Tissue ablation is predominantly cancer therapy

Tissue ablation is defined as the “removal of a body part or the destruction of its function, as by surgery, disease, or a noxious substance.” Put more simply, ablation is considered to be a therapeutic destruction and sealing of tissue.

The technologies representing the majority of physical (rather than chemical) ablation are comprised of the following:

  • Electrical
  • Radiation
  • Light
  • Radiofrequency
  • Ultrasound
  • Cryotherapy
  • Thermal (other than cryotherapy)
  • Microwave
  • Hydromechanical

Source: Report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."

The largest share of the market for energy-based ablation devices is used in cancer therapy, primarily using the radiation therapy modality. Following that is general surgery with its use of electrocautery and electrosurgical devices, RF ablation, cryotherapy, etc. Cardiovascular is thought to be third, even though cardiovascular is making the most noise in the medical press with RF and cryoablation of atrial fibrillation, this segment is thought to be third in share order. The remaining applications are relatively small and fall in line behind the three leading sectors.

Growth in the Asia/Pacific Market for Ablation Technologies

 

The Asia-Pacific market for ablation technologies looks quite different from the Americas and European Union. Here, at present, the largest market is Japan, which accounts for the majority of the market, although by population and current growth rates, the People’s Republic of China has the greatest potential. Its greater than 1.3 billion population and, more importantly, the healthcare infrastructure that the government is putting into place ensure that China will continue to comprise an ever greater share of this market.

Asia-pacific-ablation

Data in the exhibit is drawn from MedMarket Diligence report #A145, "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities."

 

 

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Shifting caseload and markets in tissue ablation

Technologies to therapeutically ablate tissue (via destruction and/or removal of abnormal tissue or creation of a therapeutic lesion as in blocking errant electrical pathways in arrhythmia) represent a remarkably diverse set of tools despite their fundamentally common capability of tissue ablation.

Spanning electrical, radiation, light/laser, radiofrequency, ultrasound, cryotherapy, thermal therapy, microwave and hydromechanical and embodied in a wide range of medical devices and equipment, all ablation types simply destroy tissue.  The differences lie in respect to the specificity of each modality in targeting disease tissue and in respect to their capacity to be integrated in different types of instruments that may match the demands of specific clinical practices.

The recent history of ablation technology market developments reveals that, despite the specialization of modalities to specific tissues, or the efforts by manufacturers to carve out clinician or disease-state niches for specific modalities, growth in different ablation procedure types and clinical practice patterns has changed steadily but not always predictably.  Recent clinical results, new ablation device innovations and other developments have had the propensity to drive shifts in patient caseload between alternative ablation types.  Given the development and manufacturing costs, have largely and unsurprisingly maintained focus in typically one modality type, seeking to provide innovations in devices and equipment that accentuate benefits for there specific modality in specific clinical applications.

Below is illustrated the worldwide market for ablation technologies in 2009 and forecast 2019.

Source: "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities." Report #A145.

Evolution of ablation technologies and migration of caseload

Technologies to therapeutically ablate tissue (via destruction and/or removal of abnormal tissue or creation of a therapeutic lesion as in blocking errant electrical pathways in arrhythmia) represent a remarkably diverse set of tools despite their fundamentally common capability of tissue ablation.

Spanning electrical, radiation, light/laser, radiofrequency, ultrasound, cryotherapy, thermal therapy, microwave and hydromechanical and embodied in a wide range of medical devices and equipment, all ablation types simply destroy tissue.  The differences lie in respect to the specificity of each modality in targeting disease tissue and in respect to their capacity to be integrated in different types of instruments that may match the demands of specific clinical practices.

The recent history of ablation technology market developments reveals that, despite the specialization of modalities to specific tissues, or the efforts by manufacturers to carve out clinician or disease-state niches for specific modalities, growth in different ablation procedure types and clinical practice patterns has changed steadily but not always predictably.  Recent clinical results, new ablation device innovations and other developments have had the propensity to drive shifts in patient caseload between alternative ablation types.  Given the development and manufacturing costs, have largely and unsurprisingly maintained focus in typically one modality type, seeking to provide innovations in devices and equipment that accentuate benefits for there specific modality in specific clinical applications.

Below is illustrated the worldwide market for ablation technologies in 2009 and forecast 2019.

Source: "Ablation Technologies Worldwide Market, 2009-2019: Products, Technologies, Markets, Companies and Opportunities." Report #A145.

Ablation and other energy-based technologies with multiple clinical applications

Manufacturers of ablation and other energy-base therapeutics are both witnessing and driving a steady evolution of multiple technologies with potential to produce therapeutic (or, in some cases, simply cosmetic) tissue effects, with different energy types competing head-on for caseload.  These innovators have continued to improve their understanding of the nature of each energy type’s impact on the target tissue(s) and have optimized the delivery to improve outcome, improve ease of use and minimize adverse collateral tissue effects or other complications.

To illustrate the breadth of applications for energy-based technologies, see the excerpt below from the table of contents to the MedMarket Diligence report #A125, "Ablation Technologies Worldwide Market, 2008-2017: Products, Technologies, Markets, Companies and Opportunities." 

 

SECTION 1:  ENERGY-BASED THERAPIES BY DISEASE STATE AND TECHNOLOGY
1.1  Cancer
1.1.1  Brachytherapy
1.1.2  Cryotherapy
1.1.3  Microwave Ablation
1.1.4  Radiation Therapy
1.1.5  Radiofrequency Ablation
1.1.6  Stereotactic Surgery
1.1.7  Laser Ablation
1.1.8  Photodynamic Therapy
1.1.9  Ultrasonic Ablation
1.2  Cardiovascular Disease
1.2.1  Angina Pectoris
1.2.2  Atrial arrhythmias
1.2.2.1  Cryoablation
1.2.2.2  Electrical Cardioversion
1.2.2.3  Microwave Ablation
1.2.2.4  RF Ablation
1.2.2.5  Temperature Controlled
1.2.2.6  Fluid Cooled
1.2.3  Bradycardia
1.2.4  Critical Ischemia
1.2.5  Vascular Occlusive Disease
1.2.6  Ventricular Arrhythmias
1.2.6.1  About ICD, CRT and CRT-D
1.2.7  Wolf-Parkinson-White Disease
1.3  Elective Surgery
1.3.1  Cosmetic Surgery
1.3.1.1  Laser Hair Removal
1.3.1.2  Port Wine Stains
1.3.1.3  Psoriasis
1.3.1.4  Varicose Veins
1.4  Ophthalmic Surgery
1.4.1  Capsulotomy Surgery
1.4.2  Laser In-Situ Keratomileusis (LASIK)
1.4.3  Laser Epithelial Keratomileusis (LASEK)
1.5  General Surgery
1.5.1  Fecal Incontinence
1.5.2  Gastroesophageal Reflux Disease (GERD)
1.6  Gynecological Applications
1.6.1  Hysterectomy
1.6.2  Menorrhagia
1.6.3  Fibroids
1.6.4  Bladder Neck Suspension
1.7  Urological Applications
1.7.1  Urinary Tract Stones
1.7.2  Benign Prostatic Hypertrophy
1.7.2.1  TUMT
1.7.2.2  TUNA
1.7.2.3  Photoselective Vaporisation of the prostate (PVP)
1.7.2.4  HoLAP
1.7.2.5  CoreTherm
1.7.2.6  TMX 3000
1.7.2.7  Prolieve
1.7.2.8  Prostiva RF Therapy
1.7.2.9  Water-Induced Thermotherapy
1.8  Tonsillectomy
1.9  Orthopedic Applications
1.9.1  Capsular Shrinkage
1.9.2  Carpal Tunnel Syndrome
1.9.3  Chondroplasty
1.9.4  Debridement
1.9.5  Epicondylitis and Tendinitis
1.9.6  Inflammatory Conditions
1.9.6.1  Nucleoplasty
 
See the report’s complete description, table of contents, and list of exhibits here.

 

Ablation and other energy-based medical technologies worldwide

The world market for energy-based devices was well in excess of $25 billion in 2008. This represents almost 14% of the total medical device market; however, the share varies from country to country, since ablation therapy is high-technology and fairly high-cost; in poorer economies low-cost medical products such as syringes and consumables account for a relatively higher share of the medical market.

Analyses of the medical market by product category typically divide it into a small number of broad product classes such as electromedical equipment; syringes, needles and catheters; medical consumables; etc. The products included in "energy-based therapies" are divided among several of these categories.

Energy-based devices are of nine main categories, and the market share by category.

Worldwide Ablation and Other Energy-based Device Market by Product Category

ablation-segments

Source:  MedMarket Diligence, LLC; Report #A125, "Ablation Technologies Worldwide Market, 2008."
 

Ultrasonic energy offers superior control of energy output. 3D control and directionality of the energy delivered provides the ability to treat a prescribed target volume and shape which is critical for tumor ablation as increased energy penetration into the target tissue enables the treatment of larger tumor volumes and reduces treatment times. Peripheral and coronary vascular occlusive conditions that afflict tens of millions of people worldwide are now being treated with technologies that enable the delivery of ultrasonic energy over the active length of a small diameter guidewire-like device in an occluded blood vessel. The popularity of ultrasonic surgical systems is being driven by their inherent advantages. These systems control bleeding by coaptive coagulation at low temperatures ranging from 50ºC to 100ºC. Coagulation occurs by means of protein denaturation as opposed to thermal welding and the absence of smoke improves the visual field.

Cryogenic energy or the extreme absence of heat is very attractive as it is highly containable and thus localized. Cryoablation can be safely employed adjacent to delicate tissue and structures such as certain vasculature. Cryoablation may eliminate many of the problems seen in treating complex arrhythmias such as pulmonary vein stenosis. Cooling freezes tissue and does not seem to cause extracellular matrix changes or damage to the endocardium, which may lower clot-related complications. Thanks largely to advances in ultrasound, which allows physicians to target diseased tissue with pinpoint accuracy, and temperature control, which allows physicians to destroy the diseased tissue without harming the surrounding healthy tissue, cryoablation has become the fastest growing minimally invasive option for prostate cancer patients.

Microwave energy offers the inherent advantage of accommodating parallel delivery points. An increased treatment area can be treated with microwave energy very efficiently. Microwave probes are ideally suited for a full spectrum of cardiac ablation procedure from simple pulmonary vein isolation in paroxysmal AF to a full Maze for permanent AF. Energy delivery times are short, on the order of 25 to 60 seconds, and the unidirectionality of the microwave ensures the protection of surrounding tissues during epicardial application–a significant requirement for beating-heart application. Microwave energy is also being used as a transurethral therapy to treat BPH.

Light energy is being harnessed and focused for a variety of therapeutic applications. CO2 lasers are being used to revascularize injured myocardial tissue while excimer lasers are being adapted to atherectomy catheters that can clear thrombosis and reperfuse vessels. Over 2 million individuals seek the therapeutic benefits of laser vision correction each year; low level “cold” lasers are being employed to treat chronic pain relief for debilitating conditions like carpal tunnel syndrome–a leading cause of lost workdays. Intense pulsed light (IPL) that affects subtle changes in collagen is being used to treat vascular and pigmentation irregularities.

Hydromechanical energy systems that jet streams of saline only five one-thousandths of an inch in diameter — about the thickness of a human hair–can precisely dissect tissue, sparing vessels and nerves, and are being employed for hepatic resection and nerve-sparing retropubic radical prostatectomy. This modality does not cause thermal damage to tissue and can sculpt, ablate and cauterize bleeders.

Radiation energy using focused arrays of intersecting beams of gamma radiation is being used to treat lesions within the brain. Radiosurgery devices that can ablate otherwise untreatable tumors and malformations when directed by computers are finding otherwise untreatable lesions.

Thermal energy is employed successfully to treat menorrhagia due to benign causes in premenopausal women. When tissue is heated above 46°C, cellular protein denatures and the cell dies. Thermal uterine balloon therapy offers a less-invasive option that allows women to preserve their uterus. Thermal therapy is also being employed for breast and prostate cancer. Implants made of ferromagnetic material that can be “turned-on” when placed within an electromagnetic field and heated in situ offer a high degree of specificity with respect to the treated tissue area.

Electrical energy delivered by small implants can deliver a life saving jolt of electricity to shock a patient’s heart back to normal when rhythmic disturbances of the lower heart chambers that can cause sudden cardiac death are detected. Similar devices deliver electrical energy to speed up a heart beating too slowly. Image-guided radiofrequency ablation which uses heat to destroy diseased tissue can preserve kidney function and avoid kidney dialysis for patients with solid renal tumors who are not surgical candidates.

Radiofrequency energy is gaining widespread use in the field of sports medicine surgery for the thermal modification of soft tissue structures within the joint. The use of radiofrequency energy for thermal chondroplasty has gained tremendous popularity because of the quality of the therapy. Radiofrequency surgical systems have the inherent ability to seal large vessels as a result of the tremendous temperatures the energy can generate.
 

Energy-based therapeutics markets by clinical application

Energy-based therapeutics include technologies to effect the destruction or treatment of tissues to remove pathology or otherwise modify tissue (e.g., for creating lesions that block the aberrant signals in arrhythmia).  These technologies include radiofrequency, microwave, laser/light, microwave, cryo, hydromechanical, ultrasound and thermal.

Some sectors of the energy-based market are growing steadily, others more rapidly. RF ablation is seeing lively growth, as are cryotherapy and microwave therapy. Overall, the market is estimated to be increasing at more than 11% per annum, which is significantly higher than growth of the medical device market overall. The buoyancy in the energy-based sector is due partly to increased uptake of these technologies and partly due to introduction of technology refinements, which in turn lead to increased usage. There is also the demographic factor; many of the conditions for which ablation products are used are commoner among older than younger patients, and lengthening life expectancy makes its own contribution to market growth.

Certain clinical sectors demonstrate a more significant share of the ablation market due to the prevalence of diseases and disorders that are amenable to these treatments.  See the current segmentation of the ablation market by clinical application.

energy-by-applicatoins

Source:  MedMarket Diligence report #A125, "Worldwide Ablation Technologies Market."

Cardiovascular applications represent the most significant application, due to the existing caseload and the adoption of ablation technologies, especially in arrhythmia management.  Secondarily, but perhaps with an even greater upside potential, is cancer therapeutics.  

Below see the current distribution of ablation therapy markets across different solid tumor types.

solid-cancers-ablation

Source:  MedMarket Diligence report #A125, "Worldwide Ablation Technologies Market."