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Wang L, Lu M, Zhang X, Zhao Z, Li X, Liu T, Xu L, Yu S. Risk factors for pulmonary cement embolism after percutaneous vertebroplasty and radiofrequency ablation for spinal metastases. Front Oncol 2023; 13:1129658. [PMID: 37213292 PMCID: PMC10196379 DOI: 10.3389/fonc.2023.1129658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/24/2023] [Indexed: 05/23/2023] Open
Abstract
Objective Pulmonary cement embolism is a rare but underestimated complication of vertebroplasty due to the relative lack of study and examination. This study aims to investigate the incidence of pulmonary cement embolism in patients with spinal metastasis who undergo PVP with RFA and to analyze the relative risk factors. Methods A total of 47 patients were retrospectively included and classified into pulmonary cement embolism (PCE) group and non-pulmonary cement embolism (NPCE) group by comparing pre- and postoperative pulmonary CT scan images. The demographic and clinical information of the patients was obtained. Demographic data in the two groups were compared using the chi-square test for qualitative data and the unpaired t test for quantitative data. Multiple logistic regression analysis was used to identify risk factors related to pulmonary cement embolism. Results Pulmonary cement embolism was detected in 11 patients (23.4%), and all patients were asymptomatic and followed up regularly. Risk analysis showed that multiple segments (≥3, p=0.022), thoracic vertebrae (p=0.0008), and unipedicular puncture approach (p=0.0059) were risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra (p<0.0001). Vein leakage of cement was related to the integrity of the vertebral cortex. Conclusion The number of involved vertebrae, lesion location, and puncture approach are independent risk factors for pulmonary cement embolism. There was a high incidence of pulmonary cement embolism if bone cement leaked into the para vertebral venous plexus in the thoracic vertebra. Surgeons should consider these factors when formulating therapeutic strategies.
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Affiliation(s)
- Luqiang Wang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Lu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinxin Zhang
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhenguo Zhao
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyang Li
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ting Liu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Libin Xu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengji Yu
- Department of Orthopedics, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Shengji Yu,
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Araki K, Shibuya K, Harimoto N, Watanabe A, Tsukagoshi M, Ishii N, Ikota H, Yokobori T, Tsushima Y, Shirabe K. A prospective study of sequential hepatic vein embolization after portal vein embolization in patients scheduled for right-sided major hepatectomy: Results of feasibility and surgical strategy using functional liver assessment. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:91-101. [PMID: 35737808 DOI: 10.1002/jhbp.1207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/25/2022] [Accepted: 06/01/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Hepatic vein embolization (HVE) added to portal vein embolization (PVE) can further increase future remnant liver volume (FRLV) compared with PVE alone. This study was aimed to evaluate feasibility of sequential HVE in a prospective trial and to verify surgical strategy using functional FRLV (fFRLV). METHODS Hepatic vein embolization was prospectively indicated for post-PVE patients scheduled for right-sided major hepatectomy if the resection limit of fFRLV using EOB-magnetic resonance imaging was not satisfied. The resection limit was fFRLV: 615 mL/m2 for predicting post-hepatectomy liver failure. Patients who underwent sequential PVE-HVE (n = 12) were compared with those who underwent PVE alone (n = 31). RESULTS All patients underwent HVE with no severe complications. Median fFRLV increased from 396 (range: 251-581) to 634 (range: 422-740) mL/m2 by sequential PVE-HVE. From PVE to HVE, both of FRLV (P < .001) and fFRLV (P = .005) significantly increased. The increased width of fFRLV was larger than that of FRLV after performing HVE. Median growth rate was 71.3 (range: 33.3-80.3) %, which was higher than that of PVE alone (27.0%, range: 6.0-78.0). All-cohort resection rate was 88.3%. Strategy of using fFRLV for the resection limit and performing HVE in patients with insufficient functional volume resulted in no liver failure in all patients who underwent hepatectomy. CONCLUSIONS Sequential HVE after PVE is feasible and safe, and HVE induced possibility of further liver growth and its functional improvement. Our surgical strategy using fFRLV may be justified.
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Affiliation(s)
- Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kei Shibuya
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.,Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Norifumi Harimoto
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Akira Watanabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mariko Tsukagoshi
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Norihiro Ishii
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hayato Ikota
- Clinical Department of Pathology, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Takehiko Yokobori
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3 cm or larger: a prospective study. Int J Clin Oncol 2022; 27:1589-1595. [PMID: 35945389 DOI: 10.1007/s10147-022-02224-7] [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: 02/15/2022] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3 cm in diameter. METHODS We included patients aged ≥ 20 years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3 cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated. RESULTS From October 2013 to March 2016, 19 patients (mean age, 75 ± 13 years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developed local tumor progression at 3 and 42 months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3 years, and 95%, 84%, and 100% at 5 years, respectively. CONCLUSION Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3 cm in diameter was safe and achieved favorable survival.
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The role of percutaneous vertebral augmentation in patients with metastatic breast cancer: Literature review including report of two cases. Breast 2022; 63:149-156. [PMID: 35397256 PMCID: PMC8991318 DOI: 10.1016/j.breast.2022.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
Patients with metastatic breast cancer are at high risk for developing vertebral compression fractures due to underlying bone metastases and bone density loss. Vertebral augmentation techniques including percutaneous vertebroplasty and percutaneous balloon kyphoplasty are techniques used to stabilize compression fractures and improve pain. However, rare complications from these interventions have been observed, including spinal cord compression, nerve root compression, venous cement embolism, and pulmonary cement embolism. These complications pose unique potential challenges for patients with cancer who may already have decreased lung function and potential for venous thromboembolism. In this review, we first describe the role of percutaneous vertebral augmentations in patients with metastatic cancer, with a particular focus on patients with breast cancer. Then, we describe complications of vertebral augmentation in two patients with metastatic breast cancer including long-term symptomatic and radiographic follow-up. Balloon kyphoplasty and percutaneous vertebroplasty are used to stabilize compression fractures and improve pain. Leakage of bone cement can cause cement emboli which can depsit in locations such as the pulmonary and renal vasculature. Management of cement emboli depends on the amount of cement embolized and the severity of symptoms. Future studies are needed to better understand the long-term radiographic and clinical consequences of cement emboli.
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Li Q, Long X, Wang Y, Fang X, Guo D, Lv J, Hu X, Cai L. Development and validation of a nomogram for predicting the probability of new vertebral compression fractures after vertebral augmentation of osteoporotic vertebral compression fractures. BMC Musculoskelet Disord 2021; 22:957. [PMID: 34784910 PMCID: PMC8597210 DOI: 10.1186/s12891-021-04845-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/05/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION New vertebral compression fractures (NVCFs) are adverse events after vertebral augmentation of osteoporotic vertebral compression fractures (OVCFs). Predicting the risk of vertebral compression fractures (VCFs) accurately after surgery is still a significant challenge for spinal surgeons. The aim of our study was to identify risk factors of NCVFs after vertebral augmentation of OVCFs and develop a nomogram. METHODS We retrospectively reviewed the medical records of patients with OVCFs who underwent percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Patients were divided into the NVCFs group and control group, base on the patients with or without NVCFs within 2 years follow-up period after surgery. A training cohort of 403 patients diagnosed in our hospital from June 2014 to December 2016 was used for model development. The independent predictive factors of postoperative VCFs were determined by least absolute shrinkage and selection operator (LASSO) logistic regression, univariate analysis and multivariate logistic regression analysis. We provided a nomogram for predicting the risk of NVCFs based on independent predictive factors and used the receiver operating characteristic curve (ROC), calibration curve, and decision curve analyses (DCA) to evaluated the prognostic performance. After internal validation, the nomogram was further evaluated in a validation cohort of 159 patients included between January 2017 and June 2018. RESULTS Of the 403 patients in the training cohort, 49(12.16%) were NVCFs at an average of 16.7 (1 to 23) months within the 2 years follow-up period. Of the 159 patients in the validation cohort, 17(10.69%) were NVCFs at an average of 8.7 (1 to 15) months within the 2 years follow-up period. In the training cohort, the proportions of elderly patients older than 80 years were 32.65 and 13.56% in the NVCFs and control group, respectively (p = 0.003). The percentages of patients with previous fracture history were 26.53 and 12.71% in the NVCFs and control group, respectively (p = 0.010). The volume of bone cement were 4.43 ± 0.88 mL and 4.02 ± 1.13 mL in the NVCFs and Control group, respectively (p = 0.014). The differences have statistical significance in the bone cement leakage, bone cement dispersion, contact with endplate, anti-osteoporotic treatment, post-op Cobb angle and Cobb angle restoration characteristics between the two groups. The model was established by multivariate logistic regression analysis to obtain independent predictors. In the training and validation cohort, the AUC of the nomogram were 0.882 (95% confidence interval (CI), 0.824-0.940) and 0.869 (95% CI: 0.811-0.927), respectively. The C index of the nomogram was 0.886 in the training cohort and 0.893 in the validation cohort, demonstrating good discrimination. In the training and validation cohort, the optimal calibration curves demonstrated the coincidence between prediction and actual status, and the decision curve analysis demonstrated that the full model had the highest clinical net benefit across the entire range of threshold probabilities. CONCLUSION A nomogram for predicting NVCFs after vertebral augmentation was established and validated. For patients evaluated by this model with predictive high risk of developing postoperative VCFs, postoperative management strategies such as enhance osteoporosis-related health education and management should be considered.
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Affiliation(s)
- Qiujiang Li
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xingxia Long
- West China Hospital, Sichuan University, Sichuan, China
| | - Yinbin Wang
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xiaomin Fang
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Donggeng Guo
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Jinhan Lv
- Graduate School of Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Xuehua Hu
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics,People's Hospital of Ningxia Hui Autonomous Region, No. 56, Zhengyuan Street, Yinchuan, 750002, Ningxia, China.
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Ouchi S, Niiyama E, Sugo K, Uto K, Takenaka S, Kikuchi A, Ebara M. Shape-memory balloon offering simultaneous thermo/chemotherapies to improve anti-osteosarcoma efficacy. Biomater Sci 2021; 9:6957-6965. [PMID: 34546257 DOI: 10.1039/d1bm00780g] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This paper proposes a shape-memory balloon (SMB) to improve bone cement injection efficiency and postoperative thermo/chemotherapy for bone tumors. The SMB consists of biodegradable poly(ε-caprolactone) (PCL), an anticancer drug (doxorubicin, DOX), and heat-generating magnetic nanoparticles (MNPs). The balloon shape is fabricated in a mold by crosslinking PCL macromonomers with DOX and MNPs. The mechanical properties and shape-transition temperature (approximately 40 °C) of the SMB are modulated by adjusting the molecular weight of PCL and the crosslinking density. This allows safe inflation at the affected site with a 400% expansion rate by simple blow molding. The expanded shape is temporarily memorized at 37 °C, and the computed tomography image shows that the bone cement is successfully injected without extra pressure or leakage. The SMB releases DOX for over 4 weeks, allowing a prolonged effect at the local site. The local dosing is constant as the medication is continuously released, demonstrating an ON-OFF switchable heating/cooling response to alternating magnetic field irradiation. In vitro cytotoxic studies have demonstrated that heat generation/drug release and only drug release from the balloon kill approximately 99% and 60% of human osteosarcoma cells, respectively. The proposed SMB is promising in postoperative local thermo/chemotherapy for bone tumors.
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Affiliation(s)
- Sosuke Ouchi
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), Ibaraki 305-0044, Japan. .,Department of Materials Science and Technology, Tokyo University of Science, Tokyo 125-8585, Japan
| | - Eri Niiyama
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), Ibaraki 305-0044, Japan. .,Graduate School of Pure and Applied Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
| | - Ken Sugo
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), Ibaraki 305-0044, Japan. .,Graduate School of Pure and Applied Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
| | - Koichiro Uto
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), Ibaraki 305-0044, Japan.
| | - Satoshi Takenaka
- Department of Orthopaedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Akihiko Kikuchi
- Department of Materials Science and Technology, Tokyo University of Science, Tokyo 125-8585, Japan
| | - Mitsuhiro Ebara
- Research Center for Functional Materials, National Institute for Materials Science (NIMS), Ibaraki 305-0044, Japan. .,Department of Materials Science and Technology, Tokyo University of Science, Tokyo 125-8585, Japan.,Graduate School of Pure and Applied Sciences, University of Tsukuba, Ibaraki 305-8577, Japan
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Lin M, Qu M, Huang W, Liu T, Duan R, Yuan Y, Gao J, Zhang M, Yu X. Clinical effectiveness of percutaneous vertebroplasty in conjunction with postoperative radiotherapy in the treatment of spinal metastases. J Cancer Res Clin Oncol 2020; 147:835-844. [PMID: 32876746 DOI: 10.1007/s00432-020-03371-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to evaluate the clinical effects of percutaneous vertebroplasty (PVP) combined with postoperative radiotherapy (RT) in the treatment of spinal metastases. METHODS Nine patients (4 males and 5 females, mean age 59.56 years) with painful pathologic compression vertebral fractures caused by metastatic cancers of the spine (5 thoracic levels, 8 lumbar levels) were admitted to our hospital between July 17, 2016 and September 25, 2018. All patients were treated with PVP via bilateral pedicle approach combined with postoperative RT to treat metastatic lesions of the centrum. The clinical records of the patients were retrospectively analyzed. Patients' demographic features and medical conditions including the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and Imageology data were observed. RESULTS Patients' mean VAS scores decreased from 8.67 ± 0.50 preoperatively to 1.78 ± 0.83 at 6 months after PVP. Moreover, the mean ODI score decreased from 74.07 ± 13.15 preoperatively to 31.87 ± 10.00 at 6 months after PVP. Significant improvement in the degree of pain and dysfunction among the enrolled patients were observed. Furthermore, the metastatic carcinoma lesion within the vertebral body was well controlled according to imaging. CONCLUSION PVP in conjunction with postoperative RT is a good treatment strategy for vertebral compression fractures caused by metastases.
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Affiliation(s)
- Miaoman Lin
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Mingjia Qu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Wei Huang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Tao Liu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Ruimeng Duan
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Yashuai Yuan
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Junxiao Gao
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Meng Zhang
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China
| | - Xiaobing Yu
- Department of Orthopaedics, Affiliated Zhongshan Hospital of Dalian University, No. 6 Jiefang Street, Dalian, 116001, Liaoning Province, China.
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Sørensen ST, Kirkegaard AO, Carreon L, Rousing R, Andersen MØ. Vertebroplasty or kyphoplasty as palliative treatment for cancer-related vertebral compression fractures: a systematic review. Spine J 2019; 19:1067-1075. [PMID: 30822527 DOI: 10.1016/j.spinee.2019.02.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty (PVP) and kyphoplasty (KP) are minimally invasive treatment options for vertebral compression fractures (VCFs) due to malignancy. PURPOSE To perform a systematic review evaluating the effectiveness and safety of vertebral augmentation for malignant VCFs. STUDY DESIGN Systematic review. STUDY SAMPLE Studies on PVP or KP for VCFs in patients with malignant spinal lesions. OUTCOME MEASURES Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), Karnofsky Performance Score (KPS), and complications were extracted from eligible studies. METHODS Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, studies published between January 1, 2000 and January 3, 2018 were identified by combining the results of a report by Health Quality Ontario with an updated literature search. RESULTS The review identified two randomized controlled trials, 16 prospective studies, 44 retrospective studies, and 25 case series for a patient sample size of 3,426. At the earliest follow-up, pain improved from 7.48 to 3.00 with PVP, and from 7.05 to 2.96 with KP. ODI improved from 74.68 to 17.73 with PVP, and from 66.02 to 34.73 with KP. KPS improved from 66.99 to 80.28. Cement leakage was seen in 37.9% and 13.6% of patients treated with PVP and KP, respectively. Symptomatic complications (N = 43) were rare. CONCLUSIONS This review showed clinically relevant improvements in pain, ODI, and KPS in patients with VCFs due to malignancy treated with either PVP or KP. Cement leakage is common, but rarely symptomatic. Percutaneous vertebroplasty and KP are safe and effective palliative procedures for painful VCFs in patients with malignant spinal lesions.
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Affiliation(s)
- Simon Thorbjørn Sørensen
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark.
| | - Andreas Ole Kirkegaard
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark
| | - Leah Carreon
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark
| | - Rikke Rousing
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej 55, 5500 Middelfart, Denmark
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Silverman JE, Gulati A. An overview of interventional strategies for the management of oncologic pain. Pain Manag 2018; 8:389-403. [PMID: 30320541 DOI: 10.2217/pmt-2018-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Pain is a ubiquitous part of the cancer experience. Often the presenting symptom of malignancy, pain becomes more prevalent in advanced or metastatic disease and often persists despite curative treatment. Although management of cancer pain improved following publication of the WHO's analgesic ladder, when used in isolation, conservative approaches often fail to control pain and are limited by intolerable side effects. Interventional strategies provide an option for managing cancer pain that remains refractory to pharmacologic therapy. The purpose of this review is to investigate these strategies and discuss the risks and benefits which must be weighed when considering their use. Therapies anticipated to have an increasingly important role in the future of cancer pain management are also discussed.
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Affiliation(s)
- Jonathan E Silverman
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 100652, USA.,Department of Anesthesiology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10065, USA
| | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 100652, USA
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Phase I clinical trial of percutaneous cryoablation for osteoid osteoma. Jpn J Radiol 2018; 36:669-675. [PMID: 30109554 DOI: 10.1007/s11604-018-0768-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/10/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This prospective phase I trial was conducted to evaluate the safety of percutaneous cryoablation for osteoid osteoma (OO). MATERIALS AND METHODS Nine patients with OO (mean tumor size: 5.9 mm; tibia, n = 5; femur, n = 2; lumbar spine, n = 2) were enrolled and treated with percutaneous cryoablation. The primary endpoint was the evaluation of the treatment safety as determined using step-by-step registration. The secondary endpoints were the incidence and grade of adverse events by CTCAE version 4.0, and the short-term efficacy of this treatment. Based on a decrease in the numerical rating scale (NRS) score, efficacy was classified as significantly effective (SE ≥ 5 or reached 0-2), moderately effective (ME 2-4), or not effective (NE < 2 or increase). RESULTS Cryoablation procedures were completed in all patients. Major adverse events (≥ grade 3) related to the procedure were not observed. Minor adverse events (≤ grade2) were observed in 22-67%. The mean NRS score was 7 before treatment, 0.6 at 4-week, 0.1 at 6-month, and 0 at 1-year post-treatment. All procedures were classified as SE. CONCLUSION Percutaneous cryoablation is a safe treatment for OO. Future phase II trials with large patient cohorts are warranted.
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Tanigawa N, Arai Y, Yamakado K, Aramaki T, Inaba Y, Kanazawa S, Matsui O, Miyazaki M, Kodama Y, Anai H, Hamanaka A. Phase I/II Study of Radiofrequency Ablation for Painful Bone Metastases: Japan Interventional Radiology in Oncology Study Group 0208. Cardiovasc Intervent Radiol 2018; 41:1043-1048. [PMID: 29675772 DOI: 10.1007/s00270-018-1944-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE A prospective multicenter phase I/II trial was performed to evaluate the clinical safety and efficacy of radiofrequency ablation (RFA) for metastatic bone tumors. MATERIALS AND METHODS Thirty-three patients (27 men, 6 women, mean age 61 years) with metastatic bone tumors were enrolled. In phase I, nine patients were enrolled, and the safety of RFA was evaluated. In phase II, 23 patients were included, and an intent-to-treat analysis was performed. The primary endpoint was to evaluate the treatment's safety. The secondary endpoint was to evaluate the efficacy of pain relief at 1 week after RFA. RESULTS RFA was performed in 32 of 33 enrolled patients. No serious complications were observed during the phase I, so phase II was performed. Four patients exhibited adverse events, including one case each of Grade 3 pain and, Grade 2 hypotension, and one patient developed Grade 1 burns at the grounding pad and puncture site. One patient died of liver failure on day 7 after RFA due to the progression of the primary lesion. The efficacy was excellent (no increase in analgesic dosage, post-RFA VAS score of 0-2 or decreased by not less than 5 compared to before RFA) in 20 patients (60.6%), good (no increase in analgesic dosage, post-RFA VAS score decreased by not less than 2 but by < 5 compared to before RFA) in 3 (9.1%), and poor in 10 patients (30.3%). Thus, the response rate was 69.7%. CONCLUSION RFA is a safe and effective method for treating painful metastatic bone tumors.
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Affiliation(s)
- Noboru Tanigawa
- Department of Radiology, Kansai Medical University, Hirakata, Japan.
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center, Tokyo, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan.,Department of Radiology, Mie University, Tsu, Japan
| | - Takeshi Aramaki
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshitaka Inaba
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, Nagoya, Japan
| | | | - Osamu Matsui
- Department of Radiology, Kanazawa University, Ishikawa, Japan
| | - Masaya Miyazaki
- Department of Interventional Radiology and Clinical Ultrasound Center, Gunma University Hospital, Maebashi, Japan
| | - Yoshihisa Kodama
- Department of Diagnostic Radiology, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Hiroshi Anai
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Akihiro Hamanaka
- Department of Radiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan.,Department of Diagnostic Radiology, Hyogo Cancer Center, Hyogo, Japan
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Combined Vertebral Augmentation and Radiofrequency Ablation in the Management of Spinal Metastases: an Update. Curr Treat Options Oncol 2017; 18:74. [DOI: 10.1007/s11864-017-0516-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Miyazaki M, Arai Y, Myoui A, Gobara H, Sone M, Rosenthal DI, Tsushima Y, Kanazawa S, Ehara S, Endo K. Phase I/II Multi-Institutional Study of Percutaneous Radiofrequency Ablation for Painful Osteoid Osteoma (JIVROSG-0704). Cardiovasc Intervent Radiol 2016; 39:1464-70. [PMID: 27491406 DOI: 10.1007/s00270-016-1438-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE This multicenter prospective study was conducted to evaluate the safety and efficacy of percutaneous radiofrequency ablation (RFA) for painful osteoid osteoma (OO). MATERIALS AND METHODS Patients with OO (femur: n = 17, tibia: n = 2, humerus: n = 1, rib: n = 1) were enrolled and treated with RFA. In phase I, nine patients were evaluated for safety. In phase II, 12 patients were accrued, and an intent-to-treat analysis was performed on all patients. The primary endpoint was to evaluate the treatment safety. The secondary endpoint was to evaluate the efficacy for pain relief by the visual analogue scale (VAS) at 4 weeks after RFA. Treatment efficacy was classified as significantly effective (SE) when VAS score decreased by ≥5 or score was <2, moderately effective when VAS score decreased by <5-≥2 and score was ≥2, and not effective (NE) when VAS score decreased by <2 or score was increased. Cases where the need for analgesics increased after treatment were also NE. RESULTS RFA procedures were completed in all patients. Minor adverse effects (AEs) were observed as 4.8-14.3 % in 12 patients, and no major AEs were observed. Mean VAS score was 7.1 before treatment, 1.6 at 1 week, 0.3 at 4 weeks, and 0.2 at 3 months. All procedures were classified as SE. Pain recurrence was not noted in any patient during follow-up (mean: 15.1 months). CONCLUSION RFA is a safe, highly effective, and fast-acting treatment for painful extraspinal OO. Future studies with a greater number of patients are needed.
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Affiliation(s)
- Masaya Miyazaki
- Department of Interventional Radiology and Clinical Ultrasound Center, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Yasuaki Arai
- Division of Diagnostic Radiology, National Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Myoui
- Medical Center for Translational Research, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Miyuki Sone
- Division of Diagnostic Radiology, National Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Daniel I Rosenthal
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Yoshito Tsushima
- Department of Interventional Radiology and Clinical Ultrasound Center, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558, Japan
| | - Shigeru Ehara
- Department of Radiology, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Japan
| | - Keigo Endo
- Department of Interventional Radiology and Clinical Ultrasound Center, Gunma University Hospital, 3-39-15, Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Mimura H, Arai Y, Yamakado K, Sone M, Takeuchi Y, Miki T, Gobara H, Sakuhara Y, Yamamoto T, Sato Y, Kanazawa S. Phase I/II Study of Radiofrequency Ablation for Malignant Renal Tumors: Japan Interventional Radiology in Oncology Study Group 0701. Cardiovasc Intervent Radiol 2015; 39:717-723. [PMID: 26696231 DOI: 10.1007/s00270-015-1275-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE This multicenter phase I/II study evaluated the safety, feasibility, and initial efficacy of radiofrequency ablation (RFA) for small malignant renal tumors. METHODS Thirty-three patients were enrolled in the study. A single session of RFA was performed in patients with a renal tumor of 1-3 cm in greatest diameter, with the exception of lesions adjacent to the renal hilum. The primary endpoint was the safety of renal RFA, and the secondary endpoints were its feasibility and initial efficacy for local control, as well as the incidence and grade of adverse events. Clinical efficacy was evaluated by CT scans within 1 week and at a further 4 weeks after the procedure using the criteria adapted from the Response Evaluation Criteria in Solid Tumors. RESULTS The RFA procedure was completed in 100% (95% confidence interval [CI] 89-100%) of all 33 patients. There were no severe adverse events (0% [95% CI 0-11%]). Among the 33 patients, a complete response, partial response, progressive disease, and stable disease were seen in 28 (85%), 0 (0%), one (3%), and one (3%) patient(s), respectively, with a tumor response rate of 85% [95% CI 68-95%]). Three patients (9%), including one ineligible patient (3%), were not evaluable. Out of 30 evaluable patients, a complete response was achieved in 28 (93%). CONCLUSION The current multicenter trial revealed that RFA is a safe, feasible, and effective treatment for small malignant renal tumors in patients who are not candidates for surgery.
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Affiliation(s)
- Hidefumi Mimura
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki, Kanagawa, 216-8511, Japan. .,Department of Radiology, Okayama University Medical School, 2-5-1 Shikata, Kita-ku, Okayama, 700-8558, Japan.
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Koichiro Yamakado
- Department of Interventional Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yoshito Takeuchi
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tsuneharu Miki
- Department of Urology, Kyoto Prefectural University of Medicine, 465 Kajiichi, Hirokoji agaru, Kawaramachi-douri, Kamijo-ku, Kyoto, 602-8566, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata, Kita-ku, Okayama, 700-8558, Japan
| | - Yusuke Sakuhara
- Department of Diagnostic and Interventional Radiology, Hokkaido University School of Medicine, 7 Nishi, 15-jo Kita, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takanobu Yamamoto
- Department of Radiology, Tochigi Cancer Center, 4-9-13 Yonan, Utsunomiya, Tochigi, 320-0834, Japan
| | - Yozo Sato
- Department of Diagnostic and Interventional Radiology, Aichi Cancer Center Hospital, 1-1 Kanokogoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata, Kita-ku, Okayama, 700-8558, Japan
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15
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Choy E, Attar EC, Oh KS, Huang AJ, Kerr DA. Case records of the Massachusetts General Hospital. Case 33-2014. A 60-year-old man with bone pain. N Engl J Med 2014; 371:1630-40. [PMID: 25337753 DOI: 10.1056/nejmcpc1310000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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16
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Gulati A, Joshi J, Baqai A. An overview of treatment strategies for cancer pain with a focus on interventional strategies and techniques. Pain Manag 2014; 2:569-80. [PMID: 24645889 DOI: 10.2217/pmt.12.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY As the incidence of cancer increases, considerations for pain treatments become more important and varied. While traditional views on pain therapy are successful in treating the majority of cancer-related pain, a continuum has developed to include interventional strategies in addition to pharmacologic management. Further improvements in understanding anatomy in the context of imaging and pathophysiology of cancer-pain syndromes direct our current interventional pain management options. We discuss the current interventional treatment options regularly used in the cancer-pain population.
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Affiliation(s)
- Amitabh Gulati
- Department of Anesthesiology & Critical Care, Board Certified in Anesthesiology & Pain Management, Memorial Sloan Kettering Cancer Center, M308, New York, NY, 10065, USA.
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17
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Huang M, Zhu H, Liu T, Cui D, Huang Y. Comparison of external radiotherapy and percutaneous vertebroplasty for spinal metastasis. Asia Pac J Clin Oncol 2014; 12:e201-8. [PMID: 24571261 DOI: 10.1111/ajco.12162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 12/21/2022]
Abstract
AIM To compare the efficacy of external radiotherapy (ERT) and percutaneous vertebroplasty (PVP) for spinal metastasis. METHODS A total of 137 patients with 174 spinal metastases between June 2006 and April 2009 in our hospital were reviewed. For their spinal metastasis, 52 patients received ERT; 46 patients received PVP; and 39 patients received both ERT and PVP. Pain and neurological deficit response, overall survival, and side effects were evaluated. RESULTS ERT combined with PVP achieved pain remission in 84.8% of the patients, which was higher than ERT (72.5%) or PVP (76.3%) alone. It also showed a higher remission rate of neurological deficits (50%) than ERT (18.2%) or PVP (11.1%) alone. Toxicities from the employed treatments were mild. The Karnofsky Performance Score and visceral or brain metastases were the significant influencing factors for overall survival. Patients with spinal metastases derived from breast cancer had a significantly better overall survival than those whose spinal metastases were derived from lung cancer. CONCLUSION ERT combined with PVP can be a more effective treatment for spinal metastases; however, prospective randomized trials are needed to draw any definitive conclusion.
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Affiliation(s)
- Min Huang
- Department of Pathophysiology, Preclinical and Forensic Medicine, Sichuan University.,Department of Medical Oncology, Cancer Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Hong Zhu
- Department of Medical Oncology, Cancer Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Taiguo Liu
- Department of Medical Oncology, Cancer Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Dandan Cui
- Department of Medical Oncology, Cancer Center, Sichuan University, Chengdu, Sichuan Province, China
| | - Ying Huang
- Department of Pathophysiology, Preclinical and Forensic Medicine, Sichuan University
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18
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Chen Y, Yan Z, Wang J, Wang X, Cheng J, Gong G, Luo J. Transarterial chemoembolization for pain relief in patients with hypervascular painful metastatic spinal tumors refractory to percutaneous vertebroplasty. J Cancer Res Clin Oncol 2013; 139:1343-8. [DOI: 10.1007/s00432-013-1445-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/24/2013] [Indexed: 11/29/2022]
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Abstract
PURPOSE OF REVIEW Cement bone augmentation has become very popular worldwide in treating painful noncomplicated spine fractures. Controversy about the effectiveness was raised by two randomized trials in 2009. Recent new evidence contradicts those findings giving credit to vertebroplasty/kyphoplasty. RECENT FINDINGS Well designed prospective clinical trials in cancer and noncancer vertebral fractures as well as an excellent meta-analysis showed that painful vertebral compression fractures have better and faster pain relief, better functional outcomes, and with low complication rate when treated with percutaneous cement than conservatively. SUMMARY The saga is unfinished. The treatment of vertebral compression fractures with cement augmentation is still in its infancy. The potential for development with new materials and the injection of biologic and active bone cements or anticancer products, in metastatic disease, will revolutionize the treatment of this condition.
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Abstract
Interventional oncology has great potential to be a good treatment modality in the field of oncology, because its procedures are minimally invasive and fairly quick. However, except for a few procedures such as percutaneous radiofrequency ablation and trans-catheter arterial chemo-embolization that have been recognized as standard treatments for hepatocellular carcinoma, most procedures have not been established as the standard treatment modality due to the limited number of clinical trials with compelling evidence. There are several common problems when performing clinical trials of interventional oncology. The first is that the outcomes of clinical trials are greatly influenced by the level of technical skill of the physicians. The second is that equipment and devices vary widely in countries and regions, and they also influence the outcomes. The third is that the methodology of clinical trials for techniques such as interventional oncology has not yet been established. The fourth is the difficulty of setting appropriate endpoints; quality of life is suitable for evaluating interventional oncology in palliative care, but it is not easy to set as the endpoint. The fifth is the difficulty of employing a blinded design, because the procedure cannot be performed without the physician's awareness. Despite such difficult situations, many multi-institutional clinical trials of interventional oncology have been carried out in Japan, with some challenging results. Establishing evidence is critical to making interventional oncology the standard treatment. Interventional radiologists should know the importance of clinical trials, and should move ahead in this direction in a step-by-step manner.
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Added value of percutaneous vertebroplasty: effects on respiratory function. AJR Am J Roentgenol 2012; 198:W51-4. [PMID: 22194515 DOI: 10.2214/ajr.11.6730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to investigate the effects of percutaneous vertebroplasty on respiratory function in patients with compression fractures caused by osteoporosis. SUBJECTS AND METHODS Ninety-eight patients (87 women, 11 men; mean age, 74 years; age range, 60-90 years) with compression fractures of 75 thoracic (Th7-Th12) and 89 lumbar (L1-L5) vertebrae were enrolled in this study. Percentage vital capacity (VC%), percentage forced vital capacity (FVC%), and percentage forced expiratory volume in 1 second (%FEV1) were measured using a spirometer before, 1 day after, and 1 month after percutaneous vertebroplasty. The Wilcoxon signed rank test was used to evaluate whether any significant differences in VC%, FVC%, or %FEV1 values existed between before, 1 day after, and 1 month after percutaneous vertebroplasty. RESULTS The VC% and FVC% values had improved significantly by 1 month after percutaneous vertebroplasty compared with before percutaneous vertebroplasty (p<0.01). No significant difference was noted between values before and 1 day after percutaneous vertebroplasty. Likewise, no significant difference was identified in %FEV1 before percutaneous vertebroplasty and either 1 day or 1 month after percutaneous vertebroplasty. The mean degree of improvement in VC% values after percutaneous vertebroplasty for patients with one vertebra treated, which we refer to as the "single-vertebroplasty" group, and for patients with two or more vertebrae treated, or "multiple-vertebroplasty" group, was 1.1%±7% (SD) and 6.3%±8%, respectively, representing a significant difference between groups (p=0.01). The mean VC% values before and 1 month after percutaneous vertebroplasty differed significantly (p=0.02) in the thoracic group and overlapping group. CONCLUSION Percutaneous vertebroplasty improves restrictive ventilatory impairment, but this improvement requires approximately 1 month to occur. Greater improvement in restrictive ventilatory dysfunction was observed in patients who underwent multiple vertebroplasty procedures than those who underwent a single procedure and in patients who underwent treatment of thoracic vertebrae than those who underwent treatment of other vertebrae.
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22
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Tancioni F, Lorenzetti MA, Navarria P, Pessina F, Draghi R, Pedrazzoli P, Scorsetti M, Alloisio M, Santoro A, Rodriguez y Baena R. Percutaneous vertebral augmentation in metastatic disease: state of the art. ACTA ACUST UNITED AC 2011; 9:4-10. [PMID: 21465731 DOI: 10.1016/j.suponc.2011.01.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Improvements in diagnosis and treatment have prolonged cancer survival, with a consequent increase in the incidence of spinal metastases and vertebral compression fractures with associated axial pain, progressive radiculomyelopathy, and mechanical instability. Pain relief in malignant vertebral compression fractures is key to achieving a better quality of life in patients under palliative care. The gold standard for pain relief is nonsteroidal anti-inflammatory drugs and opioids. Nonresponsive cases are then treated with radiotherapy, which may require 2-4 weeks to take effect and in most cases does not provide complete pain relief. Percutaneous vertebroplasty and percutaneous kyphoplasty can in particular give relief in patients with vertebral body compression fractures that do not cause neurological deficits but severely compromise quality of life because of intractable pain.
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Affiliation(s)
- Flavio Tancioni
- Department of Neurosurgery, Istituto Clinico Humanitas, Milan, Italy
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Phase I/II Study of Transjugular Transhepatic Peritoneovenous Venous Shunt, a New Procedure to Manage Refractory Ascites in Cancer Patients: Japan Interventional Radiology in Oncology Study Group 0201. AJR Am J Roentgenol 2011; 196:W621-6. [DOI: 10.2214/ajr.10.4716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chew C, Craig L, Edwards R, Moss J, O’Dwyer P. Safety and efficacy of percutaneous vertebroplasty in malignancy: a systematic review. Clin Radiol 2011; 66:63-72. [DOI: 10.1016/j.crad.2010.09.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 09/18/2010] [Accepted: 09/27/2010] [Indexed: 02/07/2023]
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25
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Sone M, Arai Y, Shimizu T, Takeuchi Y, Higashihara H, Ohgi S, Ishiguchi T, Saitoh H, Sakaguchi H, Tanaka T, Shioyama Y, Tanigawa N. Phase I/II multiinstitutional study of uterine artery embolization with gelatin sponge for symptomatic uterine leiomyomata: Japan Interventional Radiology in Oncology Study Group study. J Vasc Interv Radiol 2010; 21:1665-71. [PMID: 20884240 DOI: 10.1016/j.jvir.2010.07.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 06/30/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022] Open
Abstract
PURPOSE This multicenter prospective study was conducted to evaluate the safety and the efficacy of uterine artery embolization (UAE) with gelatin sponge for symptomatic leiomyomas. MATERIALS AND METHODS Patients with symptomatic uterine leiomyomas were enrolled and treated with UAE. In phase I, nine patients were evaluated for safety. In phase II, 24 patients were accrued, and an intent-to-treat analysis was performed on all 33 patients. The primary endpoint was safety. Secondary endpoints included technical success, hospital stay, change in symptoms, leiomyoma volume on magnetic resonance (MR) imaging, and incidence of treatment failure. RESULTS UAE procedures were performed for all 33 patients. Two patients were lost to follow-up at 3 and 12 months. The median follow-up period was 33.4 months. Minor adverse events (AEs) occurred in 10 patients (33%); major AEs of permanent amenorrhea and leiomyoma expulsion occurred in two (6%). The most common AE was transient amenorrhea. Technical success was achieved in all patients. The median hospital stay was 5 days. At 12 months after UAE, menorrhagia had improved in 90% of patients, pelvic pain in 78%, and bulk-related symptoms in 97%. The mean reduction in leiomyoma volume on MR imaging at 12 months was 61%. Treatment failure occurred in one patient, who underwent hysterectomy for recurrent menorrhagia at 21 months. CONCLUSIONS UAE with gelatin sponge is safe, with efficacy comparable to other embolic agents based on published data. Gelatin sponge should be an option for UAE, but a prospective comparison versus other standard UAE embolic agents may be warranted.
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Affiliation(s)
- Miyuki Sone
- Department of Radiology, Iwate Medical University, Uchimaru, Morioka, Japan.
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