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Cazzato RL, Garnon J, Jennings JW, Gangi A. Interventional management of malignant bone tumours. J Med Imaging Radiat Oncol 2023; 67:862-869. [PMID: 37742284 DOI: 10.1111/1754-9485.13587] [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: 05/10/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
In the last few decades, interventional radiology (IR) has significantly increased its role in the management of bone tumours including bone metastases (BM) that represent the most common type of tumour involving the bone. The current IR management of BM is based on the 'palliative-curative' paradigm and relies on the use of consolidative (i.e. osteplasty, osteosynthesis) and/or ablation (i.e. cryoablation, radiofrequency ablation, electrochemotherapy) techniques. The present narrative review will overview the current role of IR for the management of BM.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Jack William Jennings
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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2
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Cazzato RL, Dalili D, De Marini P, Koch G, Autrusseau PA, Weiss J, Auloge P, Garnon J, Gangi A. Bone Consolidation: A Practical Guide for the Interventional Radiologist. Cardiovasc Intervent Radiol 2023; 46:1458-1468. [PMID: 36539512 DOI: 10.1007/s00270-022-03340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
In recent years, interventional radiologists have been increasingly involved in the management of bone fractures resulting from benign (osteoporosis and trauma), as well as malignant (tumor-related impending or pathologic fractures) conditions. Interventional techniques used to fix fractures include image-guided osteoplasty, screw-mediated osteosynthesis, or combinations of both. In the present narrative review, we highlight the most common clinical scenarios that may benefit from such interventional techniques with specific focus on spine, pelvic ring, and long bones.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France.
| | - Danoob Dalili
- Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Dorking Road, Epsom, London, KT18 7EG, UK
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- Department of Human Anatomy, University Hospital of Strasbourg, Strasbourg, France
| | | | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, Strand London, London, WC2R 2LS, UK
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3
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Shashi KK, Shahin MM, Johnston P, Shaikh R. Cryoablation for Bone and Soft Tissue Lesions in Pediatric Patients: Complications and Preventive Measures. Cardiovasc Intervent Radiol 2023; 46:1249-1256. [PMID: 37580423 DOI: 10.1007/s00270-023-03523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To evaluate complications associated with cryoablation in a pediatric population and review preventive measures to mitigate these complications. MATERIAL AND METHODS Retrospective study including all the image guided cryoablations performed on pediatric population. Immediate and delayed complications were analyzed, and we identified the different protective measures used and the clinical outcomes from follow-up. Point estimates for the percentage of complications were calculated by maximum likelihood, and 95% confidence intervals for the true percentages were calculated using the Clopper-Pearson exact method. RESULTS Eighty-seven ablations were performed on 68 patients (age range of 2-18 years, mean 12.4 years) for non-neoplastic (70%) and neoplastic (30%) lesions. The percentage of ablations resulting in complications was 18% (95% confidence interval (CI) 11% to 28%). Of these, 5% (95% CI 1% to 11%) were grade 3 complications, and 14% (95% CI 7% to 23%) were grade 2 complications. Thermal protection was performed in 27.6% of ablations (n = 24). The mean clinical follow-up duration was 348 days. CONCLUSION Cryoablation in pediatric patients is relatively safe, with a major complication rate per ablation of 5%. Thermal protective measures can be considered to mitigate these complications.
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Affiliation(s)
- Kumar Kempegowda Shashi
- Department of Radiology, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Mohamed M Shahin
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Raja Shaikh
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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4
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Posa A, Contegiacomo A, Ponziani FR, Punzi E, Mazza G, Scrofani A, Pompili M, Goldberg SN, Natale L, Gasbarrini A, Sala E, Iezzi R. Interventional Oncology and Immuno-Oncology: Current Challenges and Future Trends. Int J Mol Sci 2023; 24:ijms24087344. [PMID: 37108507 PMCID: PMC10138371 DOI: 10.3390/ijms24087344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Personalized cancer treatments help to deliver tailored and biologically driven therapies for cancer patients. Interventional oncology techniques are able to treat malignancies in a locoregional fashion, with a variety of mechanisms of action leading to tumor necrosis. Tumor destruction determines a great availability of tumor antigens that can be recognized by the immune system, potentially triggering an immune response. The advent of immunotherapy in cancer care, with the introduction of specific immune checkpoint inhibitors, has led to the investigation of the synergy of these drugs when used in combination with interventional oncology treatments. The aim of this paper is to review the most recent advances in the field of interventional oncology locoregional treatments and their interactions with immunotherapy.
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Affiliation(s)
- Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Romana Ponziani
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Ernesto Punzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Giulia Mazza
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Annarita Scrofani
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Maurizio Pompili
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 12000, Israel
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
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5
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Iezzi R, Kovács G, Dimov V, Contegiacomo A, Posa A, Efthymiou E, Lancellotta V, Rodolfino E, Punzi E, Trajkovski ZB, Valentini V, Manfredi R, Filippiadis D. Multimodal locoregional procedures for cancer pain management: a literature review. Br J Radiol 2023; 96:20220236. [PMID: 36318237 PMCID: PMC9975366 DOI: 10.1259/bjr.20220236] [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: 02/26/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/27/2022] Open
Abstract
Pain is the most common and fearsome symptom in cancer patients, particularly in the advanced stage of disease. In cancer pain management, the first option is represented by analgesic drugs, whereas surgery is rarely used. Prior to considering surgical intervention, less invasive locoregional procedures are available from the wide pain management arsenal. In this review article, comprehensive information about the most commonly used locoregional options available for treating cancer pain focusing on interventional radiology (neurolysis, augmentation techniques, and embolization) and interventional radiotherapy were provided, also highlighting the potential ways to increase the effectiveness of treatments.
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Affiliation(s)
| | - György Kovács
- Università Cattolica del Sacro Cuore, Gemelli-INTERACTS, Rome, Italy
| | - Vladimir Dimov
- Acibadem Sistina Hospital Skopje, Skopje, North Macedonia
| | - Andrea Contegiacomo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Posa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Valentina Lancellotta
- UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Roma, Italy
| | - Elena Rodolfino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Istituto di Radiologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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6
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Iezzi R, Gangi A, Posa A, Pua U, Liang P, Santos E, Kurup AN, Tanzilli A, Tenore L, De Leoni D, Filippiadis D, Giuliante F, Valentini V, Gasbarrini A, Goldberg SN, Meijerink M, Manfredi R, Kelekis A, Colosimo C, Madoff DC. Emerging Indications for Interventional Oncology: Expert Discussion on New Locoregional Treatments. Cancers (Basel) 2023; 15:cancers15010308. [PMID: 36612304 PMCID: PMC9818393 DOI: 10.3390/cancers15010308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023] Open
Abstract
Interventional oncology (IO) employs image-guided techniques to perform minimally invasive procedures, providing lower-risk alternatives to many traditional medical and surgical therapies for cancer patients. Since its advent, due to rapidly evolving research development, its role has expanded to encompass the diagnosis and treatment of diseases across multiple body systems. In detail, interventional oncology is expanding its role across a wide spectrum of disease sites, offering a potential cure, control, or palliative care for many types of cancer patients. Due to its widespread use, a comprehensive review of the new indications for locoregional procedures is mandatory. This article summarizes the expert discussion and report from the "MIOLive Meet SIO" (Society of Interventional Oncology) session during the last MIOLive 2022 (Mediterranean Interventional Oncology Live) congress held in Rome, Italy, integrating evidence-reported literature and experience-based perceptions. The aim of this paper is to provide an updated review of the new techniques and devices available for innovative indications not only to residents and fellows but also to colleagues approaching locoregional treatments.
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Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Correspondence: (R.I.); (A.P.)
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67091 Strasbourg, France
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Correspondence: (R.I.); (A.P.)
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Ping Liang
- Department of Interventional Ultrasound, PLA Medical College & Fifth Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Ernesto Santos
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Anil N. Kurup
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, USA
| | - Alessandro Tanzilli
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Lorenzo Tenore
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Davide De Leoni
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece
| | - Felice Giuliante
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Vincenzo Valentini
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
- Internal Medicine and Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Shraga N. Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 12000, Israel
| | - Martijn Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081HV Amsterdam, The Netherlands
| | - Riccardo Manfredi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, 1 Rimini Str., 12462 Athens, Greece
| | - Cesare Colosimo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore di Roma, Largo Francesco Vito 1, 00168 Rome, Italy
| | - David C. Madoff
- Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, 330 Cedar St., TE-2, New Haven, CT 06510, USA
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7
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Yang T, Ke J, Cheng S, He Y, Huang W, Yao M, Zhou J, Zhong G, Hu Y, Zhang Y. Clinical guidelines for microwave ablation of spinal metastases. J Cancer Res Ther 2022; 18:1845-1854. [PMID: 36647941 DOI: 10.4103/jcrt.jcrt_655_22] [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: 01/13/2023]
Abstract
Spinal metastases are the most common source of morbidity in patients with cancer. Recently, microwave ablation has produced satisfactory results in the management of spinal metastases. However, there is still controversy in terms of clinical treatment, such as indication, power, time, and temperature. To standardize the application of microwave ablation technology and reduce the risk of surgical-related complications in spinal metastases, in this report, we aimed to summarize the current evidence and clinical experience of microwave ablation and developed a clinical guideline, initiated by the Musculoskeletal Tumor Group of the Committee for Minimally Invasive Therapy in Oncology of the Chinese Anti-Cancer Association. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used in to rate the quality of evidence and the strength of recommendations, and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) checklist was strictly followed to report the guideline. Finally, 15 evidence-based recommendations were formulated based on the 15 most concerned clinical questions among orthopedic surgeons, oncologists, and interventional radiologists in China. This guideline aims to promote the science-based normalization of microwave ablation for the treatment of spinal metastases.
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Affiliation(s)
- Tao Yang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jin Ke
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Shi Cheng
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yue He
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Mengyu Yao
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jielong Zhou
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Guoqing Zhong
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Yongcheng Hu
- Department of Bone Tumor, Tianjin Hospital, Tianjin, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
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8
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Pu F, Wu W, Jing D, Yu Y, Peng Y, Liu J, Wu Q, Wang B, Zhang Z, Shao Z. Three-dimensional-printed titanium prostheses with bone trabeculae enable mechanical-biological reconstruction after resection of bone tumours. BIOMATERIALS TRANSLATIONAL 2022; 3:134-141. [PMID: 36105569 PMCID: PMC9465991 DOI: 10.12336/biomatertransl.2022.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/22/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022]
Abstract
Reconstruction after resection has always been an urgent problem in the treatment of bone tumours. There are many methods that can be used to reconstruct bone defects; however, there are also many complications, and it is difficult to develop a safe and effective reconstruction plan for the treatment of bone tumours. With the rapid development of digital orthopaedics, three-dimensional printing technology can solve this problem. The three-dimensional printing of personalised prostheses has many advantages. It can be used to print complex structures that are difficult to fabricate using traditional processes and overcome the problems of stress shielding and low biological activity of conventional prostheses. In this study, 12 patients with bone tumours were selected as research subjects, and based on individualised reverse-engineering design technology, a three-dimensional model of each prosthesis was designed and installed using medical image data. Ti6Al4V was used as the raw material to prepare the prostheses, which were used to repair bone defects after surgical resection. The operation time was 266.43 ± 21.08 minutes (range 180-390 minutes), and intraoperative blood loss was 857.26 ± 84.28 mL (range 800-2500 mL). One patient had delayed wound healing after surgery, but all patients survived without local tumour recurrence, and no tumour metastasis was found. No aseptic loosening or structural fracture of the prosthesis, and no non-mechanical prosthesis failure caused by infection, tumour recurrence, or progression was observed. The Musculo-Skeletal Tumour Society (MSTS) score of limb function was 22.53 ± 2.09 (range 16-26), and ten of the 12 patients scored ≥ 20 and were able to function normally. The results showed that three-dimensional printed prostheses with an individualised design can achieve satisfactory short-term clinical efficacy in the reconstruction of large bone defects after bone tumour resection.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Zhicai Zhang
- Corresponding authors: Zengwu Shao, ; Zhicai Zhang,
| | - Zengwu Shao
- Corresponding authors: Zengwu Shao, ; Zhicai Zhang,
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9
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Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:jcm11123265. [PMID: 35743336 PMCID: PMC9225477 DOI: 10.3390/jcm11123265] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 01/10/2023] Open
Abstract
Interventional Radiology (IR) has experienced an exponential growth in recent years. Technological advances of the last decades have made it possible to use new treatments on a larger scale, with good results in terms of safety and effectiveness. In musculoskeletal field, painful bone metastases are the most common target of IR palliative treatments; however, in selected cases of bone metastases, IR may play a curative role, also in combination with other techniques (surgery, radiation and oncology therapies, etc.). Primary malignant bone tumors are extremely rare compared with secondary bone lesions: osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common; however, the role of interventional radiology in this fiels is marginal. In this review, the main techniques used in interventional radiology were examined, and advantages and limitations illustrated. Techniques of ablation (Radiofrequency, Microwaves, Cryoablation as also magnetic resonance imaging-guided high-intensity focused ultrasound), embolization, and Cementoplasty will be described. The techniques of ablation work by destruction of pathological tissue by thermal energy (by an increase of temperature up to 90 °C with the exception of the Cryoablation that works by freezing the tissue up to -40 °C). Embolization creates an ischemic necrosis by the occlusion of the arterial vessels that feed the tumor. Finally, cementoplasty has the aim of strengthening bone segment weakened by the growth of pathological tissue through the injection of cement. The results of the treatments performed so far were also assessed and presented focused the attention on the management of bone metastasis.
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10
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Mansur A, Garg T, Shrigiriwar A, Etezadi V, Georgiades C, Habibollahi P, Huber TC, Camacho JC, Nour SG, Sag AA, Prologo JD, Nezami N. Image-Guided Percutaneous Ablation for Primary and Metastatic Tumors. Diagnostics (Basel) 2022; 12:diagnostics12061300. [PMID: 35741109 PMCID: PMC9221861 DOI: 10.3390/diagnostics12061300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 02/06/2023] Open
Abstract
Image-guided percutaneous ablation methods have been further developed during the recent two decades and have transformed the minimally invasive and precision features of treatment options targeting primary and metastatic tumors. They work by percutaneously introducing applicators to precisely destroy a tumor and offer much lower risks than conventional methods. There are usually shorter recovery periods, less bleeding, and more preservation of organ parenchyma, expanding the treatment options of patients with cancer who may not be eligible for resection. Image-guided ablation techniques are currently utilized for the treatment of primary and metastatic tumors in various organs including the liver, pancreas, kidneys, thyroid and parathyroid, prostate, lung, bone, and soft tissue. This article provides a brief review of the various imaging modalities and available ablation techniques and discusses their applications and associated complications in various organs.
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Affiliation(s)
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Vahid Etezadi
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Christos Georgiades
- Division of Vascular and Interventional Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD 21287, USA; (T.G.); (C.G.)
| | - Peiman Habibollahi
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Timothy C. Huber
- Vascular and Interventional Radiology, Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR 97239, USA;
| | - Juan C. Camacho
- Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32306, USA;
- Vascular and Interventional Radiology, Radiology Associates of Florida, Sarasota, FL 34239, USA
| | - Sherif G. Nour
- Department of Radiology and Medical Imaging, Florida State University College of Medicine, Gainesville, FL 32610, USA;
| | - Alan Alper Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA;
| | - John David Prologo
- Division of Vascular and Interventional Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Nariman Nezami
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
- Experimental Therapeutics Program, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, USA
- Correspondence: or
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11
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Schwartz J, Auloge P, Koch G, Robinson JM, Garnon J, Cazzato RL, Perruisseau-Carrier J, Debry C, Gangi A. Percutaneous Cryoablation for Recurrent Head and Neck Tumors. Cardiovasc Intervent Radiol 2022; 45:791-799. [PMID: 35378612 DOI: 10.1007/s00270-022-03120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To report techniques and results of 16 cryoablation procedures in 11 patients treated for recurrent head and neck cancer. METHODS AND MATERIALS This retrospective study reviewed 11 consecutive patients with head and neck cancer recurrence after primary treatment by surgery and radiotherapy, treated with cryoablation between 2016 and 2020. Efficacy was measured by local control rate evaluated on MRI or/and PET. Tumor characteristics, number of cryoprobes, thermoprotective measures and complications were documented. RESULTS Sixteen cryoablation procedures were performed in 11 patients with head and neck cancer recurrence after surgery or radiotherapy, deemed ineligible for classic salvage treatment. Among 11 patients, four were treated for an epidermoid carcinoma, four for an adenocarcinoma and three for other types: 1 muco-epidermoid carcinoma, 1 adenoid cystic carcinoma and 1 esthesioneuroblastoma, 10/11 patients had prior surgery, 7/11 patients had prior chemotherapy and 3/11 patients had prior radiotherapy. Median number of cryoprobes was 4, [IQR, 3-6 cryoprobes], thermoprotective measures to protect surrounding organs were required for 10/16 procedures. After cryoablation, local control rate was 45.4% at a mean follow-up of 11.7 months (range 3-34 months). Among the 16 cryoablation procedures, four resulted in complications, two were considered major complications: one septic shock on inhalation pneumopathy during extubation, requiring intensive care; and one dysphonia due to a recurrent nerve injury. CONCLUSION Cryoablation as a salvage treatment for recurrence of head and neck tumors after surgery and/or radiotherapy is an effective option, especially for patients that cannot benefit from salvage surgery.
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Affiliation(s)
- Jean Schwartz
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France.
| | - Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Joey Marie Robinson
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Joffrey Perruisseau-Carrier
- Service d'oto-rhino-laryngologie, Hopitaux Universitaire de Strasbourg, 1, avenue Molière, 67200, Strasbourg, France
| | - Christian Debry
- Service d'oto-rhino-laryngologie, Hopitaux Universitaire de Strasbourg, 1, avenue Molière, 67200, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, WC2R 2LS, UK
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12
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De Tommasi F, Massaroni C, Grasso RF, Carassiti M, Schena E. Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges. SENSORS (BASEL, SWITZERLAND) 2021; 21:5470. [PMID: 34450911 PMCID: PMC8400360 DOI: 10.3390/s21165470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.
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Affiliation(s)
- Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Rosario Francesco Grasso
- Unit of Interventional Radiology, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
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13
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De Marini P, Cazzato RL, Auloge P, Koch G, Dalili D, Garnon J, Gangi A. Percutaneous image-guided thermal ablation of bone metastases: a retrospective propensity study comparing the safety profile of radio-frequency ablation and cryo-ablation. Int J Hyperthermia 2021; 37:1386-1394. [PMID: 33322960 DOI: 10.1080/02656736.2020.1859628] [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] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To retrospectively compare the safety profile of percutaneous image-guided radiofrequency ablation (RFA) and cryoablation (CA) of bone metastases (BM) with and without a propensity score analysis. METHODS Between January 2008 and April 2018, 274 consecutive patients (mean age 61.6 ± 12.1 years) with BM were treated at our Institution with RFA (53 patients; 66 BM) or CA (221 patients; 301 BM) and included in this study. Complications were assessed according to the type of ablation modality before and after applying a 1:1 propensity score method taking into account patient's demographics, BM features, procedural details and follow-up findings. RESULTS In the whole 9 BM (2.5%) reported major complications without significant difference between RFA (1/66; 1.5%) and CA (8/301; 2.7%; p = 1); 40 BM (10.9%) showed minor complications, which were more common with RFA (22/66; 33.3%) than with CA (18/301; 6.0%, p<.001) mainly due to post-procedural pain occurring more frequently with RFA than CA (20/66; 30.3% vs. 7/301; 2.3%, p<.001). Following 1:1 matching, similar results were obtained, since there were similar rates of major complications with RFA and CA (1/66 [1.5%] and 0/66 [0.0%], respectively; p = 1); and higher rates of minor complications with RFA compared to CA [33.3% (22/66) vs. 2/66 (3%); p<.001] due to preponderant postprocedural pain (90.9% [20/22] minor complications with RFA). CONCLUSIONS Similar low rates of major complications are expected with RFA and CA of BM. In the post-operative period, RFA appears more painful than CA, thus warranting for adoption of dedicated analgesic protocols for patients undergoing RFA.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
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14
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Filippiadis D, Kelekis A. Percutaneous bipolar radiofrequency ablation for spine metastatic lesions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1603-1610. [PMID: 33783627 DOI: 10.1007/s00590-021-02947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. METHODS We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information. RESULTS RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine. CONCLUSION Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
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Affiliation(s)
- Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece.
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece
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15
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Auloge P, Garnon J, Robinson JM, Thenint MA, Koch G, Caudrelier J, Weiss J, Cazzato RL, Kurtz JE, Gangi A. Percutaneous cryoablation for advanced and refractory extra-abdominal desmoid tumors. Int J Clin Oncol 2021; 26:1147-1158. [PMID: 33709291 DOI: 10.1007/s10147-021-01887-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/11/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess efficacy and safety of percutaneous cryoablation (CA) for advanced and refractory extra-abdominal desmoid tumors. MATERIALS AND METHODS This retrospective study reviewed 30 consecutive patients with symptomatic desmoid tumors evolving after "wait and watch" periods, and despite medical treatment, treated by CA between 2007 and 2019. Progression free survival (PFS), objective response rate, pain reduction (decreased of visual analogic scale pain (VAS)[Formula: see text] 3 or disappearance of pain), total volume lesion (TVL) and complications were documented. Kaplan Meier method was used to outline PFS. Paired sample t test was used to compare volume of tumors before treatment and at 1 and 3 year. RESULTS With a median follow-up of 18.5 months (range 6-93 months, interquartile range (IQR): 12-55), the PFS was 85.1% at 1 year and 77.3% at 3 years. Objective response was obtained for 80% of patients with a complete response for 43% patients. Pain reduction was obtained for 96.7% (95% confidence interval (95% CI): 90.3, 100) of patients. Median volume of desmoid tumor before treatment was 124.1cm3 (range 2-1727cm3, IQR: 54-338cm3). Median change of TLV after ablation was 66.6% (95% CI: 37.2, 72.3; p = 0.002) at 1 year and 76.4% (95% CI: 59.1, 89.8; p = 0.002) at 3 year. Adverse events rate was 36.6%, the most common was edema and temporary increase of pain in the days following CA. Four patients experienced a major complication (13.3%): 2 skin necrosis, 1 infection and 1 brachial plexopathy. CONCLUSION CA is an effective treatment for advanced and refractory extra-abdominal desmoid tumor, that induces durable responses.
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Affiliation(s)
- Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France.
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Joey Marie Robinson
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | | | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Jean Caudrelier
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Julia Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d'Oncologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
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16
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Cazzato RL, De Marini P, Leonard-Lorant I, Dalili D, Koch G, Autrusseau PA, Mayer T, Weiss J, Auloge P, Garnon J, Gangi A. Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control. Diagn Interv Imaging 2021; 102:355-361. [PMID: 33487588 DOI: 10.1016/j.diii.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases. MATERIALS AND METHODS From February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60±8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients' demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS). RESULTS Sixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38±19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31±21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2±2 (SD) (median, 1; range: 0-6) vs. 5±1 (median, 5; range: 4-8; P<0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4±4 (SD) (median, 2; range: 1-8) months follow-up. CONCLUSION Percutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.
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Affiliation(s)
- Roberto L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Ian Leonard-Lorant
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, OX37LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre A Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Theo Mayer
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
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17
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Dalili D, Isaac A, Bazzocchi A, Åström G, Bergh J, Lalam R, Weber MA, Fritz J, Mansour R. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part I. Ablation. Semin Musculoskelet Radiol 2020; 24:692-709. [PMID: 33307585 DOI: 10.1055/s-0040-1719103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Musculoskeletal (MSK) image-guided oncologic intervention is an established field within radiology. Numerous studies have described its clinical benefits, safety, cost effectiveness, patient satisfaction, and improved quality of life, thereby establishing image-guided oncologic intervention as a preferred pathway in treating patients presenting with specific benign MSK tumors. But there is a paradigm shift on the horizon because these techniques may also support established pillars (surgery, systemic treatment, radiotherapy) in the treatment of malignant MSK tumors. Unlike benign tumors, where they are used as primary therapy lines with curative intent, such interventions can be selected for malignant tumors as adjuvant treatment in painful or unstable bone or soft tissue lesions or as more palliative therapy strategies. Using examples from our clinical practices, we elaborate on the benefits of applying a multidisciplinary approach (traditionally involving MSK radiologists, oncologists, orthopaedic surgeons, microbiologists, pathologists, physiotherapists, and pain management experts), ideally within a sarcoma treatment center to deliver a patient-specific therapy plan and illustrate methods to assess the benefits of this model of care.In this article, we review the current repertoire of ablation techniques, demonstrate why such procedures offer value-based alternatives to conventional treatments of specific tumors, and reflect on future directions. Additionally, we review the advantages and limitations of each technique and offer guidance to improve outcomes.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital Stockholm, Sweden
| | - Radhesh Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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18
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Dalili D, Isaac A, Cazzato RL, Åström G, Bergh J, Mansour R, Weber MA, Garnon J, Gangi A. Interventional Techniques for Bone and Musculoskeletal Soft Tissue Tumors: Current Practices and Future Directions - Part II. Stabilization. Semin Musculoskelet Radiol 2020; 24:710-725. [PMID: 33307586 DOI: 10.1055/s-0040-1719104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Percutaneous image-guided oncologic interventions have rapidly evolved over the last two decades as an independent strategy or used within a first-, second-, or even third-line strategy in the treatment of musculoskeletal (MSK) tumors. Abundant mostly nonrandomized publications have described the safety, efficacy, and reproducibility of implementing percutaneous therapies both with curative and palliative intent. In this article, we continue to share our experience in bone and MSK soft tissue interventions focusing on stabilization and combined ablation and stabilization. We propose a pathway and explore future directions of image-guided interventional oncology related to skeletal disease. We reflect on the advantages and limitations of each technique and offer guidance and pearls to improve outcomes. Representing patterns from our practices, we demonstrate the role of collaborative working within a multidisciplinary team, ideally within a dedicated tumor treatment center, to deliver patient-specific therapy plans that are value based and favored by patients when given the choice.
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Affiliation(s)
- Danoob Dalili
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.,School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Amanda Isaac
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom
| | - Roberto Luigi Cazzato
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Gunnar Åström
- Department of Immunology, Genetics and Pathology (Oncology) and Department of Surgical Sciences (Radiology), Uppsala University, Uppsala, Sweden
| | - Jonas Bergh
- Department of Oncology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ramy Mansour
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany
| | - Julien Garnon
- Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
| | - Afshin Gangi
- School of Biomedical Engineering and Imaging Sciences, Kings College London, London, United Kingdom.,Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France
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19
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Percutaneous microwave ablation of bone tumors: a systematic review. Eur Radiol 2020; 31:3530-3541. [PMID: 33155107 DOI: 10.1007/s00330-020-07382-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
AIM To systematically review microwave ablation (MWA) protocols, safety, and clinical efficacy for treating bone tumors. MATERIALS AND METHODS A systematic literature search was conducted using PubMed, the Cochrane Library, EMBASE, and Web of Science database. Data concerning patient demographics, tumor characteristics, procedure, complications, and clinical outcomes were extracted and analyzed. RESULTS Seven non-comparative studies (6 retrospective, 1 prospective) were included accounting for 249 patients and 306 tumors (244/306 [79.7%] metastases; 25/306 [8.2%] myelomas, and 37/306 [12.1%] osteoid osteomas [OO]). In malignant tumors, MWA power was 30-70 W (except in one spinal tumors series where a mean power of 13.3 W was used) with pooled mean ablation time of 308.3 s. With OO, MWA power was 30-60 W with mean ablation time of 90-102 s. Protective measures were very sporadically used in 5 studies. Additional osteoplasty was performed in 199/269 (74.0%) malignant tumors. Clinically significant complications were noted in 10/249 (4.0%) patients. For malignant tumors, estimated pain reduction on the numerical rating scale was 5.3/10 (95% confidence intervals [95%CI] 4.6-6.1) at 1 month; and 5.3/10 (95% CI 4.3-6.3) at the last recorded follow-up (range 20-24 weeks in 4/5 studies). For OO, at 1-month follow-up, effective pain relief was noted in 92.3-100% of patients. CONCLUSION MWA is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful OO and malignant bone tumors, respectively. Although MWA seems safe, further prospective studies are warranted to further assess this aspect, and to standardize MWA protocols. KEY POINTS • Large heterogeneity exists across literature about ablation protocols used with microwave ablation applied for the treatment of benign and malignant bone tumors. • Although microwave ablation of bone tumors appears safe, further studies are needed to assess this aspect, as current literature does not allow definitive conclusions. • Nevertheless, microwave ablation is effective in achieving pain relief at short- (1 month) and mid-term (4-6 months) for painful osteoid osteomas and malignant bone tumors, respectively.
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20
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Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
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Pacella CM, Di Stasio E, Guglielmi R, Baroli A, Pedrazzini L, Misischi I, Persichetti A, Papini E. Role of laser ablation in multimodal treatment of radioiodine- refractory bone metastases of thyroid cancer: a retrospective study. Endocrine 2020; 70:338-347. [PMID: 32378155 DOI: 10.1007/s12020-020-02314-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the efficacy, safety, and pain benefits of imaging-guided laser ablation (IGLA) in patients with radioiodine-refractory (RR) bone metastases from differentiated thyroid carcinoma (DTC). PATIENTS AND METHODS The institutional medical records of patients with bone metastases from DTC treated with laser ablation (LA) were reviewed retrospectively. Local response, complications, and effects on pain relief were investigated. RESULTS Six osteolytic lesions in five patients (one male, four females; mean age 65.4 ± 5.1 years, range 58-72) were treated with IGLA. All lesions were osteolytic and all have had previous treatments with high-dose radioiodine therapy followed by external radiotherapy (EBRT). All patients assumed opioid analgesics for severe pain. Overall, the lesions (mean size 5.8 ± 3.2 cm; median 5.0 cm, range 3.0-12.0 cm) underwent nine IGLA sessions (mean 1.8 ± 0.4 sessions; median 2.0 sessions, range 1-2). In four (80%) out five lesions, cross-sectional imaging showed a nearly complete response (CR) while the largest lesion was ablated by 80%. Pain changes were assessed with the Brief Pain Inventory-Short Form, that was administered before IGLA and during a 6-month follow-up. Patients experienced significant reduction in worst pain, average pain, and pain interference. Following IGLA, the average daily opioid requirement rapidly and progressively decreased. Treatments were well-tolerated and no major complications occurred. CONCLUSIONS IGLA is an effective and safe debulking procedure and provides significant pain relief in patients suffering from DTC bone metastases that are not responsive to standard treatments. So, IGLA could be considered as part of a multimodality management of advanced thyroid cancer with RR metastatic skeletal involvement.
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Affiliation(s)
- Claudio Maurizio Pacella
- Department of Diagnostic Imaging and Interventional Radiology, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy.
| | - Enrico Di Stasio
- Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
- UOC Chemistry, Biochemistry and Clinical Molecular Biology, A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy
| | - Rinaldo Guglielmi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Alberto Baroli
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Luca Pedrazzini
- Department of Nuclear Medicine, Ospedale Busto Arsizio, ASST Valleolona, Varese, Italy
| | - Irene Misischi
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Agnese Persichetti
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano Laziale, Rome, Italy
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Cazzato RL, Garnon J, De Marini P, Auloge P, Dalili D, Koch G, Antoni D, Barthelemy P, Kurtz JE, Malouf G, Feydy A, Charles YP, Gangi A. French Multidisciplinary Approach for the Treatment of MSK Tumors. Semin Musculoskelet Radiol 2020; 24:310-322. [DOI: 10.1055/s-0040-1710052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractSeveral interventional treatments have recently been integrated into the therapeutic armamentarium available for the treatment of bone tumors. In some scenarios (e.g., osteoid osteoma), interventional treatments represent the sole and definitive applied treatment. Due to the absence of widely shared protocols and the complex multivariate scenarios underlying the clinical presentation of the remaining bone tumors including metastases, therapeutic strategies derived from a multidisciplinary tumor board are essential to provide effective treatments tailored to each patient. In the present review, we present the multidisciplinary therapeutic strategies commonly adopted for the most frequent bone tumors.
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Affiliation(s)
- Roberto Luigi Cazzato
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre De Marini
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Danoob Dalili
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Nuffield Orthopaedic Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, United Kingdom
| | - Guillaume Koch
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Delphine Antoni
- Service de Radiothérapie, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Barthelemy
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Gabriel Malouf
- Service d’Oncologie Médicale, Institut de cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Antoine Feydy
- Service de Radiologie, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Yan-Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d’Imagerie Interventionnelle, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Zheng K, Yu X, Hu Y, Zhang Y, Wang Z, Wu S, Shen J, Ye Z, Tu C, Zhang Y, Wei X, Hu Y, Wang X, Li J, Duan H, Wu Y, Xu M, Yuan Z, Wei Y, Chen B. Clinical Guideline for Microwave Ablation of Bone Tumors in Extremities. Orthop Surg 2020; 12:1036-1044. [PMID: 32776475 PMCID: PMC7454210 DOI: 10.1111/os.12749] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/08/2020] [Accepted: 06/18/2020] [Indexed: 02/05/2023] Open
Abstract
Microwave ablation has been used to treat bone tumors in extremities for more than 30 years. With improved recognition, updated microwave equipment, and expanded clinical application, microwave ablation has recently been widely used to treat bone tumors. To standardize the application of microwave ablation in the clinical treatment of bone tumors in the limbs, research results and clinical experience involving the use of microwave ablation to treat bone tumors in the limbs have been summarized, and a clinical guideline has been designed. This guideline is aimed at providing a reliable clinical basis for indications, preoperative evaluation and decision-making, perioperative treatment, complications, and other issues via evidence-based medicine. Two aspects are considered-percutaneous microwave ablation and intraoperative microwave ablation of bone tumors in extremities. Ultimately, the guideline is intended to standardize treatment and improve the clinical efficacy of microwave ablation of bone tumors in extremities.
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Affiliation(s)
- Kai Zheng
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Xiuchun Yu
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Yongcheng Hu
- Department of Bone OncologyTianjin HospitalTianjinChina
| | - Yingze Zhang
- Department of Orthopaedic SurgeryThe Third Hospital of Hebei Medical University, Orthopaedic Research Institute of Hebei ProvinceShijiazhuangChina
| | - Zhen Wang
- Department of Bone Oncology, Xijing HospitalAir Force Military Medical UniversityXi'anChina
| | - Sujia Wu
- Department of Orthopedics, School of Medicine, Jinling HospitalNanjing UniversityNanjingChina
| | - Jingnan Shen
- Department of Bone OncologyThe First Affiliated Hospital of Sun Yat Sen UniversityGuangzhouChina
| | - Zhaoming Ye
- Department of Orthopaedics, The Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Chongqi Tu
- Department of Orthopedics, West China HospitalSichuan UniversityChengduChina
| | - Yu Zhang
- Department of Orthopedics, Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhouChina
| | - Xing Wei
- Department of OrthopedicsAerospace Center HospitalBeijingChina
| | - Yong Hu
- Department of Bone Disease and Bone Tumors Surgery, The First Affiliated HospitalAnhui Medical UniversityHefeiChina
| | - Xuquan Wang
- Department of OrthopedicsGuiqian International General HospitalGuiyangChina
| | - Jiazhen Li
- Department of OrthopaedicsThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Hong Duan
- Department of Orthopedics, West China HospitalSichuan UniversityChengduChina
| | - Yuxian Wu
- Department of Bone Oncology, Qilu Hospital (Qingdao), Cheeloo College of MedicineShandong UniversityQingdaoChina
| | - Ming Xu
- Department of OrthopedicsThe 960th Hospital of the PLA Joint Logistice Support ForceJinanChina
| | - Zhenchao Yuan
- Department of Bone and Soft Tissue SurgeryGuangxi Medical University Cancer HospitalNanningChina
| | - Yongzhong Wei
- Department of OrthopaedicsThe First Affiliated Hospital With Nanjing Medical UniversityNanjingChina
| | - Bingyao Chen
- Department of OrthopedicsGuiqian International General HospitalGuiyangChina
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Filippiadis DK, Tselikas L, Bazzocchi A, Efthymiou E, Kelekis A, Yevich S. Percutaneous Management of Cancer Pain. Curr Oncol Rep 2020; 22:43. [DOI: 10.1007/s11912-020-00906-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Ravikanth R. Management of metastatic vertebral lesions by interventional techniques: Systematic review of outcomes. J Craniovertebr Junction Spine 2020; 11:61-70. [PMID: 32905009 PMCID: PMC7462143 DOI: 10.4103/jcvjs.jcvjs_56_20] [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: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/26/2022] Open
Abstract
Vertebral metastases represent an important cause of cancer-related morbidity and mortality. Among all available treatments, interventional percutaneous techniques have recently emerged as potential strategies for the management of oncologic patients with vertebral lesions. Minimally invasive image-guided therapies include “ablative” and “consolidative” ones. According to the number of metastases and the patient's performance status, ablative techniques can be performed with a curative or a palliative purpose since necrosis induced by critic changes of intralesional temperature determines both tumor debulking and destruction of pain receptors. On the other hand, consolidative treatments are based on the injection of polymethylmethacrylate cement to improve structural vertebral integrity and obtain pain alleviation and prevention of skeletal-related events. This article reviews the current recommendations supporting the role of interventional radiology in the management of vertebral metastases, focusing on the last updates in literature.
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Filippiadis DK, Cornelis FH, Kelekis A. Interventional oncologic procedures for pain palliation. Presse Med 2019; 48:e251-e256. [DOI: 10.1016/j.lpm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/11/2019] [Indexed: 01/05/2023] Open
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Barreau X, Palussiere J, Fauche C. La radiologie interventionnelle en pathologie rachidienne. Presse Med 2019; 48:696-705. [DOI: 10.1016/j.lpm.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
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Auloge P, Cazzato RL, Rousseau C, Caudrelier J, Koch G, Rao P, Chiang JB, Garnon J, Gangi A. Complications of Percutaneous Bone Tumor Cryoablation: A 10-year Experience. Radiology 2019; 291:521-528. [PMID: 30806603 DOI: 10.1148/radiol.2019181262] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Percutaneous cryoablation has been shown to be effective in the management of painful bone tumors. However, knowledge of the complication rate and risk factors for complication is currently lacking. Purpose To report the complication rate and associated risk factors for bone tumor cryoablation. Materials and Methods This retrospective study reviewed complications in 239 consecutive patients (131 men and 108 women; median age, 64 years; age range, 6-86 years) who underwent cryoablation of 320 primary or metastatic bone tumors between January 2008 and November 2017. Common Terminology Criteria for Adverse Events was used to categorize complications as major (grade 3-4) or minor (grade 1-2). Multivariable analysis was performed for variables with P values less than .20, including age, tumor location, adjacent critical structures, number of cryoprobes, and Eastern Cooperative Oncology Group performance status (ECOG-PS). Results Among the 320 tumors, the total complication rate was 9.1% (29 of 320; 95% confidence interval [CI]: 6%, 12.2%). The major complication rate was 2.5% (eight of 320; 95% CI: 0.8%, 4.2%), with secondary fracture the most frequent complication (1.2% [four of 320]; mean delay, 71 days); cryoablation site infection, tumor seeding, bleeding, and severe hypotension were each observed in 0.3% (one of 320) of procedures. Minor complications included postprocedural pain (2.2% [seven of 320]), peripheral neuropathy (0.9% [three of 320]), and temporary paresthesia (0.9% [three of 320]). For all complications, associated risk factors included ECOG-PS greater than 2 (odds ratio [OR], 3.1 [95% CI: 3, 7.6]; P = .01), long-bone cryoablation (OR, 17.8 [95% CI: 2.3, 136.3]; P = .01), and use of more than three cryoprobes (OR, 2.5 [95% CI: 1.0, 6.0]; P = .04); for major complications, associated risk factors included age greater than 70 years (OR, 7.1 [95% CI: 1.6, 31.7]; P = .01) and use of more than three cryoprobes (OR, 23.6 [95% CI: 2.8, 199.0]; P = .01). Conclusion Bone tumor cryoablation is safe, with a 2.5% rate of major complications, most commonly secondary fracture (1.2%). Major complications are associated with age greater than 70 years and use of more than three cryoprobes. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Jennings in this issue.
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Affiliation(s)
- Pierre Auloge
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Roberto L Cazzato
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Chloé Rousseau
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Jean Caudrelier
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Guillaume Koch
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Pramod Rao
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Jeanie Betsy Chiang
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Julien Garnon
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
| | - Afshin Gangi
- From the Department of Interventional Radiology, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg, France (P.A., R.L.C., J.C., G.K., J.G., A.G.); Clinical Investigation Center INSERM 1414, University Hospital of Rennes and University of Rennes, Rennes, France (C.R.); Division of Robotics and Department of Interventional Radiology, ICube, University of Strasbourg and Nouvel Hopital Civil, Strasbourg, France (P.R.); and Department of Radiology and Imaging, Queen Elizabeth Hospital, Hong Kong (J.B.C.)
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Cazzato RL, Garnon J, Shaygi B, Boatta E, Koch G, Palussiere J, Buy X, Gangi A. Percutaneous consolidation of bone metastases: strategies and techniques. Insights Imaging 2019; 10:14. [PMID: 30725322 PMCID: PMC6365313 DOI: 10.1186/s13244-019-0709-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with cancer can present with bone metastases (BM), which are frequently complicated by different types of fractures necessitating prompt management to avoid serious impairment in terms of quality of life and survival. Percutaneous image-guided bone consolidation has rapidly emerged as an alternative to surgical fixation and is mainly reserved for patients who are deemed unfit for surgical management. Two percutaneous techniques, osteoplasty and osteosynthesis, are available and are selected based on the biomechanics of the target bones as well as the fracture types. The aim of this narrative review is to present the different types of BM-related fractures and the interventional strategies and techniques underpinning their minimally invasive percutaneous fixation.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Benham Shaygi
- Department of Interventional Radiology, Royal Devon and Exeter Hospital NHS Trust, Barrack Rd, Exeter, EX2 5DW, UK
| | - Emanuele Boatta
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, 229 cours de l'Argonne, 33000, Bordeaux, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
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Buy X, Catena V, Roubaud G, Crombe A, Kind M, Palussiere J. Image-Guided Bone Consolidation in Oncology. Semin Intervent Radiol 2018; 35:221-228. [PMID: 30402004 DOI: 10.1055/s-0038-1669468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Occurrence of bone metastases is a common event in oncology. Bone metastases are associated with pain, functional impairment, and fractures, particularly when weight-bearing bones are involved. Management of bone metastases has been improved by the development of various interventional radiology consolidation techniques. Cementoplasty is based on injection of acrylic cement into a weakened bone to reinforce it and to control pain. This minimally invasive technique has proven its efficacy for flat bone submitted to compression forces. However, resistance to torsion forces is limited and, thus, treatment of long bones should be considered with caution. In recent years, variant techniques of percutaneous bone consolidation have emerged, including expansion devices for vertebral augmentation and percutaneous screw fixation for pelvic bone and proximal femur tumors. Research projects are ongoing to develop drug-loaded cements to use them as therapeutic vectors. However, release of drugs is still poorly controlled and conventional polymethylmethacrylate cement remains the gold standard in oncology. Image-guided consolidation techniques enhance the array of treatments in bone oncology. Multidisciplinary approach is mandatory to select the best indications.
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Affiliation(s)
- Xavier Buy
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Vittorio Catena
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - Amandine Crombe
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Michèle Kind
- Department of Radiology, Institut Bergonie, Bordeaux, France
| | - Jean Palussiere
- Department of Radiology, Institut Bergonie, Bordeaux, France
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Burgard CA, Dinkel J, Strobl F, Paprottka PM, Schramm N, Reiser M, Trumm CG. CT fluoroscopy-guided percutaneous osteoplasty with or without radiofrequency ablation in the treatment of painful extraspinal and spinal bone metastases: technical outcome and complications in 29 patients. ACTA ACUST UNITED AC 2018; 24:158-165. [PMID: 29770769 DOI: 10.5152/dir.2018.17265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the safety and technical outcome of computed tomography (CT) fluoroscopy-guided osteoplasty with or without prior percutaneous radiofrequency ablation (RFA) in patients with painful osteolyses. METHODS We performed a retrospective analysis of 29 patients with painful extraspinal and spinal osteolyses (16 women, 13 men; 63.1±14.4 years) who underwent CT fluoroscopy-guided osteoplasty (10-20 mAs tube current) with or without RFA (26 and 14 lesions, respectively), in 33 consecutive procedures from 2002 to 2016. Technical success was defined as at least one complete RFA cycle and subsequent polymethyl metacrylate (PMMA) bone cement injection covering ≥75% of longest diameter of extraspinal osteolysis on axial plane or of distance between vertebral endplates. Procedure-related complications within 30 days and dose-length-product (DLP) were also evaluated. RESULTS Osteolyses were located in the pelvis (acetabulum, n=10; iliac bone, n=4), spine (thoracic, n=6; lumbar, n=5; sacral, n=8), long bones (femur, n=3; tibia, n=1), sternum (n=2) and glenoid (n=1). Mean size of the treated osteolysis was 4.0±1.2 cm (range, 1.9-6.9 cm). Of 40 osteolyses, 31 (77.5%) abutted neighboring risk structures (spinal canal or neuroforamen, n=18; neighboring joint, n=11; other, n=8). Mean number of RFA electrode positions and complete ablation cycles was 1.5±0.9 and 2.1±1.7, respectively. Mean PMMA filling volume was 7.7±5.7 mL (range, 2-30 mL). Small asymptomatic PMMA leakages were observed in 15 lesions (37.5%). Mean total DLP was 850±653 mGy*cm. Six minor complications were observed, without any major complications. CONCLUSION CT fluoroscopy-guided percutaneous osteoplasty with or without concomitant RFA for the treatment of painful extraspinal and spinal osteolyses can be performed with a low complication rate and high technical success.
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Affiliation(s)
- Caroline A Burgard
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Julien Dinkel
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Frederik Strobl
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Philipp M Paprottka
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Nicolai Schramm
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Maximilian Reiser
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
| | - Christoph G Trumm
- Institute for Clinical Radiology, University Hospitals Munich - Campus Großhadern, München, Germany
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Luigi Cazzato R, Auloge P, De Marini P, Rousseau C, Chiang JB, Koch G, Caudrelier J, Rao P, Garnon J, Gangi A. Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients. Int J Hyperthermia 2018; 35:493-499. [PMID: 30307346 DOI: 10.1080/02656736.2018.1508760] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Percutaneous image-guided cryo- (CA) and radiofrequency- (RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. MATERIALS AND METHODS This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. RESULTS Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N = 37; 75,5%) or RFA (N = 12; 24,5%). Primary malignancies included thyroid (N = 11, 22.5%), breast (N = 21; 42.9%), lung (N = 8; 16.3%) and other (N = 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N = 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N = 14); 1- and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p = .002). CONCLUSIONS Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM ≤2 cm.
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Affiliation(s)
- Roberto Luigi Cazzato
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre Auloge
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre De Marini
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Chloé Rousseau
- b Clinical Investigation, INSERM 1414 , University of Rennes , Rennes , France
| | - Jeanie Betsy Chiang
- c Interventional Radiology , Queen Elizabeth Hospital , Hong Kong , Hong Kong
| | - Guillaume Koch
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Jean Caudrelier
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pramod Rao
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Julien Garnon
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Afshin Gangi
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
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Cazzato RL, Arrigoni F, Boatta E, Bruno F, Chiang JB, Garnon J, Zugaro L, Giordano AV, Carducci S, Varrassi M, Beomonte Zobel B, Bazzocchi A, Aliprandi A, Basile A, Marcia S, Masala S, Grasso RF, Squarza S, Floridi C, Ierardi AM, Burdi N, Cioni R, Napoli A, Niola R, Rossi G, Rossi UG, Venturini M, De Cobelli F, Carotti M, Gravina GL, Di Staso M, Zoccali C, Biagini R, Tonini G, Santini D, Carrafiello G, Cariati M, Silvestri E, Sconfienza LM, Giovagnoni A, Masciocchi C, Gangi A, Barile A. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2018; 124:34-49. [DOI: 10.1007/s11547-018-0938-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
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Cazzato RL, Garnon J, Koch G, Shaygi B, Tsoumakidou G, Caudrelier J, Boatta E, Buy X, Palussiere J, Gangi A. Current role of interventional radiology in the management of visceral and bone metastases from thyroid cancer. Gland Surg 2018; 7:80-88. [PMID: 29770304 DOI: 10.21037/gs.2017.12.08] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The metastatic disease from thyroid cancer represents a complex clinical scenario, which mandates a case-based multi-disciplinary approach in tertiary referral centers. Direct localised treatments such as minimally invasive interventional radiology procedures can play a vital role in providing a timely palliative or curative treatment in accordance with the patients' clinical status. In this narrative review, we present the current status of interventional radiology treatments for the management of thyroid cancer distant metastases.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Behnam Shaygi
- Department of Interventional Radiology, Royal Devon and Exeter Hospital, NHS Trust, Exeter, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Emanuele Boatta
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonié, Bordeaux, France
| | - Afshin Gangi
- Department of Interventional Radiology, Hôpitaux Universitaires de Strasbourg, place de l'Hopital, Strasbourg, France
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Epithelioid hemangioma of the scapula treated with chemoembolization and microwave ablation: Α case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:157-161. [PMID: 28159479 PMCID: PMC6136344 DOI: 10.1016/j.aott.2017.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/09/2016] [Accepted: 01/02/2017] [Indexed: 01/20/2023]
Abstract
Bone epithelioid hemangiomas are classified within benign vascular tumours but are commonly misdiagnosed as low-grade angiosarcomas or epithelioid hemangioendotheliomas. Current therapeutic interventions include various treatment options but local recurrence or distal lymph node involvement has been reported. We report a rare case of scapular epithelioid hemangioma that was initially treated using a combination of chemoembolization and microwave ablation. This combination has not been previously reported in the literature regarding the management of this tumour. A year after the first course of treatment, the tumour size has been reduced more than 70% and the patient has remarkable clinical improvement. Results reported in this case study demonstrated that combination of chemoembolization and microwave ablation is a feasible, safe and effective technique in the treatment of bone epithelioid hemangiomas. Even if the tumour is still present afterwards, a substantially smaller surgical excision will be needed.
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Arrigoni F, Bruno F, Zugaro L, Natella R, Cappabianca S, Russo U, Papapietro VR, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Developments in the management of bone metastases with interventional radiology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:166-174. [PMID: 29350645 PMCID: PMC6179078 DOI: 10.23750/abm.v89i1-s.7020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/08/2023]
Abstract
Interventional radiology has known an exponential growth in the last years. Technological advances of the last decades, have made it possible to use new treatments on a larger scale, with safe and effective results. They could be considered as palliative treatments for painful lesions but also curative procedures, as single treatment or specially in combination with other techniques (surgery, radiation and oncology therapies, etc.). The main diffuse techniques are those of thermal ablation that destroy the target lesion through the heat; however there are also endovascular therapies that destroy the target tissue thanks to devascularization. Finally the is also the possibility to stabilize pathological fractures or impending fractures. In this paper all the most diffuse and effective techniques are reviewed and also a discussion of the main indications is done, with an analisys of the success and complications rates. (www.actabiomedica.it)
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Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Low-power bipolar radiofrequency ablation and vertebral augmentation for the palliative treatment of spinal malignancies. Int J Hyperthermia 2018; 34:1282-1288. [DOI: 10.1080/02656736.2017.1422557] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Pramod Prabhakar Rao
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
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Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety. Int J Hyperthermia 2018; 34:1272-1281. [PMID: 29308694 DOI: 10.1080/02656736.2018.1425918] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Radiofrequency ablation (RFA) is the most common percutaneous technique applied to treat painful spinal metastasis; however, experience in this field is somehow still limited. A systematic literature research was performed to understand the effects of RFA in terms of analgesia and safety. MATERIALS AND METHODS Inclusion criteria for the studies were as follows: (1) randomised controlled or non-randomised studies with a prospective or retrospective design; (2) population made up of adults with spinal metastasis; (3) spinal metastasis treated with RFA alone or in combination/comparison with other treatments; (4) studies reporting about patients' pain before and at least one time-point following RFA; and (5) English-language studies. RESULTS Seven hundred and thirty-three articles were screened and 8 (4 prospective, 4 retrospective) matched the inclusion criteria. Study population ranged between 10 and 92 patients across studies. Five out of eight studies reported a highly effective pain management (≥4 points of pain reduction between baseline and the last time-point available); 2/8 studies reported moderate results (≥2 points of pain reduction between baseline and the last time-point available). All studies combined RFA with cement augmentation in the vast majority of patients (40-100%) or metastasis (94-95.8%). Grade I-IIIa neural complications were reported in up to 16% of the cases and were always managed conservatively or with steroids. CONCLUSIONS RFA, combined with vertebral augmentation in most of the cases, is effective and safe in achieving short- to mid-term (from 1 week to 6 months) analgesia in patients affected by painful spinal metastasis.
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Affiliation(s)
- Roberto Luigi Cazzato
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Julien Garnon
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Jean Caudrelier
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Pramod Prabhakar Rao
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Guillaume Koch
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Afshin Gangi
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
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Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty. Semin Intervent Radiol 2017; 34:328-336. [PMID: 29249856 PMCID: PMC5730439 DOI: 10.1055/s-0037-1608747] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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Affiliation(s)
- Alexis Kelekis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
| | - Francois H. Cornelis
- Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology and Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dimitrios Filippiadis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
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Pain management: The rising role of interventional oncology. Diagn Interv Imaging 2017; 98:627-634. [DOI: 10.1016/j.diii.2017.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 02/06/2023]
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Irreversible electroporation and thermal ablation of tumors in the liver, lung, kidney and bone: What are the differences? Diagn Interv Imaging 2017; 98:609-617. [DOI: 10.1016/j.diii.2017.07.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/20/2017] [Indexed: 12/18/2022]
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Filippiadis D, Mavrogenis AF, Mazioti A, Palialexis K, Megaloikonomos PD, Papagelopoulos PJ, Kelekis A. Metastatic bone disease from breast cancer: a review of minimally invasive techniques for diagnosis and treatment. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:729-736. [PMID: 28597402 DOI: 10.1007/s00590-017-1986-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/30/2017] [Indexed: 01/20/2023]
Abstract
Skeletal-related events in patients with metastatic bone disease include intractable severe pain, pathologic fracture, spinal cord and nerve compression, hypercalcemia and bone marrow aplasia. In patients with breast cancer, the skeleton is the most frequent site for metastases. Treatment options for metastatic bone disease in these patients include bisphosphonates, chemotherapeutic agents, opioids, hormonal therapy, minimally invasive/interventional and surgical techniques. Interventional oncology techniques for breast cancer patients with bone metastases include diagnostic (biopsy) and therapeutic (palliative and curative) approaches. In the latter, percutaneous ablation, augmentation and stabilization are included. The purpose of this article is to describe the basic concepts of biopsy, ablation, embolization and peripheral skeleton augmentation techniques in patients with metastatic bone disease from breast carcinoma. The necessity for a tailored approach applying different techniques for different cases and locations will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece.
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Argyro Mazioti
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Konstantinos Palialexis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Panayiotis J Papagelopoulos
- First Department of Orthopaedics, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
| | - Alexis Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, School of Medicine, Attikon University General Hospital, 41 Ventouri Street, Holargos, 15562, Athens, Greece
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Buy X, Cazzato RL, Catena V, Roubaud G, Kind M, Palussiere J. [Image-guided bone consolidation in oncology: Cementoplasty and percutaneous screw fixation]. Bull Cancer 2017; 104:423-432. [PMID: 28320522 DOI: 10.1016/j.bulcan.2016.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/21/2016] [Indexed: 10/19/2022]
Abstract
Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications.
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Affiliation(s)
- Xavier Buy
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France.
| | - Roberto Luigi Cazzato
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Vittorio Catena
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Guilhem Roubaud
- Institut Bergonié, département d'oncologie médicale, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Michele Kind
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Jean Palussiere
- Institut Bergonié, département de radiologie, 229, cours de l'Argonne, 33000 Bordeaux, France
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Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, Ramamurthy N, Brunese L, Gangi A, Masciocchi C. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 2017; 34:53. [PMID: 28236103 DOI: 10.1007/s12032-017-0909-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 12/31/2022]
Abstract
The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.
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Affiliation(s)
- Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, Arrigoni F, Zugaro L, Barile A, Masciocchi C, Gangi A. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol 2016; 33:140. [PMID: 27837451 DOI: 10.1007/s12032-016-0848-3] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022]
Abstract
Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
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Avoiding Complications in Bone and Soft Tissue Ablation. Cardiovasc Intervent Radiol 2016; 40:166-176. [DOI: 10.1007/s00270-016-1487-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 09/15/2016] [Indexed: 01/20/2023]
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48
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Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours. Eur Radiol 2016; 27:1477-1485. [DOI: 10.1007/s00330-016-4528-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/08/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
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Abstract
The image-guided thermal ablation procedures can be used to treat a variety of benign and malignant spinal tumours. Small size osteoid osteoma can be treated with laser or radiofrequency. Larger tumours (osteoblastoma, aneurysmal bone cyst and metastasis) can be addressed with radiofrequency or cryoablation. Results on the literature of spinal microwave ablation are scarce, and thus it should be used with caution. A distinct advantage of cryoablation is the ability to monitor the ice-ball by intermittent CT or MRI. The different thermal insulation, temperature and electrophysiological monitoring techniques should be applied. Cautious pre-procedural planning and intermittent intra-procedural monitoring of the ablation zone can help reduce neural complications. Tumour histology, patient clinical-functional status and life-expectancy should define the most efficient and least disabling treatment option.
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