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Orsi F, Hamiddin AS, Sattin C, Pizzi C, Varano GM, Della Vigna P, Mauri G, Maiettini D, Bonomo G. Liquid nitrogen-based cryoablation: complication rates for lung, bone, and soft tissue tumors cryoablation. Br J Radiol 2024; 97:1863-1869. [PMID: 39226178 PMCID: PMC11491613 DOI: 10.1093/bjr/tqae171] [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: 10/16/2023] [Revised: 03/21/2024] [Accepted: 08/22/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVE This study aimed to assess the complication rate during and 24 hours after cryoablation in lung, bone, and soft tissue tumors. METHODS We reviewed complications in a total of 85 consecutive patients who underwent cryoablation using a liquid nitrogen-based system in various lesions between April 2017 and October 2022. There were no liver and renal lesions. Complications were categorized using the Society of Interventional Radiology classification. RESULTS Eighty-five patients were treated for 96 lesions in the bone (36.4%; 35 of 96), lung (18.8%; 18 of 96), and soft tissue (44.8%; 43 of 96). The primary technical success rate was 97.7% (83 of 85). The total grade 2 and 1 complication rates were 5.2% (5/96) and 20.8% (20/96), respectively. Two patients had asymptomatic pulmonary embolisms incidentally noted at the 24-hour follow-up computed tomography (grade 2). The most frequent complications were simple and hemorrhagic pleural effusions (18.7%; 18 of 96). Lung procedures had the highest complication rate, where 13 patients (72.2%; 13 of 18) reported complications, including 2 cases of symptomatic hydropneumothorax requiring drainage (grade 2) and an additional 2 days of hospital stay. Eight patients (24.2%; 8 of 33) with bone lesions and 4 (9.3%; 4 of 43) with soft tissue lesions experienced complications. CONCLUSION Cryoablation using a liquid nitrogen-based system is safe, with only minor complications observed. ADVANCES IN KNOWLEDGE This study provides data on the safety of liquid nitrogen-based percutaneous cryoablation in tumors located in lung, in bones and in soft tissues. Despite using larger diameter cryoprobes than those typically reported with argon-based system, our experience shows that complications are mostly low and comparable in frequency and severity.
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Affiliation(s)
- Franco Orsi
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
| | - Aida Shazlin Hamiddin
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
- Selayang Hospital, Selangor, Malaysia
| | | | | | - Gianluca Maria Varano
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
| | - Paolo Della Vigna
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
| | - Giovanni Mauri
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
| | - Daniele Maiettini
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
| | - Guido Bonomo
- Department of Interventional Radiology, Istituto Europeo di Oncologia (IRCCS), Milan, Via Giuseppe Ripamonti 435, Milan-20141, Italy
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Mertens A, Essing T, Minko P, Möllenhoff K, Mattes-György K, Giesel FL, Antoch G, Luedde T, Roderburg C, Loosen SH. Selective internal radiotherapy in Germany: a review of indications and hospital mortality from 2012 to 2019. J Clin Transl Res 2023; 9:123-132. [PMID: 37179793 PMCID: PMC10171316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 05/15/2023] Open
Abstract
Background and Aim Selective internal radiotherapy (SIRT) is a minimal invasive tumor therapy for hepatocellular carcinoma (HCC), biliary tract cancer (BTC), and liver metastasis of extrahepatic tumors. Comprehensive data on past and current trends of SIRT as well as outcome parameters such as in-hospital mortality and adverse events in Germany are missing. Methods We evaluated current clinical developments and outcomes of SIRT in Germany based on standardized hospital discharge data, provided by the German Federal Statistical Office from 2012 to 2019. Results A total of 11,014 SIRT procedures were included in the analysis. The most common indication was hepatic metastases (54.3%; HCC: 39.7%; BTC: 6%) with a trend in favor of HCC and BTC over time. Most SIRTs were performed with yttrium-90 (99.6%) but the proportion of holmium-166 SIRTs increased in recent years. There were significant differences in the mean length of hospital stay between 90Y (3.67 ± 2 days) and 166Ho (2.9 ± 1.3 days) based SIRTs. Overall in-hospital mortality was 0.14%. The mean number of SIRTs/hospital was 22.9 (SD ± 30.4). The 20 highest case volume centers performed 25.6% of all SIRTs. Conclusion Our study gives a detailed insight into indications, patient-related factors, and the incidence of adverse events as well as the overall in-hospital mortality in a large SIRT collective in Germany. SIRT is a safe procedure with low overall in-hospital mortality and a well-definable spectrum of adverse events. We report differences in the regional distribution of performed SIRTs and changes in the indications and used radioisotopes over the years. Relevance for Patients SIRT is a safe procedure with very low overall mortality and a well-definable spectrum of adverse events, particularly gastrointestinal. Complications are usually treatable or self-limiting. Acute liver failure is a potentially fatal but exceptionally rare complication. 166Ho has promising beneficial bio-physical characteristics and 166Ho-based SIRT should be further evaluated against 90Y-based SIRT as the current standard of care.
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Affiliation(s)
- Alexander Mertens
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Corresponding author: Alexander Mertens Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf Moorenstraße 5, 40225 Düsseldorf, Germany. Tel: +49 211 81 16630 Fax: +49 211 81 04489
| | - Tobias Essing
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Paracelsus Medical University, Klinikum Nürnberg, 90419 Nürnberg, Germany
| | - Peter Minko
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Kathrin Möllenhoff
- Mathematical Institute, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Katalin Mattes-György
- Department of Nuclear Medicine, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Frederik L. Giesel
- Department of Nuclear Medicine, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf 40225, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Christoph Roderburg
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sven H. Loosen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
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Arai Y, Helmberger T, White S, J.Zech C. The challenge of liver tumors for interventional oncology: past, present and future - introductory editorial. Br J Radiol 2022; 95:20229005. [PMID: 36129133 PMCID: PMC9815743 DOI: 10.1259/bjr.20229005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology, and Minimal-Invasive Therapy at Munich Klinik, Bogenhausen, Germany
| | - Sarah White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Christoph J.Zech
- Section Interventional Radiology, Radiology und Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
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