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- May 7, 2012
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I've been reading a lot about RFA and its cousin, IRE, and I'm now wondering why it hasn't completely replaced surgical resection for solid tumor patients (other than brain tumors, because it doesn't relieve mass effect).
Based on what I've been reading in journals, a patient with a tumor > 5 cm could have DEB-TACE or SIRT to shrink the tumor until it's amenable to RFA or IRE, all the while taking sorafenib.
One could take a percutaneous tru-cut biopsy of the ablation margins to confirm success intraoperatively, and follow that up with a PET scan.
Another thing I was reading was about the 5-aminofluorescein-albumin dye neurosurgeons use for contrast while resecting gliomas, since they take up massive amounts of albumin. I wonder why anyone hasn't tried to conjugate Y-90 to albumin, and use that to internally irradiate the glioma? .
Another interesting thing: since oxygen is a radiosensitizer, perhaps mixing the SIRT microspheres with perfluorocarbon polymer would increase their effect, since perfluorocarbons can transport huge amounts of oxygen.
And I was reading a few articles on clostridial oncolysis. Apparently, since tumors are hypoxic, and Clostridium spp. are obligate anaerobes, they can, and have been shown to, specifically lyse tumors. And there is this Clostridium oncolyticum species that doesn't produce the dangerous alpha-toxin, and is essentially apathogenic. So perhaps embolizing a tumor with a mixture of clostridial spores and acrylic microspheres to permanently occlude the feeding vessels, thus making the tumor even more hypoxic, could be useful. Perhaps adding the cytosine deaminase gene to the bacteria, and also giving capecitabine would increase the effect.
Obviously periop allopurinol and IV fluids are a must in IO practice, in case of TLS.
I'm just an undergrad now, but I love reading about medicine, especially radiology, specifically nuclear and interventional. I wish I could become a member of RSNA; I'd love to attend one the annual meetings. I'm already a member of SNM. Hopefully during my senior undergrad immunology project I can contribute in some small way to advancing the field. Maybe make a novel tracer or something. Leeds has a medphys and molecular imaging department, so I could make the antibody, link it to DOTA-chelated Tc-99m, and then test it out in a mouse model.
Based on what I've been reading in journals, a patient with a tumor > 5 cm could have DEB-TACE or SIRT to shrink the tumor until it's amenable to RFA or IRE, all the while taking sorafenib.
One could take a percutaneous tru-cut biopsy of the ablation margins to confirm success intraoperatively, and follow that up with a PET scan.
Another thing I was reading was about the 5-aminofluorescein-albumin dye neurosurgeons use for contrast while resecting gliomas, since they take up massive amounts of albumin. I wonder why anyone hasn't tried to conjugate Y-90 to albumin, and use that to internally irradiate the glioma? .
Another interesting thing: since oxygen is a radiosensitizer, perhaps mixing the SIRT microspheres with perfluorocarbon polymer would increase their effect, since perfluorocarbons can transport huge amounts of oxygen.
And I was reading a few articles on clostridial oncolysis. Apparently, since tumors are hypoxic, and Clostridium spp. are obligate anaerobes, they can, and have been shown to, specifically lyse tumors. And there is this Clostridium oncolyticum species that doesn't produce the dangerous alpha-toxin, and is essentially apathogenic. So perhaps embolizing a tumor with a mixture of clostridial spores and acrylic microspheres to permanently occlude the feeding vessels, thus making the tumor even more hypoxic, could be useful. Perhaps adding the cytosine deaminase gene to the bacteria, and also giving capecitabine would increase the effect.
Obviously periop allopurinol and IV fluids are a must in IO practice, in case of TLS.
I'm just an undergrad now, but I love reading about medicine, especially radiology, specifically nuclear and interventional. I wish I could become a member of RSNA; I'd love to attend one the annual meetings. I'm already a member of SNM. Hopefully during my senior undergrad immunology project I can contribute in some small way to advancing the field. Maybe make a novel tracer or something. Leeds has a medphys and molecular imaging department, so I could make the antibody, link it to DOTA-chelated Tc-99m, and then test it out in a mouse model.