Cargando…

Thermal Ablation for the Treatment of Abdominal Tumors

Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures...

Descripción completa

Detalles Bibliográficos
Autores principales: Brace, Christopher L., Hinshaw, J. Louis, Lubner, Meghan G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MyJove Corporation 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197316/
https://www.ncbi.nlm.nih.gov/pubmed/21445029
http://dx.doi.org/10.3791/2596
_version_ 1782214297831604224
author Brace, Christopher L.
Hinshaw, J. Louis
Lubner, Meghan G.
author_facet Brace, Christopher L.
Hinshaw, J. Louis
Lubner, Meghan G.
author_sort Brace, Christopher L.
collection PubMed
description Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 °C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide. During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates(1,2). Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma(3-5). However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)(6,7). Microwaves may alleviate some of these problems by producing faster, volumetric heating(8-10). To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices(11-13). Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 °C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver(14-16). Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications(17). Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock (16). Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging.
format Online
Article
Text
id pubmed-3197316
institution National Center for Biotechnology Information
language English
publishDate 2011
publisher MyJove Corporation
record_format MEDLINE/PubMed
spelling pubmed-31973162011-10-24 Thermal Ablation for the Treatment of Abdominal Tumors Brace, Christopher L. Hinshaw, J. Louis Lubner, Meghan G. J Vis Exp Medicine Percutaneous thermal ablation is an emerging treatment option for many tumors of the abdomen not amenable to conventional treatments. During a thermal ablation procedure, a thin applicator is guided into the target tumor under imaging guidance. Energy is then applied to the tissue until temperatures rise to cytotoxic levels (50-60 °C). Various energy sources are available to heat biological tissues, including radiofrequency (RF) electrical current, microwaves, laser light and ultrasonic waves. Of these, RF and microwave ablation are most commonly used worldwide. During RF ablation, alternating electrical current (~500 kHz) produces resistive heating around the interstitial electrode. Skin surface electrodes (ground pads) are used to complete the electrical circuit. RF ablation has been in use for nearly 20 years, with good results for local tumor control, extended survival and low complication rates(1,2). Recent studies suggest RF ablation may be a first-line treatment option for small hepatocellular carcinoma and renal-cell carcinoma(3-5). However, RF heating is hampered by local blood flow and high electrical impedance tissues (eg, lung, bone, desiccated or charred tissue)(6,7). Microwaves may alleviate some of these problems by producing faster, volumetric heating(8-10). To create larger or conformal ablations, multiple microwave antennas can be used simultaneously while RF electrodes require sequential operation, which limits their efficiency. Early experiences with microwave systems suggest efficacy and safety similar to, or better than RF devices(11-13). Alternatively, cryoablation freezes the target tissues to lethal levels (-20 to -40 °C). Percutaneous cryoablation has been shown to be effective against RCC and many metastatic tumors, particularly colorectal cancer, in the liver(14-16). Cryoablation may also be associated with less post-procedure pain and faster recovery for some indications(17). Cryoablation is often contraindicated for primary liver cancer due to underlying coagulopathy and associated bleeding risks frequently seen in cirrhotic patients. In addition, sudden release of tumor cellular contents when the frozen tissue thaws can lead to a potentially serious condition known as cryoshock (16). Thermal tumor ablation can be performed at open surgery, laparoscopy or using a percutaneous approach. When performed percutaneously, the ablation procedure relies on imaging for diagnosis, planning, applicator guidance, treatment monitoring and follow-up. Ultrasound is the most popular modality for guidance and treatment monitoring worldwide, but computed tomography (CT) and magnetic resonance imaging (MRI) are commonly used as well. Contrast-enhanced CT or MRI are typically employed for diagnosis and follow-up imaging. MyJove Corporation 2011-03-07 /pmc/articles/PMC3197316/ /pubmed/21445029 http://dx.doi.org/10.3791/2596 Text en Copyright © 2011, Journal of Visualized Experiments http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. To view a copy of this license, visithttp://creativecommons.org/licenses/by-nc-nd/3.0/
spellingShingle Medicine
Brace, Christopher L.
Hinshaw, J. Louis
Lubner, Meghan G.
Thermal Ablation for the Treatment of Abdominal Tumors
title Thermal Ablation for the Treatment of Abdominal Tumors
title_full Thermal Ablation for the Treatment of Abdominal Tumors
title_fullStr Thermal Ablation for the Treatment of Abdominal Tumors
title_full_unstemmed Thermal Ablation for the Treatment of Abdominal Tumors
title_short Thermal Ablation for the Treatment of Abdominal Tumors
title_sort thermal ablation for the treatment of abdominal tumors
topic Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197316/
https://www.ncbi.nlm.nih.gov/pubmed/21445029
http://dx.doi.org/10.3791/2596
work_keys_str_mv AT bracechristopherl thermalablationforthetreatmentofabdominaltumors
AT hinshawjlouis thermalablationforthetreatmentofabdominaltumors
AT lubnermeghang thermalablationforthetreatmentofabdominaltumors