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Autrusseau PA, Cazzato RL, De Marini P, Auloge P, Koch G, Dalili D, Weiss J, Mayer T, Garnon J, Gangi A. Pain relief and local tumour control following percutaneous image-guided cryoablation for spine metastasis: a 12-year single-centre experience. Clin Radiol 2021; 76:674-680. [PMID: 34120732 DOI: 10.1016/j.crad.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/29/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
AIM To assess pain relief and local tumour control retrospectively in spinal metastases undergoing cryoablation. MATERIALS AND METHODS Between May 2008 and September 2020, 46 metastases in 41 consecutive patients (mean age 59.7±4.4 [SD] years; range 27-84) were treated with cryoablation in 42 interventional sessions. Patient demographics, procedural data, complications, pain, and local tumour control were analysed retrospectively. RESULTS Thirty-one patients (36 spine metastases; 32 sessions) were treated for pain relief and 10 (10 metastases; 10 sessions) for local tumour control. Clinical success was reached in 30/32 (93.8%) interventional palliative sessions. Mean pre-procedural numerical pain rate scale was 6.2±1.7 (SD), and dropped significantly to 3.5±1.8 (SD), 1.9±1.7 (SD), and 1.9±1.8 (SD) at 24-h, 1-month and at the last available follow-up (median 16.5±23.2 [SD] months), respectively. For patients requiring local tumour control, primary clinical success was reached in 6/10 (60%) spinal metastases at median 25-months follow-up. The overall complication rate was 8%, with no secondary fractures or iatrogenic thermal-mediated nerve injuries reported. CONCLUSION Percutaneous image-guided cryoablation of spinal metastases is safe and effective in achieving pain relief and local tumour control.
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Affiliation(s)
- P-A Autrusseau
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P De Marini
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - P Auloge
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - G Koch
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - D Dalili
- School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
| | - J Weiss
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - T Mayer
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - J Garnon
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France
| | - A Gangi
- Service d'Imagerie Interventionnelle, Hôpitaux Universitaires de Strasbourg, 1, Place de l'hopital, 67000 Strasbourg, France; School of Biomedical Engineering and Imaging Sciences, King's College London, London WC2R 2LS, UK
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Garnon J, De Marini P, Meylheuc L, Dalili D, Cazzato RL, Bayle B, Gangi A. Percutaneous image-guided double oblique anterior approach to the acetabulum for cementoplasty. Clin Radiol 2020; 75:964.e7-964.e12. [PMID: 32998833 DOI: 10.1016/j.crad.2020.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022]
Abstract
AIM To report the technique of percutaneous double oblique anterior access to the acetabulum and evaluate its feasibility and safety. MATERIALS AND METHODS Pelvic computed tomography (CT) examinations of 60 patients (30 men and 30 women; mean age 62.6±13.2 years) were retrieved randomly from the picture archiving and communication system (PACS). A virtual intraosseous trajectory was defined on both sides on the axial CT images with the entry point marked 1 cm above the anterosuperior iliac spine and the endpoint defined just above the level of the ischial spine at the midpoint of the posterior acetabulum. Patient age, sagittal oblique angulation, axial oblique angulation, length of intraosseous trajectory, distance from the hip joint, thickness of the iliac bone cortex, and intervening structure(s) between the skin and the bone entry points were recorded. RESULTS The mean sagittal and axial oblique angulations were 34.2±4.5° and 31.5±6.7°, respectively, and mean length of the intraosseous trajectory was 11.8±0.9 cm. The axial oblique angle and length of the intraosseous trajectory were significantly lower in the female than the male population (p<0.05). None of the virtual trajectories traversed the hip joint. In 112/120 trajectories (93.3%), there were no cortical breaches in the iliac bones. In eight trajectories in four patients, the virtual trajectory crossed either the medial iliac cortex (4/120; 3.3%) or the medial iliac cortex and the iliacus muscle (4/120; 3.3%). CONCLUSION The anterosuperior iliac and ischial spines can be used safely and reliably as landmarks to perform the double oblique anterior approach.
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Affiliation(s)
- J Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de L'Hôpital, 67096 Cedex, Strasbourg, France; UMR 7357 CNRS, ICube, INSA Strasbourg, Université de Strasbourg, 67091, Strasbourg, France.
| | - P De Marini
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de L'Hôpital, 67096 Cedex, Strasbourg, France
| | - L Meylheuc
- UMR 7357 CNRS, ICube, INSA Strasbourg, Université de Strasbourg, 67091, Strasbourg, France
| | - D Dalili
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK; School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - R L Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de L'Hôpital, 67096 Cedex, Strasbourg, France
| | - B Bayle
- UMR 7357 CNRS, ICube, INSA Strasbourg, Université de Strasbourg, 67091, Strasbourg, France
| | - A Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil, 1, Place de L'Hôpital, 67096 Cedex, Strasbourg, France
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Gaullier M, Tricard T, Garnon J, Cazzato RL, Munier P, De Marini P, Werle P, Lindner V, Gangi A, Lang H. [Percutaneous MR-guided prostate cancer cryoablation: Predictive factors and oncologic outcomes]. Prog Urol 2019; 30:12-18. [PMID: 31837926 DOI: 10.1016/j.purol.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/31/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the pejorative predictive factors on oncologic outcomes of percutaneous MR-guided whole gland prostate cancer cryoablation (CA). METHODS Medical records of patients treated from 2009 to 2012, to assess medium-term oncologic outcomes, were reviewed. Prostate biopsies were performed in local recurrence suspicion (biochemical failure, MR follow-up failure). RESULTS Among 18 patients, mean age of 72.6 (61-78), 2 (11 %) and 7 (38.9 %) biological and reported biopsy-proven local recurrence respectively with our initial technic of CA. Mean follow-up and recurrence were 56.3 (±21.7) and 20.7 (±13.9) months respectively. A previous treatment of prostate cancer (P=0.5), pre-treatment PSA (P=0.2), pre-treatment Gleason/ISUP score (P=0.4), nadir PSA post-CA (P=0.22) were not associated with recurrence. Bilateral positive cores appears as a pejorative predictive factor (P=0.04). However mean pre-treatment positive cores percentage, 25 (±16.5) in responding patients versus 40.7 (±25.2) in case of recurrence, and maximum percentage of cancer extent in each positive core, 10.6 (±9.3) in responding patients versus 18.7 (±16.5) in case of recurrence, seemed associated with local recurrence after prostate CA but our analysis wasn't able to find a difference (P=0.09 and P=0.3 respectively) due to a lack of power. CONCLUSION Bilateral positive cores appears as a pejorative predictive factor. In our experience, important tumor volume seem to be a pejorative predictive factor for oncologic outcomes after PCA whereas treatment, PSA, Gleason/ISUP score, nadir PSA are not. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Gaullier
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - T Tricard
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - J Garnon
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - R-L Cazzato
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Munier
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P De Marini
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Werle
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - V Lindner
- Service d'anatomopathologie, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - A Gangi
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
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