International Journal of Hyperthermia最新文献

Purpose: To assess the impact of Hashimoto's thyroiditis (HT) on radiofrequency ablation (RFA) outcomes for papillary thyroid microcarcinoma (PTMC).

Methods: A retrospective study of 391 PTMC patients treated with RFA from March 2017 to August 2020, divided by HT accompanied or not. Ablation area size, volume reduction ratio (VRR), lesion disappearance, complications, and recurrences were analyzed.

Results: 391 patients (mean age, 41.3 ± 11.2 [SD]; 317 women, 110 with HT) were evaluated. The follow-up time was 2 years. HT+ PTMC patients (Group A) exhibited larger ablation diameters at 1st and 3rd month post-RFA. In comparison, PTMC patients (Group B) had larger diameters at 1st and 3rd months but smaller at 6th months, returning to baseline around 6th month in Group B and 9th month in Group A. VRRs in Group B were greater than Group A at 3rd, 6th, 9th, 12th and 15th month, all p < 0.05). The Kaplan-Meier curves revealed a slower lesion disappearance rate in A (12th) compared to B group (9th). Complication and recurrence rates were similar for both groups (4.4% and 0.8% overall, Group B vs Group A: 4.3% vs 4.6%, p = 0.905; 0.4% vs 1.8%, p = 0.192).

Conclusion: HT delays the resorption of PTMC lesions following RFA, but it does not impact the procedure's effectiveness or safety. Regardless of HT status, RFA remains a viable alternative to surgery for PTMC.

Objective: Surgery and thermal ablation are both viable treatment modalities for patients diagnosed with hyperparathyroidism (HPT). However, the comparative efficacy of these approaches remains uncertain. The objective of this meta-analysis is to evaluate the effectiveness of surgical complications and therapeutic strategies in managing HPT.

Methods: The databases PubMed, EMBASE, the Cochrane Library, the Web of Science, CNKI and Wan Fang were systematically searched from inception to December 12, 2023 to identify relevant studies comparing thermal ablation with surgical parathyroid hormone therapy. Data analysis was conducted using Review Manager Version 5.4.

Result: A total of 15 studies were incorporated into the meta-analysis, comprising 1,115 participants drawn from 12 cohort studies and three randomized controlled trials. The results indicated no significant difference in parathyroid hormone levels between the two treatment options (mean difference: 29.25, 95% CI: -4.99-63.69, p = 0.09), calcium (MD: 0.00, 95%CI: 0.07-0.08, p = 0.94), phosphorus (MD: -0.05, 95% CI: -0.13-0.04, p = 0.28) and the risk of persistence and/or recurrence (OR: 1.01, 95% CI: 0.63-1.62, p = 0.97). The probability of hoarseness (OR: 0.57, 95% CI: 0.35-0.93, p = 0.02) and hypocalcemia (OR: -0.12, 95% CI: -0.19- -0.05, p < 0.01) was lower after thermal ablation than with surgery. Comparable results were observed in instances of secondary and primary hyperparathyroidism.

Conclusion: It can be concluded that surgery and thermal ablation are effective modalities for treating hyperparathyroidism. Thermal ablation has been shown to reduce the likelihood of hoarseness and hypocalcemia. Further validation of these results necessitates conducting comprehensive multicenter randomized controlled trials.

Background: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown survival benefits in select patients with peritoneal metastases (PM) from colorectal cancer (CRC). Molecular alterations, particularly RAS/BRAF mutations and Microsatellite Instability (MSI), play crucial roles in prognostic stratification and treatment planning, influencing both disease-free survival (DFS) and overall survival (OS). This scoping review evaluates the prognostic role of MSI and RAS/BRAF mutations in patients with PM-CRC treated with CRS-HIPEC.

Design: A literature search was conducted across several databases to identify papers published between 2000 and September 2024. We selected 18 publications that considered DFS and OS as primary or secondary outcomes in patients with RAS/BRAF mutations and MSI following CRS-HIPEC treatment. Studies involving appendiceal cancer, peritoneal disease from non-CRC, pediatric patients, or subjects not treated with CRS-HIPEC were excluded.

Results: Most studies suggest that RAS and BRAF mutations have a negative influence on survival outcomes. While inconsistencies exist, RAS mutations are generally associated with worse DFS. Specific KRAS subtypes such as KRASMUT2 or KRAS G12V and the BRAF V600 variant correlate with poorer prognosis. MSI status appears to attenuate the adverse effects of RAS/BRAF mutations on survival, although conflicting data persist.

Conclusion: RAS and BRAF mutations correlate with poorer outcomes in PM-CRC, underscoring the need for mutation-informed strategies to refine HIPEC and systemic therapies. Recognizing subtypes may improve patient selection for CRS-HIPEC, optimizing both local disease control and long-term survival. Future research should incorporate these molecular profiles to enhance therapeutic decision-making and better address this challenging condition.

Objective: To develop and validate a nomogram for predicting the effectiveness of high-intensity focused ultrasound (HIFU) ablation for uterine fibroids based on oxytocin experiments combined with sonographic features.

Methods: Sixty patients with uterine fibroids treated with HIFU combined with oxytocin for uterine fibroids were retrospectively analyzed. Before HIFU treatment, all patients underwent abdominal ultrasonography and oxytocin testing for classification. Predictive factors were selected through univariate and multivariate logistic regression analyses. A predictive model for the clinical efficacy of HIFU treatment of uterine fibroids was established using the R language. The model was visualized by a nomogram, and its discriminative ability, calibration, and clinical value were evaluated.

Results: Types of myomas, classification of blood flow around the myomas, location of the myomas, and classification of oxytocin were selected as the final predictive factors to construct the model. The calibration curve of the nomogram demonstrated good consistency between actual observations and nomogram predictions, with an absolute error of 0.066. The model's discriminative ability was evaluated by the area under the curve, which was 0.887 (95% CI: 0.818-0.955). The sensitivity and specificity were 84.4% and 78.8%, respectively, indicating that the model had a good predictive value for the ablation situation. Decision curve analysis showed that the model had high clinical applicability, with the maximum net benefit threshold probability interval ranging from 12.0% to 80.5%.

Conclusion: The prediction model for HIFU treatment of uterine fibroids, based on ultrasound characteristics and oxytocin test, shows strong predictive ability and may help clinicians choose suitable patients for treatment.

Background/objective: The optimal strategy for patients with colorectal liver metastases is still controversially discussed. This study aimed to evaluate the efficacy of radiofrequency ablation (RFA) combined with systemic chemotherapy plus targeted therapy as first-line treatment in patients with initially unresectable colorectal liver metastases (CRLM), to identify prognostic factors and construct nomograms predicting survival.

Methods: This retrospective study included patients with initially unresectable CRLM treated with (study group n = 74) or without (control group n = 83) RFA at the National Cancer Center from January 2018 to January 2021. Survival curves were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were used to determine prognostic factors and include these factors in the nomograms to predict progression-free survival (PFS) and overall survival (OS).

Results: The study group had significantly better median PFS (17.16 months vs. 8.35 months, p < 0.01) and OS (34.9 months vs. 21.1 months, p < 0.01) than the control group after propensity score matching. Cox regression analyses identified RFA treatment and clinical risk score (CRS) as independent prognostic factors for PFS. The largest diameter of liver metastases, RFA treatment, and CRS were independent prognostic factors for OS. Based on this finding, nomograms with good discrimination and calibration were constructed.

Conclusion: RFA combined with systemic chemotherapy plus targeted therapy as first-line treatment could significantly prolong PFS and OS in patients with initially unresectable CRLM compared with systemic chemotherapy plus targeted therapy. The nomograms predicting PFS and OS might help clinicians select personalized treatment.

Background: Increased intratumoral pressure and stiffening of the extracellular matrix are biophysical barriers to effective drug delivery in hepatocellular carcinoma (HCC). Local thermal interventions alter these biophysical characteristics of the tumor.

Purpose: To characterize time-dependent and thermal dose-related effects of radiofrequency hyperthermic (RFHT) interventions on intratumoral pressure and tumor stiffness.

Methods: Two treatment protocols (high input power > 1 W and low input power < 1 W) were investigated using a computational modeling approach and a syngeneic rat HCC tumor model with a customized monopolar RFHT system. Intratumoral pressure and stiffness were assessed using piezo-electric sensors and ultrasound shear wave elastography (SWE), respectively, across three groups (untreated tumors, tumors treated with high and low RFHT) and time points (immediately after treatment, at 24 h, and 48 h).

Results: The developed RFHT system maintained electrode-tip temperatures of 74.1 ± 5.2 °C (high RFHT) and 45.9 ± 1.6 °C (low RFHT) for 15 min. Histological analysis confirmed larger necrotic areas in the high RFHT group compared with low RFHT (p < 0.01) and control groups (p < 0.001). The initial intratumoral hypertension significantly decreased in both treated groups at 24 h and 48 h (p < 0.01 high RFHT, p < 0.05 low RFHT). Tumor stiffness significantly decreased (p < 0.05) only in the low RFHT group at the end of treatment. This change was spatially-dependent within the tumor and a recovery toward initial conditions was observed at 48 h (p < 0.01).

Conclusions: Local RFHT induces time- and heating profile-dependent alterations in intratumoral pressure and stiffness in a rat model of HCC, suggesting that RFHT interventions may modulate tumor biophysics and influence drug delivery.

Objectives: This study aimed to assess the efficacy and safety of radiofrequency ablation (RFA) for multifocal papillary thyroid carcinoma (M-PTC) and compare these outcomes with those for unifocal papillary thyroid carcinoma (U-PTC).

Methods: This retrospective multicenter study included 465 patients (367 women and 98 men) who underwent RFA for either U-PTC (411 patients) or M-PTC (54 patients) between May 2015 and October 2022. Patients were followed up at 1, 3, 6, and 12 months post-RFA, then every 6 months in the second year, and annually thereafter. After 1:1 propensity score matching (PSM), local tumor progression rate (LTP), tumor volume, volume reduction rate (VRR), tumor complete response rate (CDR), and complications were evaluated and compared between the M-PTC and U-PTC groups during the follow-up period.

Results: The median follow-up time was 23 months. The median follow-up time for the U-PTC and M-PTC groups was 23 months and 23.5 months, respectively. The overall local tumor progression rate was 0.9% (4/465), and the overall complication rate was 0.6% (3/465). After PSM, no significant differences were observed between the U-PTC and M-PTC groups regarding tumor volume (p = 0.377), VRR (p = 0.151), CDR (50% vs. 44.2%, p = 0.556), or LTP (1.9% vs. 0%, p = 0.556). Additionally, the complication rates were not significantly different between the groups (1.03% vs. 2.5%, p = 0.343).

Conclusion: After adequate preoperative evaluation, RFA is an effective and safe treatment for appropriately selected patients with M-PTC, with a prognosis similar to that of U-PTC.

Clinical magnetic nanoparticle hyperthermia therapy (MNHT) requires controlled energy deposition to achieve a prescribed tumor thermal dose. The objective of this work is to design a thermal dose feedback control to deliver prescribed Cumulative Equivalent Minutes at 43 [°C] (CEM43) based on values at selected tumor boundary points. Constraints were imposed to maintain the maximum treatment temperature below 60 [°C] and the tumor boundary at ∼ 43 [°C]. The controller was designed by performing an integrated system dynamic - finite element analysis. Finite element-bioheat transfer (FE-BHT) simulations were performed on a computational phantom developed from the imaging data of a de-identified human head divided into voxels representing the skull, cerebrospinal fluid (CSF), brain, tumor, and ventricles. A uniform distribution of magnetic nanoparticles (MNPs) in an ellipsoid was used to represent MNPs in the phantom tumor. The MNP distribution was subdivided into three domains to simulate the steerable spatially confined heating region during MNHT. Proportional-integral-derivative (PID) control and model predictive control (MPC) were explored. Regions of the phantom tumor that were undertreated during the simulated MNHT were selectively heated by adjusting the heating volume to improve the tumor coverage index (CI; tumor volume ≥ CEM43 of 20 [min]). Results show that steerable spatially confined heating improves CI by ∼15%. MPC achieves CI of 80% faster than PID (67 [min] vs. 80 [min]). Simulations demonstrated the feasibility of automated control to deliver tumor conformal thermal doses using steerable spatially confined heating.

Objective: Our study was to compare the therapeutic outcomes of radiofrequency ablation (RFA) with or without conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) within Milan criteria in subcapsular versus nonsubcapsular locations by using propensity score matching.

Materials and methods: This retrospective study included 171 consecutive HCC patients meeting Milan criteria who initially received RFA with or without cTACE at a tertiary academic center between January 2017 to December 2022. Technical success rate, progression-free survival (PFS) were recorded. Factors predicting PFS after RFA with or without cTACE were investigated through a Cox proportional hazard model.

Results: The cumulative 1-, 3-, and 5-year PFS were 73.9%%, 27.7%%, and 7.7%, respectively. The cumulative PFS rates were 76.1% and 17.3% at 1 and 3 years, respectively, in the subcapsular group and 71.8% and 37.2% in the nonsubcapsular group (p = 0.034). Matching yielded 49 matched pairs of patients. In the matched group, corresponding cumulative PFS rates were 75.6% and 14.6% at 1 and 3 years, respectively, in the subcapsular group and 69.6% and 30.2% in the nonsubcapsular group (p = 0.156). Multivariate analysis confirmed that subcapsular tumor location was not an independent risk factor for PFS. Additionally, differences in technical success rate were not significant between groups.

Conclusion: The differences in PFS rates and technical success rate in HCC patients within the Milan criteria who received RFA with or without cTACE were not significant between the subcapsular and non-subcapsular groups. Future larger prospective multicenter trials are needed to validate these findings.

Objectives: To investigate the significance of the cesarean section diverticulum (CSD) area for predicting the intraoperative massive hemorrhage during suction curettage for cesarean scar pregnancy (CSP) after focused ultrasound ablation surgery (FUAS).

Methods: Data from 90 patients undergoing suction curettage after FUAS were collected. According to their intraoperative bleeding volume, patients were categorized into three groups: Group 1 (n = 71, <200 mL), Group 2 (n = 9, 200-300 mL) and Group 3 (n = 10, ≥300 mL). Multiple liner regression analysis was performed to identify the influencing factors for CSD area and intraoperative blood loss. The ROC curve was plotted to identify the optimal cutoff values.

Results: The median CSD area size in Group 3 (336.8 mm²) was significantly greater than in Groups 1 (128.6 mm²) and 2 (121.6 mm²) (p < .05). Using multiple linear regression analysis, CSD area was associated with intraoperative blood loss (p < .05). The optimal cutoff CSD areas for predicting intraoperative massive hemorrhage volumes ≥ 200 mL and ≥ 300 mL were 202.05 mm² and 241.90 mm², respectively. The mean gestational sac diameter and preoperative symptoms (+) were positively related to CSD area, while residual myometrial thickness was negatively correlated with the CSD area. CSD area showed the greatest relationship to sonication time (r_s = 0.42), treatment time (r_s = 0.316) and total energy used for ablation (r_s = 0.415).

Conclusion: The preoperative CSD area could predict intraoperative massive hemorrhage during suction curettage after FUAS, which might inform therapy strategies for CSP patients.