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      Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation

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          Abstract

          The application of navigational systems has the potential to improve percutaneous interventions. The accuracy of ablation probe placement can be increased and radiation doses reduced. Two different types of systems can be distinguished, tracking systems and robotic systems. This review gives an overview of navigation devices for clinical application and summarizes first findings in the implementation of navigation in percutaneous interventions using irreversible electroporation. Because of the high number of navigation systems, this review focuses on commercially available ones.

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          Most cited references42

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          Microwave ablation: principles and applications.

          Microwave ablation is the most recent development in the field of tumor ablation. The technique allows for flexible approaches to treatment, including percutaneous, laparoscopic, and open surgical access. With imaging guidance, the tumor is localized, and a thin (14.5-gauge) microwave antenna is placed directly into the tumor. A microwave generator emits an electromagnetic wave through the exposed, noninsulated portion of the antenna. Electromagnetic microwaves agitate water molecules in the surrounding tissue, producing friction and heat, thus inducing cellular death via coagulation necrosis. The main advantages of microwave technology, when compared with existing thermoablative technologies, include consistently higher intratumoral temperatures, larger tumor ablation volumes, faster ablation times, and an improved convection profile. Microwave ablation has promising potential in the treatment of primary and secondary liver disease, primary and secondary lung malignancies, renal and adrenal tumors, and bone metastases. The technology is still in its infancy, and future developments and clinical implementation will help improve the care of patients with cancer. Copyright RSNA, 2005.
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            Microwave tumor ablation: mechanism of action, clinical results, and devices.

            Microwave ablation uses dielectric hysteresis to produce direct volume heating of tissue. Microwaves are capable of propagating through many tissue types, even those with high impedance such as lung or bone, with less susceptibility to "heat-sink" effects along vessels. Microwaves are highly conducive to the use of multiple applicators, showing the synergy seen with other energies, but also the potential capability for phasing of the electromagnetic field. As a result, larger, more customizable ablation zones may be created in less time. Although multiple microwave ablation systems are currently available, further study and continued development are needed. Copyright (c) 2010 SIR. Published by Elsevier Inc. All rights reserved.
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              Initial response to percutaneous ablation predicts survival in patients with hepatocellular carcinoma.

              Outcome predictors in patients with hepatocellular carcinoma (HCC) who are treated with percutaneous ablation are ill defined, and it is unknown if successful therapy is associated with improved survival. In our study, 282 cirrhotic patients with early nonsurgical HCC were treated with percutaneous ablation during a 15-year period. Single tumors were seen in 244 patients, and 2 to 3 nodules were seen in 38 patients. Initial complete response was achieved in 192 patients and was independently related to the size of the main tumor (P = .015) and tumor stage (P = .0001) ( 3 cm, 56%; 2-3 nodules, 46%). At the end of follow-up, 80 patients presented sustained complete response. The 1-, 3-, and 5-year survival rates were 87%, 51%, and 27%, respectively. The independent predictors of survival were Child-Turcotte-Pugh class (P = .0001) and initial complete response (P = .006). Child-Turcotte-Pugh class A patients with initial complete response achieved 42% survival at 5 years; this figure increased to 63% in patients with tumors 2 cm or smaller. In conclusion, our results demonstrate that initial complete response to percutaneous ablation is associated with an improved survival in both Child-Turcotte-Pugh class A and B patients with nonsurgical HCC. Accordingly, initial complete tumor necrosis should be considered a relevant therapeutic target irrespective of tumor size and liver function.
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                Author and article information

                Journal
                Technol Cancer Res Treat
                Technol. Cancer Res. Treat
                TCT
                sptct
                Technology in Cancer Research & Treatment
                SAGE Publications (Sage CA: Los Angeles, CA )
                1533-0346
                1533-0338
                02 August 2018
                2018
                : 17
                : 1533033818791792
                Affiliations
                [1 ]Department of Radiology, University Hospital Regensburg, Regensburg, Germany
                Author notes
                [*]Irene Fuhrmann, MSc, Department of Radiology, University Medical Center Regensburg, 93042 Regensburg, Germany. Email: irene.fuhrmann@ 123456ukr.de
                Author information
                http://orcid.org/0000-0001-9532-9973
                Article
                10.1177_1533033818791792
                10.1177/1533033818791792
                6077881
                30071779
                c6abee10-b19f-4ea3-8940-61c1578ce0cd
                © The Author(s) 2018

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 14 December 2017
                : 1 May 2018
                : 13 June 2018
                Categories
                Review
                Custom metadata
                corrected-proof

                interventional radiology,navigation,robotic,percutaneous intervention,ablation,irreversible electroporation

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