Perivascular parenchymal extension of the ablation zone following liver microwave ablation

Singh, Saurabh; Siriwardana, Pulathis N.; Johnston, Edward; Bandula, Steven; Davidson, Brian R; Illing, Rowland

doi:10.1136/bcr-2015-212871

Cited by 4 publications

(3 citation statements)

References 7 publications

(6 reference statements)

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“…Thrombosis of intrahepatic vessels has been reported in the literature and is a recognised complication [9]. However extension of the ablation zone along vessels has only been reported once in a patient where there was evidence of ablation zone extension around a thrombosed hepatic vein branch [10]. Perivascular extension of the ablation zone has been reported as an incidental finding in two in vivo animal studies of liver MWA [11,12].…”

Section: Introductionmentioning

confidence: 99%

“…A more recent in vivo study demonstrated vessel damage away from the ablation zone but did not mention extension of the ablation zone in the perivascular parenchyma [13]. This effect is important because thermal injury to vessels may precipitate thrombosis, as seen in the only reported clinical case and in vivo studies [10][11][12][13]. Vascular thrombosis is not rare following MWA [9], and in some cases can be a serious complication [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model

Singh

Siriwardana

Johnston

et al. 2017

International Journal of Hyperthermia

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Microwave ablation (MWA) has been proposed to suffer less from the heat sink effect compared to radiofrequency ablation but has been reported to cause extension of the ablation zone along intrahepatic vessels in clinical practice. To study this effect in detail, eight fresh porcine livers were perfused in an ex vivo organ perfusion system. Livers were perfused with oxygenated, O-positive human blood at 37 °C. Perfusion was discontinued immediately before ablation in the non-perfused group (n = 4) whilst in the perfused group (n = 4) perfusion was maintained during MWA (140 W X 2 min). Large intrahepatic vessels (> 6 mm) were avoided using ultrasound. MWA zones were bisected within 30 min of perfusion termination and sections were fixed in formalin and stained with H&E and NADH to assess cell viability. Magnetic resonance imaging (MRI) was performed on two livers (one perfused, one non-perfused) to provide imaging correlation before sectioning. Twenty-one out of a total of 30 MW ablation zones (70%) showed extension of the ablation zone along a vessel. There was no statistically significant difference (p = 1) in the incidence of ablation zone extension between perfused (9/13, 69%) and non-perfused organs (12/17, 71%). MRI also demonstrated ablation zone extension along blood vessels correlating with macroscopy in two livers. NADH staining also confirmed extension of the ablation zone. Liver MWA appears to be commonly associated with propagated thermal injury along adjacent vessels and occurs independent of active blood flow. In order to avoid possible complications through non-target tissue injury, this effect requires further investigation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model

Singh

Siriwardana

Johnston

et al. 2017

International Journal of Hyperthermia

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“…One way to obtain this is information is to apply IRE to perfused human organs (both cancer-containing and healthy). Our previous work on the clinical application of microwave ablation (MWA) to solid tumours demonstrated that a perfused organ could provide different findings, and hence a different treatment algorithm, to that derived from non-viable and non-perfused tissues [ 104 , 105 , 106 ]. Applying IRE to perfused human pancreas ex vivo, using organs deemed unsuitable for transplant and therefore declined for clinical use may aid the development of an alternative treatment protocol and help define protective criteria for vital structures.…”

Section: Pathological Response To Pancreas Ire Therapy and Mechanism Of Actionmentioning

confidence: 99%

Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy

Rai

Feakins

Pallett

et al. 2021

JCM

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Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. A systematic search was performed using PubMed regarding the clinical use and safety profile of IRE on pancreatic cancer, post-IRE sequential histological changes, associated immune response, and synergistic therapies. Animal data demonstrate that IRE induces both apoptosis and necrosis followed by fibrosis. Major complications may result from IRE; procedure related mortality is up to 2%, with an average morbidity as high as 36%. Nevertheless, prospective and retrospective studies suggest that IRE treatment may increase median overall survival of LAPC to as much as 30 months and provide preliminary data justifying the well-designed trials currently underway, comparing IRE to the standard of care treatment. The mechanism of action of IRE remains unknown, and there is a lack of data on treatment variables and efficiency in humans. There is emerging data suggesting that IRE can be augmented with synergistic therapies such as immunotherapy.

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Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature

Fujita¹,

Takahashi²,

Kanzaki³

et al. 2016

Case Rep Oncol

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A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.

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Perivascular parenchymal extension of the ablation zone following liver microwave ablation

Cited by 4 publications

References 7 publications

Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model

Perivascular extension of microwave ablation zone: demonstrated using an ex vivo porcine perfusion liver model

Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy

Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature

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