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  • Opinion
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Thermal ablation of tumours: biological mechanisms and advances in therapy

Nature Reviews Cancer volume 14, pages 199–208 (2014)Cite this article

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Abstract

Minimally invasive thermal ablation of tumours has become common since the advent of modern imaging. From the ablation of small, unresectable tumours to experimental therapies, percutaneous radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation have an increasing role in the treatment of solid neoplasms. This Opinion article examines the mechanisms of tumour cell death that are induced by the most common thermoablative techniques and discusses the rapidly developing areas of research in the field, including combinatorial ablation and immunotherapy, synergy with conventional chemotherapy and radiation, and the development of a new ablation modality in irreversible electroporation.

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Figure 1
Figure 2: The zones of hyperthermic ablation.
Figure 3: Mechanisms of cell death in cryoablation.
Figure 4: Potential immunotherapy targets that could be combined with ablation.

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Authors and Affiliations

  1. The Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, 02903, Rhode Island, USA

    Katrina F. Chu & Damian E. Dupuy

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  1. Katrina F. Chu
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  2. Damian E. Dupuy
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Correspondence to Damian E. Dupuy.

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Competing interests

Grant Support from NeuWave Medical, Madison, Wisconsin, USA (D.E.D.). Consultant for BSD Medical, Salt Lake City, Utah, USA, and Covidien, Boulder Colorado (D.E.D.). Board of directors for BSD Medical (D.E.D.). K.F.C. declares no competing interests.

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Glossary

Acoustic energy

The energy that is generated by sound waves or oscillations in pressure.

Anergy

A form of T cell or B cell inactivation in which the cell remains alive but cannot be activated to execute an immune response. Anergy is a reversible state.

Brachytherapy

The implantation of radioactive pellets, which are approximately the size of a grain of rice, into the tissue that is being treated for cancer.

Clonal deletion

Elimination of T cells or B cells that have a high avidity for self antigens, either by negative selection during lymphocyte development or by FAS ligand-mediated destruction in the peripheral blood.

Coagulative necrosis

A form of tissue necrosis in which injury denatures structural proteins and enzymes, thereby prohibiting proteolysis of dead cells. Tissue architecture is preserved for days and necrotic debris is ultimately removed by infiltrating leukocytes.

Impedance

The effective resistance of an electric circuit.

Ischaemia

A reduced or lack of blood flow.

Lipiodol

Iodized poppyseed oil, which has been used for more than a century as a radiographic contrast agent.

Nitrosative stress

Inflammation and damage caused by reactive nitrogen species.

Pathogen-associated molecular pattern

(PAMP). A highly conserved structural motif that is commonly found on microorganisms. PAMPs include sugars, proteins, lipids and nucleic acids that are all recognized by the innate immune system.

Percutaneous

Pertaining to a procedure that is carried out through the skin.

Regulatory T cells

(TReg cells). A subset of T cells that display CD25 and that can inhibit CD4+ and CD8+ T cells. TReg cells express the transcription regulator forkhead box protein P3 (FOXP3), the lack of which predisposes to autoimmune diseases.

Three-dimensional radiotherapy

The application of radiation beams that are shaped to match the tumour to more precisely target it.

Transarterial chemoembolization

A procedure whereby chemotherapy is injected directly into the arterial supply of the tumour, and embolic agents are administered that cut off its blood supply.

Trocar-type probes

Surgical instruments with a three-sided cutting point enclosed in a hollow cylinder that is used to place other devices into the blood vessel or body cavity that it enters.

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Chu, K., Dupuy, D. Thermal ablation of tumours: biological mechanisms and advances in therapy. Nat Rev Cancer 14, 199–208 (2014). https://doi.org/10.1038/nrc3672

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