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P64
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS Registry query for patients with extrahepatic cholangiocarcinoma yielded 724 individuals after excluding patients with incomplete information. The number of lymph nodes examined, number of positive lymph nodes, and the ratio of positive to examined LN were analyzed using the log rank test and Kaplan-Meier survival analysis. Results: The number of lymph nodes harvested has an effect on prognosis with overall survival (OS) decreasing markedly with less lymph nodes being examined. (p ⫽ 0.0013, Figure 1) 5 year survival in the highest quartile of nodes examined was 20% while only 9% for the lowest quartile. As expected, the detection of even one positive lymph node in the resection significantly decreases OS (p ⫽ 0.0393) with 5 year survival decreasing from 25% to 0%. An increasing number of positive lymph nodes, however, does not appear to have an effect on OS. (p ⫽ NS, Figure2) Lymph node ratio (LNR) is the number of positive lymph nodes divided by the total number of nodes examined. LNR is an important prognostic factor for OS in extrahepatic cholangiocarcinoma in patient’s with positive lymph nodes. (p ⫽ 0.0026, Figure 3) Five year survival for the quartile with the lowest ratio was 20% while 0% for the quartile with the highest ratio. Conclusions: More extensive lymph node resection and/or pathologic evaluation is associated with improved OS in extrahepatic cholangiocarcinoma. Lymph node postivity affects OS, but the number of positive lymph nodes greater than one does not have prognostic significance. LNR, like the number of lymph nodes examined, has prognostic significance for OS, but less so than number of examined lymph nodes.
P64. PILOT INVESTIGATION OF A NEW INSTRUMENT FOR NON-INVASIVE RADIOFREQUENCY ABLATION OF CANCER. J. R. Klune 1, G. Jeyabalan 1, E. S. Chory 1, J. Kanzius 2, D. A. Geller 1; 1University of Pittsburgh, Pittsburgh, PA, 2 Therm Med LLC, Erie, PA Introduction: Radiofrequency ablation (RFA) is a minimallyinvasive therapeutic option for liver, kidney, breast, and other cancers. Adequate tumor destruction with current RFA technology requires tissue heating to approximately 50° Celsius(C). Current technology is limited by operative risk, tumor size (⬃ 5 cm), and the need for image-guided invasive RFA probe placement. The purpose of this study was to develop and test a novel non-invasive radiowave machine that uses radiowaves to thermally destroy tissue without the need for needle electrode placement. Methods: An instrument consisting of a power generator (1-1000 Watts), a transmitting head, and a receiving head was designed and built for use in this project. Radiowaves are sent from the external transmitting head to the receiver across a field at 13.6 MHz. Metallic enhancer solutions (Fe, Mg, and CuSO4) were prepared at concentrations ranging from 5 to 500 uM. Temperatures were measured using a fiber-optic thermometer for real-time data. Initial studies were performed on solutions, followed by heating of cultured cells, and then in vivo rat tissue, placed between the transmitting and receiving heads. In vitro cell viability testing was performed using LDH and crystal violet assays. Results: Copper sulfate CuSO 4 enhancer solutions demonstrated the greatest temperature increases within the field compared to MgSO 4, FeSO 4, or normal saline (NSS) (data not shown). CuSO 4 produced a dose-dependent rise in temp. at concentrations ranging from 5 uM to 500 uM at 200W power compared to NSS injection (table). Incubating primary hepatocytes with 50 uM CuSO 4 for up to 2 hours did not result in significant cell death compared to control cells. Primary hepatocytes placed in the field for short time periods (4 min.) with 50 uM CuSO 4 at 100W and 400W demonstrated adequate heating with significant cell death occurring at higher temperatures. In vivo rat experiments using CuSO 4 tissue injection and field exposure at 200W resulted in a 200% greater temperature increase at the flank muscle injection site compared with control NSS-injected animals. At 24 hours post-exposure, there were no significant increases in circulating ALT, LDH, or CPK levels. Exam of the thermally targeted injection site showed localized tissue necrosis and neutro-
263
phil accumulation on H&E staining. Discussion: This novel noninvasive radiowave technology achieves localized heating of enhancer solutions efficiently in relatively short periods and at low power outputs. Exposure to the radiowave field produced in vitro cell death as well as in vivo tissue destruction when metal ion enhancer solutions were utilized. Future work will focus on specific tumor destruction with tagged enhancer solutions and targeting of in vivo tumors.
Table 1 Enhancer heating Enhancer
[uM]
CuS04 50 CuS04 50 CuS04 250 CuS04 500 Normal Saline 0.9%
Power (W)
Time (min)
Solution T 0C
0 200 200 200 200
0 5 5 5 15
25 (rm.T) 43 95 101 40
P65. COMBINED RADIOFREQUENCY ABLATION AND TRANSARTERIAL CHEMOEMBOLIZATION FOR UNRESECTABLE COLORECTAL HEPATIC METASTASES. E. L. Rosato, II, F. Palazzo, J. Weinstein, K. Chojnacki, D. Eschelman, L. Needleman; Thomas Jefferson University, Phila, PA Introduction: Hepatic metastases develop in approximately 50% of all patients diagnosed with colon cancer. Approximately 5-15% of patients are candidates for resection which results in 5 year survival in 30-50% of resected patients. Systemic chemotherapy, transarterial chemoembolization (TACE), and radiofrequency ablation (RFA) are utilized in the treatment of unresectable hepatic metastases. Few centers have reported their experience with combined treatment regimens. Methods: We retrospectively reviewed our experience with combined RFA and TACE (adriamycin,cisplatin,mitomycin C) in the management of unresectable colorectal hepatic metastases. Hospital records and a prospective hepatic tumor database were reviewed to obtain patient demographics, tumor characteristics, surgical morbidity and mortality.Survival was determined by the Kaplan-Maier statistical method. Results: Twenty-three patients with unresectable colorectal hepatic metastases were treated with TACE and RFA between 1996 and 2005. RFA was performed prior to TACE in 11 patients and after TACE in 12 patients.There were 13 females and 10 males. Mean age was 68.6 years(range4881).There were no procedure related mortalities. Two patients developed hepatic abscesses. Median,2-year, and 5-year survival were 49 months, 86%, and 20% respectively. Median follow- up was 20 months.Average length of stay was 2 days. Conclusions: RFA and TACE can be combined safely to treat colorectal liver metastases. Five- year survival was observed in 20% of patients. P66. AN INTEGRATED BIOSPECIMEN BANK AND MULTIDISCIPLINARY CLINICAL DATABASE FOR PANCREATIC CANCER. R. F. Hwang, H. Wang, A. Lara, H. Gomez, K. Pomes, T. Chang, J. L. Abbruzzese, D. B. Evans; Univ. of Texas-M.D. Anderson Cancer Center, Houston, TX Background: There is an urgent need to develop more effective therapies for patients with pancreatic cancer. Recent advances in molecular medicine necessitate a reliable source of biospecimens and the availability of an annotated clinical database to enable the development of novel therapies. However, such tools exist in few institutions because of the increasing complexity of regulations protecting patient confidentiality, the declining funding to support research, and the limited availability of pancreatic cancer tissue. We report on the development of a reliable biospecimen bank for patients with pancreatic disorders with the integration of clinical information established by our multidisciplinary pancreas tumor research group.
P64. PILOT INVESTIGATION OF A NEW INSTRUMENT FOR NON-INVASIVE RADIOFREQUENCY ABLATION OF CANCER. J. R. Klune 1, G. Jeyabalan 1, E. S. Chory 1, J. Kanzius 2, D. A. Geller 1; 1University of Pittsburgh, Pittsburgh, PA, 2 Therm Med LLC, Erie, PA Introduction: Radiofrequency ablation (RFA) is a minimallyinvasive therapeutic option for liver, kidney, breast, and other cancers. Adequate tumor destruction with current RFA technology requires tissue heating to approximately 50° Celsius(C). Current technology is limited by operative risk, tumor size (⬃ 5 cm), and the need for image-guided invasive RFA probe placement. The purpose of this study was to develop and test a novel non-invasive radiowave machine that uses radiowaves to thermally destroy tissue without the need for needle electrode placement. Methods: An instrument consisting of a power generator (1-1000 Watts), a transmitting head, and a receiving head was designed and built for use in this project. Radiowaves are sent from the external transmitting head to the receiver across a field at 13.6 MHz. Metallic enhancer solutions (Fe, Mg, and CuSO4) were prepared at concentrations ranging from 5 to 500 uM. Temperatures were measured using a fiber-optic thermometer for real-time data. Initial studies were performed on solutions, followed by heating of cultured cells, and then in vivo rat tissue, placed between the transmitting and receiving heads. In vitro cell viability testing was performed using LDH and crystal violet assays. Results: Copper sulfate CuSO 4 enhancer solutions demonstrated the greatest temperature increases within the field compared to MgSO 4, FeSO 4, or normal saline (NSS) (data not shown). CuSO 4 produced a dose-dependent rise in temp. at concentrations ranging from 5 uM to 500 uM at 200W power compared to NSS injection (table). Incubating primary hepatocytes with 50 uM CuSO 4 for up to 2 hours did not result in significant cell death compared to control cells. Primary hepatocytes placed in the field for short time periods (4 min.) with 50 uM CuSO 4 at 100W and 400W demonstrated adequate heating with significant cell death occurring at higher temperatures. In vivo rat experiments using CuSO 4 tissue injection and field exposure at 200W resulted in a 200% greater temperature increase at the flank muscle injection site compared with control NSS-injected animals. At 24 hours post-exposure, there were no significant increases in circulating ALT, LDH, or CPK levels. Exam of the thermally targeted injection site showed localized tissue necrosis and neutro-
263
phil accumulation on H&E staining. Discussion: This novel noninvasive radiowave technology achieves localized heating of enhancer solutions efficiently in relatively short periods and at low power outputs. Exposure to the radiowave field produced in vitro cell death as well as in vivo tissue destruction when metal ion enhancer solutions were utilized. Future work will focus on specific tumor destruction with tagged enhancer solutions and targeting of in vivo tumors.
Table 1 Enhancer heating Enhancer
[uM]
CuS04 50 CuS04 50 CuS04 250 CuS04 500 Normal Saline 0.9%
Power (W)
Time (min)
Solution T 0C
0 200 200 200 200
0 5 5 5 15
25 (rm.T) 43 95 101 40
P65. COMBINED RADIOFREQUENCY ABLATION AND TRANSARTERIAL CHEMOEMBOLIZATION FOR UNRESECTABLE COLORECTAL HEPATIC METASTASES. E. L. Rosato, II, F. Palazzo, J. Weinstein, K. Chojnacki, D. Eschelman, L. Needleman; Thomas Jefferson University, Phila, PA Introduction: Hepatic metastases develop in approximately 50% of all patients diagnosed with colon cancer. Approximately 5-15% of patients are candidates for resection which results in 5 year survival in 30-50% of resected patients. Systemic chemotherapy, transarterial chemoembolization (TACE), and radiofrequency ablation (RFA) are utilized in the treatment of unresectable hepatic metastases. Few centers have reported their experience with combined treatment regimens. Methods: We retrospectively reviewed our experience with combined RFA and TACE (adriamycin,cisplatin,mitomycin C) in the management of unresectable colorectal hepatic metastases. Hospital records and a prospective hepatic tumor database were reviewed to obtain patient demographics, tumor characteristics, surgical morbidity and mortality.Survival was determined by the Kaplan-Maier statistical method. Results: Twenty-three patients with unresectable colorectal hepatic metastases were treated with TACE and RFA between 1996 and 2005. RFA was performed prior to TACE in 11 patients and after TACE in 12 patients.There were 13 females and 10 males. Mean age was 68.6 years(range4881).There were no procedure related mortalities. Two patients developed hepatic abscesses. Median,2-year, and 5-year survival were 49 months, 86%, and 20% respectively. Median follow- up was 20 months.Average length of stay was 2 days. Conclusions: RFA and TACE can be combined safely to treat colorectal liver metastases. Five- year survival was observed in 20% of patients. P66. AN INTEGRATED BIOSPECIMEN BANK AND MULTIDISCIPLINARY CLINICAL DATABASE FOR PANCREATIC CANCER. R. F. Hwang, H. Wang, A. Lara, H. Gomez, K. Pomes, T. Chang, J. L. Abbruzzese, D. B. Evans; Univ. of Texas-M.D. Anderson Cancer Center, Houston, TX Background: There is an urgent need to develop more effective therapies for patients with pancreatic cancer. Recent advances in molecular medicine necessitate a reliable source of biospecimens and the availability of an annotated clinical database to enable the development of novel therapies. However, such tools exist in few institutions because of the increasing complexity of regulations protecting patient confidentiality, the declining funding to support research, and the limited availability of pancreatic cancer tissue. We report on the development of a reliable biospecimen bank for patients with pancreatic disorders with the integration of clinical information established by our multidisciplinary pancreas tumor research group.