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Houston R, Desai S, Takayanagi A, Quynh Thu Tran C, Mortezaei A, Oladaskari A, Sourani A, Siddiqi I, Khodayari B, Ho A, Hariri O. A Multidisciplinary Update on Treatment Modalities for Metastatic Spinal Tumors with a Surgical Emphasis: A Literature Review and Evaluation of the Role of Artificial Intelligence. Cancers (Basel) 2024; 16:2800. [PMID: 39199573 PMCID: PMC11352440 DOI: 10.3390/cancers16162800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 09/01/2024] Open
Abstract
Spinal metastases occur in up to 40% of patients with cancer. Of these cases, 10% become symptomatic. The reported incidence of spinal metastases has increased in recent years due to innovations in imaging modalities and oncological treatments. As the incidence of spinal metastases rises, so does the demand for improved treatments and treatment algorithms, which now emphasize greater multidisciplinary collaboration and are increasingly customized per patient. Uniquely, we discuss the potential clinical applications of AI and NGS in the treatment of spinal metastases. Material and Methods: A PubMed search for articles published from 2000 to 2023 regarding spinal metastases and artificial intelligence in healthcare was completed. After screening for relevance, the key findings from each study were summarized in this update. Results: This review summarizes the evidence from studies reporting on treatment modalities for spinal metastases, including minimally invasive surgery (MIS), external beam radiation therapy (EBRT), stereotactic radiosurgery (SRS), CFR-PEEK instrumentation, radiofrequency ablation (RFA), next-generation sequencing (NGS), artificial intelligence, and predictive models.
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Affiliation(s)
- Rebecca Houston
- Department of Neurosurgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA;
| | - Shivum Desai
- Department of Neurosurgery, Ascension Providence Hospital, 16001 W Nine Mile Rd, Southfield, MI 48075, USA;
| | - Ariel Takayanagi
- Department of Neurosurgery, Riverside University Health System, 26520 Cactus Ave, Moreno Valley, CA 92555, USA; (A.T.); (I.S.)
| | - Christina Quynh Thu Tran
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA;
| | - Ali Mortezaei
- Student Research Committee, Gonabad University of Medical Sciences, Gonabad 9P67+R29, Razavi Khorasan, Iran;
| | - Alireza Oladaskari
- School of Biological Sciences, University of California Irvine, 402 Physical Sciences Quad, Irvine, CA 92697, USA;
| | - Arman Sourani
- Department of Neurosurgery, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan JM76+5M3, Isfahan, Iran;
- Environment Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Hezar Jerib Avenue, Isfahan JM76+5M3, Isfahan, Iran
| | - Imran Siddiqi
- Department of Neurosurgery, Riverside University Health System, 26520 Cactus Ave, Moreno Valley, CA 92555, USA; (A.T.); (I.S.)
| | - Behnood Khodayari
- Department of Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, 4867 W Sunset Blvd, Los Angeles, CA 90027, USA;
| | - Allen Ho
- Department of Neurological Surgery, Kaiser Permanente Orange County, 3440 E La Palma Ave, Anaheim, CA 92806, USA;
| | - Omid Hariri
- Department of Neurosurgery, Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA;
- Kaiser Permanente Bernard J. Tyson School of Medicine, 98 S Los Robles Ave, Pasadena, CA 91101, USA;
- Department of Neurological Surgery, Kaiser Permanente Orange County, 3440 E La Palma Ave, Anaheim, CA 92806, USA;
- Department of Surgery, Western University of Health Sciences, 309 E 2nd St, Pomona, CA 91766, USA
- Department of Orthopedic Surgery, University of California Irvine School of Medicine, 1001 Health Sciences Rd, Irvine, CA 92617, USA
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Vemu SM, Farii HA, Bird JE, Lin PP, Lewis VO, Patel SS. The Use of Photodynamic Bone Stabilization to Tamponade Bleeding in a Pathologic Humeral Shaft Fracture: A Case Report. J Orthop Case Rep 2023; 13:137-143. [PMID: 37753123 PMCID: PMC10519327 DOI: 10.13107/jocr.2023.v13.i09.3906] [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: 06/08/2023] [Revised: 07/16/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Hypervascular tumors such as renal and thyroid carcinoma have a significant risk of intraoperative bleeding. To help mitigate bleeding, interventional preoperative embolization is traditionally used; however, it is success is highly variable. This is the first case report to discuss using expandable balloon implants with a minimally invasive approach to achieve fracture fixation and tamponade acute intraoperative bleeding. Case Report A 48-year-old male with clear-cell renal cell carcinoma presented with a left humeral shaft pathologic fracture. The patient was scheduled to undergo open biopsy, curettage of tumor, and fracture fixation with an intramedullary device. Intraoperatively, during open biopsy and curettage, brisk bleeding was encountered, which ceased after inserting an intramedullary photodynamic bone stabilization implant (IlluminOss). The implant's balloon expanded to the diameter of the humerus allowing for tamponade, fracture stability, and a minimally invasive approach. Conclusion We present a possible intraoperative option for achieving control of bleeding in pathologic long bone fractures by deploying a photodynamic stabilization device. The method described can have applications in specific patients and obviate the need for pre-operative embolization for highly vascular tumors due to the implant's ability to create tamponade within the bone.
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Affiliation(s)
- Sree M Vemu
- Department of Orthopedic Surgery, Houston Methodist, 6445 Main St #2500, Houston, Texas 77030, United States
| | - Humaid Al Farii
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Justin E Bird
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Patrick P Lin
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Valerae O Lewis
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
| | - Shalin S Patel
- Department of Orthopedic Surgery, University of Texas MD Anderson Cancer Center, P.O. Box 301402, Unit 1448 Houston, Texas 77230-1402, United States
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Creze M, Ghaouche J, Missenard G, Lazure T, Cluzel G, Devilder M, Briand S, Soubeyrand M, Meyrignac O, Carlier RY, Court C, Bouthors C. Understanding a mass in the paraspinal region: an anatomical approach. Insights Imaging 2023; 14:128. [PMID: 37466751 DOI: 10.1186/s13244-023-01462-1] [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: 05/09/2023] [Accepted: 06/10/2023] [Indexed: 07/20/2023] Open
Abstract
The paraspinal region encompasses all tissues around the spine. The regional anatomy is complex and includes the paraspinal muscles, spinal nerves, sympathetic chains, Batson's venous plexus and a rich arterial network. A wide variety of pathologies can occur in the paraspinal region, originating either from paraspinal soft tissues or the vertebral column. The most common paraspinal benign neoplasms include lipomas, fibroblastic tumours and benign peripheral nerve sheath tumours. Tumour-like masses such as haematomas, extramedullary haematopoiesis or abscesses should be considered in patients with suggestive medical histories. Malignant neoplasms are less frequent than benign processes and include liposarcomas and undifferentiated sarcomas. Secondary and primary spinal tumours may present as midline expansile soft tissue masses invading the adjacent paraspinal region. Knowledge of the anatomy of the paraspinal region is of major importance since it allows understanding of the complex locoregional tumour spread that can occur via many adipose corridors, haematogenous pathways and direct contact. Paraspinal tumours can extend into other anatomical regions, such as the retroperitoneum, pleura, posterior mediastinum, intercostal space or extradural neural axis compartment. Imaging plays a crucial role in formulating a hypothesis regarding the aetiology of the mass and tumour staging, which informs preoperative planning. Understanding the complex relationship between the different elements and the imaging features of common paraspinal masses is fundamental to achieving a correct diagnosis and adequate patient management. This review gives an overview of the anatomy of the paraspinal region and describes imaging features of the main tumours and tumour-like lesions that occur in the region.
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Affiliation(s)
- Maud Creze
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France.
- BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France.
| | - Jessica Ghaouche
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Gilles Missenard
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Thierry Lazure
- Department of Pathology, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU Smart Imaging, Bicêtre hospital, Le Kremlin Bicêtre, France
| | - Guillaume Cluzel
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Matthieu Devilder
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Sylvain Briand
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | | | - Olivier Meyrignac
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
- BioMaps, Université Paris-Saclay, Hôpital Kremlin-Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France
| | - Robert-Yves Carlier
- Department of Radiology, Assistance Publique des Hôpitaux de Paris, GH Université Paris- Saclay, DMU Smart Imaging, Garches Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Charles Court
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
| | - Charlie Bouthors
- Department of Orthopedic Surgery, Assistance Publique des Hôpitaux de Paris, GH Université Paris-Saclay, DMU de Chirurgie Traumatologie Orthopédique-Chirurgie Plastique- Reconstruction, Bicêtre Teaching Hospital, Le Kremlin-Bicêtre, France
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Papalexis N, Peta G, Vara G, Spinnato P, Errani C, Martella C, Miceli M, Facchini G. Palliative Arterial Embolization for Metastases of the Sternum. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03459-1. [PMID: 37188897 DOI: 10.1007/s00270-023-03459-1] [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: 12/07/2022] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND To investigate the safety and efficacy of palliative arterial embolization for metastases of the sternum. MATERIALS AND METHODS This study included 10 consecutive patients (5 M, 5 F; mean age 58.1; range 37-70) with metastases of the sternum from different primary tumors, treated with palliative arterial embolization using NBCA-Lipiodol between January 2007 and June 2022. Four patients received a second embolization at the same site, for a total of 14 embolizations. Data on technical and clinical success, as well as changes in tumor size, were collected. All embolization-related complications were evaluated according to the CIRSE classification system for complications. RESULTS Post-embolization angiography showed occlusion of more than 90% of the pathological feeding vessels in all procedures. Pain score and analgesic drug consumption were reduced by 50% in all 10 patients (100%, p < 0.05). The mean duration of pain relief was 9.5 months (range 8 to 12 months, p < 0.05). Metastatic tumor size was reduced from a mean of 71.5 cm3 (range 41.6 to 90.3 cm3) pre-embolization to a mean of 67.9 cm3 (range 38.5 to 86.1 cm3) at the 12-month follow-up (p < 0.05). None of the patients experienced embolization-related complications. CONCLUSION Arterial embolization is safe and effective as a palliative treatment for patients with metastases of the sternum who did not benefit from radiation therapy or experienced recurrence in symptoms.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulio Vara
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Spinnato
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudia Martella
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Kedra A, Dohan A, Biau D, Belbachir A, Dautry R, Lucas A, Aissaoui M, Feydy A, Soyer P, Barat M. Preoperative Arterial Embolization of Musculoskeletal Tumors: A Tertiary Center Experience. Cancers (Basel) 2023; 15:cancers15092657. [PMID: 37174122 PMCID: PMC10177012 DOI: 10.3390/cancers15092657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The purpose of this study was to report the effectiveness of preoperative transcatheter arterial embolization (TAE) of musculoskeletal tumors in terms of blood loss and functional outcomes. Patients who underwent preoperative TAE of hypervascular musculoskeletal tumors between January 2018 and December 2021 were retrospectively included. The patients' characteristics, TAE procedure details, degree of post-TAE devascularization, surgical outcomes in terms of red blood cell transfusion and functional results were collected. The degree of devascularization was compared between patients who had peri-operative transfusion and those who did not. Thirty-one patients were included. The 31 TAE procedures led to complete (58%) or near-complete (42%) tumor devascularization. Twenty-two patients (71%) had no blood transfusion during surgery. Nine patients (29%) had a blood transfusion, with a median number of red blood cell packs of three (q1, 2; q3, 4; range: 1-4). Eight patients (27%) had complete improvement of the initial musculoskeletal symptoms at the end of the follow-up, 15 (50%) had partially satisfying improvement, 4 (13%) had partially unsatisfying improvement and 3 (10%) had no improvement. Our study suggests that preoperative TAE of hypervascular musculoskeletal tumors allowed for bloodless surgery in 71% of patients and minimal transfusion needs for the remaining 29%.
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Affiliation(s)
- Alice Kedra
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anthony Dohan
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - David Biau
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Orthopedic Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Anissa Belbachir
- Department of Anesthesiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Raphael Dautry
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Alexandre Lucas
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Mathilde Aissaoui
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Antoine Feydy
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
- Department of Musculoskeletal Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
| | - Philippe Soyer
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
| | - Maxime Barat
- Department of Diagnostic and Interventional Imaging, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France
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Heptonstall N, Scott-Warren J, Berman R, Filippiadis D, Bell J. Role of interventional radiology in pain management in oncology patients. Clin Radiol 2023; 78:245-253. [PMID: 35811156 DOI: 10.1016/j.crad.2022.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022]
Abstract
This article reviews the current evidence of interventional radiology procedures for patients suffering with debilitating cancer pain, refractory to conventional therapies. Cancer pain is notoriously difficult to treat. Up to 90% of cancer patients experience pain with 56-82% of cancer pain controlled inadequately. Cancer pain influences a patient's ability to perform normal daily activities, causes higher risk of depression, and reduces quality of life. Pain-free status has been universally voted as a "good death". Alternative minimally invasive options include nerve blocks, neurolysis, bone ablation, spine and peripheral musculoskeletal augmentation techniques, embolisation, and cordotomy with evidence highlighting improved pain control, reduced analgesic requirements, and improved quality of life. Unfortunately, awareness and availability of these procedures is limited, potentially leaving patients suffering during their remaining life. The purpose of this review is to describe the basic concepts of interventional radiology techniques for pain palliation in oncology patients. In addition, emphasis will be given upon the need for an individually tailored approach aiming to augment efficacy and safety.
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Affiliation(s)
- N Heptonstall
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK.
| | - J Scott-Warren
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - R Berman
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Filippiadis
- Department of Radiology, Attikon University Hospital, Athens, Greece
| | - J Bell
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
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Transarterial Embolization of Bone Metastases. Tech Vasc Interv Radiol 2023; 26:100883. [PMID: 36889846 DOI: 10.1016/j.tvir.2022.100883] [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: 12/24/2022]
Abstract
Embolization of bone metastases is most commonly performed for hypervascular tumors prior to surgical resection. When employed in this fashion embolization can significantly decrease perioperative hemorrhage and improve surgical outcomes. In addition, embolization of bone metastases may lead to local tumor control and decreased tumoral associate bone pain. Careful techniques and choice of embolic material are required when performing embolization of bone lesions to ensure low procedural complications and high rates of clinical success.4 The indications, technical considerations, and complications associated with embolization of metastatic hypervascular bone lesions will be discussed in this review with subsequent case examples.
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Hammad A, Ahmed O, Connell PP, Olson D, Balach T. Team Approach: Management of Pathologic Fractures. JBJS Rev 2023; 11:01874474-202301000-00004. [PMID: 36722819 DOI: 10.2106/jbjs.rvw.22.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
» Optimal care for pathologic fractures centers on the use of a multidisciplinary team; thus, whenever there is a concern for pathologic fracture and proper workup is unable to be performed, prompt referral to a center equipped to manage these injuries should occur. » Fixation strategies for pathologic fractures must take into account patient characteristics, cancer subtypes, and overall goals of treatment. » As the treatments of cancers improve, patient life expectancy with disease will improve as well. This will lead to an increase in the incidence of impending or completed pathologic fractures. The broader subspecialties of orthopaedics must be aware of general principles in the diagnosis and management of these injuries.
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Affiliation(s)
- Aws Hammad
- Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medicine & Biological Sciences, Chicago, Illinois
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Marra P, Di Fazio B, Dulcetta L, Carbone FS, Muglia R, Bonaffini PA, Valle C, Corvino F, Giurazza F, Muscogiuri G, Venturini M, Sironi S. Embolization in Pediatric Patients: A Comprehensive Review of Indications, Procedures, and Clinical Outcomes. J Clin Med 2022; 11:jcm11226626. [PMID: 36431102 PMCID: PMC9696500 DOI: 10.3390/jcm11226626] [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] [Received: 08/15/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022] Open
Abstract
Embolization in pediatric patients encompasses a large spectrum of indications, ranging from the elective treatment of congenital diseases of the cardiovascular system to the urgent management of acute hemorrhagic conditions. In particular, the endovascular treatment of central and peripheral vascular malformations and hypervascular tumors represents a wide chapter for both congenital and acquired situations. Thanks to the progressive availability of low-profile endovascular devices and new embolic materials, the mini-invasive approach has gradually overtaken surgery. In this review, the main embolization procedures will be illustrated and discussed, with a focus on clinical indications and expected outcomes. The most recent mini-invasive techniques will be described, with hints on the cutting-edge devices and embolic materials.
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Affiliation(s)
- Paolo Marra
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Barbaro Di Fazio
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Correspondence: ; Tel.: +39-347-516-5851 or +39-035-267-4359
| | - Ludovico Dulcetta
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Francesco Saverio Carbone
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Riccardo Muglia
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Pietro Andrea Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Fabio Corvino
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Francesco Giurazza
- Department of Vascular and Interventional Radiology, Cardarelli Hospital, 80131 Naples, Italy
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, Insubria University, 21100 Varese, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
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Minimally Invasive Interventional Procedures for Metastatic Bone Disease: A Comprehensive Review. Curr Oncol 2022; 29:4155-4177. [PMID: 35735441 PMCID: PMC9221897 DOI: 10.3390/curroncol29060332] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Metastases are the main type of malignancy involving bone, which is the third most frequent site of metastatic carcinoma, after lung and liver. Skeletal-related events such as intractable pain, spinal cord compression, and pathologic fractures pose a serious burden on patients’ quality of life. For this reason, mini-invasive treatments for the management of bone metastases were developed with the goal of pain relief and functional status improvement. These techniques include embolization, thermal ablation, electrochemotherapy, cementoplasty, and MRI-guided high-intensity focused ultrasound. In order to achieve durable pain palliation and disease control, mini-invasive procedures are combined with chemotherapy, radiation therapy, surgery, or analgesics. The purpose of this review is to summarize the recently published literature regarding interventional radiology procedures in the treatment of cancer patients with bone metastases, focusing on the efficacy, complications, local disease control and recurrence rate.
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Digge VK, kumar V, Kar S, Sai Krishna M, Chaudhury B, Jain VK, Desai J. Is there evidence to recommend transcatheter arterial embolisation in adhesive capsulitis: A review of literature. J Orthop 2022; 30:77-82. [PMID: 35241893 PMCID: PMC8867055 DOI: 10.1016/j.jor.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypervascularity of the rotator interval with increased expression of the vascular endothelial growth factor may be the causative factor of conventionally managed adhesive capsulitis. Hence, transcatheter arterial embolisation(TAE) has emerged as an alternative treatment option to occlude the target neovessels by infusing an embolic agent. The present study reviews the literature regarding the efficacy of the TAE for adhesive capsulitis. MATERIAL AND METHODS The systematic review was performed following PRISMA guidelines. MEDLINE, Google Scholar, Scopus and Cochrane database of systemic reviews (CDSR) were searched for relevant publication (from 1960 to 2021). The search algorithm used was Transcatheter arterial embolisation and resistant adhesive capsulitis or refractory adhesive capsulitis or vascular adhesive capsulitis. The database search produced a total of 12026 publications. After exclusion of the non relevant titles, 113 abstracts were reviewed. From these abstracts, three full-text articles were obtained for final review. RESULTS All the studies were analyzed in depth. Patients with no or minimal improvement with conservative treatment for at least 3 months underwent TAE. Pre and post embolisation visual analog score(VAS), shoulder range of motion(ROM) were noted. Any additional therapy was also taken into account. Significant improvement of the VAS score and shoulder ROM was noted immediately after surgery and maintained till final follow up at 24.5 months. CONCLUSION Resistant cases of adhesive capsulitis can be managed successfully with TAE. But ample evidence is lacking regarding the appropriate patient selection and efficacy of TAE as a sole management option of resistant AC.
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Affiliation(s)
| | - Vijay kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Santanu Kar
- All India Institute of Medical Sciences, New Delhi, India
- Corresponding author. K24, Green Park Extension, 110016, New Delhi, India.
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12
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Bansal A, Goyal A, Gamanagatti S, Srivastava DN, Manhas V. Current updates in image-guided musculoskeletal interventions. J Clin Orthop Trauma 2021; 22:101601. [PMID: 34631410 PMCID: PMC8479789 DOI: 10.1016/j.jcot.2021.101601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022] Open
Abstract
Image-guided musculoskeletal interventions are frequently done in clinical practice. Even then, the literature regarding their effectiveness is relatively scarce. Image guidance adds value over the conventional landmark-based approach and should be preferred. We hereby try to list the commonly performed procedures along with the current practice guidelines regarding their clinical indications and periprocedural care.
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Affiliation(s)
- Abhinav Bansal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Shivanand Gamanagatti
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Deep Narayan Srivastava
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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13
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Taiji R, Lin EY, Lin YM, Yevich S, Avritscher R, Sheth RA, Ruiz JR, Jones AK, Chintalapani G, Nishiofuku H, Tanaka T, Kichikawa K, Gupta S, Odisio BC. Combined Angio-CT Systems: A Roadmap Tool for Precision Therapy in Interventional Oncology. Radiol Imaging Cancer 2021; 3:e210039. [PMID: 34559007 DOI: 10.1148/rycan.2021210039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Combined angiography-CT (angio-CT) systems, which combine traditional angiographic imaging with cross-sectional imaging, are a valuable tool for interventional radiology. Although cone-beam CT (CBCT) technology from flat-panel angiography systems has been established as an adjunct cross-sectional imaging tool during interventional procedures, the intrinsic advantages of angio-CT systems concerning superior soft-tissue imaging and contrast resolution, along with operational ease, have sparked renewed interest in their use in interventional oncology procedures. Owing to increases in affordability and usability due to an improved workflow, angio-CT systems have become a viable alternative to stand-alone flat-panel angiographic systems equipped with CBCT. This review aims to provide a comprehensive technical and clinical guide for the use of angio-CT systems in interventional oncology. The basic concepts related to the use of angio-CT systems, including concepts related to workflow setup, imaging characteristics, and acquisition parameters, will be discussed. Additionally, an overview on the clinical applications and the benefits of angio-CT systems in routine therapeutic and palliative interventional oncology procedures will be reviewed. Keywords: Ablation Techniques, CT-Angiography, Interventional-Body, Interventional-MSK, Chemoembolization, Embolization, Radiation Therapy/Oncology, Abdomen/GI, Skeletal-Axial Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Ryosuke Taiji
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Ethan Y Lin
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Yuan-Mao Lin
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Steven Yevich
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Rony Avritscher
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Rahul A Sheth
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Joseph R Ruiz
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - A Kyle Jones
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Gouthami Chintalapani
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Hideyuki Nishiofuku
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Toshihiro Tanaka
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Kimihiko Kichikawa
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Sanjay Gupta
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
| | - Bruno C Odisio
- From the Departments of Interventional Radiology (R.T., E.Y.L., Y.M.L., S.Y., R.A., R.A.S., S.G., B.C.O.), Anesthesiology (J.R.R.), and Imaging Physics (A.K.J.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX 77030; Siemens Healthineers, USA (G.C.); and Department of Radiology, Nara Medical University, Nara, Japan (R.T., H.N., T.T., K.K.)
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Facchini G, Parmeggiani A, Peta G, Martella C, Gasbarrini A, Evangelisti G, Miceli M, Rossi G. The role of percutaneous transarterial embolization in the management of spinal bone tumors: a literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2839-2851. [PMID: 34415449 DOI: 10.1007/s00586-021-06963-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Spinal bone tumors include a heterogeneous broad of primary or metastatic lesions that may present as incidental findings or manifest with painful symptoms and pathological fractures. Optimal management of spine bone lesions is often difficult and treatment algorithms are usually solidly based on surgery. We aimed to evaluate the contribution of trans-arterial embolization in this field, with particular attention to the procedure efficacy, technical difficulties and complications. METHODS We present a literature review on the role of trans-arterial embolization in the management of spinal bone tumors, both primary and metastatic, evaluating its contribution as preoperative treatment, palliative procedure and standalone curative strategy. RESULTS Trans-arterial embolization provides an important contribution to reducing surgery hemorrhagic risks, offering a better visualization of the operating field, and possibly increasing tumor susceptibility to chemotherapy or radiation therapy. Nonetheless, it plays an important part in pain palliation, with the unquestionable advantage of being easily repeatable in case of necessity. Its curative role as a standalone therapy is still subject of debate, and at the present time, satisfactory results have been recorded only in the treatment of aneurysmal bone cysts. CONCLUSION Percutaneous trans-arterial embolization has established as a highly useful minimally invasive procedure in the management of spinal bone lesions, particularly as adjuvant preoperative therapy and palliative treatment.
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Affiliation(s)
- Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Anna Parmeggiani
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy. .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| | - Giuliano Peta
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Claudia Martella
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Rossi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G.C.Pupilli, 1, 40136, Bologna, Italy
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15
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Eulig E, Maier J, Knaup M, Bennett NR, Hörndler K, Wang AS, Kachelrieß M. Deep learning-based reconstruction of interventional tools and devices from four X-ray projections for tomographic interventional guidance. Med Phys 2021; 48:5837-5850. [PMID: 34387362 DOI: 10.1002/mp.15160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Image guidance for minimally invasive interventions is usually performed by acquiring fluoroscopic images using a monoplanar or a biplanar C-arm system. However, the projective data provide only limited information about the spatial structure and position of interventional tools and devices such as stents, guide wires, or coils. In this work, we propose a deep learning-based pipeline for real-time tomographic (four-dimensional [4D]) interventional guidance at conventional dose levels. METHODS Our pipeline is comprised of two steps. In the first one, interventional tools are extracted from four cone-beam CT projections using a deep convolutional neural network. These projections are then Feldkamp reconstructed and fed into a second network, which is trained to segment the interventional tools and devices in this highly undersampled reconstruction. Both networks are trained using simulated CT data and evaluated on both simulated data and C-arm cone-beam CT measurements of stents, coils, and guide wires. RESULTS The pipeline is capable of reconstructing interventional tools from only four X-ray projections without the need for a patient prior. At an isotropic voxel size of 100 μ m , our methods achieve a precision/recall within a 100 μ m environment of the ground truth of 93%/98%, 90%/71%, and 93%/76% for guide wires, stents, and coils, respectively. CONCLUSIONS A deep learning-based approach for 4D interventional guidance is able to overcome the drawbacks of today's interventional guidance by providing full spatiotemporal (4D) information about the interventional tools at dose levels comparable to conventional fluoroscopy.
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Affiliation(s)
- Elias Eulig
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Joscha Maier
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Knaup
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - N Robert Bennett
- Department of Radiology, Stanford University, Stanford, California, USA
| | | | - Adam S Wang
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Marc Kachelrieß
- Division of X-Ray Imaging and Computed Tomography, German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Gouveia AG, Chan DCW, Hoskin PJ, Marta GN, Trippa F, Maranzano E, Chow E, Silva MF. Advances in radiotherapy in bone metastases in the context of new target therapies and ablative alternatives: A critical review. Radiother Oncol 2021; 163:55-67. [PMID: 34333087 DOI: 10.1016/j.radonc.2021.07.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
In patients with bone metastases (BM), radiotherapy (RT) is used to alleviate symptoms, reduce the risk of fracture, and improve quality of life (QoL). However, with the emergence of concepts like oligometastases, minimal invasive surgery, ablative therapies such as stereotactic ablative RT (SABR), radiosurgery (SRS), thermal ablation, and new systemic anticancer therapies, there have been a paradigm shift in the multidisciplinary approach to BM with the aim of preserving mobility and function survival. Despite guidelines on using single-dose RT in uncomplicated BM, its use remains relatively low. In uncomplicated BM, single-fraction RT produces similar overall and complete response rates to RT with multiple fractions, although it is associated with a higher retreatment rate of 20% versus 8%. Complicated BM can be characterised as the presence of impending or existing pathologic fracture, a major soft tissue component, existing spinal cord or cauda equina compression and neuropathic pain. The rate of complicated BM is around 35%. Unfortunately, there is a lack of prospective trials on RT in complicated BM and the best dose/fractionation regimen is not yet established. There are contradictory outcomes in studies reporting BM pain control rates and time to pain reduction when comparing SABR with Conventional RT. While some studies showed that SABR produces a faster reduction in pain and higher pain control rates than conventional RT, other studies did not show differences. Moreover, the local control rate for BM treated with SABR is higher than 80% in most studies, and the rate of grade 3 or 4 toxicity is very low. The use of SABR may be preferred in three circumstances: reirradiation, oligometastatic disease, and radioresistant tumours. Local ablative therapies like SABR can delay change or use of systemic therapy, preserve patients' Qol, and improve disease-free survival, progression-free survival and overall survival. Moreover, despite the potential benefit of SABR in oligometastatic disease, there is a need to establish the optial indication, RT dose fractionation, prognostic factors and optimal timing in combination with systemic therapies for SABR. This review evaluates the role of RT in BM considering these recent treatment advances. We consider the definition of complicated BM, use of single and multiple fractions RT for both complicated and uncomplicated BM, reirradiation, new treatment paradigms including local ablative treatments, oligometastatic disease, systemic therapy, physical activity and rehabilitation.
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Affiliation(s)
- André G Gouveia
- Radiation Oncology Department, Américas Centro de Oncologia Integrado, Rio de Janeiro, Brazil; Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Dominic C W Chan
- Department of Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, London, United Kingdom; Radiation Oncology Department, University of Manchester, United Kingdom
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Department, Hospital Sírio Libanês, São Paulo, Brazil
| | - Fabio Trippa
- Radiation Oncology Center, Santa Maria Hospital, Terni, Italy
| | | | - Edward Chow
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Mauricio F Silva
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Radiation Oncology Unit, Santa Maria Federal University, Santa Maria, Brazil; Clínica de Radioterapia de Santa Maria, Brazil.
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17
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Ribeiro FS, Jeha SAH, Dos Santos JVF, Damasceno AVSB, da Silva TMMF, do Couto FB, Reale HB. Embolization of renal tumor bone metastasis: case report. J Vasc Bras 2021; 20:e20210005. [PMID: 34211544 PMCID: PMC8218833 DOI: 10.1590/1677-5449.210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary or secondary bone tumors can manifest in different ways, from simple bone pain to possible pathological fractures. Hypervascularized tumors are of greatest concern, with increased incidence of complications. Preoperative embolization of the bone tumor is an effective measure for reducing blood loss during open surgery to excise the tumor. With appropriate experience, the risks of the procedure are minimal and final outcomes are highly satisfactory. The purpose of this paper is to describe the case of a 43-year-old male patient with a metastatic renal cell tumor in the left proximal femur (seen on lower limb computed tomography) who underwent selective preoperative embolization. The procedure resulted in a remarkable absence of bleeding and successful response to subsequent onco-orthopedic surgery.
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18
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Scandiffio R, Bozzi E, Ezeldin M, Capanna R, Ceccoli M, Colangeli S, Donati DM, Colangeli M. Image-guided Cryotherapy for Musculoskeletal Tumors. Curr Med Imaging 2021; 17:166-178. [PMID: 32842945 DOI: 10.2174/1573405616666200825162712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This article represents a review of the use of image-guided cryotherapy in the treatment of musculoskeletal tumor lesions. Cryotherapy is able to induce a lethal effect on cancer cells through direct and indirect mechanisms. In this manuscript, we combined our experience with that of other authors who have published on this topic in order to provide indications on when to use cryotherapy in musculoskeletal oncology. DISCUSSION Image-Guided percutaneous cryotherapy is a therapeutic method now widely accepted in the treatment of patients with musculoskeletal tumors. It can be used both for palliative treatments of metastatic bone lesions and for the curative treatment of benign bone tumors, such as osteoid osteoma or osteoblastoma. In the treatment of bone metastases, cryotherapy plays a major role in alleviating or resolving disease-related pain, but it has also been demonstrated that it can have a role in local disease control. In recent years, the use of cryotherapy has also expanded for the treatment of both benign and malignant soft tissue tumors. CONCLUSION Percutaneous cryotherapy can be considered a safe and effective technique in the treatment of benign and malignant musculoskeletal tumors. Cryotherapy can be considered the first option in benign tumor lesions, such as osteoid osteoma, and a valid alternative to radiofrequency ablation. In the treatment of painful bone metastases, it must be considered secondarily to other standard treatments (radiotherapy, bisphosphonate therapy, and chemotherapy) when they are no longer effective in controlling the disease or when they cannot be repeated (for example, radiotherapy).
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Affiliation(s)
- Rossella Scandiffio
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Elena Bozzi
- Division of Interventional Radiology, Cisanello University Hospital, Pisa, Italy
| | - Mohamed Ezeldin
- Department of Diagnostic and Interventional Radiology, Sohag University Hospital, Sohag, Egypt
| | - Rodolfo Capanna
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Matteo Ceccoli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Simone Colangeli
- 2nd Orthopedic Division, Department Of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Davide M Donati
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Colangeli
- Department of Musculo-Skeletal Oncology, IRCCS - Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Shaikh R, Munoz FG. Endovascular approaches in pediatric interventional oncology. CVIR Endovasc 2021; 4:2. [PMID: 33387076 PMCID: PMC7778666 DOI: 10.1186/s42155-020-00190-7] [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: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
The demand for interventional oncological (IO) treatment of pediatric cancers is becoming increasingly common, at least at several tertiary care institutions. The data and techniques used in pediatric IO are largely extrapolated from experience in adult patients. The management of pediatric tumors differs from that in adults in several categories, such as, the curative intent of treatment, wide use of general anesthesia, aggressive pain management, potentially longer hospital stay, variation in chemotherapy dosing etc. Additionally, pediatric cancers are managed by protocols directed by national and international oncology groups such as the Children’s Oncology Group (COG). Consequently, the translation and adoption of these techniques is gradual, but there is a noticeable uptrend due to the growing need. This review will update the current endovascular IO treatments for common pediatric liver, renal, bone and soft tissue tumors.
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Affiliation(s)
- Raja Shaikh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood, Boston, MA-02115, USA.
| | - Fernando Gomez Munoz
- Hospital Clinic-Hospital Sant Joan de Deu, C/ Villarroel 170, Passeig de Sant Joan de Déu, 2, Esplugues del Llobregat, 08950, Barcelona, Spain
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Salaria A, Thakur R, Aggarwal V, Dogra E, Bhardwaj R, Sharma S, Thakur P. Effect of embolization in the definitive and palliative management of bone and soft tissue tumors of the extremities. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2021. [DOI: 10.4103/jodp.jodp_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Ehne J, Tsagozis P. Current concepts in the surgical treatment of skeletal metastases. World J Orthop 2020; 11:319-327. [PMID: 32908816 PMCID: PMC7441493 DOI: 10.5312/wjo.v11.i7.319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/20/2020] [Accepted: 05/30/2020] [Indexed: 02/06/2023] Open
Abstract
Symptomatic metastatic bone disease affects a large proportion of patients with malignant tumours and significantly impairs patients’ quality of life. There are still controversies regarding both surgical indications and methods, mainly because of the relatively few high-quality studies in this field. Generally, prosthetic reconstruction has been shown to result in fewer implant failures and should be preferred in patients with a good prognosis. Survival estimation tools should be used as part of preoperative planning. Adjuvant treatment, which relies on radiotherapy and inhibition of osteoclast function may also offer symptomatic relief and prevent implant failure. In this review we discuss the epidemiology, indications for surgery, preoperative planning, surgical techniques and adjuvant treatment of metastatic bone disease.
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Affiliation(s)
- Jessica Ehne
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
| | - Panagiotis Tsagozis
- Department of Orthopedic Surgery, Karolinska University Hospital, Solna 171 76, Sweden
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22
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Wong SJ, Urlings T, Seng C, Leong S, Tan BS, Tan MH. Pre-Operative Embolisation of Musculoskeletal Tumours - A Single Centre Experience. Malays Orthop J 2020; 14:42-48. [PMID: 32296481 PMCID: PMC7156179 DOI: 10.5704/moj.2003.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The management of musculoskeletal tumours is complex and requires a multi-disciplinary approach. Preoperative embolisation can be often employed to reduce intra-operative blood loss and complication rates from surgery. We report our experience with the safety, technical success and efficacy of pre-operative embolisation in musculoskeletal tumours. Materials and Methods Thirteen consecutive patients who underwent pre-operative embolisation of a musculoskeletal tumour followed by surgical intervention at our institution from May 2012 to January 2016 were enrolled into the study. Patient demographics, tumour characteristics, embolisation techniques and type of surgery were recorded. Technical success of embolisation, amount of blood loss during surgery and transfusion requirements were estimated. Results There were five female and eight male patients who underwent pre-operative embolisation during the study period. The age ranged between 16 to 68 years, and the median age was 54. Technical success was achieved in all patients. Mean intra-operative blood loss was 1403ml, with a range of 150ml to 6900ml. Eight patients (62%) required intra-operative blood products of packed red blood cells and fresh frozen plasma. No major complications occurred during embolisation. Conclusion Pre-operative trans-arterial embolisation is feasible and safe for a variety of large and hypervascular musculoskeletal tumours. Our small series suggests that preoperative embolisation could contribute to the reduction of the intra-operative and post-operative blood product transfusion. It should be considered as a pre-operative adjunct for major tumour resections with a high risk of bleeding. The use of the haemoglobin gap complemented the assessment of perioperative blood loss.
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Affiliation(s)
- S J Wong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - T Urlings
- Department of Radiology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - C Seng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - S Leong
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - B S Tan
- Department of Vascular and Interventional Radiology (DVIR), Singapore General Hospital, Singapore
| | - M H Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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23
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Geraets SEW, Bos PK, van der Stok J. Preoperative embolization in surgical treatment of long bone metastasis: a systematic literature review. EFORT Open Rev 2020; 5:17-25. [PMID: 32071770 PMCID: PMC7017594 DOI: 10.1302/2058-5241.5.190013] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Surgery of long bone metastases is associated with a significant risk of perioperative blood loss, which may necessitate blood transfusion. Successful embolization (> 70% obliteration of vascularity) can be achieved in 36–75% of cases. The reported rate of embolization-related complications is 0–9%. Three out of six level III evidence studies showed a reduction in perioperative blood loss and/or blood transfusion requirement after preoperative embolization of renal cell carcinoma metastasis in long bones; three out of six studies did not. One level III evidence study did not show a reduction in perioperative blood loss and/or transfusion requirement after preoperative embolization of hepatocellular carcinoma metastases in long bones. There were no studies found that support preoperative embolization of thyroid metastases or other frequent long bone metastases (e.g. mamma carcinoma, lung carcinoma, or prostate carcinoma). The clinical level of evidence of the studies found is low and randomized studies taking into account primary tumour, location of metastases and type of surgery are therefore desired.
Cite this article: EFORT Open Rev 2020;5:17-25. DOI: 10.1302/2058-5241.5.190013
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Affiliation(s)
- Stijn E W Geraets
- Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - P Koen Bos
- Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Johan van der Stok
- Department of Orthopaedics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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24
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Abstract
Bone is a major site of haematogenous tumour cell spread in renal cell carcinoma (RCC), and most patients with RCC will develop painful and functionally disabling bone metastases at advanced disease stages. The prognosis of these patients is generally poor and the treatment is, therefore, aimed at palliation. However, RCC-associated bone metastases can be curable in select patients. Current data support a multimodal management strategy that includes wide resection of lesions, radiotherapy, systemic therapy, and other local treatment options, which can improve quality of life and survival. Nevertheless, the optimal approach for metastatic bone disease in RCC has not yet been defined and practical recommendations are rare. To improve the management and outcomes of patients with RCC and bone metastases, the International Kidney Cancer Coalition and the interdisciplinary working group on renal tumours of the German Cancer Society convened a meeting of experts with a global perspective to perform an unstructured review and elaborate on current treatment strategies on the basis of published data and expertise. The panel formulated recommendations for the diagnosis and treatment of patients with RCC and metastasis to the bone. Furthermore, the experts summarized current challenges and unmet patient needs that should be addressed in the future. In this Expert Consensus, Grünwald et al. summarize their recommendations for the diagnosis and treatment of patients with renal cell carcinoma and metastasis to the bone. They also outline current challenges and unmet patient needs that should be addressed in the future.
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25
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Errani C, Bazzocchi A, Spinnato P, Facchini G, Campanacci L, Rossi G, Mavrogenis AF. What’s new in management of bone metastases? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1367-1375. [DOI: 10.1007/s00590-019-02446-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/03/2019] [Indexed: 12/18/2022]
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26
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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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27
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Hashizume T, Shimohira M, Ohta K, Suzuki K, Sawada Y, Nakamura Y, Suzuki M, Murakami S, Shibamoto Y. Preoperative transcatheter arterial embolization using a gelatin sponge for head and neck tumors. MINIM INVASIV THER 2018; 28:206-212. [PMID: 30261785 DOI: 10.1080/13645706.2018.1519511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To evaluate the usefulness of preoperative transcatheter arterial embolization using a gelatin sponge for hypervascular head and neck tumors to reduce intraoperative blood loss (IBL). Material and methods: Nineteen patients underwent preoperative transcatheter arterial embolization for hypervascular head and neck tumors using a gelatin sponge. The technical success rate, devascularization rate, IBL, and complications were evaluated. Angiography images obtained before and after preoperative embolization were compared in all patients, and the devascularization rate was assessed from the relative reduction rate of contrast agent volumes. Results: The technical success rate was 100%. The median devascularization rate was 95% (range, 75-100%). The median period between embolization and surgical resection was one day (range, 1-12 days). The median IBL was 122 ml (range, 0-3780 ml). Blood transfusions were required in three cases, and their IBL and devascularization rates were 850, 1959, and 3780 ml, and 75%, 90%, and 80%, respectively. There was a complication of cerebral embolism in one out of 19 cases (5%). Conclusions: Preoperative transcatheter arterial embolization using a gelatin sponge was feasible and may contribute to decreasing IBL.
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Affiliation(s)
- Takuya Hashizume
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Masashi Shimohira
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Kengo Ohta
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Kazushi Suzuki
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Yusuke Sawada
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Yoshihisa Nakamura
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Motohiko Suzuki
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Shingo Murakami
- b Department of Otorhinolaryngology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
| | - Yuta Shibamoto
- a Department of Radiology , Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan
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28
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Zdzienicki M, Dudzisz-Śledź M, Kalinowska I, Rutkowski P. Advances in the management of giant cell tumor of bone: current options and future challenges. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2018.1512401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
| | - Monika Dudzisz-Śledź
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
| | - Iwona Kalinowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute – Oncology Center, Warsaw, Poland
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29
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Loya MF, Mangat S, Santoro GC, Martynov A, Shah SS. Prophylactic absorbable gelatin sponge embolization for angiographically occult splenic hemorrhage. Radiol Case Rep 2018; 13:753-758. [PMID: 30065796 PMCID: PMC6066598 DOI: 10.1016/j.radcr.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 01/04/2018] [Indexed: 01/01/2023] Open
Abstract
Nonoperative management of traumatic splenic hemorrhage includes the targeted administration of embolic agents. In certain instances where computed tomography angiography cannot exclude a bleed, prophylactic embolization with absorbable gelatin sponge has been used. In this retrospective case series review, we characterized the demographic data and clinical outcomes associated with 4 patients who underwent prophylactic transarterial splenic artery embolization after blunt abdominal trauma. Embolization was employed in cases where computed tomography angiography findings suggested at least a moderate splenic injury, and simultaneously where hemorrhage was not apparent during fluoroscopic angiography. Periprocedural hemodynamic status, technical success, and postoperative complications are discussed. The goal of this report was to discuss the safety and efficacy of prophylactic gelatin sponge embolization for occult splenic hemorrhage. In cases where a hemorrhagic site might be occult, this approach has the potential to minimize bleeding complications and the need for further intervention.
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Affiliation(s)
- Mohammed F Loya
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Suneet Mangat
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Giovanni C Santoro
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY 11568, USA
| | - Alexander Martynov
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
| | - Salman S Shah
- Department of Radiology, NuHealth, Nassau University Medical Center, East Meadow, NY 11554, USA
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30
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Arrigoni F, Bruno F, Zugaro L, Natella R, Cappabianca S, Russo U, Papapietro VR, Splendiani A, Di Cesare E, Masciocchi C, Barile A. Developments in the management of bone metastases with interventional radiology. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:166-174. [PMID: 29350645 PMCID: PMC6179078 DOI: 10.23750/abm.v89i1-s.7020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 01/08/2023]
Abstract
Interventional radiology has known an exponential growth in the last years. Technological advances of the last decades, have made it possible to use new treatments on a larger scale, with safe and effective results. They could be considered as palliative treatments for painful lesions but also curative procedures, as single treatment or specially in combination with other techniques (surgery, radiation and oncology therapies, etc.).The main diffuse techniques are those of thermal ablation that destroy the target lesion through the heat; however there are also endovascular therapies that destroy the target tissue thanks to devascularization. Finally the is also the possibility to stabilize pathological fractures or impending fractures. In this paper all the most diffuse and effective techniques are reviewed and also a discussion of the main indications is done, with an analisys of the success and complications rates.
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31
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Cone-beam computed tomography with automated bone subtraction in preoperative embolization for pelvic bone tumors. PLoS One 2017; 12:e0175907. [PMID: 28419147 PMCID: PMC5395210 DOI: 10.1371/journal.pone.0175907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/02/2017] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the usefulness of cone-beam computed tomography with automated bone subtraction (CBCT-ABS) in the preoperative embolization of hypervascular tumors located in the pelvic bone. MATERIALS AND METHODS This retrospective study included 26 patients with pelvic bone tumors who underwent preoperative embolization between January 2014 and October 2016. A CBCT-ABS scan was taken in a total of 17 patients (CBCT-ABS group), and only a series of digital subtraction angiographies (DSAs) was taken in the remaining 9 patients (DSA group). The percent devascularization, number of angiographic runs, total dose-area product (DAP), fluoroscopy time, interventional procedure time, operative time, and estimated blood loss were compared between the two groups using Mann-Whitney test. RESULTS The percent devascularization, interventional procedure time, fluoroscopy time, operative time, and estimated blood loss were not statistically different between the two groups (p > 0.05). On the other hand, the number of angiographic runs in the CBCT-ABS group was significantly lower than that in the DSA group (p = 0.029). The total DAP of the CBCT-ABS group (mean, 17700.7 μGym2) was higher than that of the DSA group (mean, 8939.4 μGym2) (p = 0.002). CONCLUSIONS The use of CBCT-ABS during the preoperative embolization of pelvic bone tumors significantly reduces the number of angiographic runs at the cost of an increased radiation dose.
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32
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Barile A, Arrigoni F, Zugaro L, Zappia M, Cazzato RL, Garnon J, Ramamurthy N, Brunese L, Gangi A, Masciocchi C. Minimally invasive treatments of painful bone lesions: state of the art. Med Oncol 2017; 34:53. [PMID: 28236103 DOI: 10.1007/s12032-017-0909-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 12/31/2022]
Abstract
The role of the interventional radiology (IR) in the musculoskeletal system, and in particular in the bone, is a field of knowledge that is growing significantly in the last years with indications for treatment of both benign and malign lesions. In this paper, we review the state of the art of this application of the IR in the bone (bone metastasis and benign bone lesions) with discussion about all the techniques today used.
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Affiliation(s)
- Antonio Barile
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy.
| | - Francesco Arrigoni
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Marcello Zappia
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Luca Brunese
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Carlo Masciocchi
- Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy
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Zaw T, Ni JC, Park JK, Walsworth M. Upper extremity tumor embolization using a transradial artery approach: technical note. Radiol Case Rep 2016; 11:190-4. [PMID: 27594948 PMCID: PMC4996924 DOI: 10.1016/j.radcr.2016.05.018] [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: 09/14/2015] [Revised: 04/08/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
Transradial access is being used with increasing frequency for interventional radiology procedures and offers several key advantages, including decreased access site complications and increased patient comfort. We report the technique of using transradial access to perform preoperative embolization of a humeral renal cell carcinoma metastasis and pathologic fracture. A transradial approach for performing humeral preoperative tumor embolization has not been previously reported, to our knowledge. In the appropriately selected patient, this approach may be safely used to perform upper extremity embolization.
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Affiliation(s)
- Taryar Zaw
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jason C Ni
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095-743730, USA
| | - Jonathan K Park
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095-743730, USA; Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Matthew Walsworth
- Division of Interventional Radiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 2125, Los Angeles, CA 90095-743730, USA; Department of Radiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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34
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Molnar C, Tătaru OS, Mărginean L, Borda A. Skeletal Muscle Metastases and Inferior Vena Cava Involvement in a Patient with Clear Cell Renal Cell Carcinoma and Sarcomatoid Differentiation. JOURNAL OF INTERDISCIPLINARY MEDICINE 2016. [DOI: 10.1515/jim-2016-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: Renal cell carcinoma has a propensity to propagate into the renal vein and inferior vena cava. A small percentage has distant metastasis at presentation. Pulmonary, hepatic, cerebral and bone metastases are common, but skeletal muscle involvement is rare.
Case presentation: We present the case of a 51-year-old patient complaining of right flank pain, gross hematuria and a painful left laterothoracic mass. Preoperative examination revealed a tumor in the inferior pole of the right kidney, thrombosis of the right renal vein that extended into the inferior vena cava and a left laterothoracic tumor. We decided on a preoperative digital subtraction angiography and selected embolization of the laterothoracic mass. We performed right radical nephrectomy with vena cava thrombus excision and excision of the left laterothoracic tumor. The pathological examination revealed a clear cell renal carcinoma with sarcomatoid differentiation of the right kidney. Metastases with the above features were noticed in the right adrenal gland and in the skeletal muscle of the chest wall.
Conclusions: The surgical resection of large renal tumors with associated thrombus within the inferior vena cava is challenging to any surgeon. The preoperative embolization of the metastatic tumor is helpful in the reduction of pain and intraoperative blood loss.
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Affiliation(s)
- Călin Molnar
- Surgery Clinic No. I, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Octavian-Sabin Tătaru
- Clinic of Urology, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Lucian Mărginean
- Department of Radiology, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Angela Borda
- Department of Pathology, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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Jha R, Sharma R, Rastogi S, Khan SA, Jayaswal A, Gamanagatti S. Preoperative embolization of primary bone tumors: A case control study. World J Radiol 2016; 8:378-389. [PMID: 27158424 PMCID: PMC4840195 DOI: 10.4329/wjr.v8.i4.378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/29/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time.
METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.
RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications.
CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.
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36
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Shimohira M, Nagai K, Hashizume T, Nakagawa M, Ozawa Y, Sakurai K, Matsushita Y, Yamada S, Otsuka T, Shibamoto Y. Preoperative transarterial embolization using gelatin sponge for hypervascular bone and soft tissue tumors in the pelvis or extremities. Acta Radiol 2016; 57:457-62. [PMID: 26082444 DOI: 10.1177/0284185115590435] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/15/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors plays an important role in reducing intraoperative blood loss (IBL). PURPOSE To evaluate the use of a gelatin sponge in preoperative transcatheter arterial embolization for hypervascular bone and soft tissue tumors in the pelvis or extremities. MATERIAL AND METHODS Thirty-seven patients (21 men, 16 women; median age, 61 years; age range, 23-79 years) underwent preoperative transcatheter arterial embolization between April 2004 and January 2015. Medical records and images were reviewed, and the technical success rate, clinical success rate, and complications were evaluated. Technical success was defined as a devascularization rate of 75% or higher, and clinical success was defined as intraoperative blood loss (IBL) <1500 mL in cases undergoing surgery within 3 days of transarterial embolization and <3000 mL in cases operated 4 or more days later. RESULTS Tumor sizes were in the range of 2.0-13.0 cm (median, 5.0 cm). The devascularization rate was decreased by >75% at follow-up angiography in all cases, and the technical success rate was 100 % (37/37). The median IBL was 491 mL (range, 30-3800 mL), and the clinical success rate was 89% (33/37). The minor complication of local pain was observed in 13 out of 37 cases (35%) during or after embolization, but was controllable by an analgesic. CONCLUSION Preoperative transarterial embolization using a gelatin sponge appears to be feasible and safe, and may contribute to decreasing IBL.
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Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keiichi Nagai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Hashizume
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoo Nakagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Keita Sakurai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasushi Matsushita
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Yamada
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takanobu Otsuka
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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37
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Guzik G. Results of the treatment of bone metastases with modular prosthetic replacement--analysis of 67 patients. J Orthop Surg Res 2016; 11:20. [PMID: 26849881 PMCID: PMC4744389 DOI: 10.1186/s13018-016-0353-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 01/24/2016] [Indexed: 01/31/2023] Open
Abstract
Background Surgical treatment of long-bone metastases requires a comprehensive approach. The indications for surgery are based on the patient’s general condition, type and stage of cancer, and survival time expectancy. Tumor modular endoprostheses have been increasingly used. Surgery should provide pain relief and improve the quality of life. Methods Between 2010 and 2013, 67 patients with malignant metastases were surgically treated with resection prostheses. We performed a retrospective analysis of the indications for the surgery, its course, the type of the prostheses used, and the implantation techniques applied. We evaluated the most important clinical parameters influencing the postoperative quality of life of the patients. Results Breast, prostate, and lung cancers are the most common primary tumors that metastasize to bones. The most common site of the lesions is the proximal femur; sporadically, they do occur in bones distal to the knee and elbow. After the surgery, all the patients could walk, most of them without crutches. The pain, rated on a VAS scale, decreased significantly, and the Karnofsky score improved. We observed that joint mobility and the strength of the muscles in the limbs allowed for normal functioning. Postoperative complications including infections and local tumor recurrences were rarely observed. Conclusions The use of modular prostheses is an adequate method of treatment in patients with bone metastases. A radical resection of the tumor, which prevents local recurrences and loosening of implants, gives good outcomes. Reduced joint mobility resulting from muscle attachment cutting is well tolerated and concerns mainly patients that underwent operations on the humerus.
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Affiliation(s)
- Grzegorz Guzik
- Department of Orthopaedic Oncology, Specialist Hospital in Brzozów, Podkarpacie Oncology Centre, Bielawskiego 18, 36-200, Brzozów, Poland.
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38
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López-Pousa A, Martín Broto J, Garrido T, Vázquez J. Giant cell tumour of bone: new treatments in development. Clin Transl Oncol 2015; 17:419-30. [PMID: 25617146 PMCID: PMC4448077 DOI: 10.1007/s12094-014-1268-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/18/2014] [Indexed: 01/01/2023]
Abstract
Giant cell tumour of bone (GCTB) is a benign osteolytic tumour with three main cellular components: multinucleated osteoclast-like giant cells, mononuclear spindle-like stromal cells (the main neoplastic components) and mononuclear cells of the monocyte/macrophage lineage. The giant cells overexpress a key mediator in osteoclastogenesis: the RANK receptor, which is stimulated in turn by the cytokine RANKL, which is secreted by the stromal cells. The RANK/RANKL interaction is predominantly responsible for the extensive bone resorption by the tumour. Historically, standard treatment was substantial surgical resection, with or without adjuvant therapy, with recurrence rates of 20–56 %. Studies with denosumab, a monoclonal antibody that specifically binds to RANKL, resulted in dramatic treatment responses, which led to its approval by the United States Food and Drugs Administration (US FDA). Recent advances in the understanding of GCTB pathogenesis are essential to develop new treatments for this locally destructive primary bone tumour.
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Affiliation(s)
- A López-Pousa
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain,
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39
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Son HY, An SY, Kim EY, Ahn SB, Lee BC. Selective embolization for hypervascular metastasis from differentiated thyroid cancer: a case series. J Med Case Rep 2014; 8:405. [PMID: 25471328 PMCID: PMC4289282 DOI: 10.1186/1752-1947-8-405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 10/14/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction The technique of selective embolization has been applied for years in the treatment of vascular anomalies, severe hemorrhage, and for benign and malignant tumors. Some hypervascular skeletal metastases are prone to massive hemorrhage. Case presentation We describe the cases of two patients with thyroid carcinoma presenting with neuromuscular symptoms due to large skeletal metastases in the shoulder and sternum respectively. Pre-operative percutaneous selective catheterizations of the arteries feeding the metastatic tumors were performed, followed by infusion of gelfoam. The procedures were technically successful in both patients without adverse effects or bleeding. Complete resections of the skeletal metastases were then performed without substantial bleeding. Conclusion Selective embolization is an effective treatment for bony metastases from thyroid cancer.
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Affiliation(s)
- Hee Young Son
- Department of Otorhinolaryngology, Thyroid/Head & Neck Cancer Center, Dongnam Institution of Radiological & Medical Sciences, 40 Jwadong-gil, Jangan-eup, Gijang-gun, Busan, South Korea.
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40
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41
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Prasad SC, Piccirillo E, Nuseir A, Sequino G, De Donato G, Paties CT, Sanna M. Giant Cell Tumors of the Skull Base: Case Series and Current Concepts. Audiol Neurootol 2013; 19:12-21. [DOI: 10.1159/000355701] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/16/2013] [Indexed: 12/12/2022] Open
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42
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Quinn RH, Randall RL, Benevenia J, Berven SH, Raskin KA. Contemporary management of metastatic bone disease: tips and tools of the trade for general practitioners. J Bone Joint Surg Am 2013; 95:1887-95. [PMID: 24288805 DOI: 10.2106/00004623-201310160-00011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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43
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Iwamoto S, Takao S, Nose H, Otomi Y, Takahashi M, Nishisho T, Ueno J, Yasui N, Harada M. Usefulness of transcatheter arterial embolization prior to excision of hypervascular musculoskeletal tumors. THE JOURNAL OF MEDICAL INVESTIGATION 2013; 59:284-8. [PMID: 23037202 DOI: 10.2152/jmi.59.284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The objective of this study was to evaluate the usefulness of transcatheter arterial embolization prior to surgical excision of musculoskeletal tumors. We reviewed the records of nine patients (3 females and 6 males) who received arterial embolization prior to excision of musculoskeletal tumors in our hospital from December 2009 to April 2010. We evaluated tumor region, size, histopathology, feeding artery, embolic material, and blood loss during surgery. We compared the actual amount of intraoperative bleeding with arterial embolization to estimated amounts of bleeding without embolization predicted by three orthopedic surgeons. Arterial embolization was performed on the same day or within 5 days before surgery. Operations were performed as planned in all patients without serious complications. The amount of intraoperative bleeding was 35-4200 mL and there was significantly less bleeding with arterial embolization compared with the estimated amounts (p<0.01). Our results show that arterial embolization prior to resection of hypervascular musculoskeletal tumors reduces the amount of bleeding during surgery and contributes to patient safety.
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Affiliation(s)
- Seiji Iwamoto
- Department of Radiology, the University of Tokushima, Tokushima, Japan
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Oh HL, Kang HR, Jeon SC, Lee YH. Thromboembolic events identified during diagnosis of germ cell tumors in 2 children. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 47:233-6. [PMID: 23071481 PMCID: PMC3464343 DOI: 10.5045/kjh.2012.47.3.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/11/2012] [Accepted: 08/03/2012] [Indexed: 12/02/2022]
Abstract
We describe 2 cases in which radiographic evidence of thromboembolic events was obtained during germ cell tumor diagnosis. There was no evidence of coagulation factor abnormalities or contributory procedures or drugs in either patient. We used anticoagulation therapy for thrombolysis in one patient, but in the other, the thromboembolism resolved spontaneously.
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Affiliation(s)
- Hea-Lin Oh
- Department of Pediatrics, Hanyang University Medical Center, Seoul, Korea
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45
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Lau V, Sun M, Chu F. Embolisation of hypervascular bone tumours: a pictorial essay with literature review. J Med Imaging Radiat Oncol 2012; 57:191-7. [PMID: 23551777 DOI: 10.1111/j.1754-9485.2012.02444.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 05/10/2012] [Indexed: 11/27/2022]
Abstract
Bone tumours, either primary or secondary, can present in various debilitating manners, including pain and pathological fracture. The situation is particularly problematic when the tumours are hypervascular, and located in regions where a high risk of neurological compromise is anticipated during operation, such as in the spine or sacrum. In such situations, bone tumour embolisation is a useful and effective adjunctive treatment for reducing intra-operative blood loss. This is particularly relevant in primary bone tumours such as giant cell tumours and metastatic renal cell and thyroid tumours. With a proper pre-embolisation angiogram and knowledge of anatomy, careful selective cannulation of the arterial supplies and experience in using embolic agents, the risks of non-target embolisation can be kept to minimum and the best result achieved.
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Affiliation(s)
- Vince Lau
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR, China.
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Gupta P, Gamanagatti S. Preoperative transarterial Embolisation in bone tumors. World J Radiol 2012; 4:186-92. [PMID: 22761978 PMCID: PMC3386530 DOI: 10.4329/wjr.v4.i5.186] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 02/03/2012] [Accepted: 02/10/2012] [Indexed: 02/06/2023] Open
Abstract
Bone tumors include a variety of lesions, both primary and metastatic. The treatment modalities for bone tumors vary with the individual lesion, but in general surgical excision is the treatment of choice with other adjunctive therapies. However, surgery for many bone tumors is complex due to several factors including tumor bulk, vascularity, vicinity to vital structures and potentially inaccessible location of the lesion. Transarterial Embolisation (TAE) is one of the important adjuvant treatment modalities and in some cases it may be the primary and curative treatment. Preoperative TAE has proved to be effective in both primary and metastatic bone tumors. It reduces tumor vascularity and intraoperative blood loss, the need for blood transfusion and associated complications, allows better definition of tissue planes at surgery affording more complete excision, and hence reduced recurrence. Preoperative chemoEmbolisation has also been shown to increase the sensitivity of some tumors to subsequent chemotherapy and radiotherapy. There are several techniques and embolic agents available for this purpose, but the ultimate aim is to achieve tumor devascularization. In this review, we discuss the techniques including the choice of embolic agent, application to individual lesions and potential complications.
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