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Liu P, Wei Z, Ye X. Immunostimulatory effects of thermal ablation: Challenges and future prospects. J Cancer Res Ther 2024; 20:531-539. [PMID: 38687922 DOI: 10.4103/jcrt.jcrt_2484_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/13/2023] [Indexed: 05/02/2024]
Abstract
ABSTRACT This literature explores the immunostimulatory effects of thermal ablation in the tumor microenvironment, elucidating the mechanisms such as immunogenic cell death, tumor-specific antigens, and damage-associated molecular patterns. Furthermore, it outlines critical issues associated with thermal ablation-induced immunostimulatory challenges and offers insights into future research avenues and potential therapeutic strategies.
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Affiliation(s)
- Peng Liu
- Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Lung Cancer Institute, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, No. 16766 Jingshi Road, Jinan, Shandong Province, China
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2
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Shu C, Lim M, Fang A. Transarterial Embolization and Percutaneous Ablation of Primary and Metastatic Soft Tissue Tumors. Life (Basel) 2023; 13:1485. [PMID: 37511864 PMCID: PMC10381432 DOI: 10.3390/life13071485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Soft tissue tumors (STTs) include a range of benign and malignant tumors originating from soft tissues. Transarterial and percutaneous therapies are image-guided and minimally invasive approaches for managing primary and metastatic STTs. The objective of this review is to discuss transarterial and percutaneous therapies by examining the current literature, including indications, patient selection, safety, and effectiveness. Transarterial therapies (e.g., transarterial bland embolization and transarterial chemoembolization) involve the delivery of either embolic or chemotherapeutic particles using a catheter into arteries feeding the tumor, resulting in localized tumor destruction. Percutaneous therapies (e.g., radiofrequency ablation, cryoablation, irreversible electroporation, laser ablation, and magnetic resonance-guided high-intensity focused ultrasound) involve the delivery of either hot or cold temperatures, electrical current, laser, or ultrasound to specifically target tumor cells. Both therapies have been shown to be safe and effective for reducing morbidity and local control of STTs, specifically in patients who are surgically inoperable or who are unresponsive to conventional therapies. Accurate diagnosis, staging, and histological subtype identification are crucial for treatment selection. A multidisciplinary approach, a thorough understanding of tissue anatomy and surrounding structures, as well as individualized strategies based on assessment are essential for optimal patient care.
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Affiliation(s)
- Chang Shu
- Post-Baccalaureate Premed Program, Goucher College, Baltimore, MD 21204, USA
| | - Maria Lim
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Adam Fang
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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3
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Heptonstall N, Scott-Warren J, Berman R, Filippiadis D, Bell J. Role of interventional radiology in pain management in oncology patients. Clin Radiol 2023; 78:245-253. [PMID: 35811156 DOI: 10.1016/j.crad.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022]
Abstract
This article reviews the current evidence of interventional radiology procedures for patients suffering with debilitating cancer pain, refractory to conventional therapies. Cancer pain is notoriously difficult to treat. Up to 90% of cancer patients experience pain with 56-82% of cancer pain controlled inadequately. Cancer pain influences a patient's ability to perform normal daily activities, causes higher risk of depression, and reduces quality of life. Pain-free status has been universally voted as a "good death". Alternative minimally invasive options include nerve blocks, neurolysis, bone ablation, spine and peripheral musculoskeletal augmentation techniques, embolisation, and cordotomy with evidence highlighting improved pain control, reduced analgesic requirements, and improved quality of life. Unfortunately, awareness and availability of these procedures is limited, potentially leaving patients suffering during their remaining life. The purpose of this review is to describe the basic concepts of interventional radiology techniques for pain palliation in oncology patients. In addition, emphasis will be given upon the need for an individually tailored approach aiming to augment efficacy and safety.
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Affiliation(s)
- N Heptonstall
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
| | - J Scott-Warren
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - R Berman
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Filippiadis
- Department of Radiology, Attikon University Hospital, Athens, Greece
| | - J Bell
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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4
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Dussik CM, Toombs C, Alder KD, Yu KE, Berson ER, Ibe IK, Li F, Lindskog DM, Friedlaender GE, Latich I, Lee FY. Percutaneous Ablation, Osteoplasty, Reinforcement, and Internal Fixation for Pain and Ambulatory Function in Periacetabular Osteolytic Malignancies. Radiology 2023; 307:e221401. [PMID: 36916888 DOI: 10.1148/radiol.221401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background Osteolytic neoplasms to periacetabular bone frequently cause pain and fractures. Immediate recovery is integral to lifesaving ambulatory oncologic care and maintaining quality of life. Yet, open acetabular reconstructive surgeries are associated with numerous complications that delay cancer treatments. Purpose To determine the effectiveness for short- and long-term pain and ambulatory function following percutaneous ablation, osteoplasty, reinforcement, and internal fixation (AORIF) for periacetabular osteolytic neoplasm. Materials and Methods This retrospective observational study evaluated clinical data from 50 patients (mean age, 65 years ± 14 [SD]; 25 men, 25 women) with osteolytic periacetabular metastases or myeloma. The primary outcome of combined pain and ambulatory function index score (range, 1 [bedbound] through 10 [normal ambulation]) was assessed before and after AORIF at 2 weeks and then every 3 months up to 40 months (overall median follow-up, 11 months [IQR, 4-14 months]). Secondary outcomes included Eastern Cooperative Oncology Group (ECOG) score, infection, transfusion, 30-day readmission, mortality, and conversion hip arthroplasty. Serial radiographs and CT images were obtained to assess the hip joint integrity. The paired t test or Wilcoxon signed-rank test and Kaplan-Meier analysis were used to analyze data. Results Mean combined pain and ambulatory function index scores improved from 4.5 ± 2.4 to 7.8 ± 2.1 (P < .001) and median ECOG scores from 3 (IQR, 2-4) to 1 (IQR, 1-2) (P < .001) at the first 2 weeks after AORIF. Of 22 nonambulatory patients, 19 became ambulatory on their first post-AORIF visit. Pain and functional improvement were retained beyond 1 year, up to 40 months after AORIF in surviving patients. No hardware failures, surgical site infections, readmissions, or delays in care were identified following AORIF. Of 12 patients with protrusio acetabuli, one patient required a conversion hemiarthroplasty at 24 months. Conclusion The ablation, osteoplasty, reinforcement, and internal fixation, or AORIF, technique was effective for short- and long-term improvement of pain and ambulatory function in patients with periacetabular osteolytic neoplasm. © RSNA, 2023.
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Affiliation(s)
- Christopher M Dussik
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Courtney Toombs
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Kareme D Alder
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Kristin E Yu
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Elisa R Berson
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Izuchukwu K Ibe
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Fangyong Li
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Dieter M Lindskog
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Gary E Friedlaender
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Igor Latich
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
| | - Francis Y Lee
- From the Department of Orthopaedics and Rehabilitation (C.M.D., C.T., K.D.A., K.E.Y., I.K.I., D.M.L., G.E.F., F.Y.L.), Department of Radiology and Biomedical Imaging (E.R.B.), and Yale Center for Analytical Sciences (F.L., I.L.), Yale University School of Medicine, 47 College St, New Haven, CT 06520
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Staszkiewicz R, Gładysz D, Gralewski M, Bryś K, Garczarek M, Gadzieliński M, Marcol W, Sobański D, Grabarek BO. Usefulness of Detecting Brain-Derived Neurotrophic Factor in Intervertebral Disc Degeneration of the Lumbosacral Spine. Med Sci Monit 2023; 29:e938663. [PMID: 36642939 PMCID: PMC9854178 DOI: 10.12659/msm.938663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND In determining the etiology of pain of discogenic origin, attention is paid to the role of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF). Considering the potential role of BDNF in the etiology of pain during intervertebral disc degeneration (IVDD), this study aimed to assess changes in the number of BDNF-positive nerve fibers and levels of BDNF in IVDD of the lumbosacral spine in comparison to intervertebral discs (IVDs) of the control group (cadavers). MATERIAL AND METHODS The study group comprised 113 patients with IVDD of the lumbosacral spine. The control group consisted of 81 people (cadavers). We performed hematoxylin-eosin staining to assess IVD structures (degeneration), immunohistochemistry to determine the number of BDNF-positive nerve fibers, and an enzyme-linked immunosorbent assay and western blot to quantify BDNF levels in IVDs. RESULTS Levels of BDNF in the study group were significantly higher than in the control group (17.91±19.58 pg/mg; P<0.05). Furthermore, BDNF levels were significantly higher in the annulus fibrosus compared to the nucleus pulposus of the intervertebral disc (5.50±6.40 pg/mg; P<0.05). Neither the number of BDNF-positive nerves (P=0.359) nor BDNF concentration (P=0.706) were significantly correlated with the degree of perceived pain. The number of BDNF-positive fibers per 1 mm2 was not found to differ significantly according to the radiological degree of degeneration of the lumbosacral spine based on the Pfirrmann scale (P=0.735). CONCLUSIONS The level of BDNF expression may be indicative of IVD degeneration, although it does not predict the degree of this degeneration.
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Affiliation(s)
- Rafał Staszkiewicz
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland,Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland
| | - Dorian Gładysz
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland,Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland
| | - Marcin Gralewski
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland,Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland
| | - Kamil Bryś
- Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland
| | - Michał Garczarek
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland
| | - Marcin Gadzieliński
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland
| | - Wiesław Marcol
- Department of Physiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland,Department of Neurosurgery, Provincial Specialist Hospital No. 2 in Jastrzębie-Zdrój, Jastrzębie-Zdrój, Poland
| | - Dawid Sobański
- Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland,Department of Neurosurgery, Szpital św. Rafała, Cracow, Poland
| | - Beniamin Oskar Grabarek
- Department of Neurosurgery, 5 Military Clinical Hospital with the SP ZOZ Polyclinic in Cracow, Cracow, Poland,Department of Histology, Cytophysiology, and Embryology, Faculty of Medicine in Zabrze, Academy of Silesia, Zabrze, Poland
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6
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Changes in Elements and Relationships among Elements in Intervertebral Disc Degeneration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159042. [PMID: 35897416 PMCID: PMC9332279 DOI: 10.3390/ijerph19159042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022]
Abstract
Intervertebral disc degeneration (IVDD) is a complex and progressive process of disc aging. One of the most important causes of changes in the internal environment, leading to IVDD, can be changes in the concentration of individual metal elements. This study aimed to analyze the concentrations of copper, iron, manganese, lead, zinc, sodium, potassium, phosphorus, and calcium in the degenerated intervertebral discs of the lumbosacral spine, compared to healthy intervertebral discs. The study group (S) consisted of 113 Caucasian patients, qualified by a specialist surgeon for IVDD of the lumbosacral spine. The control group (C) consisted of 81 individuals. The biological material was obtained from Caucasian human cadavers during post-mortem examination. The concentrations of individual elements were assessed using inductively coupled plasma−optical emission spectroscopy (ICP-OES). Statistically significant differences in the concentrations of microelements, depending on the degree of pain intensity, were noted for only potassium (p < 0.05). Statistically significant differences in the concentrations of the assessed microelements, depending on the degree of radiological advancement of the lesions, were noted for copper and iron (p < 0.05). In the degenerated intervertebral discs, the strongest relationships were noted between the concentrations of zinc and lead (r = 0.67; p < 0.05), zinc and phosphorus (r = 0.74; p < 0.05), and zinc and calcium (r = 0.77; p < 0.05). It has been indicated that, above all, the concentrations of copper and iron depend on the advancement of radiological changes, according to the Pfirrmann scale; however, no influence on the pain intensity, depending on the concentration of the assessed elements, was found.
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7
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Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review. Curr Oncol 2022; 29:4155-4177. [PMID: 35735441 PMCID: PMC9221897 DOI: 10.3390/curroncol29060332] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.
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Yadav A, Seth R, Gupta A. Microwave Ablation of Spinal Osteoid Osteoma—Role of Air Insulation. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1742727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractOsteoid osteomas are benign tumors seen in children and young adults. The management options include surgical resection and percutaneous ablation. In the present scenario, percutaneous ablation is the preferred modality, as it is minimally invasive, safe, and reliable. However, when the tumor is near a heat-vulnerable structure, thermal injury can occur.We report the case of spinal osteoid osteoma in a young female that was treated by microwave ablation (MWA) with air insulation to prevent heat injury to the spinal cord. Currently, there is paucity of literature describing the use of air insulation with MWA. In this report, we describe the technique, advantages, and limitations of using air insulation with MWA.
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Affiliation(s)
- Ajit Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Raghav Seth
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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9
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Yevich S, Chen S, Metwalli Z, Kuban J, Lee S, Habibollahi P, McCarthy CJ, Irwin D, Huang S, Sheth RA. Radiofrequency Ablation of Spine Metastases: A Clinical and Technical Approach. Semin Musculoskelet Radiol 2021; 25:795-804. [PMID: 34937119 DOI: 10.1055/s-0041-1740351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Percutaneous radiofrequency ablation (RFA) is an integral component of the multidisciplinary treatment algorithm for both local tumor control and palliation of painful spine metastases. This minimally invasive therapy complements additional treatment strategies, such as pain medications, systemic chemotherapy, surgical resection, and radiotherapy. The location and size of the metastatic lesion dictate preprocedure planning and the technical approach. For example, ablation of lesions along the spinal canal, within the posterior vertebral elements, or with paraspinal soft tissue extension are associated with a higher risk of injury to adjacent spinal nerves. Additional interventions may be indicated in conjunction with RFA. For example, ablation of vertebral body lesions can precipitate new, or exacerbate existing, pathologic vertebral compression fractures that can be prevented with vertebral augmentation. This article reviews the indications, clinical work-up, and technical approach for RFA of spine metastases.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Chen
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeyad Metwalli
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Lee
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peiman Habibollahi
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Colin J McCarthy
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Irwin
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven Huang
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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10
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Izzo A, Zugaro L, Fascetti E, Bruno F, Zoccali C, Arrigoni F. Management of Osteoblastoma and Giant Osteoid Osteoma with Percutaneous Thermoablation Techniques. J Clin Med 2021; 10:jcm10245717. [PMID: 34945013 PMCID: PMC8709302 DOI: 10.3390/jcm10245717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/27/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Osteoblastoma (OB) is a rare, benign bone tumor, accounting for 1% of all primary bone tumors, which occurs usually in childhood and adolescence. OB is histologically and clinically similar to osteoid osteoma (OO), but it differs in size. It is biologically more aggressive and can infiltrate extraskeletal tissues. Therapy is required because of severe bone pain worsening at night. Moreover, non-steroid anti-inflammatory drugs (NSAIDs) are not a reasonable long-term treatment option in young patients. Surgical excision, considered the gold standard in the past, is no longer attractive today due to its invasiveness and the difficulty in performing a complete resection. The treatment of choice is currently represented by percutaneous thermoablation techniques. Among these, Radiofrequency ablation (RFA) is considered the gold standard treatment, even when the lesions are located in the spine. RFA is a widely available technique that has shown high efficacy and low complication rates in many studies. Other percutaneous thermoablation techniques have been used for the treatment of OB, including Cryoablation (CA) and laser-ablation (LA) with high success rates and low complications. Nevertheless, their role is limited, and further studies are necessary.
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Affiliation(s)
- Antonio Izzo
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
- Correspondence:
| | - Luigi Zugaro
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.A.)
| | - Eva Fascetti
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (E.F.); (F.B.)
| | - Carmine Zoccali
- Orthopaedics and Traumatology Unit, Policlinico Umberto I, Sapienza University of Rome, 00185 Roma, Italy;
| | - Francesco Arrigoni
- Department of Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy; (L.Z.); (F.A.)
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11
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Filippiadis D, Mavrogenis A, Spiliopoulos S, Palialexis K, Brountzos E, Kelekis A. Percutaneous computed tomography-guided radiofrequency ablation of a spinal osteoid osteoma abutting the dura: a case report and review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2021; 31:1625-1630. [PMID: 33709268 DOI: 10.1007/s00590-021-02922-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/25/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Osteoid osteomas in the spine constitute a challenging group for both surgical and percutaneous approaches. Purpose of the present study is to report a case report of a spinal osteoid osteoma in a challenging spinal location and review literature for safety and efficacy of the technique. METHODS We report a case of spinal osteoid osteoma extending in the epidural space and abutting the dura in a pediatric patient treated by percutaneous computed tomography-guided radiofrequency ablation. This is not a systematic review of the literature. A number of separate literature searches were performed. Non-English studies and case reports were excluded from the study. All references of the obtained articles were also evaluated for any additional information. RESULTS Although all prophylactic measures were taken (hydrodissection, thermocouples and neurophysiologic monitoring) and the procedure was uneventful, patient within three hours, was unable to raise or bend the unilateral lower extremity below the knee. Pain reduction was significant from the first morning post-ablation and during the follow-up period of 18 months. MR scan was within normal limits. Dexamethasone was iv injected for 24 h and prescribed per os for 7 days. At follow-up 1 week later mobility of the lower extremity had returned to normal. CONCLUSION As far as spine ablation is concerned, all prophylactic measures should be taken; neurophysiologic monitoring seems to be more sensitive than temperature measurement. Intravenous and per os corticosteroids are extremely useful in case of nerve damage.
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Affiliation(s)
- D Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece.
| | - A Mavrogenis
- A Orthopedic Clinic, University General Hospital "ATTIKON", Athens, Greece
| | - S Spiliopoulos
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - K Palialexis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - E Brountzos
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
| | - A Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Haidari/Athens, Greece
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Bansal A, Goyal A, Gamanagatti S, Srivastava DN, Manhas V. Current updates in image-guided musculoskeletal interventions. J Clin Orthop Trauma 2021; 22:101601. [PMID: 34631410 PMCID: PMC8479789 DOI: 10.1016/j.jcot.2021.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Image-guided musculoskeletal interventions are frequently done in clinical practice. Even then, the literature regarding their effectiveness is relatively scarce. Image guidance adds value over the conventional landmark-based approach and should be preferred. We hereby try to list the commonly performed procedures along with the current practice guidelines regarding their clinical indications and periprocedural care.
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Affiliation(s)
- Abhinav Bansal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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Yildizhan S, Boyaci MG, Rakip U, Aslan A, Canbek I. Role of radiofrequency ablation and cement injection for pain control in patients with spinal metastasis. BMC Musculoskelet Disord 2021; 22:912. [PMID: 34715849 PMCID: PMC8556885 DOI: 10.1186/s12891-021-04799-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up. Methods Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure. Results The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment. Conclusion Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone.
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Affiliation(s)
- Serhat Yildizhan
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey.
| | - Mehmet Gazi Boyaci
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Usame Rakip
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Adem Aslan
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
| | - Ihsan Canbek
- Department of Neurosurgery, Afyonkarahisar Health Sciences University Faculty of Medicine, Dörtyol Neighb, 2078 st. No. 3/4, Afyonkarahisar, Turkey
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Holmes RD, Thakur Y, Mallinson P. Implications of Cone Beam CT Peripheral Edge Blurring and Signal Attenuation for Interventional Procedures. Cardiovasc Intervent Radiol 2021; 45:137-141. [PMID: 34590161 DOI: 10.1007/s00270-021-02971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
- R Davis Holmes
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Yogesh Thakur
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Lower Mainland Medical Imaging, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - Paul Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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Filippiadis D, Kelekis A. Percutaneous bipolar radiofrequency ablation for spine metastatic lesions. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1603-1610. [PMID: 33783627 DOI: 10.1007/s00590-021-02947-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/21/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this review is to become familiar with the most common indications for imaging guided percutaneous bipolar radiofrequency ablation, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. METHODS We performed a literature review excluding non-English studies and case reports. All references of the obtained articles were also evaluated for any additional information. RESULTS RFA achieves cytotoxicity by raising target area temperatures above 60 °C, and may be used to achieve total necrosis of lesions smaller than 3 cm in diameter, to debulk and reduce the pain associated with larger lesions, to prevent pathological fractures due to progressive osteolysis or for cavity creation aiming for targeted cement delivery in case of posterior vertebral wall breaching. Protective ancillary techniques should be used in order to increase safety and augment efficacy of RFA in the spine. CONCLUSION Percutaneous radiofrequency ablation of vertebral lesions is a reproducible, successful and safe procedure. Ablation should be combined with vertebral augmentation in all cases. In order to optimize maximum efficacy a patient- and a lesion-tailored approach should both be offered focusing upon clinical and performance status along with life expectancy of the patient as well as upon lesion characteristics.
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Affiliation(s)
- Dimitrios Filippiadis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece.
| | - Alexis Kelekis
- 2nd Department of Radiology, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, 1 Rimini str, 12462, Athens, Greece
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Scandiffio R, Bozzi E, Ezeldin M, Capanna R, Ceccoli M, Colangeli S, Donati DM, Colangeli M. Image-guided Cryotherapy for Musculoskeletal Tumors. Curr Med Imaging 2021; 17:166-178. [PMID: 32842945 DOI: 10.2174/1573405616666200825162712] [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] [Received: 02/28/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This article represents a review of the use of image-guided cryotherapy in the treatment of musculoskeletal tumor lesions. Cryotherapy is able to induce a lethal effect on cancer cells through direct and indirect mechanisms. In this manuscript, we combined our experience with that of other authors who have published on this topic in order to provide indications on when to use cryotherapy in musculoskeletal oncology. DISCUSSION Image-Guided percutaneous cryotherapy is a therapeutic method now widely accepted in the treatment of patients with musculoskeletal tumors. It can be used both for palliative treatments of metastatic bone lesions and for the curative treatment of benign bone tumors, such as osteoid osteoma or osteoblastoma. In the treatment of bone metastases, cryotherapy plays a major role in alleviating or resolving disease-related pain, but it has also been demonstrated that it can have a role in local disease control. In recent years, the use of cryotherapy has also expanded for the treatment of both benign and malignant soft tissue tumors. CONCLUSION Percutaneous cryotherapy can be considered a safe and effective technique in the treatment of benign and malignant musculoskeletal tumors. Cryotherapy can be considered the first option in benign tumor lesions, such as osteoid osteoma, and a valid alternative to radiofrequency ablation. In the treatment of painful bone metastases, it must be considered secondarily to other standard treatments (radiotherapy, bisphosphonate therapy, and chemotherapy) when they are no longer effective in controlling the disease or when they cannot be repeated (for example, radiotherapy).
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Affiliation(s)
- Rossella Scandiffio
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Mohamed Ezeldin
- Department of Diagnostic and Interventional Radiology, Sohag University Hospital, Sohag, Egypt
| | - Rodolfo Capanna
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ceccoli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide M Donati
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Colangeli
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
STUDY DESIGN Case series. OBJECTIVE For each of the most frequent clinical scenarios, the authors reached a consensus on how should be timing and indications be optimized to reduce risk while maintaining the expected outcomes under the Covid-19 pandemics. SUMMARY OF BACKGROUND DATA The organization of health care has been changed by the Covid-19 pandemic with a direct impact on Spine Oncology Surgery. Emergency surgery is still a priority, but in case of spinal tumors it should be better defined which conditions require emergency treatment. METHODS An expert panel with general spine surgeons, oncological spine surgeons, and radiation oncologists was formed to analyze the most frequent scenarios in spinal musculoskeletal oncology during Covid-19 pandemics. RESULTS Spine metastases can be found incidentally during follow-up or can clinically occur by increasing pain, pathologic fracture, and/or neurological symptoms. Primary spine tumors are much more rare and very rarely present with acute onset. The first step is to suspect this rare condition, to avoid to treat a primary tumor as it were a metastasis. Most complex surgery, like en bloc resection, associated with high morbidity and mortality rate for the treatment of low grade malignancy like chordoma or chondrosarcomas, if intensive care unit availability is reduced, can be best delayed some weeks, as not impacting on prognosis, due to the slow growth rate of these conditions. The currently accepted protocols for Ewing sarcoma (ES) and osteogenic sarcoma must be performed for local and systemic disease control. For ES, after the first courses of chemotherapy, radiotherapy can be selected instead of surgery, during Covid-19, to the end of the full course of chemotherapy. In immunocompromised patients, (treated by chemotherapy), it is necessary to avoid contact with affected or exposed people. CONCLUSION Even more than during normal times, a multidisciplinary approach is mandatory to share the decision to modify a treatment strategy. LEVEL OF EVIDENCE 5.
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Kalamaras AB, Wavreille V, Jones SC, Litsky AS, Selmic L. Impact of microwave ablation treatment on the biomechanical properties of the distal radius in the dog: A cadaveric study. Vet Surg 2020; 49:1388-1395. [PMID: 32706150 DOI: 10.1111/vsu.13481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether microwave ablation (MWA) modifies the biomechanical properties of the normal distal radius in the dog to better estimate the clinical impact of MWA as a tool for the treatment of neoplastic bone lesions. STUDY DESIGN Biomechanical experimental study. SAMPLE POPULATION Sixteen pairs of dog forelimbs from 16 canine cadavers. METHODS From each pair of forelimbs, one radius was randomly assigned to an MWA group, and the other radius was randomly assigned to a control group. Bone tunnels were created in each distal radial epiphysis for a length of 6 cm toward the middiaphysis. In the MWA group, the ablation probe was inserted into the bone tunnel for a series of three ablation treatments. Specimens were then tested in three-point bending to acute failure with the middle point located 3 cm from the distal articular surface (middle of the ablated zone). Load and displacement were continuously recorded to determine maximum displacement and peak load before failure. Data were analyzed with noninferiority tests. RESULTS The mean peak loads for the control group and MWA group were 1641.9 N and 1590.9 N, respectively. Microwave ablation-treated radii were not biomechanically inferior to control radii (P < .0001). CONCLUSION Microwave ablation of normal cadaveric dog distal radii did not affect the maximum displacement and peak load before failure. CLINICAL SIGNIFICANCE Microwave ablation does not affect biomechanical bending properties of the distal radius in the dog. Future studies, both cadaveric and in vivo, are required to evaluate the impact of MWA on neoplastic bone.
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Affiliation(s)
- Alexandra B Kalamaras
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Vincent Wavreille
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Stephen C Jones
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Alan S Litsky
- Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, Ohio
| | - Laura Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
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Zhao S, Zou J, Wang H, Qin J, Lu X, Zhang A, Xu LX. A new radiofrequency balloon angioplasty device for atherosclerosis treatment. Biomed Eng Online 2020; 19:44. [PMID: 32522205 PMCID: PMC7288419 DOI: 10.1186/s12938-020-00790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/04/2020] [Indexed: 11/10/2022] Open
Abstract
Background Restenosis remains a challenge in the treatment of atherosclerosis due to damage to the endothelial layer and induced proliferation of smooth muscle cells. A novel radiofrequency (RF) heating strategy was proposed to selectively ablate atherosclerosis plaque and to thermally inhibit the proliferation of smooth muscle cells while keeping the endothelial cells intact. Methods To realize the proposed strategy, a new radiofrequency balloon catheter, consisting of three ports, a three-channel tube, a balloon and an electrode patch, was designed. To evaluate the feasibility of this new design, a phantom experiment with thermocouples measuring temperatures with different voltages applied to the electrodes was conducted. A numerical model was established to obtain the 3D temperature distribution. The heating ability was also evaluated in ex vivo diseased artery samples. Results The experimental results showed that the highest temperature could be achieved in a distance from the surface of the balloon as designed. The temperature differences between the highest temperature at 0.78 mm and those of the surface reached 9.87 °C, 12.55 °C and 16.00 °C under applied 15 V, 17.5 V and 20 V heating, respectively. In the circumferential direction, the heating region (above 50 °C) spread from the middle of the two electrodes. The numerical results showed that the cooling effect counteracted the electrical energy deposition in the region close to the electrodes. The thermal lesion could be directed to cover the diseased media away from the catheter surface. The ex vivo heating experiment also confirmed the selective heating ability of the device. The temperature at the targeted site quickly reached the set value. The temperature of the external surface was higher than the inner wall surface temperature of the diseased artery lumen. Conclusion Both the experimental and numerical results demonstrated the feasibility of the newly designed RF balloon catheter. The proposed RF microelectrodes heating together with the cooling water convection can realize the desired heating in the deeper site of the blood vessel wall while sparing the thin layer of the endothelium.
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Affiliation(s)
- Shiqing Zhao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Zou
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hongying Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aili Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lisa X Xu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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Kaye EA, Solomon SB, Gutta NB, Monette S, Ezell PC, Maybody M. High-intensity focused ultrasound ablation of muscle in an anticoagulated swine model. MINIM INVASIV THER 2020; 31:89-93. [PMID: 32491939 DOI: 10.1080/13645706.2020.1760301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Image-guided non-invasive high-intensity focused ultrasound (HIFU) has been gaining recognition in treating musculoskeletal tumors and desmoids. However, there is no consensus on the appropriate perioperative management for patients on ongoing anticoagulation who undergo HIFU ablation.Material and methods: Image-guided HIFU treatment was performed in swine on an ongoing oral anticoagulation protocol (N = 5) in two treatment sessions seven days apart. On day one, a total of twenty locations were ablated, and on day eight, ten more muscle ablations were performed, and the animals were euthanized. Imaging, clinical examination, and histopathology were performed to investigate treated tissue for bleeding.Results: Imaging, clinical examination, and histopathology revealed either no bleeding or, in some samples, only small scattered cavities (0.2-2 mm in diameter) filled with blood.Conclusion: Noninvasive HIFU ablation of muscle may not require a coagulation profile within normal limits.
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Affiliation(s)
- Elena A Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Narendra Babu Gutta
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sebastien Monette
- Tri-Institutional Laboratory of Comparative Pathology, New York, NY, USA
| | - Paula C Ezell
- Research Animal Resource Center, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Majid Maybody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Filippiadis DK, Tselikas L, Bazzocchi A, Efthymiou E, Kelekis A, Yevich S. Percutaneous Management of Cancer Pain. Curr Oncol Rep 2020; 22:43. [DOI: 10.1007/s11912-020-00906-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Park SY, Chung HW, Baek JH, Lee JH, Lee MH, Lee JW. Radiofrequency ablation using injectable cooled electrode: the effects of lidocaine injection in ex vivo study. Acta Radiol 2020; 61:219-226. [PMID: 31370671 DOI: 10.1177/0284185119865722] [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: 11/16/2022]
Abstract
Background Pain control is needed during radiofrequency ablation in musculoskeletal tumor. The effect of radiofrequency ablation can be modulated by lidocaine injection. Purpose To evaluate the effects of injectable electrodes with intralesional lidocaine injection and compare its ablation performance with that of non-injectable electrodes in ex vivo pork sirloin. Material and Methods Five specimen groups were used to investigate the effects of fluid injection before radiofrequency ablation using injectable and non-injectable electrodes: three injectable electrode comparison groups with 2% lidocaine (group A); 1% lidocaine (group B); 0.9% sodium chloride (group C); injectable electrode reference group without fluid (group D); and non-injectable electrode control group (group E). The injectable and non-injectable electrodes were 17-gauge electrodes each having a 1-cm active tip. Technical parameters, ablation size, and volumes were compared between the five groups. Results Mean energies and currents during radiofrequency ablation were significantly lower for the four injectable electrode groups compared to group E (all P < 0.005). Two transverse diameters, vertical diameter, and volumes in the four injectable electrode groups were significantly smaller than those in group E (all P < 0.05). Among the injectable electrode groups, volumes and two transverse diameters were significantly smaller in group A than in group D (all P < 0.05). Conclusions A slightly smaller ablation zone is obtained when lidocaine injection is performed before radiofrequency ablation using an injectable electrode compared to a non-injectable electrode.
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Affiliation(s)
- Sun-Young Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
- Department of Radiology, Hallym University Sacred Heart Hospital, Republic of Korea
| | - Hye Won Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Min Hee Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Republic of Korea
| | - Joon Woo Lee
- Department of Radiology, Seoul National University Bundang Hospital, Republic of Korea
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Jiang T, Kelekis A, Zhao Q, Mazioti A, Liu J, Kelekis N, Tian G, Filippiadis D. Safety and efficacy of percutaneous microwave ablation for post-procedural haemostasis: a bi-central retrospective study focusing on safety and efficacy. Br J Radiol 2019; 93:20190615. [PMID: 31794250 DOI: 10.1259/bjr.20190615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To review safety and efficacy of percutaneous microwave ablation (MWA) for post-procedural haemostasis. METHODS Institutional databases retrospective research identified 10 cases of iatrogenic bleeding who underwent percutaneous MWA for post-procedural haemostasis. Ultrasound examination with Doppler and contrast enhancement identified a source of active bleeding prior to ablation; additionally they were used as guiding modality for antenna insertion whilst, post-ablation, assessed the lack of active extravasation. Target locations included liver intercostal space spleen and thyroid gland. Technical success was defined as positioning of the antenna on the desired location. Treatment end point was considered the disappearance of active extravasation in both Doppler imaging and contrast-enhanced ultrasound. RESULTS Technical success (i.e. positioning of the antenna on the desired location) was achieved in all cases. No complications were noted. All patients post MWA remained haemodynamically stable with no need for transfusion and were discharged from the hospital the next morning. Imaging and clinical follow-up in all patients before exiting the hospital did not depict any sign of active extravasation or bleeding. CONCLUSION Our limited experience reports preliminary data showing that MWA could be added in the armamentarium of percutaneous therapies for iatrogenic bleeding. More prospective studies with larger patient samples are necessary for verification of this technique as well as for drawing broader conclusions in order to evaluate the place of percutaneous ablation in the treatment algorithm of haemorrhage. ADVANCES IN KNOWLEDGE Percutaneous ablation might have a role in haemostasis in well-selected cases.
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Affiliation(s)
- Tian'an Jiang
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Alexis Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Qiyu Zhao
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Argyro Mazioti
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jia Liu
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Nikolaos Kelekis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Guo Tian
- Department of Diagnostic Ultrasound, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract
The field of robotic surgery has progressed from small teams of researchers repurposing industrial robots, to a competitive and highly innovative subsection of the medical device industry. Surgical robots allow surgeons to perform tasks with greater ease, accuracy, or safety, and fall under one of four levels of autonomy; active, semi-active, passive, and remote manipulator. The increased accuracy afforded by surgical robots has allowed for cementless hip arthroplasty, improved postoperative alignment following knee arthroplasty, and reduced duration of intraoperative fluoroscopy among other benefits. Cutting of bone has historically used tools such as hand saws and drills, with other elaborate cutting tools now used routinely to remodel bone. Improvements in cutting accuracy and additional options for safety and monitoring during surgery give robotic surgeries some advantages over conventional techniques. This article aims to provide an overview of current robots and tools with a common target tissue of bone, proposes a new process for defining the level of autonomy for a surgical robot, and examines future directions in robotic surgery.
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Campos WK, Linhares MN, Sarda J, Santos ARS, Lin K, Latini A, Walz R. Predictors of Pain Recurrence After Lumbar Facet Joint Injections. Front Neurosci 2019; 13:958. [PMID: 31619946 PMCID: PMC6763569 DOI: 10.3389/fnins.2019.00958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/26/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Facet joint injections (FJIs) of anesthetic and corticosteroids are useful for the diagnosis and treatment of low back pain (LBP). In the current study, we evaluated the efficacy of FJI on LBP treatment and the predictive variables of pain recurrence after FJI. Methods We included and followed prospectively forty-three consecutive patients with chronic LBP treated with FJI. Clinical assessments were carried out at a baseline 1 week before FJIs and after a 6-month follow-up visit using the visual analog scale (VAS) for pain, Oswestry Disability Index (ODI) for disability-specific measure and MacNab criteria for global effectiveness, and compared through analysis using paired-samples “t” tests. Multiple cox-regression analysis was used to identify the presurgical variables independently associated with pain recurrence anytime during the follow-up. In addition to the demographic, clinical, and surgical data, we also analyzed psychometric scales: Pain Catastrophizing Scale (PCS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). Results After a 6-month follow-up, thirty-two patients (74.4%) showed a clinically significant reduction of pain and twenty-seven (62.8%) reported a clinically significant improvement of disability. Presurgical catastrophizing (PCS score ≥ 5, adjusted HR 4.4, CI 95% 1.7–11.3, p = 0.002) and smoking (Adjusted HR 12.5, CI 95% 1.1–138.9, p = 0.04) remains associated with pain recurrence. Conclusion FJI reduces LBP and disability of patients with unresponsive LBP. Pain-related cognitive and behavioral factors determined by pain catastrophizing and smoking were independently associated with pain recurrence after lumbar FJI. The results support the need of a multidisciplinary approach for presurgical evaluation of patients with chronic pain.
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Affiliation(s)
- Wuilker Knoner Campos
- Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, Brazil.,Neuron Institute, Baia Sul Medical Center, Florianópolis, Brazil.,Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, Brazil.,Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Marcelo Neves Linhares
- Functional Neurosurgery Division, Department of Neurosurgery, Baia Sul Medical Center, Florianópolis, Brazil.,Neuron Institute, Baia Sul Medical Center, Florianópolis, Brazil.,Neurosurgery Division, Hospital Governador Celso Ramos, Florianópolis, Brazil.,Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Surgery, Neurosurgery Division, HU, UFSC, Florianópolis, Brazil
| | - Jamir Sarda
- Department of Psychology and Master Program of Health and Work, Univali, Itajaí, Brazil
| | | | - Kátia Lin
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, Brazil
| | - Alexandra Latini
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Laboratory of Bioenergetics and Oxidative Stress, Department of Biochemistry, Federal University of Santa Catarina (UFSC), Florianópolis, Brazil
| | - Roger Walz
- Center for Applied Neuroscience (CeNAp), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, Brazil.,Department of Internal Medicine, Neurology Division, HU, UFSC, Florianópolis, Brazil
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Tassemeier T, Haversath M, Brandenburger D, Schutzbach M, Serong S, Jäger M. [Atraumatic fractures of the spine : Current strategies for diagnosis and treatment]. DER ORTHOPADE 2019; 48:879-896. [PMID: 31511916 DOI: 10.1007/s00132-019-03804-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Atraumatic fractures of the spine are a common orthopedic disease condition that can be asymptomatic or associated with complaints of varying intensity and quality. The risk factors for such fracture forms are often metabolic and genetic diseases, which have a direct or indirect effect on bone metabolism and therefore secondarily affect the stability of the spinal vertebrae. Furthermore, benign and malignant tumors as well as infectious diseases can also be causative for atraumatic spinal fractures; however, those factors that are attributable to lifestyle habits should also not be underestimated. The treatment of affected patients is complex and nearly always interdisciplinary. In addition to purely symptom-oriented treatment concepts, orthoses in particular and when indicated surgical treatment procedures can be implemented. This article summarizes the important clinical, diagnostic and therapeutic aspects of atraumatic spinal fractures.
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Affiliation(s)
- T Tassemeier
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland.
| | - M Haversath
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - D Brandenburger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - M Schutzbach
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
| | - S Serong
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - M Jäger
- Universitätsklinik für Orthopädie und Unfallchirurgie, Universität Duisburg Essen, Essen, Deutschland
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Lea WB, Neilson JC, King DM, Tutton SM. Minimally Invasive Stabilization Using Screws and Cement for Pelvic Metastases: Technical Considerations for the Pelvic "Screw and Glue" Technique. Semin Intervent Radiol 2019; 36:229-240. [PMID: 31435131 DOI: 10.1055/s-0039-1693982] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Metastatic disease involving the pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions for unstable pelvic metastatic disease have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. While it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity.
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Affiliation(s)
- William B Lea
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John C Neilson
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M King
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Sean M Tutton
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Filippiadis DK, Cornelis FH, Kelekis A. Interventional oncologic procedures for pain palliation. Presse Med 2019; 48:e251-e256. [DOI: 10.1016/j.lpm.2019.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/11/2019] [Indexed: 01/05/2023] Open
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Cheng Z, Li X, An C, Yu X, Yu J, Han Z, Liu F, Liang P. The clinical efficacy of ultrasound-guided percutaneous microwave ablation for rib metastases with severe intractable pain: a preliminary clinical study. Onco Targets Ther 2019; 12:3459-3465. [PMID: 31123406 PMCID: PMC6511234 DOI: 10.2147/ott.s192654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/06/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose: To retrospectively evaluate the clinical efficacy of ultrasound-guided percutaneous microwave ablation (US-PMWA) for patients with rib metastases that caused severe intractable pain. Materials and methods: From Jan 2016 to Apr 2018, 9 rib metastases from 7 solid tumor patients were treated with US-PMWA. The visual analogue scale (VAS), daily opiate intake doses, local tumor control and complications were recorded and analyzed. Results: The follow-up period ranged from 6 to 33 months (median: 16 months). The procedures were successfully performed in all of the patients by one ablation. The ablation power ranged from 30 to 60 W, and the ablation time was 610.0±317.5 s. The mean preablation VAS pain score was 8.1±0.7, whereas the mean VAS pain score at 72 h postablation was 3.3±0.5 (P<0.001). All of the patients needed to apply oral and/or intravenous injection opiates to relieve severe intractable pain before ablation, with daily opiate intake doses of 61.4±30.8 mg. After ablation, five patients did not need to apply any opiate treatments 72 h after ablation, and only two patients needed oral opiates (daily opiate intake doses: 30 mg and 20 mg). Recurrence was detected in three lesions at 6, 11 and 9 months after ablation, with the maximum diameter observed being more than 4 cm. All of the patients were alive during the follow-up period. No minor or major complications occurred. Conclusion: US-PMWA appears to be feasible, convenient, safe and effective in the palliative management of refractory pain caused by rib metastases. This treatment can improve the quality of life of patients and may also achieve promising local control of tumors.
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Affiliation(s)
- Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, People's Republic of China
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Filippiadis DK, Tselikas L, Tsitskari M, Kelekis A, de Baere T, Ryan AG. Percutaneous Neurolysis for Pain Management in Oncological Patients. Cardiovasc Intervent Radiol 2019; 42:791-799. [DOI: 10.1007/s00270-019-02185-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/13/2019] [Indexed: 12/29/2022]
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Zhao S, Zou J, Zhang A, Xu LX. A New RF Heating Strategy for Thermal Treatment of Atherosclerosis. IEEE Trans Biomed Eng 2019; 66:2663-2670. [PMID: 30676939 DOI: 10.1109/tbme.2019.2894503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Restenosis remains a challenge for the treatment of atherosclerosis due to the damage of the endothelial layer and induced proliferation of the smooth muscle cell. METHODS A new RF heating strategy was proposed to selectively ablate the atherosclerosis plaque, and to thermally inhibit the proliferation of smooth muscle cells, while keeping the endothelial cells intact. To achieve the goal, an internal cooling agent and distributed electrodes have been integrated in the new designed balloon catheter to focus the shape conformal energy onto the plaque shape. A three-dimensional (3-D) model with experimentally fitted parameters has been established to demonstrate the heating ability of the design and evaluate the microelectrodes configurations for different plaque geometries. RESULTS The 3-D shape of the lesions resulting from different electrodes settings is obtained. It is found that by individual control of the micro-electrodes, special shapes of the lesions can be formed, which can match the eccentric crescent plaques. Besides, through changing of the polarity of the electrodes, separate lesions can be reached. This suggests the possibility for treatment of disconnected plaques in situ. CONCLUSION By the control of RF heating and convection coefficient of the internal cooling agent, a targeted heating region away from the inner surface of the blood vessel can be realized. SIGNIFICANCE This study has illustrated the possibility of achieving a precision thermal treatment of atherosclerosis in favor of inhibiting further restenosis.
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Bing F, Vappou J, de Mathelin M, Gangi A. Targetability of osteoid osteomas and bone metastases by MR-guided high intensity focused ultrasound (MRgHIFU). Int J Hyperthermia 2018; 35:471-479. [DOI: 10.1080/02656736.2018.1508758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fabrice Bing
- Radiology Department, Hôpital d’Annecy, Metz-Tessy, France
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Afshin Gangi
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Zhao W, Wang H, Hu JH, Peng ZH, Chen JZ, Huang JQ, Jiang YN, Luo G, Yi GF, Shen J, Gao BL. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Jpn J Clin Oncol 2018; 48:753-759. [PMID: 29931084 DOI: 10.1093/jjco/hyy090] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose To investigate the pain relief effect and safety of percutaneous radiofrequency ablation (RFA) with a multitined electrode combined with cement injection in patients with painful metastatic bone tumors. Materials and methods Sixteen patients with 34 osteolytic metastatic lesions were treated with RFA including 4 males and 12 females (age range 54-84). Thirteen patients with spinal metastases received additional cement injection. Medical imaging, a visual analog scale (VAS) and the EORTC QLQ-C30 were performed to evaluate the metastatic lesion, pain and quality of life, respectively, before and after RFA and at follow-ups. Results The RFA and/or vertebroplasty with cement injection were successful in all patients (100%). Except for one patient who had cement leakage, no intraprocedural complications occurred. After RFA, severe refractory pain was greatly relieved in all patients, with pretreatment VAS score of 8.1 ± 1.4 significantly reduced to 5.5 ± 1.1 at 24 h, 2.8 ± 0.6 at 1 week and 1.4 ± 0.8 at 6 months (P < 0.01). The EORTC QLQ-C30 scale at 1 month demonstrated significant improvement (P < 0.05) in the physical (P = 0.03) and emotion function (P = 0.003), global health status (P = 0.002), pain (P = 0.001) and insomnia (P = 0.002). The analgesics were reduced after the procedure and stopped 2 months later in all patients, with greatly improved quality of life and no apparent pain. Followed up for 6-12 months, all patients remained alive with no recurrence of pain. Palliative pain relief and safety of percutaneous radiofrequency ablation combined with cement injection for bone metastasis. Conclusion RFA with or without bone cement is safe and effective in the palliative treatment of pain caused by metastatic bone tumors.
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Affiliation(s)
- Wei Zhao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Hui Wang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Ji-Hong Hu
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Zhao-Hong Peng
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jin-Zhou Chen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jian-Qiang Huang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Yong-Neng Jiang
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Gang Luo
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Gen-Fa Yi
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Jin Shen
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
| | - Bu-Lang Gao
- Department of Medical Imaging, The First Affiliated Hospital, Kunming Medical University, 295 Xichang Road, Kunming 650032, Yunnan Province, P.R. China
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Thermal effect of percutaneous radiofrequency ablation with a clustered electrode for vertebral tumors: In vitro and vivo experiments and clinical application. J Bone Oncol 2018; 12:69-77. [PMID: 30094136 PMCID: PMC6072893 DOI: 10.1016/j.jbo.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate effects and heat distribution of radiofrequency ablation (RFA) on vertebral tumors in vitro and in vivo swine experiments and its clinical application. Materials and methods RFA was performed on the swine spine in vitro and in vivo for 20 min at 90 °C at the electrode tip, and the temperature at the electrode tip and surrounding tissues were recorded. Clinical application of ablation combined with vertebroplasty was subsequently performed in 4 patients with spinal tumors. Results In the in vitro study, the mean temperature at the front and ventral wall of the spinal canal was 50.8 °C and 43.6 °C, respectively, at 20 mm significantly greater than 37.7 °C and 33.7 ± 1.7 °C, respectively, at 10 mm ablation depth. The coagulative necrosis area was significantly (P < 0.0001) greater at 20 mm depth than at 10 mm depth (mean 17.0 × 20.7 mm2 vs. 14.2 × 16.6 mm2). In the in vivo experiment, the local temperature increased significantly (P < 0.05) from around 36 °C before ablation to over 41 °C at 20 min after ablation, with the temperature at the electrode tip (90.4 °C) and within the vertebral body (67.0 °C) significantly (P < 0.05) greater than at the posterior (41.9 °C) and lateral wall (41.8 °C). From 2 to 5 weeks, bone remodeling began. Clinically, all four patients had successful RFA and vertebroplasty, with no neurological deficits. The pain scores were significanlty (P < 0.05) improved before (4.5–10, mean 8.0) compared with at four weeks (0–1.8, mean 1.8). Conclusion The clustered electrode can be efficiently and safely applied in the treatment of spinal tumors without damaging the spinal cord and adjacent nerves by heat distribution.
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Singal A, Mattison LM, Soule CL, Iaizzo PA. Effects of Ablation (Radio Frequency, Cryo, Microwave) on Physiologic Properties of the Human Vastus Lateralis. IEEE Trans Biomed Eng 2018; 65:2202-2209. [PMID: 29989956 DOI: 10.1109/tbme.2017.2787041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Ablative treatments can sometimes cause collateral injury to surrounding muscular tissue, with important clinical implications. In this study, we investigated the changes in muscle physiology of the human vastus lateralis when exposed to three different ablation modalities: radiofrequency ablation, cryoablation, and microwave ablation. METHODS We obtained fresh vastus lateralis tissue biopsy specimens from nine patients (age range: 29-73 years) who were undergoing in vitro contracture testing for malignant hyperthermia. Using leftover waste tissue, we prepared 46 muscle bundles that were utilized in tissue baths before and after ablation. RESULTS After ablation with all the three modalities, we noted dose-dependent sustained reductions in peak force (strength of contraction), as well as transient increases in baseline force (resting muscle tension). But, over the subsequent 3-h recovery period, peak force improved and the baseline force consistently recovered to below its preablation levels. CONCLUSION The novel in vitro methodologies we developed to investigate changes in muscle physiology after ablation can be used to study a spectrum of ablation modalities and also to make head-to-head comparisons of different ablation modalities. SIGNIFICANCE As the role of ablative treatments continues to expand, our findings provide unique insights into the resulting changes in muscle physiology. These insights could enhance the safety and efficacy of ablations and help individuals design and develop novel medical devices.
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Oñate Miranda M, Moser TP. A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty). Insights Imaging 2018; 9:275-285. [PMID: 29564836 PMCID: PMC5991000 DOI: 10.1007/s13244-018-0600-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Percutaneous approaches for pelvic bone procedures (bone biopsies, tumour ablation and cementoplasty) are multiple and less well systematised than for the spine or extremities. Among the different imaging techniques that can be used for guidance, computed tomography (CT) scan is the modality of choice because of the complex pelvic anatomy. In specific cases, such as cementoplasty where real-time evaluation is a determinant, a combination of CT and fluoroscopy is highly recommended. The objective of this article is to propose a systematic approach for image-guided pelvic bone procedures, as well as to provide some technical tips. We illustrate the article with multiple examples, and diagrams of the approaches and important structures to avoid to perform these procedures safely. TEACHING POINTS • Pelvic bone procedures are safe to perform if anatomical landmarks are recognised. • The safest approach varies depending on the pelvic level. • CT is the modality of choice for guiding pelvic percutaneous procedures. • Fluoroscopy is recommended when real-time monitoring is mandatory. • MRI can also be used for guiding pelvic percutaneous procedures.
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Affiliation(s)
- Marta Oñate Miranda
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada
| | - Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada.
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Barile A, Arrigoni F, Bruno F, Palumbo P, Floridi C, Cazzato RL, Reginelli A, Zappia M, Brunese L, Zugaro L, Masciocchi C. Present role and future perspectives of interventional radiology in the treatment of painful bone lesions. Future Oncol 2018; 14:2945-2955. [PMID: 29693420 DOI: 10.2217/fon-2017-0657] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Interventional radiology has experienced an exponential growth in the last years. Nowadays it is possible to treat painful benign lesions or metastases with optimal results in terms of pain management and disease control. Among the benign lesions, osteoid osteoma is the most frequently treated with minimal invasive techniques and the results are excellent. Another lesion, traditionally treated with surgery (osteoblastoma) represent today another field of application. In the oncological field, metastases are, numerically, the most diffuse indications for treatment. Research carried out during the last decades has provided the interventional radiologist with a great variety of techniques of ablation and devices for monitoring the sensitive structures close to the target lesion. New ablation techniques and monitoring devices contribute to the achievement of significantly increasing rates of effectiveness and safety of interventional radiology procedures.
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Affiliation(s)
- Antonio Barile
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Francesco Arrigoni
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Pierpaolo Palumbo
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Chiara Floridi
- Radiology Department, Fatebenefratelli Hospital, Milan, Italy
| | - Roberto L Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Alfonso Reginelli
- Department of Radiology & Radiotherapy, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marcello Zappia
- Department of Medicine & Health Science 'V. Tiberio', University of Molise, Campobasso, Italy
| | - Luca Brunese
- Department of Medicine & Health Science 'V. Tiberio', University of Molise, Campobasso, Italy
| | - Luigi Zugaro
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnology & Applied Clinical Science, University of L'Aquila, L'Aquila, Italy
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Arrigoni F, Bruno F, Zugaro L, Splendiani A, Di Cesare E, Barile A, Masciocchi C. Role of interventional radiology in the management of musculoskeletal soft-tissue lesions. Radiol Med 2018; 124:253-258. [PMID: 29687209 DOI: 10.1007/s11547-018-0893-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/09/2018] [Indexed: 12/13/2022]
Abstract
The lesions of the soft tissues are rare and extremely heterogeneous; even if the surgical treatment is usually the standard therapy, the role of the interventional radiology (IR) in this field is growing up for multiple reasons. First, because the imaging alone usually is not able to ensure a definitive diagnosis, IR has a basic role in the staging: the percutaneous biopsy is infact an irreplaceable step. Moreover, biopsy is necessary not only for histologic evaluations but also for the biochemical and molecular studies. Furthermore, the proved safety and effectiveness of IR in a multiple oncologial applications prompt a wider use also in this field.
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Affiliation(s)
- Francesco Arrigoni
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy.
| | - Carlo Masciocchi
- Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, S. Salvatore Hospital, Vetoio Street,1, 67100, L'Aquila, Italy
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Esteban Cuesta H, Martel Villagran J, Bueno Horcajadas A, Kassarjian A, Rodriguez Caravaca G. Percutaneous radiofrequency ablation in osteoid osteoma: Tips and tricks in special scenarios. Eur J Radiol 2018; 102:169-175. [PMID: 29685532 DOI: 10.1016/j.ejrad.2018.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To define specific characteristics of osteoid osteomas treated with radiofrequency ablation, that may benefit from special technical recommendations. METHODS Retrospective analysis of all radiofrequency ablations performed by our group from January 2001 to March 2015. A descriptive study was conducted. We compared our results with the available literature to determine the most frequent special scenarios. RESULTS 207 radiofrequency ablations were performed in 200 patients. We defined the following scenarios: osteoid osteomas located in the spine, close to neurovacular structures, osteoid osteomas in small bones (hands and feet), intra-articular, deeply located or superficial and lesions with extensive periosteal reaction. CONCLUSIONS The scenarios defined required special considerations and technical variations. Implementing the different tips and tricks shown in the article, the most complex osteoid osteomas could be successfully ablated.
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Affiliation(s)
- Helena Esteban Cuesta
- Hospital Clínico Universitario Lozano Blesa, San Juan Bosco, 15, 50009, Zaragoza, Spain.
| | - José Martel Villagran
- Hospital Universitario Fundación de Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain.
| | | | - Ara Kassarjian
- Corades, LLC, Brookline, 4 Massachusetts Park St Unit 3, 02446-6244, MA, USA; Medical Service, Madrid Open Tennis, Madrid, Spain.
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41
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Kelekis A, Cornelis FH, Tutton S, Filippiadis D. Metastatic Osseous Pain Control: Bone Ablation and Cementoplasty. Semin Intervent Radiol 2017; 34:328-336. [PMID: 29249856 PMCID: PMC5730439 DOI: 10.1055/s-0037-1608747] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nociceptive and/or neuropathic pain can be present in all phases of cancer (early and metastatic) and are not adequately treated in 56 to 82.3% of patients. In these patients, radiotherapy achieves overall pain responses (complete and partial responses combined) up to 60 and 61%. On the other hand, nowadays, ablation is included in clinical guidelines for bone metastases and the technique is governed by level I evidence. Depending on the location of the lesion in the peripheral skeleton, either the Mirels scoring or the Harrington (alternatively the Levy) grading system can be used for prophylactic fixation recommendation. As minimally invasive treatment options may be considered in patients with poor clinical status or limited life expectancy, the aim of this review is to detail the techniques proposed so far in the literature and to report the results in terms of safety and efficacy of ablation and cementoplasty (with or without fixation) for bone metastases. Percutaneous image-guided treatments appear as an interesting alternative for localized metastatic lesions of the peripheral skeleton.
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Affiliation(s)
- Alexis Kelekis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
| | - Francois H. Cornelis
- Department of Radiology, Université Pierre et Marie Curie, Sorbonne Université, Tenon Hospital, Paris, France
| | - Sean Tutton
- Division of Vascular and Interventional Radiology, Department of Radiology and Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dimitrios Filippiadis
- Division of Diagnostic and Interventional Radiology, 2nd Department of Radiology, University General Hospital “ATTIKON,” Athens, Greece
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42
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Husen M, Hövel M, Jäger M. [The intraarticular osteoid osteoma : A diagnostic and therapeutic challenge]. DER ORTHOPADE 2017; 45:544-8. [PMID: 26837513 DOI: 10.1007/s00132-015-3220-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intra- and, respectively, periarticular osteoid osteoma are accompanied by sympathical arthritis which itself can irreversibly destroy the cartilage of the joint. In contrast to other locations, intra- and periarticular osteoid osteoma are rare. Reactive and symptomatic accompanying arthritis may lead to irreversible cartilage destruction especially in chronic courses. Therefore early diagnosis and therapy is crucial. We present a case report and discuss these rare tumors by reviewing the literature.
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Affiliation(s)
- M Husen
- Klinik für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstraße 55, 45137, Essen, Deutschland
| | - M Hövel
- Klinik für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstraße 55, 45137, Essen, Deutschland
| | - M Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Hufelandstraße 55, 45137, Essen, Deutschland.
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43
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Pain management: The rising role of interventional oncology. Diagn Interv Imaging 2017; 98:627-634. [DOI: 10.1016/j.diii.2017.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/27/2017] [Indexed: 02/06/2023]
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Protection of the Proximal Articular Cartilage During Percutaneous Thermal Ablation of Acetabular Metastasis Using Temperature Monitoring. Cardiovasc Intervent Radiol 2017; 41:163-169. [DOI: 10.1007/s00270-017-1755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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45
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Air-blocking ablation of osteoid osteoma; a technical note. Skeletal Radiol 2017; 46:957-960. [PMID: 28466103 DOI: 10.1007/s00256-017-2659-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma accounts for approximately 10-12% of all benign bone tumors. Surgery was the treatment of choice for osteoid osteomas until percutaneous radiofrequency ablation (RFA) was introduced in 1992. Although RFA is generally considered curative in the treatment of osteoid osteoma, disease recurrence after ablation has been reported. We report a case in which RFA was delayed by the presence air surrounding the ablation probe. In this case, ablation could only be performed after the probe was removed and saline was injected through the introducer needle to displace the air. Air is reported to decrease radiofrequency energy transmission; a simple measure like injecting saline through an introducer could prevent such a complication. We also suggest that partial air in the ablation bed surrounding the ablation probe could decrease the energy transmission and may be one of the causes of early recurrences. Saline injection could be helpful in providing a more reliable environment for ablation.
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46
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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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Kastler A, Krainik A, Sakhri L, Mousseau M, Kastler B. Feasibility of Real-Time Intraprocedural Temperature Control during Bone Metastasis Thermal Microwave Ablation: A Bicentric Retrospective Study. J Vasc Interv Radiol 2017; 28:366-371. [DOI: 10.1016/j.jvir.2016.09.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022] Open
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48
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Prud'homme C, Nueffer JP, Runge M, Dubut J, Kastler B, Aubry S. Prospective pilot study of CT-guided microwave ablation in the treatment of osteoid osteomas. Skeletal Radiol 2017; 46:315-323. [PMID: 28028574 DOI: 10.1007/s00256-016-2558-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The aims of this work were to assess the feasibility and efficacy of CT-guided microwave ablation (MWA) in the treatment of osteoid osteomas (OOs). MATERIALS AND METHODS Thirteen consecutive patients (range 11-31 years old) presenting with OO were prospectively included and treated by CT-guided MWA. Power and duration of MWA were both recorded. The patient's pain was assessed using a numeric pain rating scale (NRS), and side effects were recorded during procedures, after 1 day, 7 days and 1 month. The nidus vascularization and the volume of necrosis induced by MWA were assessed using contrast-enhanced MRI. Success was defined as the complete relief of the patient's pain 1 month after the first procedure, associated with necrosis of the nidus on follow-up MRI. RESULTS The success rate was up to 92.3% (12/13). At 1 day, 7 days and 1 month, the median NRSs were respectively 5 [interquartile range (IQR) 2-5], 0 (IQR 0-1) and 0 (IQR 0-0). Side effects observed were one partial and self-resolving lesion of a sensory branch of the radial nerve and two skin burns. The median power of the MWA used was 60 W (IQR 50-60) with a 1.5-min duration (IQR 1-2), leading to MWA-induced necrosis measuring on average 23 × 15 × 16 mm. CONCLUSION CT-guided MWA of OO has a success rate that appears to be almost similar to that of laser or radiofrequency ablation, but care must be taken to prevent nerve or skin lesions.
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Affiliation(s)
- Clara Prud'homme
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Jean-Philippe Nueffer
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Michel Runge
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Jonathan Dubut
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France
| | - Bruno Kastler
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France.,I4S Laboratory, INSERM EA4268, University of Franche-Comte, 25000, Besancon, France
| | - Sébastien Aubry
- Department of Musculoskeletal Imaging, University Hospital of Besancon, 25000, Besancon, France. .,Nanomedecine Laboratory, INSERM EA4662, University of Franche-Comte, 25000, Besancon, France.
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49
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Filippiadis DK, Velonakis G, Kostantos C, Kouloulias V, Brountzos E, Kelekis N, Kelekis A. Computed tomography-guided radiofrequency ablation of intra-articular osteoid osteoma: a single centre’s experience. Int J Hyperthermia 2017; 33:670-674. [DOI: 10.1080/02656736.2017.1294711] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- D. K. Filippiadis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - G. Velonakis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - C. Kostantos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - V. Kouloulias
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - E. Brountzos
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - N. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
| | - A. Kelekis
- 2nd Radiology Department, University General Hospital “ATTIKON”, Athens, Greece
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50
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Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, Ramamurthy N, Brunese L, Gangi A, Masciocchi C. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 2017; 34:53. [PMID: 28236103 DOI: 10.1007/s12032-017-0909-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 12/31/2022]
Abstract
The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.
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Affiliation(s)
- Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
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