Minimally Invasive Tumor Therapy Laboratory, Section of Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
Chem Phys Lipids. 2012 May;165(4):424-37. doi: 10.1016/j.chemphyslip.2011.12.002. Epub 2011 Dec 14.
Minimally invasive image-guided tumor ablation using short duration heating via needle-like applicators using energies such as radiofrequency or microwave has seen increasing clinical use to treat focal liver, renal, breast, bone, and lung tumors. Potential benefits of this thermal therapy include reduced morbidity and mortality compared to standard surgical resection and ability to treat non-surgical patients. However, improvements to this technique are required as achieving complete ablation in many cases can be challenging particularly at margins of tumors>3 cm in diameter and adjacent to blood vessels. Thus, one very promising strategy has been to combine thermal tumor ablation with adjuvant nanoparticle-based chemotherapy agents to improve efficiency. Here, we will primarily review principles of thermal ablation to provide a framework for understanding the mechanisms of combination therapy, and review the studies on combination therapy, including presenting preliminary data on the role of such variables as nanoparticle size and thermal dose on improving combination therapy outcome. We will discuss how thermal ablation can also be used to improve overall intratumoral drug accumulation and nanoparticle content release. Finally, in this article we will further describe the appealing off-shoot approach of utilizing thermal ablation techniques not as the primary treatment, but rather, as a means to improve efficiency of intratumoral nanoparticle drug delivery.
使用射频或微波等能量的针状器械进行微创影像引导肿瘤消融，通过短时间加热，已越来越多地用于治疗肝脏、肾脏、乳腺、骨骼和肺部的局部肿瘤。与标准手术切除相比，这种热疗的潜在益处包括降低发病率和死亡率，以及能够治疗不能手术的患者。然而，需要改进这项技术，因为在许多情况下，实现完全消融具有挑战性，特别是在直径>3 厘米的肿瘤边缘和紧邻血管处。因此，一种非常有前途的策略是将热肿瘤消融与基于纳米颗粒的辅助化疗药物联合使用以提高效率。在这里，我们将主要回顾热消融的原理，为理解联合治疗的机制提供一个框架，并回顾联合治疗的研究，包括介绍纳米颗粒大小和热剂量等变量在改善联合治疗效果方面的初步数据。我们将讨论热消融如何也可用于提高肿瘤内药物的总体积累和纳米颗粒的内容物释放。最后，在本文中，我们将进一步描述利用热消融技术的另一种有吸引力的分支方法，不是作为主要治疗方法，而是作为提高肿瘤内纳米颗粒药物输送效率的手段。
