Although thermal ablation, surgery, and radiotherapy are established locoregional therapies for adrenal metastases, direct comparisons among these treatments are limited. This study aimed to compare the clinical effectiveness and safety of locoregional treatments for adrenal metastases. This multicenter retrospective cohort study included patients with adrenal metastases treated with locoregional therapies, including thermal ablation, surgery, or radiotherapy. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics. Local progression-free survival (LPFS), overall survival (OS), complication rates, and cost were evaluated. Nomograms for OS prediction were developed using Least Absolute Shrinkage and Selection Operator (LASSO) Cox regression models. A total of 496 patients (median age, 57 years; 384 men) were included: surgery (n = 231), ablation (n = 132), and radiotherapy (n = 133). After IPTW adjustment, surgery and radiotherapy showed significantly improved LPFS compared with ablation (p = 0.021). Subgroup analysis demonstrated no significant differences in LPFS among treatment modalities for tumors smaller than 5 cm (p = 0.23). Regarding OS, surgery had a significantly better survival compared with ablation and radiotherapy (p = 0.004). Thermal ablation exhibited the lowest complication rates and lowest treatment cost (p < 0.001). The OS nomogram showed moderate predictive ability. Locoregional therapy strategies for adrenal metastases should be individualized. For tumors smaller than 5 cm, thermal ablation offers local tumor control comparable to surgery and radiotherapy, while providing superior safety and lower treatment costs. QuestionDirect comparative evidence among thermal ablation, surgery, and radiotherapy for adrenal metastases is limited. How do clinical effectiveness, safety, and cost of these treatment modalities compare? FindingsFor adrenal metastases smaller than 5 cm, thermal ablation provides local control comparable to surgery and radiotherapy, while being associated with significantly fewer complications and lower treatment costs. Clinical relevanceFor patients with adrenal metastases smaller than 5 cm, thermal ablation offers a minimally invasive, safer, and less costly treatment option. It provides local tumor control comparable to surgery or radiotherapy, supporting individualized treatment selection based on tumor size.

Sterotactic ablative radiotherapy vs. thermal ablation of localized renal cell carcinoma: Is there a preferred second-line management option?

Local ablative therapy has emerged as an essential treatment for patients with non-small cell lung cancer (NSCLC). Whether cryoablation is superior to thermal ablation in the era of immunotherapy and the related mechanism remains undefined. We first observed superior progression-free survival with cryoablation compared with thermal ablation in patients with oligoresidualdisease after immunotherapy. Single-cell RNA sequencing of human peripheral blood monocyte cells and mouse tumors showed that cryoablation combined with anti-PD-1 expanded more CXCL10+ macrophages than thermal ablation combination. CXCR3 blockade and inhibition of T cells egressing from draining lymph nodes abolished the systemic anti-tumor efficacy. Mechanistically, tumor DNA released by cryoablation was taken up by macrophages, activating the cGAS-STING signaling pathway, increasing the pool of CXCL10+ macrophages and CXCL10 secretion. Our study demonstrated that CXCL10+ macrophages and the CXCR3+ T cells were critical mediators of the systemic anti-tumor immunity induced by cryoablation in advanced NSCLC.

Histotripsy represents a paradigm shift in interventional oncology (IO) as the first non-invasive, non-ionising and non-thermal ultrasound-based ablation technology available for cancer therapy. Compared with thermal ablation techniques, advantages of histotripsy include tissue-selective ablation near critical structures, reduced collateral injury risk, and treatment which is unaffected by the heat sink phenomenon, ensuring predictable treatment margins. Ultrasound technology can be constrained by tissue attenuation depending on the depth of the target; however, the early phase feasibility and pivotal trial results have been promising for its application in liver cancers, with emerging translational trials in renal and pancreatic cancer. In the UK, two well-established IO sites have participated in the pivotal #HOPE4LIVER Trial that led to approval by the U.S. Food and Drug Administration (FDA) in liver tumours therapy in 2023 and obtained Medicines and Healthcare products Regulatory Agency (MHRA) Unmet Clinical Need Authorisation (UCNA) for treatment of liver tumours in UK (April, 2025) via the Innovative Devises Access Pathway (IDAP). The global-first feasibility in renal cancer (CAIN trial) was also led by the UK and completed in April 2024. This review provides an overview of histotripsy and highlights the clinical challenges in early NHS adoption such as the learning curve for operators and teams, regulatory processes, and synthesis of health economic evidence required for wider NHS commissioning. The review will also discuss the future directions of histotripsy, including combination immunomodulatory therapies, highlighting the need for continual national collaboration for successful integration in the NHS. Successfully integrating this technology into the NHS hinges on a unified national effort to navigate the clinical, regulatory and economic hurdles, ensuring its benefits reach patients nationwide.

This study aims to assess a spectral computed tomography (CT) color overlay technique for augmenting the visualization of endophytic renal tumors during percutaneous thermal ablation procedures. This retrospective study consisted of renal cryoablation procedures from June to December 2023. Of the 68 renal ablations with spectral results archived, 27 cases were assigned majority endophytic. Two radiologists reviewed and rated two series for each case: a conventional non-contrast CT series and an electron density color overlay series. Tumor conspicuity was evaluated on a continuous sliding scale. Subsequently, radiologists determined whether percutaneous ablation could proceed based on visualization using the conventional non-contrast CT series alone, using the color overlay series, or if additional contrast-enhanced CT was necessary for optimal guidance. Statistical assessment was performed using a two-sided Wilcoxon signed-rank test with a significance level of p=0.01. There was a significant (p<0.001) improvement in endophytic tumor conspicuity with the electron density fusion series (Median: 36.3) compared to the conventional CT series (Median: 19.2). When evaluating adequacy of tumor visualization for procedural planning, readers were more likely to agree when reviewing the electron density color overlay series (44% of reads; 22/50) rather than the conventional CT series (22% of reads; 11/50). Spectral CT color overlay improved visibility of endophytic renal tumors compared to conventional CT alone. This highlights the benefit of a low-noise, narrow-window color overlay for augmenting lesion localization. LEVEL OF EVIDENCE 3: Level 3, retrospective study.

Bronchoscopic thermal vapour ablation (BTVA) is a treatment option for selected patients with severe emphysema, inducing lung volume reduction through a localised inflammatory response. This study investigated sex-specific differences in outcomes and safety after BTVA. Data from the multicentre BTVA post-market registry (December 2018-July 2024) were retrospectively analysed. Sex-specific outcomes at 3, 6 and 12 months were compared, and the effect of sex on residual volume (RV%) was assessed using an adjusted mixed-effects model. A total of 231 patients (105 women) were included. In women, significant improvements were observed in forced expiratory volume in 1 s at 3, 6 and 12 months (+60 mL, +70 mL, +20 mL), RV at 6 and 12 months (-0.38 L and -0.50 L), 6-Minute Walk Distance (6-MWD) at 3 and 6 months (+17.5 m and +23.5 m), and a consistent improvement in St. George's Respiratory Questionnaire (SGRQ) at 3, 6 and 12 months (-9.3, -6.9, -9.1). In men, significant improvements were noted in RV at 3, 6 and 12 months (-0.32 L, -0.47 L, -0.32 L) and in SGRQ at 3 and 6 months (-4.8 and -3.7), but not at 12 months. An improvement in 6-MWD was not observed in men. Additionally, a significant time-by-sex interaction was observed for RV% (χ²=5.88, p=0.015), indicating distinct RV trajectories between the sexes. The results indicate that women experienced greater improvements in lung function and SGRQ scores after BTVA, which may be explained by differences in perception and reporting of functional benefits, as well as potential biological factors such as a stronger inflammatory response.

Ultrasound-guided radiofrequency ablation (RFA) of benign thyroid nodules is an effective, minimally invasive alternative to surgery but has a steep learning curve and limited formal training options. Toward addressing this gap, we developed a mixed reality simulator for thyroid nodule RFA. We implemented a real-time, voxel-based heat-transfer model of a thyroid nodule that computes temperature, thermal damage, and temperature-dependent impedance within a mixed reality simulator. The model was calibrated and verified with published RFA data from a thermal property-matched thyroid phantom and validated against published ex vivo lesion volumes. The simulator provides configurable nodule size and location, renders RFA ultrasound artifacts and lesion visualization, computes quantitative ablation metrics, and includes an interactive virtual RFA generator interface. Simulated temperature-time curves matched phantom sensor readings with a root mean square error of 1.4°C. Simulated lesion volumes were within - 7.3% to + 0.9% of the ex vivo reference across 1.0-0.125 mm3 voxel volumes and lesion aspect ratios were lower by 4.7-10.5%. In a post-use survey, a single expert clinician rated visual realism, feedback fidelity, and training utility favorably. The simulator closely reproduced phantom temperature profiles and ex vivo lesion sizes. Its architecture is configurable and extensible to other organs and thermal ablation modalities. Formal educational studies are warranted to evaluate training effectiveness of the simulator.

Thyroid-stimulating hormone (TSH) suppression therapy plays an important role in the postoperative management of patients with differentiated thyroid cancer (DTC). However, its role in low-risk DTC (LR-DTC) remains controversial. This article reviewed domestic and international guidelines and relevant literature on TSH suppression therapy, finding that current guidelines worldwide generally show a trend toward gradually relaxing TSH suppression targets for LR-DTC patients. The latest guidelines from the American Thyroid Association (ATA), the National Comprehensive Cancer Network Thyroid Carcinoma Guidelines, and the Japanese Guidelines for the Treatment of Thyroid Tumors advocate a more lenient TSH suppression strategy for LR-DTC patients, recommending no suppression for those with excellent response or those who have undergone lobectomy. The most recent European Society for Medical Oncology Clinical Practice Guidelines for thyroid cancer and the Chinese Guidelines for the Diagnosis and Treatment of Thyroid Nodules and Differentiated Thyroid Cancer primarily reference the 2015 ATA guidelines, currently adopting a mild suppression approach by recommending that the TSH levels be maintained at the low end of the normal range. Recent large-scale studies tend to support further relaxation of TSH suppression targets for LR-DTC patients. There has still been no consensus regarding the optimal duration of TSH suppression therapy, as well as its application during active surveillance and after thermal ablation. There is an urgent need for more large-scale, multicenter prospective studies to provide stronger evidence-based support for formulating TSH suppression strategies in LR-DTC patients.

Introduction Thermal ablation (TA) is increasingly used to treat benign thyroid nodules; however, a residual risk of occult malignancy persists despite two benign cytology results. We aimed to: (1) evaluate the proportion of non-benign histological results among patients excluded from TA during multidisciplinary team meetings (MDTMs); (2) identify clinical and ultrasonographic features suggestive of malignancy and (3) assess non-benign outcomes among patients treated with TA who subsequently underwent surgery. Methods We conducted a retrospective single-center cohort study in a tertiary referral hospital between January 2019 and December 2023. Patients referred for TA with two benign cytology results but excluded after MDTM review were analyzed. Patients treated with TA who later underwent surgery were also reviewed. The primary endpoint was the proportion of non-benign histological results among surgically treated patients excluded from TA after MDTM review. Results Among 573 patients discussed at MDTM, 131 (23%) were deemed ineligible for TA. Of these, 61 (47%) underwent surgery. Non-benign histology was identified in 6 of 61 operated patients (10%), corresponding to 4.6% of all excluded patients. Among 219 patients treated with TA, three (1.4%) required surgery during follow-up. Histology revealed one benign lesion, one noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and one tumor of uncertain malignant potential. Conclusion Systematic MDTM evaluation in an expert center identified non-benign nodules among patients excluded from TA, while non-benign outcomes after TA were rare. These findings should be interpreted cautiously given the retrospective design and limited number of events.

Despite the prominent success against hematologic malignancies in clinical settings, chimeric antigen receptor NK (CAR-NK) cell immunotherapy is still hindered in lung cancer tumors owing to insufficient infiltration and poor immune activation induced by the immunosuppressive tumor microenvironment (TME). Herein, a nanoengineered CAR-NK biohybrid (CK-PSI) was constructed by conjugating nanomedicine (PSI NPs) containing a near-infrared II (NIR-II) polymer and a specific small-molecule inhibitor of Smad3 (SIS3) to the surface of metabolic glycan-engineered CAR-NK cells via a bioorthogonal reaction. Anti-B7H3 CAR modification on cell vectors offers selectively targeted delivery of hitchhiking NIR-II nanomedicine into lung cancer tumors, simultaneously enabling real-time tracking of CAR-NK cells and precise localization of deep-seated tumors through NIR-II fluorescence imaging. NIR-II excitation mild photothermal therapy not only destroys tumor cells by thermal ablation but also promotes the infiltration and penetration of CK-PSI through the rupture of physical barriers within tumor tissues. More importantly, the in situ release of the Smad3 inhibitor further reduces extracellular matrix (ECM) deposition through TGF-β signaling pathway blockade in the TME, thereby boosting the infiltration and immune activation of CAR-NK cells. The bioorthogonal nanohybrid with NIR-II phototheranostic triggered cell localization and immunomodulatory capabilities provides a new paradigm for potentiating the infiltration and immune activation efficiency of CAR-NK cells against solid tumors.

Abstract Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer, which is the third-leading cause of cancer deaths worldwide. Recent updates in the Barcelona Clinic Liver Cancer (BCLC) guidelines have expanded the role of locoregional therapies to include transarterial radioembolization (TARE) along with transarterial chemoembolization (TACE) and thermal ablation. However, the selection and timing of each locoregional therapy remain a complex decision. An available approach is the combination of TACE with thermal ablation (TACE–ablate). The goal of this review is to assess the existing literature on the use of TACE–ablate for HCC. Overall, there is a suggestion of benefit in overall and progression-free survival for HCC &gt;3 cm compared with ablation or TACE alone. Current evidence suggests ablation monotherapy is effective for tumors &lt;3 cm while ablative-intent TARE is effective for tumors as large as 8 cm, though the median tumor size in key studies is &lt;3 cm. The data for TACE–ablate in tumors &lt;3 cm is mixed though it remains an option for patients with contraindications to ablation or ablative-intent radioembolization.

The complexity and dynamic nature of the tumor microenvironment (TME) pose significant challenges to effective cancer therapy. Therefore, the development of nanocomposites capable of fully exploiting TME characteristics is crucial for achieving precise and efficient tumor treatment. Herein, the cascade nanoreactor PDA@Mo2C-MnO2-Au/Apt-M (PMMAA) was successfully constructed based on Mo2C MXene and nanozymes. This nanoreactor leveraged the TME to achieve NIR-II-triggered combined photothermal therapy and chemodynamic therapy (PTT/CDT) with active targeting capability. PMMAA exhibited a photothermal conversion efficiency of 41.89% under NIR-II laser irradiation, enabling efficient thermal ablation of tumor tissues. In the acidic TME, the loaded MnO2 NPs mediated Fenton-like reactions that selectively converted endogenous H2O2 into highly cytotoxic •OH, realizing intelligent TME-responsive CDT. Notably, the embedded Au NPs in the nanoreactor exhibited glucose oxidase-like activity, catalyzing the conversion of glucose into H2O2 and gluconic acid, thereby simultaneously elevating both H2O2 levels and local acidity to establish a self-amplifying catalytic cascade. This nanozymes-based cascade amplification effect significantly enhanced CDT efficacy by promoting •OH generation. Systematic evaluations demonstrated that the nanoreactor possessed dual enzyme-mimicking activities (POD-like and GOx-like), excellent biosafety, and remarkable tumor suppression effects. This study established a new paradigm for precision cancer therapy through the rational design of multifunctional nanozymes-enhanced CDT capable of dynamically modulating the TME.

Photoacoustic technology can non-invasively obtain the temperature and pressure of tissues, holding great promise for applications in the laser thermal ablation of pigmented skin diseases. The coefficient of thermal expansion is the primary source of temperature sensitivity in photoacoustic technology. In this paper, a non-contact full-field strain measurement system based on temperature-variable three-dimensional digital image correlation is used to measure the variation of the thermal expansion coefficient of melanin in the retinal pigment epithelium layer of porcine eyes. It is found that the thermal strain of melanin exhibits non-uniformity and nonlinear increase in radial Angle and circular domain. Before the glass-transition temperature (49°C), the average coefficients of thermal expansion for concentric circular regions and different radial directions are 4.14 × 10-4 K-1 and 3.82 × 10-4 K-1, respectively. Approximating the thermal expansion coefficient of melanin with that of graphite leads to a large error, with a difference of two orders of magnitude.

Efficacy of Thermal Ablation vs. Surgical Resection for Hepatocellular Carcinoma Based on Multiparametric EOB-MRI Features: A Retrospective Cohort Study.

Women's health remains inadequately served due to the historical predominance of males as the biological reference in medical research, leading to persistent sex-based gaps in the understanding, diagnosis, and management of disease. As healthcare moves toward decentralization, e.g., through the collection of person-generated health data, point-of-care diagnostics, and wearable devices, there is a critical need for tools tailored to women's unique conditions and presentations. Ultrasound technologies, recognized for their versatility and safety, have evolved from imaging to multifunctional platforms, with growing roles in diagnosis and therapy. Diagnostic ultrasound non-invasively assesses anatomical features and functional information, and therapeutic ultrasound can perform targeted interventions, including neuromodulation, immunomodulation, thermal ablation, and drug delivery. By exploring the fundamental physical principles of ultrasound, including acoustic streaming, cavitation, and thermal interactions, and linking these mechanisms to cellular and tissue responses, this review highlights the capability of ultrasound to address female-specific health disparities, especially in conditions that are undertreated or differentially expressed in women. Advancements in ultrasound technologies could significantly enhance clinical outcomes and improve the quality of life for women affected by conditions currently underserved by traditional medical interventions.

Purpose To quantify functional liver volume (FLV) loss relative to minimal ablative margins (MAMs) achieved during percutaneous thermal ablation (TA) of liver tumors in COVER-ALL randomized controlled trial (RCT) participants. Materials and Methods In the COVER-ALL single-center RCT (June 2020 through October 2023), software-based ablation confirmation (AC) (experimental) and visual margin (control) assessment were compared among participants with histology-agnostic liver tumors. In this post hoc analysis, the authors compared CT-derived volumes, MAMs, and changes in laboratory-based hepatic function using Wilcoxon rank sum and Spearman correlation tests. Results Among 100 participants (mean age ± SD, 57.8 years ± 13.2; 61 male; experimental group, n = 74, 98 tumors ablated, median diameter = 1.5 cm; control group, n = 26, 41 tumors ablated, median diameter = 1.3 cm), the experimental and control group baseline median FLVs (1707 cm3 [IQR, 1467-1964 cm3] vs 1722 cm3 [IQR, 1338-1916 cm3]; P = .84) were comparable. The median MAM was larger in the experimental versus the control group (6 mm [IQR, 4.5-7.9 mm] vs 1 mm [IQR, 0-4 mm]; P < .001). The median percentage FLV loss was larger in the experimental versus the control group (2.9% [IQR, 1.8%-4.4%] vs 1.7% [IQR, 1.2%-3.4%]; P = .03). The median postablation FLV was comparable between the experimental and control groups (1643 cm3 [IQR, 1403-1886 cm3] and 1696 cm3 [IQR, 1315-1843 cm3]; P = .87). We observed no association between percentage FLV loss and changes in serum albumin (ρ = -0.153, P = .16) or total bilirubin concentrations (ρ = -0.128, P = .25). Conclusion Liver tumor TA resulted in minimal percentage FLV loss. Software-based AC use increased the MAM at the expense of a negligible increase in percentage FLV loss. Keywords: Ablation Techniques, Segmentation, Liver, Volume Analysis ClinicalTrials.gov: NCT04083378 Supplemental material is available online. © RSNA, 2026.

Emphysema is a phenotype of chronic obstructive pulmonary disease that is characterized by irreversible parenchyma destruction and loss of elastic recoil, resulting in air trapping and hyperinflation. Despite optimal medical management, many patients remain symptomatic. Bronchoscopic lung volume reduction (BLVR) techniques provide minimally invasive alternatives to surgery. This review summarizes the current role and future directions of advanced bronchoscopic therapies for emphysema. Established BLVR approaches aim to induce atelectasis of diseased, hyperinflated lobes using endobronchial valves or thermal vapor ablation. Patient selection and clinical efficacy is critically influenced by emphysema distribution and the presence of collateral ventilation. To address these limitations, novel therapies are being developed. Sealants are under investigation as adjuncts to valve therapy to overcome collateral ventilation. Endobronchial coils mechanically re-tension the lung parenchyma, improving elastic recoil and airway patency. Airway stents and scaffolds are designed to facilitate expiratory flow by either bypassing or preventing closure of collapsible airways. These emerging modalities may extend treatment options to patients with homogeneous disease and those with significant collateral ventilation, groups traditionally with limited existing interventions. Current BLVR therapies remain limited in homogeneous disease and collateral ventilation-positive patients. Research into novel treatments have shown promise in an expanding therapeutic landscape, though long-term safety, durability, and patient selection criteria require further study.

An explicit dynamic face-based smoothed finite element approach to thermoelastic modeling in thermal ablation therapy

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel, noninvasive therapeutic approach that shows potential in treating movement disorders, such as essential tremor, Parkinson's disease, and dystonia. This technique combines high-intensity focused ultrasound with real-time magnetic resonance imaging, allowing for accurate targeting and thermal ablation of deep brain areas without incisions or exposure to ionizing radiation. MRgFUS provides precise lesioning with intraoperative feedback, enabling immediate assessment of symptoms. Clinical trials and initial clinical applications have shown significant enhancements in motor symptoms and quality of life, boasting a favorable safety profile with fewer adverse effects compared to traditional surgical methods like deep brain stimulation (DBS). For patients who are not candidates for surgery or who prefer less invasive treatments, MRgFUS represents a valuable alternative. This brief overview serves as a useful resource for general neurologists.

Microneedles-photothermal therapy synergy in biomedicine: Innovations and applications.