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Yuan W, Di L, Yu X, Li J. Comparison of efficacy and safety of different minimally invasive therapies for thyroid nodules: A network meta-analysis. Endocrine 2024; 85:979-987. [PMID: 38517639 DOI: 10.1007/s12020-024-03782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/13/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE This study aimed to compare efficacy and safety of minimally invasive therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), ethanol ablation (EA), and laser ablation (LA) for thyroid nodules through network meta-analysis (NMA). METHODS This study searched PubMed, Web of Science, Embase, and The Cochrane Library databases to collect randomized controlled trials (RCTs) or cohort studies comparing efficacy and safety of different minimally invasive therapies for thyroid nodules. Newcastle-Ottawa Scale (NOS) was implemented to assess quality of included cohort studies, and Cochrane risk of bias assessment tool was utilized to evaluate quality of included RCTs. Eligible studies contained at least one of the following clinical outcome measures: volume reduction rate (VRR), symptom score, cosmetic score, nodule regrowth rate, and complication rate. STATA software was utilized for NMA. RESULTS Sixteen eligible studies (4 RCTs, 11 retrospective cohort studies, 1 prospective cohort study) involved 4094 patients. NMA results revealed that RFA group had the highest VRR at 1 months and 12 months. There were no significant differences in symptom scores and cosmetic scores among all treatment methods, with the lowest symptom scores and cosmetic scores in RFA group. LA group had a significantly higher nodule regrowth rate than RFA and MWA groups, with the lowest in RFA group. There were no significant differences in complication rate among all treatment methods. CONCLUSION RFA had the highest VRR for thyroid nodules, and it excelled in symptom scores, cosmetic scores, and nodule regrowth rates.
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Affiliation(s)
- Wei Yuan
- Department of Oncology, General Hospital of Yangquan Coal Industry Group, Yangquan, Shanxi Province, China.
- Department of Oncology and Interventional Radiology, Yang Quan Hospital of Shanxi Medical University, Yangquan, Shanxi Province, China.
| | - Liju Di
- Department of Oncology, General Hospital of Yangquan Coal Industry Group, Yangquan, Shanxi Province, China
- Department of Oncology and Interventional Radiology, Yang Quan Hospital of Shanxi Medical University, Yangquan, Shanxi Province, China
| | - Xiaoxin Yu
- Department of ultrasonography, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China
| | - Jian Li
- Department of endocrinology, General Hospital of Yang Quan Coal Industry Group, Yangquan, Shanxi Province, China
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Narayanan G, Mahendra AM, Gentile NT, Schiro BJ, Gandhi RT, Peña CS, Dijkstra M. Safety and Effectiveness of Irreversible Electroporation in Lymph Node Metastases. Cardiovasc Intervent Radiol 2024; 47:1066-1073. [PMID: 38943032 PMCID: PMC11303484 DOI: 10.1007/s00270-024-03795-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: 02/02/2024] [Accepted: 06/19/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE Demonstrating the safety and efficacy of percutaneous irreversible electroporation (IRE) for the treatment of lymph node metastases. MATERIALS AND METHODS An IRB-approved, single-center retrospective review was performed on patients with lymph node metastases gastrointestinal, and genitourinary primary cancers. Primary objective safety was evaluated by assessing complications graded according to the Clavien-Dindo Classification, and efficacy was determined by tumor response on follow-up imaging and local progression-free survival (LPFS). Secondary outcome measures were technical success (complete ablation with an adequate ablative margin > 5 mm), length of hospital stay and distant progression-free survival (DPFS). RESULTS Nineteen patients underwent percutaneous IRE between June 2018 and February 2023 for lymph node metastases, close to critical structures, such as vasculature, bowel, or nerves. The technical success was achieved in all cases. Complications occurred in four patients (21.1%), including two self-limiting grade 1 hematomas, a grade 1 abdominal pain, and grade 2 nerve pain treated with medication. Seventeen patients were hospitalized overnight, one patient stayed two nights and another patient stayed fourteen nights. Median follow-up was 25.5 months. Median time to local progression was 24.1 months (95% CI: 0-52.8) with 1-, 2-, and 5-year LPFS of 57.9%, 57.9% and 20.7%, respectively. Median time to distant progression was 4.3 months (95% CI: 0.3-8.3) with 1-, 2-, and 5-year DPFS of 31.6%, 13.2% and 13.2%, respectively. CONCLUSION IRE is a safe and effective minimally-invasive treatment for lymph node metastases in locations, where temperature dependent ablation may be contraindicated. Care should be taken when employing IRE near nerves.
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Affiliation(s)
- Govindarajan Narayanan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ashwin M Mahendra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Nicole T Gentile
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Brian J Schiro
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Ripal T Gandhi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Constantino S Peña
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Madelon Dijkstra
- Department of Interventional Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Deipolyi AR, Ward RC, Riaz A, Vogl TJ, Simmons RM, Pieper CC, Bryce Y. Locoregional Therapies for Primary and Metastatic Breast Cancer: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2024; 222:e2329454. [PMID: 37377360 DOI: 10.2214/ajr.23.29454] [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] [Indexed: 06/29/2023]
Abstract
Minimally invasive locoregional therapies have a growing role in the multidisciplinary treatment of primary and metastatic breast cancer. Factors contributing to the expanding role of ablation for primary breast cancer include earlier diagnosis, when tumors are small, and increased longevity of patients whose condition precludes surgery. Cryoablation has emerged as the leading ablative modality for primary breast cancer owing to its wide availability, the lack of need for sedation, and the ability to monitor the ablation zone. Emerging evidence suggests that in patients with oligometastatic breast cancer, use of locoregional therapies to eradicate all disease sites may confer a survival advantage. Evidence also suggests that transarterial therapies-including chemoembolization, chemoperfusion, and radioembolization-may be helpful to some patients with advanced liver metastases from breast cancer, such as those with hepatic oligoprogression or those who cannot tolerate systemic therapy. However, the optimal modalities for treatment of oligometastatic and advanced metastatic disease remain unknown. Finally, locoregional therapies may produce tumor antigens that in combination with immunotherapy drive anti-tumor immunity. Although key trials are ongoing, additional prospective studies are needed to establish the inclusion of interventional oncology in societal breast cancer guidelines to support further clinical adoption and improved patient outcomes.
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Affiliation(s)
- Amy R Deipolyi
- Department of Surgery, Interventional Radiology, West Virginia University/Charleston Area Medical Center, 3200 MacCorkle Ave SE, Charleston, WV 25304
| | - Robert C Ward
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI
| | - Ahsun Riaz
- Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Rache M Simmons
- Department of Surgery, Weill Medical College of Cornell University, New York, NY
| | - Claus C Pieper
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | - Yolanda Bryce
- Division of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Sotirchos VS, Petre EN, Sofocleous CT. Percutaneous image-guided ablation for hepatic metastases. J Med Imaging Radiat Oncol 2023; 67:832-841. [PMID: 37944085 DOI: 10.1111/1754-9485.13594] [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: 06/22/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023]
Abstract
The presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative-intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non-surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow-up protocols and oncologic outcomes are presented and discussed.
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Affiliation(s)
- Vlasios S Sotirchos
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elena N Petre
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Constantinos T Sofocleous
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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5
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Miao S, An Y, Liu P, Mu S, Zhou W, Jia H, Huang W, Li J, Wang R. Pectoralis muscle predicts distant metastases in breast cancer by deep learning radiomics. Acta Radiol 2023; 64:2561-2569. [PMID: 37439012 DOI: 10.1177/02841851231187373] [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] [Indexed: 07/14/2023]
Abstract
BACKGROUND Sarcopenia is associated with a poor prognosis in patients with breast cancer (BC). Currently, there are few quantitative assessments carried out between muscle biomarkers and distant metastasis using existing methods. PURPOSE To assess the predictive value of the pectoralis muscle for BC distant metastasis, we developed a deep learning radiomics nomogram model (DLR-N) in this study. MATERIAL AND METHODS A total of 493 patients with pathologically confirmed BC were registered. Image features were extracted from computed tomography (CT) images for each patient. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors for distant metastasis. The DLR-N was built based on independent prognostic factors and CT images to predict distant metastases. The model was assessed in terms of overall performance, discrimination, calibration, and clinical value. Finally, the predictive performance of the model was validated using the testing cohort. RESULTS The developed DLR-N combined multiple radiomic features and clinicopathological factors and demonstrated excellent predictive performance. The C-index of the training cohort was 0.983 (95% confidence interval [CI] = 0.969-0.998) and the C-index of the testing cohort was 0.948 (95% CI = 0.917-0.979). Decision curve analysis (DCA) showed that patients could benefit more from incorporating multimodal radiomic features into clinicopathological models. CONCLUSIONS DLR-N verified that there were biomarkers at the level of the fourth thoracic vertebra (T4) that affected distant metastasis. Multimodal prediction models based on deep learning could be a potential method to aid in the prediction of distant metastases in patients with BC.
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Affiliation(s)
- Shidi Miao
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, PR China
| | - Yunfei An
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, PR China
| | - Pingping Liu
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, PR China
| | - Shikai Mu
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, PR China
| | - Wenjin Zhou
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, PR China
| | - Haobo Jia
- School of Computer Science and Technology, Harbin University of Science and Technology, Harbin, PR China
| | - Wenjuan Huang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, PR China
| | - Jing Li
- Department of Geriatrics, the Second Affiliated Hospital, Harbin Medical University, Harbin, PR China
| | - Ruitao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, PR China
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Fatima GN, Fatma H, Saraf SK. Vaccines in Breast Cancer: Challenges and Breakthroughs. Diagnostics (Basel) 2023; 13:2175. [PMID: 37443570 DOI: 10.3390/diagnostics13132175] [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: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Breast cancer is a problem for women's health globally. Early detection techniques come in a variety of forms ranging from local to systemic and from non-invasive to invasive. The treatment of cancer has always been challenging despite the availability of a wide range of therapeutics. This is either due to the variable behaviour and heterogeneity of the proliferating cells and/or the individual's response towards the treatment applied. However, advancements in cancer biology and scientific technology have changed the course of the cancer treatment approach. This current review briefly encompasses the diagnostics, the latest and most recent breakthrough strategies and challenges, and the limitations in fighting breast cancer, emphasising the development of breast cancer vaccines. It also includes the filed/granted patents referring to the same aspects.
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Affiliation(s)
- Gul Naz Fatima
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
| | - Hera Fatma
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
| | - Shailendra K Saraf
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
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Glemarec G, Lacaze JL, Cabarrou B, Aziza R, Jouve E, Zerdoud S, De Maio E, Massabeau C, Loo M, Esteyrie V, Ung M, Dalenc F, Izar F, Chira C. Systemic treatment with or without ablative therapies in oligometastatic breast cancer: A single institution analysis of patient outcomes. Breast 2023; 67:102-109. [PMID: 36709639 PMCID: PMC9982270 DOI: 10.1016/j.breast.2022.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Local ablative treatment (LAT) is increasingly combined with systemic therapy in oligometastatic breast cancer (OMBC), without a high-level evidence to support this strategy. We evaluated the addition of LAT to systemic treatment in terms of progression-free survival (PFS) and overall survival (OS). Secondary endpoints were local control (LC) and toxicity. We sought to identify prognostic factors associated with longer OS and PFS. METHODS AND MATERIALS We identified consecutive patients treated between 2014 and 2018 for synchronous or metachronous OMBC (defined as ≤ 5 metastases). LAT included stereotactic body radiation therapy (SBRT) and volumetric modulated arc therapy (VMAT), surgery, cryotherapy and percutaneous radiofrequency ablation (PRA). PFS and OS were calculated, and Cox regression models analyzed for potential predictors of survival. RESULTS One hundred two patients were included (no-LAT, n = 62; LAT, n = 40). Sixty-four metastases received LAT. Median follow-up was 50.4 months (95% CI [44.4; 53.4]). One patient experienced grade 3 toxicity in the LAT group. Five-year PFS and OS were 34.75% (95% CI [24.42-45.26]) and 63.21% (95% CI [50.69-73.37]) respectively. Patients receiving both LAT and systemic therapy had longer PFS and OS than those with no-LAT ([HR 0.39, p = 0.002]) and ([HR 0.31, p = 0.01]). The use of LAT, HER2-positive status and hormone-receptor positivity were associated with longer PFS and OS whereas liver metastases led to worse PFS. CONCLUSIONS LAT was associated with improved outcomes in OMBC when added to systemic treatment, without significantly increasing toxicity. The prognostic factors identified to extend PFS and OS may help guide clinicians in selecting patients for LAT.
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Affiliation(s)
- Gauthier Glemarec
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Jean-Louis Lacaze
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Unit, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Richard Aziza
- Department of Radiology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Eva Jouve
- Department of Surgery, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Slimane Zerdoud
- Department of Radiology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Eleonora De Maio
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Carole Massabeau
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Maxime Loo
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Vincent Esteyrie
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Francoise Izar
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Ciprian Chira
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-O, Toulouse, France.
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Imoto S, Wang K, Bi XW, Liu G, Im YH, Im SA, Sim SH, Ueno T, Futamura M, Toi M, Fujiwara Y, Ahn SG, Lee JE, Park YH, Takao S, Oba MS, Kitagawa Y, Nishiyama M. Survival advantage of locoregional and systemic therapy in oligometastatic breast cancer: an international retrospective cohort study (OLIGO-BC1). Breast Cancer 2023; 30:412-423. [PMID: 36689066 DOI: 10.1007/s12282-023-01436-7] [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: 09/24/2022] [Accepted: 01/13/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND An international retrospective cohort study was conducted to clarify the survival advantage of combination therapy with locoregional and systemic therapy (ST) in oligometastatic breast cancer (BC). METHODS Patients with oligometastatic BC diagnosed from 2007 to 2012 were enrolled in center hospitals in China, Korea and Japan. It was defined as a low-volume metastatic disease at up to five sites and not necessarily in the same organ. Cases with brain, pleural, peritoneal and pericardial metastases were excluded. The primary endpoint was overall survival (OS) from the initial diagnosis of oligometastases. OS was summarized using the Kaplan-Meier method. A multivariable Cox regression model was used to estimate the hazard ratio (HR) for clinicopathological factors. RESULTS Among 1,295 cases registered from February 2018 to May 2019, 932 remained for analysis after the exclusion of unavailable cases and locoregional recurrence. One metastatic site was found in 400 cases, 2 in 243, 3 in 130, 4 in 86 and 5 in 73. At the median follow-up of 4.5 years, 5-year OS was 54.7% and 39.7% for 321 cases in the combination therapy group and 611 cases in the ST group, respectively. An adjusted HR was 0.66 (95% confidence interval: 0.55, 0.79). Some types of ST without chemotherapy alone, younger age, ECOG performance status 0, early-stage BC, non-triple negative subtype, fewer metastatic sites and longer duration of surgery to relapse were significantly favorable prognostic factors. CONCLUSION Combination therapy may be considered for longer survival under some conditions in oligometastatic BC.
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Affiliation(s)
| | - Kun Wang
- Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xi-Wen Bi
- Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Guangyu Liu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Young-Hyuck Im
- Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Seock-Ah Im
- Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Hoon Sim
- Center for Breast Cancer Korea, National Cancer Center, Goyang, South Korea
| | - Takayuki Ueno
- Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Masakazu Toi
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Sung Gwe Ahn
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong Eon Lee
- Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Yeon Hee Park
- Sungkyunkwan University School of Medicine, Suwon, South Korea
| | | | - Mari Saito Oba
- Clinical Research and Education Promotion Division, Department of Clinical Data Science, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuko Kitagawa
- Keio University Graduate School of Medicine, Tokyo, Japan
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Leblanc D, Cantin G, Desnoyers A, Dufresne J, Masucci GL, Panet-Raymond V, Poirier É, Soldera S, Gingras I. Management of Oligometastatic Breast Cancer: An Expert Committee's Opinion. Curr Oncol 2023; 30:1416-1425. [PMID: 36826069 PMCID: PMC9954938 DOI: 10.3390/curroncol30020108] [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: 12/06/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
Patients with oligometastatic breast cancer (BC) are candidates of choice for metastasis-directed therapy (MDT). This paper summarizes the opinions of an expert committee about the management of oligometastatic BC. The experts could complete the questionnaire from 13 September 2021, to 10 October 2021, followed by a discussion. The experts were physicians working in the Province of Quebec (Canada) and specialized in BC care, including surgical oncologists, medical oncologists, and radiation oncologists. The experts provided their opinions about the context of the disease and therapeutic approach, local and systemic therapies, and the prognosis of oligometastatic BC. In addition to the expert panel's opinions about the management of oligometastatic disease per se, the experts stated that a prospective data registry should be implemented to collect data about oligometastatic BC to improve knowledge about oligometastatic BC and implement data-driven MDT. These data could also allow for the design of treatment algorithms. In conclusion, this paper presents the expert panel's opinions about the management of oligometastatic BC and highlights the needs to be met to improve the care of this condition.
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Affiliation(s)
- Dominique Leblanc
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
- Correspondence:
| | - Guy Cantin
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Alexandra Desnoyers
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Jean Dufresne
- Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
| | | | | | - Éric Poirier
- Centre Hospitalier Universitaire de Québec—Université Laval, Québec, QC G1V 0A6, Canada
| | - Sara Soldera
- Hôpital Charles-Le Moyne, Greenfield Park, QC J4V 2H1, Canada
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De Rose F, Meduri B, Carmen De Santis M, Ferro A, Marino L, Ray Colciago R, Gregucci F, Vanoni V, Apolone G, Di Cosimo S, Delaloge S, Cortes J, Curigliano G. Rethinking breast cancer follow-up based on individual risk and recurrence management. Cancer Treat Rev 2022; 109:102434. [DOI: 10.1016/j.ctrv.2022.102434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/01/2022]
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11
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Newbury A, Ferguson C, Valero DA, Kutcher-Diaz R, McIntosh L, Karamanian A, Harman A. Interventional oncology update. Eur J Radiol Open 2022; 9:100430. [PMID: 35761853 PMCID: PMC9233207 DOI: 10.1016/j.ejro.2022.100430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 12/29/2022] Open
Abstract
Interventional Oncology (IO) is a subspecialty field of Interventional Radiology bridging between diagnostic radiology and the clinical oncology team, addressing the diagnosis and treatment of cancer. There have been many exciting advancements in the field of IO in recent years; far too many to cover in a single paper. To give each topic sufficient attention, we have limited the scope of this review article to four topics which we feel have the potential to drastically change how cancer is treated managed in the immediate future.
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Affiliation(s)
- Alex Newbury
- UMass Memorial Medical Center, Worcester, MA, USA
| | | | | | | | | | | | - Aaron Harman
- UMass Memorial Medical Center, Worcester, MA, USA
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12
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Sgalambro F, Zugaro L, Bruno F, Palumbo P, Salducca N, Zoccali C, Barile A, Masciocchi C, Arrigoni F. Interventional Radiology in the Management of Metastases and Bone Tumors. J Clin Med 2022; 11:3265. [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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Affiliation(s)
- Ferruccio Sgalambro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
| | - Luigi Zugaro
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Federico Bruno
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Pierpaolo Palumbo
- San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.B.); (P.P.)
| | - Nicola Salducca
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (N.S.); (C.Z.)
| | - Carmine Zoccali
- Oncological Orthopaedics Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (N.S.); (C.Z.)
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.S.); (A.B.); (C.M.)
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13
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Thompson SM, Welch BT, Kurup AN. Ablation for oligometastatic colorectal carcinoma in extrahepatic, extrapulmonary sites. Int J Hyperthermia 2022; 39:633-638. [DOI: 10.1080/02656736.2021.1952318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Brian T. Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - A. Nick Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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14
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Kastler A, Cornelis FH, Kastler B. Patient's selection and evaluation for bone stabilization. Tech Vasc Interv Radiol 2022; 25:100797. [DOI: 10.1016/j.tvir.2022.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Meng M, Han X, Li W, Huang G, Ni Y, Wang J, Zhang T, Dai J, Zou Z, Yang X, Ye X. CT-guided microwave ablation in patients with lung metastases from breast cancer. Thorac Cancer 2021; 12:3380-3386. [PMID: 34725933 PMCID: PMC8671896 DOI: 10.1111/1759-7714.14212] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022] Open
Abstract
Background Computed tomography (CT)‐guided percutaneous microwave ablation (MWA) is a very common ablation method that shows a good local tumor control rate in primary and secondary lung tumors. At present, few reports have explored the safety and efficacy of MWA for lung metastases from breast cancer. Methods From January 2012 to January 2018, 32 breast cancer patients with 46 pulmonary metastases received CT‐guided percutaneous MWA. The study was approved by the local institutional review board. The clinical efficacy and complications of MWA were investigated. Results The median follow‐up time was 32 months and the main effective rate was 97.8% (45/46). Five of 46 lesions had local progression (10.9%), with a median progression time of 10 months. The 1‐, 3‐, and 5‐year overall survival (OS) rates were 96.9%, 53.3%, and 17.8%, respectively. The median OS time was 36 months. Among 46 MWA treatments, 11 (23.9%) had massive pneumothorax, two (4.3%) had massive pleural effusion, and two (4.3%) had a pulmonary infection. Conclusion CT‐guided percutaneous MWA may be safe and effective for treating lung metastases from breast cancer.
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Affiliation(s)
- Min Meng
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xiaoying Han
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Wenhong Li
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yang Ni
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jiao Wang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tiehong Zhang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jianjian Dai
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhigeng Zou
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xin Ye
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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16
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Lacaze JL, Aziza R, Chira C, De Maio E, Izar F, Jouve E, Massabeau C, Pradines A, Selmes G, Ung M, Zerdoud S, Dalenc F. Diagnosis, biology and epidemiology of oligometastatic breast cancer. Breast 2021; 59:144-156. [PMID: 34252822 PMCID: PMC8441842 DOI: 10.1016/j.breast.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/31/2021] [Accepted: 06/23/2021] [Indexed: 11/01/2022] Open
Abstract
Does oligometastatic breast cancer (OMBC) deserve a dedicated treatment? Although some authors recommend multidisciplinary management of OMBC with a curative intent, there is no evidence proving this strategy beneficial in the absence of a randomized trial. The existing literature sheds little light on OMBC. Incidence is unknown; data available are either obsolete or biased; there is no consensus on the definition of OMBC and metastatic sites, nor on necessary imaging techniques. However, certain proposals merit consideration. Knowledge of eventual specific OMBC biological characteristics is limited to circulating tumor cell (CTC) counts. Given the data available for other cancers, studies on microRNAs (miRNAs), circulating tumor DNA (ctDNA) and genomic alterations should be developed Finally, safe and effective therapies do exist, but results of randomized trials will not be available for many years. Prospective observational cohort studies need to be implemented.
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Affiliation(s)
- Jean-Louis Lacaze
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France.
| | - Richard Aziza
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Imagerie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Ciprian Chira
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eleonora De Maio
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Françoise Izar
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Eva Jouve
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Carole Massabeau
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Radiothérapie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Anne Pradines
- Institut Claudius Regaud (ICR), Département Biologie Médicale Oncologique, Centre de Recherche en Cancérologie de Toulouse, (CRCT), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), INSERM UMR-1037, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Gabrielle Selmes
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Chirurgie, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Mony Ung
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Slimane Zerdoud
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département de Médecine Nucléaire, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
| | - Florence Dalenc
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département d'Oncologie Médicale, Université de Toulouse, UPS, 1 av. Irène Joliot Curie, 31059, Toulouse Cedex 9, France
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17
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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18
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Gennaro N, Schiaffino S, Mauri G, Monfardini L. The What, the Why, and the How of Liver Ablations: A Practical Guide for the Medical Oncologist. Oncology 2021; 99:722-731. [PMID: 34515198 DOI: 10.1159/000518358] [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: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.
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Affiliation(s)
- Nicolò Gennaro
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Simone Schiaffino
- Radiology Unit IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
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19
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Significance of liver metastasis volume in breast cancer patients treated with stereotactic body radiotherapy. Strahlenther Onkol 2021; 198:247-253. [PMID: 34477885 DOI: 10.1007/s00066-021-01845-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study analyzed the impact of liver metastasis (LM) volume on treatment outcomes in breast cancer (BC) patients treated with stereotactic body radiotherapy (SBRT). METHODS This single-institution retrospective analysis included 40 oligometastatic (≤ 5 metastases) BC patients with 58 liver metastases treated with SBRT between April 2013 and March 2021. The prognostic factors for local control (LC), overall survival (OS), and progression-free survival (PFS) rates were assessed. RESULTS Median follow-up time was 28.1 months. Isolated and solitary LM were seen in 26 (65%) and 24 (60%) patients, respectively. Median time to disease recurrence was 10.7 months post liver SBRT. The 2‑year OS, PFS, and LC rates were 71.4%, 27.5%, and 86.8%, respectively. In univariate analysis, patients with a gross tumor volume (GTV) of ≤ 6 cc and a planning target volume (PTV) of ≤ 38 cc demonstrated a significantly better median OS than those with GTV > 6 cc and PTV > 38 cc. In multivariate analysis, the predictive factors for worse OS were GTV > 6 cc (HR = 3.07 [95% CI, 1.14-8.22; p = 0.03]) and PTV > 38 cc (HR = 5.91 [95% CI, 1.92-18.21; p = 0.002]). No significant factor for PFS was found. Only 2 patients experienced rib fracture at 4 and 6 months post treatment, and 1 patient had a grade II duodenal ulcer. CONCLUSION Liver SBRT is an effective and safe treatment option for oligometastatic BC patients with excellent LC, promising survival, and limited toxicity. Patients with smaller tumors displayed better OS than their counterparts, validating the effectiveness of a local treatment for this group.
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20
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Fanous SN, Saleh EG, Abd Elghafar EM, Ghobrial HZ. Randomized controlled trials between dorsal root ganglion thermal radiofrequency, pulsed radiofrequency and steroids for the management of intractable metastatic back pain in thoracic vertebral body. Br J Pain 2021; 15:270-281. [PMID: 34381612 PMCID: PMC8339942 DOI: 10.1177/2049463720942538] [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: 11/15/2022] Open
Abstract
BACKGROUND Bone metastasis is a complication of various cancers causing severe pain. The current modalities for the treatment of metastatic axial pain include pharmacological, surgical and vertebral augmentation techniques, each of which has its own challenges. OBJECTIVES To evaluate the effectiveness of pulsed radiofrequency (PRF), thermal radiofrequency (RF) and steroids on dorsal root ganglion (DRG) in patients with thoracic axial pain due to vertebral metastasis. METHODS In this randomized controlled prospective study, 140 patients were assessed for eligibility, of which only 69 fulfilled the criteria. Patients were randomly divided into three equal groups, PRF, RF and steroid. RESULTS During the assessment of pain using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), Opioid consumption using oral Morphine Equivalence (OME) and Analgesic Quantification Algorithm (AQA) - at baseline, 1 week, 1 month and 3 months - 81 patients were assessed for final eligibility, of which 12 were excluded before intervention due to drop-out. The remaining 69 were randomized (mean age: 53.87 ± 10.55, 55.78 ± 7.34 and 59.39 ± 13.72) for PRF, RF and steroid, respectively with no statistical difference. VAS% and ODI% decreased significantly at 3 months in RF group (p <0.001, 0.014, respectively), as did the AQA (p <0.027). Steroid group was the worst. DISCUSSION RF on DRG is the main stay for controlling intractable metastatic pain. PRF is a good alternative.
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Affiliation(s)
- Sherry Nabil Fanous
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Emad Gerges Saleh
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ekramy Mansour Abd Elghafar
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Hossam Zarif Ghobrial
- Department of Anaesthesia, ICU and Pain
Management, National Cancer Institute, Cairo University, Cairo, Egypt
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21
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Gouveia AG, Chan DCW, Hoskin PJ, Marta GN, Trippa F, Maranzano E, Chow E, Silva MF. Advances in radiotherapy in bone metastases in the context of new target therapies and ablative alternatives: A critical review. Radiother Oncol 2021; 163:55-67. [PMID: 34333087 DOI: 10.1016/j.radonc.2021.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
In patients with bone metastases (BM), radiotherapy (RT) is used to alleviate symptoms, reduce the risk of fracture, and improve quality of life (QoL). However, with the emergence of concepts like oligometastases, minimal invasive surgery, ablative therapies such as stereotactic ablative RT (SABR), radiosurgery (SRS), thermal ablation, and new systemic anticancer therapies, there have been a paradigm shift in the multidisciplinary approach to BM with the aim of preserving mobility and function survival. Despite guidelines on using single-dose RT in uncomplicated BM, its use remains relatively low. In uncomplicated BM, single-fraction RT produces similar overall and complete response rates to RT with multiple fractions, although it is associated with a higher retreatment rate of 20% versus 8%. Complicated BM can be characterised as the presence of impending or existing pathologic fracture, a major soft tissue component, existing spinal cord or cauda equina compression and neuropathic pain. The rate of complicated BM is around 35%. Unfortunately, there is a lack of prospective trials on RT in complicated BM and the best dose/fractionation regimen is not yet established. There are contradictory outcomes in studies reporting BM pain control rates and time to pain reduction when comparing SABR with Conventional RT. While some studies showed that SABR produces a faster reduction in pain and higher pain control rates than conventional RT, other studies did not show differences. Moreover, the local control rate for BM treated with SABR is higher than 80% in most studies, and the rate of grade 3 or 4 toxicity is very low. The use of SABR may be preferred in three circumstances: reirradiation, oligometastatic disease, and radioresistant tumours. Local ablative therapies like SABR can delay change or use of systemic therapy, preserve patients' Qol, and improve disease-free survival, progression-free survival and overall survival. Moreover, despite the potential benefit of SABR in oligometastatic disease, there is a need to establish the optial indication, RT dose fractionation, prognostic factors and optimal timing in combination with systemic therapies for SABR. This review evaluates the role of RT in BM considering these recent treatment advances. We consider the definition of complicated BM, use of single and multiple fractions RT for both complicated and uncomplicated BM, reirradiation, new treatment paradigms including local ablative treatments, oligometastatic disease, systemic therapy, physical activity and rehabilitation.
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Affiliation(s)
- André G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Dominic C W Chan
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom; Radiation Oncology Department, University of Manchester, United Kingdom
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department, Hospital Sírio Libanês, São Paulo, Brazil
| | - Fabio Trippa
- Radiation Oncology Center, Santa Maria Hospital, Terni, Italy
| | | | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Mauricio F Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria, Brazil; Clínica de Radioterapia de Santa Maria, Brazil.
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22
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Chen-Xu S, Martel-Villagrán J, Bueno-Horcajadas Á. Percutaneous management of bone metastases: State of the art. RADIOLOGIA 2021; 63:345-357. [PMID: 34246425 DOI: 10.1016/j.rxeng.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/19/2021] [Indexed: 11/28/2022]
Abstract
Interventional radiology is playing an increasingly important role in the local treatment of bone metastases; this treatment is usually done with palliative intent, although in selected patients it can be done with curative intent. Two main groups of techniques are available. The first group, centered on bone consolidation, includes osteoplasty/vertebroplasty, in which polymethyl methacrylate (PMMA) is injected to reinforce the bone and relieve pain, and percutaneous osteosynthesis, in which fractures with nondisplaced or minimally bone fragments are fixed in place with screws. The second group centers on tumor ablation. tumor ablation refers to the destruction of tumor tissue by the instillation of alcohol or by other means. Thermoablation is the preferred technique in musculoskeletal tumors because it allows for greater control of ablation. Thermoablation can be done with radiofrequency, in which the application of a high frequency (450 Hz-600 Hz) alternating wave to the tumor-bone interface achieves high temperatures, resulting in coagulative necrosis. Another thermoablation technique uses microwaves, applying electromagnetic waves in an approximate range of 900 MHz-2450 MHz through an antenna that is placed directly in the core of the tumor, stimulating the movement of molecules to generate heat and thus resulting in coagulative necrosis. Cryoablation destroys tumor tissue by applying extreme cold. A more recent, noninvasive technique, magnetic resonance-guided focused ultrasound surgery (MRgFUS), focuses an ultrasound beam from a transducer placed on the patient's skin on the target lesion, where the waves' mechanical energy is converted into thermal energy (65 °C-85 °C). Treatment should be planned by a multidisciplinary team. Treatment can be done with curative or palliative intent. Once the patient is selected, a preprocedural workup should be done to determine the most appropriate technique based on a series of factors. During the procedure, protective measures must be taken and the patient must be closely monitored. After the procedure, patients must be followed up.
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Affiliation(s)
- S Chen-Xu
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
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23
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Kurup AN, Jennings JW, Tutton S, Tam AL, Kelekis A, Wood BJ, Dupuy DE, Napoli A, Park SS, Robinson SI, Rose PS, Soulen MC, White SB, Callstrom MR. Musculoskeletal Oncologic Interventions: Proceedings from the Society of Interventional Radiology and Society of Interventional Oncology Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1089.e1-1089.e9. [PMID: 34210477 DOI: 10.1016/j.jvir.2021.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/05/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
Musculoskeletal interventions are increasingly used with palliative and curative intent in the multidisciplinary treatment of oncology patients with bone and soft-tissue tumors. There is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients. Therefore, the Society of Interventional Radiology Foundation and the Society of Interventional Oncology collaborated to convene a research consensus panel to prioritize a research agenda addressing the gaps in the current evidence. This article summarizes the panel's proceedings and recommendations for future basic science and clinical investigation to chart the course for interventional oncology within the musculoskeletal system. Key questions that emerged addressed the effectiveness of ablation within specific patient populations, the effect of combination of ablation with radiotherapy and/or immunotherapy, and the potential of standardization of techniques, including modeling and monitoring, to improve the consistency and predictability of treatment outcomes.
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Affiliation(s)
- Anil Nicholas Kurup
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN.
| | - Jack W Jennings
- Division of Diagnostic Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alda L Tam
- Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alexis Kelekis
- Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bradford J Wood
- Department of Interventional Radiology, National Cancer Institute, Bethesda, Maryland
| | - Damian E Dupuy
- Department of Interventional Radiology, Cape Cod Hospital, Hyannis, Massachusetts
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sean S Park
- Radiation Oncology, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Steven I Robinson
- Medical Oncology, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Peter S Rose
- Orthopedic Surgery, Mayo Clinic College of Medicine and Science, 200 First St. SW, Rochester, MN 55905
| | - Michael C Soulen
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sarah B White
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew R Callstrom
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN
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24
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Chen-Xu S, Martel-Villagrán J, Bueno-Horcajadas Á. Percutaneous management of bone metastases: state of the art. RADIOLOGIA 2021. [PMID: 33820632 DOI: 10.1016/j.rx.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Interventional radiology is playing an increasingly important role in the local treatment of bone metastases; this treatment is usually done with palliative intent, although in selected patients it can be done with curative intent. Two main groups of techniques are available. The first group, centered on bone consolidation, includes osteoplasty / vertebroplasty, in which polymethyl methacrylate (PMMA) is injected to reinforce the bone and relieve pain, and percutaneous osteosynthesis, in which fractures with nondisplaced or minimally bone fragments are fixed in place with screws. The second group centers on tumor ablation. Tumor ablation refers to the destruction of tumor tissue by the instillation of alcohol or by other means. Thermoablation is the preferred technique in musculoskeletal tumors because it allows for greater control of ablation. Thermoablation can be done with radiofrequency, in which the application of a high frequency (450 Hz-600Hz) alternating wave to the tumor-bone interface achieves high temperatures, resulting in coagulative necrosis. Another thermoablation technique uses microwaves, applying electromagnetic waves in an approximate range of 900MHz to 2450MHz through an antenna that is placed directly in the core of the tumor, stimulating the movement of molecules to generate heat and thus resulting in coagulative necrosis. Cryoablation destroys tumor tissue by applying extreme cold. A more recent, noninvasive technique, magnetic resonance-guided focused ultrasound surgery (MRgFUS), focuses an ultrasound beam from a transducer placed on the patient's skin on the target lesion, where the waves' mechanical energy is converted into thermal energy (65°C-85°C). Treatment should be planned by a multidisciplinary team. Treatment can be done with curative or palliative intent. Once the patient is selected, a preprocedural workup should be done to determine the most appropriate technique based on a series of factors. During the procedure, protective measures must be taken and the patient must be closely monitored. After the procedure, patients must be followed up.
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Affiliation(s)
- S Chen-Xu
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, España
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Efficacy of Tract Embolization After Percutaneous Pulmonary Radiofrequency Ablation. Cardiovasc Intervent Radiol 2021; 44:903-910. [PMID: 33492452 DOI: 10.1007/s00270-020-02745-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the efficacy of tract embolization technique using gelatin sponge slurry with iodinated contrast medium (GSSI) to reduce the incidence of pneumothorax and chest tube placement after computed tomography-guided lung radiofrequency ablation (RFA). MATERIALS AND METHODS In this single-institute retrospective study, we examined all patients with metastatic cancer treated from January 2016 to December 2019 by interventional radiologists with computed tomography-guided lung RFA. Since 2017 in our institution, we have applied a tract embolization technique using GSSI for all RFA. Patients were included into those who underwent lung RFA performed either with GSSI (Group A) or without GSSI (Group B). Univariate and multivariate analyses were performed between the two groups to identify risk factors for pneumothorax and chest tube placement, including patient demographics and lesion characteristics. RESULTS This study included 116 patients (54 men, 62 women; mean age, 65 ± 11 years) who underwent RFA. Group A comprised 71 patients and Group B comprised 45 patients. Patients who underwent tract embolization had a significantly lower incidence of pneumothorax (Group A, 34% vs. Group B, 62%; p < 0.001) and chest tube insertion (Group A, 10% vs. Group B, 29%; p < 0.01). No embolic complications occurred. The hospitalization stay was significantly shorter in patients who underwent tract embolization (mean, 1.04 ± 0.2 days; p = 0.02). CONCLUSION Tract embolization after percutaneous lung RFA significantly reduced the rate of post-RFA pneumothorax and chest tube placement and was safer than the standard lung RFA technique.
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Abstract
Breast cancer is the most common cancer in women and breast cancer liver metastasis may be associated with poor outcomes. Emerging locoregional therapies can be given in outpatient settings or with short hospital stays, to provide local control, support quality of life, preserve liver function, and potentially prolong survival. This review discusses retrospective studies suggesting potential benefits of locoregional treatment of breast cancer liver metastasis. Future prospective studies are needed to demonstrate efficacy and optimize patient selection.
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Affiliation(s)
- Ariel N Liberchuk
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amy R Deipolyi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Hayek G, Kastler B. Interventional radiology for treatment of bone metastases. Cancer Radiother 2020; 24:374-378. [DOI: 10.1016/j.canrad.2020.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 12/18/2022]
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Predictors of Progression-Free Survival and Local Tumor Control after Percutaneous Thermal Ablation of Oligometastatic Breast Cancer: Retrospective Study. J Vasc Interv Radiol 2020; 31:1201-1209. [PMID: 32698956 DOI: 10.1016/j.jvir.2020.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To describe ablation of bone, liver, lung, and soft tissue tumors from oligometastatic breast cancer and to define predictors of local progression and progression-free survival (PFS). MATERIALS AND METHODS A total of 33 women (mean age 52 ± 12 years old; range, 28-69 years), underwent 46 thermal ablations of liver (n = 35), lung (n = 7), and bone/soft tissue (n = 4) metastases. Mean tumor diameter was 18 ± 15 mm (range, 6-50 mm). Ablations were performed to eradicate all evident sites of disease (n = 24) or to control growing sites in the setting of other stable or responding sites of disease (n = 22). Patient characteristics, ablation margins, imaging responses, and cases of PFS were assessed. Follow-up imaging was performed using contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging, or positron-emission tomography/ CT. RESULTS Median PFS was 10 months (95% confidence interval [CI], 6.2 -14.5 months), and time to local progression was 11 months (95% CI, 5-16 months). Eight patients (24%) maintained no evidence of disease during a median follow-up period of 39 months. Ablation margin ≥5 mm was associated with no local tumor progression. Longer PFS was noted in estrogen receptor-positive patients (12 vs 4 months; P = .037) and younger patients (12 vs 4 months; P = .039) treated to eradicate all sites of disease (13 vs 5 months; P = .05). Eighteen patients (55%) developed new metastases during study follow-up. CONCLUSIONS Thermal ablation of oligometastatic pulmonary, hepatic, bone, and soft tissue tumors can eliminate local tumor progression if margins are ≥5 mm. Longer PFS was observed in patients who were estrogen receptor-positive and patients who were younger and in whom all sites of disease were eradicated.
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CIRSE Standards of Practice on Thermal Ablation of Liver Tumours. Cardiovasc Intervent Radiol 2020; 43:951-962. [PMID: 32382856 DOI: 10.1007/s00270-020-02471-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
This CIRSE Standards of Practice document reviews current literature and provides best practices for image guided thermal ablation of liver tumours, including radiofrequency, microwave and cryoablation techniques.
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Tehrani OS. Systemic Treatments in Pregnancy-Associated Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1252:115-124. [PMID: 32816270 DOI: 10.1007/978-3-030-41596-9_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Available data on systemic treatments in pregnancy-associated breast cancer (PABC) is reviewed in this section. These treatments include chemotherapy, endocrine therapy (ET), small molecule inhibitors, monoclonal antibodies against human epidermal growth factor receptor 2 (EGFR-2) also known as HER2; and human epidermal growth factor receptor 3 (EGFR-3), also known as HER3.In local disease, systemic treatment can be delivered as neoadjuvant (before surgery) or adjuvant (after surgery) treatment. In metastatic disease, systemic therapy is the main modality of treatment.Approach to PABC is based on available data in the general population, limited only by safety issues for use of medications during gestation and lactation. Therefore, treatments are similar to non-PABC patients while trying to minimize the risk to the fetus. Available data on different chemotherapies, anti-HER2 monoclonal antibodies, ET and small molecule inhibitors are discussed in detail.
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Affiliation(s)
- Omid S Tehrani
- Department of Hematology and Medical Oncology, Stanford University, Stanford, CA, USA.
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Wang Y, Yang Y, Chen Z, Zhu T, Wu J, Su F, Deng H. Development and validation of a novel nomogram for predicting distant metastasis-free survival among breast cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:537. [PMID: 31807519 DOI: 10.21037/atm.2019.10.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Distant metastasis (DM) from breast cancer has a poor prognosis. Our objective was to develop and validate a nomogram to predict individual distant metastasis-free survival (DMFS) and risk stratification in non-metastatic breast cancer patients. Methods A nomogram was based on an analysis of 1,201 breast cancer patients treated at Sun Yat-sen Memorial Hospital from 2001 to 2014. Using univariate and multivariate analyses to identify the predictors, this model was externally validated in an independent cohort of 538 patients from the Guangdong General Hospital between 2004 and 2012. The predictive discrimination and calibration ability of this nomogram were assessed using concordance index (C-index), risk group stratification, and calibration curve. Results The 5-year DMFS in the training and validation cohorts were 95.74% and 91.02%, respectively. On multivariable analysis of training cohort, the prognostic factors in the nomogram comprised age, tumor size, lymph node status, molecular subtype, and lymphovascular invasion (LVI). The C-index of our model was 0.75 [95% confidence interval (CI): 0.67-0.83] for the training cohort and 0.71 (95% CI: 0.64-0.78) for the validation cohort. The calibration curves for 5-year DMFS showed good agreement between the model prediction and actual observation. Based on the risk stratification, Kaplan-Meier curves indicated that the low-risk group had significantly better prognosis than the high-risk group (P<0.001). Conclusions Our nomogram can provide an individual prediction of 5-year DMFS in non-metastatic breast cancer patients. This prognostic tool may help clinicians to make appropriate treatment regimens and optimal surveillance plans.
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Affiliation(s)
- Yan Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhengbo Chen
- Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Jiannan Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Heran Deng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Winkelmann MT, Clasen S, Pereira PL, Hoffmann R. Local treatment of oligometastatic disease: current role. Br J Radiol 2019; 92:20180835. [PMID: 31124700 DOI: 10.1259/bjr.20180835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The presence of distant metastases has long been a predictor of poor outcome in solid cancer. However, in an oncologic situation called oligometastatic disease (OMD), multiple studies have revealed a survival benefit with aggressive treatment of these metastases. Besides surgery and radiation therapy, local thermal therapies have developed into a treatment option for OMD. Most studies concerning local therapy of OMD are available for colorectal cancer, which is therefore the focus of this article. Furthermore, this review gives a basic overview of the most popular ablation techniques for treatment of OMD.
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Affiliation(s)
- Moritz T Winkelmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Stephan Clasen
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Philippe L Pereira
- 2 Department of Radiology, SLK-Hospital Heilbronn GmbH, Am Gesundbrunnen, Heilbronn, Germany
| | - Rüdiger Hoffmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
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Errani C, Bazzocchi A, Spinnato P, Facchini G, Campanacci L, Rossi G, Mavrogenis AF. What’s new in management of bone metastases? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1367-1375. [DOI: 10.1007/s00590-019-02446-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
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Xiao YB, Zhang B, Wu YL. Radiofrequency ablation versus hepatic resection for breast cancer liver metastasis: a systematic review and meta-analysis. J Zhejiang Univ Sci B 2019; 19:829-843. [PMID: 30387333 DOI: 10.1631/jzus.b1700516] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the comparative therapeutic efficacy of radiofrequency ablation (RFA) and hepatic resection (HR) for breast cancer liver metastases (BCLMs). METHODS Studies that had examined the outcomes for both RFA and HR for BCLM were identified by searching the electronic databases PubMed, EMBASE, and the Cochrane Library. Pooled analyzes of the overall survival (OS), disease-free survival (DFS), and short-term outcomes of BCLM were performed. RESULTS Patients with BCLM gained many more survival benefits from HR than from RFA with regard to the 3-year OS rate (combined odds ratio (OR) 0.41, 95% confidence interval (CI) 0.29-0.59, P<0.001), 5-year OS rate (combined OR 0.38, 95% CI 0.32-0.46, P<0.001), 3-year DFS (combined OR 0.36, 95% CI 0.27-0.49, P<0.001), and 5-year DFS (combined OR 0.51, 95% CI 0.40-0.66, P<0.001). RFA had fewer postoperative complications (combined OR 0.30, 95% CI 0.20-0.44, P<0.001) and shorter hospital stays (combined OR -9.01, 95% CI -13.49-4.54, P<0.001) than HR. CONCLUSIONS HR takes precedence over RFA in the treatment of patients with BCLM, considering the better survival rate. RFA gives rise to fewer complications and can be carried out with a shorter hospital stay, compared to HR. RFA should be reserved for patients who are not optimum candidates for resection.
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Affiliation(s)
- Yi-Bin Xiao
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Bo Zhang
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Yu-Lian Wu
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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Abstract
Metastatic breast cancer (MBC) is considered as incurable. The group of patients with oligometastatic disease (a few metastatic lesions and organs involved) apparently have better prognosis. It is claimed that, these patients could be treated with curative intent, and multidisciplinary aggressive approach should be considered. Despite the lack of strong data it is increasingly accepted in clinical practice. Currently, the appropriate candidate would be young woman with good performance status, low tumour burden with long disease-free interval. Because for them with already favorable nature of their disease, aggressive treatment has greater chances to improve survivals. Local ablative treatment (radiotherapy/surgery) has a crucial role in this setting. Available mainly from retrospective in nature long-term results are encouraging but need confirmation in prospective randomized studies. In this review, I discuss the definition of oligometastatic disease, its nature, currently available data and ongoing prospective randomized trials dedicated to oligometastatic breast cancer patients.
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Khan MA, Deib G, Deldar B, Patel AM, Barr JS. Efficacy and Safety of Percutaneous Microwave Ablation and Cementoplasty in the Treatment of Painful Spinal Metastases and Myeloma. AJNR Am J Neuroradiol 2018; 39:1376-1383. [PMID: 29794238 PMCID: PMC7655455 DOI: 10.3174/ajnr.a5680] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Painful spinal metastases are a common cause of cancer-related morbidity. Percutaneous ablation presents an attractive minimally invasive alternative to conventional therapies. We performed a retrospective review of 69 patients with 102 painful spinal metastases undergoing microwave ablation and cementoplasty to determine the efficacy and safety of this treatment. MATERIALS AND METHODS Procedures were performed between January 2015 and October 2016 with the patient under general anesthesia using image guidance for 102 spinal metastases in 69 patients in the following areas: cervical (n = 2), thoracic (n = 50), lumbar (n = 34), and sacral (n = 16) spine. Tumor pathologies included the following: multiple myeloma (n = 10), breast (n = 27), lung (n = 12), thyroid (n = 6), prostate (n = 5), colon (n = 4), renal cell (n = 3), oral squamous cell (n = 1), and adenocarcinoma of unknown origin (n = 1). Procedural efficacy was determined using the visual analog scale measured preprocedurally and at 2-4 weeks and 20-24 weeks postprocedure. Tumor locoregional control was assessed on follow-up cross-sectional imaging. Procedural complications were recorded to establish the safety profile. RESULTS The median ablation time was 4 minutes 30 seconds ± 7 seconds, and energy dose, 4.1 ± 1.6 kJ. Median visual analog scale scores were the following: 7.0 ± 1.8 preprocedurally, 2 ± 1.6 at 2-4 weeks, and 2 ± 2.1 at 20-24 weeks. Eight patients died within 6 months following the procedure. Follow-up imaging in the surviving patients at 20-24 weeks demonstrated no locoregional progression in 59/61 patients. Two complications were documented (S1 nerve thermal injury and skin burn). CONCLUSIONS Microwave ablation is an effective and safe treatment technique for painful spinal metastases. Further studies may be helpful in determining the role of microwave ablation in locoregional control of metastases.
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Affiliation(s)
- M A Khan
- From the Department of Radiology (M.A.K., G.D.), John Hopkins University, Baltimore, Maryland
| | - G Deib
- From the Department of Radiology (M.A.K., G.D.), John Hopkins University, Baltimore, Maryland
| | - B Deldar
- St. George's University of London (B.D.), London, UK
| | | | - J S Barr
- Orthopedics (J.S.B.), University of Mississippi Medical Centre, Jackson, Mississippi
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He Y, Peng L, Huang Y, Liu C, Zheng S, Wu K. Blood cadmium levels associated with short distant metastasis-free survival time in invasive breast cancer. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2017; 24:28055-28064. [PMID: 28994009 DOI: 10.1007/s11356-017-0412-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/03/2017] [Indexed: 02/05/2023]
Abstract
Distant metastasis is strongly associated with poor prognosis of breast cancer. Cadmium (Cd) exposure was previously found associated with breast cancer incidence. We explored the associations of blood cadmium levels (BCLs) and clinicopathologic characteristics with invasive breast cancer distant metastasis. Blood samples were collected and analyzed for BCLs by graphite-furnace atomic absorption spectrometry. Clinicopathologic characteristics, including basic clinical information and tumor characteristics, were obtained from medical records. Breast cancer distant metastasis-free survival (DMFS) time was calculated at follow-up. The associations of BCLs and clinicopathologic characteristics with DMFS time were examined by Kaplan-Meier method and Cox regression analysis, and associations between BCLs and tumor characteristics were also explored. Blood Cd level was positively associated with distant metastasis, clinical stage, BMI, and age. On univariate analysis, older age at diagnosis, family history of breast cancer, high N classification and clinical stage, positivity for human epidermal growth factor receptor 2, and high BCLs were associated with short DMFS time. On multivariate analysis model, older age at diagnosis, family history of breast cancer, high N classification, and BCLs were predictors for breast cancer distant metastasis. BCLs were a risk factor for short DMFS time of invasive breast cancer. BCLs and some clinicopathologic factors affect breast cancer distant metastasis, which needs further epidemiological and experimental studies to confirm.
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Affiliation(s)
- Yuanfang He
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Lin Peng
- Clinical Laboratory, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Yanhong Huang
- Mental Health Center, Shantou University Medical College, North Taishan Road, Shantou, Guangdong Province, 515065, China
| | - Caixia Liu
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Shukai Zheng
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China
| | - Kusheng Wu
- Department of Preventive Medicine, Shantou University Medical College, No.22, Xinling Rd., Shantou, Guangdong, 515041, China.
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Korkusuz Y, Gröner D, Raczynski N, Relin O, Kingeter Y, Grünwald F, Happel C. Thermal ablation of thyroid nodules: are radiofrequency ablation, microwave ablation and high intensity focused ultrasound equally safe and effective methods? Eur Radiol 2017; 28:929-935. [PMID: 28894936 DOI: 10.1007/s00330-017-5039-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 06/06/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study compares volume reduction of benign thyroid nodules three months after Radiofrequency Ablation (RFA), Microwave Ablation (MWA) or High Intensity Focused Ultrasound (HIFU) to evaluate which of these methods is the most effective and safe alternative to thyroidectomy or radioiodine therapy. MATERIAL AND METHODS Ninety-four patients (39 male, 55 female) with a total of 118 benign, symptomatic thyroid nodules were divided into three subgroups. HIFU was applied to 14 patients with small nodules. The other 80 patients were divided up into two groups of 40 patients each for RFA and MWA in the assumption that both methods are comparable effective. The pre-ablative and post-ablative volume was measured by ultrasound. RESULTS RFA showed a significant volume reduction of nodules of 50 % (p<0.05), MWA of 44 % (p<0.05) and HIFU of 48 % (p<0.05) three months after ablation. None of the examined ablation techniques caused serious or permanent complications. CONCLUSION RFA, MWA and HIFU showed comparable results considering volume reduction. All methods are safe and effective treatments of benign thyroid nodules. KEY POINTS • Thermal Ablation can be used to treat benign thyroid nodules • Thermal Ablation can be an alternative to thyroidectomy or radioiodine therapy • Radiofrequency Ablation, Microwave Ablation, High Intensity Focused Ultrasound are safe and effective.
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Affiliation(s)
- Yücel Korkusuz
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Gröner
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Natascha Raczynski
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.
| | - Oleg Relin
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Yasmina Kingeter
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany
| | - Frank Grünwald
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
| | - Christian Happel
- Department of Nuclear Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, D-60590, Frankfurt/Main, Germany.,German Centre for Thermoablation of Thyroid Nodules, University Hospital Frankfurt, Frankfurt, Germany
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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Abstract
In the last decade, percutaneous treatment of musculoskeletal (MSK) tumors has become more established in routine clinical care while also undergoing a number of advancements. Ablative techniques to palliate painful skeletal metastases have gained wide acceptance, while goals for ablation have evolved to include local control of oligometastases and desmoid tumors. Bone consolidation or augmentation is now frequently used in conjunction with or instead of ablation of skeletal tumors to stabilize pathologic fractures or prevent further morbidity that could result from fractures caused by tumor progression. These procedures have traditionally been performed with cement injection, although additional percutaneous consolidation or stabilization devices have been developed. Techniques to monitor the ablation zone and adjacent structures intraprocedurally are now applied to increase the number of tumors amenable to treatment. These include methods to depict, displace, or monitor critical structures adjacent to targeted MSK tumors. Finally, the role of ablation in the comprehensive care of patients with MSK tumors continues to change with the evolving triage of patients between radiation therapy, surgical resection and stabilization, and percutaneous ablative and consolidative management.
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Golse N, Adam R. Liver Metastases From Breast Cancer: What Role for Surgery? Indications and Results. Clin Breast Cancer 2017; 17:256-265. [DOI: 10.1016/j.clbc.2016.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
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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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Kurup AN, Callstrom MR. Expanding role of percutaneous ablative and consolidative treatments for musculoskeletal tumours. Clin Radiol 2017; 72:645-656. [PMID: 28363660 DOI: 10.1016/j.crad.2017.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/02/2017] [Accepted: 02/16/2017] [Indexed: 01/21/2023]
Abstract
Interventional approaches to musculoskeletal tumours have significantly changed over the last several years, and new treatments continue to be developed. All ablative modalities are currently applied to the treatment of bone tumours, including radiofrequency, cryo-, microwave, and laser ablation devices. Indications for ablation of bone and soft-tissue tumours have expanded beyond palliation of painful bone metastases and eradication of osteoid osteomas to the local control of oligometastatic disease from a number of primary tumours and ablation of desmoid tumours. In addition, tools for consolidation of bone tumours at risk of pathological fracture have also expanded. With these developments, ablation has become the primary treatment for osteoid osteomas and, at some institutions, desmoid tumours. It may be the primary or secondary treatment for palliation of painful bone tumours, frequently used in patients with pain refractory to or recurrent after radiation therapy. It is used as a treatment for limited metastatic disease or for metastases that grow disproportionately in patients with multifocal metastases, either in combination with systemic therapy or to reserve systemic therapy and its toxicity for more widespread disease progression. Moreover, percutaneous methods to consolidate bone at risk of fracture have become more commonplace, aided by techniques using materials beyond typical bone cement.
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Affiliation(s)
- A N Kurup
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
| | - M R Callstrom
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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De Cobelli F, Marra P, Ratti F, Ambrosi A, Colombo M, Damascelli A, Sallemi C, Gusmini S, Salvioni M, Diana P, Cipriani F, Venturini M, Aldrighetti L, Del Maschio A. Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions : New advances in interventional oncology: state of the art. Med Oncol 2017; 34:49. [PMID: 28220346 DOI: 10.1007/s12032-017-0903-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/12/2017] [Indexed: 12/13/2022]
Abstract
Liver thermal ablation is an alternative treatment for hepatocellular carcinoma (HCC) and secondary liver malignancies. Microwave ablation (MWA) produces large ablation zones (AZ) in short time; however, AZ prediction is based on preclinical ex vivo models, rising concerns about reproducibility and safety in humans. We aimed to investigate the effects produced by a new-generation MWA system on human liver in vivo with different approaches (percutaneous or intraoperative) and liver conditions (cirrhosis or previous chemotherapy treatment), in comparison with manufacturer-provided predictions based on ex vivo animal models. Complete tumor ablation (CA) and early clinical outcomes were also assessed. From October 2014, 60 consecutive patients (cirrhotic = 31; non-cirrhotic = 10; chemotherapy-treated = 19) with 81 liver nodules (HCC = 31; mets = 50) underwent MWA procedures (percutaneous = 30; laparotomic = 18; laparoscopic = 12), with a 2450 MHz/100 W generator with Thermosphere™ Technology (Emprint™, Medtronic). A contrast-enhanced CT or MR was performed after one month to assess CA and measure AZ. A linear correlation between AZ volumes and ablation times was observed in vivo, without differences from manufacturer-provided ex vivo predictions in all operative approaches and liver conditions. Other independent variables (sex, age, nodule location) showed no relationship when added to the model. Median (IQR) longitudinal and transverse roundness-indexes of the AZs were, respectively, 0.77(0.13) and 0.93(0.11). CA at 1 month was 93% for percutaneous and 100% for intraoperative procedures (p = 0.175). Thirty-day morbidity and mortality were 3% and 0%. MWA with Thermosphere™ Technology produces predictable AZs on human liver in vivo, according to manufacturer-provided ex vivo predictions. In our experience, this new-generation MWA system is effective and safe to treat liver malignancies in different operative and clinical settings.
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Affiliation(s)
- Francesco De Cobelli
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Marra
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy.
| | - Francesca Ratti
- Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Michele Colombo
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Damascelli
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Sallemi
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Simone Gusmini
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Salvioni
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Diana
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Cipriani
- Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Venturini
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Luca Aldrighetti
- Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Del Maschio
- Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Liver Metastases From Noncolorectal Malignancies (Neuroendocrine Tumor, Sarcoma, Melanoma, Breast). Cancer J 2016; 22:381-386. [DOI: 10.1097/ppo.0000000000000232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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