A prospective development study of software-guided radio-frequency ablation of primary and secondary liver tumors: Clinical intervention modelling, planning and proof for ablation cancer treatment (ClinicIMPPACT)

Reinhardt, Martin; Brandmaier, Philipp; Seider, Daniel; Kolesnik, Marina; Jenniskens, Sjoerd F.M.; Sequeiros, Roberto Blanco; Eibisberger, Martin; Voglreiter, Philip; Flanagan, Ronan; Mariappan, Panchatcharam; Busse, Harald; Moche, Michael

doi:10.1016/j.conctc.2017.08.004

Cited by 15 publications

(13 citation statements)

References 32 publications

(34 reference statements)

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“…Currently, the RFA Guardian is the center of a clinical trial 35 that evaluates whether peri-interventional prospective simulation could be feasible in the future. To ultimately achieve this goal, the focus of the ongoing study is to record the time required for simulating treatment using a real needle position, segmented from peri-interventional images and registered into the patient-specific model.…”

Section: Discussionmentioning

confidence: 99%

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RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors

Voglreiter

Mariappan²,

Pollari

et al. 2018

Sci Rep

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The RFA Guardian is a comprehensive application for high-performance patient-specific simulation of radiofrequency ablation of liver tumors. We address a wide range of usage scenarios. These include pre-interventional planning, sampling of the parameter space for uncertainty estimation, treatment evaluation and, in the worst case, failure analysis. The RFA Guardian is the first of its kind that exhibits sufficient performance for simulating treatment outcomes during the intervention. We achieve this by combining a large number of high-performance image processing, biomechanical simulation and visualization techniques into a generalized technical workflow. Further, we wrap the feature set into a single, integrated application, which exploits all available resources of standard consumer hardware, including massively parallel computing on graphics processing units. This allows us to predict or reproduce treatment outcomes on a single personal computer with high computational performance and high accuracy. The resulting low demand for infrastructure enables easy and cost-efficient integration into the clinical routine. We present a number of evaluation cases from the clinical practice where users performed the whole technical workflow from patient-specific modeling to final validation and highlight the opportunities arising from our fast, accurate prediction techniques.Radiofrequency ablation (RFA) of liver malignancies has become an important alternative therapy for patients who disqualify for standard surgical treatment or are in an early tumor stage 1,2 . When surgical resection is not feasible, RFA is the preferred treatment option for small liver tumors 1,2 . Moreover, patient recovery after surgical resection takes longer and post-procedural quality of life is lower than after RFA 2 .While many more options for local cancer treatment exist (e.g. Cryo Ablation 3 , Irreversible Electroporation 4 or hyperthermia in conjunction with other treatment methods 5,6 ), the clincial routine prefers RFA (or, occasionally, microwave ablation) treatment for smaller liver tumors. Although microwave ablation has become more prevalent in the past years, no statistically significant difference in survival rates compared to RFA of smaller lesions (diameter below 3.5 cm) in the liver could be found 7,8 .In RFA, interventional radiologists (IR) destroy malignant cells using percutaneous probes that induce heating in a locally delimited region around a tumor. Successful treatment is defined as complete ablation of the tumor with a safety margin of destroyed healthy tissue in its immediate vicinity.However, clinical experience with RFA indicates a significant mismatch between expected and observed lesion size, leading to reduced survival rates due to over-treatment with severe injuries (up to 9%) or under-treatment with tumor recurrence 9 (up to 40%). Further, Hildebrand et al. 10 have shown that the survival rates after 1 and 2 years significantly depend on the experience of the IR: Operating experience of 0-2 years resulted in 69...

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Section: Discussionmentioning

confidence: 99%

“…In case the resulting predicted coagulation area is unsatisfying, the IR can still adapt the treatment plan. This scenario, where treatment and simulation run in parallel, is currently being investigated in a clinical trial 35 .…”

Section: Methodsmentioning

confidence: 99%

RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors

Voglreiter

Mariappan²,

Pollari

et al. 2018

Sci Rep

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“…A first retrospective study indicated that this approach has the potential to improve the classical RFA planning based on inspection of 2 D images alone [404]. Software-guided RFA of primary and secondary liver tumors is currently evaluated in the ClinicIMPPACT study; a multicenter-, prospective-, non-randomized clinical trial to evaluate the accuracy and efficiency of innovative planning and simulation software [405]. MWA has the potential of creating larger ablation zones compared to RFA, but at the same time this yields a greater risk of thermal damage in surrounding healthy tissues, which explains the research interest in development of personalized MWA treatment planning [406].…”

Section: Treatment Planningmentioning

confidence: 99%

Heating technology for malignant tumors: a review

Kok

Cressman

Ceelen

et al. 2020

International Journal of Hyperthermia

257

188

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The therapeutic application of heat is very effective in cancer treatment. Both hyperthermia, i.e., heating to 39-45 C to induce sensitization to radiotherapy and chemotherapy, and thermal ablation, where temperatures beyond 50 C destroy tumor cells directly are frequently applied in the clinic. Achievement of an effective treatment requires high quality heating equipment, precise thermal dosimetry, and adequate quality assurance. Several types of devices, antennas and heating or power delivery systems have been proposed and developed in recent decades. These vary considerably in technique, heating depth, ability to focus, and in the size of the heating focus. Clinically used heating techniques involve electromagnetic and ultrasonic heating, hyperthermic perfusion and conductive heating. Depending on clinical objectives and available technology, thermal therapies can be subdivided into three broad categories: local, locoregional, or whole body heating. Clinically used local heating techniques include interstitial hyperthermia and ablation, high intensity focused ultrasound (HIFU), scanned focused ultrasound (SFUS), electroporation, nanoparticle heating, intraluminal heating and superficial heating. Locoregional heating techniques include phased array systems, capacitive systems and isolated perfusion. Whole body techniques focus on prevention of heat loss supplemented with energy deposition in the body, e.g., by infrared radiation. This review presents an overview of clinical hyperthermia and ablation devices used for local, locoregional, and whole body therapy. Proven and experimental clinical applications of thermal ablation and hyperthermia are listed. Methods for temperature measurement and the role of treatment planning to control treatments are discussed briefly, as well as future perspectives for heating technology for the treatment of tumors.

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“…To address this issue and assist the clinicians in a better way, use of computer-assisted electrode trajectory planning techniques has also been extensively explored, particularly for reducing the number of re-insertion attempts (Seitel et al, 2011, Singh andRepaka, 2018d). Recently, (Zhang et al, 2019b) reported an extensive review on computer-assisted needle trajectory planning for RFA and Several studies have been reported in the past on the three-dimensional image-based patient-specific model of RFA for treating tumor (Audigier et al, 2017, Audigier et al, 2015, Audigier et al, 2013, Payne et al, 2010, Rieder et al, 2011, Chen et al, 2018, Reinhardt et al, 2017, Voglreiter et al, 2018, Zorbas and Samaras, 2014, Jin et al, 2014, Moche et al, 2020. Figure 6 presents a generalized technical workflow adopted during the patient-specific modelling and simulation of RFA for treating liver tumor (Voglreiter et al, 2018).…”

Section: Image-based Multiscale Modellingmentioning

confidence: 99%

Thermal ablation of biological tissues in disease treatment: A review of computational models and future directions

Singh

Melnik

2020

Electromagnetic Biology and Medicine

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Percutaneous thermal ablation has proved to be an effective modality for treating both benign and malignant tumors in various tissues. Among these modalities, radiofrequency ablation (RFA) is the most promising and widely adopted approach that has been extensively studied in the past decades. Microwave ablation (MWA) is a newly emerging modality that is gaining rapid momentum due to its capability of inducing rapid heating and attaining larger ablation volumes, and its lesser susceptibility to the heat sink effects as compared to RFA. Although the goal of both these therapies is to attain cell death in the target tissue by virtue of heating above 50 o C, their underlying mechanism of action and principles greatly differs. Computational modelling is a powerful tool for studying the effect of electromagnetic interactions within the biological tissues and predicting the treatment outcomes during thermal ablative therapies. Such a priori estimation can assist the clinical practitioners during treatment planning with the goal of attaining successful tumor destruction and preservation of the surrounding healthy tissue and critical structures. This review provides current state-ofthe-art developments and associated challenges in the computational modelling of thermal ablative techniques, viz., RFA and MWA, as well as touch upon several promising avenues in the modelling of laser ablation, nanoparticles assisted magnetic hyperthermia and noninvasive RFA. The application of RFA in pain relief has been extensively reviewed from modelling point of view. Additionally, future directions have also been provided to improve these models for their successful translation and integration into the hospital work flow.

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A prospective development study of software-guided radio-frequency ablation of primary and secondary liver tumors: Clinical intervention modelling, planning and proof for ablation cancer treatment (ClinicIMPPACT)

Cited by 15 publications

References 32 publications

RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors

RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors

Heating technology for malignant tumors: a review

Thermal ablation of biological tissues in disease treatment: A review of computational models and future directions

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