Second, it is guided with MRI-ultrasound fusion and organ-based tracking, allowing accurate ablation planning as well as real-time guidance to comprehensively adapt successive ablations to cover tumor volume and treatment margins.
At this stage, four pilot studies have been performed on small groups of patients, showing that TMA is feasible and safe.1-4 The VIOLETTE trial is a multicentric European trial aiming to evaluate oncological results on biopsy at 1 year. It has included 76 patients, and final results will be available at the end of this year.
Preoperative prostate MRI (A) loaded in the planning and guidance software, showing the tumor contours with treatment margins. A first microwave ablation (B) is performed at 12W during 5 minutes, covering the medial part of the tumor transversally. The software shows the expected ablated area. A second ablation (C) allows to cover the totality of tumor and treatment margins. MRI performed 7 days later confirms complete ablation, with avascular area on dynamic contrast enhanced T1 sequences.
Written by: Professor Nicolas Barry Delongchamps, Service d’urologie, hôpital Cochin, Paris, France
References:
- Barry Delongchamps N, Schull A, Anract J, Abecassis JP, Zerbib M, Sibony M, Jilet L, Abdoul H, Goffin V, Peyromaure M. Feasibility and safety of targeted focal microwave ablation of the index tumor in patients with low to intermediate risk prostate cancer: Results of the FOSTINE trial. PLoS One. 2021 Jul 14;16(7): e0252040.
- Peltier A, van Velthoven R, Baudewyns A, Assenmacher G, Lemort M, Lefebvre Y, Sirtaine N, Diamand R. Targeted microwave ablation for prostate cancer (FOSTINE1b): a prospective 'ablate-and-resect' study. BJU Int. 2024 May 14. doi: 10.1111/bju.16385. Online ahead of print.
- Chiu PK, Chan CH, Yee CH, Lau SY, Teoh JY, Wong HF, Lo KL, Yuen TY, Hung HY, Cho CC, Ng CF. Transperineal Targeted Microwave Ablation (TMA) of localized prostate cancer guided by MRI-Ultrasound fusion and organ-based tracking: a pilot study. Prostate Cancer Prostatic Dis. 2022 Jul 14. doi: 10.1038/s41391-022-00577-8. Online ahead of print.
- Oderda M, Marquis A, Calleris G, D'Agate D, Faletti R, Gatti M, Marra G, Gontero P. Safety and Feasibility of Transperineal Targeted Microwave Ablation for Low- to Intermediate-risk Prostate Cancer. Eur Urol Open Sci. 2022 Oct 22; 46:3-7.