Investigation of the efficacy and safety of cryoablation and intra-arterial PD-1 inhibitor in patients with advanced disease not responding to checkpoint inhibitors: An exploratory study.

Objective: To explore the effectiveness of cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors in overcoming immune resistance in advanced solid cancers. Methods: In this pilot retrospective study, nine patients with solid cancers were treated with tumour cryoablation and arterial perfusion with programmed cell death protein 1 inhibitors, which had previously proven ineffective. The CIBERSORT software was used to estimate the levels of tumour-infiltrating immune cells in the challenged tumour. Changes in the levels of circulating T cells were assessed using flow cytometry. The primary endpoints were disease control and objective response rates, and the secondary endpoint was safety. Results: The nine patients with advanced solid tumours received cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors between June and December 2021. The median follow-up time was 5.8 months. We recorded an objective response rate in two patients (22.22%). The best overall responses were partial responses in two patients (22.22%) and one case (11.11%) of stable disease, while six patients (66.67%) presented progressive disease. However, the median overall survival time was not reached. The median progression-free survival was 2.4 months. Treatment-related severe adverse events included one case of abdominal infection and one case of upper gastrointestinal bleeding, which were cured after the intervention. The CIBERSORT software confirmed the importance of cryoablation in regulating tumour-infiltrating immune cells. Thus, macrophage polarisation from the M2 to the M1 phenotype in the challenged tumour and a gradual increase in the levels of circulating CD4+ T cells were observed after administration of the combination therapy. Conclusion: Cryoablation combined with arterial perfusion with programmed cell death protein 1 inhibitors has the potential efficacy and safety to overcome immune resistance in patients with advanced solid cancers. The combination therapy leads to macrophage polarisation from the M2 to the M1 phenotype in the challenged tumour to enhance antitumour immunity.

MR-Guided Microwave Ablation for Lung Malignant Tumor: A Single Center Prospective Study.

Objectives: To prospectively investigate the feasibility and efficacy of MRI-guided MWA for lung malignant tumor in our single center. Materials and Methods: 22 patients [mean age, 56.86 ± 13.05(23-73)years] with 23 malignant lung tumors were enrolled in the study. 21 patients had a single lesion and 1 patient had 2 lesions in the ipsilateral lung. The average maximum diameter of the lesion was 1.26 ± 0.65 (0.50-2.58)cm. Percutaneous MWA was guided by 1.5T MRI scanner using a MR-compatible microwave antenna to the target the lung lesions and ablation area was monitored intraoperatively by using a shielded MR-compatible microwave device and then follow-up. Results: All patients were successfully treated under MR-guided MWA for lung tumors. Average operation time was 72.21 ± 24.99 (36-158) mins. T2WI signal intensity of the lesion gradually decreased over the course of MWA. The center of the ablated zones showed a short T1 and short T2 signals with the ring-like of long T1 and long T2 signals surrounded after immediately evaluation. No serious complications occurred. The average follow-up period was 12.89 ± 4.33 (2.0-19.6) months. Local recurrence occurred in one patient, representing a technical efficacy of 95.5% (21/22). Conclusion: Magnetic resonance-guided microwave ablation for lung malignant tumor was feasible and demonstrated unique advantages in efficacy evaluation.

Phrenic nerve injury after the percutaneous microwave ablation of lung tumors: A single-center analysis.

Objective: This study aimed to analyze the cases of phrenic nerve injury caused by the percutaneous microwave ablation of lung tumors conducted at our center and to explore the risk factors. Materials and Methods: The data of 455 patients who underwent the percutaneous microwave ablation of lung tumors at the Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University from July 2017 to October 2021, were retrospectively analyzed. The cases of phrenic nerve injury after the percutaneous ablation were reported to analyze the risk factors involved, such as the shortest distance between tumor margin and phrenic nerve, tumor size, and ablation energy. The groups were divided based on the shortest distance between the tumor edge and the phrenic nerve into group 1, d ≤ l cm; group 2, 1 < d ≤2 cm; and group 3, d >2 cm. Lesions with a distance ≤2 cm were compared in terms of tumor size and ablation energy. Results: Among the 455 patients included in this study, 348 had primary lung cancer, and 107 had oligometastatic cancer. A total of 579 lesions were detected, with maximum diameter of 1.27 ± 0.55 cm, and the ablation energy was 9,000 (4,800-72,000) J. Six patients developed phrenic nerve injury, with an incidence of 1.32%. For these six patients, the shortest distance from the lesion edge to the phrenic nerve was 0.75 ± 0.48 cm, and the ablation energy was 10,500 (8,400-34,650) J. There were statistically significant differences in phrenic nerve injury among groups 1, 2, and 3 (P < 0.05). In patients with a distance (d) ≤ 2 cm, there were no significant differences in tumor diameter and energy between the phrenic nerve injury group and the non-injury group (P = 0.80; P = 0.41). In five out of six patients, the diaphragm level completely recovered to the pre-procedure state, and the recovery time of the phrenic nerve was 9.60 ± 5.60 months. Another one was re-examined 11 months after the procedure, and the level of the diaphragm on the affected side had partially recovered. Conclusions: Phrenic nerve injury is a rare but not negligible complication of thermal ablation and is more likely to occur in lesions with a distance ≤2 cm from the phrenic nerve.

Evaluation of the correlation between infrared thermal imaging-magnetic resonance imaging-pathology of microwave ablation of lesions in rabbit lung tumors.

PURPOSE: This study aimed to evaluate the correlation between infrared thermal imaging-magnetic resonance imaging (MRI)-pathology of microwave ablation (MWA) of lesions in rabbit lung tumors. MATERIALS AND METHODS: MR-guided MWA was performed in nine VX2 tumor-bearing rabbits. Infrared thermal imaging, postoperative MRI, and pathological presentation were obtained and analyzed. The differences between the infrared thermal imaging-MRI-pathology of MWA were compared. RESULTS: The center of the ablated lesion exhibited a high signal on T1-Vibe, and an isointense envelope was observed; the center of the ablated lesion exhibited a low signal on fat-suppressed turbo spin-echo T2-weighted imaging (TSE-T2WI-FS) and bands of high signal surrounding it compared with before MWA. No statistically significant difference existed between the maximum diameter of the central low-signal area of the ablation zone on TSE-T2WI-FS after MWA, the high-signal area of the ablation zone on T1-Vibe after MWA, and the maximum diameter of the pathological coagulation necrosis area, as well as between the maximum diameter of the isointense signal area peripheral to the ablation zone on T1-Vibe after MWA, the high-signal area peripheral to the ablation zone on TSE-T2WI-FS, the maximum diameter at the 41°C isothermal zone on infrared thermal imaging, and the maximum diameter of the pathological thermal injury zone. CONCLUSIONS: MWA of malignant lung tumors had specific MRI characteristics that were comparable with postoperative pathology. Infrared thermal imaging combined with MRI can be used to evaluate the extent of thermal damage to lung VX2 tumors.

Percutaneous radiofrequency ablation for small hepatocellular carcinoma in hepatic dome under MR-guidance: clinical safety and efficacy.

Purpose: To evaluate the clinical safety and efficacy of percutaneous radiofrequency ablation (RFA) using multitined expandable electrodes under magnetic resonance imaging (MRI) guidance in the treatment of small hepatocellular carcinomas (HCCs) in the hepatic dome.Materials and methods: The data of 49 patients with 50 HCC lesions in the hepatic dome who underwent MRI-guided RFA from April 2010 to January 2018 were retrospectively analyzed. Planning, targeting, and controlling were performed under MR-guidance during the procedure. The complications after RFA were observed. Follow-up MRI was performed to evaluate the curative effect. The local progression-free survival, recurrence-free survival, and overall survival rates were calculated using the Kaplan-Meier survival curve.Results: The procedures were successfully accomplished in all patients without major complications. The mean follow-up time was 36.9 ± 25.8 months (range, 3-99 months). Technical success was 100% after one RFA session with MRI assessment after 1 month. Local tumor progression was observed in one patient (2%) with the lesion located in the hepatic dome at 4 months on a subsequent follow-up MRI. The progression-free survival time was 25.0 ± 22.7 months (median, 17.0 months). The 1-,3-, and 5-year local tumor progression-free survival rates were all 98.0%. The 1-,3-, and 5-year recurrence-free survival rates were 68.1%, 39.9%, and 28.5%, respectively, and the estimated overall survival rates were 93.7%, 76.3%, and 54.3%, respectively.Conclusion: Planning, targeting, and controlling of RFA were well supported by MRI with acceptable time. MRI-guided RFA for small HCCs in the hepatic dome is safe and effective with fewer RF sessions.

Application of the transosseous approach for computed tomography-guided radioactive 125-iodine seed implantation for the treatment of thoracic and abdominal lymph node metastases.

AIM: This study aimed to investigate the technical procedure, safety, and clinical value of the transosseous approach for computed tomography (CT)-guided radioactive 125-iodine (125I) seed implantation for the treatment of thoracic and abdominal lymph node metastases. SUBJECTS AND METHODS: This was a retrospective study that Nine lymph node metastases in nine patients were treated in our hospital between January 2010 and August 2018. Under CT guidance, at least one puncture path was made through the transosseous approach. The seeds were planted according to the TPS. CT/MRI scans were performed every 2 months after the treatment to evaluate local therapeutic efficacy according to the Response Evaluation Criteria in Solid Tumors. RESULTS: The transosseous approach was successfully established in all patients. The median follow-up time was 11 months (6-36 months). At 2, 4, 6, 8, 10 and 12 months after operation, the objective effective rate and clinical benefit rate were 66.67%, 77.78%, 77.78%, 71.43%, 66.67% and 50.00%; and 88.89%, 88.89%, 88.89%, 71.43%, 66.67% and 50.00%, respectively. The survival rate of the patients at 6, 12, 18, 24, 30 and 36 months after operation was 53.00%, 26.00%, 26.00%, 13.00%, 13.00% and 13.00%, respectively. CONCLUSIONS: The transosseous approach for CT-guided radioactive 125I seed implantation was safe, effective, and minimally invasive for the treatment of thoracic and abdominal lymph node metastases.