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Leiphrakpam PD, Newton R, Anaya DA, Are C. Evolution and current trends in the management of colorectal cancer liver metastasis. Minerva Surg 2024; 79:455-469. [PMID: 38953758 DOI: 10.23736/s2724-5691.24.10363-2] [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: 07/04/2024]
Abstract
Metastatic colorectal cancer (mCRC) is a major cause of cancer-related death, with a 5-year relative overall survival of up to 20%. The liver is the most common site of distant metastasis in colorectal cancer (CRC), with about 50% of CRC patients metastasizing to their liver over the course of their disease. Complete liver resection is the primary modality of treatment for resectable colorectal cancer liver metastasis (CRLM), with an overall 5-year survival rate of up to 58%. However, only 15% to 20% of patients with CRLM are deemed suitable for resection at presentation. For unresectable diseases, the median survival of patients remains low even with the best chemotherapy. In recent decades, the management of CRLM has continued to evolve with the expansion of resection criteria, novel targeted systemic therapies, and improved locoregional therapies. However, due to the heterogeneity of the CRC patient population, the optimal evaluation of treatment options for CRLM remains complex. Therefore, effective management requires a multidisciplinary team to help define resectability and devise a personalized treatment approach, from the initial diagnosis to the final treatment.
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Affiliation(s)
- Premila D Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachael Newton
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA -
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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2
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Pereira PL, Siemou P, Rempp HJ, Hoffmann R, Hoffmann RT, Kettenbach J, Clasen S, Helmberger T. CT versus MR guidance for radiofrequency ablation in patients with colorectal liver metastases: a 10-year follow-up favors MR guidance. Eur Radiol 2024; 34:4663-4671. [PMID: 38041717 DOI: 10.1007/s00330-023-10270-6] [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: 04/02/2022] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES To compare the results of CT- vs MR-guided radiofrequency ablation (RFA) of liver metastases (LM) from colorectal cancer after 10 years of follow-up in an observational, retrospective, and multicentric study. METHODS A total of 238 patients with 496 LM were treated with RFA either with CT (CT group) or magnetic resonance (MR group) guidance. Every ablated LM was assessed and followed up with diagnostic MRI. Technical success, technique efficacy, predictive factors, recurrence rates, and overall survival were assessed. RESULTS The CT group comprised 143 patients and the MR group 77 patients. Eighteen patients underwent ablation with both modalities. Technical success per patient and per lesion was 88% and 93% for CT and 87% and 89.6% for MR, and technique efficacy was 97.1% and 98.6% for CT and 98.7% and 99.3% for MR respectively. Local recurrence following the first ablation (primary patency) occurred in 20.1% (CT) vs 4.6% (MR) (p < 0.001). Residual liver tumor, size of LM, and advanced N and M stage at initial diagnosis were independent predictors for overall survival in both groups. The median overall survival measured from first RFA treatment was 2.6 years. The 1-year, 5-year, and 10-year survival were 85.9%, 25.5%, and 19.1% respectively. CONCLUSIONS The MR group had significantly better local control compared to the CT group. There was no significant difference in patient survival between the two groups. CLINICAL RELEVANCE STATEMENT MR-guided radiofrequency ablation of colorectal liver metastases is safe and effective, and offers better local control than CT-guided ablation. KEY POINTS • Imaging modality for radiofrequency ablation guidance is an independent predictor of local recurrence in colorectal liver metastases. • MR-guided radiofrequency ablation achieved better local control of liver metastases from colorectal cancer than CT-guided. • The number and size of liver metastases are, among others, independent predictors of survival. Radiofrequency ablation with MR guidance improved clinical outcome but does not affect survival.
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Affiliation(s)
- Philippe Lucien Pereira
- Center for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK Kliniken GmbH Heilbronn, Heilbronn, Germany.
- Danube Private University (DPU), Krems, Austria.
| | - Panagiota Siemou
- Radiology Department, Alexandra General Hospital, Athens, Greece
| | - Hans-Jörg Rempp
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Ralf Thorsten Hoffmann
- Institute and Policlinic for Diagnostic and Interventional Radiology, Carl-Gustav Carus University of Dresden, Dresden, Germany
| | - Joachim Kettenbach
- Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, Wiener Neustadt, Austria
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | - Thomas Helmberger
- Clinic for Radiology, Neuroradiology and Nuclear Medicine Bogenhausen, Munich, Germany
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Zirakchian Zadeh M. PET/CT in assessment of colorectal liver metastases: a comprehensive review with emphasis on 18F-FDG. Clin Exp Metastasis 2023; 40:465-491. [PMID: 37682423 DOI: 10.1007/s10585-023-10231-9] [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: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
Approximately 25% of those who are diagnosed with colorectal cancer will develop colorectal liver metastases (CRLM) as their illness advances. Despite major improvements in both diagnostic and treatment methods, the prognosis for patients with CRLM is still poor, with low survival rates. Accurate employment of imaging methods is critical in identifying the most effective treatment approach for CRLM. Different imaging modalities are used to evaluate CRLM, including positron emission tomography (PET)/computed tomography (CT). Among the PET radiotracers, fluoro-18-deoxyglucose (18F-FDG), a glucose analog, is commonly used as the primary radiotracer in assessment of CRLM. As the importance of 18F-FDG-PET/CT continues to grow in assessment of CRLM, developing a comprehensive understanding of this subject becomes imperative for healthcare professionals from diverse disciplines. The primary aim of this article is to offer a simplified and comprehensive explanation of PET/CT in the evaluation of CRLM, with a deliberate effort to minimize the use of technical nuclear medicine terminology. This approach intends to provide various healthcare professionals and researchers with a thorough understanding of the subject matter.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Molecular Imaging and Therapy and Interventional Radiology Services, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Markezana A, Paldor M, Liao H, Ahmed M, Zorde-Khvalevsky E, Rozenblum N, Stechele M, Salvermoser L, Laville F, Goldmann S, Rosenberg N, Andrasina T, Ricke J, Galun E, Goldberg SN. Fibroblast growth factors induce hepatic tumorigenesis post radiofrequency ablation. Sci Rep 2023; 13:16341. [PMID: 37770545 PMCID: PMC10539492 DOI: 10.1038/s41598-023-42819-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
Image-guided radiofrequency ablation (RFA) is used to treat focal tumors in the liver and other organs. Despite potential advantages over surgery, hepatic RFA can promote local and distant tumor growth by activating pro-tumorigenic growth factor and cytokines. Thus, strategies to identify and suppress pro-oncogenic effects of RFA are urgently required to further improve the therapeutic effect. Here, the proliferative effect of plasma of Hepatocellular carcinoma or colorectal carcinoma patients 90 min post-RFA was tested on HCC cell lines, demonstrating significant cellular proliferation compared to baseline plasma. Multiplex ELISA screening demonstrated increased plasma pro-tumorigenic growth factors and cytokines including the FGF protein family which uniquely and selectively activated HepG2. Primary mouse and immortalized human hepatocytes were then subjected to moderate hyperthermia in-vitro, mimicking thermal stress induced during ablation in the peri-ablational normal tissue. Resultant culture medium induced proliferation of multiple cancer cell lines. Subsequent non-biased protein array revealed that these hepatocytes subjected to moderate hyperthermia also excrete a similar wide spectrum of growth factors. Recombinant FGF-2 activated multiple cell lines. FGFR inhibitor significantly reduced liver tumor load post-RFA in MDR2-KO inflammation-induced HCC mouse model. Thus, Liver RFA can induce tumorigenesis via the FGF signaling pathway, and its inhibition suppresses HCC development.
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Affiliation(s)
- Aurelia Markezana
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel.
| | - Mor Paldor
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Haixing Liao
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Muneeb Ahmed
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA
| | - Elina Zorde-Khvalevsky
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Nir Rozenblum
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Matthias Stechele
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Salvermoser
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Flinn Laville
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Salome Goldmann
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Nofar Rosenberg
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Tomas Andrasina
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University Brno, Brno, Czech Republic
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Eithan Galun
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel
| | - Shraga Nahum Goldberg
- The Goldyne Savad Institute of Gene and Cell Therapy, Hadassah Hebrew University Hospital, Ein Karem, Jerusalem, Israel.
- Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, MA, USA.
- Division of Image-Guided Therapy and Interventional Oncology, Department of Radiology, Hadassah Hebrew University Hospital, Jerusalem, Israel.
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Dong TT, Wang L, Li M, Yin C, Li YY, Nie F. Clinical Results, Risk Factors, and Future Directions of Ultrasound-Guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma. J Hepatocell Carcinoma 2023; 10:733-743. [PMID: 37215363 PMCID: PMC10198179 DOI: 10.2147/jhc.s409011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, with a relatively poor prognosis, especially for advanced HCC. With the availability of a variety of treatment options, the treatment strategies for HCC have become more and more diversified. Microwave ablation (MWA) has gradually been considered as a viable alternative to surgical resection (SR) owing to its comparable long-term survival, reduced complications, and greater preservation of hepatic parenchyma. However, clinical outcomes, tumor progression, and recurrence of HCC after MWA remain major concerns. Here, after reviewing the current therapeutic options for HCC, we focus on MWA, describing the advantages and challenges of MWA and the clinical results after treatment. We then focused on prognostic factors that influence post-ablation clinical outcomes and briefly presented the strategy of MWA for future clinical treatment.
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Affiliation(s)
- Tian-Tian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
| | - Lan Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
| | - Ming Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
| | - Ci Yin
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
| | - Yuan-Yuan Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, 730030, People’s Republic of China
- Ultrasound Center, Gansu Province Clinical Research Center for Ultrasound, Lanzhou, 730030, People’s Republic of China
- Intelligence Ultrasound Center, Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, 730030, People’s Republic of China
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Shahveranova A, Balli HT, Aikimbaev K, Piskin FC, Sozutok S, Yucel SP. Prediction of Local Tumor Progression After Microwave Ablation in Colorectal Carcinoma Liver Metastases Patients by MRI Radiomics and Clinical Characteristics-Based Combined Model: Preliminary Results. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03454-6. [PMID: 37156944 DOI: 10.1007/s00270-023-03454-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To investigate the predictability of local tumor progression (LTP) after microwave ablation (MWA) in colorectal carcinoma liver metastases (CRLM) patients by magnetic resonance imaging (MRI) radiomics and clinical characteristics-based combined model. MATERIALS AND METHODS Forty-two consecutive CRLM patients (67 tumors) with post-MWA complete response at 1st month MRI were included in this retrospective study. One hundred and eleven radiomics features were extracted for each tumor and for each phase by manual segmentation from pre-treatment MRI T2 fat-suppressed (Phase 2) and early arterial phase T1 fat-suppressed sequences (Phase 1). A clinical model was constructed using clinical data, two combined models were created with feature reduction and machine learning by combining clinical data and Phase 2 and Phase 1 radiomics features. The predicting performance for LTP development was investigated. RESULTS LTP developed in 7 patients (16.6%) and 11 tumors (16.4%). In the clinical model, the presence of extrahepatic metastases before MWA was associated with a high probability of LTP (p < 0.001). The pre-treatment levels of carbohydrate antigen 19-9 and carcinoembryonic antigen were higher in the LTP group (p = 0.010, p = 0.020, respectively). Patients with LTP had statistically significantly higher radiomics scores in both phases (p < 0.001 for Phase 2 and p = 0.001 for Phase 1). The classification performance of the combined model 2, created by using clinical data and Phase 2-based radiomics features, achieved the highest discriminative performance in predicting LTP (p = 0,014; the area under curve (AUC) value 0.981 (95% CI 0.948-0.990). The combined model 1, created using clinical data and Phase 1-based radiomics features (AUC value 0,927 (95% CI 0.860-0.993, p < 0.001)) and the clinical model alone [AUC value of 0.887 (95% CI 0.807-0.967, p < 0.001)] had similar performance. CONCLUSION Combined models based on clinical data and radiomics features obtained from T2 fat-suppressed and early arterial-phase T1 fat-suppressed MRI are valuable markers in predicting LTP after MWA in CRLM patients. Large-scale studies with internal and external validations are needed to come to a firm conclusion on the predictability of radiomics models in CRLM patients.
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Affiliation(s)
- Arzu Shahveranova
- Radiology Department, Cukurova University Medical School, Cukurova University Medical Faculty, Balcali Campus, 01330, Saricam, Adana, Turkey
| | - Huseyin Tugsan Balli
- Radiology Department, Cukurova University Medical School, Cukurova University Medical Faculty, Balcali Campus, 01330, Saricam, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Radiology Department, Cukurova University Medical School, Cukurova University Medical Faculty, Balcali Campus, 01330, Saricam, Adana, Turkey.
| | - Ferhat Can Piskin
- Radiology Department, Cukurova University Medical School, Cukurova University Medical Faculty, Balcali Campus, 01330, Saricam, Adana, Turkey
| | - Sinan Sozutok
- Radiology Department, Cukurova University Medical School, Cukurova University Medical Faculty, Balcali Campus, 01330, Saricam, Adana, Turkey
| | - Sevinc Puren Yucel
- Biostatistics Department, Cukurova University Medical School, Adana, Turkey
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Predictive Factors of Local Recurrence after Colorectal Cancer Liver Metastases Thermal Ablation. J Imaging 2023; 9:jimaging9030066. [PMID: 36976117 PMCID: PMC10058972 DOI: 10.3390/jimaging9030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Background: Identify risk factors for local recurrence (LR) after radiofrequency (RFA) and microwave (MWA) thermoablations (TA) of colorectal cancer liver metastases (CCLM). Methods: Uni- (Pearson’s Chi2 test, Fisher’s exact test, Wilcoxon test) and multivariate analyses (LASSO logistic regressions) of every patient treated with MWA or RFA (percutaneously and surgically) from January 2015 to April 2021 in Centre Georges François Leclerc in Dijon, France. Results: Fifty-four patients were treated with TA for 177 CCLM (159 surgically, 18 percutaneously). LR rate was 17.5% of treated lesions. Univariate analyses by lesion showed factors associated with LR: sizes of the lesion (OR = 1.14), size of nearby vessel (OR = 1.27), treatment of a previous TA site LR (OR = 5.03), and non-ovoid TA site shape (OR = 4.25). Multivariate analyses showed that the size of the nearby vessel (OR = 1.17) and the lesion (OR = 1.09) remained significant risk factors of LR. Conclusions: The size of lesions to treat and vessel proximity are LR risk factors that need to be considered when making the decision of thermoablative treatments. TA of an LR on a previous TA site should be reserved to specific situations, as there is an important risk of another LR. An additional TA procedure can be discussed when TA site shape is non-ovoid on control imaging, given the risk of LR.
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Spiliopoulos S, Moschovaki-Zeiger O, Sethi A, Festas G, Reppas L, Filippiadis D, Kelekis N. An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease. Expert Rev Med Devices 2023; 20:293-302. [PMID: 36825337 DOI: 10.1080/17434440.2023.2185137] [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: 02/25/2023]
Abstract
INTRODUCTION Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. AREAS COVERED This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years. EXPERT OPINION Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Akshay Sethi
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, NHS Grampian, Aberdeen, UK
| | - George Festas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
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Robinson TP, Pebror T, Krosin ME, Koniaris LG. Ablative Therapy in Non-HCC Liver Malignancy. Cancers (Basel) 2023; 15:cancers15041200. [PMID: 36831543 PMCID: PMC9954041 DOI: 10.3390/cancers15041200] [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: 01/11/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Surgical extirpation of liver tumors remains a proven approach in the management of metastatic tumors to the liver, particularly those of colorectal origin. Ablative, non-resective therapies are an increasingly attractive primary therapy for liver tumors as they are generally better tolerated and result in far less morbidity and mortality. Ablative therapies preserve greater normal liver parenchyma allowing better post-treatment liver function and are particularly appropriate for treating subsequent liver-specific tumor recurrence. This article reviews the current status of ablative therapies for non-hepatocellular liver tumors with a discussion of many of the clinically available approaches.
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Affiliation(s)
- Tyler P. Robinson
- Department of Surgery, Indiana University, Indianapolis, IN 46202, USA
- Correspondence: ; Tel.: +1-312-371-8360
| | - Travis Pebror
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
| | - Matthew E. Krosin
- Department of Interventional Radiology, Indiana University, Indianapolis, IN 46202, USA
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Farmer W, Hannon G, Ghosh S, Prina-Mello A. Thermal ablation in pancreatic cancer: A scoping review of clinical studies. Front Oncol 2022; 12:1066990. [DOI: 10.3389/fonc.2022.1066990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundPancreatic cancer is a deadly cancer with a 5-year survival rate less than 10%. Only 20% of patients are eligible to receive surgery at diagnosis. Hence, new therapies are needed to improve outcomes for non-surgical candidates. Thermal ablation techniques can offer a non-invasive alternative to surgery.AimThe aim of this review is to map the literature for the use of thermal ablative techniques: Radiofrequency ablation (RFA), High-intensity focused ultrasound (HIFU), Microwave ablation (MWA), and Laser ablation (LA) in the management of patients with PC.MethodsA search strategy was applied to PUBMED and EMBASE using keywords concerning pancreatic cancer, radiofrequency ablation, ultrasound ablation, laser ablation, and microwave ablation. The studies that fit this inclusion criteria were summarized in table format and results reviewed for interpretation.Results72 clinical studies were included. Most of the included studies related to RFA (n=35) and HIFU (n=27). The most common study design was retrospective (n=33). Only 3 randomized control trials (RCT) were included, all of which related to RFA. Safety outcomes were reported in 53 of the 72 studies, and survival outcomes were reported in 39. Statistically significant survival benefits were demonstrated in 11 studies.ConclusionThe evidence for the benefit of MWA and LA in PC patients is limited. RFA and HIFU are safe and feasible therapies to be used in PC patients. Further RCTs where thermal techniques are standardized and reported are necessary in the future to elucidate thermal ablation’s clinical utility, and before an evidence-based decision on its routine use in PC management can be considered.
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Lebeck Lee CM, Ziogas IA, Agarwal R, Alexopoulos SP, Ciombor KK, Matsuoka LK, Brown DB, Eng C. A contemporary systematic review on liver transplantation for unresectable liver metastases of colorectal cancer. Cancer 2022; 128:2243-2257. [PMID: 35285949 PMCID: PMC9311758 DOI: 10.1002/cncr.34170] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 12/13/2022]
Abstract
The 5-year overall survival rate of a patient with unresectable metastatic colorectal cancer is poor at approximately 14%. Similarly, historical data on liver transplantation (LT) in those with colorectal liver metastases (CRLM) showed poor outcomes, with 5-year survival rates between 12% and 21%. More recently, limited data have shown improved outcomes in select patients with 5-year overall survival rates of approximately 60%. Despite these reported survival improvements, there is no significant improvement in disease-free survival. Given the uncertain benefit with this therapeutic approach and a renewed investigational interest, we aimed to conduct a contemporary systematic review on LT for CRLM. A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis statement. English articles reporting on data regarding LT for CRLM were identified through the MEDLINE (via PubMed), Cochrane Library, and ClinicalTrials.gov databases (last search date: December 16th, 2021) by 2 researchers independently. A total of 58 studies (45 published and 13 ongoing) were included. Although early retrospective studies suggest the possibility that some carefully selected patients may benefit from LT, there is minimal prospective data on the topic and LT remains exploratory in the setting of CRLM. Additionally, several other challenges, such as the limited availability of deceased donor organs and defining appropriate selection criteria, remain when considering the implementation of LT for these patients. Further evidence from ongoing prospective trials is needed to determine if and to what extent there is a role for LT in patients with surgically unresectable CRLM.
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Affiliation(s)
- Cody M. Lebeck Lee
- Department of Internal MedicineVanderbilt University Medical CenterNashvilleTennessee
| | - Ioannis A. Ziogas
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Rajiv Agarwal
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
| | - Sophoclis P. Alexopoulos
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Kristen K. Ciombor
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
| | - Lea K. Matsuoka
- Department of SurgeryDivision of Hepatobiliary Surgery and Liver TransplantationVanderbilt University Medical CenterNashvilleTennessee
| | - Daniel B. Brown
- Department of Radiology and Radiologic SciencesDivision of Interventional RadiologyVanderbilt University Medical CenterNashvilleTennessee
| | - Cathy Eng
- Department of MedicineDivision of Hematology and OncologyVanderbilt University Medical Center/Vanderbilt‐Ingram Cancer CenterNashvilleTennessee
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12
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Minami Y, Takaki H, Yamakado K, Kudo M. How Compatible Are Immune Checkpoint Inhibitors and Thermal Ablation for Liver Metastases? Cancers (Basel) 2022; 14:cancers14092206. [PMID: 35565338 PMCID: PMC9103121 DOI: 10.3390/cancers14092206] [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: 03/10/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Although immune checkpoint inhibitors (ICIs) have achieved great progression in cancer treatment, the efficacy of ICI monotherapy is still limited. Meanwhile, the negative efficacy of thermal ablation for liver metastases is the high rate of local tumor progression. Since thermal ablation-induced inflammation and increases in tumor antigens have been suggested to promote the cancer-immunity cycle, thermal ablation and ICI can boost the immune response against cancer cells as one of the positive synergy effects. The findings of preclinical and clinical research have provided supportive evidence for the combination of ICIs with thermal ablation reversing T-cell exhaustion and demonstrating synergy. However, the clinical feasibility of immune response activation by combination therapy with ICI monotherapy and thermal ablation appears to be limited, it may be not very common phenomena. Abstract Cancer immunotherapy, which reactivates the weakened immune cells of cancer patients, has achieved great success, and several immune checkpoint inhibitors (ICIs) are now available in clinical practice. Despite promising clinical outcomes, favorable responses are only observed in a fraction of patients, and resistance mechanisms, including the absence of tumor antigens, have been reported. Thermal ablation involves the induction of irreversible damage to cancer cells by localized heat and may result in the release of tumor antigens. The combination of immunotherapy and thermal ablation is an emerging therapeutic option with enhanced efficacy. Since thermal ablation-induced inflammation and increases in tumor antigens have been suggested to promote the cancer-immunity cycle, the combination of immuno-oncology (IO) therapy and thermal ablation may be mutually beneficial. In preclinical and clinical studies, the combination of ICI and thermal ablation significantly inhibited tumor growth, and synergistic antitumor effects appeared to prolong the survival of patients with secondary liver cancer. However, evidence for the efficacy of ICI monotherapy combined with thermal ablation is currently insufficient. Therefore, the clinical feasibility of immune response activation by ICI monotherapy combined with thermal ablation may be limited, and thermal ablation may be more compatible with dual ICIs (the IO–IO combination) to induce strong immune responses.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan;
- Correspondence: ; Tel.: +81-72-366-0221 (ext. 3525); Fax: +81-72-367-2880
| | - Haruyuki Takaki
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa Nishinomiya, Nishinomiya 663-8501, Japan; (H.T.); (K.Y.)
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa Nishinomiya, Nishinomiya 663-8501, Japan; (H.T.); (K.Y.)
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi Osaka-Sayama, Osaka 589-8511, Japan;
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13
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Olthof SC, Wessling D, Winkelmann MT, Rempp H, Nikolaou K, Hoffmann R, Clasen S. Single-centre survival analysis over 10 years after MR-guided radiofrequency ablation of liver metastases from different tumour entities. Insights Imaging 2022; 13:48. [PMID: 35312842 PMCID: PMC8938560 DOI: 10.1186/s13244-022-01178-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Radiofrequency ablation (RFA) is a minimal-invasive, local therapy in patients with circumscribed metastatic disease. Although widely used, long time survival analysis of treated liver metastases is still pending while also analysing the patients’ experience of MR-based radiofrequency. Methods Monocentric, retrospective analysis of long-time overall and progression free survival (OS; PFS) of 109 patients, treated with MRI-guided hepatic RFA between 1997 and 2010, focusing on colorectal cancer patients (CRC). Complimentary therapies were evaluated and Kaplan Meier-curves were calculated. Patients’ experience of RFA was retrospectively assessed in 28 patients. Results 1-, 3-, 5-, 10-year OS rates of 109 patients with different tumour entities were 83.4%, 53.4%, 31.0% and 22.9%, median 39.2 months, with decreasing survival rates for larger metastases size. For 72 CRC patients 1-, 3-, 5-, 10-year OS rates of 90.2%, 57.1%, 36.1% and 26.5% were documented (median 39.5 months). Thereof, beneficial outcome was detected for patients with prior surgery of the CRC including chemotherapy (median 53.0 months), and for liver metastases up to 19 mm (28.5% after 145 months). Hepatic PFS was significantly higher in patients with liver lesions up to 29 mm compared to larger ones (p = 0.035). 15/28 patients remembered RFA less incriminatory than other applied therapies. Conclusions This is the first single-centre, long-time OS and PFS analysis of MRI-guided hepatic RFA of liver metastases from different tumour entities, serving as basis for further comparison studies. Patients’ experience of MR based RFA should be analysed simultaneously to the performed RFA in the future.
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Affiliation(s)
- Susann-Cathrin Olthof
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Daniel Wessling
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Moritz T Winkelmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Hansjörg Rempp
- Radiologie Waiblingen, Alter Postplatz 2, 71332, Waiblingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Stephan Clasen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.,Department of Radiology, Kreiskliniken Reutlingen, Steinenbergstraße 31, 72764, Reutlingen, Germany
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14
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Acciuffi S, Meyer F, Bauschke A, Croner R, Settmacher U, Altendorf-Hofmann A. Solitary colorectal liver metastasis: overview of treatment strategies and role of prognostic factors. J Cancer Res Clin Oncol 2021; 148:657-665. [PMID: 34914005 PMCID: PMC8881245 DOI: 10.1007/s00432-021-03880-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 12/07/2021] [Indexed: 12/09/2022]
Abstract
The following is an overview of the treatment strategies and the prognostic factors to consider in the therapeutic choice of patients characterized by solitary colorectal liver metastasis. Liver resection is the only potential curative option; nevertheless, only 25% of the patients are considered to be eligible for surgery. To expand the potentially resectable pool of patients, surgeons developed multidisciplinary techniques like portal vein embolization, two-stage hepatectomy or associating liver partition and portal vein ligation for staged hepatectomy. Moreover, mini-invasive surgery is gaining support, since it offers lower post-operative complication rates and shorter hospital stay with no differences in long-term outcomes. In case of unresectable disease, various techniques of local ablation have been developed. Radiofrequency ablation is the most commonly used form of thermal ablation: it is widely used for unresectable patients and is trying to find its role in patients with small resectable metastasis. The identification of prognostic factors is crucial in the choice of the treatment strategy. Previous works that focused on patients with solitary colorectal liver metastasis obtained trustable negative predictive factors such as presence of lymph-node metastasis in the primary tumour, synchronous metastasis, R status, right-sided primary colon tumor, and additional presence of extrahepatic tumour lesion. Even the time factor could turn into a predictor of tumour biology as well as further clinical course, and could be helpful to discern patients with worse prognosis.
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Affiliation(s)
- S Acciuffi
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - F Meyer
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - A Bauschke
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - R Croner
- Department of General, Abdominal and Vascular Surgery, University Hospital, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - U Settmacher
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - A Altendorf-Hofmann
- Department of General, Abdominal and Vascular Surgery, University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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15
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Gennaro N, Schiaffino S, Mauri G, Monfardini L. The What, the Why, and the How of Liver Ablations: A Practical Guide for the Medical Oncologist. Oncology 2021; 99:722-731. [PMID: 34515198 DOI: 10.1159/000518358] [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: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 11/19/2022]
Abstract
Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.
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Affiliation(s)
- Nicolò Gennaro
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Simone Schiaffino
- Radiology Unit IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Italy
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, IRCCS, Milan, Italy.,Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
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16
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Honglei G, Shahbaz M, Farhaj Z, Ijaz M, Kai SY, Davrieux CF, Cheng SZ. Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma: A single center, large cohort study. Medicine (Baltimore) 2021; 100:e26943. [PMID: 34449459 PMCID: PMC8389940 DOI: 10.1097/md.0000000000026943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/15/2021] [Indexed: 01/04/2023] Open
Abstract
Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.The average age was 50.1 ± 11.7 (21-83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1-8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm2 ± 3.63 (0.09-23.45 cm2). The average ablation time was 11 minutes ± 5.36 (3-20 minutes). The hospitalization period was 24 hours ± 10.16 (7-48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.
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Affiliation(s)
- Gao Honglei
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Muhammad Shahbaz
- Department of Radiology, Qilu Hospital, Shandong University, China
- Research Center for Sectional and Imaging Anatomy, Digital Human Institute, School of Basic Medical Sciences, Shandong University, Jinan, Shandong, China
- Department of General Surgery, Qilu Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Zeeshan Farhaj
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Muhammad Ijaz
- Department of Pharmacology, Shandong University, School of Pharmaceutical Sciences, China
| | - Sun Yu Kai
- Department of General Surgery, Weifang People's Hospital, Shandong, China
| | - Carlos Federico Davrieux
- DAICIM Foundation, Teaching, Research, Assistance in Minimal Invasive Surgery, Buenos Aires, Argentina
- Sanatorio de la Mujer, Rosario, Argentina
| | - Sun Zuo Cheng
- Department of General Surgery, Weifang People's Hospital, Shandong, China
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17
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Ridouani F, Ghosn M, Cornelis F, Petre EN, Hsu M, Moskowitz CS, Kingham PT, Solomon SB, Srimathveeravalli G. Ablation Zone Involution of Liver Tumors Is Faster in Patients Treated with Irreversible Electroporation Than Microwave Ablation. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:877. [PMID: 34577800 PMCID: PMC8467214 DOI: 10.3390/medicina57090877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: To compare ablation zone involution following microwave ablation (MWA) or irreversible electroporation (IRE) of liver tumors. Materials and Methods: MWA or IRE performed for colorectal cancer liver metastasis (CRLM) or hepatocellular carcinoma (HCC) during January 2011 to December 2015 were analyzed. Patients with a tumoral response on 1-year follow-up computed tomography (CT) were included. Generalized estimating equations were used to evaluate the differences between the two modalities on ablation zone involution observed on CT at 6 (M6) and 12 months (M12), and on laboratory values (total bilirubin, alanine transaminase, aspartate transaminase, alkaline phosphatase, albumin, and platelets count). The likelihood ratio test was used to assess whether the association between ablation modalities and these outcomes differed over time. Results: Seventeen (17/44, 39%) women and 27 (27/44, 61%) men were included, with 25 HCC (25/44, 57%) and 19 CRLM (19/44, 43%) patients. IRE was used in 9 (9/19, 47%) CRLM and 5 (5/25, 20%) HCC patients, respectively. All other patients had MWA. Ablation zone size and involution between IRE and MWA differed significantly over time (interaction p < 0.01), with a mean of 241.04 vs. 771.08 mm2 (ratio 0.313; 95% CI, 0.165-0.592; p < 0.01) at M6 and 60.47 vs. 589.43 mm2 (ratio 0.103; 95% CI, 0.029-0.365; p < 0.01) at M12. Changes in liver enzymes did not differ significantly between IRE and MWA at both timepoints. Conclusions: Liver tumors treated with IRE underwent faster involution when compared to tumors treated with MWA, but liver enzymes levels were comparable.
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Affiliation(s)
- Fourat Ridouani
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (F.R.); (M.G.); (E.N.P.); (S.B.S.)
| | - Mario Ghosn
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (F.R.); (M.G.); (E.N.P.); (S.B.S.)
| | - Francois Cornelis
- Department of Interventional Radiology and Oncology, Tenon Hospital, Sorbonne University, 4 Rue de la Chine, 75020 Paris, France;
| | - Elena N Petre
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (F.R.); (M.G.); (E.N.P.); (S.B.S.)
| | - Meier Hsu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.H.); (C.S.M.)
| | - Chaya S Moskowitz
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.H.); (C.S.M.)
| | - Peter T Kingham
- HepatoPancreatoBiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Stephen B Solomon
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (F.R.); (M.G.); (E.N.P.); (S.B.S.)
| | - Govindarajan Srimathveeravalli
- Department of Mechanical & Industrial Engineering, University of Massachusetts, Amherst, MA 01002, USA
- Institute for Applied Life Sciences, University of Massachusetts, Amherst, MA 01002, USA
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18
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Furtado FS, Suarez-Weiss KE, Vangel M, Clark JW, Cusack JC, Hong T, Blaszkowsky L, Wo J, Striar R, Umutlu L, Daldrup-Link HE, Groshar D, Rocco R, Bordeianou L, Anderson MA, Mojtahed A, Qadan M, Ferrone C, Catalano OA. Clinical impact of PET/MRI in oligometastatic colorectal cancer. Br J Cancer 2021; 125:975-982. [PMID: 34282295 DOI: 10.1038/s41416-021-01494-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/08/2021] [Accepted: 07/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Oligometastatic colorectal cancer (CRC) is potentially curable and demands individualised strategies. METHODS This single-centre retrospective study investigated if positron emission tomography (PET)/magnetic resonance imaging (MR) had a clinical impact on oligometastatic CRC relative to the standard of care imaging (SCI). Adult patients with oligometastatic CRC on SCI who also underwent PET/MR between 3/2016 and 3/2019 were included. The exclusion criterion was lack of confirmatory standard of reference, either surgical pathology, intraoperative gross confirmation or imaging follow-up. SCI consisted of contrast-enhanced (CE) computed tomography (CT) of the chest/abdomen/pelvis, abdominal/pelvic CE-MR, and/or CE whole-body PET/CT with diagnostic quality (i.e. standard radiation dose) CT. Follow-up was evaluated until 3/2020. RESULTS Thirty-one patients constituted the cohort, 16 (52%) male, median patient age was 53 years (interquartile range: 49-65 years). PET/MR and SCI results were divergent in 19% (95% CI 9-37%) of the cases, with PET/MR leading to management changes in all of them. The diagnostic accuracy of PET/MR was 90 ± 5%, versus 71 ± 8% for SCI. In a pairwise analysis, PET/MR outperformed SCI when compared to the reference standard (p = 0.0412). CONCLUSIONS These findings suggest the potential usefulness of PET/MR in the management of oligometastatic CRC.
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Affiliation(s)
- Felipe S Furtado
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | - Mark Vangel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.,Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey W Clark
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - James C Cusack
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Theodore Hong
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lawrence Blaszkowsky
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Newton-Wellesley Hospital, Newton, MA, USA
| | - Jennifer Wo
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robin Striar
- Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA
| | | | | | - David Groshar
- Assuta Medical Centers, Tel Aviv, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ricciardi Rocco
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Mark A Anderson
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Motaz Qadan
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Ferrone
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Martinos Center for Biomedical Imaging, Harvard Medical School, Boston, MA, USA.
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19
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Gschwend PM, Hintze JM, Herrmann IK, Pratsinis SE, Starsich FHL. Precision in Thermal Therapy: Clinical Requirements and Solutions from Nanotechnology. ADVANCED THERAPEUTICS 2021. [DOI: 10.1002/adtp.202000193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Pascal M. Gschwend
- Particle Technology Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Justin M. Hintze
- Royal College of Surgeons in Ireland 123 St Stephen's Green, Saint Peter's Dublin 2 D02 YN77 Ireland
| | - Inge K. Herrmann
- Particles‐Biology Interactions Department Materials Meet Life Swiss Federal Laboratories for Materials Science and Technology (Empa) Lerchenfeldstrasse 5 St. Gallen CH‐9014 Switzerland
- Nanoparticle Systems Engineering Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Sotiris E. Pratsinis
- Particle Technology Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
| | - Fabian H. L. Starsich
- Particles‐Biology Interactions Department Materials Meet Life Swiss Federal Laboratories for Materials Science and Technology (Empa) Lerchenfeldstrasse 5 St. Gallen CH‐9014 Switzerland
- Nanoparticle Systems Engineering Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 Zurich CH‐8092 Switzerland
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20
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Wang Y, Zhang GY, Xu LC, He XH, Huang HZ, Li GD, Wang YH, Wang GZ, Li WT. Clinical Outcomes and Predictors in Patients With Unresectable Colorectal Cancer Liver Metastases Following Salvage Percutaneous Radiofrequency Ablation: A Single Center Preliminary Experience. Technol Cancer Res Treat 2020; 19:1533033820963662. [PMID: 33034276 PMCID: PMC7549072 DOI: 10.1177/1533033820963662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: The purpose of this study was to investigate the clinical efficacy of salvage
percutaneous radiofrequency ablation in patients with unresectable
colorectal cancer liver metastases. Methods: The cohort consisted of 81 patients with 126 colorectal cancer liver
metastases who underwent radiofrequency ablation between January 2012 and
September 2016. The clinical data and ablation data were retrospectively
analyzed. The local tumor progression-free survival, overall survival, and
prognostic factors were analyzed using the log-rank test and Cox regression
model. Results: The technique success rate was 99.21%. The primary efficacy rate was 100% at
the 1-month follow-up. Minor complications were observed in 2 patients,
which recovered within 1 week. The median local tumor progression-free
survival time of all patients was 29.8 months. The absence of subsequent
chemotherapy was an independent predictor of a shorter local tumor
progression-free survival time (P < 0.001, hazard ratio:
2.823, 95% confidence interval: 1.603, 4.972). The median overall survival
time was 26.8 months. A lesion size greater than 3 cm (P =
0.011, hazard ratio: 2.112, 95% confidence interval: 1.188, 3.754) and the
presence of early local tumor progression (P = 0.011,
hazard ratio: 2.352, 95% confidence interval: 1.217, 4.545) were related to
a shorter survival time. Conclusions: Percutaneous radiofrequency ablation is safe in patients with colorectal
cancer liver metastases refractory from chemotherapy. Subsequent
chemotherapy is important to enhance local control. Small lesions and
favorable early responses are related to prolonged overall survival.
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Affiliation(s)
- Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Guang-Yuan Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Radiology, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li-Chao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Xin-Hong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Hao-Zhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Guo-Dong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Yao-Hui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
| | - Guang-Zhi Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Shandong, China
| | - Wen-Tao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China.,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai, China
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21
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Padia SA, Johnson GE, Agopian VG, DiNorcia J, Srinivasa RN, Sayre J, Shin DS. Yttrium-90 radiation segmentectomy for hepatic metastases: A multi-institutional study of safety and efficacy. J Surg Oncol 2020; 123:172-178. [PMID: 32944980 DOI: 10.1002/jso.26223] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES This study assessed the outcomes of Yttrium-90 (90 Y) radiation segmentectomy for hepatic metastases unamenable to resection or ablation. MATERIALS AND METHODS Over 6 years, 36 patients with 53 tumors underwent segmental radioembolization. Patients were not candidates for surgical resection or thermal ablation. Malignancies included metastases from colorectal cancer (31%), neuroendocrine tumors (28%), sarcoma (19%), and others (22%). Eighty-one percent of patients had undergone prior treatment with systemic chemotherapy. Ongoing systemic chemotherapy was continued. Toxicity, tumor response, tumor progression, and survival were assessed. RESULTS The median tumor size was 3.6 cm (range 1.2-6.1 cm). Adverse event rates were low, with no hepatic-related Common Terminology Criteria for Adverse Events Grade 3 or 4 toxicity. Target tumor Response Evaluation Criteria in Solid Tumors disease control rate was 92% (28% partial response, 64% stable disease). For patients with enhancing tumors (n = 14), modified Response Evaluation Criteria in Solid Tumors target tumor objective response rate was 100%. During a median follow-up of 12 months, target tumor progression occurred in 28% of treated tumors. Overall survival was 96% and 83% at 6 and 12 months, respectively. CONCLUSIONS 90 Y radiation segmentectomy for hepatic metastases demonstrates high rates of tumor control and minimal toxicity. Radiation segmentectomy should be considered for patients with metastatic hepatic malignancy who are not candidates for surgical resection.
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Affiliation(s)
- Siddharth A Padia
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Guy E Johnson
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
| | - Vatche G Agopian
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Joseph DiNorcia
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Ravi N Srinivasa
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David S Shin
- Department of Radiology, Section of Interventional Radiology, University of Washington, Seattle, Washington, USA
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22
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Abstract
With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (I) unresectable liver lesions; (II) in combination with hepatectomy; (III) in patients with significant medical comorbidities or poor performance status (PS); (IV) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection; and (V) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC).
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Affiliation(s)
- Hideo Takahashi
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.,Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Eren Berber
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, OH, USA
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23
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Liao H, Ahmed M, Markezana A, Zeng G, Stechele M, Galun E, Goldberg SN. Thermal Ablation Induces Transitory Metastatic Growth by Means of the STAT3/c-Met Molecular Pathway in an Intrahepatic Colorectal Cancer Mouse Model. Radiology 2019; 294:464-472. [PMID: 31845846 DOI: 10.1148/radiol.2019191023] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Systemic protumorigenic effects have been noted after radiofrequency ablation (RFA) of normal liver and have been linked to an interleukin 6/signal transducer and activator of transcription 3 (STAT3)/hepatocyte growth factor (HGF)/tyrosine-protein kinase Met (c-Met)/vascular endothelial growth factor (VEGF) cytokinetic pathway. Purpose To elucidate kinetics of RFA protumorigenic effects on intrahepatic metastatic implantation and growth and determine potential molecular targets for pharmacologic suppression of these effects. Materials and Methods An intrahepatic metastasis model was established by implanting CT26 and MC38 tumor cells into 216 7-8-week-old male Balb/C and C57BL6 mice, respectively, by means of splenic injection. Between June 2017 and March 2019, mice underwent tumor injection, followed 24 hours later by either standardized RFA (70°C ± 1, 5 minutes, 1-cm tip) or a sham procedure (needle placement without heating) (12 animals per arm, n = 48). Next, RFA or sham procedures were performed, followed by splenic tumor cell injection at 1 day, 3 days, or 7 days later (six animals per arm, n = 72). Finally, PHA-665752 and S3I-201 were used to block c-Met or STAT3, respectively, prior to either RFA or sham treatment (six animals per arm, n = 96). Livers were harvested at 14 days for CT26 and 21days for MC38 for tumor quantification. Ki-67 and CD34 immunohistochemistry measured proliferative indexes and microvascular density, respectively. Data were compared with analysis of variance and the two-tailed Student t test. Results RFA performed after tumor cell injection induced increased metastatic tumor number (103 ± 45 vs 52 ± 44 [CT26], P = .009 and 87 ± 51 vs 39 ± 20 [MC38], P = .007), cellular proliferation (P < .001 for both), and intratumoral neovascularization (P < .001 for both), compared with the sham procedure. Tumor cell injection performed 1 day and 3 days after RFA also increased these indexes (P < .05), while no difference was demonstrated for cell injection 7 days after RFA (P > .05). Adjuvant c-Met or STAT3 inhibition reduced intrahepatic metastatic parameters after RFA to baseline (P < .03), equivalent to the sham group (P > .05). Conclusion Radiofrequency ablation of normal liver promotes intrahepatic metastatic implantation and increased growth over a short-lived (1-3 days) temporal window in animal models. This phenomenon can be potentially neutralized with specific inhibition of pathways including hepatocyte growth factor/tyrosine-protein kinase Met and signal transducer and activator of transcription 3. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Nikolic in this issue.
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Affiliation(s)
- Haixing Liao
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Muneeb Ahmed
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Aurelia Markezana
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Guohua Zeng
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Matthias Stechele
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - Eithan Galun
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
| | - S Nahum Goldberg
- From the Goldyne Savad Institute of Gene Therapy (H.L., A.M., M.S., E.G., S.N.G.) and Department of Radiology (S.N.G.), Hadassah Hebrew University Hospital, Jerusalem, Israel; First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang Xi Road, Yuexiu District, Guangzhou, Guangdong 510120, China (H.L., G.Z.); Laboratory for Minimally Invasive Tumor Therapies, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); and Department of Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany (M.S.)
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24
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Urbonas T, Anderson EM, Gordon-Weeks AN, Kabir SI, Soonawalla Z, Silva MA, Gleeson FV, Reddy S. Factors predicting ablation site recurrence following percutaneous microwave ablation of colorectal hepatic metastases. HPB (Oxford) 2019; 21:1175-1184. [PMID: 30777696 DOI: 10.1016/j.hpb.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Microwave ablation (MWA) is a recognised treatment option for liver metastases. The size of the tumour is a well-established factor that influences the success of MWA. However, the effect of "heat sink" on the success of MWA for hepatic metastases is unclear. The aim of this study was to determine whether heat sink effect is a factor that contributes to ablation site recurrence (ASR). METHODS A prospectively maintained database of patients who underwent percutaneous MWA for treatment of colorectal liver metastases was analysed. Imaging and demographic characteristics were compared between metastases that recurred following ablation and those that did not. Proximity to a large hepatic vein was defined as <10 mm. RESULTS 126 ablations in 87 patients met the inclusion criteria and were studied over a median follow-up period of 28 (12-75) months. ASR was detected in 43 ablations (34%) and was associated with clinical risk score (CRS) ≥2 (OR 2.2 95% CI 1.3-3.3, p = 0.029), metastasis size (OR 0.953 95% CI (0.929-0.978), p < 0.001) and proximity to a large hepatic vein (OR 7.5 95%CI 2.4-22.8, p < 0.001). Proximity to a large hepatic vein was not associated with reduced overall survival (OS) but was associated with liver-specific recurrence (HR 4.7 95%CI 1.7-12.5, p = 0.004). CONCLUSIONS In addition to tumour size proximity to large hepatic venous structures is an independent predictor of ASR and liver-specific recurrence following MWA. However, this was not associated with overall survival.
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Affiliation(s)
- Tomas Urbonas
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust.
| | - Ewan M Anderson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Alex N Gordon-Weeks
- Nuffield Department of Surgical Sciences, University of Oxford, United Kingdom
| | - Syed I Kabir
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Zahir Soonawalla
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Michael A Silva
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Fergus V Gleeson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
| | - Srikanth Reddy
- Department of HPB Surgery, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust
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25
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Percutaneous image-guided therapies of primary liver tumors: Techniques and outcomes. Presse Med 2019; 48:e245-e250. [PMID: 31445698 DOI: 10.1016/j.lpm.2019.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/11/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023] Open
Abstract
Embolization and percutaneous ablations became well-established therapeutic options for hepatocellular carcinomas (HCC). All are performed under minimally invasive conditions using imaging guidance. Selection of a technique over another follows guidelines but also patient's status and availability of the techniques. The aim of this review is to present these techniques performed in routine to treat HCC and to report the outcomes.
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26
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Wu T, Zhang J, Jin Q, Gao M, Zhang D, Zhang L, Feng Y, Ni Y, Yin Z. Rhein-based necrosis-avid MRI contrast agents for early evaluation of tumor response to microwave ablation therapy. Magn Reson Med 2019; 82:2212-2224. [PMID: 31418484 DOI: 10.1002/mrm.27887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/05/2019] [Accepted: 06/11/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE Early evaluation of tumor response to thermal ablation therapy can help identify untreated tumor cells and then perform repeated treatment as soon as possible. The purpose of this work was to explore the potential of rhein-based necrosis-avid contrast agents (NACAs) for early evaluation of tumor response to microwave ablation (MWA). METHODS 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide (MTT) assay was performed to test the cytotoxicity of rhein-based NACAs against HepG2 cells. Rat models of liver MWA were used for investigating the effectiveness of rhein-based NACAs in imaging the MWA lesion, the optimal time period for post-MWA MRI examination, and the metabolic behaviors of 68 Ga-labeled rhein-based NACAs. Rat models of orthotopic liver W256 tumor MWA were used for investigating the time window of rhein-based NACAs for imaging the MWA lesion, the effectiveness of these NACAs in distinguishing the residual tumor and the MWA lesion, and their feasibility in early evaluating the tumor response to MWA. RESULTS Gadolinium 2,2',2''-(10-(2-((4-(4,5-Dihydroxy-9,10-dioxo-9,10-dihydroanthracene-2-carboxamido)butyl)amino)-2-oxoethyl)-1,4,7,10-tetraazacyclododecane-1,4,7-triyl)triacetic acid (GdL2 ) showed low cytotoxicity and high quality in imaging the MWA region. The optimal time period for post-MWA MRI examination using GdL2 was 2 to 24 h after the treatment. During 2.5 to 3.5 h postinjection, GdL2 can better visualize the MWA lesion in comparison with gadolinium 2-[4,7,10-tris(carboxymethyl)-1,4,7,10-tetraazacyclododec-1-yl]acetic acid (Gd-DOTA), and the residual tumor would not be enhanced. The tumor response to MWA as evaluated by using GdL2 -enhanced MRI was consistent with histological examination. CONCLUSION GdL2 appears to be a promising NACA for the tumor response assessment after thermal ablation therapies.
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Affiliation(s)
- Tianze Wu
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Department of TCMs Pharmaceuticals & State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Jian Zhang
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Qiaomei Jin
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Meng Gao
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Dongjian Zhang
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China
| | - Libang Zhang
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Department of TCMs Pharmaceuticals & State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu Province, People's Republic of China
| | - Yuanbo Feng
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Theragnostic Laboratory, Campus Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Yicheng Ni
- Laboratories of Translational Medicine, Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, People's Republic of China.,Theragnostic Laboratory, Campus Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Zhiqi Yin
- Department of TCMs Pharmaceuticals & State Key Laboratory of Natural Medicines, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu Province, People's Republic of China
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27
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Galata C, Wimmer E, Kasper B, Wenz F, Reißfelder C, Jakob J. Multidisciplinary Tumor Board Recommendations for Oligometastatic Malignancies: A Prospective Single-Center Analysis. Oncol Res Treat 2019; 42:87-94. [PMID: 30814474 DOI: 10.1159/000495474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND The treatment of oligometastatic disease is challenging and few data exist to guide treatment decisions. The objective of this study was to improve the data on the prevalence and treatment of patients with oligometastatic disease. METHODS We conducted a prospective single-center analysis that included all consecutive patients discussed in multidisciplinary tumor boards (MDT) between February and July 2017. Patients with oligometastatic disease were identified and treatment strategies were evaluated. RESULTS 1,673 patients were included in this study, 609 (36.4%) presented with metastatic disease, 151 (9%) had oligometastatic disease. Common metastatic sites were brain, liver, and lung. Lung cancer patients were the largest cohort (20.5%) among all patients with oligometastatic disease compared with other tumor entities. The majority of oligometastatic patients (68.9%) received local treatment with or without additional chemotherapy, 17.9% were recommended systemic therapy alone. MDT recommended watchful waiting for 4.6% of the patients. CONCLUSION Patients with oligometastatic disease represent a considerable proportion of all patients in MDT. In this study, 68.9% of patients with oligometastatic disease received regional treatment. This shows a possible treatment shift from palliative to potentially curative intent. These data may be used to design prospective clinical trials to optimize the treatment of oligometastatic disease.
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28
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Chow FCL, Chok KSH. Colorectal liver metastases: An update on multidisciplinary approach. World J Hepatol 2019; 11:150-172. [PMID: 30820266 PMCID: PMC6393711 DOI: 10.4254/wjh.v11.i2.150] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/24/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Liver metastasis is the commonest form of distant metastasis in colorectal cancer. Selection criteria for surgery and liver-directed therapies have recently been extended. However, resectability remains poorly defined. Tumour biology is increasingly recognized as an important prognostic factor; hence molecular profiling has a growing role in risk stratification and management planning. Surgical resection is the only treatment modality for curative intent. The most appropriate surgical approach is yet to be established. The primary cancer and the hepatic metastasis can be removed simultaneously or in a two-step approach; these two strategies have comparable long-term outcomes. For patients with a limited future liver remnant, portal vein embolization, combined ablation and resection, and associating liver partition and portal vein ligation for staged hepatectomy have been advocated, and each has their pros and cons. The role of neoadjuvant and adjuvant chemotherapy is still debated. Targeted biological agents and loco-regional therapies (thermal ablation, intra-arterial chemo- or radio-embolization, and stereotactic radiotherapy) further improve the already favourable results. The recent debate about offering liver transplantation to highly selected patients needs validation from large clinical trials. Evidence-based protocols are missing, and therefore optimal management of hepatic metastasis should be personalized and determined by a multi-disciplinary team.
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Affiliation(s)
| | - Kenneth Siu-Ho Chok
- Department of Surgery and State Key Laboratory for Liver Research, the University of Hong Kong, Hong Kong, China
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29
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Saccomandi P, Lapergola A, Longo F, Schena E, Quero G. Thermal ablation of pancreatic cancer: A systematic literature review of clinical practice and pre-clinical studies. Int J Hyperthermia 2018; 35:398-418. [PMID: 30428728 DOI: 10.1080/02656736.2018.1506165] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Pancreatic cancer is a challenging malignancy with low treatment option and poor life expectancy. Thermal ablation techniques were proposed as alternative treatment options, especially in advanced stages and for unfit-for-surgery patients. This systematic review describes the thermal ablative techniques -i.e., Laser (LA), Radiofrequency (RFA), Microwave (MWA) Ablation, High-Intensity Focused Ultrasound (HIFU) and cryoablation- available for pancreatic cancer treatment. Additionally, an analysis of the efficacy, complication rate and overall survival for each technique is conducted. MATERIAL AND METHODS This review collects the ex vivo, preclinical and clinical studies presenting the use of thermal techniques in the pancreatic cancer treatment, searched up to March 2018 in PubMed and Medline. Abstracts, letters-to-the-editor, expert opinions, reviews and non-English language manuscripts were excluded. RESULTS Sixty-five papers were included. For the ex vivo and preclinical studies, there are: 12 records for LA, 8 for RFA, 0 for MWA, 6 for HIFU, 1 for cryoablation and 3 for hybrid techniques. For clinical studies, 1 paper for LA, 14 for RFA, 1 for MWA, 17 for HIFU, 1 for cryoablation and 1 for hybrid techniques. CONCLUSIONS Important technological advances are presented in ex vivo and preclinical studies, as the real-time thermometry, nanotechnology and hybrid techniques to enhance the thermal outcome. Conversely, a lack of standardization in the clinical employment of the procedures emerged, leading to contrasting results on the safety and feasibility of some analyzed techniques. Uniform conclusions on the safety and feasibility of these techniques for pancreatic cancer will require further structured investigation.
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Affiliation(s)
- Paola Saccomandi
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,b Departement of Mechanical Engineering, Politecnico di Milano , Milan , Italy
| | - Alfonso Lapergola
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,c Università G. D'Annunzio , Chieti , Italy
| | - Fabio Longo
- a IHU-Strasbourg Institute of Image-Guided Surgery , Strasbourg , France.,d Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
| | | | - Giuseppe Quero
- d Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Rome , Italy
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Cornelis FH, Solomon SB. Treatment of Primary Liver Tumors and Liver Metastases, Part 2: Non-Nuclear Medicine Techniques. J Nucl Med 2018; 59:1801-1808. [PMID: 30361378 DOI: 10.2967/jnumed.116.186379] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/19/2018] [Indexed: 02/07/2023] Open
Abstract
Image-guided procedures are used worldwide in the management of primary liver tumors and liver metastases. These locoregional therapies include local tumor ablation and transarterial therapies and can occasionally downstage an inoperable patient to an operable status. In hepatocellular carcinoma, data have suggested that for tumors smaller than 2 cm ablation may be preferable to surgery. Similar results are emerging for colorectal cancer liver metastases. Catheter-directed therapies such as bland embolization, transarterial chemoembolization, and drug-eluting beads represent potential techniques that can provide survival benefit for inoperable patients. In this review we highlight the most used techniques and the evidence supporting their current indications for the treatment of liver tumors. We briefly review upcoming developments in combination strategies with temperature-sensitive liposomes or immunotherapy for enhancing ablation efficacy.
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Affiliation(s)
- Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and.,Sorbonne Université, Department of Radiology, Tenon Hospital, Paris, France
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
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The concept of oligometastases in colorectal cancer: from the clinical evidences to new therapeutic strategies. Curr Opin Oncol 2018; 30:262-268. [DOI: 10.1097/cco.0000000000000453] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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[Surgical innovations in treatment of metastatic colorectal cancer : Complexity of metastatic surgery as example for personalized medicine]. Chirurg 2018; 89:191-196. [PMID: 29318366 DOI: 10.1007/s00104-017-0583-0] [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: 10/18/2022]
Abstract
BACKGROUND Extensive, bilobular and multifocal colorectal liver metastases (CLM) or metastases that are critically situated require an experienced surgeon and advanced surgical techniques to enable curative resection. OBJECTIVE This article describes the toolbox of hepato-oncologic surgery including functional augmentation of liver segments by portal vein embolization/ligation, combinations of ablation and resection, two-stage resections and in situ split liver resection, also known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Furthermore, the curative resection of extrahepatic, oligometastatic disease are briefly discussed. MATERIAL AND METHODS Review of current literature as well as discussion of the ALPPS procedure, which was developed at our institute. RESULTS In recent years, oncologic resections for CLM have been significantly refined, leading to a constant increase of curative resection rates. CONCLUSION In a multimodality treatment setting, surgical resection of CLM remains the gold standard curative approach and even in the event of presumed hopeless cases with extensive metastasis, experienced hepatobiliary surgeons must evaluate the resectability of colorectal metastases.
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Affiliation(s)
- Nancy E Kemeny
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA, Berlin, Germany
| | - Beate Rau
- Department of General Surgery, Campus Virchow and Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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