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Slides - Society Of Interventional Radiology - Nonsurgical Treatments


									  MR-Guided Ablation of Prostate Cancer
  Recurrences: Laser and Cryoablation.
David A. Woodrum, Lance A. Mynderse, Akira Kawashima,
  Krysztof R. Gorny, Thomas D. Atwell, Ernest F. McPhail,
       Bradley Bolster, Kimberly K. Amrami, Haraldur
              Bjarnason, Matthew R. Callstrom

              Mayo Clinic, Rochester, MN
• American Cancer Society estimate: ~190,000
  new cases of prostate cancer were diagnosed in
• Traditional therapies include surgery,
  radiotherapy, or hormone therapy.
• Prostate cancer recurrence after definitive
  therapy can be as high as 30%.
• Local recurrences are associated with significant
  risk of disease progression.

• Local Ablative therapies offer the potential for
  treatment especially for patients who have been
  through surgery and radiation therapy with
  recurrence of cancer and limited treatment
          Why MRI: Lesion Conspicuity

•   Better Lesion Conspicuity
•   Multiplanar imaging
•   Better Lesion Visualization Translates into More Precise Ablation and
    Better Treatment Outcomes
     Two MRI Compatible Systems Used

• Ablates = Laser Heat       • Ablates = Freezing

• Visualase Laser Ablation   • Galil Cryoablation System
                             • Uses Argon gas through
• 980nm Laser Fiber            a small needle

• Heats the tissue cooking   • Creates an iceball around
  the tumor                    the tumor
MRI Guided Laser Ablation

Visualase Laser Ablation System
      Visualase Laser Ablation System

• Image of the laser diffusing fiber (LDF) within the
  cooling catheter system (CCS) with the low power
  localizing laser turned on
       Live MRI MRI Localizing Imaging
         Post-Ablation Contrast Tumor
     PrecontrastTemperature Imaging

                Laser Ablation Procedure
1.   Localize Tumor
2.   Place applicators     Dynamic Contrast Enhancement
3.   Apply Laser Heat              Calculated Ablation Zone
4.   Evaluate Ablation
MRI Guided Cryoablation

 Galil Cryoablation System
          Joule Thompson Effect


                  Heat Exchanger

 Helium                                      Argon
+70°C                                   -183°C
Contrast Enhanced MRI
          Probe Placement From a Suprapubic
         Post-Ablation Contrast Enhanced MRI Approach
                            Cryoablation Procedure

                               1. Localize Tumor
       Iceball Size after 11 minutes of Freezing
                               2. Place probes
                               3. Freeze x2
                               4. Evaluate Ablation

• MR guided laser ablation and cryoablation of
  prostate bed recurrences are possible and
  demonstrate no adverse events in the initial
• MR guided interventions offer the potential for
  more precise guidance, monitoring, and ablation
  in patients with prostate cancer recurrences.

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