5 ms·

This is a really neat and elegant study. All they're missing is a long-term survival curve. You're probably wondering what the catch is if you haven't spotted

This is a really neat and elegant study. All they're missing is a long-term survival curve. You're probably wondering what the catch is if you haven't spotted it yet. Ethanol ablation is usually used for carcinomas of the liver, although it sometimes sees use in some very rare cancers. So, this falls under the "extremely effective but with limited application" category. That doesn't mean it doesn't have great value, but you also don't want folk to think it's a "lethal injection for all tumours".

hanklazard 9y ago
Right. And would not be useful for tumors with poor accessibility for injection, small multifocal tumors or those with small mets, or tumors of the blood. Still, plenty of early stage cancers involve a single accessible mass and I could imagine this technique being safer and easier than full excision in some cases. This is elegant and, importantly, should be inexpensive (vs the many personalized therapies being developed)
Pica_soO 9y ago
The unique thing about this approach was that is is a gel- not being limited to encapsulated tumors?
- jszymborski 9y ago
  This article is just a proof-of-concept, and unfortunately we can't make the claim that this means we can effectively use EtOH+Gel to treat tumours that are not encapsulated; particularly because it isn't clear to me whether the cancer model used is a good model of those "hard-to-treat-w/-EtOH-ablation" cancers. There is also a very honest list of caveats in the discussion, "Although we have demonstrated the efficacy of enhanced ethanol ablation in the treatment of squamous cell carcinomas in the hamster cheek pouch, there are several limitations to this study. First, the use of a chemically-induced tumor model (in which spontaneous tumors arising in sites adjacent to a treated site would be indistinguishable from the original tumor) precluded the possibility of any long-term monitoring of tumor recurrence. Second, a single animal tumor model was utilized. Further study in other tumor models is needed to investigate such recurrence, and demonstrate therapeutic efficacy more broadly. Since this study was a proof-of-concept, sample sizes were relatively low. Although other studies have shown systemic safety of ethanol ablation in a variety of applications, more research is needed to investigate the possibility of damage to surrounding tissue. Leakage of ethanol and nearby necrosis should be minimized, and details may be specific to tumor types. Although ethyl cellulose-ethanol has been used in the treatment of venous malformations, further safety evaluations of injections to tumors are clearly necessary. The ethanol-ethyl cellulose-water system has shown promise; but its more complete characterization will inform optimization. For example, better understand- ing of physicochemical details of the sol-gel transition, e.g. involving pressure and temperature, will benefit from improved discrimination between the sol and gel phases. The mechanical phantoms proved helpful in this initial study. Follow up use of them can improve details of their poroelastic structures and properties, and thus improve their role in the design process for enhanced ethanol ablation."

hanklazard 9y ago

Right. And would not be useful for tumors with poor accessibility for injection, small multifocal tumors or those with small mets, or tumors of the blood. Still, plenty of early stage cancers involve a single accessible mass and I could imagine this technique being safer and easier than full excision in some cases. This is elegant and, importantly, should be inexpensive (vs the many personalized therapies being developed)

Pica_soO 9y ago

The unique thing about this approach was that is is a gel- not being limited to encapsulated tumors?

jszymborski 9y ago
This article is just a proof-of-concept, and unfortunately we can't make the claim that this means we can effectively use EtOH+Gel to treat tumours that are not encapsulated; particularly because it isn't clear to me whether the cancer model used is a good model of those "hard-to-treat-w/-EtOH-ablation" cancers. There is also a very honest list of caveats in the discussion, "Although we have demonstrated the efficacy of enhanced ethanol ablation in the treatment of squamous cell carcinomas in the hamster cheek pouch, there are several limitations to this study. First, the use of a chemically-induced tumor model (in which spontaneous tumors arising in sites adjacent to a treated site would be indistinguishable from the original tumor) precluded the possibility of any long-term monitoring of tumor recurrence. Second, a single animal tumor model was utilized. Further study in other tumor models is needed to investigate such recurrence, and demonstrate therapeutic efficacy more broadly. Since this study was a proof-of-concept, sample sizes were relatively low. Although other studies have shown systemic safety of ethanol ablation in a variety of applications, more research is needed to investigate the possibility of damage to surrounding tissue. Leakage of ethanol and nearby necrosis should be minimized, and details may be specific to tumor types. Although ethyl cellulose-ethanol has been used in the treatment of venous malformations, further safety evaluations of injections to tumors are clearly necessary. The ethanol-ethyl cellulose-water system has shown promise; but its more complete characterization will inform optimization. For example, better understand- ing of physicochemical details of the sol-gel transition, e.g. involving pressure and temperature, will benefit from improved discrimination between the sol and gel phases. The mechanical phantoms proved helpful in this initial study. Follow up use of them can improve details of their poroelastic structures and properties, and thus improve their role in the design process for enhanced ethanol ablation."