CT-Guided Percutaneous Chemoablation using an Ethanol-Ethiodol-Doxorubicin Emulsion for the Treatment of Metastatic Lymph Node Carcinoma: A Comparative Study

Abstract

Current therapies for metastatic lymph node (LN) are a major burden on health-care systems. Alternative such as percutaneous chemoablation using interstitial injection of ethanol or ethanol-ethiodol-drug(s) mixture (EEM) has been successfully applied to solid tumor ablation of the liver, adrenal glands, lymph nodes and others. However, EEM chemoablation efficacy on two most frequent clinical lymph node presentation, isolated or confluent, has not yet been determined. This study was designed to compare the therapeutic effects of CT-guided percutaneous EEM injection (PEEMI) on patients presenting with single or multiple confluent metastatic LN localizations from various carcinoma. Thirty six patients with metastatic LN carcinoma at various anatomical regions were enrolled from 2009 to 2010 over a nine month period. They were separated into two groups: group A includes 24 single isolated metastatic lymph nodes and group B includes 12 multiple and confluent nodes. The primary end point was the ablative efficacy of PEEMI. The intratumoral (IT) EEM distribution and the occurrence of reflux were recorded. Adjuvant systemic chemotherapy was administered after the procedure. Contrast-enhanced CT scans were performed during procedure and follow-up. Six patients were tested for Fluorodeoxyglucose (FDG) fixation before and after the procedure. For group A the EEM IT distribution-to-tumor ratio was 100% vs. 50% to 80% for group B (t 5 11.5, p , 0.05). The reflux frequency was 80% for group A versus 30% for group B. For group A, a complete response (CR) rates of 45.8%, 70.8%, 91.7% and a partial response (PR) rates of 54.2%, 29.2%, 8.3% were obtained at 3, 6 and 12 months after therapy. Regarding group B, a CR rate of 0%, 0%, 0% and PR rate of 16.7%, 50%, 58.3% were observed at similar period of time. Standardized rate by direct method was performed and the CR rate (74.5%) for group A was higher than for group B. The tumor FDG uptake was lower 6 months after PEEMII compared with the preoperative images. Five patients presenting with concomitant lung metastasis, had a good local response-node size reduction on postoperative CT scanning, but no response on lung nodules that were progressing.No serious adverse events were observed. A few patients had mild pain during the procedure, which resolved with peritumor injection of local anesthetic. No needle tract seeding or infection occurred. CT-guided PEEMI treatment is a simple, fast and predictable procedure that has better effectiveness on single, well circumscribed metastatic lymph node than on

Safety and technical feasibility of percutaneous ablation for lymph node metastases of hepatocellular carcinoma

“…Sethi et al were the first to demonstrate the feasibility of endoscopic ultrasound-guided thermal ablation of LN metastases in a porcine model [16]. Since then several researchers have reported the use of different modalities-including RFA [17,18], MWA [19], and chemotherapy [20]-for ablation of LN metastasis in humans. Local hematoma formation and abdominal pain are the most frequently reported adverse events; however, they are relatively uncommon and, when they do occur, are usually mild and self-limiting.…”

Transcatheter Arterial Chemoembolization Combined with Simultaneous Computed Tomography-guided Radiofrequency Ablation for Large Hepatocellular Carcinomas

“…Thus, the liver tissues not invaded by the cancer are preserved, which also improves liver reserve capacity; (3) the lipiodol deposition region forms a circle. The heat conduction effect of lipiodol may be employed to concentrate the heat in the lipiodol region and surrounding tissues,[ 28 29 ] forming an “oven phenomenon.” This expands the extent of ablation and inactivates the edge of the cancer, which reduces recurrence; (4) the necrotic tissues after RFA may induce immune response to cancer cells;[ 30 31 ] and (5) intensive chemotherapy may exert synergistic effects with heat ablation. Chemotherapeutics may inhibit the tolerance of cancer cells to heat, and RFA will increase the sensitivity of cancer cells to chemotherapeutics;[ 32 ] and (6) normal hepatocytes will proliferate after treatment, leading to compensatory enlargement of the liver, which improves liver function and reduces cancer stage.…”

Study of epirubicin sustained–release chemoablation in tumor suppression and tumor microenvironment remodeling

“…These agents inactivate tumor cells while remodeling the tumor microenvironment (TME) to produce a series of immunochemical reactions in order to achieve the goals of treatment; hereinafter, this is referred to as immunochemical ablation. The previously used ablation agents such as anhydrous alcohol and glacial acetic acid have been administered by local injection to rapidly dehydrate tumor cells, directly destroy cell membranes, and induce coagulation necrosis of tumor cells (1)(2)(3). However, because the speed and the scope of dispersion are not easy to control, and local pain stimulation is severe, the clinical application of these agents has been limited.…”