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Wright B, Johnson BS, Vassar M, Saidian A, Rais-Bahrami S, Gunn AJ. Trans-arterial embolization of renal cell carcinoma: a systematic review and meta-analysis. Abdom Radiol (NY) 2022; 47:2238-2243. [PMID: 35380246 DOI: 10.1007/s00261-022-03502-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate if trans-arterial embolization (TAE) of the primary tumor in patients with renal cell carcinoma (RCC) improves symptomatology such as pain and hematuria or oncologic outcomes such as progression-free survival (PFS) and overall survival (OS). MATERIALS AND METHODS The systematic review search included PubMed, Ovid/MEDLINE, and Embase for full-text English articles including randomized and non-randomized prospective trials as well as prospective and retrospective case series. To be included, prospective trials needed ≥ 25 patients in each arm while case series and retrospective chart reviews required at least two patients. Evaluated outcomes included PFS, OS, change in tumor size, improvements in pain, improvements in hematuria, and adverse events (AEs). RESULTS 1327 articles were retrieved and screened. Nine studies met inclusion criteria (retrospective case series, n = 8; non-randomized prospective trial, n = 1) which included 237 patients (M = 156 (65.8%); F = 56 (23.6%); gender unreported = 25 (10.5%); mean age: 69.4 (range: 38-87)) with a mean tumor diameter of 9.3 cm (5.2-10.5). When reported, the TNM stages were stage I (n = 10), II (n = 18), III (n = 36), and IV (n = 121). 60 patients were treated for pain and hematuria. After TAE, pain improved in 59 patients (98.3%) and hematuria improved in 57 patients (95%). A meta-analysis for improvements in pain and hematuria demonstrated an event rate of pain improvement of 0.952 (0.788-0.990; p < 0.001) and an event rate for hematuria improvement of 0.923 (0.809-0.971; p < 0.001). Median OS ranged from 1 to 39 months but only one study reported PFS (10.5 months). Only one study demonstrated a statistically significant improvement in OS with TAE when compared with patients that did not undergo TAE (p = 0.02). A reduction in tumor size was only achieved in 17 patients (17/49; 34.7%) limiting evaluation. AEs included fever (n = 115/237; 48.5%), flank pain (n = 72/237; 30.4%), nausea (n = 58/237; 24.5%), hematuria (n = 12/237; 5.1%), hypertension (n = 12/237; 5.1%), reduced GFR (n = 6/237; 2.5%), hematoma (n = 6/237,2.5%), and ileus (n = 3/237; 1.3%). CONCLUSION TAE monotherapy of the primary tumor in patients with RCC improves symptomatology such as pain and hematuria with an acceptable safety profile.
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Affiliation(s)
- Bryan Wright
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, Tulsa, OK, USA
| | - Bradley S Johnson
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, Tulsa, OK, USA
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences College of Osteopathic Medicine, Tulsa, OK, USA
| | - Ava Saidian
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, NHB 623, Birmingham, AL, USA
| | - Andrew J Gunn
- Department of Radiology, University of Alabama at Birmingham, 619 19th St S, NHB 623, Birmingham, AL, USA.
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Wulff-Burchfield E. Supportive and Palliative Care for Genitourinary Malignancies. Urol Oncol 2022. [DOI: 10.1007/978-3-030-89891-5_2] [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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3
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Kim MS, Hong HP, Kang KA, Lee YR, Joo KJ, Cho YS, Lee YG. Superselective vesical artery embolization for intractable bladder hemorrhage related to pelvic malignancy. Acta Radiol 2021; 62:1229-1237. [PMID: 32854526 DOI: 10.1177/0284185120952781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intractable bladder hemorrhage from pelvic malignancy can be potentially life-threatening and its management can be a challenging clinical problem. PURPOSE To evaluate safety, efficacy, and clinical outcome of superselective vesical artery embolization for the control of intractable bladder hemorrhage from pelvic malignancy. MATERIAL AND METHODS Between January 2010 and September 2018, 20 patients underwent superselective vesical artery embolization for intractable hematuria secondary to pelvic malignancy arising from or invading the bladder. Treatment details and clinical outcomes were obtained. RESULTS There were 12 men and 8 women (mean age = 77 years). Bilateral embolization was performed in 10 patients and unilateral approach in 10 patients. Two patients died within four days after embolization due to underlying heart failure and systemic metastasis, respectively. The remaining 18 patients had a follow-up of >30 days. Bleeding was controlled after the first embolization in 17/18 patients and after a repeat embolization in the remaining one patient. The mean follow-up period of 18 patients was 10.6 months (range = 1-77 months). Late recurrent hemorrhage (≥ 30 days after embolization) was reported in 6 (33.3%) patients. Five of these six patients underwent repeat embolization. There were no major complications related to embolization. CONCLUSION Palliative superselective vesical artery embolization is a feasible, effective, and safe procedure to control intractable hematuria in patients with pelvic malignancy.
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Affiliation(s)
- Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Sam Cho
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Abou Elkassem AM, Lo SS, Gunn AJ, Shuch BM, Dewitt-Foy ME, Abouassaly R, Vaidya SS, Clark JI, Louie AV, Siva S, Grosu AL, Smith AD. Role of Imaging in Renal Cell Carcinoma: A Multidisciplinary Perspective. Radiographics 2021; 41:1387-1407. [PMID: 34270355 DOI: 10.1148/rg.2021200202] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With the expansion in cross-sectional imaging over the past few decades, there has been an increase in the number of incidentally detected renal masses and an increase in the incidence of renal cell carcinomas (RCCs). The complete characterization of an indeterminate renal mass on CT or MR images is challenging, and the authors provide a critical review of the best imaging methods and essential, important, and optional reporting elements used to describe the indeterminate renal mass. While surgical staging remains the standard of care for RCC, the role of renal mass CT or MRI in staging RCC is reviewed, specifically with reference to areas that may be overlooked at imaging such as detection of invasion through the renal capsule or perirenal (Gerota) fascia. Treatment options for localized RCC are expanding, and a multidisciplinary group of experts presents an overview of the role of advanced medical imaging in surgery, percutaneous ablation, transarterial embolization, active surveillance, and stereotactic body radiation therapy. Finally, the arsenal of treatments for advanced renal cancer continues to grow to improve response to therapy while limiting treatment side effects. Imaging findings are important in deciding the best treatment options and to monitor response to therapy. However, evaluating response has increased in complexity. The unique imaging findings associated with antiangiogenic targeted therapy and immunotherapy are discussed. An invited commentary by Remer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Asser M Abou Elkassem
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Simon S Lo
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew J Gunn
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Brian M Shuch
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Molly E Dewitt-Foy
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Robert Abouassaly
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Sandeep S Vaidya
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Joseph I Clark
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Alexander V Louie
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Shankar Siva
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Anca-Ligia Grosu
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
| | - Andrew D Smith
- From the Department of Radiology, University of Alabama at Birmingham, 619 19th St S, JTN 452, Birmingham, AL 35249-6830 (A.M.A.E., A.J.G., A.D.S.); Department of Radiation Oncology (S.S.L.) and Department of Radiology (S.S.V.), University of Washington School of Medicine, Seattle, Wash; Department of Urology, UCLA Medical Center, Santa Monica, Calif (B.M.S.); Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio (M.E.D.F., R.A.); Division of Hematology/Oncology, Department of Internal Medicine, Loyola University Medical Center, Maywood, Ill (J.I.C.); Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada (A.V.L.); Division of Radiation Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Parkville, Victoria, Australia (S.S.); and Department of Radiation Oncology, University of Freiburg, Freiburg, Germany (A.L.G.)
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Lord J, Britton H, Spain SG, Lewis AL. Advancements in the development on new liquid embolic agents for use in therapeutic embolisation. J Mater Chem B 2020; 8:8207-8218. [DOI: 10.1039/d0tb01576h] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This review covers the current state-of-the-art in the development of liquid embolics for therapeutic embolisation.
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Affiliation(s)
- Jasmine Lord
- Department of Chemistry
- University of Sheffield
- Sheffield
- UK
| | - Hugh Britton
- Biocompatibles UK Ltd (a BTG International group company)
- Lakeview
- Camberley
- UK
| | | | - Andrew L. Lewis
- Biocompatibles UK Ltd (a BTG International group company)
- Lakeview
- Camberley
- UK
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Gunn AJ, Patel AR, Rais-Bahrami S. Role of Angio-Embolization for Renal Cell Carcinoma. Curr Urol Rep 2018; 19:76. [DOI: 10.1007/s11934-018-0827-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Niekamp A, Sheth RA, Kuban J, Avritscher R, Ganguli S. Palliative Embolization for Refractory Bleeding. Semin Intervent Radiol 2017; 34:387-397. [PMID: 29249863 DOI: 10.1055/s-0037-1608862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bleeding is a common and often challenging complication of malignancy. Etiologies of hemorrhage in this patient population vary, and bleeding may present as an acute, life-threatening emergency or a chronic, low-volume blood loss. For patients with advanced malignancies, interventions to manage bleeding must be balanced by the patient's life expectancy and quality of life. As such, minimally invasive procedures such as transarterial embolization are useful therapeutic options in appropriately selected patients. There is a rich history of palliative transarterial embolization for refractory bleeding in cancer patients. This technique was first applied in the 1970s and has since become an established treatment tool for malignancy-related bleeding throughout the body. While the preponderance of published data comprised case reports and small retrospective studies, the use of embolization continues to expand as experience grows and techniques are refined. In this review, we summarize the literature and provide our perspective on embolization for refractory bleeding in cancer patients.
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Affiliation(s)
- Andrew Niekamp
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rahul A Sheth
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Joshua Kuban
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Rony Avritscher
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Karalli A, Ghaffarpour R, Axelsson R, Lundell L, Bozoki B, Brismar T, Gustafsson O. Transarterial Chemoembolization of Renal Cell Carcinoma: A Prospective Controlled Trial. J Vasc Interv Radiol 2017; 28:1664-1672. [DOI: 10.1016/j.jvir.2017.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 08/01/2017] [Accepted: 08/01/2017] [Indexed: 01/20/2023] Open
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Lau C, O’Malley P, Gaudino M, Scherr DS, Girardi LN. Resection of Intraabdominal Tumors With Cavoatrial Extension Using Deep Hypothermic Circulatory Arrest. Ann Thorac Surg 2016; 102:836-842. [DOI: 10.1016/j.athoracsur.2016.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
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Vikram R, Beland MD, Blaufox MD, Moreno CC, Gore JL, Harvin HJ, Heilbrun ME, Liauw SL, Nguyen PL, Nikolaidis P, Preminger GM, Purysko AS, Raman SS, Taffel MT, Wang ZJ, Weinfeld RM, Remer EM, Lockhart ME. ACR Appropriateness Criteria Renal Cell Carcinoma Staging. J Am Coll Radiol 2016; 13:518-25. [DOI: 10.1016/j.jacr.2016.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 01/28/2016] [Indexed: 12/22/2022]
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12
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Reinhart HA, Ghaleb M, Davis BR. Transarterial embolization of renal tumors improves surgical outcomes: A case series. Int J Surg Case Rep 2015; 15:116-8. [PMID: 26339789 PMCID: PMC4601965 DOI: 10.1016/j.ijscr.2015.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/09/2015] [Indexed: 01/31/2023] Open
Abstract
Our study shows transarterial embolization had a decreased in blood loss. TAE allowed high stage tumors of greater average size to be removed. Time to surgery post embolization varied from several hours to one day.
Introduction Operative treatment of renal tumors can be associated with a high rate of perioperative morbidity related to hemorrhage and injury to adjacent anatomical structures. This morbidity of solid organ surgery is especially prevalent when the lesion involves chronic inflammation or a desmoplastic reaction from a rapidly growing tumor. No consensus on the use of transarterial embolization has been fashioned as the number of prospective studies is small. This study proposes to examine the beneficial effects of selective transarterial embolization of the kidney prior to surgical resection. Presentation of case A retrospective case matched review was performed of consecutive nephroureterectomies evaluating outcomes of patients receiving transarterial embolization versus those patients who received no embolization. The records were obtained from University Medical Center of El Paso for the time period of 05/2011–12/2014. Data examined included patient demographics, operative blood loss, operative time, transfusion requirements, and pathology. Previous studies have shown that preoperative embolization of renal tumors resulted in a decreased need for blood transfusion. Conclusion Our review showed transarterial embolization had a decrease in blood loss and required no transfusions. It also facilitated a larger and more advanced tumor resection. Our series of patients tolerated transarterial embolization well and had good surgical outcomes. Transarterial embolization of kidneys prior to radical nephroureterectomy results in a safe and uncomplicated operative course with less perioperative morbidity when compared to resection alone.
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Affiliation(s)
- Henry A Reinhart
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, 4800 Alberta Avenue, El Paso, TX 79905, United States.
| | - Melhem Ghaleb
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Radiology, 5001 El Paso Drive, El Paso, TX 79905, United States.
| | - Brian R Davis
- Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, Department of Surgery, 4800 Alberta Avenue, El Paso, TX 79905, United States.
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Abstract
Interventional oncology, a term commonly used to indicate the minimally invasive procedures performed by interventional radiologists to diagnose and manage cancer, encompasses a broad spectrum of techniques unique to interventional radiology that have been established as a vital part of the multidisciplinary oncologic cancer care team. This article provides an updated overview of the variety of applications of image-guided procedures to distinct clinical scenarios, such as the diagnosis, treatment, and management of complications of malignancies.
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Affiliation(s)
- Bruno C Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1471, Houston, TX 77030, USA.
| | - Michael J Wallace
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 1471, Houston, TX 77030, USA
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Abstract
Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.
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Affiliation(s)
- David Li
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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15
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Vora A, Brodsky R, Nolan J, Ram S, Richter L, Yingling C, Venkatesan K, Ghasemian R, Hwang J, Horton K, Verghese M. Incidence of postembolization syndrome after complete renal angioinfarction: a single-institution experience over four years. Scand J Urol 2013; 48:245-51. [PMID: 24215333 DOI: 10.3109/21681805.2013.852620] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Renal angioinfarction (RAI) has been used for various indications in the management of renal tumors. While historically used for palliation of local symptoms (pain or hematuria), this technique has theoretical use in facilitating radical nephrectomy by allowing early ligation of the renal vein, decreasing blood loss and creating edema in resection planes. A common impediment to embolization is the development of postembolization syndrome (PES), which has been reported to have an incidence as high as 89%. This study reports the authors' experience with RAI as a safe palliative and adjunctive procedure over 4 years. MATERIAL AND METHODS From 2008 to 2011, 113 patients underwent complete RAI at Washington Hospital Center for palliative or adjunctive therapy by an interventional radiologist. Procedures were performed in a radiology suite using mild sedation with vascular access obtained by femoral artery puncture. RAI was performed by subsegmental injection of polyvinyl alcohol particles. RESULTS All 113 patients underwent successful RAI with confirmation of total arterial flow ablation via postprocedure arteriogram: 38 underwent embolization for preoperative adjunctive therapy, 34 for palliation of renal mass, 36 for trauma/hemorrhage and five for symptomatic renal artery pseudoaneurysm after partial nephrectomy. PES occurred in 33 out of 75 patients (44.0%), with symptomatic PES in only two patients (2.6%). No major complications (>Clavien grade III) occurred. Thirty-eight patients were excluded from analysis as they underwent radical nephrectomy within 24 h, preventing accurate assessment of PES. CONCLUSIONS RAI is a safe and reliable procedure for palliation of renal masses, as an adjunctive procedure for radical nephrectomy, and for conservative management of renal hemorrhage or aneurysm. PES occurs in relatively few patients, with no major complications, and should not impede clinical consideration of this procedure.
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Affiliation(s)
- Anup Vora
- Departments of Urology, Washington Hospital Center , Washington DC , USA
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16
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Vourganti S, Shuch B, Bratslavsky G. Surgical management of large renal tumors. Expert Rev Anticancer Ther 2011; 11:1889-900. [PMID: 22117156 DOI: 10.1586/era.11.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The surgical management of patients with renal cell carcinoma has undergone many changes. With equivalent oncologic outcomes and appreciation of the importance of renal functional preservation, the utilization of nephron-sparing partial nephrectomy has increased in recent years. Nevertheless, tumors of larger size continue to be preferentially treated with radical nephrectomy. Here, we present evidence that improvements in techniques and durability of oncologic outcomes has justified the use of nephron sparing to accomplish renal functional preservation even in patients with large renal tumors. In addition, surgical technical considerations when managing such tumors are discussed. Finally, we discuss cytoreductive surgery and the evolving role of systemic targeted therapies in the management of advanced metastatic disease.
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Affiliation(s)
- Srinivas Vourganti
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-1107, USA
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17
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Thacker PG, Friese JL, Loe M, Biegler P, Larson M, Andrews J. Embolization of nonliver visceral tumors. Semin Intervent Radiol 2011; 26:262-9. [PMID: 21326571 DOI: 10.1055/s-0029-1225667] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Catheter-directed embolization of visceral tumors, with the exception of the liver, has received limited attention in the literature. The visceral arterial anatomy can be complex and its understanding is critical for procedure planning and limiting complications. Embolization of splenic neoplasms is exceedingly rare. Preoperative embolization for adrenal, renal, and gut tumors plays an important role in select patients. Embolization has been used successfully in the treatment of pancreatic insulinomas and in limited cases of unresectable pancreatic adenocarcinomas. Embolization of bleeding visceral tumors can be accomplished with a high likelihood of success.
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Affiliation(s)
- Paul G Thacker
- Vascular and Interventional Radiology, Mayo Clinic, Rochester, Minnesota
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18
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Bilbao JI, Martínez-Cuesta A, Urtasun F, Cosín O. Complications of embolization. Semin Intervent Radiol 2011; 23:126-42. [PMID: 21326756 DOI: 10.1055/s-2006-941443] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Embolization is a remarkably versatile procedure used in nearly all vascular and nonvascular systems to treat a wide range of pathology. The published literature is rich with studies demonstrating the enormous therapeutic potential offered by embolization procedures, and the possibilities continue to expand with the advent of new embolization agents and techniques. Unfortunately, with this variety and innovation comes a wide spectrum of potential complications, not always easy to classify and summarize, associated with embolization. This article reviews the procedures and associated complications of arterial and venous embolization procedures, organized by vascular distribution.
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Affiliation(s)
- José I Bilbao
- Department of Radiology, Clínica Universitaria de Navarra, Pamplona, Spain
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19
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Desai KR, Chen RI. Endovascular therapy for palliative care of cancer patients. Semin Intervent Radiol 2011; 24:382-90. [PMID: 21326590 DOI: 10.1055/s-2007-992326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interventional radiology procedures often play an integral role in the diagnosis and treatment of patients with cancer. In the latter stages of cancer treatment, palliative care therapies may be sought for improvement in the quality of remaining life for oncology patients. Increased awareness among interventionalists and referring oncologists regarding minimally invasive treatments for palliation is desirable to provide additional options for patients. In particular, endovascular therapies can provide control of symptoms and complications related to incurable malignancies.
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Affiliation(s)
- Kush R Desai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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20
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Richey SL, Culp SH, Jonasch E, Corn PG, Pagliaro LC, Tamboli P, Patel KK, Matin SF, Wood CG, Tannir NM. Outcome of patients with metastatic renal cell carcinoma treated with targeted therapy without cytoreductive nephrectomy. Ann Oncol 2010; 22:1048-1053. [PMID: 21115604 DOI: 10.1093/annonc/mdq563] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cytoreductive nephrectomy (CN) became a standard procedure in metastatic renal cell carcinoma (mRCC) in the immunotherapy era. Historically, median overall survival (OS) of patients treated with interferon alpha (IFN-α) without CN was 7.8 months. Median OS in patients treated with targeted therapy (TT) without CN is unknown. PATIENTS AND METHODS We retrospectively reviewed records of patients with mRCC who received TT without CN. Kaplan-Meier methods and Cox regression analysis were used to estimate median OS and identify poor prognostic factors. RESULTS One hundred and eighty-eight patients were identified. Most patients had intermediate-risk (54.8%) or poor-risk (44.1%) disease. Median OS for all patients was 10.4 months [95% confidence interval (CI) 8.1-12.5]. By multivariable analysis, elevated baseline lactate dehydrogenase and corrected calcium, performance status of two or more, retroperitoneal nodal metastasis, thrombocytosis, current smoking, two or more metastatic sites, and lymphopenia were independent risk factors for inferior OS. Patients with four or more factors had increased risk of death (hazard ratio 8.83, 95% CI 5.02-15.5, P < 0.001) and 5.5-month median OS. Nineteen patients (10.0%) survived for 2+ years. CONCLUSIONS These data highlight the improved OS of patients with mRCC treated with TT without CN, compared with historical IFN-α treatment, and may guide the design of trials investigating the role of CN in the TT era.
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Affiliation(s)
- S L Richey
- Department of Genitourinary Medical Oncology
| | | | - E Jonasch
- Department of Genitourinary Medical Oncology
| | - P G Corn
- Department of Genitourinary Medical Oncology
| | | | - P Tamboli
- Department of Pathology, The University of Texas MD Anderson Cancer Center
| | - K K Patel
- Department of Internal Medicine, The University of Texas Health Science Center, Houston, USA
| | | | | | - N M Tannir
- Department of Genitourinary Medical Oncology.
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21
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Rodríguez Carvajal R, Orgaz A, Leal JI, Peinado FJ, Vicente S, Gil J, Flores A, Fontcuberta J, Buendia E, Bolufer E, Gómez A, Doblas M. Renal embolization and nephrectomy in a single surgical act in high-risk renal tumor pathology. Ann Vasc Surg 2010; 25:222-8. [PMID: 20947293 DOI: 10.1016/j.avsg.2010.03.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 02/07/2010] [Accepted: 03/16/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Renal artery embolization is a procedure that has been shown to be useful as a concomitant treatment for the resection of large renal tumors. Over the years, preoperative renal artery embolization concomitant with nephrectomy as a treatment option has proved to be useful in reducing morbi-mortality rates; however this procedure is not exempt from significant iatrogenia. Performing this technique in conjunction with nephrectomy in a single surgical act helps to maintain the advantages of this treatment, which in turn considerably reduces the associated morbi-mortality rates. METHODS This study presents seven patients selected by the Urology Service in a nonconsecutive manner who underwent renal artery embolization concomitant with nephrectomy in a single surgical procedure for large renal tumors, thus presenting a variation to the usual techniques to improve and simplify the procedure. RESULTS General data were obtained from all patients including age, gender, characteristics of the tumor, and symptomatology at the time of diagnosis. For all the cases, use of resources was analyzed in terms of duration of surgery, the amount of iodinated contrast medium used during the embolization procedure, and the mean duration of hospital and intensive care unit stay. Complications were evaluated with respect to general morbi-mortality associated with the complete procedure, hematic losses during the procedure, transfusion requirements, and renal function (calculated by measuring preoperative and 48-hour postoperative serum creatinine levels). All patients reported having symptoms at the time of diagnosis, all of them had tumors measuring >13 cm in diameter (major). In all the cases, 100% technical success was obtained with the embolization and nephrectomy. The mean duration of surgery in the case of embolization with coils was 45 minutes, and 25 minutes in the case of embolization with Amplatzer. A mean volume of 115 mL of contrast medium was used in the case of embolization with coils, whereas for the other cases, a mean volume of 71 mL of iodinated contrast was used. Among all the patients, only two of them required to be cared at the intensive care unit during 24 hours. On an average, reported blood loss was 380 mL. During the procedure, two patients (28.6%) required a transfusion of two units of red cells. No cases of perioperative or postoperative mortality were reported. With respect to morbidity, only one patient (14.3%) experienced a complication in the form of a superficial infection of the surgical wound, which was later resolved by antibiotic therapy. One patient (14.3%) presented a slightly higher preintervention level of creatinine (1.42). Two patients (28.6%), both of whom underwent embolization by using coils, experienced deterioration of postoperative renal function. CONCLUSION Preoperative embolization of the renal artery as a coadjuvant treatment option in high-risk renal neoplasia has clear technical benefits for the subsequent nephrectomy and also medical benefits for the patients. Performing both the procedures concomitantly as a single surgical act seems to retain the advantages of the embolization procedure, by reducing mortality rates and producing little associated morbidity. Technically, embolization with Amplatzer plugs seems to be faster and easier as compared with embolization with coils.
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Zhang M, Fabiilli ML, Haworth KJ, Fowlkes JB, Kripfgans OD, Roberts WW, Ives KA, Carson PL. Initial investigation of acoustic droplet vaporization for occlusion in canine kidney. ULTRASOUND IN MEDICINE & BIOLOGY 2010; 36:1691-703. [PMID: 20800939 PMCID: PMC2951622 DOI: 10.1016/j.ultrasmedbio.2010.06.020] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 05/20/2010] [Accepted: 06/23/2010] [Indexed: 05/04/2023]
Abstract
Acoustic droplet vaporization (ADV) shows promise for spatially and temporally targeted tissue occlusion. In this study, substantial tissue occlusion was achieved in operatively exposed and transcutaneous canine kidneys by generating ADV gas bubbles in the renal arteries or segmental arteries. Fifteen canines were anesthetized, among which 10 underwent laparotomy to externalize the left kidney and five were undisturbed for transcutaneous ADV. The microbubbles were generated by phase conversion of perfluoropentane droplets encapsulated in albumin or lipid shells in the blood. A 3.5-MHz single-element therapy transducer was aligned with an imaging array in a water tank with direct access to the renal artery or a segmental artery. In vivo color flow and spectral Doppler imaging were used to identify the target arteries. Tone bursts of 1 kHz pulse repetition frequency with 0.25% duty cycle vaporized the droplets during bolus passage. Both intracardiac (IC) and intravenous (IV) injections repeatedly produced ADV in chosen arteries in externalized kidneys, as seen by B-mode imaging. Concurrent with this in two cases was the detection by pulse-wave Doppler of blood flow reversal, along with a narrowing of the waveform. Localized cortex occlusion was achieved with 87% regional flow reduction in one case using IC injections. Vaporization from IV injections resulted in a substantial echogenicity increase with an average half-life of 8 min per droplet dose. Gas bubbles sufficient to produce some shadowing were generated by transcutaneous vaporization of intrarenal artery or IV-administered droplets, with a tissue path up to 5.5 cm.
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Affiliation(s)
- M Zhang
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI 48109-5667, USA.
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23
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Mukund A, Gamanagatti S. Ethanol ablation of renal cell carcinoma for palliation of symptoms in advanced disease. J Palliat Med 2010; 13:117-20. [PMID: 20109003 DOI: 10.1089/jpm.2009.0243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of transarterial alcohol ablation of renal cell carcinoma (RCC) with distant metastasis for control of symptoms caused by primary disease. This was a retrospective study consisting of eight patients having stage IV RCC. The primary indication for embolization was hematuria in seven patients and flank pain in one patient. All eight patients underwent renal artery embolization with ethanol and gelatin sponge pledgets. After embolization periodic evaluation was done every 3 months up to 1 year. Patients treated for hematuria did not complain of hematuria at 3- and 6-month follow-up except one who died of disease after 5 months. At 9-month follow-up five patients were free of hematuria while one developed hematuria after 6 months of treatment and died after 8 months. After 1 year three patients had no hematuria. One patient who developed hematuria at 9 months died after 11 months, another patient died of cardiac arrest at 10 months. The only patient who was treated for flank pain did not complain of pain up to 1-year follow-up. To conclude, transarterial embolization of renal tumor using ethanol is very effective in controlling local symptoms such as hematuria and pain. Thus, it may be an alternative treatment offered to symptomatic patients who are either not fit for surgery or not willing to undergo surgery.
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Affiliation(s)
- Amar Mukund
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India.
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24
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[What is the importance of kidney cancer surgery in contrast with targeted therapies?]. Bull Cancer 2010; 97:91-6. [PMID: 20418208 DOI: 10.1684/bdc.2010.1074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the extraordinary development of the medical treatment of kidney cancer, its treatment remains very surgical in localized and metastatic stage. Advances in surgery have accompanied the advent of targeted therapies. The laparoscopy has become the reference procedure for radical nephrectomy in the case of T1-T2 tumors. Partial nephrectomy, currently widespread, should be the first surgical procedure to consider in cases of tumors less than 4 cm. Partial nephrectomy for tumors between 4 and 7 cm is feasible for selected patients with favorable tumor localization. In the future, the use of neo-adjuvant anti-angiogenesis agents could broaden the scope of partial nephrectomy. Laparoscopic partial nephrectomy is spreading but is still considered as a therapeutic option, conducted in reference centres. In case of metastatic disease, pending the results of randomized trials including patients on anti-angiogenesis agents, cytoreductive nephrectomy remains indicated for patients in good general condition with kidney cancer metastatic immediately.
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Akhtar K, Lee G, Khan M, Mitchell A, Livni N, Christmas T. The role of embolization in the management of tumour recurrence after radical nephrectomy. Br J Hosp Med (Lond) 2010; 71:52. [PMID: 20081645 DOI: 10.12968/hmed.2010.71.1.45976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article presents the case of a 56-year-old woman who developed a tumour recurrence following radical nephrectomy. This was invading the descending colon and causing severe gastrointestinal haemorrhage. Angiography revealed neovascularization from T11 and T12 intercostal arteries, which were successfully embolized percutaneously.
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Affiliation(s)
- Kashif Akhtar
- Trauma and Orthopaedic Surgery, North West Thames Rotation
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Mahnken AH, Penzkofer T, Bruners P, Günther RW, Brehmer B. Interventional management of a renal cell carcinoma by radiofrequency ablation with tagging and cooling. Korean J Radiol 2009; 10:523-6. [PMID: 19721840 PMCID: PMC2731873 DOI: 10.3348/kjr.2009.10.5.523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 04/06/2009] [Indexed: 01/28/2023] Open
Abstract
Over the last few years, percutaneous radiofrequency (RF) ablation has been successfully established as a viable treatment modality for small peripheral renal cell carcinoma (RCC). This technique is limited by central tumor location and tumor size. We report the interventional management of a 5.3 cm mixed RCC with central and exophytic parts by combining the RF ablation with embolization, tagging, and retrograde, as well as anterograde cooling. The potential pitfalls of complex hybrid interventions for treating RCC are discussed.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic Radiology, Aachen University Hospital, Aachen, Germany.
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Onozawa S, Murata S, Shimizu A, Tajima H, Hidaka F, Kumita SI, Nomura K. Comparative study of transcatheter renal arterial embolization with and without closed renal circuit: pharmacokinetic and histologic assessment in pigs. Radiology 2009; 250:714-20. [PMID: 19164114 DOI: 10.1148/radiol.2503080215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the degree of renal necrosis and the leakage of absolute ethanol by using two methods: transcatheter renal artery embolization (TAE) and TAE performed with a closed renal circuit (CRC) (TAE/CRC), both performed by using ethanol and iodized oil, in a pig model. MATERIALS AND METHODS All animal experiments were conducted in accordance with our university guidelines for animal care and experimentation. Fourteen pigs were classified in two groups: standard TAE and TAE/CRC groups. In the TAE/CRC group, the renal artery and vein were occluded with balloon catheters; in the TAE group, only the renal artery was occluded. An emulsion of absolute ethanol (0.5 mL per kilogram of body weight) and iodized oil (emulsion ratio, 4:1) was injected in the renal artery in both groups. In the TAE/CRC group, we aspirated the blood containing the emulsion via the renal vein during arterial infusion. We measured the ethanol concentrations of the systemic circulation. Four days after embolization, the kidneys in both groups were removed and histopathologic examination was performed and results were compared. RESULTS The mean systemic ethanol concentration was less than 0.1 mg/mL in the TAE/CRC group and 0.28 mg/mL +/- 0.15 (standard deviation) in the TAE group (P < .002). In both groups, about 90% of the kidney was shown histopathologically to have undergone coagulation necrosis (no significant difference). The frequency of venous thrombus formation was significantly lower (P = .009) in the TAE/CRC group. CONCLUSION TAE/CRC dramatically reduces ethanol leakage to the systemic circulation without a decrease in embolization effect in the normal swine kidney, and it also reduces the likelihood of venous thrombus formation.
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Affiliation(s)
- Shiro Onozawa
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 118-8603, Japan.
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Shuch B, La Rochelle JC, Wu J, Klatte T, Riggs SB, Kabbinavar F, Belldegrun AS, Pantuck AJ. Performance status and cytoreductive nephrectomy: redefining management in patients with poor performance. Cancer 2008; 113:1324-31. [PMID: 18661529 DOI: 10.1002/cncr.23708] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3). METHODS Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified. Patient records were reviewed for age, symptoms, ECOG PS, tumor size, stage, grade, histology, sarcomatoid features, lymph node metastasis, site of metastasis, and the presence of bone metastases (BM) in weight-bearing structures. The relation of ECOG PS to outcome variables was evaluated. RESULTS Four hundred eighteen patients underwent CN, including 117 patients who had an ECOG PS of 0, 274 patients who had an ECOG PS of 1, and 27 patients who had an ECOG PS of 2/3. Patients who had a worse ECOG PS were younger, had higher tumor classification and grade, and more frequently demonstrated anemia and BM. Only 37.5% of patients who had an ECOG PS of 2/3 experienced an improvement in performance in the postoperative period, and only 57.5% went on to receive systemic therapy, of whom none attained an objective responses. The median disease-specific survival for patients who had an ECOG PS of 0, 1, and 2/3 was 27 months, 13.8 months, and 6.6 months, respectively (P<.001). Patients who had an ECOG PS of 2/3 could be stratified further by the presence or absence of BM into 2 groups (median disease-specific survival: 17.7 months and 2.1 months, respectively; P = .006). CONCLUSIONS Surgery in patients who have a poor performance may serve a palliative function but should be performed with caution because of the poor outcome of such patients. ECOG PS is influenced strongly by BM. A subset of patients with an ECOG PS of 2/3 that are symptomatic specifically from BM may derive greater benefit from CN than patients who hare symptomatic because of visceral metastases.
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Affiliation(s)
- Brian Shuch
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90095-1738, USA
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30
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Mahnken AH, Bruners P, Günther RW. Techniques of interventional tumor therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2008; 105:646-53. [PMID: 19471636 DOI: 10.3238/arztebl.2008.0646] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 05/26/2008] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The last few years have seen the rapid development of new image-guided interventions for the local treatment of malignant tumors. The goal of this article is to provide an overview of the techniques that are most commonly used today in interventional oncology. METHODS Selective literature review on the current state of image-guided interventional techniques for local tumor therapy. RESULTS While surgery, radiation oncology, and systemic chemotherapy are still the three main pillars of tumor therapy, a broad range of minimally invasive, image-guided techniques for local tumor treatment is now available. These may be categorized as percutaneous injection of a toxic substance, transarterial embolization, thermal ablation, and internal radiotherapy. The choice of treatment depends on the type, location, and size of tumor. The greatest amount of clinical experience to date has been gathered in the treatment of primary and secondary hepatic malignancy, but there are interventional treatment options for virtually all regions of the body. At present, the utility of this form of treatment is limited for very large or multiple tumors; novel therapeutic options for these situations are now being studied. DISCUSSION The outcome of treatment depends on a judicious determination of the indication for it. The indication should be established by interdisciplinary consensus after all treatment options have been considered.
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Affiliation(s)
- Andreas H Mahnken
- Klinik für radiologische Diagnostik, Universitätsklinikum der RWTH Aachen.
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He H, Ping F, Chen G, Zhang S. Chemoembolization of tongue carcinoma with ethylcellulose microcapsuled carboplatinum and its basic study. ACTA ACUST UNITED AC 2008; 36:114-22. [PMID: 18437588 DOI: 10.1080/10731190801932108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE By using lingual artery chemoembolization on the basis of detailed basic studies to search an additional way for treatment of certain tongue carcinoma. METHODS Study of lingual artery cast specimens in post-mortem human was processed. Patients with tongue carcinoma were chemoembolized with Carboplatinum microcapsules. RESULTS Microcapsule embolism located approximately at the fifth to the sixth branches level of deep lingual artery. Effective clinical outcomes complied with the anatomy. CONCLUSION Lingual artery chemoembolization with microcapsuled Carboplatinum of 214.0 +/- 48.0 microm showed nice efficacy in therapy of mid-tongue carcinoma.
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Affiliation(s)
- Hong He
- Second Affiliated Hospital, School of Medicine, Zhe Jiang University, Hang Zhou, China
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Rassweiler J, Prager P, Haferkamp A, Alken P, Kauffmann GW, Richter G. Transarterial Nephrectomy: The Current Status of Experimental and Clinical Studies. J Endourol 2008; 22:767-82. [DOI: 10.1089/end.2007.9826] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jens Rassweiler
- Department of Urology, SLK Kliniken Heilbronn, University of Heidelberg, Germany
| | - Peter Prager
- Department of Radiology, SLK Kliniken Heilbronn, University of Heidelberg, Germany
| | - Axel Haferkamp
- Department of Urology, Medical School Heidelberg, University of Heidelberg, Germany
| | - Peter Alken
- Department of Urology, Medical School of Mannheim, University of Heidelberg, Germany
| | - Günther W. Kauffmann
- Department of Radiology, Medical School Heidelberg, University of Heidelberg, Germany
| | - Götz Richter
- Department of Radiology, Medical School Heidelberg, University of Heidelberg, Germany
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Murata S, Tajima H, Onozawa S, Kumita S, Kondo Y, Nomura K. Pilot study of transcatheter arterial ethanol embolization under closed renal circuit for large renal cell carcinomas. Eur Radiol 2008; 18:1464-72. [PMID: 18351354 DOI: 10.1007/s00330-008-0895-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 02/04/2008] [Accepted: 02/07/2008] [Indexed: 11/28/2022]
Abstract
The safety of a new technique, designated "transcatheter arterial embolization (TAE) with aspiration via a balloon-occluded renal drainage vein" (TAE-ABOD), for the management of large renal cell carcinomas (RCCs). The subjects were 25 patients with RCC who underwent a total of 27 sessions of TAE-ABOD. This TAE-ABOD technique incorporates two procedures: balloon occlusion of renal drainage vein and infusion of absolute ethanol into the tumor-feeding arteries during aspiration of blood via a balloon catheter, thereby reducing leakage of absolute ethanol into the systemic circulation. Our primary endpoint was to establish a safe regimen for high-dose ethanol injection therapy, and our secondary endpoint was to assess global survival of the patients. The administered dose of ethanol ranged from 0.2 to 0.5 ml/kg [median: 0.34 (SD: 0.10) ml/kg], increased in a stepwise manner. The systemic ethanol concentration was measurable in 14 patients, and was less than 0.1 mg/ml in 12 and from 0.1 to less than 0.2 mg/ml in two. There were no major complications such as renal failure or renal abscess. TAE-ABOD can safely deliver a high dose of absolute ethanol for the treatment of large RCCs.
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Affiliation(s)
- Satoru Murata
- Department of Radiology/Center for Advanced Medical Technology, Nippon Medical School, 1-1-5 Sendagi, Bunkyou-ku, Tokyo 113-8602, Japan.
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Espinosa G, Miranda LCD, Matias VADC, Fonseca JLTD, Chagas VLA, Rocha FLD. Embolização pré operatória de tumores renais com microparticulas esféricas de tecnologia nacional. (Spherus®-First line Brasil). Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000100012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os autores relatam pela primeira vez utilização de uma nova partícula para embolização, constituída de um núcleo de acetato de polivinil revestido por polivinil-álcool, de forma esférica (Spherus®-First Line Brasil), como preparo pré-operatório em três pacientes portadores de neoplasia renal, na intenção de diminuir o tamanho do tumor e prevenir complicações hemorrágicas durante o ato operatório. Estas novas partículas foram projetadas e elaboradas nos laboratórios da COPPE/UFRJ. A embolização intra-arterial pré-operatória com estas novas partículas ocasionou acentuada isquemia em todo o tecido tumoral facilitando o procedimento cirúrgico.
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He H, Huang JQ, Ping FY, Chen GF, Zhang SZ. Deep lingual arterial chemoembolization of tongue carcinoma with microcapsuled anticancer drug. J Zhejiang Univ Sci B 2007; 8:704-8. [PMID: 17910111 PMCID: PMC1997222 DOI: 10.1631/jzus.2007.b0704] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Microcapsule chemoembolism is a promising treatment of tumors. We describe a deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum. METHODS Lingual artery cast specimens from cadavers were microscopically examined, and 78 patients with tongue cancer were recruited and treated with the deep lingual arterial embolization therapy. RESULTS Microcapsule embolism occurred approximately at the fifth or sixth level of the deep lingual artery branches. The five-year survival rate was 88.5% (69 out of 78), and the ten-year survival rate 52.6% (41 out of 78). CONCLUSION The deep lingual arterial embolization of tongue carcinoma with microcapsuled carboplatinum is an effective therapy to treat carcinoma in mid-margin or mid-body of the tongue.
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Affiliation(s)
- Hong He
- Department of Stomatology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Jian-qi Huang
- Department of Stomatology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Fei-yun Ping
- Department of Stomatology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
- †E-mail:
| | - Guan-fu Chen
- Department of Stomatology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
| | - Su-zhan Zhang
- Cancer Institute, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
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Maxwell NJ, Saleem Amer N, Rogers E, Kiely D, Sweeney P, Brady AP. Renal artery embolisation in the palliative treatment of renal carcinoma. Br J Radiol 2007; 80:96-102. [PMID: 17495058 DOI: 10.1259/bjr/31311739] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study is to review the role and technique of renal artery embolisation (RAE), and assess its effectiveness in the palliative treatment of unresectable or inoperable renal cell carcinoma (RCC) in our institution. The study group consisted of 19 consecutive patients (16 male, 3 female; age range 47-87 years) who underwent palliative RAE for the treatment of renal carcinoma between January 2000 and December 2005. Unresectable disease was present in 11 patients (3 stage IVa, 8 stage IVb). Potentially resectable disease was present in 8 patients (4 stage II, 1 stage IIIa, 1 stage IIIb, 2 stage IIIc); however, these patients were unfit for surgery for other reasons. 13 patients presented with haematuria, which was gross in 7 patients. Nine patients complained of flank pain. RAE was performed using polyvinyl alcohol or embosphere particles, metallic coils and, in some cases, absolute alcohol was necessary. At the time of analysis, 12 patients had died while 7 patients were still alive, with an overall median survival for the study group of 6 months. In the 7 patients with transfusion dependant gross haematuria, there was stabilization of the haemoglobin level post-embolisation. In the 9 patients who presented with flank pain, symptoms improved or resolved in 8 patients. The median length of hospital stay for the 18 patients who were discharged was 5.0 days. RAE is a safe and tolerable management option for patients with inoperable or unresectable renal carcinoma as a means of palliation of local symptoms and improving clinical status, with low morbidity and shorter hospital stay.
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Affiliation(s)
- N J Maxwell
- Department of Diagnostic Radiology, Mercy University Hospital, Grenville Place, Cork, Ireland
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He H, Huang J, Ping F, Chen G, Zhang S, Dong Y. Anatomical and clinical study of lingual arterial chemoembolization for tongue carcinoma. ACTA ACUST UNITED AC 2007; 103:e1-5. [PMID: 17317232 DOI: 10.1016/j.tripleo.2006.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Revised: 10/02/2006] [Accepted: 11/09/2006] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of this study was to develop an alternative treatment approach using lingual artery chemoembolization for certain tongue carcinomas. STUDY DESIGN Fifty-three lingual artery, postmortem, cast human specimens were studied. Seventy-eight patients with tongue carcinoma were chemoembolized with Car-platinum microcapsules. RESULTS The deposition of the microcapsule embolism was approximately at the fifth- to the sixth-branch level of the deep lingual artery. The results complied with the anatomy, and the clinical outcomes were effective. CONCLUSIONS Lingual artery chemoembolization showed efficacy for curing carcinoma in the midmargin and midbody areas of the tongue, within the limitations of this study.
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Affiliation(s)
- Hong He
- Second Affiliated Hospital, School of Medicine, Zhe Jiang University, Hang Zhou, China.
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Gallucci M, Guaglianone S, Carpanese L, Papalia R, Simone G, Forestiere E, Leonardo C. Superselective Embolization as First Step of Laparoscopic Partial Nephrectomy. Urology 2007; 69:642-5; discussion 645-6. [PMID: 17445641 DOI: 10.1016/j.urology.2006.10.048] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/02/2006] [Accepted: 10/05/2006] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Laparoscopic partial nephrectomy is currently very hard to perform because of the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. The aim of this study was to propose a method to decrease the risk of bleeding, consisting of the superselective embolization of tumor vessels before performing the laparoscopic partial nephrectomy. METHODS Fifty patients with small, solitary, enhancing, predominantly exophytic renal tumors underwent a superselective radiographically guided embolization of tumor vessels. An average of 6 hours after embolization, the patients underwent partial laparoscopic nephrectomy, with transperitoneal access and three trocars placed, under balanced general anesthesia. The mean operative time was measured, as was the mean estimated blood loss. RESULTS The mean operative time was 90 minutes, the mean estimated blood loss was 200 mL, and the average hospital stay was 6 days. Complications were reported in only 2 patients. The final pathologic evaluation confirmed the diagnosis of renal cell carcinoma in 43 cases. The median follow-up was 11 months and, to date, the examinations have revealed no recurrences in any of the cases. CONCLUSIONS Superselective embolization is a valid option for laparoscopic partial nephrectomy. The procedure does not require any regional vascular control or clamping, reduces the estimated blood loss, and reduces the operative time.
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Affiliation(s)
- Michele Gallucci
- Department of Urology, Regina Elena Cancer Institute, Rome, Italy.
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Ljungberg B, Hanbury DC, Kuczyk MA, Merseburger AS, Mulders PFA, Patard JJ, Sinescu IC. Renal cell carcinoma guideline. Eur Urol 2007; 51:1502-10. [PMID: 17408850 DOI: 10.1016/j.eururo.2007.03.035] [Citation(s) in RCA: 399] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 03/17/2007] [Indexed: 01/31/2023]
Abstract
OBJECTIVES The European Association of Urology (EAU) Guideline Group for renal cell carcinoma (RCC) prepared this guideline to help urologists assess the evidence-based management of RCC and to incorporate the guideline recommendations into their clinical practice. METHODS The recommendations provided in the current guideline are based on a systematic literature search using MedLine, the Cochrane Central Register of Controlled Trials, and publications and review articles. RESULTS A limited number of prospective randomised studies are available with high-level evidence. Most publications concerning RCC are based on retrospective analyses, including some larger multicentre validation studies and well-designed controlled studies. CONCLUSIONS It must be stressed that the current guideline contains information for the treatment of an individual patient according to a standardised general approach. Updated recommendations concerning diagnosis, treatment, and follow-up can improve the clinical handling of patients with RCC.
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Affiliation(s)
- Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden, and Department of Urology, Lister Hospital, Stevenage, UK.
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40
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Guy L, Alfidja AT, Chabrot P, Ravel A, Boiteux JP, Boyer L. Palliative transarterial embolization of renal tumors in 20 patients. Int Urol Nephrol 2007; 39:47-50. [PMID: 17310315 DOI: 10.1007/s11255-006-9072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Accepted: 06/19/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate immediate technical and clinical results of palliative transarterial renal embolization in patients with symptomatic renal tumors. METHODS Parenchymal embolization of 20 renal tumors was performed in 20 symptomatic patients with hematuria and/or lumbar pain and/or para-neoplastic syndrome. Seven patients were inoperable because of poor general condition, and 15 patients had metastatic lesions. RESULTS Immediate technical success was observed, with post-infarction pain in all patients requiring analgesia in 12 cases (which was successful in 90%); 8 patients had transitory fever. With a median follow up of 8.1 (range 4-27) months, recurrent hematuria was noted in two patients for which partial embolization was initially chosen; pain did not recur in any patients. CONCLUSIONS Palliative embolization of advanced symptomatic renal tumors is easy to accomplish with low morbidity. It helps to alleviate invalidating symptoms in a multidisciplinary management of advanced renal tumors.
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Affiliation(s)
- Laurent Guy
- Department of Urology, University Hospital, CHU G. Montpied BP 69, 63000 Clermont-Ferrand, France.
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Somani BK, Nabi G, Thorpe P, Hussey J, McClinton S. Therapeutic Transarterial Embolisation in the management of benign and malignant renal conditions. Surgeon 2006; 4:348-52. [PMID: 17152199 DOI: 10.1016/s1479-666x(06)80110-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to critically appraise the efficacy and complications of Therapeutic Transarterial Embolisation (TAE) in various benign and malignant renal conditions. MATERIAL AND METHODS The records of all patients who underwent renal embolisation procedures, at a single institution, between March 1992 and March 2004, were reviewed. The patients were identified from hospital records via the procedure coding system and the radiology department procedures book and were analysed retrospectively. Twenty-nine patients were analysed, looking at indications, clinical outcome, complications and long-term results. RESULTS Twenty-nine patients underwent 35 embolisation procedures during this period. Fourteen patients with benign diseases underwent 17 embolisation procedures for haematuria or intractable pain. In the haematuria group, selective embolisation was used to treat bleeding post percutaneous nephrolithotomy (PCNL) (n=4), angiomyolipoma (n=2), arteriovenous (AV) malformation (n=l1), renal artery aneurysm (n=1) and renal trauma (n=2). In the renal pain group (n=3), non-selective embolisation was done. Two of these patients had recurrence of pain despite repeat embolisation and subsequently underwent nephrectomy. Fifteen patients with advanced renal malignancy, who were deemed unfit for surgery, underwent 18 embolisation procedures for symptomatic haematuria. Twelve of the 15 patients had successful outcomes with cessation of haematuria. Three patients required repeat embolisation procedures for continuing haematuria with success. There were no major embolisation-related complications. Minor complications were self-limiting and settled with conservative management. CONCLUSION Renal artery embolisation is effective in managing haematuria in benign and malignant renal conditions where indicated, with minor and easily treatable adverse effects
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Affiliation(s)
- B K Somani
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, AB25 2WA, UK
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Mottet N. Place de la néphrectomie dans la prise en charge des cancers du rein métastatiques. ACTA ACUST UNITED AC 2006; 40:273-9. [PMID: 17100164 DOI: 10.1016/j.anuro.2006.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Metastatic kidney cancer is still a devastating disease but it represents a very heterogeneous situation. Some patients will have a median survival limited to some months, while others will live several years. If the initial diagnosis of kidney cancer at metastatic stage is quite uncommon, it raises the question of whether or not performing initial nephrectomy. The point was long debated as it was suggested that initial nephrectomy could result in a spontaneous metastase regression and protect against local complications (hematuria, local pain,...). Today, nephrectomy must not be systematic, as effective alternative treatments are often available. Furthermore spontaneous postoperative metastasis regression is unusual. Two recent prospective randomized trials clarified the impact of initial nephrectomy. It is now accepted that initial surgery prior to systemic immunotherapy results in 30% survival benefit. However this procedure should only be considered for highly selected cases: patients in otherwise good condition (ECOG 0-1), macroscopically complete local resection, no supra-hepatic caval thrombus, and patients suitable for systemic immunotherapy treatment. Several questions remain unanswered, such as lymph node dissection to be performed, and its real survival impact. Furthermore the definition of "suitable" patients for immunotherapy has to be clarified, based on the recent results from the Percy Quatro study. It would probably be more effective to consider only patients with an expected good survival benefit using immunotherapy, such as those classified as "good prognosis" based on the CRECY criteria. Finally the development of new drugs, targeting mainly the angiogenic pathway may lead to different future indications in this setting.
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Affiliation(s)
- N Mottet
- Clinique mutualiste, 3, rue Le Verrier, 42013 Saint-Etienne cedex 2, France.
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Buse S, Gilfrich C, Wagener N, Pfitzenmaier J, Haferkamp A, Hohenfellner M. Thoraco-abdominal approach to large retroperitoneal tumours. BJU Int 2006; 98:969-72. [PMID: 16879442 DOI: 10.1111/j.1464-410x.2006.06418.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the thoraco-abdominal approach for resection of retroperitoneal tumours, as this approach is rarely used because, although exposure is excellent, morbidity is presumed to be increased. PATIENTS AND METHODS From October 2003 to September 2005, 21 patients (six female, 15 male), aged 14-76 years, underwent resection of very large and/or T4 retroperitoneal tumours through a thoraco-abdominal approach. RESULTS In 16 (76%) patients tumour resection was complete. There were no significant complications during surgery. After surgery, there were complications in six patients (29%), in four of whom there was no long-term impairment. One patient died at 75 days after surgery from a complicated retroperitoneal haematoma. The mean (range) estimated blood loss was 2883 (50-20 000) mL, the intensive-care unit stay was 3.85 (0-30) days and the intermediate-care unit stay 2.6 (0-9) days. With a mean follow-up of 9.6 (1-19) months, 15 patients (72%) are recurrence-free, two (10%) have progressive disease, and four (19%) have died from malignancy. CONCLUSIONS The thoraco-abdominal approach permits excellent exposure of the retroperitoneum for large and/or T4 tumours, allowing radical surgery in cases considered otherwise inoperable. Additional advantages are the possibilities of early vascular control and easy surgical extension of the procedure. These facts, combined with the reasonable morbidity found in our series, support the integration of the thoraco-abdominal approach in the regular options for urological surgery.
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Affiliation(s)
- Stephan Buse
- Department of Urology, University of Heidelberg, Germany.
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Baggish AL, Smith RN, Palacios I, Vlahakes GJ, Yoerger DM, Picard MH, Lowry PA, Jang IK, Fifer MA. Pathological effects of alcohol septal ablation for hypertrophic obstructive cardiomyopathy. Heart 2006; 92:1773-8. [PMID: 16807273 PMCID: PMC1861291 DOI: 10.1136/hrt.2006.092007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The pathological effects and the mechanisms of action of intracoronary administration of ethanol for alcohol septal ablation (ASA) for the management of hypertrophic obstructive cardiomyopathy (HOCM) are unknown. METHODS We examined surgical specimens and, in one case, autopsy specimens from four patients who underwent surgical septal myectomy 2 days to 14 months after unsuccessful ASA. RESULTS Pathological examination early after ASA showed coagulative necrosis of both the myocardium and the septal perforator arteries. Affected arteries were distended and occluded by necrotic intraluminal debris, without platelet-fibrin thrombi. Late after unsuccessful ASA, excised septal tissue was heterogeneous, containing a region of dense scar, and adjacent tissue containing viable myocytes and interspersed scar. CONCLUSIONS Intracoronary administration of ethanol in patients with HOCM causes acute myocardial infarction with vascular necrosis. The coagulative necrosis of the arteries, their distension by necrotic debris and the absence of platelet-fibrin thrombi distinguish ethanol-induced infarction from that caused by atherosclerotic coronary artery disease. The direct vascular toxicity of ethanol may be an important aspect of the mechanism of successful ASA.
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Affiliation(s)
- A L Baggish
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sengupta S, Zincke H, Leibovich BC, Blute ML. Surgical treatment of stage pT3b renal cell carcinoma in solitary kidneys: a case series. BJU Int 2005; 96:54-7. [PMID: 15963120 DOI: 10.1111/j.1464-410x.2005.05566.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the surgical management of patients with renal cell carcinoma (RCC) in a solitary kidney (managed preferentially by nephron-sparing surgery, NSS, to avoid dialysis) and extending into the renal vein or inferior vena cava (T3b). PATIENTS AND METHODS We identified 13 patients treated surgically between 1977 and 2002 for stage T3b RCC in a solitary kidney; their charts were reviewed to ascertain details of management, pathology and outcomes. RESULTS NSS was successful in seven patients (four in situ and three extracorporeally). Five patients had radical nephrectomy (RN), four after failed NSS. The mean (sem) operative duration was longer for NSS, at 5.8 (0.7) h, than RN, at 3.3 (0.6) h. There was one death during surgery before nephrectomy, and eight other complications in six patients. At a median (range) follow-up of 24 (0-204) months, eight patients had died, four from RCC (all having had NSS) at a median interval of 9.5 (7-16) months. Of the five patients alive at a median follow-up of 25 months, four had no identifiable disease, whilst one had systemic recurrence. CONCLUSIONS NSS combined with venous tumour thrombectomy for treating T3b RCC involving a solitary kidney is feasible, albeit complicated. There was oncological success in a third of the patients. The treatment of these patients needs to be individualized, as alternatives to NSS (RN or observation) have obvious disadvantages.
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Sengupta S, Leibovich BC, Blute ML, Zincke H. Surgery for metastatic renal cell cancer. World J Urol 2005; 23:155-60. [PMID: 15988593 DOI: 10.1007/s00345-005-0504-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2004] [Accepted: 11/15/2004] [Indexed: 12/18/2022] Open
Abstract
Renal cell carcinoma (RCC) often presents in its metastatic form, or progresses after curative treatment. While the management of metastatic RCC has historically been mainly surgical, contemporary approaches often incorporate systemic immunotherapy. This review examines the current indications and scope of surgical treatment of patients with metastatic RCC. Surgery is sometimes indicated for symptom palliation at either the primary or secondary sites. However, other less invasive therapies may be equally effective, and should be considered carefully. Cytoreductive surgery prior to immunotherapy appears to confer a survival advantage, but only selected patients are suitable for this treatment regimen. Primary immunotherapy followed by surgical removal of the tumour in partial responders is an alternative treatment strategy, which has not yet been evaluated as in randomized trials. As immunotherapy develops further, the precise timing and role of surgery in multimodality treatment will need to be carefully evaluated. Occasionally, the complete surgical excision of metastases, and the primary tumour, if present, is feasible and this may prolong survival. Empirically, it would seem that such patients should also be treated with adjuvant immunotherapy, as eventual relapse is frequent. Surgery with the aim of inducing spontaneous tumour regression is not justifiable, given the rarity of this phenomenon.
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Affiliation(s)
- Shomik Sengupta
- Department of Urology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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47
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Blasco Alfonso JE, Pallás Costa Y, Ferrer Puchol MD, Hernández Montes E. Embolización arterial selectiva en un caso de carcinoma de células renales como alternativa terapéutica. Actas Urol Esp 2005; 29:314-7. [PMID: 15945260 DOI: 10.1016/s0210-4806(05)73246-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We show a big renal cell carcinoma case in an aged woman with many pathology associated. In view of the family refuse to make the radical surgery and the high surgical risk we decided to apply transarterial embolization treatment with polivinil alcohol particles (PVA). 28 months later the patient becames with no symptoms and with high quality life. We come to the conclusion that embolization is an effective therapeutic for the symptoms control in selectionated cases.
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Abstract
Embolisation has become an accepted modality of cancer treatment in patients with a variety of clinical scenarios. It is commonly used in clinical practice in the treatment of hepatocellular carcinoma, hepatic metastases from colorectal cancer and neuroendocrine tumours, and renal cell carcinoma. This review summarizes the current evidence for the efficacy of embolotherapy in these clinical settings, together with the associated complications.
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Affiliation(s)
- J A Goode
- The Royal London Hospital, Barts and The London NHS Trust, Whitechapel Road, London, E1 1BB, UK
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49
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50
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Singh R, O'Brien T. The role of transarterial embolization in the treatment of renal cell carcinoma. BJU Int 2003. [DOI: 10.1111/j.1464-410x.2004.t01-1-04581_93_1.x] [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]
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