Microwave ablation therapy

Microwave Ablation Therapy 226 Cryotherapy 226 Summary 229 References 229... 

Dong et al. (2003) report a 5-year survival of 56.7% in 234 patients with hepatocellular carcinoma treated with microwave ablation therapy. Shibata et al. (2002b) compared RF and microwave ablation in the treatment of small hepatocellular carcinomas and found no difference in therapeutic effect or complication rates between the two techniques, although RF ablation was completed with fewer sessions. There is less evidence for the therapeutic effect of microwave ablation in patients with colorectal liver metastases. In one series of 74 patients with colorectal liver metastases a 5-year survival rate of 29% was achieved, with no major complications observed (Liang et al. 2003). At present, there is, however no substantial series of patients with hepatic metastases treated with microwave coagulation. 

Seki T, Wakabayashi M, Nakagawa T, Itho T, Shiro T, Kuni-eda K, Sato M, Uchiyama S, Inoue K (1994) Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 74 817-825 Shibata T, limuro Y, Yamamoto Y et al (2002) Small hepatocellular carcinoma comparison of radio-frequency ablation and percutaneous microwave coagulation therapy. Radiology 223 331-337... 

Shiina S, Teratani T, Obi S, Hamamura K, Koike Y, Omata M (2002) Nonsurgical treatment of hepatocellular carcinoma from percutaneous ethanol injection therapy and percutaneous microwave coagulation therapy to radiofrequency ablation. Oncology 62 64-68 Simon CJ, Dupuy DE, Mayo-Smith WW (2005) Microwave ablation principles and applications. Radiographics 25 [Suppl 1] S69-S83... 

These include mainly thermal ablative techniques such as laser-induced thermotherapy, radiofrequency and microwave ablation, but also chemoembolization as well as selective internal irradiation therapy. 

All of the percutaneous techniques are limited by the size and number of the lesions (up to three lesions each measuring up to 4 cm) as well as their location. Subdiaphragmatic lesions may be percutaneously inaccessible, and lesions close to large vascular structures respond poorly to thermal ablation techniques (RFA, MCT, Cryo, and LIPC). On the contrary, intra-arterial techniques are not limited by the number, size, or location of the lesions rather by the hepatic function reserve, as shown in Table 10.2. TACE, trans-arterial chemo-embolization TARE, trans-arterial radio-embolization MCT, microwave coagulation therapy RFA, radio frequency ablation LIPC, laser interstitial photocoagulation Cryo, cryo-ablation PEI, percutaneous ethanol injection PAAI, percutaneous acetic acid injection PCI, percutaneous chemotherapy injection... 

The management of lower urinary tract symptoms suggestive of clinical symptomatic BPH remains somewhat controversial. Treatment options range from watchful waiting, for those patients wishing to delay any active therapy, to minimally invasive treatment, such as transurethral needle ablation of the prostate and transurethral microwave therapy, to surgical interventions in the form of transurethral prostatectomy or open enucleation of the prostate. Most patients present with difficulties in urination for which a variety of medical therapies are available, including synthetic 5-a-reductase inhibitors, a-blockers, and plant extracts (Boyle et al., 2000). 

Combination therapy The use of local-interventional procedures is restricted to a maximum tumour size of 5 cm in diameter. Therefore, a combination of two local techniques is seen as promising. The joint application of PEI and TAB has proved its efficacy for some time. (177) Similarly, there have been reports about the successful use of TACE following laser thermal ablation. (136) Further encouraging options include a combination of TACE and RFTA, TACE with microwave coagulation (149) or TACE with cryotherapy. Using TACE, the size of the HCC can be reduced in some cases, making it possible to carry out subsequent ablation with better results. 

Recently, several minimally invasive, image-guided therapies have been developed for the local treatment of primary and secondary neoplasms, in patients who are poor surgical candidates. These minimally invasive methods of therapy permit the destruction of tumor without necessitating their removal and rely on different mechanisms for tumor destruction. Radiofrequency, microwave, and laser ablation all destroy tumor by thermal injury. Cryoablation and... 

Neoadjuvant TACE - Frankfurt Protocol (TACE Followed by LITT) 114 Combined Interventional Therapies Combination of TACE and PEI 116 Combination of TACE and Radiation Combination of TACE and Thermal Ablation (LITT / RE) 118 Combination of TACE and Microwave Coagulation 118 Combination of TACE and Cryotherapy 119 Conclusion 119 References 119... 

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