method.The percentage of CD133-positive LCSCs and the mRNA and protein levels of CD133 were detected by flow cytometry, qRT-PCR and Western blot.The insufficient thermal ablation model of HepG2 cells was treated with variable doses of amarogentin for 24 h; the percentage of CD133-positive LCSCs, the proliferation and apoptosis of liver cancer cells, and the mRNA and protein levels of CD133, TBC1D15, and p53were detected by flow cytometry, qRT-PCR and Western blot. Results The percentage of CD133-positive HepG2 cells and the mRNA and protein levels of CD133 and TBC1D15in the insufficient thermal ablation model were significantly higher than those in the normal HepG2 cells.Amarogentin then markedly decreased the percentage of CD133-positive LCSCs, the proliferation rate of HepG2 cells, and the mRNA and protein levels of CD133 and TBC1D15 in the insufficient thermal ablationresidual model (all P < 0.05);inversely, the apoptosis rate of HepG2 cells and the phosphorylated levels of p53 in the insufficient thermal ablation model were significantly increased (all P < 0.05). Conclusion Amarogentin could reduce the proportion of LCSCs after insufficient thermal ablation, inhibit the proliferation, and promote the apoptosis of LCSCs, which maybe associated with increasing the phosphorylation of p53 and inhibiting the expression of TBC1D15.

Randomized controlled trial of endovenous N-butylcyanoacrylate endovenous nonthermal ablation and radiofrequency endovenous thermal ablation for incompetent great saphenous veins / 中华普通外科杂志

Objective:To evaluate the safety and efficacy of n-butyl cyanoacrylate (NBCA) in treating great saphenous vein(GSV) incompetence.Methods:60 patients (60 limbs) with GSV incompetence were randomly divided into NBCA glue group (30 cases) and radiofrequency ablation(RFA) group in 30 cases. The clinical outcomes, venous clinical severity score(VCSS), and quality of life using the Aberdeen varicose vein questionnaire(AVVQ) were evaluated. The primary endpoint is the occlusion rate of GSV at 3 months after surgery.Results:For the two groups, the occlusion rate of GSV was 100% immediately after surgery and at 3 months follow-up. AVVQ and VCSS were improved in the two groups( P<0.05). In terms of complications, the NBCA group had scleroma in 3 cases, pain and skin redness in 1 case respectively, but no ecchymosis and numbness. In the RFA group, numbness occurred in 1 case, skin redness in 2 cases, scleroma in 3 cases, ecchymosis and pain in 4 cases respectively. The incidence of ecchymosis and total complications in the NBCA group was significantly lower than that in the RFA group( P<0.05). No DVT or other adverse event occurred in both groups. Conclusion:NBCA and RFA have the same short-term closure rate. Furthermore, the NBCA treatment requires less equipment, no use of tumescent anesthetic, and has lower incidence in terms of complications than that of RFA.

Current Status and Progress of Thermal Ablation Combined with Immunotherapy for Lung Tumors / 中国肺癌杂志

Recent studies have shown that tumor immune microenvironment is closely related to tumor progression, metastasis, recurrence and response to treatment. Some immunotherapies also offer hope for cancer patients. However, the efficacy of tumor immunotherapy is uncertain and has some side effects. In order to enhance its efficacy, tumor immunotherapy combined with tumor thermal ablation has been studied. Thermal ablation has the advantages of minimally invasive, rapid recovery, safety, fewer complications, conformation, reliable effect, repeatable, low cost, and has become the fourth tumor treatment measure after surgery, radiotherapy, and drug therapy. It can directly kill tumor cells and modulate the immune system through a variety of mechanisms, although the corresponding mechanisms are not well understood, but combined tumor immunotherapy has been proposed to treat several solid malignancies. In this review, the current status and progress of thermal ablation combined with immunotherapy for lung tumor were reviewed, and further studies on the efficacy and safety of thermal ablation combined with immunotherapy were expected.
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Early hepatocellular carcinoma: does hepatectomy and local thermal ablation therapy compete or complement each other / 国际外科学杂志

Hepatectomy and local thermal ablation therapy (LTAT) are the two most commonly used curable therapeutic methods for hepatocellular carcinoma. Early hepatocellular carcinoma (diameter ≤ 3 cm) is not only the best indication of hepatectomy, but also the most advantageous field of LTAT. For its treatment, whether hepatectomy or LTAT is the first choice has always been a controversial topic. With the establishment of the concept of minimally invasive liver resection and the improvement of minimally invasive treatment technology for more than 20 years, the curative effect and safety of hepatocellular carcinoma have been further improved. In contrast, LTAT in the treatment of early hepatocellular carcinoma lacks innovative progress and systematic promotion in quality management, concept and technology, and the overall efficacy lacks substantial improvement, so its academic status is challenged. This paper briefly describes the academic status and relationship of hepatectomy and LTAT in the comprehensive treatment of early hepatocellular carcinoma from the aspects of the characteristics of hepatectomy and LTAT, the causes influencing the treatment decision-making and the prospect of future treatment mode. It is pointed out that at the present stage in China, hepatectomy and LTAT are very complementary to the treatment of early hepatocellular carcinoma, and they are not competitive with each other, Instead, they complement each other.

Review of Computer Modeling and Simulation of Spinal Thermal Ablation / 中国医疗器械杂志

Thermal ablation surgery can effectively eliminate bone tumors in the spine and meanwhile reduce damage to the human body. To realize the computer modeling and simulation of spine thermal ablation surgery, it is necessary to ensure the accuracy of both spine modeling and simulation temperature. This review summarizes the research progress of this field and analyzes the prospects from two aspects: computer modeling based on spine segmentation from medical images and simulation calculation of temperature field in ablation surgery. The research on spine segmentation has made great progress, but there are still some problems that prevent it from being applied in clinical simulation. Related research has been trying to solve the problems. For the ablation surgery of the spine, some researchers have tried ablation simulation and obtained simulation results that are relatively consistent with the actual temperature value.

Experimental study on temperature dependence of dielectric properties of biological tissues at 2 450 MHz / 生物医学工程学杂志

The temperature dependence of relative permittivity and conductivity of

Perfluorobutane contrast-enhanced ultrasonography: a new standard for ultrasonography-guided thermal ablation of sonographically occult liver tumours?

INTRODUCTION@#Image-guided thermal ablation, preferably with ultrasonography (US), is increasingly used for treatment of small liver tumours. Perfluorobutane-contrast-enhanced US (pCEUS) is a promising tool that may allow for targeting of tumours that are otherwise imperceptible on greyscale US. Although pCEUS has been reported to be effective, the literature has been limited outside of Japan and South Korea. We aimed to provide data that supports the use of pCEUS in the thermal ablation of sonographically occult liver tumours.@*METHODS@#We conducted a retrospective single-centre study of 35 consecutive patients who underwent pCEUS-guided ablation of 48 liver tumours with a median size of 1.2 cm. Periprocedural, one-month post-treatment and relevant follow-up imaging studies were reviewed. Electronic records were also obtained, with long-term follow-up data of 12-28 months being available for 32 patients.@*RESULTS@#36 (75%) tumours that were imperceptible on greyscale US became visible with pCEUS. Overall, complete tumour ablation at one month was 89%. 1 (3%) patient developed a major complication following treatment, while 6 (17%) had minor post-treatment complaints. The local tumour progression rate was 17%, with a median time of 14 months.@*CONCLUSION@#pCEUS has a role in US-guided thermal ablation of liver tumours, offering a high technical success rate that is comparable to reported data. Additional benefits may include improved procedural time and freedom from ionising radiation.

Advances in Ultrasound Tissue Characterization and Its Application in Thermal Ablation of Tumors / 中国医疗器械杂志

The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient

Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition) / 中国肺癌杂志

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Clinical analysis of 31 lung metastases patients by percutaneous thermal ablation in a single center / 中国胸心血管外科临床杂志

@#Objective    To explore the factors that affect the accuracy of percutaneous thermal ablation of lung metastases and coping strategies. Methods    We retrospectively analyzed the clinical data of 31 patients who met the conditions for thermal ablation of lung metastases in Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine between October 2019 and December 2020. There were 19 males and 12 females with a mean age of 40-81 (62.8±10.3) years. A total of 33 metastases tumors were thermally ablated, 12 were radiofrequency ablation and 19 were microwave ablation. Results    Of the 33 metastatic tumors, 5 targets showed significant puncture deviation, 4 of them completed the ablation after adjustment and 1 failed. The result of the univariate logistic regression showed the distance within the lung parenchyma (P=0.043) and the maximum diameter of the tumor (P=0.025) were independent risk factors for the accuracy of percutaneous thermal ablation. In terms of correlation, there was a positive correlation between the accuracy of percutaneous thermal ablation and the distance within the lung parenchyma (P=0.033), and a negative correlation between the maximum diameter of metastases tumor (P=0.004) and hemoptysis (P=0.015). Complete ablation rate was 87.8% (29/33). Conclusion    When we perform CT-guided percutaneous thermal ablation of lung metastases, we must fully prepare the deviation plan for the small diameter tumor, the long travel distance in the lung parenchyma, and hemoptysis during puncture. Complete ablation can be achieved by fully identifying the anatomical features of the tumor and its surrounding structures, shortening the travel distance in the lung parenchyma and increasing the ablation range.

Predictive effects of a combined indicator in patients with hepatocellular carcinoma after thermal ablation

Aim: This study aimed to investigate the predictive power of the combination of Systemic Immune-Inflammation Index (SII) and albumin-bilirubin (ALBI) grade in prognosis outcomes of early-stage hepatocellular carcinoma (HCC) after thermal ablation. Materials and Methods: This retrospective study was reviewed and approved by our institutional review board, and written informed consent was obtained from each patient. According to the Milan criteria, a total of 405 treatment-naïve patients with clinicopathologically confirmed HCC were enrolled who subsequently underwent thermal ablation from 2011 to 2016. The outcomes of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were statistically analyzed. Results: The median follow-up time of this study was 45.1 months (range, 1.3–83.2 months). After thermal ablation in patients with SII-ALBI Grades 1, 2, and 3, the cumulative 5-year OS rates were 81.7%, 63.2%, and 26.9%; the 5-year CSS rates were 82.4%, 67.5%, and 26.9%; and the 5-year RFS rates were 49.3%, 44.6%, and 25.3%, respectively (all P < 0.001). On multivariate Cox regression analyses, SII-ALBI was independently associated with the three outcomes after adjustment for various confounders (all P < 0.05). In addition, SII-ALBI played a predictive role in OS, CSS, and RFS for patients with negative alpha-fetoprotein (AFP) (P < 0.05). Compared with SII and ALBI, the AUCs for the prediction of OS and CSS using SII-ALBI were superior to single indicator (bothP < 0.05). Conclusion: Elevated preablation SII-ALBI is associated with shorter OS, CSS, and RFS in patients with early-stage HCC. Our indicator showed the potential to be a supplement tool for patients with negative AFP during follow-up

Analysis of imaging-guided thermal ablation puncture routes for tumors of the hepatic caudate lobe

Aims: The goal of this study was to analyze the puncture routes of imaging-guided thermal ablation for tumors of the hepatic caudate lobe. Materials and Methods: The imaging-guided thermal ablation puncture routes of 12 cases of hepatic caudate lobe tumors were collected in our hospital from January 2013 to February 2019. The puncture routes were retrospectively analyzed, and the experience of thermal ablation therapy for hepatic caudate lobe tumors was summarized. Results: Among the 12 cases of hepatic caudate lobe tumors, puncture routes were divided into the anterior (through the left lobe of the liver) approach (six cases), the right hepatic approach (five cases), and the transthoracic approach (one case). Different ablation electrodes were selected according to the puncture route and method of guiding. No serious postoperative complications were noted. Conclusion: The hepatic caudate lobe is surrounded by the inferior vena cava, hepatic vein, and hepatic hilum, leading to great difficulties and risks in performing minimally invasive treatment of hepatic caudate lobe malignancies. Therefore, selecting an appropriate puncture route is an important factor in the success of the treatment

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.

Advances and Challenges of Local Thermal Ablation in Non-small Cell Lung Cancer / 中国肺癌杂志

Non-small cell lung cancer (NSCLC) is the most common pathological type of primary lung cancer. Currently, main treatment approaches for NSCLC patients include surgical resection, radiotherapy, chemotherapy, targeted therapy and so on. In recent years, thermal ablation has received increasing attention in the treatment of various stages of NSCLC. As a safe and efficient local treatment, thermal ablation may bring potential clinical benefits to NSCLC patients. However, many issues remain unsolved and further investigation is needed in the clinical application of thermal ablation in NSCLC. In this review, we aim to summarize the applications of thermal ablation in NSCLC and further discuss the emerging controversies as well as future research directions.

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.

Progress of ultrasound-guided thermal ablation combined with immune checkpoint inhibitors for treating hepatocellular carcinoma / 中国介入影像与治疗学

Ultrasound-guided thermal ablation has become an important method for treatment of hepatocellular carcinoma (HCC) due to its advantages of minimally invasive and less complications, which not only has curative effect, but also can enhance the anti-tumor immune response of patients. However, as a local treatment, tumor recurrence has become the primary problem affecting curative effect of thermal ablation. In recent years, immunotherapy combined with local therapy has exhibited great exploration value with the emergence of immune checkpoint inhibitors. The advancements of ultrasound-guided thermal ablation combined with immune checkpoint inhibitors in treatment of HCC were mainly reviewed in this article.

Enzyme histochemical detection of cell viability in ablation area of thyroid nodules at 6 months after microwave ablation / 第二军医大学学报

Objective To explore the cell viability in the ablation area of thyroid nodules at 6 months after microwave ablation by enzyme histochemical staining. Methods Twenty-four ablation areas of thyroid nodules were selected from 20 patients who underwent histopathological assessment of the ablation area by core needle biopsy at 6 months after microwave ablation between Dec. 2017 and Sep. 2018. Core needle biopsy was performed at the central and marginal regions of the ablation area with a cutting biopsy needle. The specimens were obtained and placed in liquid nitrogen to make frozen sections. Enzyme histochemical staining was used to detect the activities of succinate dehydrogenase (SDH) and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d), and the difference of cell morphology and histological structure was compared with H-E staining results. Results The specimens of the central and marginal regions of 24 ablation areas were successfully obtained. The histochemical staining of SDH and NADPH-d in the central region of ablation area had good consistency, and the negative rates were both 95.83% (23/24). The histochemical staining of SDH and NADPH-d in the marginal region of ablation area also had good consistency, and the negative rates were both 91.67% (22/24). H-E staining of 23 central regions and 22 marginal regions showed pink amorphous mass of necrosis. H-E staining of 1 central region and 2 marginal regions showed partly necrotic and fibrous tissue hyperplasia. The location of fibrous tissue hyperplasia was consistent with the location of the positive region of enzyme histochemical staining. Conclusion At 6 months after microwave ablation, the tissue in the ablation area of thyroid nodules is consistent with coagulative necrosis, and is still inactivated. SDH or NADPH-d enzyme histochemical staining combined with H-E staining can objectively evaluate the old ablation area.

Nonsurgical treatment for thyroid nodules / 中国实用内科杂志

Thyroid nodule is a very common disease, and most of the diseases are asymptomatic with benign ultrasound or cytology,which do not require treatment. A regular observation is commonly required, and its frequency should be determined based on the potential risk of malignancy. Only a few benign nodules need intervention due to some certain factors including neck discomfort,cosmetic problem and patients' desire. The nonsurgical treatments include thyroxine suppression therapy, percutaneous ethanol injection, thermal ablation, and radioactive iodine therapy, etc. Currently, active surveillance and thermal ablation are still an experimental treatment in debate for low-risk thyroid cancer. In a patient-centered approach, clinicians should assess the indications,benefits, and risks of various nonsurgical treatments in order to avoid over-treatment.

Potential threat of pharyngo-esophageal diverticulum to thermal ablation treatment of thyroid nodule and rapid differential diagnosis through swallow contrast-enhanced ultrasonography / 中华超声影像学杂志

Objective To explore the potential risk of misdiagnosis of pharyngeal esophageal diverticulum( PED) for the treatment of thyroid nodules with thermal ablation and its rapid and effective method of diagnosis . Methods The process of diagnosis and treatment were reviewed on 5 cases of PEDs which had been misdiagnosed as thyroid nodules and recommended for thermal ablation therapy . A comprehensive analysis was carried out for the reasons of misdiagnosis ,the timing and clues of the diagnosis as well as the advantage of swallow contrast-enhanced ultrasonography ( sCEUS ) in achieving rapid and correct diagnosis . Results The lack of recognition and vigilance to the acoustic image of PED were the direct causes of misdiagnosis . Five cases of PED misdiagnosed as thyroid nodules were all discovered by the same chief operator before thermal ablation . They were confirmed through sCEUS and mistreatment by ablation were fortunately avoided ,but all true thyroid nodules requiring treatment were safely ablated . Conclusions PED is easily misdiagnosed as thyroid nodule .Improving the recognition and vigilance of the ultrasonic features of PED ,strictly implementing the reconfirming ultrasound examination by the chief operator ,and promptly conducting sCEUS are sensible measures to quickly correct the diagnosis and prevent w rong ablation of PED .