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Aurilio G, Mauri G, Rossi D, Della Vigna P, Bonomo G, Varano GM, Maiettini D, Rocca MC, Verri E, Cullurà D, Nolé F, Orsi F. Image-Guided Ablations in Patients with Recurrent Renal Cell Carcinoma. J Clin Med 2023; 12:4902. [PMID: 37568303 PMCID: PMC10420241 DOI: 10.3390/jcm12154902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Renal cell carcinoma (RCC) is one of the most frequently diagnosed tumors and a leading cause of death. The high risk of local recurrence and distant metastases represent a significant clinical issue. Different image-guided ablation techniques can be applied for their treatment as an alternative to surgery, radiotherapy or systemic treatments. A retrospective analysis was conducted at our institution, including a total number of 34 RCC patients and 44 recurrent RCC tumors in different locations (kidney, lung, adrenal gland, liver, pancreas, pararenal and other) using microwave ablation, radiofrequency ablation, cryoablation and laser ablation. The estimated time to local and distant tumor progression after treatment were 22.53 ± 5.61 months and 24.23 ± 4.47 months, respectively. Systemic treatment was initiated in 10/34 (29%) treated patients with a mean time-to-systemic-therapy of 40.92 ± 23.98 months. Primary technical success was achieved in all cases and patients while the primary efficacy rate was achieved in 43/44 (98%) cases and 33/34 (97%) patients, respectively, with a secondary technical success and efficacy rate of 100%. At a mean follow-up of 57.52 months ± 27.86 months, local tumor progression occurred in 3/44 (7%) cases and distant progression in 25/34 (74%) patients. No significant complications occurred. Image-guided ablations can play a role in helping to better control recurrent disease, avoiding or delaying the administration of systemic therapies and their significant adverse effects.
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Affiliation(s)
- Gaetano Aurilio
- Division of Cancer Prevention and Genetics, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy;
| | - Giovanni Mauri
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Duccio Rossi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Paolo Della Vigna
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Guido Bonomo
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Gianluca Maria Varano
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Daniele Maiettini
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
| | - Maria Cossu Rocca
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Elena Verri
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Daniela Cullurà
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Nolé
- Department of Oncology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (M.C.R.); (E.V.); (D.C.); (F.N.)
| | - Franco Orsi
- Division of Interventional Radiology, Istituto Europeo di Oncologia IEO, European Institute of Oncology IRCCS, 20122 Milan, Italy; (G.M.); (P.D.V.); (G.B.); (G.M.V.); (D.M.); (F.O.)
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Bazzocchi A, Aparisi Gómez MP, Taninokuchi Tomassoni M, Napoli A, Filippiadis D, Guglielmi G. Musculoskeletal oncology and thermal ablation: the current and emerging role of interventional radiology. Skeletal Radiol 2023; 52:447-459. [PMID: 36346453 DOI: 10.1007/s00256-022-04213-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/05/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022]
Abstract
The role of interventional radiology (IR) is expanding. With new techniques being developed and tested, this radiology subspecialty is taking a step forward in different clinical scenarios, especially in oncology. Musculoskeletal tumoral diseases would definitely benefit from a low-invasive approach that could reduce mortality and morbidity in particular. Thermal ablation through IR has already become important in the palliation and consolidation of bone metastases, oligometastatic disease, local recurrences, and treating specific benign tumors, with a more tailored approach, considering the characteristics of every patient. As image-guided ablation techniques lower their invasiveness and increase their efficacy while the collateral effects and complications decrease, they become more relevant and need to be considered in patient care pathways and clinical management, to improve outcomes. We present a literature review of the different percutaneous and non-invasive image-guided thermal ablation methods that are currently available and that could in the future become relevant to manage musculoskeletal oncologic diseases.
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Affiliation(s)
- Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy.
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology, IMSKE, Valencia, Spain
| | - Makoto Taninokuchi Tomassoni
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Alessandro Napoli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Dimitrios Filippiadis
- 2nd Radiology Department, Medical School, University General Hospital "ATTIKON", National and Kapodistrian University of Athens, Athens, Greece
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
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3
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Smith KA, Welch BT, Kurup AN, Schmitz JJ, VanBuren WM, Ehman EC, Welch TL, Cope AG, Koepsel EK, Atwell TD, Burnett TL. Feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2669-2673. [PMID: 34773468 DOI: 10.1007/s00261-021-03344-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate the feasibility and safety of percutaneous image-guided cryoablation of abdominal wall endometriosis (AWE). MATERIALS AND METHODS A retrospective review of percutaneous cryoablation (CT or MR) of AWE was performed from January 2018 to December 2020. Eighteen patients were identified from an internal percutaneous ablation database. Technical success, complications, and outcomes were analyzed according to standard nomenclature. RESULTS Patients comprised 18 females (mean age 36.9 years) who underwent 18 cryoablation procedures to treat 23 AWE deposits. Three of the 18 cases were performed under MR guidance, while the remaining 15 employed CT guidance. Technical success was achieved in all 18 cases (100%). Fifteen of 18 patients (83%) had biopsy proven AWE deposits prior to treatment. Hydrodisplacement was used to displace adjacent bowel, bladder, or neurovascular structures in 13/18 cases (72%). The mean number of probes used per case was 3. Sixteen of 23 (70%) of AWE deposits had imaging follow-up (median 85 days). Of the 16 lesions with imaging follow-up, 15 (94%) demonstrated no residual enhancement or T1 hyperintensity at the treatment site and 1 lesion (6%) demonstrated residual/progressive disease. At clinical follow-up, 13 of 14 (93%) patients reported improvement in AWE-related symptoms. Eleven patients had clinically documented pain scores before and after ablation and all demonstrated substantial symptomatic improvement. No society of interventional radiology (SIR) major complications were observed. CONCLUSIONS Percutaneous cryoablation of AWE is feasible with a favorable safety profile. Further longitudinal studies are needed to document durable response over time.
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Affiliation(s)
- Katherine A Smith
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | | | - Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Tasha L Welch
- Department of Anesthesiology, Mayo Clinic, Rochester, USA
| | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA
| | | | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, USA
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Mikhail M, Chua KJ, Khizir L, Tabakin A, Singer EA. Role of metastasectomy in the management of renal cell carcinoma. Front Surg 2022; 9:943604. [PMID: 35965871 PMCID: PMC9372304 DOI: 10.3389/fsurg.2022.943604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
Treatment of metastatic renal cell carcinoma (mRCC) has evolved with the development of a variety of systemic agents; however, these therapies alone rarely lead to a complete response. Complete consolidative surgery with surgical metastasectomy has been associated with improved survival outcomes in well-selected patients in previous reports. No randomized control trial exists to determine the effectiveness of metastasectomy. Therefore, reviewing observational studies is important to best determine which patients are most appropriate for metastasectomy for mRCC and if such treatment continues to be effective with the development of new systemic therapies such as immunotherapy. In this narrative review, we discuss the indications for metastasectomies, outcomes, factors associated with improved survival, and special considerations such as location of metastasis, number of metastases, synchronous metastases, and use of systemic therapy. Additionally, alternative treatment options and trials involving metastasectomy will be reviewed.
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Affiliation(s)
| | | | | | | | - Eric A. Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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Thompson SM, Welch BT, Kurup AN. Ablation for oligometastatic colorectal carcinoma in extrahepatic, extrapulmonary sites. Int J Hyperthermia 2022; 39:633-638. [DOI: 10.1080/02656736.2021.1952318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
| | - Brian T. Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - A. Nick Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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6
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Brassetti A, Proietti F, Leonardo C, Simone G. The Value of Metastasectomy in Renal Cell Carcinoma in 2021. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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Haroon M, Sathiadoss P, Hibbert RM, Jeyaraj SK, Lim C, Schieda N. Imaging considerations for thermal and radiotherapy ablation of primary and metastatic renal cell carcinoma. Abdom Radiol (NY) 2021; 46:5386-5407. [PMID: 34245341 DOI: 10.1007/s00261-021-03178-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/20/2022]
Abstract
Ablative (percutaneous and stereotactic) thermal and radiotherapy procedures for management of both primary and metastatic renal cell carcinoma are increasing in popularity in clinical practice. Data suggest comparable efficacy with lower cost and morbidity compared to nephrectomy. Ablative therapies may be used alone or in conjunction with surgery or chemotherapy for treatment of primary tumor and metastatic disease. Imaging plays a crucial role in pre-treatment selection and planning of ablation, intra-procedural guidance, evaluation for complications, short- and long-term post-procedural surveillance of disease, and treatment response. Treatment response and disease recurrence may differ considerably after ablation, particularly for stereotactic radiotherapy, when compared to conventional surgical and chemotherapies. This article reviews the current and emerging role of imaging for ablative therapy of renal cell carcinoma.
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9
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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10
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Rojo RD, Perez JVD, Damasco JA, Yu G, Lin SC, Heralde FM, Novone NM, Santos EB, Lin SH, Melancon MP. Combinatorial effect of radium-223 and irreversible electroporation on prostate cancer bone metastasis in mice. Int J Hyperthermia 2021; 38:650-662. [PMID: 33882773 PMCID: PMC8495630 DOI: 10.1080/02656736.2021.1914873] [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: 02/03/2023] Open
Abstract
BACKGROUND Metastatic prostate cancer in bone is difficult to treat as the tumor cells are relatively resistant to hormonal or chemotherapies when compared to primary prostate cancer. Irreversible electroporation (IRE) is a minimally invasive ablation procedure that has potential applications in the management of prostate cancer in bone. However, a common limitation of IRE is tumor recurrence, which arises from incomplete ablation that allows remaining cancer cells to proliferate. In this study, we combined IRE with radium-223 (Ra-223), a bone-seeking radionuclide that emits short track length alpha particles and thus is associated with reduced damage to the bone marrow and evaluated the impact of the combination treatment on bone-forming prostate cancer tumors. METHODS The antitumor activity of IRE and Ra-223 as single agents and in combination was tested in vitro against three bone morphogenetic protein 4 (BMP4)-expressing prostate cancer cell lines (C4-2B-BMP4, Myc-CaP-BMP4, and TRAMP-C2-BMP4). Similar evaluation was performed in vivo using a bone-forming C4-2B-BMP4 tumor model in nude mice. RESULTS IRE and Ra-223 as monotherapy inhibited prostate cancer cell proliferation in vitro, and their combination resulted in significant reduction in cell viability compared to monotherapy. In vivo evaluation revealed that IRE with single-dose administration of Ra-233, compared to IRE alone, reduced the rate of tumor recurrence by 40% following initial apparent complete ablation and decreased the rate of proliferation of incompletely ablated tumor as quantified in Ki-67 staining (53.58 ± 16.0% for IRE vs. 20.12 ± 1.63%; for IRE plus Ra-223; p = 0.004). Histological analysis qualitatively showed the enhanced killing of tumor cells adjacent to bone by Ra-223 compared to those treated with IRE alone. CONCLUSION IRE in combination with Ra-223, which enhanced the destruction of cancer cells that are adjacent to bone, resulted in reduction of tumor recurrence through improved clearance of proliferative cells in the tumor region.
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Affiliation(s)
- Raniv D. Rojo
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States of America,College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila, National Capital Region 1000, Republic of the Philippines
| | - Joy Vanessa D. Perez
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States of America,College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila, National Capital Region 1000, Republic of the Philippines
| | - Jossana A. Damasco
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States of America
| | - Guoyu Yu
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas, 77030, United States of America
| | - Song-Chang Lin
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas, 77030, United States of America
| | - Francisco M. Heralde
- College of Medicine, University of the Philippines Manila, Pedro Gil St., Ermita, Manila, National Capital Region 1000, Republic of the Philippines
| | - Nora M. Novone
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas, 77030, United States of America
| | - Elmer B. Santos
- Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas, 77030, United States of America
| | - Sue-Hwa Lin
- Department of Translational Molecular Pathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas, 77030, United States of America,MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, 6767 Bertner Ave., Houston, Texas, 77030, United States of America
| | - Marites P. Melancon
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, United States of America,MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, 6767 Bertner Ave., Houston, Texas, 77030, United States of America
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De Raffele E, Mirarchi M, Casadei R, Ricci C, Brunocilla E, Minni F. Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature. World J Clin Cases 2020; 8:4450-4465. [PMID: 33083404 PMCID: PMC7559688 DOI: 10.12998/wjcc.v8.i19.4450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies.
CASE SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases. He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites, including resection of more than 38 metastases, and 5 years after his last MSX.
CONCLUSION This case highlights that effective multimodality therapeutic strategies, including multiple systemic treatments and iterative aggressive surgical resection, can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.
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Affiliation(s)
- Emilio De Raffele
- Dipartimento dell'Apparato Digerente, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Mariateresa Mirarchi
- Dipartimento Strutturale Chirurgico, Ospedale SS Antonio e Margherita, Tortona (AL) 15057, Italy
| | - Riccardo Casadei
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Claudio Ricci
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Eugenio Brunocilla
- Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
| | - Francesco Minni
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
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12
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Raffele ED, Mirarchi M, Casadei R, Ricci C, Brunocilla E, Minni F. Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i19.4451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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13
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Welch BT, Ehman EC, VanBuren WM, Cope AG, Welch TL, Woodrum DA, Kurup AN, Burnett TL. Percutaneous cryoablation of abdominal wall endometriosis: the Mayo Clinic approach. Abdom Radiol (NY) 2020; 45:1813-1817. [PMID: 31894380 DOI: 10.1007/s00261-019-02379-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abdominal wall endometriosis (AWE) is a rare form of endometriosis that often results in substantial pain and debility. The current treatment algorithm for AWE is not well established. The purpose of this review is to describe the Mayo Clinic experience with thermal ablation of symptomatic AWE as well as to review current imaging and interventional literature regarding the diagnosis and treatment of AWE.
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Affiliation(s)
- Brian T Welch
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA.
| | - Eric C Ehman
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | | | - Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Tasha L Welch
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - David A Woodrum
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - A Nick Kurup
- Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Tatnai L Burnett
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
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Kohlenberg J, Welch B, Hamidi O, Callstrom M, Morris J, Sprung J, Bancos I, Young W. Efficacy and Safety of Ablative Therapy in the Treatment of Patients with Metastatic Pheochromocytoma and Paraganglioma. Cancers (Basel) 2019; 11:cancers11020195. [PMID: 30736463 PMCID: PMC6407137 DOI: 10.3390/cancers11020195] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/03/2019] [Accepted: 02/05/2019] [Indexed: 12/25/2022] Open
Abstract
Metastatic pheochromocytoma and paraganglioma (PPGL) are incurable neuroendocrine tumors. The goals of treatment include palliating symptoms and reducing tumor burden. Little is known about the use of radiofrequency ablation (RFA), cryoablation (CRYO), and percutaneous ethanol injection (PEI) to treat metastatic PPGL. We performed a retrospective study of patients age 17 years and older with metastatic PPGL who were treated with ablative therapy at Mayo Clinic, USA, between June 14, 1999 and November 14, 2017. Our outcomes measures were radiographic response, procedure-related complications, and symptomatic improvement. Thirty-one patients with metastatic PPGL had 123 lesions treated during 42 RFA, 23 CRYO, and 4 PEI procedures. The median duration of follow-up was 60 months (range, 0–163 months) for non-deceased patients. Radiographic local control was achieved in 69/80 (86%) lesions. Improvement in metastasis-related pain or symptoms of catecholamine excess was achieved in 12/13 (92%) procedures. Thirty-three (67%) procedures had no known complications. Clavien-Dindo Grade I, II, IV, and V complications occurred after 7 (14%), 7 (14%), 1 (2%), and 1 (2%) of the procedures, respectively. In patients with metastatic PPGL, ablative therapy can effectively achieve local control and palliate symptoms.
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Affiliation(s)
- Jacob Kohlenberg
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Brian Welch
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Oksana Hamidi
- Division of Endocrinology and Metabolism, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390, USA.
| | - Matthew Callstrom
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Jonathan Morris
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Juraj Sprung
- Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Irina Bancos
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - William Young
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Guida A, Albiges L. Traitement des métastases osseuses du cancer du rein. Bull Cancer 2019; 105 Suppl 3:S268-S279. [PMID: 30595156 DOI: 10.1016/s0007-4551(18)30382-5] [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: 11/17/2022]
Abstract
TREATING PATIENTS WITH BONE METASTASES FROM RENAL CELL CARCINOMA Bone metastases (BMs) are common and cause morbidity in cancer patients. One third of metastatic renal cancer (mRCC) patients present metastatic disease to the bone. BMs cause severe complications such as fracture, spinal cord compression and pain requiring surgery or radiotherapy. Hypercalcaemia is a common feature in mRCC as well as an established poor prognosis factor. BMs impact negatively on prognosis and affect quality of life. Correct management of BMs from RCC requires a multimodal evaluation to optimize care and quality of life. In this review, we discuss current evidences on the role of systemic treatments in BMs management, bone-targeting agents benefits in skeletal-related events prevention and local therapeutic approaches to BM in mRCC. Define prognosis of systemic disease and identify the main goal of treatment are crucial for the selection of the best strategy.
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Affiliation(s)
| | - Laurence Albiges
- Département d'oncologie médicale, Gustave Roussy, Villejuif, France..
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16
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Salabert L, Sionneau B, Cochin V, Ravaud A, Gross-Goupil M. Traitement focal et traitement systémique dans la prise en charge du cancer du rein métastatique : une question de complémentarité. Bull Cancer 2019; 105 Suppl 3:S221-S228. [PMID: 30595150 DOI: 10.1016/s0007-4551(18)30376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
FOCAL TREATMENT AND SYSTEMIC THERAPY IN METASTATIC KIDNEY CANCER COMPLEMENTARY APPROACHES: To treat metastatic renal cell carcinoma, therapies used are with an oral intake, for the vast majority, and have many side effects that may compromise observance. Strategies of drug holiday have been studied and, in case of an indolent and oligometastatic tumor, studies have shown that active surveillance is possible to delay the introduction of systemic treatment, without compromising the patient survival. A multimodal approach combining systemic and focal treatments can be done with several objectives: to delay even more introduction of systemic treatment by focally treating metastases, to allow drug holiday after partial response to medical treatment by local control of persistent metastases, and to permit drug continuation even in case of dissociated response to systemic therapy, by focal treatment of metastasis(es) in progression. Technics that can be used for focal treatment are metastasectomy, radiofrequency ablation or cryotherapy, and stereotactic radiotherapy. In literature, studies that evaluated this approach are for almost retrospective studies, but they have reported interesting results in terms of local control and low morbidity. In the era of checkpoint's inhibitors, it seems important to make prospective collections of data to validate these practices. In any case, and because international recommendations about multimodal approach are poor, discussions between the different actors of the patient care are essential to find the most beneficial treatment for him.
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Affiliation(s)
- Laura Salabert
- Service oncologie médicale, centre hospitalo-universitaire Bordeaux, France
| | - Baptiste Sionneau
- Service oncologie médicale, centre hospitalo-universitaire Bordeaux, France
| | - Valérie Cochin
- Service oncologie médicale, centre hospitalo-universitaire Bordeaux, France
| | - Alain Ravaud
- Service oncologie médicale, centre hospitalo-universitaire Bordeaux, France; Université de Bordeaux, France
| | - Marine Gross-Goupil
- Service oncologie médicale, centre hospitalo-universitaire Bordeaux, France.
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Abstract
Image-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.
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Stewart CL, Warner S, Ito K, Raoof M, Wu GX, Kessler J, Kim JY, Fong Y. Cytoreduction for colorectal metastases: liver, lung, peritoneum, lymph nodes, bone, brain. When does it palliate, prolong survival, and potentially cure? Curr Probl Surg 2018; 55:330-379. [PMID: 30526930 DOI: 10.1067/j.cpsurg.2018.08.004] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/28/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Susanne Warner
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Kaori Ito
- Department of Surgery, Michigan State University, Lansing, MI
| | - Mustafa Raoof
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA
| | - Geena X Wu
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Jonathan Kessler
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA
| | - Jae Y Kim
- Division of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA.
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Guida A, Escudier B, Albiges L. Treating patients with renal cell carcinoma and bone metastases. Expert Rev Anticancer Ther 2018; 18:1135-1143. [PMID: 30183421 DOI: 10.1080/14737140.2018.1520097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Bone metastases (BMs) are common and cause morbidity in cancer patients. This review focuses on evidence in BMs from metastatic renal cell carcinoma (mRCC) management and discusses current evidence on the role of systemic treatments in BMs management, bone-targeting agents' benefits in skeletal-related events prevention and local therapeutic approaches to BM in mRCC. Areas covered: A comprehensive review of literature concerning incidence, prognosis, and therapeutic approaches of BMs was performed, focusing on the latest emerging evidence in management of BMs from mRCC. Expert commentary: One-third of mRCC patients present metastatic disease to the bone. BMs impact negatively the prognosis and decrease quality of life. Adequate management of BMs from RCC requires a multimodal evaluation to optimize care and quality of life. Both tyrosine-kinase inhibitors and immunotherapy may be effective in BMs treatment. BMs cause severe complications such as fracture, spinal cord compression, and pain requiring surgery or radiotherapy and several local approaches are available to achieve a local control of the disease. Defining prognosis of systemic disease and identifying the main goal of treatment is crucial for the selection of the best strategy.
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Affiliation(s)
- Annalisa Guida
- a Department of Medical Oncology , Gustave Roussy , Villejuif , France.,b Department of Biomedical, Metabolic and Neural Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Bernard Escudier
- a Department of Medical Oncology , Gustave Roussy , Villejuif , France
| | - Laurence Albiges
- a Department of Medical Oncology , Gustave Roussy , Villejuif , France
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Cazzato RL, Arrigoni F, Boatta E, Bruno F, Chiang JB, Garnon J, Zugaro L, Giordano AV, Carducci S, Varrassi M, Beomonte Zobel B, Bazzocchi A, Aliprandi A, Basile A, Marcia S, Masala S, Grasso RF, Squarza S, Floridi C, Ierardi AM, Burdi N, Cioni R, Napoli A, Niola R, Rossi G, Rossi UG, Venturini M, De Cobelli F, Carotti M, Gravina GL, Di Staso M, Zoccali C, Biagini R, Tonini G, Santini D, Carrafiello G, Cariati M, Silvestri E, Sconfienza LM, Giovagnoni A, Masciocchi C, Gangi A, Barile A. Percutaneous management of bone metastases: state of the art, interventional strategies and joint position statement of the Italian College of MSK Radiology (ICoMSKR) and the Italian College of Interventional Radiology (ICIR). Radiol Med 2018; 124:34-49. [DOI: 10.1007/s11547-018-0938-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
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Percutaneous microwave ablation for local control of metastatic renal cell carcinoma. Abdom Radiol (NY) 2018; 43:2446-2454. [PMID: 29464274 DOI: 10.1007/s00261-018-1498-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the article is to evaluate the safety and oncologic efficacy of microwave ablation for metastatic renal cell carcinoma (mRCC). MATERIALS AND METHODS From September 2011 to December 2016, 33 mRCC were ablated in 18 patients using percutaneous microwave ablation. Sites of mRCC include retroperitoneum (n = 12), contralateral kidney (n = 6), liver (n = 6), lung (n = 5), adrenal gland (n = 5). Technical success, local, and distant tumor progression, and complications were assessed at immediate and follow-up imaging. The Kaplan-Meier method was used for survival analysis. RESULTS Technical success was achieved for 33/33 (100%) mRCC tumors. Ablation provided durable local control for 28/30 (93%) mRCC tumors in 17 patients at a median duration of clinical and imaging follow-up of 1.6 years (IQR 0.7-3.6) and 0.8 years (IQR 0.5-2.7), respectively. In-hospital and perioperative mortality was 0%. There were 5 (15%) procedure-related complications including one high-grade event (Clavien-Dindo III). Four patients have died from mRCC at a median of 1.3 years (range 0.7-5.1) following ablation. Estimated OS (95% CI number still at risk) at 1, 2, and 5 years were 86% (53-96%, 11), 75% (39-92%, 8), and 75% (39-92%, 3), respectively. CONCLUSIONS Microwave ablation of oligometastatic renal cell carcinoma is safe and provides durable local control in appropriately selected patients.
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22
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Feasibility and outcomes of percutaneous thermal ablation of hepatocellular carcinoma in a transplanted allograft. Abdom Radiol (NY) 2018; 43:1478-1481. [PMID: 28936550 DOI: 10.1007/s00261-017-1323-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To examine the safety, feasibility, and oncologic control following percutaneous image-guided thermal ablation of hepatocellular carcinoma (HCC) in a transplanted allograft. MATERIALS AND METHODS Retrospective review was performed to identify patients who underwent liver transplantation for HCC and subsequently underwent percutaneous hepatic thermal ablation for recurrent HCC within the allograft between January 1st, 2000-September 1st, 2016. Eleven patients with hepatic allograft HCC underwent twelve percutaneous thermal ablation procedures to treat 16 lesions. Patient, procedural characteristics, and local oncologic efficacy were reviewed. Complications were characterized via the Common Terminology for Clinically Adverse Events nomenclature [CTCAE] v4.03). RESULTS Eleven transplant recipients underwent treatment of 16 HCC tumors in their allografts during 12 ablation sessions. Mean follow-up time was 25 months (range 2-96 months). Local oncologic control was achieved in 10 of 11 tumors (91%) with imaging follow-up. One patient (8%) with Roux-en-Y biliary reconstruction developed a major complication with hepatic abscess. CONCLUSION Thermal ablation of recurrent HCC in transplanted allografts can be accomplished safely with acceptable rates of local control for patients with duct-to-duct biliary reconstruction. Due to the high number of patients deemed surgically unresectable, the morbidity of surgical resection, the side effects of targeted therapies, and significant mortality associated with recurrences in the transplanted allograft, patients may benefit from percutaneous thermal ablative treatments. Further study is needed to assess the role of thermal ablation in allograft HCC recurrences as primary therapy or in a multimodality approach with emerging systemic therapies.
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23
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Psutka SP, Master VA. Role of metastasis-directed treatment in kidney cancer. Cancer 2018; 124:3641-3655. [PMID: 29689599 DOI: 10.1002/cncr.31341] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 12/12/2022]
Abstract
Despite the rapid elaboration of multiple, novel systemic agents introduced for metastatic renal cell carcinoma (mRCC) in recent years, a durable complete response remains elusive with systemic therapy alone. Definitive treatment of the metastatic deposit remains the sole potentially curative option and is a cornerstone of mRCC therapy, offering potential for both local control and palliation of tumor-related symptoms. In this review, the evidence supporting the definitive treatment of mRCC is examined and summarized, including the use of surgical metastasectomy, thermal ablation, radiotherapy, and other minimally invasive options. Multimodal approaches, including the combination of metastasectomy with novel systemic agents, are discussed. Finally, the authors review considerations for patient selection for this type of therapy and summarize available risk-stratification tools that may help guide shared decision making.
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Affiliation(s)
- Sarah P Psutka
- Division of Urology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois.,Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Viraj A Master
- Department of Urology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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24
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Melancon MP, Appleton Figueira T, Fuentes DT, Tian L, Qiao Y, Gu J, Gagea M, Ensor JE, Muñoz NM, Maldonado KL, Dixon K, McWatters A, Mitchell J, McArthur M, Gupta S, Tam AL. Development of an Electroporation and Nanoparticle-based Therapeutic Platform for Bone Metastases. Radiology 2018; 286:149-157. [PMID: 28825892 DOI: 10.1148/radiol.2017161721] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To assess for nanopore formation in bone marrow cells after irreversible electroporation (IRE) and to evaluate the antitumoral effect of IRE, used alone or in combination with doxorubicin (DOX)-loaded superparamagnetic iron oxide (SPIO) nanoparticles (SPIO-DOX), in a VX2 rabbit tibial tumor model. Materials and Methods All experiments were approved by the institutional animal care and use committee. Five porcine vertebral bodies in one pig underwent intervention (IRE electrode placement without ablation [n = 1], nanoparticle injection only [n = 1], and nanoparticle injection followed by IRE [n = 3]). The animal was euthanized and the vertebrae were harvested and evaluated with scanning electron microscopy. Twelve rabbit VX2 tibial tumors were treated, three with IRE, three with SPIO-DOX, and six with SPIO-DOX plus IRE; five rabbit VX2 tibial tumors were untreated (control group). Dynamic T2*-weighted 4.7-T magnetic resonance (MR) images were obtained 9 days after inoculation and 2 hours and 5 days after treatment. Antitumor effect was expressed as the tumor growth ratio at T2*-weighted MR imaging and percentage necrosis at histologic examination. Mixed-effects linear models were used to analyze the data. Results Scanning electron microscopy demonstrated nanopores in bone marrow cells only after IRE (P , .01). Average volume of total tumor before treatment (503.1 mm3 ± 204.6) was not significantly different from those after treatment (P = .7). SPIO-DOX was identified as a reduction in signal intensity within the tumor on T2*-weighted images for up to 5 days after treatment and was related to the presence of iron. Average tumor growth ratios were 103.0% ± 75.8 with control treatment, 154.3% ± 79.7 with SPIO-DOX, 77% ± 30.8 with IRE, and -38.5% ± 24.8 with a combination of SPIO-DOX and IRE (P = .02). The percentage residual viable tumor in bone was significantly less for combination therapy compared with control (P = .02), SPIO-DOX (P , .001), and IRE (P = .03) treatment. The percentage residual viable tumor in soft tissue was significantly less with IRE (P = .005) and SPIO-DOX plus IRE (P = .005) than with SPIO-DOX. Conclusion IRE can induce nanopore formation in bone marrow cells. Tibial VX2 tumors treated with a combination of SPIO-DOX and IRE demonstrate enhanced antitumor effect as compared with individual treatments alone. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Marites P Melancon
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Tomas Appleton Figueira
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - David T Fuentes
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Li Tian
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Yang Qiao
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Jianhua Gu
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Mihai Gagea
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Joe E Ensor
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Nina M Muñoz
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Kiersten L Maldonado
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Katherine Dixon
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Amanda McWatters
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Jennifer Mitchell
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Mark McArthur
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Sanjay Gupta
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
| | - Alda L Tam
- From the Departments of Interventional Radiology (M.P.M., T.A.F., L.T., Y.Q., N.M.M., K.D., A.M., S.G., A.L.T.), Veterinary Medicine and Surgery (M.G., J.M., M.M.), and Imaging Physics (D.T.F., K.L.M.), the University of Texas M.D. Anderson Cancer Center, PO Box 301402, Unit 1471; Houston, TX 77230-1402; and Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Tex (J.G., J.E.E.)
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Gardner CS, Ensor JE, Ahrar K, Huang SY, Sabir SH, Tannir NM, Lewis VO, Tam AL. Cryoablation of Bone Metastases from Renal Cell Carcinoma for Local Tumor Control. J Bone Joint Surg Am 2017; 99:1916-1926. [PMID: 29135665 DOI: 10.2106/jbjs.16.01182] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with bone metastases from renal cell carcinoma often are not surgical candidates and have a poor prognosis. There are limited data on the use of cryoablation as a locoregional therapy for bone metastases. Our objective was to assess the local tumor-control rate following cryoablation of bone metastases in the setting of renal cell carcinoma. METHODS We retrospectively reviewed the medical records of patients with metastatic renal cell carcinoma who underwent cryoablation for bone metastases between 2007 and 2014. We excluded patients if the intent of treatment was for pain palliation only, if cryoablation was performed without an attempt for complete tumor control (cytoreduction), or if the patient had no further follow-up beyond the cryoablation procedure. We recorded patient demographics, procedural variables, and complications. Cross-sectional imaging and clinical follow-up were reviewed to determine disease recurrence. The median overall survival and recurrence-free survival were determined using the Kaplan-Meier method. RESULTS Forty patients (30 male and 10 female) with 50 bone metastases were included for analysis. The mean patient age was 62 years (range, 47 to 82 years). The median follow-up was 35 months (95% confidence interval [CI], 22.7 to 74.4 months). Twenty-five (62.5%) of the 40 patients had oligometastatic disease, defined as ≤5 metastases at the time of ablation. The mean tumor size was 3.4 ± 1.5 cm. Metastases in the pelvic region represented 68% of the treated tumors (34 of 50). The overall local tumor-control rate per lesion was 82% (41 of 50). Patients with oligometastatic disease experienced better local tumor control (96% [24 of 25]) compared with patients who had >5 metastases (53.3% [8 of 15]) (p = 0.001). The local tumor-control rate was better for lesions for which a larger mean difference between maximum ice-ball diameter and maximum lesion diameter was achieved (2.2 ± 0.9 cm for those without recurrence versus 1.35 ± 1.2 cm for those with recurrence; p = 0.005). There were 3 grade-3 complications and 1 grade-4 complication. CONCLUSIONS Cryoablation can be effective for achieving local oncologic control in bone metastases from renal cell carcinoma and may represent a valuable alternative to surgical metastasectomy in select patients. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Carly S Gardner
- 1Department of Radiology, Baylor College of Medicine, Houston, Texas 2Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, Texas 3Departments of Interventional Radiology (K.A., S.Y.H., S.H.S., and A.L.T.), Genitourinary Medical Oncology (N.M.T.), and Orthopaedic Oncology (V.O.L.), University of Texas MD Anderson Cancer Center, Houston, Texas
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Expanding the borders: Image-guided procedures for the treatment of musculoskeletal tumors. Diagn Interv Imaging 2017; 98:635-644. [DOI: 10.1016/j.diii.2017.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/11/2022]
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Welch BT, Schmitz JJ, Atwell TD, McGauvran AM, Kurup AN, Callstrom MR, Schmit GD. Evaluation of infectious complications following percutaneous liver ablation in patients with bilioenteric anastomoses. Abdom Radiol (NY) 2017; 42:1579-1582. [PMID: 28111698 DOI: 10.1007/s00261-017-1051-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Prior bilioenteric anastomosis (BEA) has been associated with elevated risk of abscess formation after thermal ablation of hepatic tumors. We assessed the incidence of hepatic abscess after thermal ablation in a BEA cohort treated with extended antibiotic regimens following ablation. MATERIALS AND METHODS Retrospective review was performed to identify patients with BEA who underwent percutaneous hepatic thermal ablation between January 1, 2003-September 1, 2016. Fifteen patients with BEA underwent 18 percutaneous thermal ablation procedures. Patient and procedural characteristics were reviewed, as well as the antibiotic regiment utilized post ablation. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE) v4.03]. RESULTS Fifteen patients with BEA underwent treatment of 49 liver lesions during 18 ablation sessions. Mean follow-up in these patients was 39 months (range 3-138 months). Two patients (11%) developed hepatic abscesses, both of which occurred within 45 days of the ablation procedure while the patients were still on extended prophylactic antibiotic therapy. No additional CTCAE clinically significant complications were observed. CONCLUSION Thermal ablation of hepatic tumors can be accomplished safely in patients with BEA. Long-term post-procedural antibiotics may mitigate the risk of hepatic abscess formation. Due to the high number of patients who are deemed surgically unresectable, patients with BEA may have limited alternate treatment modalities and percutaneous hepatic thermal ablative treatments warrant consideration.
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Affiliation(s)
- B T Welch
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA.
| | - J J Schmitz
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
| | - T D Atwell
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
| | - A M McGauvran
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
| | - A N Kurup
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
| | - M R Callstrom
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
| | - G D Schmit
- Mayo Clinic Department of Radiology, 200 1st ST SW, Rochester, MN, 55905, USA
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Psutka SP, Heidenreich M, Boorjian SA, Bailey GC, Cheville JC, Stewart-Merrill SB, Lohse CM, Atwell TD, Costello BA, Leibovich BC, Thompson RH. Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes. BJU Int 2016; 119:116-127. [DOI: 10.1111/bju.13620] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sarah P. Psutka
- Department of Urology; Mayo Clinic; Rochester MN USA
- Division of Urology; John H. Stroger Jr. Hospital of Cook County; Chicago IL USA
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Zargar H, Atwell TD, Cadeddu JA, de la Rosette JJ, Janetschek G, Kaouk JH, Matin SF, Polascik TJ, Zargar-Shoshtari K, Thompson RH. Cryoablation for Small Renal Masses: Selection Criteria, Complications, and Functional and Oncologic Results. Eur Urol 2016; 69:116-28. [DOI: 10.1016/j.eururo.2015.03.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/11/2015] [Indexed: 12/27/2022]
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Rodriguez Faba O, Akdogan B, Marszalek M, Langenhuijsen JF, Brookman-May S, Stewart GD, Capitanio U, Sanguedolce F. Current Status of Focal Cryoablation for Small Renal Masses. Urology 2015; 90:9-15. [PMID: 26743392 DOI: 10.1016/j.urology.2015.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/21/2015] [Accepted: 11/30/2015] [Indexed: 12/27/2022]
Abstract
Focal cryoablation is an established minimally invasive technique for the treatment of small renal masses. Because of the lack of robust evidence, it is indicated in selected patients who have relative contraindications to extirpative approaches. With appropriate selection of patients, cryoablation is safe and effective. Main advantages are low risk for complication, minimal invasiveness, and good functional outcomes; oncological outcomes require further studies. The role of the percutaneous approach has been expanding because of its ability to reduce pain and hospitalization, the possibility of performing the procedure under sedation, and the fact that it is potentially more cost effective.
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Affiliation(s)
| | - Bullent Akdogan
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - J F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sabine Brookman-May
- Department of Urology, Ludwig Maximilian University, Campus Grosshadern, Munich, Germany
| | - Grant D Stewart
- Edinburgh Urological Cancer Group, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Umberto Capitanio
- King's College Hospital NHS Foundation Trust, Northampton General Hospital NHS Trust, Cliftonville, UK
| | - Francesco Sanguedolce
- Department of Urology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Steers WD. This Month in Adult Urology. J Urol 2014. [DOI: 10.1016/j.juro.2014.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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