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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.

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mr guided ablation of prostate cancer recurrences laser and cryoablation
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
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.
background4
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.
slide5

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

Visualase Laser Ablation System

980nm Laser Fiber

Heats the tissue cooking the tumor

Ablates = Freezing

Galil Cryoablation System

Uses Argon gas through a small needle

Creates an iceball around the tumor

Two MRI Compatible Systems Used
mri guided laser ablation

MRI Guided Laser Ablation

Visualase Laser Ablation System

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

laser ablation procedure

Live MRI Temperature Imaging

Post-Ablation Contrast Imaging

Dynamic Contrast Enhancement

Calculated Ablation Zone

Precontrast MRI Localizing Tumor

Laser Ablation Procedure
  • Localize Tumor
  • Place applicators
  • Apply Laser Heat
  • Evaluate Ablation
mri guided cryoablation

MRI Guided Cryoablation

Galil Cryoablation System

joule thompson effect
Joule Thompson Effect

Orifice

Heat Exchanger

Argon

Helium

-183°C

+70°C

cryoablation procedure

Contrast Enhanced MRI

Probe Placement From a Suprapubic Approach

Localize Tumor

Place probes

Freeze x2

Evaluate Ablation

Post-Ablation Contrast Enhanced MRI

Iceball Size after 11 minutes of Freezing

Cryoablation Procedure
conclusions
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.