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Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts

Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

A panel of Japanese experts on tumor ablation therapy gathered to reach a general consensus on topics surrounding ablation therapy.

Materials and methods

Questionnaires relating to ablation protocols for radiofrequency ablation (RFA) and cryoablation, as well as ancillary procedures required for safe and secure ablation therapy, were sent to seven institutions. Experts from these institutions discussed each topic based on the evidence and the questionnaire data, and a consensus was reached at an annual meeting of the Japan Image-guided Ablation Group in Maebashi, Japan, in October 2015.

Results

A consensus was reached on each of six topics, including “management of antiplatelet and anticoagulation drug therapy”; “pain control in the perioperative period”; “arterial embolization combined with ablation therapy”; “protection of non-target organs”; “RFA and cryoablation protocols”; and “ablative margins.”

Conclusions

The consensus achieved here will serve as the framework for tumor ablation therapies in Japan.

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References

  1. Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, et al. Chinese expert consensus workshop report: guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer. 2015;6(1):112–21.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Yamanaka T, Yamakado K, Yamada T, Fujimori M, Takaki H, Nakatsuka A, et al. CT-guided percutaneous cryoablation in renal cell carcinoma: factors affecting local tumor control. J Vasc Interv Radiol: JVIR. 2015;26(8):1147–53.

    Article  PubMed  Google Scholar 

  3. Nakatsuka A, Yamakado K, Uraki J, Takaki H, Yamanaka T, Fujimori M, et al. Safety and clinical outcomes of percutaneous radiofrequency ablation for intermediate and large bone tumors using a multiple-electrode switching system: a phase II clinical study. J Vasc Interv Radiol: JVIR. 2015.

  4. Kumasaka S, Miyazaki M, Tsushima Y. CT-guided percutaneous cryoablation of an aggressive osteoblastoma: a case report. J Vasc Interv Radiol: JVIR. 2015;26(11):1746–8.

    Article  PubMed  Google Scholar 

  5. Yamakado K, Matsumine A, Nakamura T, Nakatsuka A, Takaki H, Matsubara T, et al. Radiofrequency ablation for the treatment of recurrent bone and soft-tissue sarcomas in non-surgical candidates. Int J Clin Oncol. 2014;19(5):955–62.

    Article  PubMed  Google Scholar 

  6. Takaki H, Yamakado K, Nakatsuka A, Yamada T, Uraki J, Kashima M, et al. Computed tomography fluoroscopy-guided radiofrequency ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas invisible on ultrasonographic images. Int J Clin Oncol. 2013;18(1):46–53.

    Article  PubMed  Google Scholar 

  7. Iguchi T, Inoue D, Yabushita K, Sakaguchi K, Tatsukawa M, Sasaki H, et al. Effect of CT fluoroscopy-guided transpulmonary radiofrequency ablation of liver tumours on the lung. Br J Radiol. 1016;2012(85):e373–7.

    Google Scholar 

  8. Atwell TD, Carter RE, Schmit GD, Carr CM, Boorjian SA, Curry TB, et al. Complications following 573 percutaneous renal radiofrequency and cryoablation procedures. J Vasc Interv Radiol: JVIR. 2012;23(1):48–54.

    Article  PubMed  Google Scholar 

  9. Miyazaki M, Aoki J, Miyazaki A, Nakajima T, Koyama Y, Shinozaki T, et al. Percutaneous radiofrequency ablation of osteoid osteoma using cool-tip electrodes without the cooling system. Jpn J Radiol. 2011;29(2):138–43.

    Article  PubMed  Google Scholar 

  10. Yasui K, Kanazawa S, Sano Y, Fujiwara T, Kagawa S, Mimura H, et al. Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience. Radiology. 2004;231(3):850–7.

    Article  PubMed  Google Scholar 

  11. Yamakado K, Nakatsuka A, Akeboshi M, Takeda K. Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition. J Vasc Interv Radiol: JVIR. 2003;14(9 Pt 1):1183–6.

    Article  PubMed  Google Scholar 

  12. Gillams A, Goldberg N, Ahmed M, Bale R, Breen D, Callstrom M, et al. Thermal ablation of colorectal liver metastases: a position paper by an international panel of ablation experts, the Interventional Oncology Sans Frontieres meeting 2013. Eur Radiol. 2015;25(12):3438–54.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria—a 10-year update. J Vasc Interv Radiol: JVIR. 2014;25(11):1691–705, e4.

  14. Takaki H, Yamakado K, Nakatsuka A, Yamada T, Shiraki K, Takei Y, et al. Frequency of and risk factors for complications after liver radiofrequency ablation under CT fluoroscopic guidance in 1500 sessions: single-center experience. AJR Am J Roentgenol. 2013;200(3):658–64.

    Article  PubMed  Google Scholar 

  15. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003;226(2):441–51.

    Article  PubMed  Google Scholar 

  16. Zargar H, Atwell TD, Cadeddu JA, de la Rosette JJ, Janetschek G, Kaouk JH, et al. Cryoablation for small renal masses: selection criteria, complications, and functional and oncologic results. Eur Urol. 2016;69(1):116–28.

    Article  PubMed  Google Scholar 

  17. Guidelines for the management of anticoagulant and antiplatelet therapy in patients with cardiovascular diseases. Japanese Circulation Society. 2009.

  18. Grines CL, Bonow RO, Casey DE Jr, Gardner TJ, Lockhart PB, Moliterno DJ, et al. Prevention of premature discontinuation of dual antiplatelet therapy in patients with coronary artery stents: a science advisory from the American Heart Association, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, American College of Surgeons, and American Dental Association, with representation from the American College of Physicians. J Am Dent Assoc. 2007;138(5):652–5.

    Article  PubMed  Google Scholar 

  19. Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol. 2005;62(8):1217–20.

    Article  PubMed  Google Scholar 

  20. Eikelboom JW, Hirsh J, Spencer FA, Baglin TP, Weitz JI. Antiplatelet drugs: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e89S–119S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al. Dabigatran versus warfarin in patients with atrial fibrillation. New Engl J Med. 2009;361(12):1139–51.

    Article  CAS  PubMed  Google Scholar 

  22. Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative bridging anticoagulation in patients with atrial fibrillation. New Engl J Med. 2015;373(9):823–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. de Baere T. Lung tumor radiofrequency ablation: where do we stand? Cardiovasc Interv Radiol. 2011;34(2):241–51.

    Article  Google Scholar 

  24. Mulier S, Ni Y, Jamart J, Ruers T, Marchal G, Michel L. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg. 2005;242(2):158–71.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Sofocleous CT, Sideras P, Petre EN. “How we do it”—a practical approach to hepatic metastases ablation techniques. Tech Vasc Interv Radiol. 2013;16(4):219–29.

    Article  PubMed  Google Scholar 

  26. Yokoyama K, Ikeda O, Kawanaka K, Nakasone Y, Inoue S, Tamura Y, et al. Pain control in patients with hepatocellular carcinoma treated by percutaneous radiofrequency ablation: comparison of the efficacy of one-shot and continuous intravenous fentanyl delivery. Acta Radiol. 2014;55(10):1219–25.

    Article  PubMed  Google Scholar 

  27. Kang TW, Rhim H, Lee MW, Kim YS, Choi D, Lee WJ, et al. Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm: comparison of effects of thermal protection and therapeutic efficacy. AJR Am J Roentgenol. 2011;196(4):907–13.

    Article  PubMed  Google Scholar 

  28. Okuma T, Matsuoka T, Yamamoto A, Oyama Y, Toyoshima M, Nakamura K, et al. Frequency and risk factors of various complications after computed tomography-guided radiofrequency ablation of lung tumors. Cardiovasc Interv Radiol. 2008;31(1):122–30.

    Article  Google Scholar 

  29. Gazzera C, Fonio P, Faletti R, Dotto MC, Gobbi F, Donadio P, et al. Role of paravertebral block anaesthesia during percutaneous transhepatic thermoablation. Radiol Med (Torino). 2014;119(8):549–57.

    Article  Google Scholar 

  30. Hiraki T, Gobara H, Shibamoto K, Mimura H, Soda Y, Uka M, et al. Technique for creation of artificial pneumothorax for pain relief during radiofrequency ablation of peripheral lung tumors: report of seven cases. J Vasc Interv Radiol: JVIR. 2011;22(4):503–6.

    Article  PubMed  Google Scholar 

  31. Allaf ME, Varkarakis IM, Bhayani SB, Inagaki T, Kavoussi LR, Solomon SB. Pain control requirements for percutaneous ablation of renal tumors: cryoablation versus radiofrequency ablation—initial observations. Radiology. 2005;237(1):366–70.

    Article  PubMed  Google Scholar 

  32. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 1999;19(3):329–38.

    Article  CAS  PubMed  Google Scholar 

  33. Miyayama S, Yamakado K, Anai H, Abo D, Minami T, Takaki H, et al. Guidelines on the use of gelatin sponge particles in embolotherapy. Jpn J Radiol. 2014;32(4):242–50.

    Article  PubMed  Google Scholar 

  34. Yamanaka T, Yamakado K, Takaki H, Nakatsuka A, Shiraki K, Hasegawa H, et al. Ablative zone size created by radiofrequency ablation with and without chemoembolization in small hepatocellular carcinomas. Jpn J Radiol. 2012;30(7):553–9.

    Article  PubMed  Google Scholar 

  35. Sugimori K, Nozawa A, Morimoto M, Shirato K, Kokawa A, Saito T, et al. 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: JVIR. 2005;16(6):849–56.

    Article  PubMed  Google Scholar 

  36. Dong W, Zhang T, Wang ZG, Liu H. Clinical outcome of small hepatocellular carcinoma after different treatments: a meta-analysis. World J Gastroenterol. 2014;20(29):10174–82.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol. 2013;19(24):3872–82.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Rhim H, Lee MH, Kim YS, Choi D, Lee WJ, Lim HK. Planning sonography to assess the feasibility of percutaneous radiofrequency ablation of hepatocellular carcinomas. AJR Am J Roentgenol. 2008;190(5):1324–30.

    Article  PubMed  Google Scholar 

  39. Goto E, Tateishi R, Shiina S, Masuzaki R, Enooku K, Sato T, et al. Hemorrhagic complications of percutaneous radiofrequency ablation for liver tumors. J Clin Gastroenterol. 2010;44(5):374–80.

    PubMed  Google Scholar 

  40. Chen JX, Guzzo TJ, Malkowicz SB, Soulen MC, Wein AJ, Clark TW, et al. Complication and readmission rates following same-day discharge after percutaneous renal tumor ablation. J Vasc Interv Radiol: JVIR. 2016;27(1):80–6.

    Article  PubMed  Google Scholar 

  41. Miller JM, Julien P, Wachsman A, Van Allan RJ, Friedman ML. The role of embolization in reducing the complications of cryoablation in renal cell carcinoma. Clin Radiol. 2014;69(10):1045–9.

    Article  CAS  PubMed  Google Scholar 

  42. Gervais DA, Arellano RS, McGovern FJ, McDougal WS, Mueller PR. Radiofrequency ablation of renal cell carcinoma: part 2. Lessons learned with ablation of 100 tumors. AJR Am J Roentgenol. 2005;185(1):72–80.

    Article  PubMed  Google Scholar 

  43. Campbell C, Lubner MG, Hinshaw JL, Munoz del Rio A, Brace CL. Contrast media-doped hydrodissection during thermal ablation: optimizing contrast media concentration for improved visibility on CT images. AJR. Am J Roentgenol. 2012;199(3):677–82.

    Article  Google Scholar 

  44. Hasegawa T, Takaki H, Miyagi H, Nakatsuka A, Uraki J, Yamanaka T, et al. Hyaluronic acid gel injection to prevent thermal injury of adjacent gastrointestinal tract during percutaneous liver radiofrequency ablation. Cardiovasc Interv Radiol. 2013;36(4):1144–6.

    Article  Google Scholar 

  45. Minami Y, Kudo M. Radiofrequency ablation of hepatocellular carcinoma: a literature review. Int J Hepatol. 2011;2011:104685.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Rosenthal DI, Hornicek FJ, Torriani M, Gebhardt MC, Mankin HJ. Osteoid osteoma: percutaneous treatment with radiofrequency energy. Radiology. 2003;229(1):171–5.

    Article  PubMed  Google Scholar 

  47. Inoue M, Nakatsuka S, Jinzaki M. Cryoablation of early-stage primary lung cancer. BioMed Res Int. 2014;2014:521691.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Wang C, Wang H, Yang W, Hu K, Xie H, Hu KQ, et al. Multicenter randomized controlled trial of percutaneous cryoablation versus radiofrequency ablation in hepatocellular carcinoma. Hepatology. 2015;61(5):1579–90.

    Article  PubMed  Google Scholar 

  49. Ni Y, Mulier S, Miao Y, Michel L, Marchal G. A review of the general aspects of radiofrequency ablation. Abdom Imaging. 2005;30(4):381–400.

    Article  CAS  PubMed  Google Scholar 

  50. Georgiades C, Rodriguez R, Azene E, Weiss C, Chaux A, Gonzalez-Roibon N, et al. Determination of the nonlethal margin inside the visible “ice-ball” during percutaneous cryoablation of renal tissue. Cardiovasc Interv Radiol. 2013;36(3):783–90.

    Article  Google Scholar 

  51. Venkatesan AM, Wood BJ, Gervais DA. Percutaneous ablation in the kidney. Radiology. 2011;261(2):375–91.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Masaya Miyazaki.

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On behalf of Japan Image-guided Ablation Group.

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Miyazaki, M., Iguchi, T., Takaki, H. et al. Ablation protocols and ancillary procedures in tumor ablation therapy: consensus from Japanese experts. Jpn J Radiol 34, 647–656 (2016). https://doi.org/10.1007/s11604-016-0569-8

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  • DOI: https://doi.org/10.1007/s11604-016-0569-8

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