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Braud A, Auloge P, Meyer N, Bouvrais C, Gharbi M, Lang H, Gangi A, Lipsker D. Neoadjuvant in Situ and Systemic Immunotherapy with Lymph Node Cryoablation in Resectable Stage III Melanoma Metastasis: a Proof-of-Concept Study. Cardiovasc Intervent Radiol 2024; 47:567-572. [PMID: 38570342 DOI: 10.1007/s00270-024-03699-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/27/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Complete lymph node dissection is the recommended treatment for clinically detectable lymph nodes in stage III melanoma. This surgery is associated with substantial morbidity. We hypothesize that combining percutaneous imaging-guided cryoablation of locoregional lymph nodes metastases with neoadjuvant in situ and systemic immunotherapy could allow disease control and evaluate the feasibility of this combination in this proof-of-concept study. METHODS We enrolled 15 patients with stage IIIB/IIIC melanoma. Patients were treated as follows: a single 240 mg flat dose infusion of nivolumab on day 1, cryoablation under local anesthesia using CT on day 2, and a single intralesional injection of 10-20 mg of ipilimumab into the lymphadenopathy treated by cryotherapy on day 3. Five-eight weeks after this procedure, complete lymph node dissection was performed according to routine care. The primary outcome measure of this study was feasibility, measured as the number of failures (i.e., inability to complete the entire procedure). RESULTS The procedure was carried out successfully in 15 out of 15 patients with an observed number of failures of 0. The Bayesian analysis showed an estimated failure rate of 4.2% [0.2-20.6]. Eight patients (53%) had adverse events secondary to either immunotherapy or cryotherapy. Grade 3/4 events occurred in three patients, but all resolved quickly and patients could proceed to surgery as scheduled. Eight patients (53%) had a pathological complete or near complete response. CONCLUSION Combining percutaneous cryotherapy with in situ ipilimumab and systemic nivolumab for stage III resectable melanoma is feasible with tolerable toxicity.
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Affiliation(s)
- Antoine Braud
- Dermatologic Clinic, University Hospital of Strasbourg, Strasbourg, France.
| | - Pierre Auloge
- Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Public Health Department, University Hospital of Strasbourg, Strasbourg, France
| | - Caroline Bouvrais
- Direction de la Recherche Clinique et de l'innovation (DRCI), University Hospital of Strasbourg, Strasbourg, France
| | - Mousselim Gharbi
- Department of Gynecology, University Hospital of Strasbourg, Strasbourg, France
| | - Hervé Lang
- Departments of Urology, University Hospital of Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Dan Lipsker
- Dermatologic Clinic, University Hospital of Strasbourg, Strasbourg, France
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Gowda PC, Dunlap RH, Ahlawat S, Gross JM, Morris CD, Lyons GR. Recurrent chondromyxoid fibroma of the distal femur treated with percutaneous cryoablation. Skeletal Radiol 2023; 52:2497-2501. [PMID: 37544967 DOI: 10.1007/s00256-023-04414-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Chondromyxoid fibroma is a rare, benign tumor of the bone with excellent prognosis but a high rate of recurrence. We report a patient presenting with pain and a history of chondromyxoid fibroma of the distal left femur previously treated with multiple prior curettage and bone graft procedures. Magnetic resonance imaging and histopathology indicated a recurrence of tumor. Due to the small size of the tumor recurrence and challenges associated with prior open surgery, the patient underwent cryoablation of the lesion with computed tomography guidance. Follow-up 18 months later indicated a resolution of pain and improvement on magnetic resonance imaging, and no concerns after 20 months. To our knowledge, this is the first reported case of chondromyxoid fibroma treated with cryoablation. This case suggests cryoablation could be considered in the setting of recurrent chondromyxoid fibroma for local tumor control.
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Affiliation(s)
- Prateek C Gowda
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Robert H Dunlap
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shivani Ahlawat
- Division of Musculoskeletal Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Gray R Lyons
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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Jouffrieau C, Cazzato RL, Gabriele V, Faller E, Weiss J, Host A, Garnon J, Garbin O, Gangi A. Percutaneous Imaging-guided Cryoablation of Endometriosis Scars of the Anterior Abdominal Wall. J Minim Invasive Gynecol 2023; 30:890-896. [PMID: 37422051 DOI: 10.1016/j.jmig.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 05/16/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE To evaluate the safety and clinical efficacy of percutaneous imaging-guided cryoablation for the management of anterior abdominal wall endometriosis. DESIGN Patients with abdominal wall endometriosis underwent percutaneous imaging-guided cryoablation and had a 6-month follow-up. SETTING Data dealing with patients' and anterior abdominal wall endometriosis (AAWE) characteristics, cryoablation, and clinical and radiologic outcomes were retrospectively collected and analyzed. PATIENTS Twenty-nine consecutive patients underwent cryoablation from June 2020 to September 2022. INTERVENTIONS Interventions were performed under US/computed tomography (CT) guidance or magnetic resonance imaging (MRI) guidance. Cryoprobes were directly inserted into the AAWE, and cryoablation was performed with a single 5 to 10 minute freezing cycle, which was stopped when the iceball expanded 3 to 5 mm beyond AAWE borders as assessed on intra-procedural cross-sectional imaging. MEASUREMENTS AND MAIN RESULTS Fifteen patients (15/29; 51.7%) had prior endometriosis, 28 (28/29; 95.5%) had previous cesarian section, and 22 (22/29; 75.9%) referred association between symptoms and menses. Cryoablation was performed under local (16/29; 55.2%) or general anesthesia (13/29; 44.8%) and mainly in an out-patient basis (18/20; 62%). There was only one (1/29; 3.5%) minor procedure-related complication. Complete symptom relief was recorded in 62.1% (18/29) and 72.4% (21/29) patients at 1 and 6 months, respectively. In the whole population, pain significantly dropped at 6 months compared to the baseline (1.1 ± 2.3; range 0-8 vs 7.1 ± 1.9; range 3-10; p <.05). Eight (8/29; 27.6%) patients presented residual symptoms at 6 months, and 4 (4/29; 13.8%) had an MRI-confirmed residual/recurring disease. Contrast-enhanced MRI obtained for the first 14 (14/29; 48.3%) patients of the series, all without signs of residual/recurring disease, demonstrated a significantly smaller ablation area compared to the baseline volume of the AAWE (1.0 cm3 ± 1.4; range 0-4.7; vs 11.1 ± 9.9 cm3; range 0.6-36.4; p <.05). CONCLUSION Percutaneous imaging-guided cryoablation of AAWE is safe and clinically effective in achieving pain relief.
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Affiliation(s)
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Victor Gabriele
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Emilie Faller
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julia Weiss
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Aline Host
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Julien Garnon
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
| | - Olivier Garbin
- Gynecology Unit, CMCO (Drs. Jouffrieau, Gabriele, Faller, Host, and Garbin)
| | - Afshin Gangi
- Department of Interventional Radiology (Drs. Cazzato, Weiss, Garnon, and Gangi), University Hospital of Strasbourg, Strasbourg, France
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de Jager NS, van Oostenbrugge TJ, Pätz T, Jenniskens SFM, Fütterer JJ, Langenhuijsen JF, Overduin CG. Intraoperative MRI-derived volumetric ablation margins and initial correlation with local outcome after MRI-guided cryoablation of renal tumors. Cancer Imaging 2023; 23:31. [PMID: 36998028 PMCID: PMC10064595 DOI: 10.1186/s40644-023-00546-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE To assess volumetric ablation margins derived from intraoperative pre- and post-ablation MRI after magnetic resonance imaging (MRI)-guided percutaneous cryoablation of renal tumors and explore its correlation with local treatment success. METHODS Retrospective analysis was performed on 30 patients (mean age 69y) who underwent percutaneous MRI-guided cryoablation between May 2014 and May 2020 for 32 renal tumors (size: 1.6-5.1 cm). Tumor and ice-ball volumes were segmented on intraprocedural pre- and post-ablation MR images using Software Assistant for Interventional Radiology (SAFIR) software. After MRI-MRI co-registration, the software automatically quantified the minimal treatment margin (MTM),defined as the smallest 3D distance between the tumor and ice-ball surface. Local tumor progression (LTP) after cryoablation was assessed on follow-up imaging. RESULTS Median follow-up was 16 months (range: 1-58). Local control after cryoablation was achieved in 26 cases (81%) while LTP occurred in 6 (19%). The intended MTM of ≥5 mm was achieved in 3/32 (9%) cases. Median MTM was significantly smaller for cases with (- 7 mm; IQR:-10 to - 5) vs. without LTP (3 mm; IQR:2 to 4) (P < .001). All cases of LTP had a negative MTM. All negative treatment margins occurred in tumors > 3 cm. CONCLUSIONS Determination of volumetric ablation margins from intraoperative MRI was feasible and may be useful in predicting local outcome after MRI-guided renal cryoablation. In our preliminary data, an intraoperative MRI-derived minimal margin extending at least 1 mm beyond the MRI-visible tumor led to local control and this was more difficult to achieve in tumors > 3 cm. Ultimately, online margin analysis may be a valuable tool to intraoperatively assess therapy success, but larger prospective studies are needed to establish a reliable threshold for clinical use.
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Affiliation(s)
- Nienke S de Jager
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Tim J van Oostenbrugge
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Torben Pätz
- Fraunhofer Institute for Digital Medicine, Max-von-Laue-Str. 2, 28359, Bremen, Germany
| | - Sjoerd F M Jenniskens
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands
| | - Johan F Langenhuijsen
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands
| | - Christiaan G Overduin
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, P.O. Box 9101, 6525, Nijmegen, GA, Netherlands.
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Shimizu K, Enoki K, Kameoka Y, Motohashi K, Yanagisawa T, Miki J, Baba A, Sekiguchi H, Sadaoka S. Image-guided percutaneous cryoablation of T1b renal cell carcinomas in patients with comorbidities. Jpn J Radiol 2021; 39:1213-1222. [PMID: 34228240 DOI: 10.1007/s11604-021-01168-8] [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: 12/20/2020] [Accepted: 06/29/2021] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the influence of comorbidities and tumor characteristics on outcomes following percutaneous cryoablation (PCA) of T1b renal cell carcinoma (RCC). MATERIALS AND METHODS Age-adjusted Charlson comorbidity index (ACCI); standardized system for quantitating renal tumor size, location, and depth (RENAL nephrometry score [RNS]); and local tumor control and survival were retrospectively investigated in 28 patients who underwent PCA for stage T1b RCC. Risk factors for elevated serum creatinine levels were also investigated. RESULTS Complete ablation was obtained in 27 of 28 patients. Two cases of metastasis were observed; one patient died 12 months after PCA. Overall survival at 5 years was 79.1%, with a mean follow-up of 42.0 ± 16.0 months. Local tumor control was not correlated with the ACCI and RNS. Worsening renal function 3 months after PCA was observed in ten patients, and it correlated with the presence of single kidneys (7/28 patients; p = 0.023). Significant worsening of renal function continued until 1 year after PCA (p = 0.013). Having a single kidney was a risk factor for worsened renal function after PCA (odds ratio, 8.00; 95% confidence interval 1.170-54.724). CONCLUSION PCA for T1b RCC confers positive local tumor control regardless of comorbidities and tumor characteristics.
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Affiliation(s)
- Kanichiro Shimizu
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan.
| | - Keitaro Enoki
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Yoshihiko Kameoka
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Kenji Motohashi
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita 163-1, Kashiwa-shi, Chiba, Japan
| | - Jun Miki
- Department of Urology, Kashiwa Hospital, The Jikei University School of Medicine, Kashiwashita 163-1, Kashiwa-shi, Chiba, Japan
| | - Akira Baba
- Department of Radiology, Jikei University School of Medicine, Nishisinnbashi 3-19-1, Minato-ku, Tokyo, Japan
| | - Huruki Sekiguchi
- Department of Cardiology, Tokyo Women's Medical University Hospital, Kawada-cho 8-1, Shinjuku-ku, Tokyo, Japan
| | - Shunichi Sadaoka
- Department of Radiology, Kashiwa Hospital, The Jikei University School of Medicine, Jikei University, Kashiwashita 163-1, Kashiwa-shi, Chiba, 277-8567, Japan
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Yanagisawa T, Miki J, Shimizu K, Fukuokaya W, Urabe F, Mori K, Sasaki H, Kimura T, Miki K, Egawa S. Functional and oncological outcome of percutaneous cryoablation versus laparoscopic partial nephrectomy for clinical T1 renal tumors: A propensity score-matched analysis. Urol Oncol 2020; 38:938.e1-938.e7. [PMID: 33036899 DOI: 10.1016/j.urolonc.2020.09.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 04/02/2020] [Revised: 08/07/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the clinical trifecta of percutaneous cryoablation (PCA) vs. laparoscopic partial nephrectomy (LPN) for cT1 renal tumors. PATIENTS AND METHODS We retrospectively analyzed the records of patients who had undergone 2 types of nephron sparing surgeries (NSS) PCA or LPN for cT1 renal tumors between November 2011 and December 2019. The cohorts were matched by one-to-one propensity scores based on patient demographics, renal function, and tumor complexity. Perioperative and oncological outcomes and preservation of renal function following surgery were compared. RESULTS After matching, a total of 180 patients who had undergone NSS for de novo renal tumors were evaluable: 90 for PCA and 90 for LPN. No statistically significant differences were noted among the measured baseline characteristics in the propensity score-matched cohorts. Overall perioperative complication rates were 5.5% in the PCA and 11.1% in the LPN groups (P = 0.28). The rate of eGFR preservation 1 to 3 months after surgery was significantly higher for PCA than for LPN (92.8 ± 11.5% vs. 88.5 ± 14.6%, P = 0.03). Median follow-up was 33 months for PCA and 18 months for LPN (P < 0.001). Three residual and 4 recurrent tumors were later diagnosed in the PCA group and 1 recurrent tumor in the LPN group. The 5-year local recurrence-free survival was lower for PCA than LPN (90.2% vs. 98.5%, P = 0.36). The 5-year metastasis-free survival rate was similar in both groups (98.4% vs. 100%, P = 0.38). The 5-year overall and cancer-specific survival rates were comparable in both groups (91.7% vs. 98.9%, P = 0.53, and 95% vs. 100%, P = 0.55, respectively). CONCLUSIONS Clinical T1 RCC patients are better treated with LPN if technically possible. Though PCA had a higher local recurrence rate, medium-term local control was not inferior to LPN. Additionally, PCA patients tended to retain renal function without severe complications. PCA appears to be a reasonable option for patients with high comorbidity at presentation.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kanichiro Shimizu
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroshi Sasaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenta Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Liu HY, Shen SH, Hsu LN, Chiang PH. Comparisons of percutaneous versus retroperitoneoscopic cryoablation for renal masses. Int Urol Nephrol 2018; 50:1407-15. [PMID: 30022280 DOI: 10.1007/s11255-018-1925-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Preserving renal function and controlling oncological outcomes are pertinent while managing renal tumours. We compared outcomes of percutaneous cryoablation (PCA) and retroperitoneoscopic cryoablation (RCA) in patients with renal neoplasms. METHODS We identified 108 patients with renal tumours at two medical centres, where 63 patients received PCA and 45 patients underwent RCA from August 2009 to July 2015, and they were followed up until February 2017. We compared preoperative and postoperative parameters, namely gender, systemic diseases, age, American Society of Anesthesiologists score, body mass index (BMI), haemoglobin, the estimated glomerular filtration rate, tumour size, operative time, tumour type, Clavien-Dindo classification of surgical complications, and tumour recurrence, by using an independent sample t test, Pearson's Chi-square test, Fisher's exact test, a Mann-Whitney test, and a generalised linear model. RESULTS Based on baseline characteristics, we found that the patients in the PCA group were older and had higher BMI than those in the RCA group, whereas the patients in the RCA group had more comorbidities than those in the PCA group. Retroperitoneoscopic and percutaneous methods had similar operative times, blood transfusion rates, postoperative fever episodes, and complication rates for either minor or major complications. However, the percutaneous method was associated with a shorter length of stay. No patient experienced deterioration in renal function until 2 years after both procedures. Impaired renal function was found in both groups in the 3-year follow-up. In both groups, tumour recurrence was significant for tumours > 4 cm. CONCLUSIONS Our results confirm that both cryoablation methods (PCA and RCA) are safe and effective for renal cell carcinoma. Favourable oncological control was achieved in both groups if the renal tumour size was ≤ 4 cm.
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Lin M, Liang SZ, Wang XH, Liang YQ, Zhang MJ, Niu LZ, Chen JB, Li HB, Xu KC. Clinical efficacy of percutaneous cryoablation combined with allogenic NK cell immunotherapy for advanced non-small cell lung cancer. Immunol Res. 2017;65:880-887. [PMID: 28508945 DOI: 10.1007/s12026-017-8927-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this study, the safety and clinical efficacy of cryosurgery combined with allogenic NK cell immunotherapy for the treatment of advanced non-small cell lung cancer (NSCLC) were evaluated. From July 2016 to March 2017, we enrolled 60 patients who met the enrollment criteria and divided them into two groups: (1) the simple cryoablation group (n = 30) and (2) the cryoablation combined with allogenic NK cell group (n = 30). The changes in immune function, quality of life, and clinical response were evaluated. We found that allogenic NK cells combined with cryosurgical treatment for advanced NSCLC have a synergistic effect, which not only enhancing the immune function of patients, improving the quality of life, and significantly increasing the response rate (RR) and disease control rate (DCR) compared to cryoablation group. This study is the first clinical trial of allogenic NK cells combined with cryosurgery for the treatment of advanced NSCLC and preliminaily its safety and efficacy.
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Bhindi B, Mason RJ, Haddad MM, Boorjian SA, Leibovich BC, Atwell TD, Weisbrod AJ, Schmit GD, Thompson RH. Outcomes After Cryoablation Versus Partial Nephrectomy for Sporadic Renal Tumors in a Solitary Kidney: A Propensity Score Analysis. Eur Urol 2017; 73:254-259. [PMID: 28967553 DOI: 10.1016/j.eururo.2017.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 05/18/2017] [Accepted: 09/07/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND While partial nephrectomy (PN) is considered the standard approach for a tumor in a solitary kidney, percutaneous cryoablation (PCA) is emerging as an alternative nephron-sparing option. OBJECTIVE To compare outcomes between PCA and PN for tumors in a solitary kidney. DESIGN, SETTING, AND PARTICIPANTS Patients who underwent PCA or PN between 2005 and 2015 for a single primary renal tumor in a solitary kidney were identified using Mayo Clinic Registries. Exclusion criteria were inherited tumor syndromes and salvage procedures. INTERVENTION PCA and PN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To achieve balance in baseline characteristics, we used inverse probability of treatment weighting (IPTW) based on propensity to receive treatment. The risk of having a post-treatment complication and percent drop in estimated glomerular filtration rate (eGFR), as well as the risks of local/ipsilateral recurrence, distant metastasis, and cancer-specific mortality, were compared between groups using logistic, linear, and Fine-and-Gray competing risk regression models. RESULTS AND LIMITATIONS The cohort included 118 patients (PCA: 54; PN: 64) with a median follow-up of 47 mo (interquartile range 18, 74). In unadjusted analyses, PCA was associated with a lower risk of complications (15% vs 31%; odds ratio [OR]=0.38; 95% confidence interval [CI] 0.15, 0.96; p=0.04). However, upon accounting for baseline differences with IPTW adjustment, there was no longer a significant difference in the risk of complications (28% vs 29%; OR=0.95; 95% CI 0.53, 1.69; p=0.9). There were no significant differences between PCA and PN in percentage drop in eGFR at discharge (mean: 11% vs 16%; β=-5%; 95% CI -13, 3; p=0.2) or at 3 mo (12% vs 9%; β=3%; 95% CI -3, 10; p=0.3). Likewise, no significant differences were noted in local recurrence (HR=0.87; 95% CI 0.38, 1.98; p=0.7), distant metastases (HR=0.60; 95% CI 0.30, 1.20; p=0.2), or cancer-specific mortality (HR=1.13; 95% CI 0.32, 3.98; p=0.8). Limitations include the sample size, given the relative rarity of renal masses in solitary kidneys. CONCLUSIONS Our study found no significant difference in complications, renal function outcomes, and oncologic outcomes between PN and PCA for patients with a tumor in a solitary kidney. Validation in a larger multi-institutional analysis may be warranted. PATIENT SUMMARY Partial nephrectomy (surgery) and percutaneous cryoablation are both options for treating a kidney tumor while preserving the normal portion of the kidney. In patients with a tumor in their only kidney, we found no difference in the risk of complications, kidney function outcomes, or cancer control outcomes between these two approaches.
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Affiliation(s)
- Bimal Bhindi
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Ross J Mason
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | - Grant D Schmit
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Lin M, Xu K, Liang S, Wang X, Liang Y, Zhang M, Chen J, Niu L. Prospective study of percutaneous cryoablation combined with allogenic NK cell immunotherapy for advanced renal cell cancer. Immunol Lett 2017; 184:98-104. [PMID: 28274792 DOI: 10.1016/j.imlet.2017.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 03/02/2017] [Accepted: 03/03/2017] [Indexed: 11/23/2022]
Abstract
In this study, the clinical efficacy of cryosurgery combined with allogenic NK cell immunotherapy for advanced renal cell cancer was evaluated. From July to December 2016, we enrolled 60 patients who met the enrollment criteria and divided them into two groups: (1) the simple cryoablation group (n=30); and (2) the cryoablation combined with allogenic NK cells group (n=30). The clinical efficacy, quality of life, immune function, and other related indicators were evaluated. Combining allogeneic NK cells with cryoablation had a synergistic effect, not only enhancing the immune function and improving the quality of life of the patients, but also significantly exhibiting good clinical efficacy of the patients. This study is the first clinical trial that has evaluated the safety and efficacy of allogenic NK cells combined with cryosurgery for the treatment of renal cell cancer.
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Mavrovi E, Vaz G, Thiesse P, Richioud B. Percutaneous cryoablation: A promising treatment for peripheral schwannoma. Diagn Interv Imaging 2016; 97:923-5. [PMID: 27316572 DOI: 10.1016/j.diii.2016.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Affiliation(s)
- E Mavrovi
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France.
| | - G Vaz
- Department of Oncologic Surgery, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - P Thiesse
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - B Richioud
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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Alnaggar M, Niu L, Li J, Yao F, Wang Y, Zeng J, Ye J, Chen J, Mu F, Xu K. Cryoprotective therapy for huge hepatocellular carcinoma: a study of 14 patients with a single lesion. Cryobiology 2014; 69:457-61. [PMID: 25445461 DOI: 10.1016/j.cryobiol.2014.10.004] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/03/2014] [Accepted: 10/07/2014] [Indexed: 02/07/2023]
Abstract
Percutaneous cryoablation is a potential cure for hepatocellular carcinoma (HCC). This study reviewed retrospectively clinical data from 14 patients who underwent cryoablation of huge HCC (long diameter >7 cm). The side effects of cryosurgeries and liver function reverse were recorded and compared everyday. All the patients survived cryosurgery and none died before leaving hospital 2 weeks later. Despite liver-protective treatment before cryosurgery, alanine transaminase (ALT) and aspartate transaminase (AST) levels were increased significantly, but returned to preoperative levels 2 weeks post-cryosurgery. Before cryosurgery, mean total bilirubin (T.BIL) and direct bilirubin (D.BIL) levels were normal; 8-10 days after cryosurgery, they increased more than two-fold, but returned to the preoperative level 2 weeks post-cryosurgery. Serum transaminase and bilirubin levels were compared between hepatitis B positive and negative patients. The hepatitis B negative group's AST level increased significantly 1 day post-cryosurgery (mean, 186 U/L) and decreased to the preoperative level at day 14. In the hepatitis B positive group, means transaminase and bilirubin reached peak values at different days post-cryosurgery. Overall, ALT and AST are valuable indicators of liver function impairment following cryosurgery. In patients with hepatitis B virus, close attention to the serum bilirubin level should be paid 8-10 days after cryosurgery. Liver-protective treatment may alleviate liver function impairment caused by cryosurgery of huge HCC.
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Affiliation(s)
- Mohammed Alnaggar
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 of JieFang Road, Wuhan 430032, China
| | - Lizhi Niu
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jialiang Li
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Fei Yao
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Yuan Wang
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jianying Zeng
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Jin Ye
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 of JieFang Road, Wuhan 430032, China
| | - Jibing Chen
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Feng Mu
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Kecheng Xu
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
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Ali AMA, Lizhi N, Jialiang L, Fei Y, Yuan W, Jianying Z, Jin Y, Jibing C, Feng M, Kecheng X. Cryoprotective therapy for hepatocellular carcinoma: study of 51 patients with a single lesion. Cryobiology 2014; 69:61-7. [PMID: 24859156 DOI: 10.1016/j.cryobiol.2014.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 01/25/2014] [Revised: 02/27/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023]
Abstract
Percutaneous cryoablation is a potentially curative treatment for hepatocellular carcinoma (HCC). After liver cryosurgery, rapid elevations of transaminases and bilirubin are common, but are usually transient and normalize within a few days. This study retrospectively reviewed clinical data from 51 patients who underwent liver cryoablation in our hospital during the past 4.5 years. Sixty-six percutaneous cryoablations were performed in these patients and transaminase and bilirubin levels before and after the procedure were observed. Although most patients received liver-protective treatment before cryosurgery, transaminase levels were double (mean alanine transaminase (ALT) and aspartate transaminase (AST) were 71 U/L and 85 U/L, respectively) the normal ranges in our hospital. One day after cryosurgery, ALT and AST had increased 3.3-fold (peak mean was 241 U/L) and 5-fold (peak mean was 427 U/L), respectively, but were close to the preoperative level 5 days post-cryosurgery. No significant increase of serum bilirubin was observed. Serum transaminase and bilirubin levels were compared between hepatitis B positive and hepatitis B negative patients. Only in the hepatitis B positive group were total bilirubin (74 μmol/L/23 μmol/L=3.2) and direct bilirubin (45 μmol/L/12 μmol/L=3.8) more than 3 times the preoperative level 7-9 days after treatment. Overall, ALT and AST are valuable as indicators of liver function impairment following cryosurgery. In patients with hepatitis B virus, serum bilirubin was 3 times the preoperative level 7-9 days after cryosurgery. Liver-protective treatment may alleviate liver function impairment due to cryosurgery.
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Affiliation(s)
- Alnaggar Mohammed Abdulatef Ali
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 of JieFang Road, Wuhan 430032, China
| | - Niu Lizhi
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Li Jialiang
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Yao Fei
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Wang Yuan
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Zeng Jianying
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Ye Jin
- Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1277 of JieFang Road, Wuhan 430032, China
| | - Chen Jibing
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Mu Feng
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Xu Kecheng
- Fuda Cancer Hospital, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
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Liang Z, Fei Y, Lizhi N, Jianying Z, Zhikai Z, Jibing C, Jialiang L, Kecheng X. Percutaneous cryotherapy for metastatic bladder cancer: experience with 23 patients. Cryobiology 2013; 68:79-83. [PMID: 24368268 DOI: 10.1016/j.cryobiol.2013.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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: 08/08/2013] [Revised: 11/06/2013] [Accepted: 12/16/2013] [Indexed: 12/31/2022]
Abstract
Bladder cancer is the most common malignancy of the urinary tract and in many patients is metastatic at diagnosis. Chemotherapy is the standard treatment for these patients but has serious side effects and in many patients is not tolerated. To avoid the side effects of systemic chemotherapy, patients with late stage bladder cancer have sought cryotherapy in our hospital. We reviewed data for the past 4 years to evaluate the safety and efficiency of percutaneous cryotherapy in 23 patients. Within 3 days after cryosurgery, all complications of bladder cancer (e.g. hematuria, urinary irritation, hypogastralgia, lumbago) had decreased to some degree. No new complications (e.g. bladder perforation) occurred and all complications had disappeared completely after 2 weeks. The progression-free survival (PFS) of these patients was 14 ± 8 months. There was no effect on PFS of tumor location or histopathology; however, differentiation status and tumor size influenced the therapeutic effect of percutaneous cryoablation. In conclusion, percutaneous cryotherapy may be a safe and efficacious therapeutic option in the treatment of metastatic bladder cancer.
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Affiliation(s)
- Zhou Liang
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Lung Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Yao Fei
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Niu Lizhi
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Lung Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Zeng Jianying
- Fuda Institute of Lung Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Zhang Zhikai
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
| | - Chen Jibing
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Lung Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Li Jialiang
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China.
| | - Xu Kecheng
- Fuda Cancer Hospital, Jinan University School of Medicine, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China; Fuda Institute of Cryosurgery for Cancer, No. 2 Tangdexi Road, Tianhe District, Guangzhou 510665, China
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