Technical and Practical Considerations for Device Selection in Locoregional Ablative Therapy

Abstract

Percutaneous image-guided ablation is increasingly being used as definitive treatment of primary and metastatic focal malignancies, local therapy for tumors in poor operative candidates, and for pain palliation. Advances in tissue ablation technologies with development of new modalities have made device selection an increasingly complex endeavor. As the arsenal of ablation devices continues to evolve, each is slowly finding its optimal niche; however, the clinical benefits and limitations of each tool are still not conclusively delineated, with significant overlap in effective and safe applicability. In many scenarios, the choice of ablation modality is dependent on the available equipment, operator expertise, and institutional preference. However, a firm understanding of the physical, chemical, and biological mechanisms underlying induction of tissue necrosis, the realworld benefits and shortcomings of each technology, and the performance profile for each ablation technique in specific organ systems is critical in choosing the most favorable device for each individual clinical situation. This article aims to provide practical guidance on ablative device selection by briefly reviewing the mechanism of action of currently available thermal and nonthermal ablation technologies, highlighting the clinical and technical advantages or disadvantages of each modality, and utilizing a case-based format to illustrate selection considerations and practical application of ablation equipment in assorted clinical cases. Ablation Modalities and Mechanisms of Action Thermal AblationHyperthermic or heat-based ablation techniques cause cellular death by coagulative necrosis, leading to denaturation of intracellular enzymes and protein complexes, and leading to structural damage and apoptosis. Irreversible cellular injury typically occurs when cells are heated to greater than 60°C, and ensues more rapidly as temperature rises.1 Examples of commonly utilized hyperthermic ablation modalities include radiofrequency ablation (RFA) and microwave ablation (MWA). Other hyperthermic modalities, including high- AbstractPercutaneous ablation therapy is an essential component of contemporary interventional oncologic therapy of primary and secondary malignancies. The growing armamentarium of available ablation technologies calls for thorough understanding of the different ablation modalities to optimize device selection in individual clinical settings.The goal of the current article is to provide direction on ablative device selection by reviewing device mechanisms of action, advantages and disadvantages, and practical considerations in real-life case scenarios.

Comparison of Radiofrequency Ablation and Surgical Resection of Tumor Pathology Liver in the Gomel Regional Clinical Oncological Dispensary

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