Microwave Ablation with Tumor Permittivity Microwave Ablation with - PowerPoint PPT Presentation

Microwave Ablation with Tumor Permittivity Microwave Ablation with Tumor Permittivity Feedback Control: an Feedback Control: an Ablate & Ablate & Resect bl bl & & Resect Study in 10 Patients with S Study in 10 Patients with S d d i i 0 0 i i i h i h Pulmonary Malignancies Pulmonary Malignancies Farrah J. Wolf, MD, Farrah J. Wolf, MD, Bassam Bassam Aswad Aswad, MD, , MD, Thomas Ng, MD, & Damian E. Thomas Ng, MD, & Damian E. Dupuy Dupuy, MD, FACR , MD, FACR Departments of Diagnostic Imaging, Pathology, Thoracic Surgery, Departments of Diagnostic Imaging, Pathology, Thoracic Surgery, & Office of Research Administration & Office of Research Administration Rhode Island Hospital Rhode Island Hospital Rhode Island Hospital Rhode Island Hospital

Disclosures Disclosures Disclosures Disclosures Damian E. Damian E. Dupuy Dupuy, MD , MD MedWaves MedWaves  Grant Support Grant Support –

Background Background Background Background Pulmonary Tumor Ablation Pulmonary Tumor Ablation  20 20- -25% patients with NSCLC present 25% patients with NSCLC present p p p p with localized disease with localized disease IIIa  surgical resection  Stage I, II and Stage I, II and IIIa surgical resection  RFA is a safe and valuable RFA is a safe and valuable tx tx option option  Most widely used ablative modality Most widely used ablative modality y y y y  Surgically Surgically unresectable unresectable  Medically inoperable Medically inoperable

Background Background Background Background  Advantages of microwave ablation Advantages of microwave ablation  Hotter Hotter  Faster Faster  ↓ ↓ Heat sink Heat sink  No grounding pads No grounding pads

Background Background Background Background ↑ Kinetic Kinetic Heat Heat Energy Energy Energy Energy

Background Background Background Background Dielectric Dielectric A Applied A Applied li d li d Properties of Properties of Permittivity Permittivity Conditions Conditions Tissues Tissues Physical Elements Physical Elements Physical Elements Physical Elements

Background Background Background Background Tumor Permittivity Feedback Control Tumor Permittivity Feedback Control “Temperature Control” “Temperature Control” Temperature Control Temperature Control Mode Mode Power 10 Power 10- -32 Watts 32 Watts Frequency 902 Frequency 902- -928 MHz 928 MHz

Background Background Background Background Maximize energy deposition within tumor Maximize energy deposition within tumor + + Minimize the reflectivity/reverse power Minimize the reflectivity/reverse power Hotter Hotter intra intra- -tumoral tumoral temperatures temperatures with penetration with penetration into surrounding aerated lung tissue into surrounding aerated lung tissue g g g g Oncologic resection margin (1cm) Oncologic resection margin (1cm)

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Study Design Study Design  Prospective study  Prospective study Prospective study Prospective study  Ablate and Ablate and Resect Resect Protocol Protocol  IRB approved IRB approved IRB approved IRB approved  HIPPA compliant HIPPA compliant  10 consecutive patients at our institution 10 consecutive patients at our institution  Inclusion Criteria Inclusion Criteria

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Patients Patients  Surgical resection of a biopsy Surgical resection of a biopsy-proven Su g ca Su g ca esect o esect o o a b opsy o a b opsy p o e proven p o e pulmonary malignancy pulmonary malignancy  Pre  Pre Pre-operative staging CT and PET Pre operative staging CT and PET operative staging CT and PET-CT operative staging CT and PET CT CT CT  Informed consent obtained prior to Informed consent obtained prior to enrollment enrollment enrollment enrollment

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Patients Patients  March 2009  March 2009 March 2009 March 2009 – January 2010 January 2010 January 2010 January 2010  10 patients (6 male, 4 female) 10 patients (6 male, 4 female)  Mean age 71 years (range, 52 M Mean age 71 years (range, 52-82) M 71 71 ( ( 52 82) 52 82) 82)  Underwent intra Underwent intra- -operative MWA of a operative MWA of a resectable resectable pulmonary malignancy pulmonary malignancy

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Endometrial Endometrial Colorectal Colorectal 5 pts 5 pts Mets Mets AdenoCa AdenoCa Primary Disease Primary Disease 3 pts 3 pts 3 pts 3 pts SCC SCC

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Tumors Tumors  Mean maximum tumor diameter 2 4cm  Mean maximum tumor diameter 2.4cm Mean maximum tumor diameter 2 4cm Mean maximum tumor diameter 2.4cm  range, 0.9 range, 0.9- -5.0cm 5.0cm Mean tumor volume 8 6cm 3 Mean tumor volume 8.6cm 3  Mean tumor volume 8.6cm Mean tumor volume 8 6cm 53cm 3  range, 0.4 range, 0.4- -53cm

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Ablate & Ablate & Resect Resect Protocol Protocol  Initial consultation Initial consultation  Intra Intra- -Op Op  GETA GETA GETA GETA  Thoracotomy Thoracotomy with tumor exposure with tumor exposure  Aeration of lung tissue via double Aeration of lung tissue via double Aeration of lung tissue via double lumen ET Aeration of lung tissue via double-lumen ET lumen ET lumen ET  MWA and Air MWA and Air- -leak testing leak testing  Standard Resection (wedge or Standard Resection (wedge or Standard Resection (wedge or lobectomy Standard Resection (wedge or lobectomy lobectomy) lobectomy)  Pathologic analysis Pathologic analysis

Materials & Methods Materials & Methods Materials & Methods Materials & Methods MWA Technique MWA Technique  Straight 14 Gauge 4cm active tip MW  Straight, 14 Gauge, 4cm active tip MW Straight 14 Gauge 4cm active tip MW Straight, 14 Gauge, 4cm active tip MW antenna antenna

Materials & Methods Materials & Methods Materials & Methods Materials & Methods MWA Antenna MWA Antenna Cutting Tip Cutting Tip Cutting Tip Cutting Tip Antenna Antenna Reflectivity and Temp Sensor Reflectivity and Temp Sensor

Materials & Methods Materials & Methods Materials & Methods Materials & Methods MWA Technique MWA Technique Tumor Permittivity Feedback Control Tumor Permittivity Feedback Control Tumor Permittivity Feedback Control Tumor Permittivity Feedback Control  “Temperature Control Mode” “Temperature Control Mode”  Power 10 Power 10- -32 Watts 32 Watts  Energy efficient design Energy efficient design  Frequency 902 F F Frequency 902-928 MHz 902 902 928 MH 928 MH 928 MHz 120 ・ C  Target Temp 110 Target Temp 110- -120 C  Single 10 minute ablation Single 10 minute ablation

Materials & Methods Materials & Methods Materials & Methods Materials & Methods Pathologic Analysis of Pathologic Analysis of Resected Resected Specimens Specimens  Gross inspection and sectioning Gross inspection and sectioning Gross inspection and sectioning Gross inspection and sectioning  Maximum diameters Maximum diameters  Prolate  Prolate Prolate ellipse volumetric estimations Prolate ellipse volumetric estimations ellipse volumetric estimations ellipse volumetric estimations  H & E staining H & E staining  Cellular death confirmed with NADH C ll l Cellular death confirmed with NADH C ll l d d th th fi fi d d ith NADH ith NADH assays assays  + staining = mitochondrial enzymatic + staining = mitochondrial enzymatic activity, cellular viability activity, cellular viability

Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Ablation Zone Characteristics: Ablation Zone Characteristics:  Ablation zone measurements  Ablation zone measurements Ablation zone measurements Ablation zone measurements  Grossly measurable in 5 Grossly measurable in 5 resected resected specimens specimens  Mean maximum diameter 4.8cm Mean maximum diameter 4.8cm Mean maximum diameter 4 8cm Mean maximum diameter 4 8cm  (range, 3.0 (range, 3.0- -6.5) 6.5) Mean volume 15 1cm 3  Mean volume 15.1cm Mean volume 15 1cm Mean volume 15.1cm  (range, 7.3 (range, 7.3- -25.1) 25.1)

Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Ablation Zone Characteristics Ablation Zone Characteristics  Pleural retraction  Pleural retraction Pleural retraction Pleural retraction 5.0cm, SCC 5.0cm, SCC

Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Results: Gross Analysis Ablation Zone Characteristics Ablation Zone Characteristics  Hyperemic ellipsoid zone of coagulation  Hyperemic ellipsoid zone of coagulation Hyperemic ellipsoid zone of coagulation Hyperemic ellipsoid zone of coagulation necrosis necrosis 2.5cm, 2.5cm, AdenoCa AdenoCa