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Kulkarni CB, Pullara SK, C S R, Moorthy S. Complications of Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma. Acad Radiol 2024; 31:2987-3003. [PMID: 38092590 DOI: 10.1016/j.acra.2023.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 07/21/2024]
Abstract
Radiofrequency ablation (RFA) is a potentially curative treatment option for early Hepatocellular carcinoma. The RFA is considered safe with a relatively low incidence of complications ranging from 2%-7.9%. Though most of the complications are self-limiting, sometimes they can be life-threatening. The occurrence of the particular complication depends on various factors like tumour location and morphology, underlying disease and ablation technique. A detailed understanding of potential complications along with the associated risk factors will help to employ strategies to prevent them, identify them early and manage them when they occur. This article demonstrates various radiofrequency ablation-related complications and discusses the risk factors and technical strategies to minimise them and achieve complete ablation of the tumour.
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Affiliation(s)
- Chinmay Bhimaji Kulkarni
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India.
| | - Sreekumar Karumathil Pullara
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Rajsekar C S
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
| | - Srikanth Moorthy
- Department of Radiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Amrita Lane, Ponekkra. Elamakkara P.O. 682041, Kochi, Kerala, India
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2
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Wu L, Hu M, Li P, Man Q, Yuan Q, Zhang X, Qiu Y, Chen L, Fan J, Zhang K. Microwave ablation combined with percutaneous vertebroplasty for treating painful non-small cell lung cancer with spinal metastases under real-time temperature monitoring. J Cancer Res Ther 2024; 20:540-546. [PMID: 38687923 DOI: 10.4103/jcrt.jcrt_1074_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/01/2023] [Indexed: 05/02/2024]
Abstract
PURPOSE To retrospectively study the therapeutic effect and safety performance of the combination strategies of the computed tomography (CT)-guided microwave ablation (MWA) and percutaneous vertebroplasty (PVP) as a treatment for painful non-small cell lung cancer (NSCLC) with spinal metastases. MATERIALS AND METHODS A retrospective review included 71 patients with 109 vertebral metastases who underwent microwave ablation combined with percutaneous vertebroplasty by the image-guided and real-time temperature monitoring. Treatment efficacy was determined by comparing visual analog scale (VAS) scores, daily morphine equivalent opioid consumption, and Oswestry Disability Index (ODI) scores before treatment and during the follow-up period. RESULTS Technical success was achieved in all patients. The mean pre-procedure VAS score and morphine doses were 6.6 ± 1.8 (4-10) and 137.2 ± 38.7 (40-200) mg, respectively. The mean VAS scores and daily morphine doses at 24 h and 1, 4, 12, and 24 weeks postoperatively were 3.3 ± 1.9 and 73.5 ± 39.4 mg; 2.2 ± 1.5 and 40.2 ± 29.8 mg; 1.7 ± 1.2 and 31.3 ± 23.6 mg; 1.4 ± 1.1 and 27.3 ± 21.4 mg; and 1.3 ± 1.1 and 24.8 ± 21.0 mg, respectively (all P < 0.001). ODI scores significantly decreased (P < 0.05). Minor cement leakage occurred in 51 cases (46.8%), with one patient having a grade 3 neural injury. No local tumor progression was observed by follow-up imaging. CONCLUSIONS MWA combined with PVP can significantly relieve pain and improve patients' quality of life, which implied this is an effective treatment option for painful NSCLC with spinal metastases. Additionally, its efficacy should be further verified through the mid- and long-term studies.
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Affiliation(s)
- Linlin Wu
- Department of Oncology, Tengzhou Central People's Hospital Affiliated Xuzhou Medical University, Tengzhou City, Shandong Province, China
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Jiang W, Lee S, Caruana D, Zhuang KD, Cazzato R, Latich I. Recent Advances in Minimally Invasive Management of Osteolytic Periacetabular Skeletal Metastases. Semin Intervent Radiol 2024; 41:154-169. [PMID: 38993598 PMCID: PMC11236455 DOI: 10.1055/s-0044-1787165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Painful skeletal osteolytic metastases, impending pathological fractures, and nondisplaced fractures present as a devastating clinical problem in advanced stage cancer patients. Open surgical approaches provide excellent mechanical stabilization but are often associated with high complication rates and slow recovery times. Percutaneous minimally invasive interventions have arisen as a pragmatic and logical treatment option for patients with late-stage cancer in whom open surgery may be contraindicated. These percutaneous interventions minimize soft tissue dissection, allow for the immediate initiation or resumption of chemotherapies, and present with fewer complications. This review provides the most up-to-date technical and conceptual framework for the minimally invasive management of osseous metastases with particular focus on periacetabular lesions. Fundamental topics discussed are as follows: (1) pathogenesis of cancer-induced bone loss and the importance of local cytoreduction to restore bone quality, (2) anatomy and biomechanics of the acetabulum as a weight-bearing zone, (3) overview of ablation options and cement/screw techniques, and (4) combinatorial approaches. Future studies should include additional studies with more long-term follow-up to better assess mechanical durability of minimally invasive interventions. An acetabulum-specific functional and pain scoring framework should be adopted to allow for better cross-study comparison.
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Affiliation(s)
- Will Jiang
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Sangmin Lee
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
| | - Dennis Caruana
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Kun Da Zhuang
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore, Singapore
| | - Roberto Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), Strasbourg, France
| | - Igor Latich
- Department of Radiology and Biomedical Imaging, Yale Interventional Oncology, New Haven, Connecticut
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Marcelin C, Maas P, Jambon E, Maaloum R, Andreo IM, Le Bras Y, Roman H, Grenier N, Brun JL, Cornelis FH. Long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis. Eur Radiol 2024:10.1007/s00330-024-10689-5. [PMID: 38512491 DOI: 10.1007/s00330-024-10689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To retrospectively evaluate the long-term outcomes after percutaneous cryoablation of abdominal wall endometriosis (AWE). METHOD The Institutional Review Board approved this retrospective observational review of 40 consecutive patients, of a median age of 37 years (interquartile range [IQR] 32-40 years), presenting with a total of 52 symptomatic AWE nodules. All patients underwent cryoablation between January 2013 and May 2022 with a minimum follow-up period of 12 months. Outcomes were assessed using a visual analog scale (VAS) that measured pain, as well as by magnetic resonance imaging (MRI). The pain-free survival rates were derived using the Kaplan-Meier estimator. Adverse events were analyzed and graded using the classification system of the Cardiovascular and Interventional Radiological Society of Europe. RESULTS The median follow-up time was 40.5 months (IQR 26.5-47.2 months). The median VAS score before cryoablation was 8 (IQR 7-9). Complete relief of symptoms was documented in 80% (32/40) of patients at 3 months after initial cryoablation and correlated with the absence of residual endometriosis nodules on MRI. The median pain-free survival rates were 89.2% [95% CI, 70.1-96.4%] at 36 months and 76.8% [95% CI, 55.3-83.8%] after 60 months. No patient or lesion characteristics were found to be prognostic of failure. No major adverse events or side effects were reported in long term. CONCLUSION Cryoablation safely and effectively afforded long-term pain relief for patients with AWE nodules. CLINICAL RELEVANCE STATEMENT AWE cryoablation was found to be safe and effective in the long-term. KEY POINTS • Cryoablation is highly effective with 80% of patients experiencing complete relief of AWE symptoms after a single procedure. • Cryoablation is safe without long-term adverse events or side effects. • The median pain-free survival rates are 89.2% at 36 months and 76.8% at 60 months.
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Affiliation(s)
- Clément Marcelin
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France.
- Université de Bordeaux, INSERM, Bordeaux Institute of Oncology, BRIC U1312, 33000, Bordeaux, France.
| | - Philippe Maas
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Eva Jambon
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Rim Maaloum
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Isabelle Molina Andreo
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Yann Le Bras
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Horace Roman
- Clinique Tivoli- Ducos, Institut Franco-Européen Multidisciplinaire d'Endométriose (IFEMEndo), 33000, Bordeaux, France
| | - Nicolas Grenier
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service d'imagerie diagnostique et thérapeutique de l'adulte, 3300, Bordeaux, France
| | - Jean-Luc Brun
- Centre Hospitalier Universitaire (CHU) de Bordeaux, Service de gynécologie, 33000, Bordeaux, France
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA
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5
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De Vita E, Lo Presti D, Massaroni C, Iadicicco A, Schena E, Campopiano S. A review on radiofrequency, laser, and microwave ablations and their thermal monitoring through fiber Bragg gratings. iScience 2023; 26:108260. [PMID: 38026224 PMCID: PMC10660479 DOI: 10.1016/j.isci.2023.108260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Thermal ablation of tumors aims to apply extreme temperatures inside the target tissue to achieve substantial tumor destruction in a minimally invasive manner. Several techniques are comprised, classified according to the type of energy source. However, the lack of treatment selectivity still needs to be addressed, potentially causing two risks: i) incomplete tumor destruction and recurrence, or conversely, ii) damage of the surrounding healthy tissue. Therefore, the research herein reviewed seeks to develop sensing systems based on fiber Bragg gratings (FBGs) for thermal monitoring inside the lesion during radiofrequency, laser, and microwave ablation. This review shows that, mainly thanks to multiplexing and minimal invasiveness, FBGs provide an optimal sensing solution. Their temperature measurements are the feedback to control the ablation process and allow to investigate different treatments, compare their outcomes, and quantify the impact of factors such as proximity to thermal probe and blood vessels, perfusion, and tissue type.
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Affiliation(s)
- Elena De Vita
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
| | - Daniela Lo Presti
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Carlo Massaroni
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Agostino Iadicicco
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
| | - Emiliano Schena
- Department of Engineering, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Stefania Campopiano
- Department of Engineering, University of Naples “Parthenope”, 80143 Naples, Italy
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6
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Shashi KK, Shahin MM, Johnston P, Shaikh R. Cryoablation for Bone and Soft Tissue Lesions in Pediatric Patients: Complications and Preventive Measures. Cardiovasc Intervent Radiol 2023; 46:1249-1256. [PMID: 37580423 DOI: 10.1007/s00270-023-03523-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE To evaluate complications associated with cryoablation in a pediatric population and review preventive measures to mitigate these complications. MATERIAL AND METHODS Retrospective study including all the image guided cryoablations performed on pediatric population. Immediate and delayed complications were analyzed, and we identified the different protective measures used and the clinical outcomes from follow-up. Point estimates for the percentage of complications were calculated by maximum likelihood, and 95% confidence intervals for the true percentages were calculated using the Clopper-Pearson exact method. RESULTS Eighty-seven ablations were performed on 68 patients (age range of 2-18 years, mean 12.4 years) for non-neoplastic (70%) and neoplastic (30%) lesions. The percentage of ablations resulting in complications was 18% (95% confidence interval (CI) 11% to 28%). Of these, 5% (95% CI 1% to 11%) were grade 3 complications, and 14% (95% CI 7% to 23%) were grade 2 complications. Thermal protection was performed in 27.6% of ablations (n = 24). The mean clinical follow-up duration was 348 days. CONCLUSION Cryoablation in pediatric patients is relatively safe, with a major complication rate per ablation of 5%. Thermal protective measures can be considered to mitigate these complications.
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Affiliation(s)
- Kumar Kempegowda Shashi
- Department of Radiology, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, 72202, USA
| | - Mohamed M Shahin
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Patrick Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Raja Shaikh
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
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7
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Najdawi M, Razakamanantsoa L, Mousseaux C, Bendifallah S, Touboul C, Thomassin-Naggara I, Bazot M, Barral M, Cornelis FH. Resolution of Pain after Percutaneous Image-Guided Cryoablation of Extraperitoneal Endometriosis. J Vasc Interv Radiol 2023; 34:1192-1198. [PMID: 37003579 PMCID: PMC10625427 DOI: 10.1016/j.jvir.2023.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/15/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
PURPOSE To retrospectively evaluate the relief of pain after percutaneous image-guided cryoablation of symptomatic extraperitoneal endometriosis (EE). MATERIAL AND METHODS From 2017 to 2022, cryoablation of EE was performed at a single institution on a total of 47 lesions in 42 consecutive patients (median age, 37 years; interquartile range [IQR], 33-39.5 years). Patient and procedural characteristics were reviewed retrospectively. Tolerance and outcomes in terms of pain and patient satisfaction were evaluated. RESULTS The median follow-up duration was 13.5 months (IQR, 1.1-37.7 months) after cryoablation. The median pain-free survival rate was 93.8% (95% confidence interval [CI], 77.3-98.4) at 6 months and 82.7% (95% CI, 58.8-93.5) after 12 months. Pain decreased from a median of 8/10 (IQR, 7-9) on the visual analog scale to 0/10 (IQR, 0-1) at the last follow-up (P < .0001). The median Patient Global Impression of Change score recorded at the last follow-up was 1/7 (IQR, 1-2). The efficacy rate of cryoablation to avoid secondary surgery was 92.8% (39/42) per patient and 93.6% (44/47) per nodule treated. Four patients (9.5%, 4/42) experienced an adverse event in the days following the procedure, and 1 patient (2%) experienced a severe adverse event. CONCLUSIONS Percutaneous cryoablation is safe and effective in significantly reducing pain and obtaining local control of EE.
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Affiliation(s)
- Milan Najdawi
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, Paris, France
| | - Leo Razakamanantsoa
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, Paris, France
| | - Cyril Mousseaux
- Department of Nephrology, Tenon Hospital, Sorbonne University, Paris, France
| | - Sofiane Bendifallah
- Department of Gynecology, Tenon Hospital, Sorbonne University, Paris, France
| | - Cyril Touboul
- Department of Gynecology, Tenon Hospital, Sorbonne University, Paris, France
| | | | - Marc Bazot
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, Paris, France
| | - Matthias Barral
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, Paris, France
| | - Francois H Cornelis
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, Paris, France; Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.
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8
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Jing R, Merritt T, Gemmete JJ. Diaphragmatic Injury with Empyema Development after Microwave Ablation of a Liver Dome Lesion. Semin Intervent Radiol 2023; 40:258-261. [PMID: 37484437 PMCID: PMC10359124 DOI: 10.1055/s-0043-1769774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Percutaneous microwave ablation (MWA) of the liver is a minimally invasive procedure that utilizes high frequency electromagnetic waves to generate heat and induce tumor necrosis. MWA has been proven to be a safe and effective treatment option for primary and metastatic liver tumors. The treatment of liver dome lesions can present a technical challenge due to the proximity of the hepatic dome to the diaphragm and lung parenchyma. In this report, we present a case of diaphragmatic injury and subsequent empyema following MWA of a liver dome lesion.
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Affiliation(s)
- Ran Jing
- Integrated IR/DR Residency, Michigan Medicine, Ann Arbor, Michigan
| | - Travis Merritt
- Integrated IR/DR Residency, Michigan Medicine, Ann Arbor, Michigan
| | - Joseph J. Gemmete
- Departments of Radiology, Neurosurgery, Neurology, and Otolaryngology, Michigan Medicine, Ann Arbor, Michigan
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Ranjbartehrani P, Ramirez DA, Schmidlin F, Etheridge M, Iaizzo PA, Shao Q, Bischof JC. Nerve Protection During Prostate Cryosurgery. Ann Biomed Eng 2023; 51:538-549. [PMID: 36088432 DOI: 10.1007/s10439-022-03059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/13/2022] [Indexed: 11/30/2022]
Abstract
Cryosurgery is a minimally invasive approach to the treatment of focal prostate cancer (PCa). A major complication is the cryoinjury to the cavernous nerve in the neurovascular bundle (NVB). This nerve cryoinjury halts conduction of action potentials (APs) and can eventually result in erectile dysfunction and therefore diminished quality of life for the patient. Here, we propose the application of cryoprotective agents (CPA) to the regions of the nerves in the NVB, prior to prostate cryosurgery, to minimize non-recoverable loss of AP conduction. We modeled a cryosurgical procedure based on data taken during a clinical case and applied ex-vivo porcine phrenic nerves and rat sciatic nerve with temperature profile of NVB. The APs were measured before and after the CPA exposures and during 3 h of recovery. Comparisons of AP amplitude recovery with various CPA compositions reveal that certain CPAs (e.g., 5% DMSO + 7.5% Trehalose and 5% M22 for porcine and rat nerves, respectively) showed little or no toxicity and effective cryoprotection from freezing (on average 48% and 30% of recovered AP, respectively). In summary, we demonstrate that neural conduction can be preserved after exposure to freezing conditions if CPAs are properly selected and deployed onto the nerve.
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Affiliation(s)
- Pegah Ranjbartehrani
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA
| | - David A Ramirez
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Franz Schmidlin
- Urology Center Hirslanden Grangettes Group, Geneva, Switzerland
| | - Michael Etheridge
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA
| | - Paul A Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA.,Department of Surgery, University of Minnesota, Minneapolis, USA.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA
| | - Qi Shao
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA.
| | - John C Bischof
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA. .,Department of Biomedical Engineering, University of Minnesota, Minneapolis, USA. .,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, USA.
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10
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Wang B, Zhang K, Zhang X, Yang S, Hu M, Li P, Yang W, Fan J, Xing C, Yuan Q. Microwave ablation combined with cementoplasty under real-time temperature monitoring in the treatment of 82 patients with recurrent spinal metastases after radiotherapy. BMC Musculoskelet Disord 2022; 23:1025. [PMID: 36443787 PMCID: PMC9706973 DOI: 10.1186/s12891-022-05999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The spine is the most frequently affected part of the skeletal system to metastatic tumors. External radiotherapy is considered the first-line standard of care for these patients with spine metastases. Recurrent spinal metastases after radiotherapy cannot be treated with further radiotherapy within a short period of time, making treatment difficult. We aimed to evaluate the effectiveness and safety of MWA combined with cementoplasty in the treatment of spinal metastases after radiotherapy under real-time temperature monitoring. METHODS In this retrospective study, 82 patients with 115 spinal metastatic lesions were treated with MWA and cementoplasty under real-time temperature monitoring. Changes in visual analog scale (VAS) scores, daily morphine consumption, and Oswestry Disability Index (ODI) scores were noted. A paired Student's t-test was used to assess these parameters. Complications during the procedure were graded using the CTCAE version 5.0. RESULTS Technical success was attained in all patients. The mean VAS score was 6.3 ± 2.0 (range, 4-10) before operation, and remarkable decline was noted in one month (1.7 ± 1.0 [P < .001]), three months (1.4 ± 0.8 [P < .001]), and six months (1.3 ± 0.8 [P < .001]) after the operation. Significant reductions in daily morphine consumption and ODI scores were also observed (P < .05). Cement leakage was found in 27.8% (32/115) of lesions, with no obvious associated symptoms. CONCLUSION MWA combined with cementoplasty under real-time temperature monitoring is an effective and safe method for recurrent spinal metastases after radiotherapy.
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Affiliation(s)
- Baohu Wang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Kaixian Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Xusheng Zhang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Sen Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Miaomiao Hu
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Peishun Li
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Wanying Yang
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Jing Fan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Chao Xing
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
| | - Qianqian Yuan
- grid.508306.8Department of Oncology, Tengzhou Central People’s Hospital Affiliated to Jining Medical College, 181 Xingtan Road, Tengzhou, 277500 Shandong Province China
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Efficacy and Safety of Angioplasty Balloon Interposition in CT-Guided Percutaneous Thermal Ablation of Hepatic Malignancies to Protect Adjacent Organs. Cardiovasc Intervent Radiol 2022; 45:1401-1407. [PMID: 35794280 PMCID: PMC9458570 DOI: 10.1007/s00270-022-03184-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 05/21/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of placing angioplasty balloons between the liver surface and adjacent organs in CT-guided thermal ablation of subcapsular liver malignancies in case of inadequate success of conventional dissection techniques. MATERIALS AND METHODS A retrospective, single-centre database query identified 327 hepatic malignancies in 153 patients treated in 215 sessions from 2016 to 2018 by thermal ablation. Demographic data, tumour size, distance to adjacent structures, complications and long-term outcomes were assessed when ancillary procedures were performed to protect adjacent organs. RESULTS In 21 of 327 (6.4%) ablations, thermal protection was necessary. Balloon interposition was successfully performed in 9 cases in 8 patients after hydrodissection or gas insufflation failed to separate adherent organs. Median pre- and post-balloon insertion distance was 0 mm [0-2 mm] and 17 mm [8-20 mm]. No balloons were damaged, ruptured or slid away from their initial position. Technical success of MWA and protection of adherent structures were achieved in all procedures. In a median follow-up of 11.5 months [0-49 months], the local control rate was 88.9% as 1 patient was treated twice with an interval of 3 months for local recurrence. Three non-process-related major complications and 1 minor complication occurred. CONCLUSION Balloon interposition is a safe and feasible method to enable thermal ablation to a greater number of patients, even after established thermo-protective techniques fail to separate the colon or stomach from the liver surface.
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12
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Schwartz J, Auloge P, Koch G, Robinson JM, Garnon J, Cazzato RL, Perruisseau-Carrier J, Debry C, Gangi A. Percutaneous Cryoablation for Recurrent Head and Neck Tumors. Cardiovasc Intervent Radiol 2022; 45:791-799. [PMID: 35378612 DOI: 10.1007/s00270-022-03120-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To report techniques and results of 16 cryoablation procedures in 11 patients treated for recurrent head and neck cancer. METHODS AND MATERIALS This retrospective study reviewed 11 consecutive patients with head and neck cancer recurrence after primary treatment by surgery and radiotherapy, treated with cryoablation between 2016 and 2020. Efficacy was measured by local control rate evaluated on MRI or/and PET. Tumor characteristics, number of cryoprobes, thermoprotective measures and complications were documented. RESULTS Sixteen cryoablation procedures were performed in 11 patients with head and neck cancer recurrence after surgery or radiotherapy, deemed ineligible for classic salvage treatment. Among 11 patients, four were treated for an epidermoid carcinoma, four for an adenocarcinoma and three for other types: 1 muco-epidermoid carcinoma, 1 adenoid cystic carcinoma and 1 esthesioneuroblastoma, 10/11 patients had prior surgery, 7/11 patients had prior chemotherapy and 3/11 patients had prior radiotherapy. Median number of cryoprobes was 4, [IQR, 3-6 cryoprobes], thermoprotective measures to protect surrounding organs were required for 10/16 procedures. After cryoablation, local control rate was 45.4% at a mean follow-up of 11.7 months (range 3-34 months). Among the 16 cryoablation procedures, four resulted in complications, two were considered major complications: one septic shock on inhalation pneumopathy during extubation, requiring intensive care; and one dysphonia due to a recurrent nerve injury. CONCLUSION Cryoablation as a salvage treatment for recurrence of head and neck tumors after surgery and/or radiotherapy is an effective option, especially for patients that cannot benefit from salvage surgery.
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Affiliation(s)
- Jean Schwartz
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France.
| | - Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Joey Marie Robinson
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
| | - Joffrey Perruisseau-Carrier
- Service d'oto-rhino-laryngologie, Hopitaux Universitaire de Strasbourg, 1, avenue Molière, 67200, Strasbourg, France
| | - Christian Debry
- Service d'oto-rhino-laryngologie, Hopitaux Universitaire de Strasbourg, 1, avenue Molière, 67200, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, place de l'hopital, 67000, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, WC2R 2LS, UK
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13
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Bode AD, Heithaus RE, Prologo D. External Skin Warming Using Saline Soaked Gauze During Cryoablation with in Vivo Temperature Data: A Letter to the Editor. J Vasc Interv Radiol 2022; 33:856-857. [DOI: 10.1016/j.jvir.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/28/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022] Open
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14
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Yadav A, Seth R, Gupta A. Microwave Ablation of Spinal Osteoid Osteoma—Role of Air Insulation. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1742727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractOsteoid osteomas are benign tumors seen in children and young adults. The management options include surgical resection and percutaneous ablation. In the present scenario, percutaneous ablation is the preferred modality, as it is minimally invasive, safe, and reliable. However, when the tumor is near a heat-vulnerable structure, thermal injury can occur.We report the case of spinal osteoid osteoma in a young female that was treated by microwave ablation (MWA) with air insulation to prevent heat injury to the spinal cord. Currently, there is paucity of literature describing the use of air insulation with MWA. In this report, we describe the technique, advantages, and limitations of using air insulation with MWA.
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Affiliation(s)
- Ajit Yadav
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Raghav Seth
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Arun Gupta
- Department of Interventional Radiology, Sir Ganga Ram Hospital, New Delhi, India
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15
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Percutaneous Cryoablation of Large Tumors: Safety, Feasibility, and Technical Considerations. Cardiovasc Intervent Radiol 2021; 45:69-79. [PMID: 34859309 DOI: 10.1007/s00270-021-03025-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Large tumors may prove unsuitable for surgical cure or other local therapies due to their size, involvement of critical structures, prior non-ablative treatment failure, or coexisting disease burden. This study was performed to assess the safety and feasibility of percutaneous cryoablation for treatment of large tumors exceeding 6 cm in size, and to highlight the key technical considerations inherent to such cases. MATERIALS AND METHODS This single-institution retrospective study identified 77 patients (42 male, 35 female; median age 55 years) who underwent 96 cryoablation procedures for treatment of 78 tumors (mean diameter 9.8 ± 3.6 cm) from 2008 through 2020. Technical success, procedure-related complications, mortality, oncologic outcomes, and procedural logistics were evaluated. Technical success was defined as ice ball extension at least 5 mm beyond the tumor margins. RESULTS Intentional subtotal ablations were performed in 32% of cases due to tumor encroachment on vulnerable structures or as part of staged/combined therapies. Of the 68% of cases that were planned for complete ablation, the technical success rate was 100%. Major complications occurred after 19/96 (20%) procedures, with hemorrhage and acute kidney injury each occurring in 6/96 (6%). Post-procedural myositis occurred in 24/96 (25%) cases and was not considered a major complication in the absence of acute kidney injury. Local recurrence occurred in 2/23 (8.7%) of patients undergoing ablation for cure or local control at a median follow-up duration of 13 months. CONCLUSION Percutaneous cryoablation may be used to treat large (> 6 cm) tumors with a high degree of technical success and an acceptable safety profile.
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16
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Ablation Techniques in Cancer Pain. Cancer Treat Res 2021; 182:157-174. [PMID: 34542882 DOI: 10.1007/978-3-030-81526-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Painful bone metastases are a frequently encountered problem in oncology practice. The skeletal system is the third most common site of metastatic disease and up to 85% of patients with breast, prostate, and lung cancer may develop bone metastases during the course of their disease.
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17
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The Pain Crisis: Interventional Radiology's Role in Pain Management. AJR Am J Roentgenol 2021; 217:676-690. [DOI: 10.2214/ajr.20.24265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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De Tommasi F, Massaroni C, Grasso RF, Carassiti M, Schena E. Temperature Monitoring in Hyperthermia Treatments of Bone Tumors: State-of-the-Art and Future Challenges. SENSORS (BASEL, SWITZERLAND) 2021; 21:5470. [PMID: 34450911 PMCID: PMC8400360 DOI: 10.3390/s21165470] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 12/22/2022]
Abstract
Bone metastases and osteoid osteoma (OO) have a high incidence in patients facing primary lesions in many organs. Radiotherapy has long been the standard choice for these patients, performed as stand-alone or in conjunction with surgery. However, the needs of these patients have never been fully met, especially in the ones with low life expectancy, where treatments devoted to pain reduction are pivotal. New techniques as hyperthermia treatments (HTs) are emerging to reduce the associated pain of bone metastases and OO. Temperature monitoring during HTs may significantly improve the clinical outcomes since the amount of thermal injury depends on the tissue temperature and the exposure time. This is particularly relevant in bone tumors due to the adjacent vulnerable structures (e.g., spinal cord and nerve roots). In this Review, we focus on the potential of temperature monitoring on HT of bone cancer. Preclinical and clinical studies have been proposed and are underway to investigate the use of different thermometric techniques in this scenario. We review these studies, the principle of work of the thermometric techniques used in HTs, their strengths, weaknesses, and pitfalls, as well as the strategies and the potential of improving the HTs outcomes.
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Affiliation(s)
- Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
| | - Rosario Francesco Grasso
- Unit of Interventional Radiology, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, School of Medicine, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy;
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentations, Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy; (F.D.T.); (C.M.)
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19
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Serrano E, Zarco F, Gill AE, Hawkins CM, Macías N, Inarejos Clemente EJ, Torner F, Barber I, Corominas D, González EL, López-Rueda A, Gómez FM. Percutaneous cryoablation of chondroblastoma and osteoblastoma in pediatric patients. Insights Imaging 2021; 12:106. [PMID: 34313884 PMCID: PMC8314258 DOI: 10.1186/s13244-021-01036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To review the safety and efficacy of percutaneous cryoablation for the treatment of chondroblastoma and osteoblastoma in the pediatric and adolescent population. MATERIALS AND METHODS A retrospective review from 2016 to 2020 was performed to evaluate clinical and imaging response to percutaneous cryoablation in 11 symptomatic patients with diagnosis of chondroblastoma and osteoblastoma treated from two pediatric hospitals with at least 12-month follow-up. Technical success (correct needle placement and potential full coverage of the tumor with the planned ablation zone) and clinical success (relief of the symptoms) were evaluated. The primary objective was to alleviate pain related to the lesion(s). Immediate and late complications were recorded. Patients were followed in clinic and with imaging studies such as MRI or CT for a minimum of 6 months. RESULTS A total of 11 patients were included (mean 14 years, age range 9-17; male n = 8). Diagnoses were osteoblastoma (n = 4) and chondroblastoma (n = 7). Locations were proximal humerus (n = 1), femur condyle (n = 1), and proximal femur (n = 1) tibia (n = 3), acetabulum (n = 3), thoracic vertebra (n = 1) and lumbar vertebra (n = 1). Cryoablation was technically successful in all patients. Clinical success (cessation of pain) was achieved in all patients. No signs of recurrence were observed on imaging follow-up in any of the patients. One of the patients developed periprocedural right L2-L3 transient radiculopathy as major immediate complication. CONCLUSIONS Percutaneous image-guided cryoablation can be considered potentially safe and effective treatment for chondroblastoma and osteoblastoma in children and adolescents.
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Affiliation(s)
- Elena Serrano
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Federico Zarco
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Anne E Gill
- Department of Interventional Radiology, Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia
| | - C Matthew Hawkins
- Department of Interventional Radiology, Children's Healthcare of Atlanta, Egleston Hospital, Atlanta, Georgia
| | - Napoleón Macías
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | | | - Ferran Torner
- Pediatric Orthopaedics and Traumatology Department, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ignasi Barber
- Department of Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Daniel Corominas
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Enrique Ladera González
- Department of Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Antonio López-Rueda
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain.,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Fernando M Gómez
- Department of Interventional Radiology, Hospital Clínic Barcelona, Barcelona, Spain. .,Department of Interventional Radiology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
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20
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Giraud N, Buy X, Vuong NS, Gaston R, Cazeau AL, Catena V, Palussiere J, Roubaud G, Sargos P. Single-Center Experience of Focal Thermo-Ablative Therapy After Pelvic Radiotherapy for In-Field Prostate Cancer Oligo-Recurrence. Front Oncol 2021; 11:709779. [PMID: 34381730 PMCID: PMC8350731 DOI: 10.3389/fonc.2021.709779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In-field prostate cancer (PCa) oligo-recurrence after pelvic radiotherapy is a challenging situation for which metastasis-directed treatments may be beneficial, but options for focal therapies are scarce. METHODS We retrospectively reviewed data for patients with three or less in-field oligo-recurrent nodal, bone and/or locally recurrent (prostate, seminal vesicles, or prostatic bed) PCa lesions after radiation therapy, identified with molecular imaging (PET and/or MRI) and treated by focal ablative therapy (cryotherapy or radiofrequency) at the Institut Bergonié between 2012 and 2020. Chosen endpoints were the post-procedure PSA response (partially defined as a >50% reduction, complete as a PSA <0.05 ng/ml), progression-free survival (PFS) defined as either a biochemical relapse (defined as a rise >25% of the Nadir and above 2 ng/ml), radiological relapse (on any imaging technique), decision of treatment modification (hormonotherapy initiation or line change) or death, and tolerance. RESULTS Forty-three patients were included. Diagnostic imaging was mostly 18F-Choline positron emission tomography/computerized tomography (PET/CT) (75.0%), prostate specific membrane antigen (PSMA) PET/CT (9.1%) or a combination of pelvic magnetic resonance imaging (MRI), CT, and 99 mTc-bone scintigraphy (11.4%). PSA response was observed in 41.9% patients (partial in 30.3%, complete in 11.6%). In the hormone-sensitive exclusive focal ablation group (n = 31), partial and complete PSA responses were 32.3 and 12.9% respectively. Early local control (absence of visible residual active target) on the post-procedure imaging was achieved with 87.5% success. After a median follow-up of 30 months (IQR 13.3-56.8), the median PFS was 9 months overall (95% CI, 6-17), and 17 months (95% CI, 11-NA) for PSA responders. Complications occurred in 11.4% patients, with only one grade IIIb Dindo-Clavien event (uretral stenosis requiring endoscopic uretrotomy). CONCLUSION In PCa patients showing in-field oligo-recurrence after pelvic radiotherapy, focal ablative treatment is a feasible option, possibly delaying a systemic treatment initiation or modification. These invasive strategies should preferably be performed in expert centers and discussed along other available focal strategies in multi-disciplinary meetings.
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Affiliation(s)
- Nicolas Giraud
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
| | - Xavier Buy
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Nam-Son Vuong
- Urology Department, Clinique Saint Augustin, Bordeaux, France
| | - Richard Gaston
- Urology Department, Clinique Saint Augustin, Bordeaux, France
| | | | - Vittorio Catena
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Jean Palussiere
- Oncologic Imaging Department, Institut Bergonié, Bordeaux, France
| | - Guilhem Roubaud
- Medical Oncology Department, Institut Bergonié, Bordeaux, France
| | - Paul Sargos
- Radiation Oncology Department, Institut Bergonié, Bordeaux, France
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21
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De Marini P, Cazzato RL, Auloge P, Koch G, Dalili D, Garnon J, Gangi A. Percutaneous image-guided thermal ablation of bone metastases: a retrospective propensity study comparing the safety profile of radio-frequency ablation and cryo-ablation. Int J Hyperthermia 2021; 37:1386-1394. [PMID: 33322960 DOI: 10.1080/02656736.2020.1859628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To retrospectively compare the safety profile of percutaneous image-guided radiofrequency ablation (RFA) and cryoablation (CA) of bone metastases (BM) with and without a propensity score analysis. METHODS Between January 2008 and April 2018, 274 consecutive patients (mean age 61.6 ± 12.1 years) with BM were treated at our Institution with RFA (53 patients; 66 BM) or CA (221 patients; 301 BM) and included in this study. Complications were assessed according to the type of ablation modality before and after applying a 1:1 propensity score method taking into account patient's demographics, BM features, procedural details and follow-up findings. RESULTS In the whole 9 BM (2.5%) reported major complications without significant difference between RFA (1/66; 1.5%) and CA (8/301; 2.7%; p = 1); 40 BM (10.9%) showed minor complications, which were more common with RFA (22/66; 33.3%) than with CA (18/301; 6.0%, p<.001) mainly due to post-procedural pain occurring more frequently with RFA than CA (20/66; 30.3% vs. 7/301; 2.3%, p<.001). Following 1:1 matching, similar results were obtained, since there were similar rates of major complications with RFA and CA (1/66 [1.5%] and 0/66 [0.0%], respectively; p = 1); and higher rates of minor complications with RFA compared to CA [33.3% (22/66) vs. 2/66 (3%); p<.001] due to preponderant postprocedural pain (90.9% [20/22] minor complications with RFA). CONCLUSIONS Similar low rates of major complications are expected with RFA and CA of BM. In the post-operative period, RFA appears more painful than CA, thus warranting for adoption of dedicated analgesic protocols for patients undergoing RFA.
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Affiliation(s)
- Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
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22
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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23
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Auloge P, Garnon J, Robinson JM, Thenint MA, Koch G, Caudrelier J, Weiss J, Cazzato RL, Kurtz JE, Gangi A. Percutaneous cryoablation for advanced and refractory extra-abdominal desmoid tumors. Int J Clin Oncol 2021; 26:1147-1158. [PMID: 33709291 DOI: 10.1007/s10147-021-01887-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/11/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess efficacy and safety of percutaneous cryoablation (CA) for advanced and refractory extra-abdominal desmoid tumors. MATERIALS AND METHODS This retrospective study reviewed 30 consecutive patients with symptomatic desmoid tumors evolving after "wait and watch" periods, and despite medical treatment, treated by CA between 2007 and 2019. Progression free survival (PFS), objective response rate, pain reduction (decreased of visual analogic scale pain (VAS)[Formula: see text] 3 or disappearance of pain), total volume lesion (TVL) and complications were documented. Kaplan Meier method was used to outline PFS. Paired sample t test was used to compare volume of tumors before treatment and at 1 and 3 year. RESULTS With a median follow-up of 18.5 months (range 6-93 months, interquartile range (IQR): 12-55), the PFS was 85.1% at 1 year and 77.3% at 3 years. Objective response was obtained for 80% of patients with a complete response for 43% patients. Pain reduction was obtained for 96.7% (95% confidence interval (95% CI): 90.3, 100) of patients. Median volume of desmoid tumor before treatment was 124.1cm3 (range 2-1727cm3, IQR: 54-338cm3). Median change of TLV after ablation was 66.6% (95% CI: 37.2, 72.3; p = 0.002) at 1 year and 76.4% (95% CI: 59.1, 89.8; p = 0.002) at 3 year. Adverse events rate was 36.6%, the most common was edema and temporary increase of pain in the days following CA. Four patients experienced a major complication (13.3%): 2 skin necrosis, 1 infection and 1 brachial plexopathy. CONCLUSION CA is an effective treatment for advanced and refractory extra-abdominal desmoid tumor, that induces durable responses.
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Affiliation(s)
- Pierre Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France.
| | - Julien Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Joey Marie Robinson
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | | | - Guillaume Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Jean Caudrelier
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Julia Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Roberto Luigi Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
| | - Jean Emmanuel Kurtz
- Service d'Oncologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 3 rue des Alisiers, 67100, Strasbourg, France
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24
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Cazzato RL, De Marini P, Leonard-Lorant I, Dalili D, Koch G, Autrusseau PA, Mayer T, Weiss J, Auloge P, Garnon J, Gangi A. Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control. Diagn Interv Imaging 2021; 102:355-361. [PMID: 33487588 DOI: 10.1016/j.diii.2020.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases. MATERIALS AND METHODS From February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60±8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients' demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS). RESULTS Sixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38±19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31±21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2±2 (SD) (median, 1; range: 0-6) vs. 5±1 (median, 5; range: 4-8; P<0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4±4 (SD) (median, 2; range: 1-8) months follow-up. CONCLUSION Percutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.
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Affiliation(s)
- Roberto L Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France.
| | - Pierre De Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Ian Leonard-Lorant
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, OX37LD Oxford, United Kingdom; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre A Autrusseau
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Theo Mayer
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, Strand, WC2R 2LS London, United Kingdom
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Moynagh MR, Dowdy SC, Welch B, Glaser GE, Schmitz JJ, Jatoi A, Langstraat CL, Block MS, Kurup AN, Kumar A. Image-guided tumor ablation in gynecologic oncology: Review of interventional oncology techniques and case examples highlighting a collaborative, multidisciplinary program. Gynecol Oncol 2020; 160:835-843. [PMID: 33388156 DOI: 10.1016/j.ygyno.2020.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 01/20/2023]
Abstract
As interventional oncology services within radiology mature, image-guided ablation techniques are increasingly applied to recurrent gynecologic malignancies. Ablation may be performed using thermal techniques like cryoablation, microwave ablation, or radiofrequency ablation, as well as non-thermal ones, such as focused ultrasound or irreversible electroporation. Feasibility and approach depend on tumor type, size, number, anatomic location, proximity of critical structures, and goals of therapy. Current indications include local control of limited metastatic disease or palliation of painful bone metastases refractory or unsuitable to conventional therapies. Technical aspects of these procedures, including methods to protect nearby critical structures are presented through illustrative examples. Cases amenable to image-guided ablation include, but are not limited to, hepatic or pulmonary metastases, musculoskeletal metastases, retroperitoneal nodal metastases, pelvic side wall disease, abdominal wall disease, and vaginal or vulvar tumors. Protective maneuvers, such as hydro-displacement of bowel, neuromonitoring, and retrograde pyeloperfusion through ureteral stents, permit safe ablation despite close proximity to vulnerable nerves or organs. Image-guided ablation offers an alternative modality to achieve local tumor control without the risks associated with surgery or systemic treatment in appropriately selected patients. A multidisciplinary approach to use of image-guided ablation includes collaboration between gynecologic oncology, interventional radiology, anesthesia, urology and radiation oncology teams allowing for appropriate patient-centered case selection. Long-term follow up and additional studies are needed to determine the oncologic benefits of such techniques.
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Affiliation(s)
- Michael R Moynagh
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Sean C Dowdy
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Brian Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Gretchen E Glaser
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Aminah Jatoi
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - Carrie L Langstraat
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America
| | - Matthew S Block
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States of America
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Amanika Kumar
- Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, United States of America.
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Bhatt AA, Woodard GA, Lee CU. Hydrodissection - Practical applications in ultrasound-guided breast interventions. Clin Imaging 2020; 72:198-203. [PMID: 33486301 DOI: 10.1016/j.clinimag.2020.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/19/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022]
Abstract
Hydrodissection is a procedural tactic utilized in various interventions. It is a technique which helps separate structures in order to safely perform a certain procedure. This article will provide a review of hydrodissection, how to perform this technique, and why it can be useful in breast interventions.
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Affiliation(s)
- Asha A Bhatt
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America.
| | - Genevieve A Woodard
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America
| | - Christine U Lee
- Mayo Clinic, Department of Radiology - Division of Breast Imaging, 200 1(st) Street SW, Rochester, MN 55905, United States of America
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Cazzato RL, Garnon J, Koch G, Dalili D, Rao PP, Weiss J, Bauones S, Auloge P, de Marini P, Gangi A. Musculoskeletal interventional oncology: current and future practices. Br J Radiol 2020; 93:20200465. [DOI: 10.1259/bjr.20200465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Management of musculoskeletal (MSK) tumours has traditionally been delivered by surgeons and medical oncologists. However, in recent years, image-guided interventional oncology (IO) has significantly impacted the clinical management of MSK tumours. With the rapid evolution of relevant technologies and the expanding range of clinical indications, it is likely that the impact of IO will significantly grow and further evolve in the near future.In this narrative review, we describe well-established and new interventional technologies that are currently integrating into the IO armamentarium available to radiologists to treat MSK tumours and illustrate new emerging IO indications for treatment.
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Affiliation(s)
- Roberto Luigi Cazzato
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Guillaume Koch
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Danoob Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Windmill Rd, Oxford OX3 7LD, United Kingdom
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - Julia Weiss
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Salem Bauones
- Department of Radiology, King Fahad Medical City, Riyadh, 11525, Saudi Arabia
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Pierre de Marini
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg 1 place de l’hôpital, 67000, Strasbourg, France
- Department of Interventional Radiolgy, Guy's and St Thomas' NHS Foundation Trust, King's College London, London WC2R 2LS, United Kingdom
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Cazzato RL, Palussière J, Auloge P, Rousseau C, Koch G, Dalili D, Buy X, Garnon J, De Marini P, Gangi A. Complications Following Percutaneous Image-guided Radiofrequency Ablation of Bone Tumors: A 10-year Dual-Center Experience. Radiology 2020; 296:227-235. [DOI: 10.1148/radiol.2020191905] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Spinal metastases treated with bipolar radiofrequency ablation with increased (>70°C) target temperature: Pain management and local tumor control. Diagn Interv Imaging 2020; 102:27-34. [PMID: 32482583 DOI: 10.1016/j.diii.2020.04.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE To investigate the safety and clinical efficacy of bipolar radiofrequency ablation (b-RFA) with increased (>70°C) target temperature for the treatment of spine metastases with the intent of achieving pain relief or local tumor control. MATERIALS AND METHODS Thirty-one patients with a total of 37 metastases who were treated with b-RFA with increased temperature and vertebroplasty from January 2016 to May 2019 were retrospectively included. There were 20 women and 11 men with a mean age of 62.4±10.5 (SD) years (range: 40-78years). Patients and metastases characteristics, procedure details and clinical outcomes were analyzed. RESULTS Metastases were predominantly located in lumbar (22/37; 59.5%) or thoracic spine (13/37; 35.1%). Mean target temperature was 88.4±3.5 (SD) °C (range: 70-90°C). Technical success was 100% (37/37 metastases). One (1/37; 2.7%) major complication unrelated to b-RFA was reported. One (1/37; 2.7%) metastasis was lost to follow-up. Favorable outcome was noted in patients receiving b-RFA for pain management (16/20 metastases; 80%; mean follow-up, 3.4±2.9 [SD] months) or with oligometastatic/oligoprogressive disease (6/6 metastases; 100%; mean follow-up, 5.0±4.6 [SD] months). In patients receiving b-RFA to prevent complications, favorable outcome was noted in 6/10 metastases (60%; mean follow-up, 3.8±4.8 [SD] months). CONCLUSIONS B-RFA with increased target temperature has an excellent safety profile and results in high rates of pain relief and local metastasis control in patients with oligometastatic/oligoprogressive disease. Suboptimal results are achieved in patients receiving b-RFA to prevent complications related to the growth of the index tumor.
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Sandberg JK, Shoaf KR, Lungren MP, Young VA, Josephs S, Thakor AS. Dynamic Hydrodissection for Skin Protection during Cryoablation of Superficial Lesions. J Vasc Interv Radiol 2020; 31:1942-1945. [PMID: 32418774 DOI: 10.1016/j.jvir.2020.01.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jesse K Sandberg
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
| | - Kevin R Shoaf
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
| | - Matthew P Lungren
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
| | - Victoria A Young
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
| | - Shellie Josephs
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
| | - Avnesh S Thakor
- Department of Pediatric Interventional Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine 3155 Porter Drive, Stanford, CA 94034
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31
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Auloge P, Cazzato RL, Chiang JB, Caudrelier J, Weiss J, De Marini P, Koch G, Garnon J, Gangi A. Performance of a New Blunt-Tip Needle for the Displacement of Critical Structure in Thermal Ablation. Cardiovasc Intervent Radiol 2020; 43:924-930. [PMID: 32342162 DOI: 10.1007/s00270-020-02472-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/27/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE To ascertain the performance of a new blunt-tip needle (HydroGuard®), which allows injection of fluids during needle advancement in order to safely approach, displace and insulate nearby critical structures during thermal ablation (TA). MATERIALS AND METHODS This study included 27 consecutive patients treated by TA [cryoablation (CA), radiofrequency (RFA), and microwave MWA)] between April 2018 and January 2019. During TA, hydro- or gas dissection was performed with HydroGuard® needle to displace and protect critical structures close to the tumor (< 10 mm). Technical and clinical success, distance between critical structure and tumor before and after hydro/gas dissection and complications were recorded. RESULTS Eighteen patients were treated by CA (66.7%), 7 by MWA (25.9%) and 2 by RFA (7.4%). Majority of patients were treated with a curative intent (24/27; 88.8%). Adjacent critical structures include vessels (n = 3), nerves (n = 10), ureter/renal pelvis (n = 3), bowel/rectum (n = 10), stomach: (n = 3), diaphragm (n = 2), and pleura (n = 1). Technical success was 100%. Clinical success was 88% (24/27). Median minimum distance to adjacent critical structures before hydro/gas dissection was 1 mm (range 0-9 mm; IQR: 0-3 mm) versus 10.5 mm (range 4-47 mm; IQR: 9.7-18 mm) after displacement. Of the 27 patients treated, four developed complications (14.8%; 95% CI: 1.4-28.2): 1 major (3.7%; 95% CI: 0-10.8) and 3 minors (11.1%; 95% CI: 0-23). Only one minor complication was related to inadequate hydro-dissection, resulting in close proximity of the critical structure to the ablation zone. CONCLUSION HydroGuard® is a safe and effective needle when used to approach, displace and insulate nearby critical structures during TA.
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Affiliation(s)
- Pierre Auloge
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France.
| | - Roberto L Cazzato
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Jeanie Betsy Chiang
- Department of Radiology and Imaging, Queen Elizabeth Hospital, Yau Ma Tei, Hong Kong
| | - Jean Caudrelier
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Julia Weiss
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Pierre De Marini
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Guillaume Koch
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Julien Garnon
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
| | - Afshin Gangi
- Interventional Radiology, Imagerie Interventionnelle, Nouvel Hôpital Civil, University Hospital of Strasbourg, 1 Place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France
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Carabin J, Bouhamama A, Vaz G, Cuinet M, Ricoeur A, Thibaut A, Beji H, Mastier C, Pilleul F. Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation. J Vasc Interv Radiol 2020; 31:558-563.e3. [PMID: 32113799 DOI: 10.1016/j.jvir.2019.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/04/2019] [Accepted: 10/08/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of cryoablation for venous malformations. MATERIALS AND METHODS A total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19-58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0-8), and median initial lesion size was 32.5 mm (range, 11-150 mm). RESULTS The median VAS score at 3 mo was 0 (range, 0-4), and the median lesion size at 3 mo was 0 mm (range, 0-142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria. CONCLUSIONS Percutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.
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Affiliation(s)
- Jonathan Carabin
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France.
| | - Amine Bouhamama
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Gualter Vaz
- Department of Orthopedic Surgery, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Marie Cuinet
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Alexis Ricoeur
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Antoine Thibaut
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Hedi Beji
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Charles Mastier
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
| | - Frank Pilleul
- Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France
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Sato Y, Hasegawa T, Chatani S, Murata S, Inaba Y. Percutaneous Radiofrequency Ablation for Liver Tumors: Technical Tips. INTERVENTIONAL RADIOLOGY 2020; 5:50-57. [PMID: 36284662 PMCID: PMC9550427 DOI: 10.22575/interventionalradiology.2020-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
Percutaneous radiofrequency ablation (RFA) has been accepted as a minimally invasive therapeutic treatment for liver malignancies. Although RFA is usually applied for the treatment of small liver tumors (<3 cm), several technical developments have expanded the use of RFA. RFA is now used for the treatment of large liver tumors, and the number of complications associated with this treatment has decreased. These refinements may ultimately lead to better long-term prognosis. Here, we review recent refinements of liver RFA and provide technical tips.
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Affiliation(s)
- Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital
| | - Takaaki Hasegawa
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital
| | - Shohei Chatani
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital
| | - Shinichi Murata
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital
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Lecigne R, Garnon J, Cazzato RL, Auloge P, Dalili D, Koch G, Gangi A. Transforaminal Insertion of a Thermocouple on the Posterior Vertebral Wall Combined with Hydrodissection during Lumbar Spinal Radiofrequency Ablation. AJNR Am J Neuroradiol 2019; 40:1786-1790. [PMID: 31558495 DOI: 10.3174/ajnr.a6233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/01/2019] [Indexed: 01/23/2023]
Abstract
The purpose of the present article is to describe the technique of transforaminal insertion of an ultrathin thermosensor in the anterior epidural space in 13 patients treated by radiofrequency ablation. The mean time taken to position the thermosensor was 10.6 minutes (range, 5-38 minutes). Technical success was 93% (correct positioning in 13/14 levels). Additional hydrodissection was performed through the same access in 11 cases. No postoperative neural deficit was elicited in any of the cases.
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Affiliation(s)
- R Lecigne
- From the Department of Radiology (R.L.), Pôle d'imagerie, Centre Hospitalier Universitaire, Cedex, France
| | - J Garnon
- Department of Interventional Radiology (J.G., R.L.C., P.A., G.K., A.G.), Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - R L Cazzato
- Department of Interventional Radiology (J.G., R.L.C., P.A., G.K., A.G.), Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - P Auloge
- Department of Interventional Radiology (J.G., R.L.C., P.A., G.K., A.G.), Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - D Dalili
- Department of Radiology and Radiological Science (D.D.), Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - G Koch
- Department of Interventional Radiology (J.G., R.L.C., P.A., G.K., A.G.), Hopitaux Universitaires de Strasbourg, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology (J.G., R.L.C., P.A., G.K., A.G.), Hopitaux Universitaires de Strasbourg, Strasbourg, France
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Abstract
OBJECTIVE. The aim of this observational study was to assess safety and clinical outcomes of percutaneous image-guided cryoablation (CA) to treat osteoblastomas (OBs) at various osseous sites. MATERIALS AND METHODS. A retrospective search was performed to identify patients presenting with painful OBs who underwent CA at the University Hospitals of Strasbourg between March 2007 and December 2018. Ten patients (seven men, three women; median age, 21 years old) were identified and included. Medical records were reviewed to assess complications and clinical outcomes. RESULTS. Median OB diameter was 16.5 mm (range, 16-28 mm). OBs were located in the spine (n = 7), calcaneus (n = 1), fibula (n = 1), and third metacarpal bone (n = 1). In 90% of cases (n = 9), one or more critical structures were within 1 cm of the OB (median distance, 5 mm; range, 2-8 mm), thus requiring extensive protective measures. Technical success was achieved in all cases. Two (20%) immediate neural complications were noted. One major complication was consistent with a permanent sensory deficit of the arm. One minor complication was consistent with a transient right Horner syndrome, which completely resolved after 48 hours with high-dose steroids. Median clinical follow-up was 12 months. Primary clinical success was 100% and 78% at 1 and 12 months of follow-up, respectively, with two patients presenting with recurring pain. CONCLUSION. Percutaneous image-guided CA represents an effective therapeutic option for patients affected by painful OBs; the safety profile of the procedure is acceptable as long as comprehensive protective measures are deployed in light of the frequent close proximity of critical structures.
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36
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Recognition and management of dermatologic complications from interventional radiology procedures. Diagn Interv Imaging 2019; 100:659-670. [PMID: 31302074 DOI: 10.1016/j.diii.2019.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023]
Abstract
A variety of dermatologic complications can occur after interventional radiology procedures, including fluoroscopy-induced radiation dermatitis, thermal skin injury from tumor ablation, non-target embolization to the skin, allergic reactions related to interventional radiology procedures, and dermatitis and infections at catheter sites. Yet, interventional radiologists typically lack training in dermatology. This review focuses on recognition of dermatologic complications and introduces basic principles for management of these complications. By taking a more active role in the diagnosis, management, and follow-up of dermatologic complications, interventional radiologists can improve the care for patients suffering iatrogenic skin inury.
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de Marini P, Cazzato RL, Garnon J, Shaygi B, Koch G, Auloge P, Tricard T, Lang H, Gangi A. Percutaneous MR-guided prostate cancer cryoablation technical updates and literature review. BJR Open 2019; 1:20180043. [PMID: 33178928 PMCID: PMC7592492 DOI: 10.1259/bjro.20180043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/25/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Prostate cancer (PCa) is the most common malignant tumor in males. The benefits in terms of overall reduction in specific mortality due to the widespread use of Prostate Specific Antigen (PSA) screening and the advancements in the curative treatments (radical prostatectomy or radiotherapy) appear to have reached a plateau. There remains, however, the questions of overdiagnosis and overtreatment of such patients. Currently, the main challenge in the treatment of patients with clinically organ-confined PCa is to offer an oncologically efficient treatment with as little morbidity as possible. Amongst the arising novel curative techniques for PCa, cryoablation (CA) is the most established one, which is also included in the NICE and AUA guidelines. CA is commonly performed under ultrasound guidance with the inherent limitations associated with this technique. The recent advancements in MRI have significantly improved the accuracy of detecting and characterizing a clinically significant PCa. This, alongside the development of wide bore interventional MR scanners, has opened the pathway for in bore PCa treatment. Under MRI guidance, PCa CA can be used either as a standard whole gland treatment or as a tumor targeted one. With MR-fluoroscopy, needle guidance capability, multiplanar and real-time visualization of the iceball, MRI eliminates the inherent limitations of ultrasound guidance and can potentially lead to a lower rate of local complications. The aim of this review article is to provide an overview about PCa CA with a more specific insight on MR guided PCa CA; the limitations, challenges and applications of this novel technique will be discussed.
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Affiliation(s)
- Pierre de Marini
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Behnam Shaygi
- Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Guillaume Koch
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Pierre Auloge
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital of Strasbourg, 1 Place de l'Hôpital, Strasbourg Cedex, France
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Hsieh YC, Limquiaco JL, Lin CC, Chen WT, Lin SM. Radiofrequency ablation following artificial ascites and pleural effusion creation may improve outcomes for hepatocellular carcinoma in high-risk locations. Abdom Radiol (NY) 2019; 44:1141-1151. [PMID: 30460530 DOI: 10.1007/s00261-018-1831-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the outcomes of radiofrequency ablation (RFA) following artificial ascites (AA) and artificial pleural effusion (AP) creation for hepatocellular carcinoma (HCC) in high-risk locations. MATERIALS AND METHODS Eligible patients were divided into 2 study periods (non-AAAP and AAAP groups) with AAAP performed in the latter period. Local tumor progression, primary technique effectiveness and complications were compared between patients with and without AAAP. Cumulative probability of local tumor progression and overall survival were estimated with Kaplan-Meier curves. RESULTS One hundred thirty-eight patients with 195 tumors were evaluated. AAAP was performed in 48 patients with 76 tumors. Local tumor progression rates at 12 and 24 months were 9.3% and 22.2% in the non-AAAP group versus 5.5% and 9% in the AAAP group (p < 0.0001). Primary technique effectiveness was achieved in 76.5% of the non-AAAP group versus 89.5% of the AAAP group (p = 0.046). Night (7.6%) major complications occurred in the non-AAAP group and 2 (2.6%) cases occurred in the AAAP group. Therapy-oriented severity grading system after RFA was lower in the AAAP group (p = 0.02). Overall survival rates at 12 and 24 months were 85.6% and 77.7% in the non-AAAP group versus 97.2% and 89.7% in the AAAP group (p = 0.033). CONCLUSION RFA following AA and AP for high-risk located HCC may improve outcomes.
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Affiliation(s)
- Yi-Chung Hsieh
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Jenny L Limquiaco
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
- Division of Gastroenterology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Chen-Chun Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Wei-Ting Chen
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan
| | - Shi-Ming Lin
- Division of Hepatology, Department of Gastroenterology and Hepatology, Liver Research Unit, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan.
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Bing F, Cabras P, De Mathelin M, Gangi A, Vappou J. MR-guided high intensity focused ultrasound (MRgHIFU) ablation of bone lesions: Impact of the ultrasound focusing on the thermal curves and of dissection needles interposition on the ultrasound field. J Neuroradiol 2019. [DOI: 10.1016/j.neurad.2019.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Image-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.
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Yevich S, Odisio BC, Sheth R, Tselikas L, de Baère T, Deschamps F. Integrated CT-Fluoroscopy Equipment: Improving the Interventional Radiology Approach and Patient Experience for Treatment of Musculoskeletal Malignancies. Semin Intervent Radiol 2018; 35:229-237. [PMID: 30402005 DOI: 10.1055/s-0038-1669962] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Integrated CT-fluoroscopy equipment augments the comprehensive approach to the treatment of musculoskeletal (MSK) malignancy by interventional radiology techniques. As the role of minimally invasive treatment expands to meet the highly variable presentation of MSK malignancy, creative solutions to treatment challenges are required to improve locoregional tumor control and durability of pain palliation. Challenges to effective treatment can often be attributed to a combination of aggressive tumor biology, large size, forbidding location, and adverse vascularity. In these cases, a tailored treatment approach may necessitate the application of multiple interventional radiology (IR) techniques that require different image guidance capabilities. Integrated CT-fluoroscopy equipment provides the means to leverage both imaging modalities within the same procedural setting to facilitate the simultaneous application of multiple synergistic treatments and protective measures. This article examines the potential role of hybrid units in the IR treatment of challenging MSK malignancies as a means to empower a paradigm transition for a more comprehensive and patient-tailored approach.
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Affiliation(s)
- Steven Yevich
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bruno C Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rahul Sheth
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Thierry de Baère
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
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Luigi Cazzato R, Auloge P, De Marini P, Rousseau C, Chiang JB, Koch G, Caudrelier J, Rao P, Garnon J, Gangi A. Percutaneous image-guided ablation of bone metastases: local tumor control in oligometastatic patients. Int J Hyperthermia 2018; 35:493-499. [PMID: 30307346 DOI: 10.1080/02656736.2018.1508760] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Percutaneous image-guided cryo- (CA) and radiofrequency- (RFA) ablations have been widely used in the treatment of painful bone metastases (BM). However, paucity of data is available for the performance of these treatments when used with a curative intent. The aim of this study is to investigate the local progression free-survival (LPFS) after radical percutaneous image-guided ablation of BM in oligometastatic patients, and to identify predictive factors associated with local tumor progression. MATERIALS AND METHODS This is a retrospective review of all patients who underwent percutaneous image-guided CA or RFA of BM with a radical intent between 2007 and 2018. RESULTS Forty-six patients with a total of forty-nine BM underwent percutaneous image-guided CA (N = 37; 75,5%) or RFA (N = 12; 24,5%). Primary malignancies included thyroid (N = 11, 22.5%), breast (N = 21; 42.9%), lung (N = 8; 16.3%) and other (N = 9; 18,3%) cancers. Additional consolidation was performed after ablation in 20.4% cases (N = 10). Mean follow-up was 34.1 ± 22 months. Local progression at the treated site was observed in 28.5% cases (N = 14); 1- and 2-year LPFS was 76.8% and 71.7%, respectively. Size of BM (>2 cm) predicted local tumor progression (p = .002). CONCLUSIONS Percutaneous image-guided locoregional therapies used in the radical treatment of BM in oligometastatic patients demonstrate significant rates of LPFS providing the size of BM ≤2 cm.
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Affiliation(s)
- Roberto Luigi Cazzato
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre Auloge
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pierre De Marini
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Chloé Rousseau
- b Clinical Investigation, INSERM 1414 , University of Rennes , Rennes , France
| | - Jeanie Betsy Chiang
- c Interventional Radiology , Queen Elizabeth Hospital , Hong Kong , Hong Kong
| | - Guillaume Koch
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Jean Caudrelier
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Pramod Rao
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Julien Garnon
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
| | - Afshin Gangi
- a Interventional Radiology , University Hospital of Strasbourg , Strasbourg , France
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Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques. Cardiovasc Intervent Radiol 2018; 42:344-357. [DOI: 10.1007/s00270-018-2089-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
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Michaelides M, Drakonaki E, Petridou E, Pantziara M, Ioannides C. Osteoid osteoma of the scaphoid bone associated with flexor carpi radialis calcific tendinitis and treated with CT-guided RF ablation. Skeletal Radiol 2018. [PMID: 29541786 DOI: 10.1007/s00256-018-2926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteoid osteomas of the wrist are relatively rare and the diagnosis is challenging due to atypical clinical features. We describe a case of an osteoid osteoma of the scaphoid bone associated with calcific tendinitis of the adjacent flexor carpi radialis tendon and periarticular soft tissue calcifications in a 21-year-old man presenting with radial-sided wrist pain. The lesion was successfully treated with CT-guided RF ablation. To our knowledge, this is the first description of an osteoid osteoma of the wrist associated with calcific tendinitis and periarthritis. In addition, we discuss the technical details and difficulties of CT-guided RF ablation of scaphoid osteoid osteomas.
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Affiliation(s)
- Michalis Michaelides
- MRI/CT Department, Ygia Polyclinic Hospital, 21 Nafpliou str., PO Box 56174, 3305, Limassol, Cyprus.
| | | | - Elia Petridou
- MRI/CT Department, Ygia Polyclinic Hospital, 21 Nafpliou str., PO Box 56174, 3305, Limassol, Cyprus
| | - Maria Pantziara
- MRI/CT Department, Ygia Polyclinic Hospital, 21 Nafpliou str., PO Box 56174, 3305, Limassol, Cyprus
| | - Cleanthis Ioannides
- MRI/CT Department, Ygia Polyclinic Hospital, 21 Nafpliou str., PO Box 56174, 3305, Limassol, Cyprus
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Bing F, Vappou J, de Mathelin M, Gangi A. Targetability of osteoid osteomas and bone metastases by MR-guided high intensity focused ultrasound (MRgHIFU). Int J Hyperthermia 2018; 35:471-479. [DOI: 10.1080/02656736.2018.1508758] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fabrice Bing
- Radiology Department, Hôpital d’Annecy, Metz-Tessy, France
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Afshin Gangi
- ICube, University of Strasbourg, Strasbourg, France
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Oñate Miranda M, Moser TP. A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty). Insights Imaging 2018; 9:275-285. [PMID: 29564836 PMCID: PMC5991000 DOI: 10.1007/s13244-018-0600-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/12/2018] [Accepted: 01/19/2018] [Indexed: 12/24/2022] Open
Abstract
Percutaneous approaches for pelvic bone procedures (bone biopsies, tumour ablation and cementoplasty) are multiple and less well systematised than for the spine or extremities. Among the different imaging techniques that can be used for guidance, computed tomography (CT) scan is the modality of choice because of the complex pelvic anatomy. In specific cases, such as cementoplasty where real-time evaluation is a determinant, a combination of CT and fluoroscopy is highly recommended. The objective of this article is to propose a systematic approach for image-guided pelvic bone procedures, as well as to provide some technical tips. We illustrate the article with multiple examples, and diagrams of the approaches and important structures to avoid to perform these procedures safely. TEACHING POINTS • Pelvic bone procedures are safe to perform if anatomical landmarks are recognised. • The safest approach varies depending on the pelvic level. • CT is the modality of choice for guiding pelvic percutaneous procedures. • Fluoroscopy is recommended when real-time monitoring is mandatory. • MRI can also be used for guiding pelvic percutaneous procedures.
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Affiliation(s)
- Marta Oñate Miranda
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada
| | - Thomas P Moser
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), 1000 rue St-Denis, Montréal, QC, H2X 0C1, Canada.
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Cazzato RL, Garnon J, Caudrelier J, Rao PP, Koch G, Gangi A. Percutaneous radiofrequency ablation of painful spinal metastasis: a systematic literature assessment of analgesia and safety. Int J Hyperthermia 2018; 34:1272-1281. [PMID: 29308694 DOI: 10.1080/02656736.2018.1425918] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Radiofrequency ablation (RFA) is the most common percutaneous technique applied to treat painful spinal metastasis; however, experience in this field is somehow still limited. A systematic literature research was performed to understand the effects of RFA in terms of analgesia and safety. MATERIALS AND METHODS Inclusion criteria for the studies were as follows: (1) randomised controlled or non-randomised studies with a prospective or retrospective design; (2) population made up of adults with spinal metastasis; (3) spinal metastasis treated with RFA alone or in combination/comparison with other treatments; (4) studies reporting about patients' pain before and at least one time-point following RFA; and (5) English-language studies. RESULTS Seven hundred and thirty-three articles were screened and 8 (4 prospective, 4 retrospective) matched the inclusion criteria. Study population ranged between 10 and 92 patients across studies. Five out of eight studies reported a highly effective pain management (≥4 points of pain reduction between baseline and the last time-point available); 2/8 studies reported moderate results (≥2 points of pain reduction between baseline and the last time-point available). All studies combined RFA with cement augmentation in the vast majority of patients (40-100%) or metastasis (94-95.8%). Grade I-IIIa neural complications were reported in up to 16% of the cases and were always managed conservatively or with steroids. CONCLUSIONS RFA, combined with vertebral augmentation in most of the cases, is effective and safe in achieving short- to mid-term (from 1 week to 6 months) analgesia in patients affected by painful spinal metastasis.
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Affiliation(s)
- Roberto Luigi Cazzato
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Julien Garnon
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Jean Caudrelier
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Pramod Prabhakar Rao
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Guillaume Koch
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
| | - Afshin Gangi
- a Department of Interventional Radiology , Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg) , Strasbourg , France
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Garnon J, Cazzato RL, Koch G, Uri IF, Tsoumakidou G, Caudrelier J, Tricard T, Gangi A, Lang H. Trans-rectal Ultrasound-Guided Autologous Blood Injection in the Interprostatorectal Space Prior to Percutaneous MRI-Guided Cryoablation of the Prostate. Cardiovasc Intervent Radiol 2017; 41:653-659. [PMID: 29230498 DOI: 10.1007/s00270-017-1853-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a novel technique of ultrasound-guided injection of autologous blood in the interprostatorectal space, in an attempt to facilitate ablative prostatic procedures by widening durably the space between the rectum and the prostate. MATERIALS AND METHODS Between April and November 2016, four consecutive patients underwent the haemoprotection injection technique. For each patient, we recorded the time to perform the technique, the amount of injected blood, the achieved distances between the rectum and the prostate post-injection at fixed defined points (apex, middle, and base of prostate at the midline, left, and right sides of the gland), the extension of the ice ball outside the prostate capsule at those fixed points, and whether any residual blood was present on 1-month follow-up MRI. RESULTS Mean time to perform haemoprotection injection was 54 min, with an average blood volume of 103 cc. Mean distance achieved at the apex, middle, and base of the prostate, respectively, was 12, 13, and 16 mm in the midline; 8, 10, and 13 mm on the left side; and 9, 10, and 13 mm on the right side. The mean extension distance of the ice ball beyond the capsule was 4, 6, and 6 mm in the midline; 4, 5, and 6 mm on the left side; and 1, 3, and 3 mm on the right side. No residual blood was present on 1-month follow-up MRI in all patients. No rectal fistula occurred. CONCLUSION Haemoprotection may create a safe and effective virtual space between the prostate and rectum.
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Affiliation(s)
- Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Ishaq Fahmi Uri
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Thibault Tricard
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
| | - Hervé Lang
- Department of Urology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67098, Strasbourg Cedex, France
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50
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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