` EpE @@@ @@@@Zr%=QE`E EN DB E     & . 67 P C i sk\`  of Surgery 8XA@9XDUvBUvBLs&s8X5` *Liver Neoplasms/th [Therapy]y]osage]CY&Langenbecks Archives of Surgery 8XA@9XDUvBUvBLs&s8X5`possible. The long-term efficacy of RF ablation in this group of patients has to be evaluated. [References: 19] t or nBecker, D., J. M. Hansler, et al. (1999). "Percutaneous ethanol injection and radio-frequency ablation for the treatment of nonresectable colorectal liver metastases - techniques and results. [Review] [19 refs]." Langenbecks Archives of Surgery 384(4): 339-343. BACKGROUND: Percutaneous ethanol injection (PEI) and radio-frequency (RF) ablation are possible palliative treatment modalities for patients with non-resectable liver metastases of colorectal carcinomas. The different techniques are explained and r; Allegra2000Atkinson20000 Bilchik2000 Blackwell2000 Bruix2000  Buczkowski1997 Chapman2000 Christman2000 Chung2000 Curley19999 Daemen19981 Debelak2000 Delrio19999 Dodd2000 Ellis1999 Fleming1999 Gillams2000 Granchi1999 Hoekstra19988 Iizuka19988 Izzo19999 Kane20000 Karahan2000 Kolios19988  Korteling1998 Lee1999 Lees20002  Leunissen1998Livraghi2000 Llovet2000 Mahvi1999 Morton20000  Patterson1997 Pearson1999 Ramming2000 Rhim20000  Rodriguez1998 Roh1999 Rose20000 Sala20000  Scudamore1997 Shapiro1997 Sherar19988  Skinner1998 Smeets19989 Soulen2000 Tanabe1998 Tanabe1999  Timmermans1998 Tsioulias2000Venkatakrishnan2000 Vos1998 Washington2000 Wellens1998 Wood20000 Wright20000 Yamashita2000  Yoon1998  Yoon199900  Yoon199800  Yoon1998  ST :EP Iid don thswop orimisgnr selustf rot eht ertaemtno filev remattssase .FRr selustw re eomere cnuoariggn ;os AuthorsIJournals Keywords                                `QT I Allegra, D. Asahina, Y.Atkinson, J.B. Becker, D. Bilchik, A.J.Blackwell, T.S. Bruix, J.Buczkowski, A.K. Chapman, W.C.Christman, J.W. Chung, M. Curley, S.A. Daemen, M. Debelak, J.P. Delrio, P.Dodd, G.D., III Ellis, L.M. Enomoto, N. Fleming, R.Y. Gillams, A.R. Granchi, J. Hahn, E.G. Hansler, J.M. Himeno, Y. Hoekstra, A. Iizuka, M.N. Itakura, J. Izumi, N. Izzo, F. Kanazawa, N. Kane, R.A. Karahan, O.I. Kolios, M.C.Korteling, B.J.Lee, F.T., Jr. Lees, W.R. Leunissen, J. Livraghi, T. Llovet, J.M. Mahvi, D.M. Miyake, S. Morton, D.L. Noguchi, O.Patterson, E.J. Pearson, A.S. Ramming, K.P. Rhim, H.Rodriguez, L.M. Roh, M.S. Rose, D.M. Sakai, T. Sala, M.Scudamore, C.H. Shapiro, A.M. Sherar, M.D. Skinner, M.G. Smeets, J.L. Soulen, M.C. Strobel, D. Tanabe, K. K. Tanabe, K.K.Timmermans, C.Tsioulias, G.J. Uchihara, M.Venkatakrishnan, A. Vos, M.Washington, M.K. Wellens, H.J. Wood, T.F.Wright, Pinson C. Yamashita, Y. Yoon, S. S. Yoon, S.S.    Am.J.Surg. Ann.Surg.Annals of Surgery Arch.Surg.p CancerJ.Invest Surg.0+Journal of Cardiovascular Electrophysiology$Langenbecks Archives of SurgeryLiver Transplantation Oncologist Physics in Medicine & Biology RadiographicsSurgical Oncology  (#*Atrioventricular Node/su [Surgery] *Brain *Breast,&*Carcinoma,Hepatocellular/th [Therapy]*Catheter Ablation($*Colorectal Neoplasms/pa [Pathology]*Computer Simulation *Cryosurgeryl$*Electrophysiology/mt [Methods](%*Ethanol/ad [Administration & Dosage] *Heart Block/di [Diagnosis]*Hyperthermia,Induced *Liver$*Liver Neoplasms/sc [Secondary]os *Liver Neoplasms/th [Therapy]*Liver/su [Surgery]$*Lung Neoplasms/sc [Secondary] *Lung Neoplasms/th [Therapy]*Palliative Care/$*Sepsis Syndrome/et [Etiology]0 (Antineoplastic Agents)0 (Chemotactic Factors)io(%0 (macrophage inflammatory protein 2) 0 (Monokines)0 (NF-kappa B)inf0 (Tumor Necrosis Factor)64-17-5 (Ethanol)9008-11-1 (Interferons)administration & dosageAdultadverse effectsAged Algorithms analysis Animalor Antineoplastic Agents0-Antineoplastic Agents/administration & dosage0*Antineoplastic Agents/tu [Therapeutic Use]($Atrioventricular Node/pa [Pathology]0*Atrioventricular Node/pp [Physiopathology] Biophysicsblood blood supply Brain Neoplasms/th [Therapy] Breast Neoplasms/th [Therapy]Carcinoma,Hepatocellular,'Carcinoma,Hepatocellular/pa [Pathology]Catheter Ablation Chemoembolization,Therapeutic$Chemotactic Factors/bl [Blood]teiClinical TrialsCold$Colorectal Neoplasms/*pathology(#Colorectal Neoplasms/mo [Mortality]$!Colorectal Neoplasms/th [Therapy]Comparative Study complications Cryosurgeryla$ Cryosurgery/is [Instrumentation] diagnosis DiathermyDisease Models,AnimalDogsElectrocoagulationEmbolization,Therapeutic$!Enzyme-Linked Immunosorbent Assay epidemiologya Ethanol (($Ethanol/ad [Administration & Dosage] Ethanol/tu [Therapeutic Use]]Feasibility Studies Femaleiol Femoral Vein Gene Therapy Heart Block/pa [Pathology]Heart Block/su [Surgery]Heat Hepatitis CHuman,)Hyperthermia,Induced/is [Instrumentation] Incidence InflammationsInfusions, Intra-Arterial injuriese$ Interferons/tu [Therapeutic Use] LaparoscopyyaLaser Coagulation LasersLength of Stayion LeucovorinLight CoagulationLiverLiver DiseasesLiver Neoplasmson4/Liver Neoplasms/drug therapy/*secondary/surgery$Liver Neoplasms/pa [Pathology] Liver Neoplasms/th [Therapy]Liver/pa [Pathology]sLungrLung/me [Metabolism]sLung/pa [Pathology]]s Magnetic Resonance ImagingMaler methodseoMicroscopy,Electron]s Microwaves Middle AgelasMonokines/bl [Blood]s Morbidity Necrosist NeedlesNeoplasm Recurrence,LocalNeoplasm Staging NeoplasmsNeoplasms/th [Therapy] NF-kappa B/me [Metabolism]t APalliative Care pathologyPatient Selection Perfusion PrognosisProspective Studies Radiation Radio WavesRatsaRats,Sprague-Dawleybo RecurrenceecuRetrospective StudiesRisk Risk Factors secondary statistics & numerical dataZSupport, Non-U.S. Gov't Support, U.S. Gov't, P.H.S.Support,Non-U.S.Gov't Support,U.S.Gov't,Non-P.H.S.A surgery,N,&Surgical Procedures,Minimally InvasiveSurvival Analysis Survival Rate SyndromeU Temperaturetherapeutic use therapyThrombocytopeniae Time FactorsUTomography,X-Ray ComputedTreatment OutcomeTumor Necrosis Factor(#Tumor Necrosis Factor/an [Analysis]2) UltrasonicsUltrasonography United States  b\Bilchik,A.J. Wood,T.F. Allegra,D. Tsioulias,G.J. Chung,M. Rose,D.M. Ramming,K.P. Morton,D.L. 2000ztCryosurgical ablation and radiofrequency ablation for unresectable hepatic malignant neoplasms: a proposed algorithm Arch.Surg. 1356657-662 6/2000le308 patients: 68 RF (40 RF alone, 14 resection+RF, 9 cryo+RF, 5 resection+cryo+RF), 240 cryo (159 cryo alone, 81 resection+cryo). Approx 30% with additional disease on initial IOUS. Approx 12% with extrahepatic disease on initial laparoscopy. RF group better length of procedure, hospitalization and morbidity than cryo. RF alone was better than cryo alone, local recurrence similar. Multiple lesions (>3): increased blood loss and thrombocytopenia with CSA alone than with RF alone, RF with Cryo, or RF with cryo and resection. Large lesions (>3cm): increased local recurrence with RF, increased # of ablations73 PM:10843361\Vanalysis Catheter Ablation Cryosurgery epidemiology Female Human Laparoscopy Length of Stay Liver Liver Neoplasms Male methods Middle Age Morbidity Neoplasm Recurrence,Local Recurrence Retrospective Studies statistics & numerical data Support,Non-U.S.Gov't surgery Time Factors Treatment Outcome United States Neoplasms blood Thrombocytopenia^WBACKGROUND: Thermal ablation of unresectable hepatic tumors can be achieved by cryosurgical ablation (CSA) or radiofrequency ablation (RFA). The relative advantages and disadvantages of each technique have not yet been determined. HYPOTHESIS: Radiofrequency ablation of malignant hepatic neoplasms can be performed safely, but is currently limited by size. Cryosurgical ablation, while associated with higher morbidity, is more effective for larger unresectable hepatic malignant neoplasms. DESIGN: Retrospective analysis of prospective patient database. PATIENTS AND METHODS: Between July 1992 and September 1999, 308 patients with liver tumors not amenable to curative surgical resection were treated with CSA and/or RFA (percutaneous, laparoscopic, celiotomy). No patient had preoperative evidence of extrahepatic disease. All patients underwent laparoscopy with intraoperative ultrasound if technically possible. Both RFA and CSA were performed under ultrasound guidance. Resection, as an adjunctive procedure, was combined with ablation in certain patients. RESULTS: Laparoscopy identified extrahepatic disease in 12% of patients, and intraoperative hepatic ultrasound identified additional lesions in 33% of patients, despite extensive preoperative imaging. Radiofrequency ablation alone or combined with resection or CSA resulted in reduced blood loss (P<.05), thrombocytopenia (P<.05), and shorter hospital stay compared with CSA alone (P<.05). Median ablation times for lesions greater than 3 cm were 60 minutes with RFA and 15 minutes with CSA (P<.001). Local recurrence rates for lesions greater than 3 cm were also greater with RFA (38% vs 17%). CONCLUSIONS: Laparoscopy and intraoperative ultrasound are essential in staging patients with hepatic malignant neoplasms. Radiofrequency ablation when combined with CSA reduces the morbidity of multiple freezes. Although RFA is safer than CSA and can be performed via different approaches (percutaneously, laparoscopically, or at celiotomy), it is limited by tumor size (<3 cm). Percutaneous RFA should be considered in high-risk patients or those with small local recurrencesUI - 20300347 LA - eng PT - Journal Article DA - 20000726 IS - 0004-0010 SB - AIM SB - IM CY - UNITED STATES JC - 8IA RefMgr field[1]: Journal RefMgr field[8]: Not in FileD=http://archsurg.ama-assn.org/issues/v135n6/rfull/sws9003.html'rlJohn Wayne Cancer Institute at Saint John's Health Center, Santa Monica, Calif 90404, USA. bilchika@jwci.orgZSHepatic cryoablation, but not radiofrequency ablation, results in lung inflammationkyChapman,W.C. Debelak,J.P. Wright,Pinson C. Washington,M.K. Atkinson,J.B. Venkatakrishnan,A. Blackwell,T.S. Christman,J.W.m 2000 5/2000hb*Catheter Ablation *Cryosurgery *Liver/su [Surgery] *Sepsis Syndrome/et [Etiology] 0 (Chemotactic Factors) 0 (macrophage inflammatory protein 2) 0 (Monokines) 0 (NF-kappa B) 0 (Tumor Necrosis Factor) Adult Animal Chemotactic Factors/bl [Blood] Enzyme-Linked Immunosorbent Assay Incidence injuries Liver Liver/pa [Pathology] Lung Lung/me [Metabolism] Lung/pa [Pathology] methods Microscopy,Electron Monokines/bl [Blood] Necrosis NF-kappa B/me [Metabolism] Rats Rats,Sprague-Dawley Support,U.S.Gov't,Non-P.H.S. surgery Syndrome Tumor Necrosis Factor Tumor Necrosis Factor/an [Analysis] United States Inflammation752-761Annals of Surgery 2315$RFA vs. cryo of 35% liver volume in rats. Lung inflammation, NF-kappaB activation after cryo but not RF. EM performed cryo disruption of plasma membrane with leakage of intact organelles into space of Disse, RF intact plasma membrane with completely disrupted intracellular contents. f `OBJECTIVE: To compare the effects of 35% hepatic cryoablation with a similar degree of radiofrequency ablation (RFA) on lung inflammation, nuclear factor kappaB (NF-kappaB) activation, and production of NF-kappaB dependent cytokines. SUMMARY BACKGROUND DATA: Multisystem injury, including acute lung injury, is a severe complication associated with hepatic cryoablation of 30% to 35% or more of liver parenchyma, but this complication has not been reported with RFA. METHODS: Sprague-Dawley rats underwent 35% hepatic cryoablation or RFA and were killed at 1, 2, and 6 hours. Liver and lung tissue were freeze-clamped for measurement of NF-kappaB activation, which was detected by electrophoretic mobility shift assay. Serum concentrations of tumor necrosis factor alpha and macrophage inflammatory protein 2 were measured by enzyme-linked immunosorbent assay. Histologic studies of pulmonary tissue and electron microscopy of ablated liver tissue were compared among treatment groups. RESULTS: Histologic lung sections after cryoablation showed multiple foci of perivenular inflammation, with activated lymphocytes, foamy macrophages, and neutrophils. In animals undergoing RFA, inflammatory foci were not present. NF-kappaB activation was detected at 1 hour in both liver and lung tissue samples of animals undergoing cryoablation but not after RFA, and serum cytokine levels were significantly elevated in cryoablation versus RFA animals. Electron microscopy of cryoablation-treated liver tissue demonstrated disruption of the hepatocyte plasma membrane with extension of intact hepatocyte organelles into the space of Disse; RFA-treated liver tissue demonstrated coagulative destruction of hepatocyte organelles within an intact plasma membrane. To determine the stimulus for systemic inflammation, rats treated with cryoablation had either immediate resection of the ablated segment or delayed resection after a 15-minute thawing interval. Immediate resection of the cryoablated liver tissue prevented NF-kappaB activation and lung injury; however, pulmonary inflammatory changes were present when as little as a 15-minute thaw interval preceded hepatic resection. CONCLUSIONS: Hepatic cryoablation, but not RFA, induces NF-kappaB activation in the nonablated liver and lung and is associated with acute lung injury. Lung inflammation is associated with the thawing phase of cryoablation and may be related to soluble mediator(s) released from the cryoablated tissue. These findings correlate the clinical observation of an increased incidence of multisystem injury, including adult respiratory distress syndrome (ARDS), after cryoablation but not RFADB - MEDLINE UI - 20231477 IN - Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN, USA. will.chapman@surgery.mc.vanderbilt.edu JC - 67s, 67S, 0372354 Journal Subset AIM Journals CP - United States PT - Journal Article LG - English EM - 20000607 Revised: 20001218. Entry Week: 20000607 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 0003-4932,394 PM:10767797hbMinimally invasive treatment of malignant hepatic tumors: at the threshold of a major breakthroughnhDodd,G.D.,III Soulen,M.C. Kane,R.A. Livraghi,T. Lees,W.R. Yamashita,Y. Gillams,A.R. Karahan,O.I. Rhim,H. 2000 1/2000xqadministration & dosage Antineoplastic Agents Chemoembolization,Therapeutic Cryosurgery diagnosis Diathermy Electrocoagulation Ethanol Human Laser Coagulation Liver Neoplasms Magnetic Resonance Imaging methods Microwaves Patient Selection Radiation secondary surgery Surgical Procedures,Minimally Invasive therapeutic use therapy Tomography,X-Ray Computed United StatesUI - 20144973 LA - eng RN - 0 (Antineoplastic Agents) PT - Journal Article PT - Review PT - Review, Tutorial DA - 20000303 IS - 0271-5333 SB - IM CY - UNITED STATES JC - RDG RefMgr field[1]: Journal RefMgr field[8]: Not in File 9-27 Radiographics201,&Review of 6 modalities. Good picturesSix existing minimally invasive techniques for the treatment of primary and secondary malignant hepatic tumors--radio-frequency ablation, microwave ablation, laser ablation, cryoablation, ethanol ablation, and chemoembolization--are reviewed and debated by noted authorities from six institutions from around the world. All of the authors currently believe that surgery remains the treatment of choice for patients with resectable hepatic tumors. However, the clinical results of each of the minimally invasive techniques presented have exceeded those obtained with conventional chemotherapy or radiation therapy. Thus, for nonsurgical patients, these techniques are becoming standard independent or adjuvant therapies. In addition, with continued improvement in technology and increasing clinical experience, one or more of these minimally invasive techniques may soon challenge surgical resection as the treatment of choice for patients with limited hepatic tumorn'hbDepartment of Radiology, University of Texas Health Science Center at San Antonio, 78284-7800, USA507 PM:10682768l RZ41LENonsurgical treatment of hepatocellular carcinoma. [Review] [15 refs]"Llovet,J.M. Sala,M. Bruix,J. 200011/2000e*Carcinoma,Hepatocellular/th [Therapy] *Liver Neoplasms/th [Therapy] 0 (Antineoplastic Agents) 64-17-5 (Ethanol) 9008-11-1 (Interferons) Antineoplastic Agents/tu [Therapeutic Use] Carcinoma,Hepatocellular/pa [Pathology] Catheter Ablation Chemoembolization,Therapeutic Embolization,Therapeutic Ethanol/ad [Administration & Dosage] Gene Therapy Human Interferons/tu [Therapeutic Use] Liver Liver Neoplasms/pa [Pathology] Neoplasm Staging Palliative Care Prognosis Radiation therapy United StatesiSuppl-5eLiver Transplantations6n 6:Suppl 2e.'1. Outcome from nonsurgical treatment is directly related to stage of hepatocellular cancer (HCC) and degree of liver function impairment. 2. Ablative percutaneous procedures, such as alcohol injection or radiofrequency thermal therapy, are most effective in the destruction of solitary tumors of 3 cm or less. 3. In most cases, nonsurgical treatments are not curative, but may slow tumor progression and can provide palliation. 4. Arterial embolization or chemoembolization has an antitumor effect, but it has not been shown to affect patient outcome. 5. Radiation therapy, chemotherapy, hormonal manipulation, and interferon have not been consistently effective in HCC. 6. Ablative procedures, embolization, and systemic chemotherapy should be avoided in patients with advanced cirrhosis. [References: 15]DB - MEDLINE UI - 20538800 IN - Barcelona-Clinic Liver Cancer Group, the Liver Unit, Institut d'Investigacions Biomediques August Pi i Sunyer, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain JC - dk0 Journal Subset Index Medicus CP - United States PT - Journal Article PT - Review PT - Review, Tutorial LG - English EM - 20001222. Entry Week: 20001222 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 1527-6465PJRadiofrequency ablation of hepatic malignancies: is heat better than cold?Mahvi,D.M. Lee,F.T.,Jr. 1999 7/1999d]Cold Comparative Study Cryosurgery Diathermy Heat Human Liver Neoplasms therapy United StatesUI - 99325617 LA - eng PT - Comment PT - Editorial DA - 19990805 IS - 0003-4932 SB - AIM SB - IM CY - UNITED STATES JC - 67S RefMgr field[1]: Journal RefMgr field[8]: Not in File 9-11 Ann.Surg. 2301voCommentary on Curley et al. discuss high local recurrence in other studies, IOUS, Pringle, advantages of cryo.111 PM:10400030VOIntraoperative radiofrequency ablation or cryoablation for hepatic malignanciesm\VPearson,A.S. Izzo,F. Fleming,R.Y. Ellis,L.M. Delrio,P. Roh,M.S. Granchi,J. Curley,S.A. 199912/1999HBAlgorithms Carcinoma,Hepatocellular Catheter Ablation Clinical Trials Comparative Study complications Cryosurgery epidemiology Female Heat Human Liver Liver Neoplasms Male methods Middle Age Morbidity Necrosis Needles Neoplasm Recurrence,Local Prospective Studies Recurrence secondary surgery Ultrasonography United StatesUI - 20134339 LA - eng PT - Journal Article DA - 20000307 IS - 0002-9610 SB - AIM SB - IM CY - UNITED STATES JC - 3Z4 RefMgr field[1]: Journal RefMgr field[8]: Not in File592-599 Am.J.Surg. 1786SNonrandomized, median FU 15mos. Cryo: 88 tumors in 54 patients, 40% complication rate, 13.6% local recurrence. Intraop RF (LaVeen electrode): 138 tumors in 92 patients, 3.3% complication rate, 2.2% local recurrence.BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into two consecutive prospective, nonrandomized trials. The liver tumors were treated intraoperatively with cryoablation or RFA; intraoperative ultrasonography was used to guide placement of cryoprobes or RFA needles. All patients were followed up postoperatively to assess complications, treatment response, and local recurrence of malignant disease. RESULTS: Cryoablation was performed on 88 tumors in 54 patients, and RFA was used to treat 138 tumors in 92 patients. Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation (40.7% complication rate). In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). CONCLUSIONS: RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA'jdDepartment of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA88 PM:10670879 1039458843 1999^WSurgical treatment and other regional treatments for colorectal cancer liver metastases197-208LEThe liver is the most common site of distant metastasis from colorectal cancer. About one-fourth of patients with liver metastases from colorectal cancer have no other sites of metastasis and can be treated with regional therapies directed toward their liver tumors. Surgical resection of colorectal cancer liver metastases can result in a 24%-38% five-year survival, but only a minority of patients are candidates for resection. Other regional therapies such as cryosurgery, radiofrequency ablation, and hepatic intra-arterial chemotherapy may be offered to patients with unresectable but isolated liver metastases. The efficacy of these treatments is still being determined. For most patients with spread of metastatic colorectal cancer beyond the liver, systemic chemotherapy rather than regional therapy is a more appropriate option.'PIDepartment of Surgery, Massachusetts General Hospital, Boston 02114, USA. Yoon, S. S. Tanabe, K. K.811083-7159 Journal Article Review Review, Tutorial OncologistAntineoplastic Agents/administration & dosage Colorectal Neoplasms/*pathology Cryosurgery Human Infusions, Intra-Arterial Liver Neoplasms/drug therapy/*secondary/surgery Radio Waves Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Survival Analysislehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=10394588a&Liver tumor ablation techniques@:Scudamore,C.H. Patterson,E.J. Shapiro,A.M. Buczkowski,A.K. 1997 7/1997adverse effects blood blood supply Clinical Trials Cryosurgery Ethanol Heat Human Light Coagulation Liver Liver Neoplasms Necrosis secondary surgery therapy United StatesUI - 97429683 LA - eng PT - Journal Article PT - Review PT - Review, Tutorial DA - 19971009 IS - 0894-1939 SB - IM CY - UNITED STATES JC - AZA RefMgr field[1]: Journal RefMgr field[8]: Not in File157-164tJ.Invest Surg.104 ReviewDespite advances in surgical technique, patients with primary and secondary liver tumors remain a difficult management problem, as most tumors are unresectable at presentation. Alternative therapies, involving the in situ destruction of liver tumors, have recently come under scrutiny as palliative options. Percutaneous ethanol injection and cryosurgery have been advocated, but both have associated technical difficulties and adverse effects. Novel liver tumor ablation techniques have recently been developed that work via the induction of localized hyperthermia. There is mounting evidence to support a hypothesis that cancer cells are more selectively sensitive to heat than are normal cells, due to the poor blood supply of neoplastic tissue and the decreased vasodilatation capacity of the neovascular bed. These ablative modalities induce a variable degree of tumor necrosis in unresectable tumors, and therefore may provide useful palliation. Clinical trials are needed to determine the true nature and degree of any palliative benefit. In addition, the determinants of treatment efficacy and the predictability of the necrotic zone must be better understood before these techniques can be contemplated as alternatives to liver resection for cure'hbSection of Hepatobiliary and Pancreatic Surgery, University of British Columbia, Vancouver, Canada122 PM:928399960Skinner,M.G. Iizuka,M.N. Kolios,M.C. Sherar,M.D. 1998tmA theoretical comparison of energy sources--microwave, ultrasound and laser--for interstitial thermal therapy$Physics in Medicine & Biologyr4312 3535-3547912/1998dJDBioheat equation with laser, US, and MW (1gHz) in different tissues. 268iHB*Brain *Breast *Computer Simulation *Hyperthermia,Induced *Liver Biophysics Brain Neoplasms/th [Therapy] Breast Neoplasms/th [Therapy] Human Hyperthermia,Induced/is [Instrumentation] Lasers Liver Liver Neoplasms/th [Therapy] Microwaves Neoplasms/th [Therapy] Perfusion Support,Non-U.S.Gov't Temperature therapy UltrasonicsA number of heating sources are available for minimally invasive thermal therapy of tumours. The purpose of this work was to compare, theoretically, the heating characteristics of interstitial microwave, laser and ultrasound sources in three tissue sites: breast, brain and liver. Using a numerical method, the heating patterns, temperature profiles and expected volumes of thermal damage were calculated during standard treatment times with the condition that tissue temperatures were not permitted to rise above 100 degrees C (to ensure tissue vaporization did not occur). Ideal spherical and cylindrical applicators (200 microm and 800 microm radii respectively) were modelled for each energy source to demonstrate the relative importance of geometry and energy attenuation in determining heating and thermal damage profiles. The theoretical model included the effects of the collapse of perfusion due to heating. Heating patterns were less dependent on the energy source when small spherical applicators were modelled than for larger cylindrical applicators due to the very rapid geometrical decrease in energy with distance for the spherical applicators. For larger cylindrical applicators, the energy source was of greater importance. In this case, the energy source with the lowest attenuation coefficient was predicted to produce the largest volume of thermally coagulated tissue, in each tissue sitezDB - MEDLINE UI - 99084375 IN - Ontario Cancer Institute/Princess Margaret Hospital, Department of Medical Biophysics, University of Toronto, Canada JC - p6j, 0401220 Journal Subset Index Medicus CP - England PT - Journal Article LG - English EM - 19990303 Revised: 20001218. Entry Week: 19990303 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 0031-9155 @  ; Skinner,M.G. Iizuka,M.N. Kolios,M.C. Sherar,M.D. 1998tmA theoretical comparison of energy sources--microwave, ultrasound and laser--for interstitial thermal therapy$Physics in Medicine & Biologyr4312 3535-3547912/1998dJDBioheat equation with laser, US, and MW (1gHz) in different tissues.  540,Transvenous cold mapping and cryoablation of the AV node in dogs: observations of chronic lesions and comparison to those obtained using radiofrequency ablationtnRodriguez,L.M. Leunissen,J. Hoekstra,A. Korteling,B.J. Smeets,J.L. Timmermans,C. Vos,M. Daemen,M. Wellens,H.J. 199810/1998e*Atrioventricular Node/su [Surgery] *Cryosurgery *Electrophysiology/mt [Methods] *Heart Block/di [Diagnosis] Animal Atrioventricular Node/pa [Pathology] Atrioventricular Node/pp [Physiopathology] Catheter Ablation Cold Comparative Study Cryosurgery/is [Instrumentation] Disease Models,Animal Dogs Feasibility Studies Female Femoral Vein Heart Block/pa [Pathology] Heart Block/su [Surgery] Inflammation Male methods Temperature United States 1055-10612+Journal of Cardiovascular Electrophysiology910Cryo: homogeneous dense fibrous tissue without viable myocytes. RF: inhomogeneous dense fibrous tissue with strands of viable myocardium X RINTRODUCTION: Radiofrequency (RF) is the most commonly used energy source for the treatment of cardiac arrhythmias. Surgical experience has shown that cryoablation also is effective for ablating arrhythmias. The aims of this study were to (1) investigate the feasibility of inducing permanent complete AV block (CAVB), (2) investigate the value of cold mapping to select the cryoablation site to produce permanent CAVB, (3) study the macro- and microscopic lesion characteristics 6 weeks later, and (4) compare them to those produced with RF energy. METHODS AND RESULTS: A new steerable 8.5-French bipolar electrode catheter having a thermocouple with a 3-mm tip using N2O as the refrigerant controlled by a cryoconsole was used. Six mongrel dogs were anesthetized, and the catheter was positioned via the femoral vein across the tricuspid valve to record a large low right atrial and a small His-bundle potential. After cold mapping (-15 degrees to -20 degrees C tip temperature) resulted in ECG modifications, cryothermia (-70 degrees C) was given twice, lasting 5 minutes each, to create permanent CAVB (Cryo group). Additionally, RF catheter ablation of the AV node was performed in two anesthetized mongrel dogs (RF group). In the Cryo group, a permanent proximal CAVB was created in four dogs (block occurred within 10 to 20 sec of cryothermia). Permanent right bundle branch block was obtained in one dog and transient CAVB in the remaining dog. In both dogs of the RF group, permanent CAVB was obtained. The cryolesions consisted of well-circumscribed, homogeneous areas of fibrotic tissue without viable cardiomyocytes. Lesions produced with RF were less circumscribed and inhomogeneous, with clear evidence of viable cardiomyocytes and cartilage formation (patchy lesions). CONCLUSIONS: (1) Permanent CAVB can be created by using a steerable cryoablation catheter. (2) Histologically, cryoablated sites were homogeneous and showed fibrotic tissue without signs of chronic inflammation and no evidence of viable myocytes. (3) Lesions created with RF were less homogenous and still contained viable myocytes within the lesion and cartilage formation. (4) The arrhythmogenic significance of these differences requires further study. (5) The technology of using reversible cold mapping has the potential to identify the successful ablation site and warrants further clinical studyvpDB - MEDLINE UI - 99032495 IN - Department of Cardiology, Academic Hospital, Maastricht, The Netherlands. lm.rodriguez@cardio.azm.nl JC - by4, 9010756 Journal Subset Index Medicus CP - United States PT - Journal Article LG - English EM - 19990122 Revised: 20001218. Entry Week: 19990122 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 1045-3873 &Liver tumor ablation techniques@:Scudamore,C.H. Patterson,E.J. Shapiro,A.M. Buczkowski,A.K. 1997 7/1997adverse effects blood blood supply Clinical Trials Cryosurgery Ethanol Heat Human Light Coagulation Liver Liver Neoplasms Necrosis secondary surgery therapy United StatesUI - 97429683 LA - eng PT - Journal Article PT - Review PT - Review, Tutorial DA - 19971009 IS - 0894-1939 SB - IM CY - UNITED STATES JC - AZA RefMgr field[1]: Journal RefMgr field[8]: Not in File157-164tJ.Invest Surg.104 ReviewDespite advances in surgical technique, patients with primary and secondary liver tumors remain a difficult management problem, as most tumors are unresectable at presentation. Alternative therapies, involving the in situ destruction of liver tumors, have recently come under scrutiny as palliative options. Percutaneous ethanol injection and cryosurgery have been advocated, but both have associated technical difficulties and adverse effects. Novel liver tumor ablation techniques have recently been developed that work via the induction of localized hyperthermia. There is mounting evidence to support a hypothesis that cancer cells are more selectively sensitive to heat than are normal cells, due to the poor blood supply of neoplastic tissue and the decreased vasodilatation capacity of the neovascular bed. These ablative modalities induce a variable degree of tumor necrosis in unresectable tumors, and therefore may provide useful palliation. Clinical trials are needed to determine the true nature and degree of any palliative benefit. In addition, the determinants of treatment efficacy and the predictability of the necrotic zone must be better understood before these techniques can be contemplated as alternatives to liver resection for cure'hbSection of Hepatobiliary and Pancreatic Surgery, University of British Columbia, Vancouver, Canada122 PM:928399960Skinner,M.G. Iizuka,M.N. Kolios,M.C. Sherar,M.D. 1998tmA theoretical comparison of energy sources--microwave, ultrasound and laser--for interstitial thermal therapy$Physics in Medicine & Biologyr4312 3535-3547912/1998dJDBioheat equation with laser, US, and MW (1gHz) in different tissues. 268iHB*Brain *Breast *Computer Simulation *Hyperthermia,Induced *Liver Biophysics Brain Neoplasms/th [Therapy] Breast Neoplasms/th [Therapy] Human Hyperthermia,Induced/is [Instrumentation] Lasers Liver Liver Neoplasms/th [Therapy] Microwaves Neoplasms/th [Therapy] Perfusion Support,Non-U.S.Gov't Temperature therapy UltrasonicsA number of heating sources are available for minimally invasive thermal therapy of tumours. The purpose of this work was to compare, theoretically, the heating characteristics of interstitial microwave, laser and ultrasound sources in three tissue sites: breast, brain and liver. Using a numerical method, the heating patterns, temperature profiles and expected volumes of thermal damage were calculated during standard treatment times with the condition that tissue temperatures were not permitted to rise above 100 degrees C (to ensure tissue vaporization did not occur). Ideal spherical and cylindrical applicators (200 microm and 800 microm radii respectively) were modelled for each energy source to demonstrate the relative importance of geometry and energy attenuation in determining heating and thermal damage profiles. The theoretical model included the effects of the collapse of perfusion due to heating. Heating patterns were less dependent on the energy source when small spherical applicators were modelled than for larger cylindrical applicators due to the very rapid geometrical decrease in energy with distance for the spherical applicators. For larger cylindrical applicators, the energy source was of greater importance. In this case, the energy source with the lowest attenuation coefficient was predicted to produce the largest volume of thermally coagulated tissue, in each tissue sitezDB - MEDLINE UI - 99084375 IN - Ontario Cancer Institute/Princess Margaret Hospital, Department of Medical Biophysics, University of Toronto, Canada JC - p6j, 0401220 Journal Subset Index Medicus CP - England PT - Journal Article LG - English EM - 19990303 Revised: 20001218. Entry Week: 19990303 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 0031-9155VPMultidisciplinary management of metastatic colorectal cancer. [Review] [94 refs]Yoon,S.S. Tanabe,K.K. 199811/1998ry*Colorectal Neoplasms/pa [Pathology] *Liver Neoplasms/sc [Secondary] *Liver Neoplasms/th [Therapy] *Lung Neoplasms/sc [Secondary] *Lung Neoplasms/th [Therapy] 0 (Antineoplastic Agents) Antineoplastic Agents/tu [Therapeutic Use] Colorectal Neoplasms/mo [Mortality] Colorectal Neoplasms/th [Therapy] Cryosurgery Human Leucovorin Liver Lung Radiation surgery Survival Rate therapy197-207Surgical Oncology7 3-4vYGood review of incidence and diagnosis of colorectal metastases, treatment, and survival.D>When colorectal cancer metastasizes to distant organs, usually multiple sites are involved and treatment consists primarily of systemic chemotherapy and supportive care. Chemotherapeutic agents effective against metastatic colorectal cancer include 5-fluorouracil, often used in combination with leucovorin or methotrexate, and irinotecan (CPT-11). Median survival with optimal chemotherapy regimens ranges from 10 to 15 months. Less frequently, colorectal cancer metastasizes only to the liver or lung. In a minority of these cases, surgical resection can be performed and results in a median survival of 28-46 months for hepatic resections and 24-25 months for pulmonary resections. Five-year survival rates range from 24 to 38% and 21 to 44% for hepatic and pulmonary resections, respectively. For isolated liver metastases that are not surgically resectable, other regional therapies that can be considered are hepatic cryosurgery, radiofrequency ablation, and hepatic arterial infusion chemotherapy. Median survival following cryosurgery is between 26 and 30 months, while median survival following radiofrequency ablation has not been established in large series. Hepatic arterial infusion chemotherapy, especially with newer combination drug regimens, may increase survival in patients with isolated liver metastases compared to systemic chemotherapy, but this must be confirmed in randomized, prospective trials. Colorectal cancer metastases to the brain can be treated with radiation therapy or surgical resection, but median survival with treatment is less than one year. [References: 94]yDB - MEDLINE UI - 20140340 IN - Department of Surgery, Massachusetts General Hospital, Boston 02114, USA JC - byv, BYV, 9208188 Journal Subset Index Medicus CP - Netherlands PT - Journal Article PT - Review PT - Review, Academic LG - English EM - 20000302 Revised: 20001218. Entry Week: 20000302 RefMgr field[1]: Journal RefMgr field[8]: Not in File RefMgr field[26]: 0960-7404,264 PM:10677170