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Liu C, Liu T, Fang J, Liu X, Du C, Luo Q, Song L, Liu G, Li W, Li W, Geng L. Identifying symptom clusters and temporal interconnections in patients with lung tumors after CT-guided microwave ablation: A network analysis. Support Care Cancer 2024; 32:377. [PMID: 38780815 DOI: 10.1007/s00520-024-08560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To explore symptom clusters and interrelationships using a network analysis approach among symptoms in patients with lung tumors who underwent computed tomography (CT)-guided microwave ablation (MWA). METHODS A longitudinal study was conducted, and 196 lung tumor patients undergoing MWA were recruited and were measured at 24 h, 48 h, and 72 h after MWA. The Chinese version of the MD Anderson Symptom Inventory and the Revised Lung Cancer Module were used to evaluate symptoms. Network analyses were performed to explore the symptom clusters and interrelationships among symptoms. RESULTS Four stable symptom communities were identified within the networks. Distress, weight loss, and chest tightness were the central symptoms. Distress, and weight loss were also the most key bridge symptoms, followed by cough. Three symptom networks were temporally stable in terms of symptom centrality, global connectivity, and network structure. CONCLUSION Our findings identified the central symptoms, bridge symptoms, and the stability of symptom networks of patients with lung tumors after MWA. These network results will have important implications for future targeted symptom management intervention development. Future research should focus on developing precise interventions for targeting central symptoms and bridge symptoms to promote patients' health.
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Affiliation(s)
- Chunqin Liu
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
- School of Medicine, Jinggangshan University, Ji'an, Jiangxi, China
| | - Tianchi Liu
- Department of Out-Patient, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jia Fang
- Department of Nursing, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, Guangzhou, China
| | - Xiaohua Liu
- Department of Out-Patient, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Chunling Du
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Qin Luo
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liqin Song
- School of Nursing, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guangxin Liu
- School of Nursing, Shandong First Medical University, Tai'an, Shandong, China
| | - Wenjuan Li
- Department of Out-Patient, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Weifeng Li
- Department of Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Li Geng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Microwave Ablation of Adrenal Metastasis after Resistance to Stereotactic Body Radiation Therapy: Don't Forget the Takotsubo! Cardiovasc Intervent Radiol 2023; 46:280-281. [PMID: 36175654 DOI: 10.1007/s00270-022-03285-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/11/2022] [Indexed: 02/04/2023]
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3
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Liu W, Zhang Y, Fu YF, Ma WM. Image-guided radiofrequency ablation for adrenal metastatic tumors: a systematic review and meta-analysis. Int J Hyperthermia 2023; 40:2185575. [PMID: 36889697 DOI: 10.1080/02656736.2023.2185575] [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: 03/10/2023] Open
Abstract
PURPOSE To evaluate the safety and clinical efficacy of image-guided radiofrequency ablation (RFA) in patients exhibiting adrenal metastatic tumors (AMTs). METHODS The PubMed, Web of Science, and Wanfang databases were searched for relevant studies published as of November 2022, and study results were pooled for subsequent analysis. The endpoints of this meta-analysis included primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year overall survival (OS) rates. RESULTS This analysis incorporated 11 studies enrolling 351 patients that underwent RFA treatment for 373 AMTs. The pooled primary and secondary technical success, local hemorrhage, pneumothorax, hypertensive crisis, local recurrence, and 1- and 3-year OS rates in these patients were 84%, 91%, 4%, 6%, 7%, 19%, 82%, and 46%, respectively. The 1-year OS (I2 = 75.2%, p = 0.003) and 3-year OS (I2 = 81.4%, p = 0.001) endpoints were subject to significant heterogeneity. Subgroup analyses suggested that primary technical success rates were < 80% in patients with tumors exhibiting a mean diameter ≥ 4 cm. Guidance type and tumor size had no impact on a hypertensive crisis or local recurrence rates. CONCLUSIONS These data indicate that image-guided RFA represents a safe and effective means of treating AMTs.
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Affiliation(s)
- Wei Liu
- Department of Oncology, Xuzhou Central Hospital, Xuzhou, P.R. China
| | - Ying Zhang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, P.R. China
| | - Yu-Fei Fu
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, P.R. China
| | - Wei-Ming Ma
- Department of Urological Surgery, Xuzhou Central Hospital, Xuzhou, P.R. China
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4
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Percutaneous ablation for adrenal metastases: a systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2022; 17:549-560. [PMID: 36818506 PMCID: PMC9909773 DOI: 10.5114/wiitm.2022.119585] [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: 07/17/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Imaging-guided percutaneous ablation (PA) is commonly employed for the treatment of patients diagnosed with adrenal metastasis (AM), but comprehensive analyses are essential to validate the efficacy and safety of this approach. Aim The present meta-analysis was designed to evaluate the safety, efficacy, and long-term outcomes associated with the imaging-guided PA treatment of AM. Material and methods Relevant studies in the PubMed, Embase, and Wanfang databases published as of June 2022 were identified, and pooled endpoint analyses were performed with Stata 12.0. Results This meta-analysis included 15 studies. Overall, the respective pooled primary technical success, secondary technical success, local hemorrhage, pneumothorax, hypertension crisis, local recurrence, 1-year overall survival (OS), and 3-year OS rates in study participants were 88%, 93%, 3%, 6%, 6%, 19%, 80%, and 46%. High levels of heterogeneity were evident for the 1-year OS (I2 = 79.6%) and 3-year OS endpoints (I2 = 67.1%), but meta-regression analyses failed to identify predictors of these OS rates. Low heterogeneity was observed for subgroups of patients who had undergone cryoablation (I2 = 0%) or patients with multiple primary cancers (I2 = 0%) with respect to 1-year OS. Similarly, low heterogeneity for the 3-year OS endpoint was detected in subgroups of patients who had undergone cryoablation (I2 = 0%), ultrasound-guided PA (I2 = 0%), individuals with AMs secondary to hepatocellular carcinoma (I2 = 0%), and patients with multiple primary cancers (I2 = 0%). Conclusions These results suggest imaging-guided PA to be a safe and effective treatment for AM associated with satisfactory long-term patient outcomes.
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Percutaneous cryoablation of adrenal metastases: technical feasibility and safety. Abdom Radiol (NY) 2021; 46:2805-2813. [PMID: 33543315 DOI: 10.1007/s00261-020-02848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/20/2020] [Accepted: 10/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the technical feasibility and outcomes of adrenal metastases cryoablation. MATERIALS AND METHODS This is an IRB approved retrospective review of adrenal metastases cryoablation between April 2003 and October 2018. Forty percutaneous cryoablation procedures were performed on 40 adrenal metastases in 34 patients. Histology, tumor size, ablation zone size, major vessel proximity, local recurrences, complications, and anesthesia-managed hypertension monitoring was collected. Complications were graded according to the Common Terminology of Complications and Adverse Events (CTCAE). RESULTS Mean tumor and ablation size was 3.2 cm and 5.2 cm, respectively. Local recurrence rate was 10.0% (N = 4/40) for a mean follow-up time of 1.8 years. Recurrences for tumors > 3 cm (21.0%, N = 4/19) was greater than for tumors ≤ 3 cm (0.0%, N = 0/21) (p = 0.027). Proximity of major vasculature (i.e., IVC & aorta) did not statistically effect recurrence rates (p = 0.52), however, those that recurred near vasculature were > 4 cm. Major complication (≥ grade 3) rate was 5.0% (N = 2/40), with one major complication attributable to the procedure. Immediate escalation of blood pressure during the passive stick phase (between freeze cycles) or post procedure thaw phase was greater in patients with residual adrenal tissue (N = 21/38) versus masses replacing the entire adrenal gland (N = 17/38), (p = 0.0020). Lower blood pressure elevation was noted in patients with residual adrenal tissue who were pre-treated with alpha blockade (p = 0.015). CONCLUSIONS CT-guided percutaneous cryoablation is a safe, effective and low morbidity alternative for patients with adrenal metastases. Transient hypertension is related only to residual viable adrenal tissue but can be safely managed and prophylactically treated.
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Park BK, Fujimori M, Shen SH, Pua U. Asian Conference on Tumor Ablation Guidelines for Adrenal Tumor Ablation. Endocrinol Metab (Seoul) 2021; 36:553-563. [PMID: 34107604 PMCID: PMC8258324 DOI: 10.3803/enm.2021.1008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Thermal ablation is a good alternative treatment in patients who are unable to undergo adrenalectomy. Even though the Asian Conference on Tumor Ablation (ACTA) has been held for many years, adrenal ablation guidelines have not been established. No guidelines for adrenal ablation are established in American and European countries, either. The aim of this review was to introduce the first version of ACTA guidelines for adrenal tumor ablation.
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Affiliation(s)
- Byung Kwan Park
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Masashi Fujimori
- Department of Radiology, Mie University School of Medicine, Tsu,
Japan
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital,
Singapore
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7
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Pan S, Baal JD, Chen WC, Baal U, Pai JS, Baal JH, Zagoria R. Image-Guided Percutaneous Ablation of Adrenal Metastases: A Meta-Analysis of Efficacy and Safety. J Vasc Interv Radiol 2021; 32:527-535.e1. [PMID: 33518369 DOI: 10.1016/j.jvir.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/23/2020] [Accepted: 12/08/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of percutaneous ablation of adrenal metastases through a meta-analysis of various image-guided percutaneous ablation techniques. MATERIALS AND METHODS A comprehensive literature search of PubMed and Embase databases was performed for studies evaluating the efficacy and/or safety of image-guided percutaneous ablation of adrenal metastases. A total of 37 studies published between 2009 and 2020 were analyzed, comprising a sample size of 959 patients. Proportion estimates of overall survival, local control, and toxicity were analyzed in a pooled meta-analysis. The pooled prevalence of adverse events after ablation was calculated based on common terminology criteria for adverse events (CTCAE) grading. RESULTS Of the 959 included patients, 320 (33.3%) underwent radiofrequency ablation, 72 (7.5%) microwave ablation, 95 (9.9%) cryoablation, and 46 (4.8%) ethanol injections for treatment of adrenal metastases. The remaining 426 (44.4%) patients were from studies involving a mixture of the 4 listed percutaneous ablation techniques. The pooled 1-year local control rate was 80% (95% confidence interval [CI], 76%-83%). The pooled 1-year overall survival rate was 77% (95% CI, 70%-83%). The overall rate of severe adverse events after ablation (CTCAE grade 3 or higher) was 16.1%. The overall rate of low-grade adverse events after ablation (CTCAE grade 2 or lower) was 32.6%. Approximately 21.9% (n = 203) of patients experienced intraprocedural hypertensive crises, the majority of which were reversed with antihypertensive medications. CONCLUSIONS This study demonstrates that image-guided percutaneous ablation can be effective in achieving acceptable short- to mid-term local tumor control and overall survival with a moderate safety profile.
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Affiliation(s)
- Simon Pan
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Joe D Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California.
| | - William C Chen
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Ulysis Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Jonathan S Pai
- Department of Medicine, University of Southern California, Los Angeles, California
| | - Jed H Baal
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California
| | - Ronald Zagoria
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, California; Department of Urology, University of California, San Francisco, California
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Liu B, Mo C, Wang W, Ye J, Jiang C, Xie X, Huang J, Huang G, Long H, Xie X. Treatment outcomes of percutaneous radiofrequency ablation versus adrenalectomy for adrenal metastases: a retrospective comparative study. J Endocrinol Invest 2020; 43:1249-1257. [PMID: 32166699 DOI: 10.1007/s40618-020-01212-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To retrospectively evaluate the clinical outcomes of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) in treatment of adrenal metastasis (AM), and to compare with adrenalectomy (Adx). METHODS From June 2008 to August 2018, a total of 60 patients with AM treated at our hospital were retrospectively reviewed, of whom 29 treated by RFA (RFA group) and 31 by Adx (Adx group). The technical success, local tumor progression (LTP) and overall survival (OS) after the treatment were evaluated and compared. RESULTS In RFA group, the first technical success was 72.4% and the second technical success was 86.2%. In Adx group, all the AMs were successfully resected. After 24.5 ± 19.1 months follow-up period, a total of 8 patients (6 in RFA group and 2 in Adx group) were detected LTP. The 1-, 2- and 3- LTP rates after treatment were 17.1%, 30.9% and 44.7% in RFA group, and 6.5%, 6.5% and 6.5% in Adx group, respectively (P = 0.028). However, for AM ≤ 5 cm, the LTP between the two groups were comparable (P = 0.068). The 1-, 2- and 3- OS rates after treatment for AM were 85.0%, 42.4% and 27.8% in RFA group, and 93.0%, 66.1% and 52.3% in Adx group, respectively (P = 0.057). RFA offered shorter treatment time (23.6 ± 16.9 vs. 155.6 ± 58.8 min, P < 0.001), shorter hospital stay (7.8 ± 3.9 vs. 15.0 ± 4.9 days, P < 0.001), and lower hospital cost ($3405.7 ± 1067.8 vs. $5248.0 ± 2261.3, P = 0.003) than Adx. CONCLUSION In comparison with Adx, percutaneous US-guided RFA, as an alternative treatment, is feasible and effective in controlling AM, especially in AM ≤ 5 cm in diameter.
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Affiliation(s)
- B Liu
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China.
| | - C Mo
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - W Wang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - J Ye
- Division of Interventional Ultrasound, Department of Medical Ultrasonics, Foshan First Municipal People's Hospital (The Affiliated Foshan Hospital of Sun Yat-Sen University), 81 Lingnan North Road, Foshan, 528000, Guangdong, China
| | - C Jiang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - X Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - J Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - G Huang
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - H Long
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China
| | - X Xie
- Division of Interventional Ultrasound, Department of Medical Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Road 2, Guangzhou, 510080, China.
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Microwave Ablation of Adrenal Tumors in Patients With Continuous Intra-Arterial Blood Pressure Monitoring Without Prior Alpha-Adrenergic Blockade: Safety and Efficacy. Cardiovasc Intervent Radiol 2020; 43:1384-1391. [PMID: 32529338 DOI: 10.1007/s00270-020-02547-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/29/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Evaluate the safety and efficacy of adrenal microwave ablation performed with continuous intra-arterial blood pressure monitoring (IABPM) and without alpha-adrenergic blockade (AAB) as pretreatment. MATERIAL AND METHODS A single-center, retrospective review of all percutaneous adrenal microwave ablation performed between 2011 and 2018. Microwave ablation was completed on 11 patients, with a total of 15 adrenal tumors with a mean size of 3.3 cm (1.4-6.9 cm) treated metastatic RCC, HCC, esophageal carcinoma, adrenal adenoma. Cases were performed without prior AAB, but with continuous IABPM and rapid intervention using short-acting antihypertensive medications. RESULTS There were no post-procedural episodes of hypertension, no neurological or cardiovascular complications, and no SIR moderate or worse adverse event complications. Mean intraprocedural maximum systolic blood pressure (SBP) was 211 mmHg (range: 132-288), with an average increase in SBP of 100 mmHg (range: 23-180). A hypertensive crisis (SBP ≥ 180 and/or DBP ≥ 120) occurred in 9 of the 15 procedures (60%) with a mean length of 3.0 min (range: 1-12). The technical success rate was 100% (15/15 procedures). The mean follow-up time was 2.4 years (range: 0.9-7.7 years), with primary and secondary efficacy rates of 77% and 87%, respectively, and an overall survival of 82%. CONCLUSION In this single-center retrospective study, microwave ablation of adrenal tumors without AAB was safe and effective when performed with continuous arterial line monitoring of vital signs and the use of short-acting, rapid-onset antihypertensive medications. LEVEL OF EVIDENCE Level 4, Case Series.
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10
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Voglhuber T, Kessel KA, Oechsner M, Vogel MME, Gschwend JE, Combs SE. Single-institutional outcome-analysis of low-dose stereotactic body radiation therapy (SBRT) of adrenal gland metastases. BMC Cancer 2020; 20:536. [PMID: 32513136 PMCID: PMC7282163 DOI: 10.1186/s12885-020-07030-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adrenal gland metastases are a common diagnostic finding in various tumor diseases. Due to the increased use of imaging methods, they are diagnosed more frequently, especially in asymptomatic patients. SBRT has emerged as a new, alternative treatment option in the field of radiation oncology. In the past, it was often used for treating inoperable lung, liver, prostate, and brain tumors. Meanwhile, it is also an established keystone in the treatment of oligometastatic diseases. This retrospective study aims to evaluate the effect of low-dose SBRT in patients with adrenal metastases. METHODS We analyzed a group of 31 patients with 34 adrenal gland lesions treated with low-dose SBRT between July 2006 and July 2019. Treatment-planning was performed through contrast-enhanced CT, followed by image-guided stereotactic radiotherapy using cone-beam CT. The applied cumulative median dose was 35 Gy; the median single dose was 7 Gy. We focused on local control (LC), progression-free survival (PFS), overall survival (OS), as well as acute and late toxicity. RESULTS Seven adrenal gland metastases (20.6%) experienced local failure, 80.6% of the patients faced a distant progression. Fourteen patients were still alive. Median follow-up for all patients was 9.8 months and for patients alive 14.4 months. No treatment-related side-effects >grade 2 occurred. Of all, 48.4% suffered from acute gastrointestinal disorders; 32.3% reported acute fatigue, throbbing pain in the renal area, and mild adrenal insufficiency. Altogether, 19.4% of the patients faced late-toxicities, which were as follows: Grade 1: 12.9% gastrointestinal disorders, 3.2% fatigue, Grade 2: 9.7% fatigue, 6.5% headache, 3.2% loss of weight. The 1-year OS and probability of LF were 64 and 25.9%, respectively. CONCLUSION Low-dose SBRT has proven as an effective and safe method with promising outcomes for treating adrenal metastases. There appeared no high-grade toxicities >grade 2, and 79.4% of treated metastases were progression-free. Thus, SBRT should be considered as a therapy option for adrenal metastases as an individual therapeutic concept in the interdisciplinary discussion as an alternative to surgical or systemic treatment.
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Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.
| | - Kerstin A Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Heidelberg, Germany
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11
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Ierardi AM, Carnevale A, Angileri SA, Pellegrino F, Renzulli M, Golfieri R, Zhang D, Sun H, Giganti M, Dionigi G, Carrafiello G. Outcomes following minimally invasive imagine-guided percutaneous ablation of adrenal glands. Gland Surg 2020; 9:859-866. [PMID: 32775281 DOI: 10.21037/gs.2020.03.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Whilst surgery represents the gold standard for the treatment of adrenal primary malignant tumors, metastatic involvement of the adrenal glands is generally approached conservatively; however, surgery for local control has been controversial, and several reports have described the utility of surgical removal in terms of prolonged survival in selected patients. Different techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser induced thermal therapy (LITT), cryoablation (CRA), and chemical ablation, are employed in percutaneous image-guided ablation for primary and metastatic malignancies of the adrenal glands, in case of patients with multiple comorbidities or who refuse surgery. Technical success, clinical success and safety were analysed and discussed in this systematic review. Tumor size was found a significant determinant for local disease control; histology of the primary malignancy and coexistence of tumor elsewhere were correlated with prognosis. These procedures resulted to be feasible and safe, with hypertensive crisis representing the most common complication. Although there is lack of evidence in the literature concerning outcomes compared with surgery, percutaneous ablation may represent a useful therapeutic option for controlling unresectable adrenal metastases, offering patients opportunities for improved survival.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Via A di Rudinì 8, 20142 Milan, Italy
| | - Aldo Carnevale
- Department of Radiology, University Hospital of Ferrara, via A. Moro 8, 44124 Ferrara, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, San Paolo Hospital, Via A di Rudinì 8, 20142 Milan, Italy
| | - Fabio Pellegrino
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, via L. Ariosto 35, 44121 Ferrara, Italy
| | - Matteo Renzulli
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Daqi Zhang
- Division of thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, China
| | - Hui Sun
- Division of thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun, China
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, via L. Ariosto 35, 44121 Ferrara, Italy
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Gianpaolo Carrafiello
- Unità Operativa di Radiologia, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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12
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Hypertensive Crisis during Microwave Ablation of Adrenal Neoplasms: A Retrospective Analysis of Predictive Factors. J Vasc Interv Radiol 2019; 30:1343-1350. [DOI: 10.1016/j.jvir.2019.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/29/2018] [Accepted: 01/12/2019] [Indexed: 12/11/2022] Open
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13
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Liang KW, Jahangiri Y, Tsao TF, Tyan YS, Huang HH. Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters. J Vasc Interv Radiol 2019; 30:1335-1342.e1. [PMID: 31375447 DOI: 10.1016/j.jvir.2019.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/20/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. MATERIALS AND METHODS A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. RESULTS A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI], -33.93 to -24.19), DBP (-16.03 mm Hg; 95% CI, -18.33 to -13.73), and the number of antihypertensive medications used (-1.43; 95% CI, -1.97 to -0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. CONCLUSIONS Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
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Affiliation(s)
- Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C.
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14
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Huang J, Xie X, Lin J, Wang W, Zhang X, Liu M, Li X, Huang G, Liu B, Xie X. Percutaneous radiofrequency ablation of adrenal metastases from hepatocellular carcinoma: a single-center experience. Cancer Imaging 2019; 19:44. [PMID: 31242934 PMCID: PMC6595611 DOI: 10.1186/s40644-019-0231-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022] Open
Abstract
Background The prognosis of adrenal metastases (AM) from hepatocellular carcinoma (HCC) with surgical contraindication was poor. This study evaluated the feasibility, safety and treatment efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for the local treatment of AM originated from HCC. Methods A retrospective study was carried out on 22 patients (21 male and 1 female, mean age, 53.0 ± 13.0 years) who had single AM (mean diameter, 4.0 ± 1.8 cm, range, 1.7–8.0 cm) originated from HCC and received US-guided percutaneous RFA at our institution. The diagnosis was established on typical radiologic findings. The primary technical success was defined as the tumour being completely ablated in the first RFA session. The secondary technical success was defined as tumour residual left from the first ablation was completely ablated by a second ablation session. Local tumour progression (LTP) and overall survival (OS) were estimated by using Kaplan-Meier analysis. Results A total of 25 ablation sessions were performed. The primary technical success and the secondary technical success were 77.3% (17 of 22) and 86.4% (19 of 22), respectively, with the major complication rate at 4.5% (1 of 22). The median follow-up period after RFA was 10 months (3–55 months). During the follow-up period, five patients were detected LTP. The LTP at 3, 6, and 12 months were 15.8, 26.3, and 26.3%, respectively. Nine patients died of distant extra-adrenal metastases and another five of liver failure due to HCC. The OS at 6, 12, 24 months after RFA for AM were at 79.7, 52.6, and 32.9%, respectively. Conclusion Percutaneous US-guided RFA in the treatment of AM originated from HCC is feasible, safe and effective.
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Affiliation(s)
- Jingzhi Huang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaohua Xie
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jinhua Lin
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Wei Wang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaoer Zhang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Ming Liu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaoju Li
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Guangliang Huang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Baoxian Liu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Xiaoyan Xie
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
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15
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Jalón-Monzón A, Castanedo-Álvarez D, Hevia-Suárez M, Álvarez-Múgica M, Medina-González A, Escaf-Barmadah S. Results of adrenalectomy in lung cancer metastases. Actas Urol Esp 2018; 42:600-605. [PMID: 29609826 DOI: 10.1016/j.acuro.2018.02.003] [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: 12/05/2017] [Revised: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to report our centre's experience over the past 15 years with patients with lung carcinoma and adrenal metastases treated sequentially with lung resection and adrenalectomy. PATIENTS AND METHODS We analysed a retrospective series of 19 patients who underwent adrenalectomy for lung carcinoma metastasis. All patients were operated on at the same centre, between October 2000 and October 2015. We performed a descriptive analysis and an overall survival and disease-free survival analysis. RESULTS The study included 13 men and 6 women. The most common primary lung tumour was adenocarcinoma, 87.5% of which were G3. In 7 patients, the adrenal metastasis was detected synchronously, and in 12 patients it was detected metachronously. The median size of the metastasis was 63mm. Twenty-one percent of the cases presented local recurrence, and 79% presented distant metastasis. The median DFS was 21.5 months, while the DFS at 5 years was calculated at 58.33%. The median overall survival was 37.3 months, while survival at 5 years was calculated at 42.86%. None of the prognostic factors evaluated were statistically significant. CONCLUSIONS Adrenalectomy in cases of isolated lung carcinoma metastasis can offer increased overall survival. Age and the degree of differentiation of the primary lung carcinoma are the factors that most influence poorer survival.
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Toesca DAS, Koong AJ, von Eyben R, Koong AC, Chang DT. Stereotactic body radiation therapy for adrenal gland metastases: Outcomes and toxicity. Adv Radiat Oncol 2018; 3:621-629. [PMID: 30370363 PMCID: PMC6200881 DOI: 10.1016/j.adro.2018.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk. Methods and Materials Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery. Results In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40 Gy (range, 20-54 Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P = .0006). Patients with metastases <2.9 cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ≥2.9 cm (P = .01). Incidence of grade 2 toxicity was 17% with no case of grade ≥3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6 ± 8 mL/min/1.73 m2 compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P = .7 and P = .9, respectively). Conclusions SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.
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Affiliation(s)
- Diego A S Toesca
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Amanda J Koong
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford, California
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