Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment.

Abstract

Fifty-five liver metastases in 21 patients were treated with interstitial laser photocoagulation (ILP). Tumors were irradiated with a neodymium yttrium aluminum garnet laser via optical fibers passed through 19-gauge needles inserted under ultrasound (US) guidance. Heating of the tumor was evident at real-time US as an expanding and coalescing echogenic zone around the needle tips. After ILP, dynamic computed tomography (CT) showed laser-induced necrosis as a new area of nonenhancement. Necrosis of tumor volume was more than 50% in 82% (45 of 55) of the tumors, and 100% necrosis was achieved in 38% (21 of 55). Metastases smaller than 4 cm in diameter were treated more effectively and required fewer treatment sessions than did those larger than 4 cm. Complications were minor and included severe pain in four cases, persistent pain for up to 10 days in 11 cases, and asymptomatic subcapsular hematoma (four cases) and pleural effusion (six cases) seen with CT. ILP is safe and effective for liver tumor destruction, and US and CT are useful in different aspects of treatment monitoring.

Gold nanorod assisted near-infrared plasmonic photothermal therapy (PPTT) of squamous cell carcinoma in mice

“…In cases of recurrent tumors or those with ill-defined margins, alternative and multimodal oncological approaches are employed. The primary [40][41][42] and adjunctive [43][44][45][46] treatment of cancers by induced hyperthermia is a well established but burgeoning field of medical research. Here, temperatures in tumor-loaded tissues are elevated to 40-43°C [47] and above by selective or non-selective application of microwave, radio, ultrasound, alternating magnetic, infrared, or visible radiation.…”

“…Under mild temperature increases, clinical studies indicate an acceleration in both perfusion and reoxygenation [50,51] of tumor tissues, thereby increasing the efficacy of cytostatic drug delivery (chemosensitization) and radiotherapy (radiosensitization), respectively. In all cases, clinical studies indicate statistically significant benefits to local tumor control and overall survival rates for primary [40][41][42] and conjunctive hyperthermia [52][53][54][55][56]. Although promising, conventional non-invasive hyperthermic strategies are often less selective than those basedon or used in combination with thermal contrast agents, in many cases, causing damage to surrounding healthy tissues, as well as significant discomfort.…”

“…Selectivity is achieved by focused directional control or invasive [40][41][42] (fiber optic) positioning of the incident radiation, often pulsed [28][29][30] or continuous wave [24-28, 30, 48] (cw) laser, and is typically accompanied by preferential administration of photoactive molecules [60][61][62] or nano-scale particles. Photoexcitation of the latter two results in nonradiative relaxation by local heat transfer to the surrounding tumor environment.…”

Photodynamic therapy of a transplanted pancreatic cancer model using meta-tetrahydroxyphenylchlorin (mTHPC)

“…In patients with small cancers localized to the pancreas who are unfit for pancreatectomy because of their general medical condition and for whom there are no other therapeutic options, it would now seem justified to consider pilot clinical studies if the free flow of bile is protected by a biliary endoprosthesis. Laser fibres could be positioned in the tumour through needles placed percutaneously under ultrasound or computerized tomography (CT) guidance, as is done routinely in the management of small liver tumours (Amin et al, 1993), and the results assessed by contrast-enhanced CT scans.…”

Comparison between interstitial laser thermotherapy and excision of an adenocarcinoma transplanted into rat liver

“…One of the advantages of local tissue destruction is that the trauma is small compared with surgery. It has been shown that interstitial laser thermotherapy induces well-defined and reproducible liver necrosis and that it may be efficient in local treatment of liver tumours (Amin et al, 1993;van Hillegersberg et al, 1994;Moller et al, 1996Moller et al, , 1997Tranberg et al, 1996).…”