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Lee YC, Hong JA, Chou HP, Chang NW, Weng CY, Huang CS, Hsu PK, Guo CY, Liu CA, Wu HT, Shen SH, Chen CK. Risk factors associated with complications and local tumour progression in image-guided triple-freezing cryoablation for lung tumour: a longitudinal study. Int J Hyperthermia 2025; 42:2492769. [PMID: 40320685 DOI: 10.1080/02656736.2025.2492769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 04/03/2025] [Accepted: 04/09/2025] [Indexed: 05/22/2025] Open
Abstract
PURPOSE This study aimed to investigate the efficacy of triple-freezing cryoablation, the temporal changes of ablation zones, and their association with local tumor progression in patients with lung malignancy. METHODS This retrospective analysis included patients who underwent triple-freezing cryoablation for lung tumors between 2009 and 2017. The size, shape of the ablation zones, and procedure related complications were evaluated. Fine-Gray regression analysis was utilized to determine the risk factors associated with recurrence while considering mortality as a competing risk. RESULTS The study included 41 patients, with 58 ablation sessions for 76 lesions. A tumor size >2 cm was associated with a higher rate of local tumor progression (subdistribution hazard ratio [SHR], 2.623, 95% CI, 1.126-6.107, p = 0.025). An ablation zone-tumor ratio ≥2 emerged as an independent predictor of less local tumor progression (SHR, 0.384, 95% confidence interval [CI]; 0.168-0.877; p = 0.023). There was a 1.7% incidence of adverse events classified as CTCAE (v5.0) grade 3 or higher. Patients without subsequent local tumor progression showed a greater decrease in the ablation zone minor axis at the 6 month-follow up computed tomography (CT) than those with recurrence (25.8% decrease [interquartile range (IQR), 10.3-47.5%] vs 2.4% decrease [IQR, -10.0-7.9%]; p = 0.004). CONCLUSION An ablation zone-tumor ratio of ≥2 was associated with less local tumor progression, and a smaller decrease in the ablation zone at the 6-month follow-up CT indicated a higher rate of subsequent local tumor progression.
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Affiliation(s)
- Ying-Chi Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-An Hong
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Ping Chou
- Division of Radiology, Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Nai-Wen Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Yao Weng
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Sheng Huang
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Kuei Hsu
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Healthcare and Services Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-An Liu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Ta Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Kong Y, Huang X, Cao X, Tang F, Zhou X. Early Recurrence of Colorectal Liver Metastasis (Number ≤ 5 and Largest Diameter ≤ 3 cm) after Resection or Thermal Ablation: a Multi-center Study of Patterns, Safety, Survival and Risk Factors. J Gastrointest Cancer 2025; 56:77. [PMID: 40072796 DOI: 10.1007/s12029-025-01200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2025] [Indexed: 03/14/2025]
Abstract
OBJECTIVE To compare early recurrence patterns, safety, survival and investigate the clinical risk factors of early recurrence (ER) after liver resection or thermal ablation (TA) for patients with colorectal liver metastases (CRLM) with number ≤ 5 and largest diameter ≤ 3 cm. MATERIALS AND METHODS This retrospective study included patients with CRLM who underwent liver resection or TA between January 2016 and December 2021 at two hospitals in China. The Kaplan-Meier method and log-rank test were used to assess recurrence-free survival (RFS) and overall survival (OS). Risk factors for ER were analysed using univariate and multivariate Cox regression analyses. RESULTS 303 patients with 632 liver metastases were enrolled. The most common early recurrence pattern was intrahepatic recurrence (IHR) in resection group and TA group. There was no significant difference in 6-month RFS rate (65.81% vs 66.23%) and median OS (P = 0.10) between two groups. Patients without ER had better OS than those with ER (P < 0.05). The incidence of serious complications (P = 0.013), length of hospitalization (P < 0.01), and albumin-bilirubin (ALBI) score (P = 0.038) in TA group were significantly better than resection group. The diameter of liver metastases (HR: 4.89, 95% CI: 1.16-20.60; P = 0.031) and clinical risk score (CRS) (HR: 1.86, 95% CI: 1.06-3.25; P = 0.029) were independent risk factors for ER. CONCLUSION For CRLM with largest diameter ≤ 3 cm and number ≤ 5, the efficacy of receiving resection or TA is comparable, and the safety of TA is better. TA may be considered as the first-line local treatment option for patients with CRLM.
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Affiliation(s)
- Yaqing Kong
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaoyu Huang
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiaojing Cao
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Fan Tang
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiang Zhou
- Department of Interventional Therapy, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Gachouch O, Giammarinaro B, Kangot T, Monini C, Souchon R. A Novel Ultrasound Thermometry Method Based on Thermal Strain and Short and Constant Acoustic Bursts: Preliminary Study in Phantoms. SENSORS (BASEL, SWITZERLAND) 2025; 25:385. [PMID: 39860753 PMCID: PMC11769532 DOI: 10.3390/s25020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 12/17/2024] [Accepted: 12/21/2024] [Indexed: 01/27/2025]
Abstract
In the field of ultrasound therapy, the estimation of temperature to monitor treatments is becoming essential. We hypothesize that it is possible to measure temperature directly using a constant acoustic power burst. Under the assumption that the acoustic attenuation does not change significantly with temperature, the thermal strain induced by such bursts presents a linear relation with temperature. A mathematical demonstration is given in the introduction. Then, simulations of ultrasound waves in a canine liver model were conducted at different temperatures (from 20 °C to 90 °C). Finally, experimental measurements on phantom samples were performed over the same temperature range. The simulation and experimental results both showed a linear relation between thermal strain and temperature. This relation may suggest the foundation of a new ultrasound-based thermometry method. The potential and limitations of the method are discussed.
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Affiliation(s)
- Omar Gachouch
- LabTAU, INSERM, F-69003 Lyon, France
- Centre Léon Bérard, F-69003 Lyon, France
- Université Lyon 1, F-69003 Lyon, France
| | - Bruno Giammarinaro
- LabTAU, INSERM, F-69003 Lyon, France
- Centre Léon Bérard, F-69003 Lyon, France
- Université Lyon 1, F-69003 Lyon, France
| | - Teymour Kangot
- LabTAU, INSERM, F-69003 Lyon, France
- Centre Léon Bérard, F-69003 Lyon, France
- Université Lyon 1, F-69003 Lyon, France
| | - Caterina Monini
- LabTAU, INSERM, F-69003 Lyon, France
- Centre Léon Bérard, F-69003 Lyon, France
- Université Lyon 1, F-69003 Lyon, France
| | - Rémi Souchon
- LabTAU, INSERM, F-69003 Lyon, France
- Centre Léon Bérard, F-69003 Lyon, France
- Université Lyon 1, F-69003 Lyon, France
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Li L, Tian S, Han X, Tian J, Zhang C. Computed tomography-guided radioactive iodine-125 seed implantation for liver malignancies in challenging locations. J Cancer Res Ther 2024; 20:1165-1172. [PMID: 39206978 DOI: 10.4103/jcrt.jcrt_2638_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/02/2024] [Indexed: 09/04/2024]
Abstract
AIMS This study aimed to retrospectively assess the safety and efficacy of radioactive iodine-125 (I-125) seed implantation for liver malignancies in challenging locations. MATERIALS AND METHODS Between December 2015 and December 2021, 49 patients with 60 liver malignancies in challenging locations who underwent computed tomography (CT)-guided I-125 seed implantation were retrospectively analyzed. The primary endpoints included technical success rate and overall survival (OS), whereas the secondary endpoints included progression-free survival (PFS), disease control rate (DCR), objective response rate (ORR), and liver recurrence. Potential factors associated with liver recurrence were also evaluated. RESULTS The technical success rate was 100%. The median follow-up duration was 12 months (range, 2-68 months). The mean OS and PFS were 17.58 months (95% CI: 13.64-21.52 months) and 13.14 months (95% CI: 10.36-15.92 months), respectively. The 2-month, 6-month, and 1-year DCR and ORR were 97.96% and 93.88%, 93.75% and 77.08%, and 93.48% and 60.87%, respectively. The 6- and 12-month tumor recurrence rates were 20.41% and 28.26%, respectively. The Kaplan-Meier method was used to estimate the time of liver recurrence, with our results showing that patients with primary intrahepatic cholangiocarcinoma had an increased likelihood of having earlier liver recurrence. No major complications developed during follow-up. CONCLUSION CT-guided radioactive I-125 implantation could be a safe and effective alternative with promising survival benefits and high local control rates for liver malignancies in challenging locations.
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Affiliation(s)
- Lin Li
- Department of Operating Room, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Interventional Oncology Institute, Shandong University, Jinan, China
| | - Shuhui Tian
- Department of Interventional and Minimally Invasive Oncology, The Second Hospital of Shandong University, Jinan, China
| | - Xujian Han
- Interventional Oncology Institute, Shandong University, Jinan, China
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jing Tian
- Department of Interventional and Minimally Invasive Oncology, The Second Hospital of Shandong University, Jinan, China
| | - Cunjing Zhang
- Interventional Oncology Institute, Shandong University, Jinan, China
- Dean Office, Jinan Vocational College of Nursing, Jinan, China
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Grange L, Grange R, Bertholon S, Morisson S, Martin I, Boutet C, Grange S. Virtual reality for interventional radiology patients: a preliminary study. Support Care Cancer 2024; 32:416. [PMID: 38847962 DOI: 10.1007/s00520-024-08621-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/30/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The aim of this prospective study was to evaluate the tolerance and feasibility of using virtual reality headsets with patients during interventional radiology procedures. MATERIAL AND METHOD In this single-center prospective study, the use of a virtual reality headset in addition to the usual analgesic and anxiolytic treatment was proposed to all patients presenting in the interventional radiology department from December 2020 to June 2022. Exclusion criteria were as follows: (1) patients with whom it was not possible to communicate (2) epileptic patients, (3) non-verbal patients, and (4) pregnant women. The main objective was to evaluate the safety of the procedure by screening complications during and after the procedure. The second objective was to evaluate feasibility, as defined by the number of patients using the helmet until the end of the procedure. Effectiveness (patient's self-evaluation of pain and anxiety), comfort, satisfaction, emotions felt, sense of security, and feeling of immersion were also evaluated. Caregivers completed a feedback questionnaire. RESULTS Virtual reality headsets were offered to 100 patients, 9 of whom declined. Procedures were achieved in 93.5% of cases: 6/91 patients removed the headset before the end of the procedure. There were minor adverse events in 2/85 (2.3%) procedures (discomfort and nausea) and no major adverse events. 93.9% of patients found an overall benefit, and 90.2% would recommend virtual reality to another patient. 94.4% of caregivers were satisfied with the virtual reality equipment. The mean pain level was 2.5 ± 2.7 before the procedure, 3.3 ± 2.5 during the procedure, and 1.6 ± 2.7 after the procedure. Mean anxiety scores were 4.6 ± 2.9 before the procedure, 3.1 ± 2.7 during the procedure, and 1.1 ± 1.9 after the procedure. CONCLUSION The use of virtual reality technology as a complement to traditional therapy for procedures under local anesthesia is feasible and safe in interventional radiology and can be beneficial for pain and anxiety management.
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Affiliation(s)
- Loïc Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Bertholon
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Stéphanie Morisson
- Department of Supportive Care in Oncology, University Hospital of Saint Etienne, Saint-Priest-En-Jarez, France
| | - Isabelle Martin
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France.
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Chlorogiannis DD, Moussa AM, Zhao K, Alexander ES, Sofocleous CT, Sotirchos VS. Imaging Considerations before and after Liver-Directed Locoregional Treatments for Metastatic Colorectal Cancer. Diagnostics (Basel) 2024; 14:772. [PMID: 38611685 PMCID: PMC11011364 DOI: 10.3390/diagnostics14070772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Colorectal cancer is a leading cause of cancer-related death. Liver metastases will develop in over one-third of patients with colorectal cancer and are a major cause of morbidity and mortality. Even though surgical resection has been considered the mainstay of treatment, only approximately 20% of the patients are surgical candidates. Liver-directed locoregional therapies such as thermal ablation, Yttrium-90 transarterial radioembolization, and stereotactic body radiation therapy are pivotal in managing colorectal liver metastatic disease. Comprehensive pre- and post-intervention imaging, encompassing both anatomic and metabolic assessments, is invaluable for precise treatment planning, staging, treatment response assessment, and the prompt identification of local or distant tumor progression. This review outlines the value of imaging for colorectal liver metastatic disease and offers insights into imaging follow-up after locoregional liver-directed therapy.
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Affiliation(s)
| | - Amgad M. Moussa
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Ken Zhao
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Erica S. Alexander
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | | | - Vlasios S. Sotirchos
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Lucignani G, De Lorenzis E, Ierardi AM, Silvani C, Marmiroli A, Nizzardo M, Albo G, Carrafiello G, Montanari E, Boeri L. Perioperative and Survival Outcomes of Patients Treated With Robot-Assisted Partial Nephrectomy and Percutaneous Microwave Ablation for Small Renal Masses: A Single Center Experience. Clin Genitourin Cancer 2024; 22:237-243. [PMID: 38065718 DOI: 10.1016/j.clgc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Robot assisted partial nephrectomy (RAPN) and microwave ablation (MWA) are 2 of the most advanced techniques for the management of localized small renal masses. PURPOSE To compare the perioperative, functional and oncological results of RAPN and MWA. MATERIALS AND METHODS Data from 171 consecutive patients undergoing either RAPN or MWA for a localized small renal mass at a single academic center was retrospectively collected. Baseline features included patients' demographics and masses' characteristics. Procedures were compared in terms of perioperative outcomes and renal function variation Progression of a persistent lesion or local recurrence after a complete treatment defined local tumor progression. Descriptive statistics and survival analysis tested the association between predictors and local tumor progression. RESULTS Of all, 109 and 62 patients underwent RAPN and MWA. Patients in the MWA group were older (P = .002) had higher Charlson Comorbidity Index (CCI) (P < .001) and higher frequency of preoperative chronic kidney disease (P < .001). MWA led to a shorter postoperative hospitalization time (P < .001) and lower incidence of medical complications (6.5% vs. 22.9%, P = .02) than RAPN. GFR decline was similar between groups both at discharge (P = .39) and at the time of last follow up (P = 1.00). A lower rate of secondary interventions (11.7% vs. 2.8%, P = .037) and a better disease-free survival (83.2% vs. 96.5%, P = .027) were reported after RAPN. Conversely, cancer specific and overall survival were comparable (P > .05). At univariate regression analysis, MWA was associated with local tumor progression (HR 3.46, P = .040). CONCLUSION MWA displayed a lower perioperative impact, while functional outcomes were similar after each intervention. RAPN resulted superior in terms of tumor eradication, but no difference was noted regarding cancer specific survival. Thus, MWA represents a valid alternative in frail patients, though less radical than RAPN.
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Affiliation(s)
- Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Ierardi
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Marmiroli
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Nizzardo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Qu D, Liu Y, Jiang J, Shi Q, Zhou H, Wang Z. Pregnancy outcomes following ultrasound-guided high-intensity focused ultrasound in submucous leiomyomas: a retrospective study. Int J Hyperthermia 2023; 40:2193363. [PMID: 36966814 DOI: 10.1080/02656736.2023.2193363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
OBJECTIVE To investigate the impact of ultrasound-guided high-intensity focused ultrasound (USgHIFU) on pregnancy in submucous leiomyomas. MATERIALS AND METHODS Between October 2015 and October 2021, a retrospective observational study was conducted at the Affiliated Hospital of North Sichuan Medical College, China, for 32 women with submucous leiomyomas who became pregnant after USgHIFU. Pregnancy outcomes, submucous leiomyomas characteristics, and USgHIFU parameters were analyzed. RESULTS A total of 17 (53.1%) deliveries were successfully achieved, with full-term delivery in 16 (94.1%) patients and preterm delivery in 1 (5.9%). After USgHIFU, the effective volume in the uterus cavity and the volume of submucous leiomyomas shrank in all 32 patients. The median time to achieve pregnancy after USgHIFU was 11.0 months. Before pregnancy, myoma type was downgraded in 13 (40.6%) patients, stable in 10 (31.3%) and upgraded in 9 (28.1%). The vaginal expulsion rate of submucous leiomyomas was 28.1%, with complete expulsion in 3 (9.4%) patients and partial expulsion in 6 (18.8%). After USgHIFU, the size of submucous leiomyomas did not increase in each trimester (all p > 0.05). The high complications rate during pregnancy (7/17, 41.2%) was associated with advanced maternal age, with only one (5.9%) premature rupture of membranes possibly associated with submucous leiomyomas. There were 6 (35.5%) vaginal delivery and 11 (64.7%) cesarean sections. All 17 newborns developed well, with a mean birth weight of 3482 g. CONCLUSIONS In patients with submucous leiomyomas, pregnancies and full-term deliveries can be successfully achieved following USgHIFU, with few related complications.
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Short-term outcome of adrenal radiofrequency ablation of adrenal cysts: a single-center experience. Sci Rep 2023; 13:3267. [PMID: 36841893 PMCID: PMC9968339 DOI: 10.1038/s41598-023-30330-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/21/2023] [Indexed: 02/27/2023] Open
Abstract
Percutaneous thermal ablation is a minimally invasive treatment for liver, kidney, lung, bone, and thyroid tumors. This treatment also has been used to treat adrenal tumors in patients, but there is no evidence for the efficacy of thermal ablation of adrenal cysts. The present study was performed to analyze the experience of a single center with percutaneous radiofrequency ablation (RFA) of adrenal cysts and to evaluate its efficacy. The present study enrolled all patients who underwent percutaneous RFA for unilateral adrenal cysts from 2019 to 2021. All patients underwent USG-guided percutaneous aspiration of cystic fluid, followed by RFA. A total nine patients with adrenal cysts were included in this study. All of them underwent technically successful percutaneous RFA, with no immediate complication. Follow-up CT 3 months after RFA showed that six of the nine adrenal cysts showed good responses, with reductions in cyst volume ranging from 86.4 to 97.9%. One patient had poor response in the cyst size (volume reduction rate 11.2%). She underwent secondary RFA with resulting that the cyst volume reduced by 91.1%. After a median follow-up period of 17.2 months, eight patients showed no evidence of regrowth. The patient, who showed evidence of regrowth, declined any other treatment and has been under regular surveillance. None of the nine patients developed adrenal insufficiency during the follow-up period. In conclusion, percutaneous RFA is a safe and effective minimally invasive treatment for adrenal cysts, suggesting that percutaneous RFA may be a good alternative option in selected patients.
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Barrow B, Martin Ii RCG. Microwave ablation for hepatic malignancies: a systematic review of the technology and differences in devices. Surg Endosc 2023; 37:817-834. [PMID: 36076101 DOI: 10.1007/s00464-022-09567-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Microwave ablation (MWA) has become the standard thermal-based treatment for hepatic malignancies in patients who have unresectable disease based on the biology of the tumor, the patients' comorbidities, and certain disease sites. The technical effectiveness, ablation success, local recurrence rates of hepatic malignancies treated with the various commercial microwave ablation devices has not been previously published in the peer reviewed literature. The aim of this systematic review is to summarize the clinical outcomes for the various MWA devices in the use of a hepatic malignancies to best educate hepatic surgeons as well as interventional radiologists. METHODS A comprehensive review of the literature and instructions for use of each device that was published from 1/2013 to 12/2020 was performed. The main outcomes extracted were technical success, ablation success, major complications, local and new recurrence rates, recurrence-free survival, ablation volumes, time, and the number of antennas required. A qualitative review of the literature was performed. RESULTS In total, 29 studies reporting data on 3250 patients and 4500 tumors were included in this review. Median patient age was 60.5 years (range 3-91). 76.3% (2420 M/753 F) of patients were male. Hepatocellular carcinoma (55%) was the most common tumor pathology followed by colorectal liver metastasis (10%) and cholangiocarcinoma (4%). A majority of studies reported technical success (range, 91.6-100%) and ablation success (range, 73.1-100%), as well as major complications (range, 0-9.1%). Local recurrence (range, 0-50%) was reported by 21 of the studies; however, new recurrence (range, 12.2-64%) was reported less frequently (6 studies) and were further specified in 12, six, and four studies as intrahepatic distant recurrence (11.3-54.2%), extrahepatic distant recurrence (3.6-20%), and metastasis (1.1-36%). A total of three, six, and five studies report disease, progression, and recurrence-free survival rates, respectively. CONCLUSION Microwave ablation is frequently used for the treatment of hepatic malignancies. A thorough understanding of the clinical outcomes associated with different pathologies and MWA devices can improve surgeon awareness and help prepare for operative planning and patient management. More consistent reporting of key outcomes in the literature is needed to achieve such an understanding.
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Affiliation(s)
- Brooke Barrow
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA
| | - Robert C G Martin Ii
- Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40292, USA.
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Pal K, Sheth RA. Engineering the Tumor Immune Microenvironment through Minimally Invasive Interventions. Cancers (Basel) 2022; 15:196. [PMID: 36612192 PMCID: PMC9818918 DOI: 10.3390/cancers15010196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
The tumor microenvironment (TME) is a unique landscape that poses several physical, biochemical, and immune barriers to anti-cancer therapies. The rapidly evolving field of immuno-engineering provides new opportunities to dismantle the tumor immune microenvironment by efficient tumor destruction. Systemic delivery of such treatments can often have limited local effects, leading to unwanted offsite effects such as systemic toxicity and tumor resistance. Interventional radiologists use contemporary image-guided techniques to locally deliver these therapies to modulate the immunosuppressive TME, further accelerating tumor death and invoking a better anti-tumor response. These involve local therapies such as intratumoral drug delivery, nanorobots, nanoparticles, and implantable microdevices. Physical therapies such as photodynamic therapy, electroporation, hyperthermia, hypothermia, ultrasound therapy, histotripsy, and radiotherapy are also available for local tumor destruction. While the interventional radiologist can only locally manipulate the TME, there are systemic offsite recruitments of the immune response. This is known as the abscopal effect, which leads to more significant anti-tumoral downstream effects. Local delivery of modern immunoengineering methods such as locoregional CAR-T therapy combined with immune checkpoint inhibitors efficaciously modulates the immunosuppressive TME. This review highlights the various advances and technologies available now to change the TME and revolutionize oncology from a minimally invasive viewpoint.
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Affiliation(s)
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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12
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Aguado A. Role of Interventional Radiology in Pediatric Cancer Patients. Curr Oncol Rep 2022; 24:1731-1740. [PMID: 36057070 DOI: 10.1007/s11912-022-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW Pediatric interventional radiology (IR) is a growing subspecialty. Here, we review the current role of IR in children with cancer, which uses imaging such as ultrasound, fluoroscopy, and computed tomography to perform minimally invasive procedures. These include biopsy, needle localization, central venous access, thermal ablation, transarterial chemoembolization, transarterial radioembolization with yttrium-90, non-tunneled/tunneled drainage catheter placement, and lymphatic interventions. RECENT FINDINGS Although locoregional therapies for the treatment of cancer in adults are common, they are less common in children, perhaps due to the relative rarity of cancer in children, their typically better performance status, and paucity of comorbidities. Preliminary results from small-scale studies for ablation, transarterial chemoembolization, and transarterial radioembolization with yttrium-90 used in the front-line armamentarium of curative therapy are encouraging. Pediatric IR offers an array of minimally invasive procedures intended to diagnose and treat pediatric cancer patients. However, more research is required to determine the efficacy of locoregional therapy in children and to define the clinical scenarios where benefit is likely to be optimized.
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Affiliation(s)
- Allison Aguado
- Division of Interventional Radiology, Nemours Children's Health, 1600 Rockland Rd., Wilmington, DE, 19803, USA.
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13
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Dong Y, Zhang Q, Chen H, Jin Y, Ji Z, Han H, Wang W. Radiomics of Multi-modality Ultrasound in Rabbit VX2 Liver Tumors: Differentiating Residual Tumors from Hyperemic Rim After Ablation. J Med Biol Eng 2022. [DOI: 10.1007/s40846-022-00763-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Analysis of Infectious Complications after Thermal Ablation of Hepatocellular Carcinoma and the Impact on Long-Term Survival. Cancers (Basel) 2022; 14:cancers14215198. [PMID: 36358617 PMCID: PMC9657620 DOI: 10.3390/cancers14215198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/16/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Although thermal ablation has been widely used in treatments of HCC due to its unique advantages of less trauma, safety, postoperative complications still occur in clinical practice. Infectious complications are the third most common complication. The objective of our retrospective study was to summarize the clinical characteristics of infection after thermal ablation for HCC patients and to explore whether it affects tumor recurrence and overall survival. We enrolled 49 patients who developed postoperative infections and matched the same number of control patients, and we also summarized the clinical features and treatment of mild and severe infections. We found that postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. Empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection. Abstract Purpose: This study aims to complete a detailed record of the clinical characteristics and treatment of HCC patients with post-ablation infection and evaluate the infections on recurrence-free survival (RFS) and overall survival (OS) among patients receiving ultrasound-guided thermal ablation. Methods: 3117 patients with liver tumors receiving thermal ablation from January 2010 to December 2021 were analyzed. A total of 49 patients with infectious complications after thermal ablation were selected as the infection group. A total of 49 patients without postoperative infection were randomly selected among those who underwent ablation within three days before or after the treatment date of the infection group as the control group. The clinical characteristics of both groups were analyzed by an independent sample t-test and chi-square test. A log-rank test was performed to compare the RFS and OS data. A multivariate Cox regression model was employed to identify prognostic factors influencing RFS and OS. Subgroup analyses of mild and severe infections were conducted to explore the infection-related situation further. Results: Between mild and severe infection groups, there were statistically significant differences in the infection position (p = 0.043), positive rate of body fluid culture (p = 0.002), proportion of catheter drainage (p = 0.017), use of advanced antibiotics (p = 0.006), and outcome (p = 0.00). The Kaplan–Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence (p = 0.028), and severe infection was significantly associated with overall survival (p = 0.049). The cox model showed that postoperative infection was an independent variable for RFS deterioration (HR = 1.724, 95% CI: 1.038–2.862, p = 0.035). Conclusions: Postoperative infection among patients receiving ultrasound-guided thermal ablation adversely affected tumor progression. In addition, empirical antibiotics and catheterization to reduce pressure inside the lesion should be utilized to minimize symptoms in patients with postoperative infection.
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Tanaka T, Anan A, Takata K, Fukuda H, Yamauchi R, Inomata S, Yokoyama K, Takeyama Y, Shakado S, Sakisaka S, Hirai F. Multipolar radiofrequency ablation via three bipolar electrodes with C-arm type X-ray fluoroscopy assistance for hepatocellular carcinoma: An observational study. Medicine (Baltimore) 2022; 101:e30725. [PMID: 36197247 PMCID: PMC9509166 DOI: 10.1097/md.0000000000030725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/24/2022] [Indexed: 11/25/2022] Open
Abstract
The present study aimed to investigate the therapeutic efficacy and safety of the insertion technique of 3 bipolar electrodes in patients with hepatocellular carcinoma (HCC), using C-arm type X-ray fluoroscopy-assisted ultrasonography (US) in guiding a multipolar radiofrequency ablation (RFA) system. Seventy-three patients with HCC treated with a multipolar RFA system (1 electrode, n = 2; 2 electrodes, n = 56; 3 electrodes, n = 17) were enrolled in this retrospective cohort study. To analyze their therapeutic outcome in this study, we divided among 17 patients using 3 electrodes into 2 subgroups: the C-arm type X-ray fluoroscopy-assisted (n = 7) and the US-guided alone groups (n = 10). Therapeutic efficacy and safety were analyzed between the 2 groups. Multipolar RFA treatment was performed safely in all cases, and no severe adverse events occurred. Comparing the patient background of the group treated using 1 or 2 electrodes with that treated using 3 electrodes, larger-sized HCC was treated using 3 electrodes (P < .001). The differences in overall and recurrence-free survival rates between the 1- or 2-electrode and the 3-electrode groups were not significantly different (P = .843 and P = .891). Comparing the C-arm type X-ray fluoroscopy-assisted and the US-guided alone groups among patients treated using 3 electrodes, technical factors such as total ablation time and the number of sessions were not significantly different between the 2 groups. The local tumor progression rate was not significantly different between the 2 groups (P = .942). Multipolar RFA treatment was effective for the treating HCC; using 3 electrodes was suitable for larger-sized HCCs. The technical approach with C-arm type X-ray fluoroscopy assistance using 3 electrodes was useful for operators to perform safe and appropriate insertion techniques by synchronizing the US and X-ray fluoroscopy images.
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Affiliation(s)
- Takashi Tanaka
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Akira Anan
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuhide Takata
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Hiromi Fukuda
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinjiro Inomata
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Satoshi Shakado
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Fumihito Hirai
- Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Ma L, Liang H, Han B, Yang S, Zhang X, Liao H. Augmented reality navigation with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. Int J Comput Assist Radiol Surg 2022; 17:1543-1552. [PMID: 35704238 DOI: 10.1007/s11548-022-02671-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a novel augmented reality (AR) surgical navigation method with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. A preliminary study is carried out to verify its feasibility. METHODS Two three-dimensional (3D) point clouds of the liver surface are derived from the preoperative images and intraoperative tracked US images, respectively. To compensate for the soft tissue deformation, the point cloud registration between the preoperative images and the liver is performed using the non-rigid iterative closest point (ICP) algorithm. A 3D AR device based on integral videography technology is designed to accurately display naked-eye 3D images for surgical navigation. Based on the above registration, naked-eye 3D images of the liver surface, planning path, entry points, and tumor can be overlaid in situ through our 3D AR device. Finally, the AR-guided targeting accuracy is evaluated through entry point positioning. RESULTS Experiments on both the liver phantom and in vitro pork liver were conducted. Several entry points on the liver surface were used to evaluate the targeting accuracy. The preliminary validation on the liver phantom showed average entry-point errors (EPEs) of 2.34 ± 0.45 mm, 2.25 ± 0.72 mm, 2.71 ± 0.82 mm, and 2.50 ± 1.11 mm at distinct US point cloud coverage rates of 100%, 75%, 50%, and 25%, respectively. The average EPEs of the deformed pork liver were 4.49 ± 1.88 mm and 5.02 ± 2.03 mm at the coverage rates of 100% and 75%, and the average covered-entry-point errors (CEPEs) were 4.96 ± 2.05 mm and 2.97 ± 1.37 mm at 50% and 25%, respectively. CONCLUSION Experimental outcomes demonstrate that the proposed AR navigation method based on US-assisted point cloud registration has achieved an acceptable targeting accuracy on the liver surface even in the case of liver deformation.
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Affiliation(s)
- Longfei Ma
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hanying Liang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Boxuan Han
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Shizhong Yang
- Hepato-Pancreato-Biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
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Minier C, Hermida M, Allimant C, Escal L, Pierredon-Foulongne MA, Belgour A, Piron L, Taourel P, Cassinotto C, Guiu B. Software-based assessment of tumor margins after percutaneous thermal ablation of liver tumors: A systematic review. Diagn Interv Imaging 2022; 103:240-250. [PMID: 35246412 DOI: 10.1016/j.diii.2022.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study was to make a systematic review of clinical studies evaluating software-based tumor margin assessment after percutaneous thermoablation (PTA) of liver tumors. MATERIALS AND METHODS A systematic literature search was performed through Pubmed/MEDLINE, Embase and the Cochrane Library. Original studies published in English that reported on software-based assessment of ablation margins (AM) following PTA of liver tumors were selected. Studies were analyzed with respect to design, number of patients and tumors, tumor type, PTA technique, tumor size, target registration error, study outcome(s) (subtypes: feasibility, comparative, clinical impact, predictive or survival), and follow-up period. RESULTS Twenty-nine articles (one multi-center and two prospective studies) were included. The majority were feasibility (26/29, 89.7%) or predictive (23/29, 79.3%) studies. AM was a risk factor of local tumor progression (LTP) in 25 studies (25/29, 86.2%). In nine studies (9/29, 31%) visual assessment overestimated AM compared with software-aided assessment. LTP occurred at the location of the thinnest margin in nine studies (9/29, 31%). Time for registration and analysis was heterogeneously reported, ranging between 5-30 min. Mean target registration error was reported in seven studies (7/29, 24.1%) at 1.62 mm (range: 1.20-2.23 mm). Inter-operator reproducibility was high (kappa range: 0.686-1). Ascites, liver deformation and inconspicuous tumor were major factors of co-registration error. CONCLUSION Available studies present a low level of evidence overall, since most of them are feasibility, retrospective and single-center studies.
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Affiliation(s)
- Chloé Minier
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Margaux Hermida
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Carole Allimant
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Laure Escal
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | | | - Ali Belgour
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France
| | - Patrice Taourel
- Department of Radiology, Lapeyronie University Hospital, 34090, Montpellier, France
| | | | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34090, Montpellier, France.
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Imaging appearance of residual HCC following incomplete trans-arterial chemoembolization on contrast-enhanced imaging. Abdom Radiol (NY) 2022; 47:152-160. [PMID: 34643782 DOI: 10.1007/s00261-021-03298-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to describe changes in contrast agent kinetics in HCC following incomplete trans-arterial chemoembolization (TACE) on contrast-enhanced ultrasound (CEUS) and MRI/CT. METHODS Patients with residual HCC proven by biopsy, retreatment angiography, or 4-8 month MRI demonstrating tumor progression were identified. Pre-treatment and 4-6-week follow-up CE-MRI/CT and CEUS exams were collected for blinded reads by two experienced readers for each modality to evaluate arterial phase hyper-enhancement (APHE) and washout within the residual HCC. A third reader provided tie-breaking decisions for any disagreements. RESULTS Contrast-enhanced imaging data were collected from 29 patients with residual HCC post-TACE. On CEUS, 84.2% of patients with baseline APHE demonstrated APHE post-TACE (p = 0.25). On CE-MRI/CT, 57.1% of patients with baseline APHE later demonstrated APHE (p = 0.004). As for washout, on CEUS 33.3% of patients with baseline washout retained washout post-TACE (p = 0.01), while on CE-MRI/CT only 18.8% of patients with baseline washout later demonstrated washout (p < 0.001). Among CEUS readers, reader agreement was 100% for baseline APHE, 66.7% for baseline washout (K = 0.35), 84.2% for post-TACE APHE (K = 0.35), and 57.9% for post-TACE washout (K = - 0.09). On CE-MRI/CT, reader agreement was 65.5% for baseline APHE (K = 0.19), 55.2% for baseline washout (K = 0.12), 48.3% for post-TACE APHE (K = - 0.07), and 58.6% for post-TACE washout (K = 0.04). CONCLUSION Common diagnostic features of treatment-naïve HCC like APHE and washout can be substantially altered by TACE and should be considered when diagnosing residual disease on contrast-enhanced imaging.
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Bao F, Yu F, Wang R, Chen C, Zhang Y, Lin B, Wang Y, Hao X, Gu Z, Fang W. Electromagnetic bronchoscopy guided microwave ablation for early stage lung cancer presenting as ground glass nodule. Transl Lung Cancer Res 2021; 10:3759-3770. [PMID: 34733626 PMCID: PMC8512468 DOI: 10.21037/tlcr-21-474] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with early-stage lung cancer are sometimes medically inoperable, and for patients with multiple primary lung cancers, surgical resection alone sometimes proves to be impractical. Local treatments like microwave ablation (MWA) are investigational alternatives for these patients. Most reported MWA procedures for lung cancers are performed percutaneously under CT guidance. MWA navigated by electromagnetic bronchoscopy (ENB) has been limitedly studied. In this study, we aimed to evaluate the safety and feasibility of MWA under ENB guidance in patients with inoperable early-stage lung cancers or multiple primary lung cancers which cannot be completely resected. Methods From June 2019 to December 2020, preliminary attempts of ENB-guided MWA were made in five medically inoperable patients with a single early-stage lung cancer and ten patients with multiple primary lung cancers which were difficult to resect at the same time. For patients with concomitant pulmonary nodules which needed surgical resection, thoracoscopic resections were performed following ENB-guided MWA. The safety, feasibility, and technique effectiveness of treatments were evaluated. Results ENB-guided MWA for 15 ground glass nodules (GGNs) in 15 patients was completed in accordance with the planned protocol. Biopsy of 13 GGNs showed malignancy. Five patients received simple ENB-guided MWA without simultaneous surgical resection and ten patients received simultaneous surgical resection for 13 concomitant pulmonary nodules. CT scan by the first postoperative week showed technique effectiveness of ablation for 11 nodules indicated for MWA. Four patients had mild complications after the procedure and recovered shortly after treatment. Conclusions For medically inoperable patients with a single GGN manifesting early-stage lung cancer and patients with multiple primary early-stage lung cancers which cannot be resected at the same time, ENB-guided MWA might be a safe and feasible alternative local treatment, whether combined with surgical resection or not. However, large, prospective, randomized, multicenter studies are needed to confirm its role in the treatment of early-stage lung cancer.
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Affiliation(s)
- Feichao Bao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Fenghao Yu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rui Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chunji Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yonghui Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Boyu Lin
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhitao Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Imaging following thermal ablation of early lung cancers: expected post-treatment findings and tumour recurrence. Clin Radiol 2021; 76:864.e13-864.e23. [PMID: 34420686 DOI: 10.1016/j.crad.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
Thermal ablation is a minimally invasive technique that is growing in acceptance and popularity in the management of early lung cancers. Although curative resection remains the optimal treatment strategy for stage I pulmonary malignancies, percutaneous ablative treatments may also be considered for selected patients. These techniques can additionally be used in the treatment of oligometastatic disease. Thermal ablation of early lung tumours can be achieved using several different techniques. For example, microwave ablation (MWA) and radiofrequency ablation (RFA) utilise extreme heat, whereas cryoablation uses extremely cold temperatures to cause necrosis and ultimately cell death. Typically, post-ablation imaging studies are performed within the first 1-3 months with subsequent imaging performed at regular intervals to ensure treatment response and to evaluate for signs of recurrent disease. Surveillance imaging is usually undertaken with computed tomography (CT) and integrated positron-emission tomography (PET)/CT. Typical imaging findings are usually seen on CT and PET/CT following thermal ablation of lung tumours, and it is vital that radiologists are familiar with these appearances. In addition, radiologists should be aware of the imaging findings that indicate local recurrence following ablation. The objective of this review is to provide an overview of the expected post-treatment findings on CT and PET/CT following thermal ablation of early primary lung malignancies, as well as describing the imaging appearances of local recurrence.
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21
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Boninsegna E, Simonini E, Crosara S, De Angelis M, Boccia L, Colopi S. Large Multifocal Hepatocarcinoma: Technical Details of Treatment with Combined Transarterial Chemoembolization, Microwave and Radiofrequency Ablation. J Gastrointest Cancer 2021; 52:300-305. [PMID: 32436050 DOI: 10.1007/s12029-020-00416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy.
| | - Emilio Simonini
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Stefano Crosara
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Michela De Angelis
- Department of Surgery, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Luigi Boccia
- Department of Surgery, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
| | - Stefano Colopi
- Department of Radiology, Azienda Socio Sanitaria Territoriale di Mantova, Mantova, Italy
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22
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Lei T, Guo X, Gong C, Chen X, Ran F, He Y, Shi Q, He J. High-intensity focused ultrasound ablation in the treatment of recurrent ovary cancer and metastatic pelvic tumors: a feasibility study. Int J Hyperthermia 2021; 38:282-287. [PMID: 33612045 DOI: 10.1080/02656736.2021.1889698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the feasibility of high-intensity focused ultrasound (HIFU) ablation for treating metastatic pelvic tumors and recurrent ovary cancer. MATERIALS AND METHODS Eight patients with metastatic pelvic tumors or recurrent ovary cancer were enrolled in this study. Among them, 5 patients had ovarian cancer, 1 had cervical cancer, 1 had endometrial cancer, and 1 had rectal cancer. Six of them received abdominal surgical operation for their primary cancer, no one received radiotherapy. HIFU treatment was performed under conscious sedation. Vital signs were monitored during the procedure, and adverse effects were recorded. Postoperative follow-up was performed to observe pain relief and the improvement of the patient's quality of life. RESULTS The median age of the patients was 54 (range: 33-76) years, with a total of 12 lesions. The average volume of the lesions was 238.0 cm3. Six patients completed 12 months follow-up. Postoperative pain relief rate was 60% (3/5), and the quality of life improved in the short term. The main adverse effect of HIFU was pain in the treated area, with the pain score lower than 4, and all of which was self-relieved within 1 day after HIFU treatment. No serious complications such as skin burn, intestinal perforation, and nerve injury occurred. CONCLUSION HIFU is feasible for the treatment of metastatic pelvic tumors or recurrent ovary cancer without serious complications. Therefore, HIFU seems a promising treatment for recurrent ovary cancer, metastatic pelvic tumors from cervical cancer, endometrial cancer, and rectal cancer.
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Affiliation(s)
- Tingting Lei
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Xu Guo
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Chunmei Gong
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Xuelian Chen
- Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Feng Ran
- Department of Oncology, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Yuchun He
- Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
| | - Qiuling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Jia He
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China.,Department of Gynecology and Obstetrics, Suining Municipal Hospital of Traditional Chinese Medicine, Sichuan, PR China
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23
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Sun X, Yang Z, Mei J, Lyu N, Lai J, Chen M, Zhao M. The guiding value of microvascular invasion for treating early recurrent small hepatocellular carcinoma. Int J Hyperthermia 2021; 38:931-938. [PMID: 34121576 DOI: 10.1080/02656736.2021.1937715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI) have worse survival. Whether the presence of MVI indicates the necessity of more aggressive locoregional treatments for recurrences remains to be elucidated. METHODS We reviewed patients who underwent curative hepatectomy for primary HCC in our institution, and 379 patients with recurrent HCC up to three nodules smaller than 3 cm were enrolled. The Kaplan-Meier method was adopted to compare the secondary recurrence-free survival (sRFS) and post-recurrence survival (PRS) among patients undergoing hepatectomy, RFA and transarterial chemoembolization plus RFA (TACE-RFA). Cox regression analyses were performed to identify independent prognostic factors. RESULTS Both the sRFS and PRS of the MVI (-) group were significantly longer than those of the MVI (+) group (p = 0.001 and 0.011). For patients with MVI (-), no significant difference was found in sRFS or PRS among recurrent HCC patients receiving hepatectomy, RFA or TACE-RFA (p = 0.149 and 0.821). A similar trend was found in patients with MVI (+) (p = 0.851 and 0.960). Further analysis found that TACE-RFA provided better sRFS than hepatectomy or RFA alone in patients with MVI (+) and early recurrence within two years (p = 0.036 and 0.044). CONCLUSION For HCC patients with MVI (+) and early small recurrence, TACE-RFA could achieve better prognosis than hepatectomy or RFA alone, while RFA alone provided comparable survival benefits compared with hepatectomy or TACE-RFA in other HCC patients with small recurrence.
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Affiliation(s)
- Xuqi Sun
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China
| | - Ziliang Yang
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jie Mei
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ning Lyu
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Jinfa Lai
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Minshan Chen
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Ming Zhao
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, China.,Minimally Invasive Interventional Division, Liver Cancer Group, Sun Yat-Sen University Cancer Center, Guangzhou, China
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Li H, Chen L, Zhu GY, Yao X, Dong R, Guo JH. Interventional Treatment for Cholangiocarcinoma. Front Oncol 2021; 11:671327. [PMID: 34268114 PMCID: PMC8276166 DOI: 10.3389/fonc.2021.671327] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022] Open
Abstract
Cholangiocarcinoma (CCA) is the second most common type of primary liver malignancy. The latest classification includes intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma, with the latter one further categorized into perihilar and distal cholangiocarcinoma. Although surgical resection is the preferred treatment for CCA, less than half of the patients are actually eligible for radical surgical resection. Interventional treatment, such as intra-arterial therapies, ablation, and brachytherapy (iodine-125 seed implantation), has become an acceptable palliative treatment for patients with unresectable CCA. For these patients, interventional treatment is helpful for locoregional control, symptom relief, and improving quality of life. Herein, in a timely and topical manner, we will review these advances and highlight future directions of research in this article.
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Affiliation(s)
- Hang Li
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Li Chen
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Guang-Yu Zhu
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Xijuan Yao
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Rui Dong
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Jin-He Guo
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
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25
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Donlon P, Dennedy MC. Thermal ablation in adrenal disorders: a discussion of the technology, the clinical evidence and the future. Curr Opin Endocrinol Diabetes Obes 2021; 28:291-302. [PMID: 33741778 PMCID: PMC8183491 DOI: 10.1097/med.0000000000000627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To summarise the emerging role of thermal ablation as a therapeutic modality in the management of functioning adrenal tumours and metastases to the adrenal gland. RECENT FINDINGS Observational evidence has demonstrated the benefit of thermal ablation in (i) resolving adrenal endocrinopathy arising from benign adenomas, (ii) treating solitary metastases to the adrenal and (iii) controlling metastatic adrenocortical carcinoma and phaeochromocytoma/paraganglioma. SUMMARY Microwave thermal ablation offers a promising, minimally invasive therapeutic modality for the management of functioning adrenocortical adenomas and adrenal metastases. Appropriate technological design, treatment planning and choice of imaging modality are necessary to overcome technical challenges associated with this emerging therapeutic approach.
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Affiliation(s)
- Padraig Donlon
- Adrenal Research Laboratory, The Discipline of Pharmacology and Therapeutics, Lambe Institute for Translational Research, School of Medicine, National University of Ireland Galway, Ireland
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Zhao Q, Cheng Z, Han Z, Liu F, Yu X, Tan X, Han B, Dou J, Yu J, Liang P. Percutaneous Microwave Ablation Versus Open Surgical Resection for Colorectal Cancer Liver Metastasis. Front Oncol 2021; 11:638165. [PMID: 34046342 PMCID: PMC8144705 DOI: 10.3389/fonc.2021.638165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/08/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To compare the therapeutic outcomes between open surgical resection (OSR) and percutaneous microwave ablation (PMWA) for colorectal liver metastasis (CRLM) ≤3 cm. Methods In this retrospective study, 200 consecutive patients with 306 CRLMs were reviewed. Overall survival (OS), disease-free survival (DFS), local tumour progression (LTP), intrahepatic distant recurrence, and extrahepatic metastasis were analysed to compare the therapeutic efficacy. Cox proportional hazards regression analysis was used to identify the prognostic factors for OS and DFS. Major complications and postoperative hospital stay were also assessed. Result The 1-, 3-, and 5-year OS rates were 91.6%, 64.1%, and 46.3%, respectively, in the PMWA group and 89.7%, 62.4% and 44.7%, respectively, in the OSR group (P=0.839). The 1-, 3-, and 5-year DFS rates were 61.9%, 44.8%, and 41.3%, respectively, in the PMWA group and 58.1%, 24.4%, and 18.3%, respectively, in the OSR group (P =0.066). The two groups had comparable 5-year cumulative rates of intrahepatic distant recurrence (P=0.627) and extrahepatic metastasis (P=0.884). The 5-year cumulative LTP rate was lower in the OSR group than in the PMWA group (P=0.023). The rate of major complications was higher in the OSR group than in the PMWA group (P =0.025), and the length of hospital stay after treatment was shorter in the PMWA group (P<0.001). Conclusion There were no significant differences in OS or DFS between the two groups. PMWA was associated with increased LTP, fewer postoperative days and fewer major complications.
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Affiliation(s)
- Qinxian Zhao
- People's Liberation Army General Hospital, Beijing, China
| | - Zhigang Cheng
- People's Liberation Army General Hospital, Beijing, China
| | - Zhiyu Han
- People's Liberation Army General Hospital, Beijing, China
| | - Fangyi Liu
- People's Liberation Army General Hospital, Beijing, China
| | - Xiaoling Yu
- People's Liberation Army General Hospital, Beijing, China
| | - Xianliang Tan
- Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Bin Han
- Affiliated Hospital of Shanxi College of Traditional Chinese Medicine, Taiyuan, China
| | - Jianping Dou
- People's Liberation Army General Hospital, Beijing, China
| | - Jie Yu
- People's Liberation Army General Hospital, Beijing, China
| | - Ping Liang
- People's Liberation Army General Hospital, Beijing, China
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27
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Microwave ablation of cT1a renal cell carcinoma: oncologic and functional outcomes at a single center. Clin Imaging 2021; 76:199-204. [PMID: 33964597 DOI: 10.1016/j.clinimag.2021.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 04/12/2021] [Accepted: 04/25/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE Percutaneous ablation is an established alternative to surgical intervention for small renal masses. Radiofrequency and cryoablation have been studied extensively in the literature. To date, series assessing the efficacy and safety of microwave ablation (MWA) are limited. We present a cohort of 110 renal tumors treated with MWA. METHODS A review of the medical record between January 2015 and July 2019 was performed, retrospectively identifying 101 patients (110 tumors). All ablations were performed by a single board-certified urologist/interventional radiologist. Demographic information, intraoperative, postoperative, and follow-up surveillance data were recorded. RESULTS Median (IQR) age was 69.7 years (60.8-77.0); 27 (24%) were female. Median (IQR) BMI was 27.0 (25.1-30.2) and Charleston Comorbidity Index was 5.0 (4.0-6.0). 82 tumors were biopsy-confirmed renal cell carcinoma/oncocytic neoplasms. Median (IQR) tumor size was 2.0 cm (1.5-2.6). Median (IQR) RENAL nephrometry score was 6.0 (5.0-8.0). Technical success was achieved in all patients and all but one patient were discharged on the same day. Median (IQR) eGFR at baseline and 1 year were 71.9 mL/min/1.73 m2 (56.5-82) and 63.0 mL/min/1.73 m2 (54.0-78.2); the difference was -5.3 (p = 0.12). Two Clavien-Dindo type-I complications, one type-II complication, and one type-III complication were experienced in this cohort. Median radiographic follow-up was 376.5 days with 2 tumors (2.4% of RCC/oncocytic neoplasms) having recurred to date. CONCLUSIONS MWA is a safe and efficacious treatment option for small renal masses with minimal adverse events and low rates of recurrence in this cohort of 101 patients. Continued follow-up is needed to assess long-term outcomes.
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Abdelkader NA, Abdelaleem MH, El-maaty MAA, Sayed SA, Aly HI. Role of transient elastography in the prediction of de novo recurrence of hepatocellular carcinoma after radiofrequency ablation: single-center Egyptian study. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00099-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Radiofrequency is one of the curative treatment options for hepatocellular carcinoma (HCC). Despite the progressive improvements in the efficacy of radiofrequency, the survival of patients with HCC who undergo radiofrequency remains disappointing, mainly due to frequent intrahepatic recurrence of HCC after radiofrequency. We aimed to evaluate the role of transient elastography (TE) in the prediction of de novo recurrence of HCC after radiofrequency and to compare between transient elastography and the serological fibrosis indices in the prediction of de novo recurrence of HCC.
Results
Thirty HCC patients underwent baseline transient elastography for preinterventional assessment of the degree of fibrosis. Also noninvasive serum fibrosis indices were calculated from baseline data, including age platelet index (API), cirrhosis discrimination score (CDS), and FIB-4 index. Patients achieving complete response after 1 month post radiofrequency ablation were followed for further 12 months by triphasic abdominal CT scan to detect de novo lesions according to modified RECIST criteria. Baseline means of CDS, FIB4, and API were 6.03 ± 1.5, 3.98 ± 2.58, and 1.24 ± 1.08, respectively. Transient elastography revealed 28 patients with F4 and only 2 patients with F3 (mean liver stiffness 22.45 ± 10.36 Kba). There was a significant negative correlation between liver stiffness (LS) and de novo recurrence of HCC (mean of LS in patients with a complete response was 17.19 ± 3.32 while in those with de novo recurrence was 36.94 ± 5.93, with the best cut off value ≥24.65 (p value < 0.001). There was no significant correlation between CDC, FIB4, API scores, and de novo recurrence of HCC. It was found that the liver stiffness was significantly associated with the prediction of hepatic decompensation (p value <0.001). Also, liver stiffness at the cutoff value > 42.75 (p value = 0.031) was significantly associated with the prediction of 1-year mortality after radiofrequency ablation.
Conclusion
Our data suggested that liver stiffness measurement in hepatocellular carcinoma patients was a useful predictor of de novo recurrence, overall survival, and possibility of hepatic decompensation after radiofrequency ablation.
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Minami Y, Minami T, Ueshima K, Yagyu Y, Tsurusaki M, Okada T, Hori M, Kudo M, Murakami T. Three-Dimensional Radiological Assessment of Ablative Margins in Hepatocellular Carcinoma: Pilot Study of Overlay Fused CT/MRI Imaging with Automatic Registration. Cancers (Basel) 2021; 13:cancers13061460. [PMID: 33806751 PMCID: PMC8004695 DOI: 10.3390/cancers13061460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We investigate the feasibility of image fusion application for ablative margin assessment in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) and possible causes for a wrong initial evaluation of technical success through a side-by-side comparison. METHODS A total of 467 patients with 1100 HCCs who underwent RFA were reviewed retrospectively. Seventeen patients developed local tumor progressions (LTPs) (median size, 1.0 cm) despite initial judgments of successful ablation referring to contrast-enhanced images obtained in the 24 h after ablation. The ablative margins were reevaluated radiologically by overlaying fused images pre- and post-ablation. RESULTS The initial categorizations of the 17 LTPs had been grade A (absolutely curative) (n = 5) and grade B (relatively curative) (n = 12); however, the reevaluation altered the response categories to eight grade C (margin-zero ablation) and nine grade D (existence of residual HCC). LTP occurred in eight patients re-graded as C within 4 to 30.3 months (median, 14.3) and in nine patients re-graded as D within 2.4 to 6.7 months (median, 4.2) (p = 0.006). Periablational hyperemia enhancements concealed all nine HCCs reevaluated as grade D. CONCLUSION Side-by-side comparisons carry a risk of misleading diagnoses for LTP of HCC. Overlay fused imaging technology can be used to evaluate HCC ablative margin with high accuracy.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
- Correspondence: ; Tel.: +81-72-366-0221 (ext. 3149); Fax: +81-72-367-2880
| | - Tomohiro Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Yukinobu Yagyu
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Masakatsu Tsurusaki
- Department of Radiology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (Y.Y.); (M.T.)
| | - Takuya Okada
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Hori
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan; (T.M.); (K.U.); (M.K.)
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan; (T.O.); (M.H.); (T.M.)
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Zangiacomo RN, Martins GLP, Viana PCC, Horvat N, Arap MA, Nahas WC, Srougi M, Cerri GG, Menezes MR. Percutaneous thermoablation of small renal masses (T1a) in surgical candidate patients: oncologic outcomes. Eur Radiol 2021; 31:5370-5378. [PMID: 33392662 DOI: 10.1007/s00330-020-07496-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/25/2020] [Accepted: 11/10/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the local tumour progression-free survival (LTPFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS) of healthy surgical candidates who underwent percutaneous thermoablation (TA) as a first-line therapy for small renal masses (T1a). METHODS The institutional review board approved this bi-institutional retrospective study of 85 consecutive surgical candidates with 97 biopsy-proven malignant renal masses (T1a) treated with percutaneous TA from 2008 to 2016. The LTPFS, MFS, CSS and OS rates were calculated using the Kaplan-Meier method. Descriptive analysis was also performed. RESULTS The median tumour size was 2.3 cm (range, 0.7-3.9 cm). The minimal and mean follow-up periods were 24 and 56 months, respectively. Local recurrence was detected in four patients (4.7%) at 8.5, 13.8, 58.0 and 64.0 months of follow-up and retreated successfully with percutaneous TA. No patient developed metastatic renal cell carcinoma, and none died due to renal oncologic complications. One patient died of heart attack. The 5-year LTPFS, OS, MFS and CSS rates were 93.0%, 98.4%, 100% and 100%, respectively. Only two patients (2.3%) had major complications (Clavien-Dindo grade > II), including ureteropelvic junction stenosis and urinary obstruction due to ureteral blood clots. CONCLUSIONS Our study demonstrates that percutaneous TA is a feasible and effective first-line therapy for healthy surgical candidates with small renal masses (T1a). The 5-year LTPFS, OS, CSS and MFS rates were 93.0%, 98.4%, 100% and 100%, respectively, with a major complication rate of only 2.3%. KEY POINTS • Image-guided percutaneous thermoablation of small renal malignancies was effective in 95.3% of the healthy surgical candidates. • Major complications were detected in 2.3% of the patients. • The local tumour progression-free survival rate was 97.6% and 93.0% at 3 and 5 years, respectively.
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Affiliation(s)
- Renato N Zangiacomo
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil
| | - Guilherme L P Martins
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil.,Department of Interventional Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Públio C C Viana
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil.,Department of Interventional Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil.,Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Natally Horvat
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil.,Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Marco A Arap
- Department of Urology, Hospital Sirio-Libanes, Sao Paulo, Brazil.,Department of Urology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - William C Nahas
- Department of Urology, Hospital Sirio-Libanes, Sao Paulo, Brazil.,Department of Urology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Miguel Srougi
- Department of Urology, Hospital Sirio-Libanes, Sao Paulo, Brazil.,Department of Urology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Giovanni G Cerri
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil.,Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Marcos R Menezes
- Department of Radiology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, R. Dr. Ovídio Pires de Campos, 872, São Paulo, SP, 05403-911, Brazil. .,Department of Interventional Radiology, Hospital Sirio-Libanes, Sao Paulo, Brazil.
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Reducing Pain by Artificial Ascites Infusion During Radiofrequency Ablation for Subcapsular Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2021; 44:565-573. [PMID: 33388866 DOI: 10.1007/s00270-020-02723-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate therapeutic effects of artificial ascites (AA) infusion in patients with subcapsular hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and to determine whether this infusion can reduce pain. METHODS AND MATERIALS From 2011 to 2016, 123 patients with treatment-naïve single subcapsular HCC (≤ 2.5 cm) who underwent RFA were retrospectively included. Patients were divided into two groups according to AA infusion. After RFA, medical records were used to analyze pain scores during a 24-h period and to determine the opioid used that compared using Mann-Whitney U test. We also conducted subgroup analysis of the patients with HCCs located adjacent to parietal peritoneum. After follow-up period, we analyzed local tumor progression (LTP) and recurrence-free survival using Kaplan-Meier method. RESULTS AA was infused in 76 patients (61.8%, 76/123). Pain score using numeric rating scale (NRS) was significantly lower in AA infusion group than in control group (2.54 ± 2.8 vs. 3.66 ± 3.2, p = 0.048). Dose of opioids used was not significantly different between two groups (1.62 ± 3.4 mg vs. 1.66 ± 3 mg, p = 0.698). However, in subgroup analysis (N = 45), NRS score and dose of opioids used were significantly lower in AA infusion group (p = 0.03, p = 0.032, respectively). LTP rate was not significantly different between two groups (p = 0.673). CONCLUSION AA infusion was an effective and safe way to reduce pain when performing RFA for subcapsular HCC. In particular, in patients with subcapsular HCC adjacent to parietal peritoneum, dose of opioid to use pain control was significantly lower with AA infusion.
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Park BK, Shen SH, Fujimori M, Wang Y. Asian Conference on Tumor Ablation guidelines for renal cell carcinoma. Investig Clin Urol 2021; 62:378-388. [PMID: 34190433 PMCID: PMC8246015 DOI: 10.4111/icu.20210168] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 01/20/2023] Open
Abstract
Thermal ablation has been established as an alternative treatment for renal cell carcinoma (RCC) in patients who are poor candidates for surgery. However, while American and European guidelines have been established for American and European patients, respectively, no ablation guidelines for Asian patients with RCCs have been established many years after the Asian Conference on Tumor Ablation (ACTA) had been held. Given that Western guidelines are difficult to apply to Asian patients due to differences in body habitus, economic status, and insurance systems, the current review sought to establish the first version of the ACTA guidelines for treating a RCC with thermal ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Shu Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Mie Prefecture, Japan
| | - Yi Wang
- Department of Urology, Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing, China
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33
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Dou JP, Han ZY, Liu F, Cheng Z, Yu X, Yu J, Liang P. Beneficial body mass index to enhance survival outcomes in patients with early-stage hepatocellular carcinoma following microwave ablation treatment. Int J Hyperthermia 2020; 37:110-118. [PMID: 31969030 DOI: 10.1080/02656736.2020.1712482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: To identify the beneficial body mass index (BMI) for patients with hepatocellular carcinoma (HCC) to achieve longer survival time following curative microwave ablation (MWA).Methods: This retrospective study evaluated 474 patients with solitary primary HCC who underwent MWA. BMI at initial admission and other characteristics were collected. The associations of the BMI with the overall survival (OS) and disease-free survival (DFS) were analyzed by Cox proportional hazards regression analysis in multiple models. A two-piecewise linear regression model was applied to examine the threshold effect of the BMI on OS and DFS by maximized log likelihood method. The threshold level was determined by using trial and error.Results: Patients with a normal BMI range achieved improved survival outcomes but similar DFS in multiple models. In the model with adjustments of the age, size, and Charlson score, patients with BMI ≤ 22.9 and ≤24.9 kg/m2 exhibited a lower death rate than patients with BMI ≤18.5 kg/m2 (p < 0.05). U-shaped relationships between the BMI and OS were illustrated when the BMI was set as a continuous variable. The death prevalence decreased with an increasing BMI up to the first turning point of 21.5 and increased with an increasing BMI up to the second turning point of 23.1 (p = 0.00). The threshold effect analysis indicated that no turning point was selected in the DFS results (p = 0.10).Conclusions: The beneficial BMI level for HCC patients following MWA, with a more likely favorable survival outcome, is 21.5 to 23.1 kg/m2.
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Affiliation(s)
- Jian-Ping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Rogger TM, Michielan A, Sferrazza S, Pravadelli C, Moser L, Agugiaro F, Vettori G, Seligmann S, Merola E, Maida M, Ciarleglio FA, Brolese A, de Pretis G. Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma: A case report and review of the literature. World J Gastroenterol 2020; 26:5375-5386. [PMID: 32994695 PMCID: PMC7504251 DOI: 10.3748/wjg.v26.i35.5375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radiofrequency ablation (RFA) and microwave ablation (MWA) represent the standard of care for patients with early hepatocellular carcinoma (HCC) who are unfit for surgery. The incidence of reported adverse events is low, ranging from 2.4% to 13.1% for RFA and from 2.6% to 7.5% for MWA. Gastrointestinal tract (GIT) injury is even more infrequent (0.11%), but usually requires surgery with an unfavourable prognosis. Due to its low incidence and the retrospective nature of the studies, the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics, comorbidities and treatment approaches. CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location. He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever. A subcutaneous abscess was diagnosed and treated by percutaneous drainage. A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall. The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulent abdominal collection. An over-the-scope clip (OTSC) was used to successfully close the defect. CONCLUSION This is the first reported case of RFA-related GIT injury to have been successfully treated with an OTSC, which highlights the role of this endoscopic treatment for the management of this complication.
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Affiliation(s)
- Teresa Marzia Rogger
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Andrea Michielan
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sandro Sferrazza
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Cecilia Pravadelli
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Luisa Moser
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Flora Agugiaro
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni Vettori
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Sonia Seligmann
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Elettra Merola
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S.Elia-Raimondi Hospital, Caltanissetta, Caltanissetta 93100, Italy
| | | | - Alberto Brolese
- Department of Surgery, Hepato-biliary Surgery Unit, Santa Chiara Hospital, Trento 38122, Italy
| | - Giovanni de Pretis
- Department of Surgery, Gastroenterology and Digestive Endoscopy Unit, Santa Chiara Hospital, Trento 38122, Italy
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Microwave Ablation Versus Wedge Resection for Stage I Non-small Cell Lung Cancer Adjacent to the Pericardium: Propensity Score Analyses of Long-term Outcomes. Cardiovasc Intervent Radiol 2020; 44:237-246. [PMID: 32909064 PMCID: PMC7806557 DOI: 10.1007/s00270-020-02601-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/15/2020] [Indexed: 02/06/2023]
Abstract
Objective The present study has compared the long-term outcomes between performing wedge resection (WR) and microwave ablation (MWA) as first-line treatment of stage I non–small cell lung cancer (NSCLC) patients with tumors adjacent to the pericardium. Materials and Methods Between January 2014 and December 2018, a total of 223 consecutive patients with T1N0 NSCLC underwent first-line treatment by WR (n = 155) or image-guided lung MWA (n = 68). This study has compared the progression-free survival (PFS) and overall survival (OS) rates between the two treatments before and after propensity score matching. Subgroup analysis of these outcomes was conducted based on the distance from the pericardium. Results The median follow-up time was 47 months. Propensity matching yielded 56 pairs of patients. In the two matched groups, the PFS rates in the WR group at 3 and 5 years were 66.0% and 56.0% and 54.0% and 36.0%, respectively, in the MWA group (P = 0.029). Meanwhile, the corresponding OS rates for the WR group at 3 and 5 years were 81.0% and 72.0% and 60.0% and 55.0% in the MWA group, respectively (P = 0.031). Subgroup analysis, done according to the treatment modality, indicated that local tumor recurrence and PFS for NSCLCs that were close but not contiguous to the pericardium were different from those contiguous to the pericardium (P = 0.018 and P = 0.025, respectively). Conclusion WR provided better long-term tumor control and OS compared to MWA for stage I NSCLC adjacent to the pericardium as a first-line treatment. MWA can be considered as an alternative option for high-risk and inoperable patients, particularly for tumors that were not contiguous to the pericardium.
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Park HJ, Kim SY. Imaging Modalities for Hepatocellular Carcinoma Surveillance: Expanding Horizons beyond Ultrasound. JOURNAL OF LIVER CANCER 2020; 20:99-105. [PMID: 37384318 PMCID: PMC10035675 DOI: 10.17998/jlc.20.2.99] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 06/30/2023]
Abstract
In Asian countries favoring loco-regional treatment such as surgical resection or ablation, very early-stage hepatocellular carcinoma (HCC) should be the main target for surveillance. Even though ultrasound (US) has been accepted as a primary imaging modality for HCC surveillance, its performance in detecting very early-stage HCCs is insufficient. Moreover, in more than 20% of patients at high risk for HCC, visualization of the liver on US may be limited owing to the advanced distortion and heterogeneity of the liver parenchyma. Recently revised HCC clinical guidelines allow the use of alternative surveillance tools including computed tomography or magnetic resonance imaging in patients with inadequate US exams. This paper summarizes the findings of recent studies using imaging modalities other than US as surveillance tools for HCC as well as strengths and limitations of these modalities.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and the Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Based on Surveillance, Epidemiology, and End Results studies, most renal cancers are low grade and slow growing. Long-term, single-center studies show excellent outcomes for T1a renal cell carcinoma (RCC), comparable to partial nephrectomy without affecting renal function and with much lower rates of complications. However, there are no multicenter randomized controlled trials of multiple ablative modalities or comparison with partial nephrectomy, and most studies are single-arm observational studies with short-term and intermediate follow-up. For treatment of stage T1a RCC, percutaneous TA is an effective alternative to surgery with preservation of renal function, low risk, and comparable overall and disease-specific survival.
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38
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Páez-Carpio A, Vollmer I, Paredes P. Evaluación de la respuesta al tratamiento con radiofrecuencia de un nódulo pulmonar mediante ecografía con contraste (CEUS). Arch Bronconeumol 2020; 56:531-532. [DOI: 10.1016/j.arbres.2020.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 11/25/2022]
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Wu Y, Qi H, Cao F, Shen L, Chen S, Xie L, Huang T, Song Z, Zhou D, Fan W. TACE-Sorafenib With Thermal Ablation Has Survival Benefits in Patients With Huge Unresectable Hepatocellular Carcinoma. Front Pharmacol 2020; 11:1130. [PMID: 32903854 PMCID: PMC7438914 DOI: 10.3389/fphar.2020.01130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/10/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose To investigate the effectiveness and safety of transarterial chemoembolization (TACE) combined with sorafenib and thermal ablation in patients with huge hepatocellular carcinoma (HCC). Materials and Methods This retrospective study examined 50 patients with huge unresectable HCC treated from January 2009 to December 2015. Among them, 28 cases received TACE-sorafenib treatment (TACE-sorafenib group), and 22 cases received TACE-sorafenib plus thermal ablation treatment (TACE-sorafenib-thermal ablation group). The Overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were compared. Results The median follow-up was 13.5 months (ranges 4.2 to 96.7 months). The median OS was significantly longer in the TACE-sorafenib-thermal ablation group than that in the TACE-sorafenib group (20.8 vs. 10.4 months, P=0.003). The median PFS of the ablation and no ablation groups were 4.3 vs. 7.1 months (P=0.546). The treatment modality was an independent predictor of OS (P=0.004). There were no notable drug-related high grade adverse events or permanent adverse sequelae. Conclusion TACE-sorafenib-thermal ablation provided extended OS to patients with huge unresectable HCC and could be a better choice than TACE-sorafenib.
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Affiliation(s)
- Ying Wu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shuanggang Chen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin Xie
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ze Song
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Danyang Zhou
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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40
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Is There a Role for Combination, Single-Session Selective Transarterial Embolization and Microwave Ablation for Large Renal Masses? Cardiovasc Intervent Radiol 2020; 43:1468-1473. [PMID: 32613266 DOI: 10.1007/s00270-020-02568-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Thermal ablation of small renal tumors is safe and efficacious. Thermoablation of tumors greater than 3 cm has decreased efficacy and a greater risk of complications. Combined embolization and radiofrequency ablation has shown encouraging results. We report on the use of combined single-session transarterial embolization and microwave ablation to treat large renal masses. MATERIALS AND METHODS After obtaining IRB approval, a review of the medical record between October 2016 and January 2020 was performed. Patients with renal tumors who underwent combined transarterial embolization and microwave ablation were assessed retrospectively. Patient demographic information, intraoperative, postoperative, and follow-up data were recorded. RESULTS Eleven patients were identified meeting inclusion criteria. The mean age was 73 years, with 64% male, an average BMI of 26.5, and average Charleston Comorbidity Index of 6.7. Nine tumors were identified as clear cell carcinoma, one as papillary carcinoma and one as an oncocytic neoplasm. Average tumor size was 4.5 cm (2.7-8.3), with an average RENAL score of 8.5. Successful ablation with a 5 mm margin was achieved in all patients, and in all cases, ablation and embolization were performed on the same day. The only related post-procedure complication was a single groin hematoma. Surveillance was performed with CT or MRI. Average follow-up was 419.5 days (range 27-747), with no patients showing evidence of recurrence to date. CONCLUSIONS Combined single-session transarterial embolization and microwave ablation is technically feasible, safe, and efficacious in treating large renal tumors in a series of 11 patients with no recurrence to date. LEVEL OF EVIDENCE Level 4, case series.
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Song Z, Ye J, Wang Y, Li Y, Wang W. Computed tomography-guided iodine-125 brachytherapy for unresectable hepatocellular carcinoma. J Cancer Res Ther 2020; 15:1553-1560. [PMID: 31939437 DOI: 10.4103/jcrt.jcrt_629_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose This study aimed to retrospectively assess the outcome of interstitial iodine-125 brachytherapy for unresectable hepatocellular carcinoma (HCC). Materials and Methods Between February 2013 and March 2019, 57 patients with 108 unresectable HCC lesions treated with computed tomography (CT)-guided iodine-125 seed brachytherapy were retrospectively analyzed. The primary endpoint was overall survival (OS). The secondary endpoints included local tumor control and progression-free survival (PFS). Potential factors associated with OS were assessed. Results The mean follow-up duration was 24.3 ± 15.6 months (median, 20.5 months; range, 3.9-66.8 months). The median OS time was 23.6 months (95% confidence interval [CI], 18.4-28.8 months). The 1-, 2-, and 3-year actuarial OS rates were 80.0%, 46.1%, and 24.3%, respectively. The median PFS time was 12 months (95% CI, 9.9-14.5 months). The 1- and 2-year actuarial PFS rates were 50% and 20.1%, respectively. Local progression was noted in 11 (11.3%) of 108 lesions with mean local control time of 20.5 ± 8.8 months. The 1- and 2-year local control rates were 96.5% and 88.8%, respectively. Barcelona clinic liver cancer stage and Child-Pugh score were independent risk factors affecting the prognosis (hazard ratio [HR] = 0.330 [95% CI, 0.128-0.853] and HR = 0.303 [95% CI, 0.151-0.610], respectively). Hepatic artery pseudoaneurysm was found in 1 (1.8%) patient with lesion located in the porta hepatis. No other major complications developed during follow-up. Conclusion CT-guided iodine-125 brachytherapy may be an effective and safe alternative with promising survival and increased local control rate in unresectable HCC treatment.
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Affiliation(s)
- Zhaomin Song
- Department of Oncology, The Third Hospital of Qinhuangdao City, Qinhuangdao City, Hebei Province, China
| | - Jiacheng Ye
- Department of Interventional Medicine, Nanping First Hospital Affiliated to Fujian Medical University, Nanping City, Fujian Province, China
| | - Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Institute of Tumor Intervention, Shandong University, Jinan City, Shandong Province, Nanping City, Fujian Province, China
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Yang DP, Zhuang BW, Wang YZ, Lin MX, Xu M, Kuang M, Lei YY, Xie XY, Xie XH. Thermal ablation versus hepatic resection for the treatment of liver metastases from gastrointestinal stromal tumors: a retrospective study. Int J Hyperthermia 2020; 37:592-599. [PMID: 32484012 DOI: 10.1080/02656736.2020.1772513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: The study aimed to compare effectiveness and safety of thermal ablation and hepatic resection in patients with liver metastases of gastrointestinal stromal tumors (GISTs).Method: A total of 55 patients (27 in the ablation group and 28 in the surgery group) with liver metastases were included. Overall survival (OS) and progression-free survival (PFS) were assessed with Kaplan-Meier's survival estimate curves. Univariate and multivariate regression analyses were carried out to identify potential prognostic factors.Results: The median OS was 102.0 months in the ablation group and 117.0 months in the surgery group (p = .875). The 1-, 3- and 5-year OS rates were 100%, 88.9% and 74.1% in the ablation group and 92.8%, 82.1% and 78.6% in the surgery group, respectively. The 1-, 3- and 5-year PFS rates were 48.1%, 25.9% and 18.5% in the ablation group and 67.8%, 64.3% and 64.3% in the surgery group, respectively. Multivariate analysis showed that preoperative tyrosine kinase inhibitor (TKI) treatment (progressive disease, PD) (HR, 13.985; 95% CI, 1.791-109.187; p = .012) was the only significant independent prognostic factor for OS. Tumor number (HR, 1.318; 95% CI, 1.021-1.702; p = .034) was identified as an independent predictor for PFS in multivariate analysis. There were fewer postoperative complications (18.5% vs. 78.6%, p = .001) and shorter lengths of hospital stay (8.0 vs. 16.5 days, p = .001) in the ablation group.Conclusion: Compared with resection, thermal ablation offered comparable OS for liver metastases of GISTs. Furthermore, thermal ablation had the advantages of fewer complications and shorter lengths of hospital stay.
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Affiliation(s)
- Dao-Peng Yang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bo-Wen Zhuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu-Zhao Wang
- Sun Yat-Sen University School of Medicine, Guangzhou, China
| | - Man-Xia Lin
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming Kuang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.,Department of Liver Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yang-Yang Lei
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Hua Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Shousha HI, Fouad R, Elbaz TM, Sabry D, Mahmoud Nabeel M, Hosni Abdelmaksoud A, Mahmoud Elsharkawy A, Soliman ZA, Habib G, Abdelaziz AO. Predictors of recurrence and survival of hepatocellular carcinoma: A prospective study including transient elastography and cancer stem cell markers. Arab J Gastroenterol 2020; 21:95-101. [PMID: 32439234 DOI: 10.1016/j.ajg.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 03/23/2020] [Accepted: 04/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND STUDY AIMS To investigate whether the measurement of liver stiffness (LSM) using fibroscan and the serum Cancer Stem Cells (CSC): Ep-CAM and cytokeratin-19, could predict the recurrence of hepatocellular carcinoma (HCC) and their impact on clinical outcome and overall survival. PATIENTS AND METHODS This is a prospective study, including 179 HCV-related HCC patients. All patients were treated following the BCLC guidelines. All HCC patients had transient elastography, measurements of Ep-CAM and cytokeratin-19 before and six months post-treatment. We looked for predictors of recurrence and performed a survival analysis using Kaplan-Meier estimates. RESULTS TACE was the most common procedure (77.1%), followed by microwave ablation (15.6%). Complete ablation was achieved in 97 patients; 55 of them developed HCC recurrence. After treatment, LSM increased significantly with a significant reduction in CSCs levels in complete and partial response groups. The median time to observe any recurrence was 14 months. LSM increased significantly post-treatment in patients with recurrence versus no recurrence. Higher levels of CSCs were recorded at baseline and post-treatment in patients with recurrence but without statistical significance. We used univariate analysis to predict the time of recurrence by determining baseline CK-19 and platelet levels as the key factors, while the multivariate analysis determined platelet count as a single factor. The univariate analysis for prediction of overall survival included several factors, LSM and EpCAM (baseline and post-ablation) among them, while multivariate analysis included factors such as Child score B and incomplete ablation. CONCLUSION Dynamic changes were observed in LSM and CSCs levels in response to HCC treatment and tumour recurrence. Child score and complete ablation are factors that significantly affect survival.
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Affiliation(s)
- Hend Ibrahim Shousha
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| | - Rabab Fouad
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tamer Mahmoud Elbaz
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Sabry
- Medical Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Mahmoud Nabeel
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hosni Abdelmaksoud
- Diagnostic and Interventional Radiology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Aisha Mahmoud Elsharkawy
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Zeinab Abdellatif Soliman
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Habib
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Omar Abdelaziz
- Endemic Medicine and Hepato-gastroenterology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Brandi G, Rizzo A, Dall’Olio FG, Felicani C, Ercolani G, Cescon M, Frega G, Tavolari S, Palloni A, De Lorenzo S, Abbati F, Mollica V, Ricci AD, Serra C. Percutaneous radiofrequency ablation in intrahepatic cholangiocarcinoma: a retrospective single-center experience. Int J Hyperthermia 2020; 37:479-485. [DOI: 10.1080/02656736.2020.1763484] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Filippo Gustavo Dall’Olio
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cristina Felicani
- Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Matteo Cescon
- Department of Medical and Surgical Sciences-DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Giorgio Frega
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Simona Tavolari
- Center of Applied Biomedical Research, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Andrea Palloni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Stefania De Lorenzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Abbati
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Veronica Mollica
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Angela Dalia Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Carla Serra
- Department of Organ Insufficiency and Transplantation, S. Orsola-Malpighi Hospital, Bologna, Italy
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Follow-up of percutaneous microwave (MW) ablation of hepatic lesion: predictive value of CT at 24-h compared with CT at 1 month. Med Oncol 2020; 37:41. [PMID: 32266568 DOI: 10.1007/s12032-020-01364-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022]
Abstract
To retrospectively assess the predictive value of the CT performed at 24 h, compared with the CT performed at 1 month, in the evaluation of the technical success of microwave (MW) ablation of hepatic lesions. In a single center, 50 patients with HCC underwent percutaneous MW ablation between November 2016 and March 2019. Each patient underwent a contrast-enhanced CT exam at 24 h and at 1 month after the procedure. For each patient, was assessed the presence or absence of residual disease, the appearance of a new lesion, complications, and the involvement of the hepatic capsule, both at 24-h and at 1 month. Overall correlation between residual disease, appearance of a new nodule and complications was also assessed. A total of 50 hepatic lesions were treated with US-guided MW ablation. Patients' mean age was 70.9 years (range 28-87 years). Mean nodule diameter was 17.6 mm (range 7-35 mm). Contingency tables and the χ2 test showed a strong association when looking at capsule involvement (accuracy: 100%), residual disease (accuracy: 90%; p-value 0.003), and the appearance of a new HCC nodule (accuracy: 88%; p-value 0.007); regarding complications, the accuracy was 78% (p-value 0.014). Optimal correlation was reached in 62% of cases, moderate correlation in 26%, minimum correlation in 10% of cases; no cases of zero correlation were recorded. CT at 24 h and 1 month showed comparable efficacy in evaluating residual disease after MW thermal ablation of liver lesions. However, further studies are needed to assess which factors may cause false-negative results at the 24-h CT.
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Omari J, Drewes R, Orthmer M, Hass P, Pech M, Powerski M. Treatment of metastatic gastric adenocarcinoma with image-guided high-dose rate, interstitial brachytherapy as second-line or salvage therapy. ACTA ACUST UNITED AC 2020; 25:360-367. [PMID: 31348004 DOI: 10.5152/dir.2019.18390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of image-guided high-dose rate interstitial brachytherapy (iBT) for the treatment of patients with hepatic, lymphatic, and pancreatic metastases originating from gastric cancer, an entity rarely surgically treatable with curative intent. METHODS Twelve patients with a cumulative number of 36 metastases (29 liver, 2 pancreatic, 5 lymph node) from histologically proven gastric adenocarcinoma received iBT between 2010 and 2016 and were retrospectively analyzed. Every patient underwent palliative chemotherapy prior to iBT. The iBT procedure employs a temporarily, intratumorally placed iridium-192 source in a single fraction with the goal of tumor cell eradication. Effectiveness was assessed clinically and by radiologic imaging every three months. RESULTS Local tumor control was achieved in 32 of all treated metastases (89%). Four lesions showed a local recurrence after 7 months. Lesion sizes varied from 9 to 102 mm with a median of 20 mm. The median progression-free survival was 6.6 months (range, 1.8-46.8 months). The median overall survival was 11.4 months (range, 5-47 months). One patient suffered a major complication following iBT, hepatic hematoma and abscess (Common Terminology Criteria for Adverse Events grade 3), successfully dealt with by transcutaneous drainage. CONCLUSION iBT is an overall safe procedure, which facilitates high rates of local tumor control in treatment of metastatic gastric adenocarcinoma. Compared with surgical metastasectomy, similar overall survival rates could be achieved in our patient collective after iBT application.
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Affiliation(s)
- Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Ralph Drewes
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Max Orthmer
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Peter Hass
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany;Department of Radiology, Gdansk University School of Medicine, Gdansk, Poland
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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Liu F, Yuan H, Li X, Tang J, Tian X, Ji K. A new management strategy for renal angiomyolipomas: superselective arterial embolization in combination with radiofrequency ablation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:766. [PMID: 32042782 DOI: 10.21037/atm.2019.11.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The present study analyzed the safety and efficacy of superselective arterial embolization (SAE) combined with radiofrequency ablation (RFA) to treat renal angiomyolipoma (RAML). Methods This retrospective study included the clinical data of 6 patients with RAML treated between March 2016 and October 2017. All patients underwent RFA treatment immediately after SAE guided by angio-computed tomography (angio-CT). The tumor size, renal function and complications, and time to recurrence were compared before and after treatment. Results The success rate of the SAE + RFA technique was 100%, and no serious complications were found during or after surgery. After treatment, the patients' symptoms, including low back pain and hematuria, were relieved. The pre-treatment creatinine level (55.6±11.0 µmol/L) did not differ significantly from the post-treatment creatinine level (68.2±13.7 µmol/L), which was measured 1 day after surgery (t=1.75, P=0.109). The mean follow-up time was 29.5±6.1 months. By the end of the follow-up period, the maximum diameter of the tumor was 3.1±0.6 cm, which was significantly smaller than the pre-treatment diameter of 5.9±1.01 cm (t=5.83, P<0.001). At 3 months after surgery, the maximum diameter of the tumor was reduced by 22-38% in all 6 patients. At the last follow-up examination, the maximum diameter of the tumor was reduced by 36-61%. Contrast-enhanced CT or magnetic resonance imaging scans showed that the enhanced part of the original lesion had disappeared, the renal parenchyma was full of even fat signals, and only one patient had new enhanced lesions at the site of the original lesions. Conclusions SAE combined with RFA is a safe and effective treatment for RAML, and its strengths qualify it to become a new treatment strategy for RAML.
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Affiliation(s)
- Fengyong Liu
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Hongjun Yuan
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Xin Li
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jing Tang
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Xiaomei Tian
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Kan Ji
- The First Medical Center of PLA General Hospital, Beijing 100853, China
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Kim R, Jeong WK, Kang TW, Song KD, Lee MW, Ahn SH, Rhim H. Intrahepatic distant recurrence after radiofrequency ablation of hepatocellular carcinoma: relationship with portal hypertension. Acta Radiol 2019; 60:1609-1618. [PMID: 31042068 DOI: 10.1177/0284185119842830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ran Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sundelin MO, Lagerveld B, Ismail M, Keeley FX, Nielsen TK. Repeated Cryoablation as Treatment Modality After Failure of Primary Renal Cryoablation: A European Registry for Renal Cryoablation Multinational Analysis. J Endourol 2019; 33:909-913. [DOI: 10.1089/end.2019.0444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Brunolf Lagerveld
- Department of Urology, Onze lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Mohamed Ismail
- Department of Urology, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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Chen C, Wang Y, Li G, Xu L, Wang Y, Huang H, Wang B, Li W, He X. Feasibility of CT-CT fusion imaging for evaluation of the cryoablation margins in visible hepatocellular carcinoma on unenhanced CT images: Initial experience. J Interv Med 2019; 2:60-64. [PMID: 34805874 PMCID: PMC8562177 DOI: 10.1016/j.jimed.2019.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To demonstrate the feasibility of CT-CT fusion imaging for assessment of the cryoablation margins in visible hepatocellular carcinoma (HCC) on unenhanced CT images. Methods This retrospective study analyzed 14 patients with 14 HCC lesions treated with CT-guided cryoablation. Nine lesions in nine patients who developed local tumor progression (LTP) during the follow-up period of at least 8 months were reviewed. The unenhanced CT data were used to retrospectively create fusion images of the intraoperative CT images on a workstation. The minimal ablative margin (MAM) was assessed on the fusion images. The concordance between the site of LTP and the MAM area was also assessed. Results Eight of the nine lesions with LTP were in the subcapsular region of the liver. Seven of the nine cases were treated by cryoablation combined with transcatheter arterial chemoembolization. The median time required to fuse the images for the nine lesions was 5:17 min (range, 5:04–7:37 min). The site of LTP relative to the HCC lesion was craniocaudal in nine, dorsoventral in six, and lateral in seven lesions. In all lesions, the site of LTP was congruent with the MAM area. Conclusions CT-CT fusion imaging enables a real-time intraoperative treatment evaluation for HCC lesions visible on unenhanced CT images. Fused imaging evaluation has proved to be an accurate and useful tool for assessment of the cryoablation margins.
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Affiliation(s)
- Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Yaohui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Guodong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Haozhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Biao Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Centerl, Shanghai, 200032, China
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