Ablative therapy

Large warts Treat warts greater than 10 mm in diameter with surgical excision. Use imiquimod for three to four treatment cycles to reduce the number of warts and improve surgical outcomes. Fifty percent reduction in wart size after four treatment cycles warrants continued use of imiquimod until warts clear or eight cycles have been completed less than 50% reduction warrants surgical excision or other ablative therapy. 

Pregnancy Agents contraindicated in pregnancy include podofilox, fluorouracil, and podophyllin. Imiquimod is not approved for use in pregnancy, although it has been considered after signed consent has been obtained. Bichloroacetic and trichloroacetic acid have been used without problems. Ablative therapy is also a viable option. 

Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal warts (ie, condyloma acuminatum see Chapter 61). The 5% cream is applied three times weekly and washed off 6-10 hours after each application. Recurrences appear to be less common than after ablative therapies. Imiquimod is also effective against actinic keratoses, and possibly, molluscum contagiosum. Local skin reactions are the most common side effect these tend to resolve within weeks after therapy. However, pigmentary skin changes may persist. Systemic adverse effects such as fatigue and influenza-like syndrome have occasionally been reported. 

The management of hyperthyroidism due to amiodarone has been reviewed in the light of the practices of 101 European endocrinologists (60). Most (82%) treat type I amiodarone-induced hyperthyroidism with thionamides, either alone (51%) or in combination with potassium perchlorate (31%) the preferred treatment for type II hyperthyroidism is a glucocorticoid (46%). Some initially treat all cases, before the type has been established, with a combination of thionamides and glucocorticoids. After restoration of normal thyroid function, 34% recommend ablative therapy in type I hyperthyroidism and only 8% in type II. If amiodarone therapy needs to be restarted, 65% recommend prophylactic thyroid ablation in type I hyperthyroidism and 70% recommend a wait-and-see strategy in type II. 

Maintenance therapy of cervical dysplasias after standard excisional or ablative therapy Cream Reduction of recurrence was achieved 329... 

Cha C, De MR, Blumgart L. Surgery and ablative therapy for hepatocellular carcinoma. J Clin Gastroenterol 2002 35 S130-7. 

Many patients choose to have ablative therapy with rather than undergo repeated courses of PTU or MMI most receiving RAI eventually become hypothyroid and require thyroid hormone supplementation. 

Kessinger A, Armitage JO, Landmark JD, et al. Autologous peripheral hematopoietic stem cell transplantation restores hematopoietic function following marrow ablative therapy. Blood 1988 71 723-727. 

Dick EA, Taylor-Robinson SD, Thomas HC, Gedroyc WMW. Ablative therapy for liver tumors. Gut 2002 50 733-739. 

Kacher DF, Jolesz FA. MR imaging-guided breast ablative therapy. Radiol Clin North... 

Langenhoff BS, Oyen WJ, Jager GJ, Strijk SP, Wobbes T, Corstens FH, Ruers TJ (2002) Efficacy of fluorine-18-deoxyglucose positron emission tomography in detecting tumor recurrence after local ablative therapy for liver metastases a prospective study. J Clin Oncol 20 4453-4458... 

Combinatorial applications of °Y and ablative techniques such as RFA and cryo-ablation may provide an option for those patients who would otherwise require surgical resection, but are at high surgical risk due to co-morbidities or prefer less invasive means of treating their disease. Y has been shown to reduce tumor burden in downstaging to transplant or resection for HCC patients [55-57], In patients presenting with tumors which are not amenable to ablative therapy due to excessive size (6-8 cm), °Y microspheres could be used to reduce these lesions (< 3 cm), followed by the use of ablative therapy to effect further response. This presumes... 

Xiao H, Zhuang W, Wang S, et al. (2002) Arterial embolization a novel approach to thyroid ablative therapy for Graves disease. J Clin Endocrinol Metabol 87 3583-3589... 

Percutaneous thermal ablation therapies have been receiving increasing attention as a potential primary treatment for focal HCC and fiver metastases. Possible advantages of ablative therapies as compared to surgical resection include a lower morbidity and mortality... 

The majority of primary and secondary malignant hepatic tumors are not suitable for surgical resection, which makes systemic chemotherapy treatments and/or local ablative therapies important components of intention-to-treat concepts or palliation. Tumor load and type of response determine the efficacy of these therapies. 

Tumors not suitable for local ablative therapy such as radiofrequency and laser ablation... 

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