Pedro Moreira1, Kemal Tuncali2, Clare M Tempany2, Junichi Tokuda2. 1. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA. Electronic address: plopesdafrotamoreira@bwh.harvard.edu. 2. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St. Boston, 02115 Massachusetts, USA.
Abstract
RATIONALE AND OBJECTIVES: There have been multiple investigations defining and reporting the effectiveness of focal cryoablation as a treatment option for organ-confined prostate cancer. However, the impact of cryo-needle/probe placement accuracy within the tumor and gland has not been extensively studied. We analyzed how variations in the placement of the cryo-needles, specifically errors leading to incomplete ablation, may affect prostate cancer's resulting cryoablation. MATERIALS AND METHODS: We performed a study based on isothermal models using Monte Carlo simulations to analyze the impact of needle placement errors on tumor coverage and the probability of positive ablation margin. We modeled the placement error as a Gaussian noise on the cryo-needle position. The analysis used retrospective MRI data of 15 patients with biopsy-proven, unifocal, and MRI visible prostate cancer to calculate the impact of placement error on the volume of the tumor encompassed by the -40°C and -20°C isotherms using one to four cryo-needles. RESULTS: When the standard deviation of the placement error reached 3 mm, the tumor coverage was still above 97% with the -20°C isotherm, and above 81% with the -40°C isotherm using two cryo-needles or more. The probability of positive margin was significantly lower considering the -20°C isotherm (0.04 for three needles) than using the -40°C isotherm (0.66 for three needles). CONCLUSION: The results indicated that accurate cryo-needle placement is essential for the success of focal cryoablation of prostate cancer. The analysis shows that an admissible targeting error depends on the lethal temperature considered and the number of cryo-needles used.
RATIONALE AND OBJECTIVES: There have been multiple investigations defining and reporting the effectiveness of focal cryoablation as a treatment option for organ-confined prostate cancer. However, the impact of cryo-needle/probe placement accuracy within the tumor and gland has not been extensively studied. We analyzed how variations in the placement of the cryo-needles, specifically errors leading to incomplete ablation, may affect prostate cancer's resulting cryoablation. MATERIALS AND METHODS: We performed a study based on isothermal models using Monte Carlo simulations to analyze the impact of needle placement errors on tumor coverage and the probability of positive ablation margin. We modeled the placement error as a Gaussian noise on the cryo-needle position. The analysis used retrospective MRI data of 15 patients with biopsy-proven, unifocal, and MRI visible prostate cancer to calculate the impact of placement error on the volume of the tumor encompassed by the -40°C and -20°C isotherms using one to four cryo-needles. RESULTS: When the standard deviation of the placement error reached 3 mm, the tumor coverage was still above 97% with the -20°C isotherm, and above 81% with the -40°C isotherm using two cryo-needles or more. The probability of positive margin was significantly lower considering the -20°C isotherm (0.04 for three needles) than using the -40°C isotherm (0.66 for three needles). CONCLUSION: The results indicated that accurate cryo-needle placement is essential for the success of focal cryoablation of prostate cancer. The analysis shows that an admissible targeting error depends on the lethal temperature considered and the number of cryo-needles used.
Authors: Pedro Moreira; Niravkumar Patel; Marek Wartenberg; Gang Li; Kemal Tuncali; Tamas Heffter; Everette C Burdette; Iulian Iordachita; Gregory S Fischer; Nobuhiko Hata; Clare M Tempany; Junichi Tokuda Journal: Phys Med Biol Date: 2018-10-16 Impact factor: 3.609
Authors: Nicola L Robertson; Yipeng Hu; Hashim U Ahmed; Alex Freeman; Dean Barratt; Mark Emberton Journal: Eur Urol Date: 2013-01-03 Impact factor: 20.096
Authors: Kimberly L Santucci; John M Baust; Kristi K Snyder; Robert G Van Buskirk; John G Baust Journal: Cancer Control Date: 2018 Jan-Mar Impact factor: 3.302