MR-Guided Ablation of Prostate Cancer Recurrences: Laser and Cryoablation.

1
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

2
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.

3
Surgery
4
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.

5
Why MRI Lesion Conspicuity

• Better Lesion Conspicuity
• Multiplanar imaging
• Better Lesion Visualization Translates into More
  Precise Ablation and Better Treatment Outcomes

6
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

7
MRI Guided Laser Ablation

• Visualase Laser Ablation System

8
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

9
Laser Ablation Procedure

1. Localize Tumor
2. Place applicators
3. Apply Laser Heat
4. Evaluate Ablation

10
MRI Guided Cryoablation

• Galil Cryoablation System

11
Joule Thompson Effect
Orifice
Heat Exchanger
Argon
Helium
70C
-183C
12
Cryoablation Procedure

1. Localize Tumor
2. Place probes
3. Freeze x2
4. Evaluate Ablation

13
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.