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Title: Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action

Abstract

Purpose. To evaluate the effects of particle size and course of action of superselective bland transcatheter arterial embolization (TAE) on the efficacy of radiofrequency ablation (RFA). Methods. Twenty pigs were divided into five groups: group 1a, 40-{mu}m bland TAE before RFA; group 1b, 40-{mu}m bland TAE after RFA; group 2a, 250-{mu}m bland TAE before RFA; group 2b, 250-{mu}m bland TAE after RFA and group 3, RFA alone. A total of 40 treatments were performed with a combined CT and angiography system. The sizes of the treated zones were measured from contrast-enhanced CTs on days 1 and 28. Animals were humanely killed, and the treated zones were examined pathologically. Results. There were no complications during procedures and follow-up. The short-axis diameter of the ablation zone in group 1a (mean {+-} standard deviation, 3.19 {+-} 0.39 cm) was significantly larger than in group 1b (2.44 {+-} 0.52 cm; P = 0.021), group 2a (2.51 {+-} 0.32 cm; P = 0.048), group 2b (2.19 {+-} 0.44 cm; P = 0.02), and group 3 (1.91 {+-} 0.55 cm; P < 0.001). The greatest volume of ablation was achieved by performing embolization with 40-{mu}m particles before RFA (group 1a; 20.97 {+-} 9.65 cm{sup 3}). Atmore » histology, 40-{mu}m microspheres were observed to occlude smaller and more distal arteries than 250-{mu}m microspheres. Conclusion. Bland TAE is more effective before RFA than postablation embolization. The use of very small 40-{mu}m microspheres enhances the efficacy of RFA more than the use of larger particles.« less

Authors:
 [1];  [2]; ;  [3];  [4]; ;  [2];  [1]; ;  [2]
  1. Nara Medical University, Department of Radiology (Japan)
  2. RWTH Aachen University, Applied Medical Engineering, Helmholtz-Institute Aachen (Germany)
  3. RWTH Aachen University, Department of Pathology, Aachen University Hospital (Germany)
  4. RWTH Aachen University, Institute for Laboratory Animal Science (Germany)
Publication Date:
OSTI Identifier:
22113648
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 36; Journal Issue: 3; Other Information: Copyright (c) 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; BIOMEDICAL RADIOGRAPHY; BRACHYTHERAPY; HISTOLOGY; PARTICLE SIZE; RADIOWAVE RADIATION; SWINE; YTTRIUM 90

Citation Formats

Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp, Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de, Braunschweig, Till, E-mail: tbraunschweig@ukaachen.de, Westphal, Saskia, E-mail: swestphal@ukaachen.de, Woitok, Anna, E-mail: awoitok@ukaachen.de, Penzkofer, Tobias, E-mail: penzkofer@rad.rwth-aachen.de, Bruners, Philipp, E-mail: bruners@rad.rwth-aachen.de, Kichikawa, Kimihiko, E-mail: kkichika@naramed-u.ac.jp, Schmitz-Rode, Thomas, E-mail: smiro@hia.rwth-aachen.de, and Mahnken, Andreas H., E-mail: mahnken@rad.rwth-aachen.de. Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action. United States: N. p., 2013. Web. doi:10.1007/S00270-012-0497-7.
Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp, Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de, Braunschweig, Till, E-mail: tbraunschweig@ukaachen.de, Westphal, Saskia, E-mail: swestphal@ukaachen.de, Woitok, Anna, E-mail: awoitok@ukaachen.de, Penzkofer, Tobias, E-mail: penzkofer@rad.rwth-aachen.de, Bruners, Philipp, E-mail: bruners@rad.rwth-aachen.de, Kichikawa, Kimihiko, E-mail: kkichika@naramed-u.ac.jp, Schmitz-Rode, Thomas, E-mail: smiro@hia.rwth-aachen.de, & Mahnken, Andreas H., E-mail: mahnken@rad.rwth-aachen.de. Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action. United States. doi:10.1007/S00270-012-0497-7.
Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp, Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de, Braunschweig, Till, E-mail: tbraunschweig@ukaachen.de, Westphal, Saskia, E-mail: swestphal@ukaachen.de, Woitok, Anna, E-mail: awoitok@ukaachen.de, Penzkofer, Tobias, E-mail: penzkofer@rad.rwth-aachen.de, Bruners, Philipp, E-mail: bruners@rad.rwth-aachen.de, Kichikawa, Kimihiko, E-mail: kkichika@naramed-u.ac.jp, Schmitz-Rode, Thomas, E-mail: smiro@hia.rwth-aachen.de, and Mahnken, Andreas H., E-mail: mahnken@rad.rwth-aachen.de. Sat . "Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action". United States. doi:10.1007/S00270-012-0497-7.
@article{osti_22113648,
title = {Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action},
author = {Tanaka, Toshihiro, E-mail: toshihir@bf6.so-net.ne.jp and Isfort, Peter, E-mail: isfort@hia.rwth-aachen.de and Braunschweig, Till, E-mail: tbraunschweig@ukaachen.de and Westphal, Saskia, E-mail: swestphal@ukaachen.de and Woitok, Anna, E-mail: awoitok@ukaachen.de and Penzkofer, Tobias, E-mail: penzkofer@rad.rwth-aachen.de and Bruners, Philipp, E-mail: bruners@rad.rwth-aachen.de and Kichikawa, Kimihiko, E-mail: kkichika@naramed-u.ac.jp and Schmitz-Rode, Thomas, E-mail: smiro@hia.rwth-aachen.de and Mahnken, Andreas H., E-mail: mahnken@rad.rwth-aachen.de},
abstractNote = {Purpose. To evaluate the effects of particle size and course of action of superselective bland transcatheter arterial embolization (TAE) on the efficacy of radiofrequency ablation (RFA). Methods. Twenty pigs were divided into five groups: group 1a, 40-{mu}m bland TAE before RFA; group 1b, 40-{mu}m bland TAE after RFA; group 2a, 250-{mu}m bland TAE before RFA; group 2b, 250-{mu}m bland TAE after RFA and group 3, RFA alone. A total of 40 treatments were performed with a combined CT and angiography system. The sizes of the treated zones were measured from contrast-enhanced CTs on days 1 and 28. Animals were humanely killed, and the treated zones were examined pathologically. Results. There were no complications during procedures and follow-up. The short-axis diameter of the ablation zone in group 1a (mean {+-} standard deviation, 3.19 {+-} 0.39 cm) was significantly larger than in group 1b (2.44 {+-} 0.52 cm; P = 0.021), group 2a (2.51 {+-} 0.32 cm; P = 0.048), group 2b (2.19 {+-} 0.44 cm; P = 0.02), and group 3 (1.91 {+-} 0.55 cm; P < 0.001). The greatest volume of ablation was achieved by performing embolization with 40-{mu}m particles before RFA (group 1a; 20.97 {+-} 9.65 cm{sup 3}). At histology, 40-{mu}m microspheres were observed to occlude smaller and more distal arteries than 250-{mu}m microspheres. Conclusion. Bland TAE is more effective before RFA than postablation embolization. The use of very small 40-{mu}m microspheres enhances the efficacy of RFA more than the use of larger particles.},
doi = {10.1007/S00270-012-0497-7},
journal = {Cardiovascular and Interventional Radiology},
number = 3,
volume = 36,
place = {United States},
year = {Sat Jun 15 00:00:00 EDT 2013},
month = {Sat Jun 15 00:00:00 EDT 2013}
}
  • The purpose of this study was to evaluate the effect of renal artery embolization with small and narrowly calibrated microparticles on the coagulation diameter, volume, and shape of radiofrequency ablations (RFAs) in porcine kidneys. Forty-eight RFAs were performed in 24 kidneys of 12 pigs. In 6 animals, bilateral renal artery embolization was performed with small and narrowly calibrated microparticles. Upper and lower kidney poles were ablated with identical system parameters. Applying three-dimensional segmentation software, RFAs were segmented on registered 2 mm-thin macroscopic slices. Length, depth, width, volume{sub s}egmented, and volume{sub c}alculated were determined to describe the size of the RFAs.more » To evaluate the shape of the RFAs, depth-to-width ratio (perfect symmetry-to-lesion length was indicated by a ratio of 1), sphericity ratio (perfect sphere was indicated by a sphericity ratio of 1), eccentricity (perfect sphere was indicated by an eccentricity of 0), and circularity (perfect circle was indicated by a circularity of 1) were determined. Embolized compared with nonembolized RFAs showed significantly greater depth (23.4 {+-} 3.6 vs. 17.2 {+-} 1.8 mm; p < 0.001) and width (20.1 {+-} 2.9 vs. 12.6 {+-} 3.7 mm; p < 0.001); significantly larger volume{sub s}egmented (8.6 {+-} 3.2 vs. 3.0 {+-} 0.7 ml; p < 0.001) and volume{sub c}alculated (8.4 {+-} 3.0 ml vs. 3.3 {+-} 1.1 ml; p < 0.001); significantly lower depth-to-width (1.17 {+-} 0.10 vs. 1.48 {+-} 0.44; p < 0.05), sphericity (1.55 {+-} 0.44 vs. 1.96 {+-} 0.43; p < 0.01), and eccentricity (0.84 {+-} 0.61 vs. 1.73 {+-} 0.91; p < 0.01) ratios; and significantly greater circularity (0.62 {+-} 0.14 vs. 0.45 {+-} 0.16; p < 0.01). Renal artery embolization with small and narrowly calibrated microparticles affected the coagulation diameter, volume, and shape of RFAs in porcine kidneys. Embolized RFAs were significantly larger and more spherical compared with nonembolized RFAs.« less
  • Purpose. To evaluate the feasibility and safety of minimally invasive, percutaneous techniques in metachronous recurrent renal cell cancers (RCCs) in solitary kidneys. Methods. In 4 patients, recurrent RCC was treated by radiofrequency ablation (RFA) (RITA, StarBurst) alone, and in 2 patients by RFA in combination with superselective transarterial particle-lipiodol embolization using 3 Fr microcatheters. RFA was guided by computed tomography in 5 patients, and by magnetic resonance imaging in 1 patient. Mean tumor diameter was 26.7 mm (range 10-45 mm). All interventions were technically successful; during follow-up 1 patient developed recurrent RCC, which was retreated by RFA after embolization. Results.more » No major peri- or postprocedural complications occurred. Changes in creatinine (pre- vs. post-intervention, 122 vs. 127 {mu}mol/l) and calculated creatinine clearance (pre- vs. post-intervention, 78 vs. 73 ml/min) after ablation were minimal. Conclusion. In single kidneys, percutaneous, minimally invasive techniques are safe and feasible. In large tumors, or where there are adjacent critical structures, we prefer a combination of embolization and thermal ablation (RFA)« less
  • Radiofrequency ablation is increasingly being acknowledged as a valid treatment for renal cell carcinoma in patients in whom definitive curative resection is deemed either undesirable or unsafe. A number of published series have shown the technique to have encouraging results and relatively low complication rates. In this article, we report a case of delayed life-threatening hematuria requiring transcatheter embolization of a bleeding intrarenal artery in a patient who had undergone imaging-guided radiofrequency ablation of a 3 cm renal cell carcinoma. To our knowledge, such a complication has not been reported previously.
  • The purpose of the study was to evaluate the feasibility, safety, and therapeutic effects of the combination of renal arterial embolization and radiofrequency (RF) ablation to reinforce the anticancer effect on renal cell carcinomas (RCCs) measuring 3.5 cm or larger. This study was undertaken to evaluate this combined therapy on large RCCs-based tumor geometry. Eleven patients with 12 RCCs 3.5 cm or larger in diameter (3.5-9.0 cm) underwent combined therapy. Two were exophytic tumors, and the remaining 10 tumors had components extending into the renal sinus fat. Tumor vessels were selectively embolized in nine patients and the renal artery wasmore » completely embolized in two patients with polyvinyl alcohol or ethanol mixed with iodized oil. RF ablation was percutaneously done under the computed tomographic (CT)-fluoroscopic guidance. Response to treatment was evaluated by dynamic contrast-enhanced CT and magnetic resonance (MR) imaging. Tumor enhancement was eliminated after a single RF session in nine tumors (75%), after two sessions in two tumors (17%), and after four sessions in one tumor (8%). Both exophytic tumors (100%) and 7 of 10 tumors having components in the renal sinus fat (70%) were completely ablated with a single RF session. All tumors remained controlled during a mean follow-up period of 13 months and showed significant reduction in tumor sizes (5.2 {+-} 1.7 cm to 3.6 {+-} 1.4 cm, p < 0.001). A delayed abscess developed in the ablated lesion in a patient, which was percutaneously drainaged. Combined therapy as described in this report is a feasible, relatively safe, and promising treatment method for large RCCs regardless of tumor geometry.« less
  • Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery. The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor seeding after radiofrequency ablation for hepatocellularmore » carcinoma.« less