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Sapoval M, Querub C, Pereira H, Pellerin O, Boeken T, Di Gaeta A, Ahmar MA, Lefevre-Colau MM, Nguyen C, Daste C, Lacroix M, Laredo JD, Sabatier B, Martelli N, Chatellier G, Déan C, Rannou F. Genicular artery embolization for knee osteoarthritis: Results of the LipioJoint-1 trial. Diagn Interv Imaging 2024; 105:144-150. [PMID: 38102013 DOI: 10.1016/j.diii.2023.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and efficacy of transient genicular artery embolization (GAE) using an ethiodized oil-based emulsion for the treatment of knee osteoarthritis (KOA). MATERIALS AND METHODS This prospective, single-arm, open-label, multicenter, first-in-human cohort trial was registered on ClinicalTrials.gov (NCT04733092). The main inclusion criterion was diagnosis of KOA according to a visual analogue scale (VAS) pain score ≥ 40 mm (score range: 0-100 mm), despite conservative treatment for at least three months. Treatment efficacy was assessed using changes in VAS pain score, Mean Western Ontario & McMaster Universities osteoarthritis (WOMAC) function score (normalized to 100; score ranging from 0 to100) and outcome measures in rheumatoid arthritis clinical trials (OMERACT)-Osteoarthritis Research Society (OARSI) set of responder criteria. RESULTS Twenty-two consecutive participants (13 women; mean age, 66 ± 9 [standard deviation (SD)]) were included and underwent GAE. Emulsion consisted in a mixture of ioversol and ethiodized oil (ratio 1:3, respectively) prepared extemporaneously. The rate of serious adverse events attributed to GAE within one month was 5% (1/22), corresponding to reversible worsening of renal function. Immediate technical success rate was 100%. Mean VAS pain score dropped from 74.4 ± 16.5 (SD) mm at baseline to 37.2 ± 26.7 (SD) mm at three months (P < 0.001). Mean WOMAC function score (normalized to 100: score ranging from 0 to 100) decreased from 57.3 ± 17.1 (SD) at baseline to 33.5 ± 25.9 (SD) at three months (P < 0.001). At three months, 16 out of 22 participants (73%) were considered responders according to the OMERACT-OARSI set of responder criteria, including high improvement in either pain or WOMAC function, or improvement in both pain and WOMAC function. CONCLUSION GAE using an ethiodized oil-based emulsion is safe and improves pain and function in participants with KOA for at least three months.
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Affiliation(s)
- Marc Sapoval
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; Université Paris Cité, PARCC - INSERM Unité-970, 75015 Paris, France.
| | - Charles Querub
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Helena Pereira
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Clinical Research Unit, 75015 Paris, France
| | - Olivier Pellerin
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; Université Paris Cité, PARCC - INSERM Unité-970, 75015 Paris, France
| | - Tom Boeken
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France; HeKA team, INRIA, 75012 Paris, France
| | - Alessandro Di Gaeta
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Marc Al Ahmar
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - Marie-Martine Lefevre-Colau
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université de Paris Cité, INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Christelle Nguyen
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
| | - Camille Daste
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université de Paris Cité, INSERM UMR-S 1153, Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, 75004 Paris, France
| | - Maxime Lacroix
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Service d'imagerie, 75015 Paris, France
| | - Jean-Denis Laredo
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service de Chirurgie Orthopédique Et Traumatologique, 75010 Paris, France
| | - Brigitte Sabatier
- HeKA team, INRIA, 75012 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Pharmacie, 75015 Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Pharmacie Clinique, 91400 Orsay, France
| | - Nicolas Martelli
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Pharmacie, 75015 Paris, France; Université Paris-Saclay, Faculté de Pharmacie, GRADES, 91400 Orsay, France
| | - Gilles Chatellier
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Clinical Research Unit, 75015 Paris, France
| | - Carole Déan
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Vascular and Oncological Interventional Radiology, 75015 Paris, France
| | - François Rannou
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, 75014 Paris, France; Université Paris Cité, INSERM UMR-S 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, 75006 Paris, France
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Guerra X, Sapoval M, Querub C, Al Ahmar M, Di Gaeta A, Dean C, Pellerin O, Boeken T. Repeat Prostatic Artery Embolization with the Addition of a Liquid Embolic Agent: Short-term Results. Acad Radiol 2023:S1076-6332(23)00541-X. [PMID: 37996363 DOI: 10.1016/j.acra.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023]
Abstract
RATIONALE AND OBJECTIVES The long-term effectiveness of prostatic artery embolization (PAE) can be hampered by the recanalization of the previously embolized prostatic arteries (PA). The use of a liquid embolic agent (LEA) could limit this risk. The purpose of this study was to assess the safety and efficacy of repeat PAE (rePAE) using a LEA (Squid Peri) coupled with microspheres in patients experiencing recurring symptoms after initial embolization. MATERIALS AND METHODS This retrospective single-center study included all consecutive patients who underwent rePAE using Squid Peri coupled with microspheres. Angiographic patterns of prostatic revascularization were identified. Outcomes were assessed at the 3-month follow-up using the International Prostate Symptom Score (IPSS) and the Quality of Life (QoL) score. The primary endpoint was clinical success defined as an IPSS < 18 with > 25% decrease and a QoL score ≤ 3 with ≥ 1 point decrease. Safety was assessed by using the modified Clavien-Dindo classification. RESULTS 30 consecutive men (mean age: 67.1 ± 9.5 years) were included. Recanalization of the previously embolized PA was found in 83.3% of patients. Technical success was 93.3%. Median follow-up was 4.9 months [IQR: 3.9 - 9.8]. Clinical success rate was 76.7%, with a mean decrease in IPSS of -9.3 ± 7.3 (p < 0.001) and a median decrease in QoL of -2 [IQR: - 4 - - 1] (p < 0.001). One patient presented with an acute urinary retention requiring readmission (grade IIIa complication). CONCLUSION Repeat PAE using Squid Peri coupled with microspheres is safe and effective for patients with recurring symptoms after initial embolization.
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Affiliation(s)
- Xavier Guerra
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France.
| | - Marc Sapoval
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; PARCC U 970, INSERM, Paris, France
| | - Charles Querub
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France
| | - Marc Al Ahmar
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Alessandro Di Gaeta
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Carole Dean
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Olivier Pellerin
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; PARCC U 970, INSERM, Paris, France
| | - Tom Boeken
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; HeKA team, INRIA, Paris, France
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Kedra A, Boeken T, Di Gaeta A, Querub C, Al Ahmar M, Déan C, Sapoval M, Pellerin O. Exploring a Novel Technique to Tackle the Shortage of Devices for Hepatic Arterial Infusion Chemotherapy: Early Results of an Alternate Approach for Percutaneous Arterial Port Catheter Placement. Cancers (Basel) 2023; 15:4730. [PMID: 37835422 PMCID: PMC10571966 DOI: 10.3390/cancers15194730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
Dedicated catheters for hepatic arterial infusion chemotherapy were removed from the market. The purpose of this study was to assess the results of a novel approach to overcome the shortage of dedicated catheters for hepatic arterial infusion chemotherapy in the treatment of colorectal cancer liver metastases. We retrospectively included patients who underwent a percutaneous placement of a hepatic intra-arterial port catheter in a single tertiary center from February 2021 to June 2022. We examined the patient baseline characteristics, technical features of the modified procedures, technical success rates, complications and oncological outcomes. Fourteen patients (median age: 60 years; q1 = 54; q3 = 70; range: 53-81 years) underwent 15 modified procedures. The main modification of our placement technique consisted of the use of an indwelling 5-Fr Vertebral catheter, on the tip of which we created a two-sided additional lateral hole. The catheter was connected to a pediatric port. The primary success rate was 100%, and the secondary success rate was 93.3%. There were two late major complications, graded IIIa according to the Clavien-Dindo classification. The median liver progression free survival was 6.1 months (q1 = 2.5; q3 = 7.2; range: 1.3-11.6). Our experience suggests that the derived utilization of the devices used routinely in interventional radiology provides an effective solution that can compensate for the shortage of dedicated devices.
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Affiliation(s)
- Alice Kedra
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
| | - Tom Boeken
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
- HeKA Team, INRIA, 75015 Paris, France
| | - Alessandro Di Gaeta
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
| | - Charles Querub
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
| | - Marc Al Ahmar
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
| | - Carole Déan
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
| | - Olivier Pellerin
- Vascular and Oncological Interventional Radiology Department, Assistance Publique—Hôpitaux de Paris Hôpital Européen Georges Pompidou, 75015 Paris, France; (T.B.); (A.D.G.); (C.Q.); (M.A.A.); (C.D.); (M.S.); (O.P.)
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
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Lehrer R, Sapoval M, Di Gaeta A, Querub C, Al Ahmar M, Dean C, Pellerin O, Boeken T. Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03424-y. [PMID: 37029235 DOI: 10.1007/s00270-023-03424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE). MATERIALS AND METHODS This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points' decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery. RESULTS A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40-75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1-36.9]) months and 8.9 [3.4-10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9-49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63-32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%). CONCLUSION Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.
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Affiliation(s)
- Raphael Lehrer
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Alessandro Di Gaeta
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Charles Querub
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
| | - Marc Al Ahmar
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Carole Dean
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Olivier Pellerin
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Tom Boeken
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
- Faculté de Santé, Université de Paris Cité, Paris, France.
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France.
- HeKA Team, INRIA, Paris, France.
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Abstract
In his pioneering work, Okuno and colleagues demonstrated the benefit of musculoskeletal (MSK) embolization, using imipenem as an embolic agent, in various diseases such as knee osteoarthritis (KOA), adhesive capsulitis (AC), tennis elbow and other sports injuries. As imipenem is a last-resort, broad spectrum antibiotic, its use is often not feasible depending on countries and their drug regulation. Since then, several other studies have used other material products such as microparticles or liquid embolics. In addition, several products in development or that are used in other indications may prove useful after full clinical evaluation of safety and efficacy. In this article we will develop our recommendations, through an analysis of recent publications on MSK embolization.
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Affiliation(s)
- Charles Querub
- Interventional Radiology Hôpital Européen Georges Pompidou, Paris, France.
| | - Marc Al Ahmar
- Interventional Radiology Hôpital Européen Georges Pompidou, Paris, France
| | - Tom Boeken
- Interventional Radiology Hôpital Européen Georges Pompidou, Paris, France
| | | | - Olivier Pellerin
- Interventional Radiology Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Sapoval
- Interventional Radiology Hôpital Européen Georges Pompidou, Paris, France
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Najafi A, Al Ahmar M, Bonnet B, Delpla A, Kobe A, Madani K, Roux C, Deschamps F, de Baère T, Tselikas L. The PEARL Approach for CT-guided Lung Biopsy: Assessment of Complication Rate. Radiology 2021; 302:473-480. [PMID: 34726537 DOI: 10.1148/radiol.2021210360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Percutaneous CT-guided biopsy of lung nodules is an established method with high diagnostic accuracy but a high rate of pneumothorax and chest tube insertion compared with endobronchial methods. Purpose To investigate the effect of a protocol combining patient positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching (PEARL) on complication rate after percutaneous CT-guided lung biopsy, especially chest tube insertion. Materials and Methods In a secondary analysis of both prospectively and retrospectively acquired data from December 2019 to November 2020, consecutive participants underwent biopsy with use of the PEARL protocol (prospective data) and were compared with patients who underwent biopsy at the same tertiary cancer center according to the standard method without any additional techniques (controls, retrospective data). Patient demographics, lesion characteristics, intraprocedural data, complications, and histologic results were recorded and compared. Results One hundred patients in the control group (mean age ± standard deviation, 63 years ± 12; 61 men) and 100 participants in the PEARL group (mean age, 64 years ± 12; 48 men) were evaluated. No differences were found in patient and lesion characteristics. The emphysema rate was 47 of 100 patients (47%) in both groups. The rate of pneumothorax was 37 of 100 patients (37%) in the control group versus 16 of 100 (16%) in the PEARL group (P = .001). Of the pneumothoraxes that occurred, fewer were during the intervention in the PEARL group, with 21 of 37 onsets (57%) in the control group versus three of 16 onsets (19%) in the PEARL group (P < .001). A chest tube was inserted in 13 of 100 patients (13%) in the control group and only in one of 100 (1%) in the PEARL group (P = .002). Histologic findings were diagnostic in 94 of 100 patients (94%) in the control group and 95 of 100 (95%) in the PEARL group (P > .99). Conclusion During CT-guided percutaneous lung biopsy, a protocol of positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching, or PEARL, reduced rates of pneumothorax and chest tube insertion. © RSNA, 2021.
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Affiliation(s)
- Arash Najafi
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Marc Al Ahmar
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Baptiste Bonnet
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Alexandre Delpla
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Adrian Kobe
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Khaled Madani
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Charles Roux
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Frédéric Deschamps
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Thierry de Baère
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
| | - Lambros Tselikas
- From the Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, Île-de France, France
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Madani K, Najafi A, Boticella A, Roux C, Tselikas L, Delpla A, Al Ahmar M, de Baere T, Deschamps F. Combined local treatments for vertebral metastases with limited epidural extension. Support Care Cancer 2021; 30:337-345. [PMID: 34287688 DOI: 10.1007/s00520-021-06443-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Vertebral metastases with limited epidural extension (VMLEE) are frequently encountered in cancer patients; they can cause severe and debilitating symptoms including pain and neurological impairment and are usually treated by radiotherapy. In this study, we mainly evaluated the safety of combined local treatments (CLT), associating radiofrequency ablation (RFA) with vertebroplasty and radiotherapy (RT) to treat VMLEE. Also, we aimed to evaluate the short-term efficacy of CLT on bone metastases palliation and long-term prevention of skeletal-related events. METHODS We retrospectively reviewed treatment complications, pain palliation, and skeletal complications after combined local treatments (CLT) for vertebral metastasis with limited epidural extension (VMLEE). RESULTS Eighteen consecutive patients had CLT for 24 VMLEE, between June 2016 and January 2021. No major post-treatment complication was recorded. Nine patients had pain before the initiation of CLT. One month after CLT, only 3 patients had residual pain with a significant decrease of visual analogue scale (VAS), from 7.3 ± 2.4 to 2 ± 0 (p = .008), as well as the mean morphine milligram equivalent dose from 196.6 ± 135.7 to 38.5 ± 26, p = .008. Mean follow-up was 16.7 ± 11.5 months. Only one vertebra showed an increase of a preexisting vertebral fracture. Nine VMLEE had evidence of residual disease, including 2 which resulted in spinal cord compression (2, 11 months). CONCLUSION CLT was safe and effective for pain palliation and long-term prevention of skeletal-related events for treatment of patients with VMLEE. The effectiveness of this combined treatment on tumor control and epidural involvement on the long term needs further investigation.
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Affiliation(s)
- Khaled Madani
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France.
| | - Arash Najafi
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Angela Boticella
- Department of Radiation Therapy, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Charles Roux
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Alexandre Delpla
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Marc Al Ahmar
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France
| | - Frédéric Deschamps
- Department of Interventional Radiology, Gustave Roussy Cancer Campus, 114 Rue Édouard Vaillant, 94800, Villejuif, France.
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Assouline J, Tselikas L, Roux C, Yevich S, Delpla A, Najafi A, Al Ahmar M, Bijot JC, de Baère T, Deschamps F. Prophylactic Percutaneous Consolidation of Large Osteolytic Tumors of the Pelvic Ring Using Fixation by Internal Cemented Screws. Radiol Imaging Cancer 2021; 3:e200137. [PMID: 33988476 DOI: 10.1148/rycan.2021200137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose To evaluate the efficacy, durability, and safety of percutaneous fixation by internal cemented screw (FICS) for prophylactic consolidation of impending pathologic fractures of the pelvic ring. Materials and Methods In this single-institute retrospective study, patients with large, minimally symptomatic to asymptomatic osteolytic tumors of the pelvic ring that were treated with percutaneous cone-beam CT-guided FICS procedures were included (January 2014 to May 2019). Follow-up cross-section imaging and clinical reports were reviewed for procedural complications and assessment of the long-term consolidation efficacy on the basis of the development of pathologic fracture or need for additional surgical intervention. All continuous variables were expressed as a mean with standard deviation, and dichotomous variables were expressed as frequencies and percentages. Results Fifty consecutive patients (mean age, 60 years ± 12; 27 men) underwent prophylactic FICS for consolidation of 54 osteolytic tumors (mean size, 51 mm ± 21.5; range, 30-114 mm). Local tumor destruction was performed in association with FICS in 38 patients (76%) using percutaneous thermal and/or radiation therapy. Follow-up exceeded a year in 35 patients (70%), with mean follow-up of 22 months ± 18 (range, 1-67 months). Long-term consolidation efficacy was 98% (49 of 50), with the development of a pathologic fracture in only one patient 20 months after FICS. Procedural complications were limited to two patients with self-resolving hematoma, one patient with inflammatory sciatic pain, and one patient with focal pain at the ischial tuberosity. Conclusion Percutaneous FICS provides a safe and durable minimally invasive treatment for the prevention of pathologic fractures of the pelvic ring. Keywords: Interventional-MSK, Percutaneous, Skeletal-Axial, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Jessica Assouline
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Lambros Tselikas
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Charles Roux
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Steven Yevich
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Alexandre Delpla
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Arash Najafi
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Marc Al Ahmar
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Jean-Charles Bijot
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Thierry de Baère
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
| | - Frédéric Deschamps
- From the Department of Interventional Radiology, Gustave Roussy-Cancer Center, 114 Rue Edouard Vaillant, 94805 Villejuif, France (J.A., L.T., C.R., S.Y., A.D., A.N., M.A.A., J.C.B., T.d.B., F.D.); Laboratory of Translational Research in Immunology (LRTI), INSERM U1015, Villejuif France (L.T.); and University Paris-Sud Le Kremlin Bicêtre, France (L.T., T.d.B., F.D.)
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Najafi A, de Baere T, Purenne E, Bayar A, Al Ahmar M, Delpla A, Roux C, Madani K, Assouline J, Deschamps F, Tselikas L. Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study. Eur Radiol 2021; 31:5361-5369. [PMID: 33474569 DOI: 10.1007/s00330-020-07675-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/22/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Curative treatment of oligometastatic pulmonary disease aims at eradication of all metastases. Radiofrequency ablation (RFA) has been shown to be an efficient method and the frequency of local tumor progression (LTP) should be minimized. The objective of this study was to determine the morphological and treatment-related risk factors for LTP after RFA of pulmonary metastases. MATERIALS AND METHODS All patients treated with RFA for pulmonary metastases from 2002 to 2014 were reviewed. All LTPs from 2011 to 2014 were individually matched on the basis of tumor size, number, and histology. In total, 48 LTPs and 112 controls were blindly analyzed for morphological factors including vicinity of bronchus and vessels as well as treatment-related factors such as the size of the ablation zone and ablation margins. RESULTS In the simple regression analysis, the significant predictive variables were ≤ 5-mm distance to a large bronchus (OR = 4.94; p = 0.0095) or large vessel (OR = 7.09; p < 0.001), minimal ablation margin (≤ 5 mm (OR = 42.67; p < 0.001), and a central-peripheral ablation offset/ablation zone size > 0.36 (OR = 13.83; p = 0.013). In the multiple regression model, only a minimal ablation margin ≤ 5 mm remained a significant risk factor for LTP. CONCLUSION Only the minimal ablation margin remains significant in the multiple regression analysis; the other factors are presumably surrogates of an insufficient ablation margin. Improvement of lung RFA outcomes can probably be obtained by immediate post RFA evaluation of ablation margins to ensure a minimal ablation margin of at least 5 mm. KEY POINTS • A distance < 5 mm to a bronchus or vessel of over 3 mm diameter is associated with insufficient ablation margin and thus risk factors for local tumor progression after pulmonary radiofrequency ablation. • A minimal ablation margin of > 5 mm after pulmonary RFA is associated with significantly less local tumor progression and should be looked for at the end of treatment session before needle removal in order to decrease local tumor progression. • Tumor location, pleural contact, occurrence of intra-alveolar hemorrhage, pulmonary atelectasis, and pneumothorax are not associated with an increased risk of local tumor progression.
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Affiliation(s)
- Arash Najafi
- Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. .,Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Thierry de Baere
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Edouard Purenne
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Amine Bayar
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Marc Al Ahmar
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexandre Delpla
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Charles Roux
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Khaled Madani
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Jessica Assouline
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Frederic Deschamps
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Lambros Tselikas
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
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10
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Dassa M, Roux C, Tselikas L, Delpla A, Yevich S, Faron M, Teriitehau C, Hakime A, Al Ahmar M, de Baère T, Deschamps F. Image-guided Percutaneous Fixation with Internal Cemented Screws of Impending Femoral Neck Pathologic Fractures in Patients with Metastatic Cancer: Safety, Efficacy, and Durability. Radiology 2020; 297:721-729. [DOI: 10.1148/radiol.2020201341] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Moulin B, Tselikas L, Gravel G, Al Ahmar M, Delpla A, Yevich S, Hakime A, Territehau C, De Baere T, Deschamps F. Safety and Efficacy of Multilevel Thoracolumbar Vertebroplasty in the Simultaneous Treatment of Six or More Pathologic Compression Fractures. J Vasc Interv Radiol 2020; 31:1683-1689.e1. [PMID: 32921566 DOI: 10.1016/j.jvir.2020.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the safety and efficacy of multilevel thoracolumbar vertebroplasty in the simultaneous treatment of ≥ 6 painful pathologic compression fractures. MATERIALS AND METHODS Retrospective review was conducted of 50 consecutive patients treated with vertebroplasty for ≥ 6 pathologic compression fractures in a single session for pain palliation at a tertiary single cancer center from 2015 to 2019. Outcomes measured included procedural safety according to Common Terminology Criteria for Adverse Events (CTCAE), change in 4-week postprocedure back pain by numeric rating scale (NRS), comparison of daily opioid medication consumption, and development of skeletal-related events. RESULTS A total of 397 pathologic compression fractures were treated during 50 sessions (mean, 7.9 per patient ± 1.5). Mean procedure duration was 162 minutes ± 35, mean postoperative hospitalization duration was 1.6 days ± 0.9, and mean follow-up duration was 401 days ± 297. Seven complications were recorded, including 1 case of symptomatic polymethyl methacrylate pulmonary embolism. No major complications (CTCAE grade 4/5) were reported. NRS pain score was significantly decreased (5.0 ± 1.8 vs 1.7 ± 1.4; P < .0001), with a mean score decrease of 3.3 points (66%). Opioid agent use decreased significantly (76 mg/24 h ± 42 vs 45 mg/24 h ± 37; P = .0003), with a mean decrease of 30 mg/24 h (39%). Skeletal-related events occurred in 7 patients (14%). CONCLUSIONS Multilevel vertebroplasty for ≥ 6 pathologic compression fractures is safe and provides significant palliative benefit when performed simultaneously.
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Affiliation(s)
- Benjamin Moulin
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France.
| | - Lambros Tselikas
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France; Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Guillaume Gravel
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Marc Al Ahmar
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Alexandre Delpla
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Steven Yevich
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Antoine Hakime
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Christophe Territehau
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France
| | - Thierry De Baere
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France; Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Fréderic Deschamps
- Interventional Radiology Unit and Imaging Department and Anesthesiology Unit, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, Villejuif 94805, France; Université Paris-Sud, Le Kremlin Bicêtre, France
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12
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Moulin B, Delpla A, Tselikas L, Al Ahmar M, Prud'homme C, Roux C, Yevich S, Laurent S, Hakime A, Territehau C, Gravel G, De Baere T, Deschamps F. Multi-Level Vertebroplasty for 6 or More Painful Osteoporotic Vertebral Body Compression Fractures Performed in the Same Procedural Setting: A Safety and Efficacy Report in Cancer Patients. Cardiovasc Intervent Radiol 2020; 43:1041-1048. [PMID: 32382857 DOI: 10.1007/s00270-020-02480-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess safety and efficacy of multi-level vertebroplasty, when treating 6 or more levels in the same procedural setting for the management of osteoporotic vertebral compression fractures (oVCF) in cancer patients. MATERIALS AND METHODS Single institution retrospective review from 2015 to 2019 of patients treated for multi-level oVCF in a single session procedural setting by vertebroplasty of 6 or more levels. Procedure outcomes collected included procedural complications, pre- and 4 week post-procedure pain score by numeric rating scale, opioid usage, and vertebral height changes. RESULTS In total, 197 vertebral levels were treated in 24 procedures (mean 8.2 ± 1.8 levels). Mean procedure duration was 167 + / - 41 min, and mean postoperative hospitalization duration was 2.1 + / - 1.9 days. Four grade I or II complications occurred according to CIRSE classification. Two patients had a symptomatic pulmonary cement embolism; although there was no statistical difference between pre- and postoperative mean blood saturation (95.9 + / - 1.7% and 94.8 + / - 2.0%, respectively, p = 0.066). Pain score significantly improved after treatment (6.5 ± 1.3 vs 3.2 + / - 1.4, p < 0.0001) with a mean decrease of 3.3 (51%). Post-procedure daily opioid use also significantly improved (mean 35.8 + / - 36.8 mg/24 h vs 18.5 + / - 27.8 mg/24 h, p = 0.0089), with a mean decrease of 17.3 mg/24 h (48%). Refracture was found in 2 of 105 levels treated (1.9%), and no difference was found in thoraco-lumbar height and angulation. Five patients experienced new painful fractures at a non-treated level. CONCLUSION Multi-level vertebroplasty for 6 or more levels is a safe and effective treatment for the management of multi-level oVCF in cancer patients.
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Affiliation(s)
- Benjamin Moulin
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.
| | - Alexandre Delpla
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Lambros Tselikas
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Marc Al Ahmar
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Clara Prud'homme
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Charles Roux
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Steven Yevich
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Sophie Laurent
- Pain Management Unit, Institut Gustave Roussy, Villejuif, Paris, France
| | - Antoine Hakime
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Christophe Territehau
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Guillaume Gravel
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France
| | - Thierry De Baere
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
| | - Fréderic Deschamps
- Department Interventional Radiology Unit, Imaging Department, Gustave Roussy Cancer Campus, 114 rue Edouard Vaillant, 94805, Villejuif, France.,Université Paris-Sud, Le Kremlin Bicêtre, France
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Delpla A, Tselikas L, De Baere T, Laurent S, Mezaib K, Barat M, Nguimbous O, Prudhomme C, Al Ahmar M, Moulin B, Deschamps F. Correction to: Preventive Vertebroplasty for Long-Term Consolidation of Vertebral Metastases. Cardiovasc Intervent Radiol 2020; 43:807. [DOI: 10.1007/s00270-020-02445-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chassagnon G, Gregory J, Al Ahmar M, Magdeleinat P, Legmann P, Coste J, Revel MP. Risk factors for hemoptysis complicating 17-18 gauge CT-guided transthoracic needle core biopsy: multivariate analysis of 249 procedures. Diagn Interv Radiol 2018; 23:347-353. [PMID: 28762333 DOI: 10.5152/dir.2017.160338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE We aimed to identify modifiable and nonmodifiable risk factors for hemoptysis complicating computed tomography (CT)-guided transthoracic needle biopsy. METHODS All procedures performed in our institution from November 2013 to May 2015 were reviewed. Hemoptysis was classified as mild if limited to hemoptoic sputum and abundant otherwise. Presence of intra-alveolar hemorrhage on postbiopsy CT images was also evaluated. Patient- and lesion-related variables were considered nonmodifiable, while procedure-related variables were considered modifiable. RESULTS A total of 249 procedures were evaluated. Hemoptysis and alveolar hemorrhage occurred in 18% and 58% of procedures, respectively, and were abundant or significant in 8% and 17% of procedures, respectively. Concordance between the occurrence of significant alveolar hemorrhage (grade ≥2) and hemoptysis was poor (κ=0.28; 95% CI [0.16-0.40]). In multivariate analysis, female gender (P = 0.008), a longer transpulmonary needle path (P = 0.014), and smaller lesion size (P = 0.044) were independent risk factors for hemoptysis. Transpulmonary needle-path length was the only risk factor for abundant hemoptysis with borderline statistical significance (P = 0.049). CONCLUSION The transpulmonary needle path should be as short as possible to reduce the risk of abundant hemoptysis during CT-guided transthoracic needle biopsy.
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Affiliation(s)
- Guillaume Chassagnon
- Department of Radiology, Paris Descartes University, Sorbonne Paris Cité Groupe Hospitalier Cochin-Hotel Dieu, Paris, France.
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