Advertisement

CardioVascular and Interventional Radiology

, Volume 36, Issue 3, pp 773–782 | Cite as

Superselective Particle Embolization Enhances Efficacy of Radiofrequency Ablation: Effects of Particle Size and Sequence of Action

  • Toshihiro Tanaka
  • Peter Isfort
  • Till Braunschweig
  • Saskia Westphal
  • Anna Woitok
  • Tobias Penzkofer
  • Philipp Bruners
  • Kimihiko Kichikawa
  • Thomas Schmitz-Rode
  • Andreas H. Mahnken
Laboratory Investigation

Abstract

Purpose

To evaluate the effects of particle size and course of action of superselective bland transcatheter arterial embolization (TAE) on the efficacy of radiofrequency ablation (RFA).

Methods

Twenty pigs were divided into five groups: group 1a, 40-μm bland TAE before RFA; group 1b, 40-μm bland TAE after RFA; group 2a, 250-μm bland TAE before RFA; group 2b, 250-μm bland TAE after RFA and group 3, RFA alone. A total of 40 treatments were performed with a combined CT and angiography system. The sizes of the treated zones were measured from contrast-enhanced CTs on days 1 and 28. Animals were humanely killed, and the treated zones were examined pathologically.

Results

There were no complications during procedures and follow-up. The short-axis diameter of the ablation zone in group 1a (mean ± standard deviation, 3.19 ± 0.39 cm) was significantly larger than in group 1b (2.44 ± 0.52 cm; P = 0.021), group 2a (2.51 ± 0.32 cm; P = 0.048), group 2b (2.19 ± 0.44 cm; P = 0.02), and group 3 (1.91 ± 0.55 cm; P < 0.001). The greatest volume of ablation was achieved by performing embolization with 40-μm particles before RFA (group 1a; 20.97 ± 9.65 cm3). At histology, 40-μm microspheres were observed to occlude smaller and more distal arteries than 250-μm microspheres.

Conclusion

Bland TAE is more effective before RFA than postablation embolization. The use of very small 40-μm microspheres enhances the efficacy of RFA more than the use of larger particles.

Keywords

Embolization Experimental interventional radiology Interventional oncology Radiofrequency ablation 

Notes

Acknowledgments

The authors acknowledge the advice of Marian Pahud (Valkenburg, The Netherlands).

Conflict of interest

This study was sponsored in parts by CeloNova Bio-Sciences, San Antonio, TX, USA. This work was among the 10 % best-rated scientific papers at CIRSE 2012, and we were invited to submit it here. The authors declare that they have no conflict of interest.

References

  1. 1.
    Goldberg SN, Hahn PF, Tanabe KK et al (1998) Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9:101–111PubMedCrossRefGoogle Scholar
  2. 2.
    Bleicher RJ, Allegra DP, Nora DT et al (2003) Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned. Ann Surg Oncol 10:52–58PubMedCrossRefGoogle Scholar
  3. 3.
    Mostafa EM, Ganguli S, Faintuch S et al (2008) Optimal strategies for combining transcatheter arterial chemoembolization and radiofrequency ablation in rabbit VX2 hepatic tumors. J Vasc Interv Radiol 19:1740–1748PubMedCrossRefGoogle Scholar
  4. 4.
    Nakai M, Sato M, Sahara S et al (2007) Radiofrequency ablation in a porcine liver model: effects of transcatheter arterial embolization with iodized oil on ablation time, maximum output, and coagulation diameter as well as angiographic characteristics. World J Gastroenterol 13:2841–2845PubMedGoogle Scholar
  5. 5.
    Yamakado K, Nakatsuka A, Takaki H et al (2008) Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology 247:260–266PubMedCrossRefGoogle Scholar
  6. 6.
    Kagawa T, Koizumi J, Kojima S, et al; Tokai RFA Study Group (2010) Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma: comparison with surgical resection Cancer 116:3638–3644Google Scholar
  7. 7.
    Shibata T, Isoda H, Hirokawa Y et al (2009) Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 252:905–913PubMedCrossRefGoogle Scholar
  8. 8.
    Kim JH, Yoon HK, Ko GY et al (2010) Nonresectable combined hepatocellular carcinoma and cholangiocarcinoma: analysis of the response and prognostic factors after transcatheter arterial chemoembolization. Radiology 255:270–277PubMedCrossRefGoogle Scholar
  9. 9.
    Lencioni R, Crocetti L, Petruzzi P et al (2008) Doxorubicin-eluting bead–enhanced radiofrequency ablation of hepatocellular carcinoma: a pilot clinical study. J Hepatol 49:217–222PubMedCrossRefGoogle Scholar
  10. 10.
    Stampfl S, Bellemann N, Stampfl U et al (2009) Arterial distribution characteristics of Embozene particles and comparison with other spherical embolic agents in the porcine acute embolization model. J Vasc Interv Radiol 20:1597–1607PubMedCrossRefGoogle Scholar
  11. 11.
    Bonomo G, Pedicini V, Monfardini L et al (2010) Bland embolization in patients with unresectable hepatocellular carcinoma using precise, tightly size-calibrated, anti-inflammatory microparticles: first clinical experience and one-year follow-up. Cardiovasc Intervent Radiol 33:552–559PubMedCrossRefGoogle Scholar
  12. 12.
    Goldberg SN, Grassi CJ, Cardella JF et al (2005) Society of Interventional Radiology Technology Assessment Committee. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 16:765–778PubMedCrossRefGoogle Scholar
  13. 13.
    Morimoto M, Numata K, Nozawa A et al (2010) Radiofrequency ablation of the liver: extended effect of transcatheter arterial embolization with iodized oil and gelatin sponge on histopathologic changes during follow-up in a pig model. J Vasc Interv Radiol 21:1716–1724PubMedCrossRefGoogle Scholar
  14. 14.
    Sugimori K, Nozawa A, Morimoto M et al (2005) Extension of radiofrequency ablation of the liver by transcatheter arterial embolization with iodized oil and gelatin sponge: results in a pig model. J Vasc Interv Radiol 16:849–856PubMedCrossRefGoogle Scholar
  15. 15.
    Iwamoto T, Kawai N, Sato M et al (2008) Effectiveness of hepatic arterial embolization on radiofrequency ablation volume in a swine model: relationship to portal venous flow and liver parenchymal pressure. J Vasc Interv Radiol 19:1646–1651PubMedCrossRefGoogle Scholar
  16. 16.
    Bonomo G, Della Vigna P Monfardini L et al (2012) Combined therapies for the treatment of technically unresectable liver malignancies: bland embolization and radiofrequency thermal ablation within the same session. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-012-0341-0
  17. 17.
    Brown KT (2004) Fatal pulmonary complications after arterial embolization with 40–120-μm Tris–acryl gelatin microspheres. J Vasc Interv Radiol 15:197–200PubMedCrossRefGoogle Scholar
  18. 18.
    Toyoda H, Kumada T, Sone Y (2009) Impact of a unified CT angiography system on outcome of patients with hepatocellular carcinoma. AJR Am J Roentgenol 192:766–774PubMedCrossRefGoogle Scholar
  19. 19.
    Park IJ, Kim HC, Yu CS et al (2008) Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol 15:227–232PubMedCrossRefGoogle Scholar
  20. 20.
    Aloia TA, Vauthey JN, Loyer EM et al (2006) Solitary colorectal liver metastasis: resection determines outcome. Arch Surg 141:460–466PubMedCrossRefGoogle Scholar
  21. 21.
    Yoon HM, Kim JH, Shin YM et al (2012) Percutaneous radiofrequency ablation using internally cooled wet electrodes for treatment of colorectal liver metastases. Clin Radiol 67:122–127PubMedCrossRefGoogle Scholar
  22. 22.
    de Baere T, Elias D, Dromain C et al (2000) Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 year. Am J Roentgenol 175:1619–1625CrossRefGoogle Scholar
  23. 23.
    Crocetti L, de Baere T, Lencioni R (2010) Quality improvement guidelines for radiofrequency ablation of liver tumors. Cardiovasc Intervent Radiol 33:11–17PubMedCrossRefGoogle Scholar
  24. 24.
    de Baere T, Deschamps F (2011) Arterial therapies of colorectal cancer metastases to the liver. Abdom Imaging 36:661–670PubMedCrossRefGoogle Scholar
  25. 25.
    Guiu B, Deschamps F, Aho S et al (2012) Liver/biliary injuries following chemoembolisation of endocrine tumours and hepatocellular carcinoma: lipiodol vs drug-eluting beads. J Hepatol 56:609–617PubMedCrossRefGoogle Scholar
  26. 26.
    Lewis AL, Taylor RR, Hall B et al (2006) Pharmacokinetic and safety study of doxorubicin-eluting beads in a porcine model of hepatic arterial embolization. J Vasc Interv Radiol 17:1335–1343PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2012

Authors and Affiliations

  • Toshihiro Tanaka
    • 1
    • 2
  • Peter Isfort
    • 2
    • 3
  • Till Braunschweig
    • 4
  • Saskia Westphal
    • 4
  • Anna Woitok
    • 5
  • Tobias Penzkofer
    • 2
    • 3
  • Philipp Bruners
    • 2
    • 3
  • Kimihiko Kichikawa
    • 1
  • Thomas Schmitz-Rode
    • 2
  • Andreas H. Mahnken
    • 2
    • 3
  1. 1.Department of RadiologyNara Medical UniversityKashiharaJapan
  2. 2.Applied Medical Engineering, Helmholtz-Institute AachenRWTH Aachen UniversityAachenGermany
  3. 3.Department of Diagnostic and Interventional Radiology, Aachen University HospitalRWTH Aachen UniversityAachenGermany
  4. 4.Department of Pathology, Aachen University HospitalRWTH Aachen UniversityAachenGermany
  5. 5.Institute for Laboratory Animal ScienceRWTH Aachen UniversityAachenGermany

Personalised recommendations