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Ahmed, Muneeb; Moussa, Marwan; Goldberg, S. Nahum
Chemistry and physics of lipids, 05/2012, Volume: 165, Issue: 4Journal Article
► Combining image-guided thermal ablation with nanoparticle-based chemotherapy increases tumor destruction and intratumoral drug accumulation. ► Strategies to further improve treatment efficacy include optimization of the nanoparticle delivery vehicle and ablation parameters. ► Using additional agents to target specific hyperthermia-related cellular stress pathways are likely to provide additional benefit. ► Incorporation of ablation techniques as adjuvants to improve effects of primary nanoparticle based chemotherapies will also likely prove to be clinically relevant. Minimally invasive image-guided tumor ablation using short duration heating via needle-like applicators using energies such as radiofrequency or microwave has seen increasing clinical use to treat focal liver, renal, breast, bone, and lung tumors. Potential benefits of this thermal therapy include reduced morbidity and mortality compared to standard surgical resection and ability to treat non-surgical patients. However, improvements to this technique are required as achieving complete ablation in many cases can be challenging particularly at margins of tumors>3cm in diameter and adjacent to blood vessels. Thus, one very promising strategy has been to combine thermal tumor ablation with adjuvant nanoparticle-based chemotherapy agents to improve efficiency. Here, we will primarily review principles of thermal ablation to provide a framework for understanding the mechanisms of combination therapy, and review the studies on combination therapy, including presenting preliminary data on the role of such variables as nanoparticle size and thermal dose on improving combination therapy outcome. We will discuss how thermal ablation can also be used to improve overall intratumoral drug accumulation and nanoparticle content release. Finally, in this article we will further describe the appealing off-shoot approach of utilizing thermal ablation techniques not as the primary treatment, but rather, as a means to improve efficiency of intratumoral nanoparticle drug delivery.
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