VIEWS: 8 PAGES: 13 POSTED ON: 11/8/2010
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 Background • American Cancer Society estimate: ~190,000 new cases of prostate cancer were diagnosed in 2009. • 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. Surgery Background • 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 options. 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 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 Orifice 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 Conclusions • MR guided laser ablation and cryoablation of prostate bed recurrences are possible and demonstrate no adverse events in the initial patients. • MR guided interventions offer the potential for more precise guidance, monitoring, and ablation in patients with prostate cancer recurrences.
"Slides - Society Of Interventional Radiology - Nonsurgical Treatments"