Complete Ablation Group Research Articles

A novel role of AIM2 inflammasome-mediated pyroptosis in radiofrequency ablation of hepatocellular carcinoma

Introduction and ObjectivesThe absence of melanoma 2 (AIM2) protein triggers the activation of the inflammasome cascade. It is unclear whether AIM2 plays a role in hepatocellular carcinoma (HCC) and radiofrequency ablation (RFA), which uses radiofrequency waves to treat tumors. In this study, we investigated if RFA could induce pyroptosis, also called cell inflammatory necrosis, in HCC through AIM2-inflammasome signaling in vivo and in vitro. Materials and MethodsBALB/c nude mice were used to generate HepG2 or SMMC-7721 cell-derived tumor xenografts. HCC cells with knockdown or overexpression of AIM2 were created using short hairpin RNA (shRNA) and expression vector transfection, respectively, for functional and mechanistic studies. Downstream effects were examined using flow cytometry, qRT-PCR, ELISAs, and other molecular assays. ResultsRFA significantly suppressed tumor growth in HCC cell xenografts. Flow cytometry analysis revealed that RFA could induce pyroptosis. Furthermore, AIM2, NLRP3, caspase-1, γ-H2AX, and DNA-PKc had significantly greater expression levels in liver tissues from mice treated with RFA compared with those of the controls. Additionally, interleukin (IL)-1β and IL-18 expression levels were significantly higher in the HCC cell-derived xenograft mice treated with RFA compared with those without RFA. Notably, a significantly greater effect was achieved in the RFA complete ablation group versus the partial ablation group. Knockdown or overexpression of AIM2 in HCC cells demonstrated that AIM2 exerted a role in RFA-induced pyroptosis. ConclusionsRFA can suppress HCC tumor growth by inducing pyroptosis via AIM2. Therefore, therapeutically intervening with AIM2-mediated inflammasome signaling may help improve RFA treatment outcomes for HCC patients.

Transarterial chemoembolization combined with radiofrequency ablation for medium and large hepatocellular carcinoma: insufficient ablation is associated with intrahepatic distant metastasis and extrahepatic metastasis.

To compare the prognosis of complete and insufficient ablation of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in treating medium and large hepatocellular carcinoma (HCC) and to explore the differences in recurrence patterns between the two groups. Patients´ medical records and imaging data of patients with confirmed HCC from January 2014 to January 2022 were collected. These patients were divided into 2 groups: complete ablation (n=172) and insufficient ablation (n=171). Overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier curve and the log-rank test was used to compared. Fisher's exact test was used to compare recurrence patterns between the two groups. The median OS time was 72.8 months (95%CI:69.5-76.1) and 62.0 months (95%CI: 55.3-68.7) in the complete and insufficient ablation groups, respectively. The median PFS time in the complete ablation group was 67.8 months (95% CI: 65.2-70.4) and 38.6 months (95%CI: 29.8-47.4) in the insufficient ablation group. The OS and PFS rates of the complete ablation group were significantly better than those of the insufficient ablation group (P<0.001). In the complete ablation group, 25(41%) patients experienced local tumor progression(LTP), 36(59%) experienced intrahepatic distant progression(IDP), and 0(0%) experienced extrahepatic progression (EP). In the insufficient ablation group, 51 (32.1%) patients experienced LTP, 96 (60.4%) experienced IDP, and 12 (7.5%) experienced EP. The progression patterns of the two groups were statistically significant (P=0.039). Insufficient ablation indicates a poor survival outcome of TACE combined with RFA for medium and large HCC and can promote intrahepatic distant and extrahepatic metastasis.

Is partial ablation appropriate for benign thyroid nodules? A retrospective study with long-term follow-up after microwave ablation

Objective This retrospective study aimed to investigate the efficacy and safety of partial ablation (PA) for benign thyroid nodules (BTNs) using microwave ablation (MWA) in a long-term follow-up. Materials and methods Between February 2015 and April 2019, 236 patients with 236 BTNs (maximum diameter ≥2 cm) treated with ultrasound-guided MWA were enrolled. Contrast-enhanced ultrasound (CEUS) was performed within 3 d after ablation to determine whether there was residual tissue according to which the patients were assigned PA or complete ablation (CA). The volume reduction ratio (VRR) and complications were evaluated during follow-up. Results Eighty-two patients were enrolled in the PA group, and 154 were enrolled in the CA group. Both groups achieved continuous reductions in nodule volume and increases in VRR within 2 years after ablation. Although the VRR of the PA group at 4 years was lower than that of the CA group (65.54 vs. 95.08%; p<.05), PA still achieved ‘technical efficacy’ with a volume reduction of more than 50%. The complication and side effect rates between the two groups showed no significant difference (p>.05). Conclusions Both PA and CA were safe and effective in reducing the volumes of BTNs in the long-term follow-up. For nodules with a large initial volume and dangerous location, PA with a small amount of residual tissue may be acceptable.

Investigating the Accuracy of Ultrasound-Ultrasound Fusion Imaging for Evaluating the Ablation Effect via Special Phantom-Simulated Liver Tumors

The goal of this study was to investigate the accuracy of ultrasound-ultrasound (US-US) fusion imaging for evaluating the ablation effect via phantom-simulated liver tumors. Twenty special phantom models were established, ablated and divided into a complete ablation group (n = 10) and an incomplete ablation group (n = 10). US-US fusion imaging was performed to evaluate the ablation effect. Gross specimens were observed as a standard reference. In this US-US fusion imaging study, the registration success rate was 100% (20/20), and the assessment time was 3.8 ± 0.9 min. The accuracy rate of the evaluation was 100% (20/20). There was no significant difference in the residual pseudo-tumoral area between the evaluation with US-US fusion imaging and gross specimen observation (p = 0.811), and the measurement error was 1.1 ± 0.6 mm. In conclusion, the feasibility and accuracy of US-US fusion imaging when evaluating the ablation effect can be investigated with this phantom-simulated liver tumor ablation model in an ideal state.

Percutaneous Irreversible Electroporation (IRE) of Hepatic Malignancy: A Bi-institutional Analysis of Safety and Outcomes

AimIrreversible electroporation (IRE) is a non-thermal ablative option in patients unsuitable for standard thermal ablation, due to its potential to preserve collagenous structures (vessels and ducts) and a reduced susceptibility to heat sink effects. In this series from two large tertiary referral hepatobiliary centres, we aim to assess the safety/outcomes of hepatic IRE.Materials and MethodsBi-institutional retrospective, longitudinal follow-up series of IRE for primary hepatic malignancy; [hepatocellular carcinoma (n = 20), cholangiocarcinoma (n = 3)] and secondary metastatic disease; colorectal (n = 28), neuroendocrine (n = 1), pancreatic (n = 1), breast (n = 1), gastrointestinal stromal tumour (GIST, n = 1) and malignant thymoma (n = 1). Outcome measures included procedural safety/effectiveness, time to progression and time to death.ResultsBetween 2013 and 2017, 52 patients underwent percutaneous IRE of 59 liver tumours in 53 sessions. All tumours were deemed unsuitable for thermal ablation. Cases were performed using ultrasound (US) or computed tomography (CT) guidance. A complete ablation was achieved in n = 44, (75%) of cases with an overall complication rate of 17% (n = 9). Of the complete ablation group, median time to progression was 8 months. At 12 months, 44% were progression-free (95% CI 30–66%). The data suggest that larger lesion size (> 2 cm) is associated with shorter time to progression and there is highly significant difference with faster time to progression in mCRC compared with HCC. Median survival time was 38 months.ConclusionThis bi-institutional review is the largest UK series of IRE and suggests this ablative technology can be a useful tool, but appears to mainly induce local tumour control rather than cure with HCC having better outcomes than mCRC.

Analysis of the factors affecting the efficacy of (131)I remnant ablation in patients after thyroidectomy for papillary thyroid microcarcinoma

Objective: To investigate the influential factors of efficacy of the first (131)I ablation therapy for thyroid remnant in papillary thyroid microcarcinoma (PTMC) patients after thyroidectomy. Methods: Eighty-nine PTMC patients who underwent twice (131)I ablation therapy and (131)I whole body follow-up scan ((131)I-WBS) within 5 to 8 months in our department from September 2007 to October 2016 were identified and enrolled in present study. Patients were divided into complete-ablation group and uncomplete-ablation group according to whether or not radioactivity was detected at the thyroid bed in (131)I-WBS. The χ(2) test and multi-variance Binary logistic regression were performed for the factors which might affect the therapeutic efficacy. Results: The first (131)I ablation therapy was successful in 41 of 89 patients (46.07%). Residual thyroid weight was found to be associated with therapeutic efficacy (P<0.05), while gender, age, surgical method, lesions'maximum diameter, with or without LN metastasis, with or without distant metastasis, time of operation from first (131)I treatment, lesions'number, thyroid stimulating hormone (TSH), thyroglobulin (Tg), the consistency of (131)I-WBS and (99)Tc(m)-pertechnatate, TNM stage, ATA risk, Tg/TSH ratio were not significant associated with therapeutic efficacy. Binary logistic regression analysis was performed in these respects and it indicated that residual thyroid weight and ATA risk were not statistically significant independent variable (P>0.05). Conclusions: Residual thyroid weight might affect efficacy of the first (131)I ablation therapy on thyroid remnant in PTMC patients after thyroidectomy, but it is not an independent factor. Multiple interrelated factors should be considered when predicting the efficacy of the first (131)I ablation therapy.

Assessment of ablation zone of liver tumor by 3DUS-US fusion imaging based on electromagnetic positioning: an experimental study

Objective To investigate the feasibility and accuracy of three-dimensional ultrasound-ultrasound (3DUS-US) fusion imaging based on electromagnetic positioning in the assessment of ablation zone of liver tumor through experimental study in phantom models. Methods Sixteen phantom models which could be ablated and used to assess the ablation zone were established. Then, they were ablated and divided into complete ablation group (n=8) and incomplete ablation group (n=8) randomly. Their ablation effects were assessed by 3DUS-US fusion imaging. If the tumor model was assessed as incomplete ablation, the maximum thickness of the residual tumor was measured. The assessments of gross specimen were used as golden standard to validate the feasibility and accuracy of assessment of 3DUS-US fusion imaging. The success rate of registration, duration time of fusion imaging, accuracy rate of assessment and measurement error in incomplete ablation group were recorded. Results All of the 16 phantom models were produced successfully. The success rate of registration was 100% and the duration time of 3DUS-US fusion imaging was (3.9±1.0)min. The accuracy rate of assessment was 100%. There was no significant difference between the assessment of residual tumor thickness in incomplete ablation group by 3DUS-US fusion imaging and gross specimen (t=-0.814, P=0.442), and the measurement error was (1.1±0.6)mm. Conclusions 3DUS-US fusion imaging based on electromagnetic positioning is a feasible, accurate and convenient method in the assessment of ablation zone of liver tumor. It would be a new immediate precise assessment method during ablation procedure for liver tumor. Key words: Ultrasonography; Ablation techniques; Image fusion; Electromagnetic positioning

Evaluation of the ablation margin of hepatocellular carcinoma using CEUS-CT/MR image fusion in a phantom model and in patients

BackgroundTo assess the accuracy of contrast-enhanced ultrasound (CEUS)-CT/MR image fusion in evaluating the radiofrequency ablative margin (AM) of hepatocellular carcinoma (HCC) based on a custom-made phantom model and in HCC patients.MethodsTwenty-four phantoms were randomly divided into a complete ablation group (n = 6) and an incomplete ablation group (n = 18). After radiofrequency ablation (RFA), the AM was evaluated using ultrasound (US)-CT image fusion, and the results were compared with the AM results that were directly measured in a gross specimen. CEUS-CT/MR image fusion and CT-CT / MR-MR image fusion were used to evaluate the AM in 37 tumors from 33 HCC patients who underwent RFA.ResultsThe sensitivity, specificity, and accuracy of US-CT image fusion for evaluating AM in the phantom model were 93.8, 85.7 and 91.3%, respectively. The maximal thicknesses of the residual AM were 3.5 ± 2.0 mm and 3.2 ± 2.0 mm in the US-CT image fusion and gross specimen, respectively. No significant difference was observed between the US-CT image fusion and direct measurements of the AM of HCC. In the clinical study, the success rate of the AM evaluation was 100% for both CEUS-CT/MR and CT-CT/MR-MR, and the duration was 8.5 ± 2.8 min (range: 4–12 min) and 13.5 ± 4.5 min (range: 8–16 min) for CEUS-CT/MR and CT-CT/MR-MR, respectively. The sensitivity, specificity, and accuracy of CEUS-CT/MR imaging for evaluating the AM were 100.0, 80.0, and 90.0%, respectively.ConclusionsA phantom model composed of carrageenan gel and additives was suitable for the evaluation of HCC AM. CEUS-CT/MR image fusion can be used to evaluate HCC AM with high accuracy.

Parameters Influencing Curative Effect of 131I Therapy on Pediatric Differentiated Thyroid Carcinoma: A Retrospective Study.

BACKGROUND This study aimed to investigate the parameters influencing the effectiveness of first 131I thyroid remnant ablation and then 131I treatment of metastatic lesions in children and adolescents with differentiated thyroid carcinoma (DTC). MATERIAL AND METHODS A total of 88 children and adolescents with DTC were divided into 2 groups: 56 in the complete-ablation group and 32 in the incomplete-ablation group for the first 131I ablation; 32 in the incomplete-ablation group were further divided: 19 in the complete-remission group and 13 in the incomplete-remission group for subsequent 131I treatment of metastatic lesions. Influential parameters were analyzed using t test, t' test, rank-sum test, χ2-test, and Fisher exact test, and logistic regression analysis was performed. Radioactive iodine uptake (RAIU), lymph node metastases, and pulmonary metastases were selected as influential parameters. RESULTS After logistic regression analysis, RAIU, only lymph node metastases, and pulmonary metastasis were significantly associated with the complete-ablation rate. High levels of RAIU and serum thyroglobulin (Tg) were not conducive to disease remission after subsequent 131I treatment of metastatic lesions. The remission rate of patients with pulmonary metastasis was lower than the rate of patients with lymph node metastases or no metastases. CONCLUSIONS Results demonstrated that a high remission rate is associated with low postoperative RAIU and Tg. Lymph node metastasis and pulmonary metastasis reduce the complete-remission rate of first 131I ablation therapy. Pulmonary metastasis reduces the remission rate of subsequent 131I treatment. Also, 131I treatment for pediatric DTC with pulmonary metastasis achieved progression-free survival.

Radiofrequency ablation combined with transarterial chemoembolization for treating of hepatic metastases

Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for treating of hepatic metastasis. Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63±12 (42-82) years. Tumor size was (4.5±2.4) cm (min.1.5 cm, max. 12.0 cm). Totally 47 lesions were treated with single metastasis in 29 cases and multiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA+TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and then TACE. For multiple lesions, RFA+TACE was given one by one for each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA+TACE were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA+TACE. Twenty patients were in the partially ablated group. Follow up time was 25±10 (10-40) months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month (95%CI: 24-32 months). Survival ration at 1, 2, 3 years for the whole group was 91.7%(33/36),55.5%(20/36),36.1%(13/36) for the whole group. The 3 years survival for complete and partial ablation group was 75.0%(12/16),5.0%(1/20),there was a significant difference between the two groups(P<0.01). Conclusion For patients with hepatic metastasis, RFA+TACE can effectively control the local lesion. Complete ablation is the key point for a better survival. Key words: Liver neoplasms; Neoplasm metastasis; Catheter ablation; Embolization, therapeutic

Risk factors and prognosis for patients with residual tumor after radiofrequency ablation of hepatocellular carcinoma

To investigate the risk factors and prognosis of patients with residual tumor after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The clinicopathological data of 114 patients with HCC undergoing RFA in our hospital from May 2000 to March 2007 were retrospectively studied, and the prognostic factors of residual tumor were analyzed. After one session of RFA, 90 patients had complete ablation and 24 had residual tumor. The median overall survivals in the complete ablation group and residual tumor group were 40 and 29 months, respectively. There was no statistically significant difference between those two groups (P = 0.242). 24 patients with residual tumor were re-treated by RFA or hepatectomy or TACE. Among them 11 patients achieved complete response and 13 incomplete response, their median overall survival were 53 and 28 months, respectively. There was no significant difference between first complete ablation group and second complete response group (P = 0.658). However, compared with the first complete ablation group, the incomplete response group had poor prognosis (P = 0.012). Multivariate analysis showed that tumor size > 3 cm (P = 0.007) and proximity to a large vessel (P = 0.042) were independent risk factors for residual tumor after RFA. Tumor size > 3 cm and proximity to a large vessel are independent risk factors for residual tumor after RFA. Further treatment of residual tumor is necessary to eliminate the tumor and improve prognosis.

The use of PTC and RFA as treatment alternatives with low procedural morbidity in non-small cell lung cancer

Minimally invasive percutaneous ablative therapies for treating lung cancers are currently being studied as treatment alternatives. This present study investigated the efficacies of percutaneous thoracic cryotherapy (PTC) and radiofrequency ablation (RFA) on clinical courses of pulmonary malignant tumours, especially in the setting of non-surgical candidates. Sixty-five patients with lung malignancy underwent sixty-seven sessions of RFA and nine sessions of PTC. We evaluated the results of RFA and PTC including efficacies, local progression rate, survival rate, and complications. Twenty-nine patients (43.3%) treated with RFA and six patients (66.7%) with PTC attained complete ablation. In small-sized lung mass (⩽3 cm), complete ablation rate of RFA and PTC was increased to 76.2% and 85.7%, respectively. Additionally, we have found that the complete ablation group had significantly higher survival duration and progression free survival duration compared with the partial ablation group. Moreover, the complication profile was acceptable and the pain associated with the procedures disappeared within 1 day; 42 patients (62.7%) after RFA and all patients after PTC. This study provides evidence for the use of PTC and RFA as treatment alternatives with low procedural morbidity in the management of inoperable pulmonary malignant tumours, although the current study is limited by the small sample size and the short follow-up period.

Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: evaluation with follow-up helical CT.

We sought to describe the appearance of primary and secondary lung malignancies treated with radiofrequency ablation on follow-up helical CT and to identify the important CT findings for evaluating therapeutic efficacy and response on follow-up CT. Among the 21 patients in our study population, 17 had lung cancer and four had metastatic nodules. All patients underwent follow-up helical CT immediately after undergoing percutaneous radiofrequency ablation, 1 month later, and then every 3 months. Two reviewers interpreted the CT findings and reached a consensus opinion. Patients were divided into two groups on the basis of the posttreatment contrast-enhanced CT findings-those with a complete ablation and those with a partial ablation. The serial changes in the enhancement pattern, size, peripheral ground-glass opacities, and other findings in the treated area in the two groups were assessed on follow-up CT. In the complete ablation group (n = 9 patients), the ablated lesions were completely without contrast enhancement on follow-up CT, and the mean percentage of decrease in the size of the ablated lesions at 3, 6, 9, 12, and 15 months was 5.7%, 11.4%, 14.3%, 40%, and 40%, respectively, compared with the lesion size on the follow-up CT scans obtained immediately after treatment. In the partial ablation group (n = 12 patients), the ablated lesions had various degrees of enhancement, and the mean percentage of ablated lesion size gradually increased after the 6-month follow-up CT examination. Enveloped ground-glass opacity surrounding tumor was seen in five (23.8%) of 21 lesions on the immediate follow-up CT scans. Of the CT findings of lung malignancy after radiofrequency ablation therapy, the enhancement pattern and the size of the change in the ablated lesion are the most important factors for determining whether a complete ablation has been achieved.

Indications, technique, and efficacy of alcohol injection of enlarged parathyroid glands in patients with primary hyperparathyroidism

Background: Percutaneous alcohol ablation of the parathyroid gland (PAAP) has been proposed as an alternative treatment for primary hyperparathyroidism in patients unsuitable for surgery. The current study aimed to determine the (1) selection criteria, (2) associated morbidity, and (3) efficacy of PAAP. Methods: From 1987 to 1998, 36 patients with primary hyperparathyroidism (mean age 65 years) underwent PAAP. The indications for PAAP were (1) medical comorbidity, (2) technically unsafe reoperative surgery, (3) partial ablation of a single remaining gland, and (4) patient choice. Results: There were no long-term complications. Two patients had temporary recurrent laryngeal nerve injury and 4 had temporary hypocalcemia. Over a median follow-up of 16 months, 12 (33%) of the patients remained eucalcemic. For analysis purposes patients were separated into 2 separate groups: 29 with attempted complete ablation and 7 with partial ablation of a single remaining gland only. Ten of the complete ablation group (34%) remained eucalcemic. In the partial ablation group only 2 remained eucalcemic, but all had adequately controlled serum calcium levels. Conclusion: PAAP should be considered for hyperparathyroid patients with excessive reoperative morbidity or prohibitive medical comorbidity or those in whom the intent is to partially ablate a single remaining enlarged gland. In these patients close follow-up of serum calcium is required, and repeat treatments may be necessary because recurrence of hypercalcemia is likely. (Surgery 1998;124:1011-20.)