A multi‐step, incremental expansion method for radio frequency ablation: optimization of the procedure to prevent increases in intra‐tumor pressure and to reduce the ablation time

Kotoh, Kazuhiro; Nakamuta, Makoto; Morizono, Shusuke; Kohjima, Motoyuki; Arimura, Eiichirou; Fukushima, Marie; Enjoji, Munechika; Sakai, Hironori; Nawata, Hajime

doi:10.1111/j.1478-3231.2005.01051.x

Cited by 62 publications

(81 citation statements)

References 11 publications

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“…The tumor then bursts with an audible popping sound, leading to an explosive intravascular spread of the tumor cells into the portal or arterial branches. In one study, scattered recurrences could be completely prevented by replacing the current RFA protocols by slower and more progressive treatment protocols [120], which increased intratumoral pressure much less [124]. Survival of patients with scattered recurrences is significantly worse [120].…”

Section: Oncological Arguments With Indirect Evidence Pro and Contra mentioning

confidence: 99%

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

et al. 2008

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Background: A recent proposal of a randomized trial comparing resection and radiofrequency ablation (RFA) in a selected subgroup of patients with small resectable colorectal liver metastases (CRLM) has initiated a debate on this issue. Meanwhile, new data have been published. The aim of the study was to update and critically review the oncological evidence in favor of and against the use of RFA for resectable CRLM in general and in favor of and against conducting a randomized trial in a selected subgroup of patients. Methods: An exhaustive review was carried out of papers and abstracts on RFA of colorectal metastases published before July 15, 2008. Results: Local recurrence rate after resection of CRLM is 1.2–10.4%. Local recurrence rate after RFA of CRLM is between 1.7 and 66.7%. For tumors <3 cm, local control after open RFA is equivalent to resection. Local recurrence rates, however, are higher for larger tumors and for the percutaneous and laparoscopic route. Accumulating evidence suggests that RFA and resection induce profoundly different biological effects, which may influence survival. Conclusions: Local recurrence rate after open RFA for CRLM <3 cm seems to be equivalent to resection. A randomized trial under strict conditions would be justified in this subgroup of patients. A randomized trial is currently not justified for larger tumors or for percutaneous or laparoscopic RFA, since local recurrence rates in these groups are too high to be acceptable for resectable tumors.

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Section: Oncological Arguments With Indirect Evidence Pro and Contra mentioning

confidence: 99%

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

et al. 2008

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“…The main constituent of most biological tissues, including liver tissue, is water; over about 100°C the phase change takes place and, since vapor is a good dielectric, it progressively insulates the active electrode leading to the interruption of the ablation procedure [13,14]. The vaporization of the liquids contained in the tissue also generates a pressure increase in the heating point; this is particularly significant for encapsulated tumors since it might cause the dislodgement and scattering of malignant cells around the ablated tumor [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Fiber-optic combined FPI/FBG sensors for monitoring of radiofrequency thermal ablation of liver tumors: ex vivo experiments

et al. 2014

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We present a biocompatible, all-glass, 0.2 mm diameter, fiber-optic probe that combines an extrinsic Fabry-Perot interferometry and a proximal fiber Bragg grating sensor; the probe enables dual pressure and temperature measurement on an active 4 mm length, with 40 Pa and 0.2°C nominal accuracy. The sensing system has been applied to monitor online the radiofrequency thermal ablation of tumors in liver tissue. Preliminary experiments have been performed in a reference chamber with uniform heating; further experiments have been carried out on ex vivo porcine liver, which allowed the measurement of a steep temperature gradient and monitoring of the local pressure increase during the ablation procedure.

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“…Berber et al (15) reported that for the ablation of tumors larger than 3 cm in diameter, ablation using an initial smaller deployment of 20 mm to create a nucleus of ablation can result in a larger ablation area in a shorter total ablation time, compared with an initial larger deployment of 30 mm with slower advancement to the final diameter. Kotoh et al (16) reported that multi-step ablation requires a shorter time compared to single-step ablation. Based on the findings of these studies, we used a stepwise extension technique in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

Koda

Tokunaga

Matono

et al. 2011

Experimental and Therapeutic Medicine

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Abstract. The purpose of the present study was to compare the size and configuration of the ablation zones created by SuperSlim and CoAccess electrodes, using various ablation algorithms in ex vivo bovine liver and in clinical cases. In the experimental study, we ablated explanted bovine liver using 2 types of electrodes and 4 ablation algorithms (combinations of incremental power supply, stepwise expansion and additional low-power ablation) and evaluated the ablation area and time.In the clinical study, we compared the ablation volume and the shape of the ablation zone between both electrodes in 23 hepatocellular carcinoma (HCC) cases with the best algorithm (incremental power supply, stepwise expansion and additional low-power ablation) as derived from the experimental study. In the experimental study, the ablation area and time by the CoAccess electrode were significantly greater compared to those by the SuperSlim electrode for the single-step (algorithm 1, p=0.0209 and 0.0325, respectively) and stepwise expansion algorithms (algorithm 2, p=0.0002 and <0.0001, respectively; algorithm 3, p= 0.006 and 0.0407, respectively). However, differences were not significant for the additional low-power ablation algorithm. In the clinical study, the ablation volume and time in the CoAccess group were significantly larger and longer, respectively, compared to those in the SuperSlim group (p=0.0242 and 0.009, respectively). Round ablation zones were acquired in 91.7% of the CoAccess group, while irregular ablation zones were obtained in 45.5% of the SuperSlim group (p= 0.0428). In conclusion, the CoAccess electrode achieves larger and more uniform ablation zones compared with the SuperSlim electrode, though it requires longer ablation times in experimental and clinical studies.

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A multi‐step, incremental expansion method for radio frequency ablation: optimization of the procedure to prevent increases in intra‐tumor pressure and to reduce the ablation time

Abstract: The multi-step method can be recommended to reduce the ablation time, and suppress the increase in pressure.

Cited by 62 publications

References 11 publications

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

Radiofrequency Ablation versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial?

Fiber-optic combined FPI/FBG sensors for monitoring of radiofrequency thermal ablation of liver tumors: ex vivo experiments

Comparison between different thickness umbrella-shaped expandable radiofrequency electrodes (SuperSlim and CoAccess): Experimental and clinical study

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