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Pedraza-Sánchez JP, Chaves-Marcos R, Mazuecos-Quirós J, Bisonó-Castillo ÁL, Osmán-García I, Gutiérrez-Marín CM, Medina López RA, Juárez Soto Á. Percutaneous radiofrequency ablation is an effective treatment option for small renal masses, comparable to partial nephrectomy. Eur Radiol 2023; 33:7371-7379. [PMID: 37280356 DOI: 10.1007/s00330-023-09779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/20/2023] [Accepted: 04/14/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The standard therapy for small renal masses (SRMs) remains partial nephrectomy (PN), which is associated with relatively high morbidity and complication rate. Therefore, percutaneous radiofrequency ablation (PRFA) emerges as an alternative therapy. This study aimed to compare the efficacy, safety, and oncological outcomes of PRFA versus PN. METHODS A multicenter non-inferiority study with retrospective analysis of 291 patients with SRMs (N0M0), who underwent PN or PRFA (2:1), recruited prospectively from two hospitals in the Andalusian Public Health System, Spain, between 2014 and 2021. Comparisons of treatment features were evaluated using the t test, Wilcoxon-Mann-Whitney U test, chi-square test, Fisher test, and Cochran-Armitage trend test. Kaplan-Meier curves depicted overall survival (OS), local recurrence-free survival (LRFS), and metastasis-free survival (MFS) rates in the overall study population. RESULTS A total of 291 consecutive patients were identified; 111 and 180 patients underwent PRFA and PN, respectively. Median follow-up time was 38 and 48 months, and mean hospitalization days were 1.04 and 3.57 days, respectively. The variables underpinned with high surgical risk were significantly increased in PRFA compared to those in PN (mean age was 64.56 and 57.47 years, the solitary kidney presence was 12.6% and 5.6%, ASA score ≥ 3 was 36% and 14.5%, respectively). The rest of oncological outcomes were comparable amongst PRFA and PN. Patients undergoing PRFA did not improve OS, LRFS, and MFS compared to those undergoing PN. Limitations comprise retrospective design and limited statistical power. CONCLUSION PRFA for SMRs in high-risk patients is non-inferior in terms of oncological outcomes and safety compared to PN. CLINICAL RELEVANCE STATEMENT Our study has a direct clinical application as it proves that radiofrequency ablation is an effective and uncomplicated therapeutic option for patients with small renal masses. KEY POINTS •There are non-inferiority results in overall survival, local recurrence-free survival, and metastasis-free survival between PRFA and PN. •Our two-center study showed that PRFA is non-inferior to PN in oncological outcomes. •Contrast-enhanced power ultrasound-guided PRFA provides an effective therapy for T1 renal tumors.
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Affiliation(s)
- José Pablo Pedraza-Sánchez
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain.
| | - Reyes Chaves-Marcos
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Javier Mazuecos-Quirós
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
| | - Álvaro Luis Bisonó-Castillo
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
| | - Ignacio Osmán-García
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Carlos Miguel Gutiérrez-Marín
- Department of Radiology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Rafael Antonio Medina López
- Department of Urology and Nephrology, Virgen del Rocío University Hospital, Biomedical Institute of Seville (Ibis), CSIC/University of Seville, Seville, Spain
| | - Álvaro Juárez Soto
- Urology Clinical Unit, University Hospital of Jerez de La Frontera, Ctra. Trebujena, S/N, 11407, Jerez de La Frontera, Cádiz, Spain
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Nebelung H, Radosa CG, Schön F, Blum SFU, Böhme C, Hoffmann RT, Plodeck V. Impact of the COVID-19 pandemic on therapeutic interventional oncology procedures and diagnostic CT/MRI examinations at a German university hospital. ROFO-FORTSCHR RONTG 2023; 195:707-712. [PMID: 37224865 DOI: 10.1055/a-2081-4012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE The COVID-19 pandemic led to the implementation of severe restrictions on public life in Germany and a reduction in the number of non-COVID patients presenting for care. The aim of this study was to measure the impact on the number of therapeutic interventional oncology procedures in relation to diagnostic imaging studies at a high-volume radiology department. MATERIALS AND METHODS The numbers of therapeutic interventional oncology procedures and diagnostic CT/MRI examinations for the years 2010 to 2021 were extracted using the hospital information system. Monthly data from January 2010 to December 2019 were used to build forecasting models for the timeframe from January 2020 to December 2021. Real procedure numbers were compared with predicted numbers to calculate residual differences, which were considered statistically significant if the real number was outside the 95 % confidence interval (p < 0.05). RESULTS During the first German lockdown (March/April 2020), the number of outpatient CT/MRI examinations decreased significantly, with a less pronounced decrease of overall CT/MRI numbers. The second German lockdown (January-May 2021) led to lower than predicted outpatient CT numbers, whereas outpatient MRI numbers in part even exceeded predicted numbers and overall CT/MRI numbers stayed within confidence limits. The lockdowns had a more pronounced negative effect on the number of oncological MRI examinations compared to CT examinations. The number of therapeutic interventional oncology procedures showed no significant decrease during both lockdowns. CONCLUSION Lockdown measures had minor impact on the number of therapeutic interventional oncology procedures, possibly due to a shift from more resource-intensive therapies like surgery towards interventional oncology. The overall numbers of diagnostic imaging decreased during the first lockdown, while the second lockdown had less negative impact. The number of oncological MRI examinations was affected most severely. To avoid adverse outcomes, specific protocols for patient management during future pandemic outbreaks should be implemented and continuously adapted. KEY POINTS · COVID-19 lockdowns had minor effect on therapeutic interventional oncology procedures.. · Numbers of diagnostic outpatient imaging procedures dropped markedly, especially during the first lockdown.. · The number of oncological MRI examinations showed a significant decrease during both lockdowns.. CITATION FORMAT · Nebelung H, Radosa CG, Schön F et al. Impact of the COVID-19 pandemic on therapeutic interventional oncology procedures and diagnostic CT/MRI examinations at a German university hospital. Fortschr Röntgenstr 2023; 195: 707 - 712.
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Affiliation(s)
- Heiner Nebelung
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christoph Georg Radosa
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Felix Schön
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sophia Freya Ulrike Blum
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Böhme
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Verena Plodeck
- Institute and Polyclinic for Diagnostic und Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Bruners P. [CT-guided local ablative interventions]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01164-1. [PMID: 37306751 DOI: 10.1007/s00117-023-01164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Applicator-based local ablations under computed tomography (CT) guidance for the treatment of malignant tumors have found their way into clinical routine. OBJECTIVES The basic principles of the different ablation technologies and their specific clinical field of application are described. MATERIALS AND METHODS A comprehensive literature review regarding applicator-based ablation techniques was carried out. RESULTS Radiofrequency (RFA) and microwave ablation (MWA) represent two image-guided hyperthermal treatment modalities that have been established for the treatment of primary and secondary liver malignancies. In addition, both techniques are also applied for local ablative therapy of lung- and kidney tumors. Cryoablation is mainly used for the local ablation of T1 kidney cancer and due to its intrinsic analgetic characteristics for application in the musculoskeletal system. Nonresectable pancreatic tumors and centrally located liver malignancies can be treated with irreversible electroporation. This nonthermal ablation modality preserves the structure of the extracellular matrix including blood vessels and ducts. Technical advancements in the field of CT-guided interventions include the use of robotics, different tracking and navigation technologies and the use of augmented reality with the goal to achieve higher precision, shorter intervention time and thereby reduce radiation exposure. CONCLUSION Percutaneous ablation techniques under CT guidance are an essential part of interventional radiology and they are suited for local treatment of malignancies in most organ systems.
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Affiliation(s)
- Philipp Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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Ablation zone considerations in cryoablation of RCC: accuracy of manufacturer provided model and change from first to second freeze cycle. Clin Imaging 2022; 89:10-15. [DOI: 10.1016/j.clinimag.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
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Yuan F, Wei SH, Konecny GE, Memarzadeh S, Suh RD, Sayre J, Lu DS, Raman SS. Image-Guided Percutaneous Thermal Ablation of Oligometastatic Ovarian and Non-Ovarian Gynecologic Tumors. J Vasc Interv Radiol 2021; 32:729-738. [PMID: 33608192 DOI: 10.1016/j.jvir.2021.01.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/30/2020] [Accepted: 01/17/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the safety, feasibility, and efficacy of percutaneous thermal ablation (TA) in the treatment of metastatic gynecologic (GYN) tumors. MATERIALS AND METHODS A study cohort of 42 consecutive women (mean age, 59. years; range, 25-78 years) with metastatic GYN tumors (119 metastatic tumors) treated with radiofrequency (n = 47 tumors), microwave (n = 47 tumors), or cryogenic (n = 30 tumors) ablation from over 2,800 ablations performed from January 2001 to January 2019 was identified. The primary GYN neoplasms consisted of ovarian (27 patients; 77 tumors; mean tumor diameter [MTD], 2.50 cm), uterine (7 patients; 26 tumors; MTD, 1.89 cm), endometrial (5 patients; 10 tumors; MTD, 2.8 cm), vaginal (2 patients; 5 tumors; MTD, 2.40 cm), and cervical (1 patient; 1 tumor; MTD, 1.90 cm) cancers. In order of descending frequency, metastatic tumors treated by TA were located in the liver or liver capsule (74%), lungs (13%), and peritoneal implants (9%). Single tumors were also treated in the kidneys, rectus muscle, perirectal soft tissue (2.5%), and retroperitoneal lymph nodes (1.6%). All efficacy parameters of TA and definitions of major and minor adverse events are categorized by the latest Society of Interventional Radiology reporting standards. RESULTS The median follow-up of treated patients was 10 months. After the initial ablation, 95.6% of the patients achieved a complete tumor response confirmed by contrast-enhanced magnetic resonance imaging or computed tomography. On surveillance imaging, 8.5% of the ablated tumors developed local progression over a median follow-up period of 4.1 months. Five of 8 tumors with local recurrence underwent repeated treatment over a mean follow-up period of 18 months, and 4 of 5 tumors achieved complete eradication after 1 additional treatment session that resulted in a secondary efficacy of 80%. The overall technique efficacy of TA was 96.2% over a median follow-up period of 10 months. CONCLUSIONS TA was safe and effective for the local control of metastatic GYN tumors in the lungs, abdomen, and pelvis, with an overall survival rate of 37.5 months and a local progression-free survival rate of 16.5 months, with only 4.8% of treated patients experiencing a major adverse event.
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Affiliation(s)
- Frank Yuan
- Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California.
| | - Sindy H Wei
- Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - Gottfried E Konecny
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - Sanaz Memarzadeh
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - Robert D Suh
- Division of Thoracic Diagnostic and Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - James Sayre
- Department of Radiological Sciences & Biostatistics, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - David S Lu
- Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
| | - Steven S Raman
- Division of Abdominal Imaging and Cross-Sectional Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angles, California
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Meng L, Zhang X, Xu R, Wu B, Zhang X, Wei Y, Li J, Shan H, Xiao Y. A preliminary comparative study of percutaneous CT-guided cryoablation with surgical resection for osteoid osteoma. PeerJ 2021; 9:e10724. [PMID: 33520471 PMCID: PMC7812921 DOI: 10.7717/peerj.10724] [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: 08/28/2020] [Accepted: 12/16/2020] [Indexed: 12/28/2022] Open
Abstract
Background The traditional treatment for osteoid osteoma is the nidus’ surgical resection, which was difficult to eradicate with more invasive and complications because of osteosclerosis surrounding the nidus. This study aimed to analyze the efficacy and safety of percutaneous CT-guided cryoablation of osteoid osteoma at different sites (especially refractory sites such as the spine). Methods Fifteen patients with osteoid osteoma who underwent cryoablation at our institution were analyzed retrospectively on their imaging data and clinical visual analog scale (VAS) pain scores before and after the procedure. Fifty-three patients underwent surgical resection during the period were also included in this study as a control group. Treatment efficacy was assessed primarily by comparing the differences in VAS scores at different time points in each group of patients by paired-sample t-test. Differences in length of hospital stay and complications between the two groups were also compared. Results The technical success rate was 100% in both the cryoablation and surgical resection group. Cryoablation had a significantly shorter hospitalization time than surgery (p = 0.001). Clinically, the post-operative VAS scores were all significantly improved compared to the pre-operative period, and the clinical cure was achieved in both groups. Surgical operations had more complications than cryoablation, although there was no significant difference. In the group of cryoablation, only one patient had mild numbness of the left lower extremity, which relieved itself; two patients had mild post-operative pain. No patients in the cryoablation group experienced recurrence during the follow-up period. In the surgery group, three of the patients experienced massive bleeding (>500 ml), and two underwent transfusion therapy. Only one patient in the surgical resection group experienced a recurrence at 29 months postoperatively and underwent a second resection. All patients had local scars on the skin after surgical resection. Conclusion Cryoablation is a minimally invasive, safe, and effective treatment strategy for osteoid osteoma, and is fully comparable to surgical resection.
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Affiliation(s)
- Liangliang Meng
- Medical School of Chinese PLA, Beijing, China.,Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiao Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruijiang Xu
- Department of Pediatric Surgery, Chinese PLA General Hospital, Beijing, China
| | - Bin Wu
- Department of Radiology, Chinese PAP Beijing Corps Hospital, Beijing, China
| | - Xiaobo Zhang
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yingtian Wei
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Husheng Shan
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yueyong Xiao
- Department of Radiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
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Abstract
PURPOSE OF REVIEW Radiogenomics is a growing field that has garnered immense interest over the past decade, owing to its numerous applications in the field of oncology and its potential value in improving patient outcomes. Current applications have only begun to delve into the potential of radiogenomics, and particularly in interventional oncology, there is room for development and increased value of these applications. RECENT FINDINGS The field of interventional oncology (IO) has seen valuable radiogenomic applications, from prediction of response to locoregional therapies in hepatocellular carcinoma to identification of genetic mutations in non-small cell lung cancer. Future directions that can increase the value of radiogenomics include applications that address tumor heterogeneity, predict immune responsiveness of tumors, and differentiate between oligoprogression and early widespread progression, among others. Radiogenomics, whether in terms of methodologies or applications, is still in the early stages of development and far from maturation. Future applications, particularly in the field of interventional oncology, will allow realization of its full potential.
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