Horkan Clare, Ahmed Muneeb, Liu Zhengjun, Gazelle G Scott, Solazzo Stephanie A, Kruskal Jonathan B, Goldberg S Nahum
Laboratory for Minimally Invasive Tumor Therapy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Vasc Interv Radiol. 2004 Mar;15(3):269-74. doi: 10.1097/01.rvi.0000109396.74740.c4.
To determine whether pharmacologic agents can be used to modulate blood flow in hepatic and renal tumors sufficiently to alter the extent of radiofrequency (RF)-induced coagulation.
VX2 tumors (8-15 mm) were implanted in the liver (n = 25) or kidney (n = 8) of 33 New Zealand White rabbits. RF was applied to tumors for 6 minutes with use of conventional electrodes (125 mA +/- 35; 90 degrees C +/- 2 degrees C tip temperature). In the hepatic model, blood flow was modulated with use of halothane, epinephrine, or arsenic trioxide (2-6 mg/kg). Laser Doppler flowmetry was used to quantify changes in hepatic blood flow. Correlation of blood flow with induced coagulation diameter was performed. RF ablation was then performed in a renal model with and without arsenic trioxide.
For liver tumors, halothane and arsenic trioxide reduced blood flow to 40.3% +/- 17.8% and 29% +/- 15% of normal, respectively, whereas epinephrine increased blood flow to 207.8% +/- 97.9%. Correlation of blood flow to coagulation diameter was demonstrated (R(2) = 0.40). Coagulation measured 7 mm +/- 1 with epinephrine, 10 mm +/- 1 with normal blood flow, 12 mm +/- 3 with halothane, and 13 mm +/- 3 with arsenic trioxide (P <.04 compared with controls). In the renal model, arsenic trioxide decreased blood flow (44% +/- 16%) and increased coagulation diameter (10.9 mm +/- 1) compared with controls (84% +/- 11% and 7.6 mm +/- 1; P <.01, both comparisons).
RF-induced coagulation necrosis in rabbit hepatic and renal tumors is affected by tumor blood flow. Pharmacologic modulation of tumor blood flow may provide a noninvasive way to decrease blood flow during thermally mediated ablation therapy, potentially enabling the creation of larger zones of coagulation necrosis.
确定药物制剂是否可用于充分调节肝肿瘤和肾肿瘤的血流，以改变射频（RF）诱导的凝固范围。
将VX2肿瘤（8 - 15毫米）植入33只新西兰白兔的肝脏（n = 25）或肾脏（n = 8）。使用传统电极（125毫安±35；尖端温度90摄氏度±2摄氏度）对肿瘤施加RF 6分钟。在肝脏模型中，使用氟烷、肾上腺素或三氧化二砷（2 - 6毫克/千克）调节血流。使用激光多普勒血流仪量化肝脏血流的变化。进行血流与诱导凝固直径的相关性分析。然后在有和没有三氧化二砷的情况下，在肾模型中进行RF消融。
对于肝肿瘤，氟烷和三氧化二砷分别将血流减少至正常的40.3%±17.8%和29%±15%，而肾上腺素将血流增加至207.8%±97.9%。显示了血流与凝固直径的相关性（R² = 0.40）。使用肾上腺素时凝固测量为7毫米±1，正常血流时为10毫米±1，氟烷时为12毫米±3，三氧化二砷时为13毫米±3（与对照组相比，P <.04）。在肾模型中，与对照组相比（84%±11%和7.6毫米±1），三氧化二砷减少了血流（44%±16%）并增加了凝固直径（10.9毫米±1；两次比较P均<.01）。
兔肝肿瘤和肾肿瘤中RF诱导的凝固性坏死受肿瘤血流影响。肿瘤血流的药物调节可能提供一种非侵入性方法，在热介导的消融治疗期间减少血流，潜在地实现更大范围的凝固性坏死区域的形成。
