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Nishiofuku H, Oshima K, Toyoda S, Umeoka K, Matsuzawa M, Yamanaka N, Nakahama A, Matsumoto T, Kido A, Shinomiya T, Tanaka T. Palliative Radiofrequency Ablation Therapy for Intractable Cancer-Related Pain Due to Malignant Psoas Syndrome: Case Report. J Palliat Med 2024; 27:283-287. [PMID: 37768841 DOI: 10.1089/jpm.2023.0066] [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] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Uncontrollable cancer pain is a highly feared and debilitating symptom. The effectiveness of radiofrequency ablation (RFA) for osseous metastases with intractable cancer-related pain refractory to pharmacological therapy has been reported previously. This case report is the first to demonstrate the use of RFA to achieve pain relief in a patient suffering severe pain caused by para-aortic lymph node metastasis. A 55-year-old male complained of intractable pain in the left groin and perineum due to malignant psoas syndrome caused by metastatic para-aortic lymph nodes. The pain was refractory to medications including opioids and nerve blocks. Considering the dermatome indicating referred pain and the imaging findings, RFA of the area of invasion was performed at the L3 level. The severe pain was relieved within 24 hours without any complications. Opioids were tapered at each postoperative outpatient visit. We discuss the use of RFA for control of intractable cancer-related pain refractory to medication, including opioids.
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Affiliation(s)
- Hideyuki Nishiofuku
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
- Department of Palliative Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Keisuke Oshima
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
| | - Shohei Toyoda
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
| | - Kyoko Umeoka
- Department of Palliative Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Miyuki Matsuzawa
- Department of Palliative Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Nobuki Yamanaka
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Aya Nakahama
- Department of Palliative Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Takeshi Matsumoto
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Toshiaki Shinomiya
- Department of Palliative Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, Kashihara, Japan
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Ikuta S, Nakajima T, Aihara T, Fujikawa M, Yamanaka N. A Liver-First Approach Using Ablation for Oligometastatic Pancreatic Cancer: A Report of a Successful Case. Cureus 2023; 15:e46671. [PMID: 37942384 PMCID: PMC10628600 DOI: 10.7759/cureus.46671] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2023] [Indexed: 11/10/2023] Open
Abstract
Pancreatic cancer (PC) is a highly aggressive malignancy, often accompanied by liver metastases as a common manifestation. While palliative chemotherapy remains the mainstay treatment for liver metastatic PC, local treatment approaches have gained attention, especially for patients with oligometastasis who exhibit a positive response to chemotherapy. This case report illustrates the successful application of a liver-first strategy in a 79-year-old male diagnosed with liver oligometastatic PC, originating in the pancreatic tail. The strategy encompassed percutaneous microwave ablation for liver metastases, followed by FOLFIRINOX (5-fluorouracil, folic acid, irinotecan, and oxaliplatin) chemotherapy, and subsequent primary tumor resection. The patient has remained disease-free for over a year post-surgery. This multidisciplinary approach may hold promise for selected patients with liver oligometastatic PC, although further research and case studies are needed for comprehensive evaluation.
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3
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Kravitz S, Kipp J, Gallagher A. Sclerotherapy and its complications: a literature review and a case report. J Wound Care 2023; 32:S16-S20. [PMID: 37682798 DOI: 10.12968/jowc.2023.32.sup9.s16] [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] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Hard-to-heal or recurrent leg ulcers can have multiple aetiologies. One of these is incompetent veins. The main focus of this article is to discuss the common treatment for venous leg ulcers with the use of sclerotherapy. This simple surgical procedure obliterates smaller veins and telangiectasia. Veins with larger diameters (varicosities) can be treated with ablation therapy. The intent of sclerosis or ablation therapy is to destroy the incompetent veins and allow the collateral circulation to improve venous return, decreasing venous hypertension, which then enhances skin closure, wound healing and the resolution of the ulcer.
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Affiliation(s)
- Steven Kravitz
- Temple University School of Podiatric Medicine, Philadelphia, PA, US
| | - Jennifer Kipp
- Temple University School of Podiatric Medicine, Philadelphia, PA, US
| | - Amanda Gallagher
- Temple University School of Podiatric Medicine, Philadelphia, PA, US
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4
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Parra-Lucares A, Villa E, Romero-Hernández E, Méndez-Valdés G, Retamal C, Vizcarra G, Henríquez I, Maldonado-Morales EAJ, Grant-Palza JH, Ruíz-Tagle S, Estrada-Bobadilla V, Toro L. Tic-Tac: A Translational Approach in Mechanisms Associated with Irregular Heartbeat and Sinus Rhythm Restoration in Atrial Fibrillation Patients. Int J Mol Sci 2023; 24:12859. [PMID: 37629037 PMCID: PMC10454641 DOI: 10.3390/ijms241612859] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Atrial fibrillation (AF) is a prevalent cardiac condition predominantly affecting older adults, characterized by irregular heartbeat rhythm. The condition often leads to significant disability and increased mortality rates. Traditionally, two therapeutic strategies have been employed for its treatment: heart rate control and rhythm control. Recent clinical studies have emphasized the critical role of early restoration of sinus rhythm in improving patient outcomes. The persistence of the irregular rhythm allows for the progression and structural remodeling of the atria, eventually leading to irreversible stages, as observed clinically when AF becomes permanent. Cardioversion to sinus rhythm alters this progression pattern through mechanisms that are still being studied. In this review, we provide an in-depth analysis of the pathophysiological mechanisms responsible for maintaining AF and how they are modified during sinus rhythm restoration using existing therapeutic strategies at different stages of clinical investigation. Moreover, we explore potential future therapeutic approaches, including the promising prospect of gene therapy.
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Affiliation(s)
- Alfredo Parra-Lucares
- Critical Care Unit, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Cardiovascular Department, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Eduardo Villa
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Gabriel Méndez-Valdés
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Catalina Retamal
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Geovana Vizcarra
- Division of Internal Medicine, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
| | - Ignacio Henríquez
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Juan H. Grant-Palza
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | - Sofía Ruíz-Tagle
- School of Medicine, Faculty of Medicine, Universidad de Chile, Santiago 8380420, Chile
| | | | - Luis Toro
- Division of Nephrology, Department of Medicine, Hospital Clínico Universidad de Chile, Santiago 8380420, Chile
- Centro de Investigación Clínica Avanzada, Hospital Clínico, Universidad de Chile, Santiago 8380420, Chile
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Umakoshi N, Matsui Y, Tomita K, Uka M, Kawabata T, Iguchi T, Hiraki T. Image-Guided Ablation Therapies for Extrahepatic Metastases from Hepatocellular Carcinoma: A Review. Cancers (Basel) 2023; 15:3665. [PMID: 37509326 PMCID: PMC10378118 DOI: 10.3390/cancers15143665] [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: 06/13/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The most common sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, intra-abdominal lymph nodes, bones, and adrenal glands, in that order. Although systemic therapies are a common treatment for patients with extrahepatic metastases, local ablative therapies for the extrahepatic metastatic lesions can be performed in selected patients. In this article, the literature on image-guided thermal ablation for metastasis to each organ was reviewed to summarize the current evidence. Radiofrequency ablation was the most commonly evaluated technique, and microwave ablation, cryoablation, and percutaneous ethanol injection were also utilized. The local control rate of thermal ablation therapy was relatively favorable, at approximately 70-90% in various organs. The survival outcomes varied among the studies, and several studies reported that the absence of viable intrahepatic lesions was associated with improved survival rates. Since only retrospective data from relatively small studies has been available thus far, more robust studies with prospective designs and larger cohorts are desired to prove the usefulness of thermal ablation for extrahepatic metastases from HCC.
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Affiliation(s)
- Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Okayama University Graduate School of Health Science, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kitaku, Okayama 700-8558, Japan
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6
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Baqal O, El Masry HZ. Ablative Management of Persistent Atrial Fibrillation (PeAF) with Posterior Wall Isolation (PWI): Where Do We Stand? J Cardiovasc Dev Dis 2023; 10:273. [PMID: 37504529 PMCID: PMC10380213 DOI: 10.3390/jcdd10070273] [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: 05/31/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Atrial fibrillation is a diverse clinical entity, with persistent atrial fibrillation (PeAF) being particularly challenging to manage. Through this paper, we discuss notable developments in our understanding of ablative strategies for managing PeAF, with a special focus on posterior wall isolation (PWI).
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Affiliation(s)
- Omar Baqal
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Hicham Z El Masry
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
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Abdelkader A, Abdelkhalek R, Hosny H, Emara MH, Elshamy M. Bacterial infections and fever after hepatocellular carcinoma ablation therapy: Predictive role of procalcitonin. Clin Exp Hepatol 2023; 9:122-128. [PMID: 37502430 PMCID: PMC10369656 DOI: 10.5114/ceh.2023.127400] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
Aim of the study Hepatocellular carcinoma (HCC) is a leading cause of mortality among patients with liver cirrhosis. According to the current practice guidelines, different ablations are used either as curative or palliative therapies. The current study aimed at determining bacterial infections as causes of fever and the predictive role of procalcitonin (PCT) among patients with HCC who had ablation therapy. Material and methods This cross sectional study was carried out on 100 patients with HCC during the period from November 2019 to December 2021. All patients were evaluated by full history taking, clinical examination, complete blood picture (CBC), liver biochemistry, coagulation profile, kidney function, C-reactive protein (CRP), serum PCT and blood cultures. All were done for all participants at the 4th day follow-up after the procedures of ablation. HCC was treated according to the guidelines. Results The frequency of fever after HCC ablation was 64% with variable intensities. Bacterial cultures were positive in 20 patients (20%). Twenty-four out of 100 patients had abnormally high PCT level. There was a highly statistically significant increase of PCT level in patients with a high CRP count and positive blood culture, p < 0.05. There was a statistically significant correlation between increased levels of PCT and levels of CRP, WBCs, albumin, AST, ALT, degree of fever, creatinine and BUN. Conclusions Bacterial infection accounts for 20% of fever among HCC patients after ablation therapy. PCT is 100% sensitive and specific for detection of the bacterial causes of fever among those patients.
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Affiliation(s)
| | | | - Hanaa Hosny
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H. Emara
- Faculty of Medicine, Kafrelsheikh University, Kafr El-Shikh, Egypt
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Rahbar Kouibaran F, Sabatino M, Barozzi C, Diemberger I. Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria. Int J Mol Sci 2023; 24:ijms24076470. [PMID: 37047444 PMCID: PMC10095038 DOI: 10.3390/ijms24076470] [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: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
ANP is mainly synthesized by the atria, and upon excretion, it serves two primary purposes: vasodilation and increasing the renal excretion of sodium and water. The understanding of ANP's role in cardiac systems has improved considerably in recent decades. This review focuses on several studies demonstrating the importance of analyzing the regulations between the endocrine and mechanical function of the heart and emphasizes the effect of ANP, as the primary hormone of the atria, on atrial fibrillation (AF) and related diseases. The review first discusses the available data on the diagnostic and therapeutic applications of ANP and then explains effect of ANP on heart failure (HF) and atrial fibrillation (AF) and vice versa, where tracking ANP levels could lead to understanding the pathophysiological mechanisms operating in these diseases. Second, it focuses on conventional treatments for AF, such as cardioversion and catheter ablation, and their effects on cardiac endocrine and mechanical function. Finally, it provides a point of view about the delayed recovery of cardiac mechanical and endocrine function after cardioversion, which can contribute to the occurrence of acute heart failure, and the potential impact of restoration of the sinus rhythm by extensive ablation or surgery in losing ANP-producing sites. Overall, ANP plays a key role in heart failure through its effects on vasodilation and natriuresis, leading to a decrease in the activity of the renin-angiotensin-aldosterone system, but it is crucial to understand the intimate role of ANP in HF and AF to improve their diagnosis and personalizing the patients' treatment.
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Affiliation(s)
| | - Mario Sabatino
- Unit of Heart Failure and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Chiara Barozzi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Unit of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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9
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Beyna T. Performing Barrett's ablation: Tips and Tricks. Gastrointest Endosc 2023; 97:1137-1143. [PMID: 36716895 DOI: 10.1016/j.gie.2023.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Torsten Beyna
- Department of General Internal Medicine and Gastroenterology, Evangelisches Krankenhaus Düsseldorf, Germany.
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10
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Numakura K, Nakai Y, Kojima T, Osawa T, Narita S, Nakayama M, Kitamura H, Nishiyama H, Shinohara N. Overview of clinical management for older patients with renal cell carcinoma. Jpn J Clin Oncol 2022; 52:665-681. [PMID: 35397166 DOI: 10.1093/jjco/hyac047] [Citation(s) in RCA: 2] [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: 11/24/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
The rapidly increasing pool of older patients being diagnosed with and surviving their cancer is creating many challenges. Regarding localized renal cell carcinoma, surgery is considered as gold standard treatment options even in older men, whereas active surveillance and ablation therapy are alternative options for a proportion of these patients. With regard to advanced disease, anti-vascular endothelial growth factor tyrosine kinase inhibitors (VEGFR-TKI) and immune check point inhibitor are standard treatment modalities, although treatment choice from multiple regimens and prevention of adverse events need to be considered. Better assessment techniques, such as comprehensive geriatric assessment to meet the unique needs of older patients, are a central focus in the delivery of high-quality geriatric oncology care. Through this process, shared decision-making should be adopted in clinical care to achieve optimal goals of care that reflect patient and caregiver hopes, needs and preferences. It is necessary to continue investigating oncological outcomes and complications associated with treatment in this population to ensure appropriate cancer care. In this narrative review, we completed a literature review of the various treatments for renal cell carcinoma in older patients that aimed to identify the current evidence related to the full range of the treatments including active surveillance, surgery, ablation therapy and systemic therapy. Prospectively designed studies and studies regarding geriatric assessment were preferentially added as references. Our goals were to summarize the real-world evidence and provide a decision framework that guides better cancer practices for older patients with renal cell carcinoma.
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Affiliation(s)
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Masashi Nakayama
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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11
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Staehler M, Schuler T, Spek A, Rodler S, Tamalunas A, Fürweger C, Muacevic A. Propensity Score-Matched Analysis of Single Fraction Robotic Radiosurgery Versus Open Partial Nephrectomy in Renal Cell Carcinoma: Oncological Outcomes. Cureus 2022; 14:e21623. [PMID: 35233307 PMCID: PMC8881236 DOI: 10.7759/cureus.21623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 12/28/2022] Open
Abstract
Introduction High-dose local stereotactic robotic radiosurgery (RRS) is a non-invasive alternative to surgery in renal masses and selected patients. We have, so far, limited its use to the elderly and patients at high risk from surgery. In this study, we matched patients with renal tumors who were treated with single fraction RRS to patients who underwent open partial nephrectomy (OPN). Methods Between January 2009 and December 2017, we included 571 consecutive patients undergoing OPN and 99 patients who underwent RRS in this retrospective analysis. Patients had to have a follow-up of at least six months and we were able to match 35 with a propensity score. Matching criteria were Eastern Cooperative Oncology Group (ECOG) status, age, clinical tumor, nodes, and metastases (TNM), and tumor diameter. Tumor response, renal function, survival, and adverse events were evaluated every three months until progression or death. Results Median age was 65 years for RRS (range 58-75) and 71 (range 56-76) for OPN (p=0.131). Median diameter of renal tumors was 2.8 cm (range 2.4-3.9) for RRS and 3.5 cm (2.8-4.5) for OPN, p=0.104. Median follow-up was 28.1 months (range 6.0-78.3 months). Local tumor control nine months after RRS and OPN was 98% (95% CI: 89-99%). Renal function remained stable with a median creatinine clearance (Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)) at baseline of 76.8mlmin/1.73m2 (range 25.3-126.3) and 70.3ml/min/1.73m2 (range 18.6-127.3) at follow-up (p=0.89). Median overall survival was not reached. No difference in overall survival (OS) was seen in RRS compared to OPN (p=0.459). Conclusions Single fraction RRS is an alternative to OPN in patients unfit for surgery. Oncological and functional results are comparable to those of OPN. Further studies are needed to determine long-term results and limits of RRS in this setting and in younger patients.
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Affiliation(s)
- Michael Staehler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Tina Schuler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Annabel Spek
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Severin Rodler
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Alexander Tamalunas
- Urology, University Hospital, Ludwig Maximilians University Munich, Munich, DEU
| | - Christoph Fürweger
- Medical Physics, European CyberKnife Center, Munich, DEU.,Stereotaxy and Neurosurgery, University Hospital Cologne, Cologne, DEU
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12
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Sullivan R, Mulki R, Peter S. The role of ablation in the treatment of dysplastic Barrett's esophagus. Ther Adv Gastrointest Endosc 2021; 14:26317745211049967. [PMID: 34708203 PMCID: PMC8544766 DOI: 10.1177/26317745211049967] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Endoscopic eradication therapy for Barrett's esophagus has been established as an effective management strategy for patients with Barrett's esophagus with dysplasia and early esophageal cancer. Among the endoscopic therapies, ablation techniques such as radiofrequency ablation and cryoablation are effective primary treatment interventions with acceptable low complication rates forming the spectrum of a multimodal approach. Appropriate selection of patients, high-definition endoscopic evaluation, and dedicated histological assessment are important cornerstones to help navigate to the best effective treatment method. Carefully structured surveillance programs and preventive measures will be needed to provide long-term durability for maintaining complete remission.
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Affiliation(s)
- Rebecca Sullivan
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ramzi Mulki
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shajan Peter
- Associate Professor, Basil Hirschowitz Endoscopic Centre of Endoscopic Excellence, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 6th Floor Jefferson Tower, 625 19th Street South, Birmingham, AL 35249, USA
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13
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Gottlieb LA, Dekker LRC, Coronel R. The Blinding Period Following Ablation Therapy for Atrial Fibrillation: Proarrhythmic and Antiarrhythmic Pathophysiological Mechanisms. JACC Clin Electrophysiol 2021; 7:416-430. [PMID: 33736761 DOI: 10.1016/j.jacep.2021.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 11/13/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 02/01/2023]
Abstract
Atrial fibrillation (AF) causes heart failure, ischemic strokes, and poor quality of life. The number of patients with AF is estimated to increase to 18 million in Europe in 2050. Pharmacological therapy does not cure AF in all patients. Ablative pulmonary vein isolation is recommended for patients with drug-resistant symptomatic paroxysmal AF but is successful in only about 60%. In patients in whom ablative therapy is successful on the long term, recurrence of AF may occur in the first weeks to months after pulmonary vein ablation. The early recurrence (or delayed cure) of AF is not understood but forms the basis for the generally accepted 3-month blinding (or blanking) period after ablation therapy, which is not included in the evaluation of the eventual success rate of the procedures. The underlying pathophysiological processes responsible for early recurrence and the delayed cure are unknown. The implicit assumption of the blinding period is that the AF mechanism in this period is different from the ablation-targeted AF mechanism (ectopy from the pulmonary veins). In this review, we evaluate the temporary and long-lasting pro- and antiarrhythmic effects of each of the pathophysiological processes and interventions (necrosis, ischemia, oxidative stress, edema, inflammation, autonomic nervous activity, tissue repair, mechanical remodeling, and use of antiarrhythmic drugs) occurring in the blinding period that can modulate AF mechanisms. We propose that stretch-reducing ablation scar is a permanent antiarrhythmic mechanism that develops during the blinding period and is the reason for delayed cure.
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Affiliation(s)
- Lisa A Gottlieb
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
| | - Lukas R C Dekker
- Department of Electrical Engineering, University of Technology, Eindhoven, the Netherlands; Cardiology Department, Catharina Hospital, Eindhoven, the Netherlands.
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute, University of Bordeaux, Pessac, France; Department of Experimental Cardiology, Amsterdam University Medical Centre, Academic Medical Centre, Amsterdam, the Netherlands
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14
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Kim MJ, Kim YA, Cho SW, Kim SJ, Lee KE, Park YJ, Park DJ, Cho BY. Secular Trends in Ablation Therapy for Graves' Disease: An Analysis of a 15-Year Experience at a Tertiary Hospital in South Korea. J Clin Med 2021; 10:1629. [PMID: 33921321 DOI: 10.3390/jcm10081629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 01/22/2023] Open
Abstract
Ablation therapy, such as radioactive iodine (RAI) therapy or thyroidectomy, is generally used as the second-line treatment for Graves' disease (GD) in Asia. This study investigated changes in the clinical characteristics and outcomes of ablation therapies for GD over 15 years. Patients who underwent ablation therapy between 2001 and 2015 at a single tertiary hospital were included. Among the 10,991 GD patients treated over this 15-year period, 1357 (12.3%) underwent ablation therapy, and the most common reason was intractable GD. The proportion of patients who underwent any type of ablation therapy significantly decreased from 9.0% (2001-2005) to 7.7% (2011-2015). However, the proportion of patients who underwent surgery significantly increased from 1.1% (2001-2005) to 2.4% (2011-2015), and the proportion of patients who received ablation therapy due to suspected thyroid cancer increased from 5% to 13% over time. With a median follow-up duration of 6.2 years, remission was achieved in 86% and 98% of patients in the RAI and surgery groups, respectively, and these rates remained stable over time. In conclusion, although the proportion of patients who underwent ablation therapy for GD decreased during 15 years, the proportion of those who underwent surgery increased in association with the increased rate of suspected thyroid cancers.
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Attanasio P, Huemer M, Kaehler N, Keller T, Schreiber T, Niehues R, Katsani-Potempa D, Klein RM, Landmesser U, Deisenhofer I, Tutdibi O, Bourier F. Safe procedures despite ultra low radiation doses during catheter ablations of atrial and ventricular arrhythmias-A multicenter experience. Pacing Clin Electrophysiol 2021; 44:807-813. [PMID: 33665850 DOI: 10.1111/pace.14205] [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] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 01/05/2021] [Accepted: 02/07/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite the development of non-fluoroscopic catheter visualization options, fluoroscopy is still used in most ablation procedures. The aim of this multicenter study was to evaluate the safety and efficacy of a new ultra-low dose radiation protocol for EP procedures in a large number of patients. METHODS AND RESULTS A total of 3462 consecutive patients (male 1926 (55.6%), age 64.4 ± 14.0 years, BMI 26.65 ± 4.70) undergoing radiofrequency ablation (left atrial (n = 2316 [66.9%], right atrial (n = 675 [19.5%], or ventricular (n = 471 [13.6%]) in three German centers were included in the analysis. Procedures were performed using a new ultra-low dose protocol operating at 8nGy for fluoroscopy and 36nGy for cine-loops. Additionally a very low framerate (2-3FPS) was used. Using the new protocol very low Air kerma-area product (KAP) values were achieved for left atrial ablations (104.25 ± 84.22 μGym2 ), right atrial ablations (70.98 ± 94.79 μGym2 ) and ablations for ventricular tachycardias or PVCs (78.62 ± 66.59 μGym2 ). Acute procedural success was achieved in 3289/3388 (97.1%) while the rate of major complications was very low compared to previously published studies not using low dose settings (n = 20, 0.6%). CONCLUSION The ultra-low dose, low framerate protocol leads to very low radiation doses for all EP procedures while neither procedural time, fluoroscopy time nor success or complication rates were compromised. When compared to current real-world Air KAP data the new ultra-low dose fluoroscopy protocol reduces radiation exposure by more than 90%.
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Affiliation(s)
- Philipp Attanasio
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Martin Huemer
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Nora Kaehler
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Theresa Keller
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schreiber
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Reinhard Niehues
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Dimitra Katsani-Potempa
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Rolf Michael Klein
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany.,Department of Cardiology, University Hospital Witten/Herdecke, Witten, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
| | - Osman Tutdibi
- Augusta Krankenhaus Düsseldorf, Department of Cardiology, Academic Teaching Hospital of the University Faculty of Health, Düsseldorf, Germany
| | - Felix Bourier
- Department of Electrophysiology, German Heart Center Munich, Munich, Germany
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16
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Minami Y, Kudo M. Image Guidance in Ablation for Hepatocellular Carcinoma: Contrast-Enhanced Ultrasound and Fusion Imaging. Front Oncol 2021; 11:593636. [PMID: 33747913 PMCID: PMC7973273 DOI: 10.3389/fonc.2021.593636] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
The ultrasound (US) imaging technology, including contrast-enhanced US (CEUS) and fusion imaging, has experienced radical improvement, and advancement in technology thus overcoming the problem of poor conspicuous hepatocellular carcinoma (HCC). On CEUS, the presence or absence of enhancement distinguishes the viable portion from the ablative necrotic portion. Using volume data of computed tomography (CT) or magnetic resonance imaging (MRI), fusion imaging enhances the three-dimensional relationship between the liver vasculature and HCC. Therefore, CT/MR-US fusion imaging provides synchronous images of CT/MRI with real-time US, and US-US fusion imaging provides synchronous US images before and after ablation. Moreover, US-US overlay fusion can visualize the ablative margin because it focuses the tumor image onto the ablation zone. Consequently, CEUS and fusion imaging are helpful to identify HCC with little conspicuity, and with more confidence, we can perform ablation therapy. CEUS/fusion imaging guidance has improved the clinical effectiveness of ablation therapy in patients with poor conspicuous HCCs. Therefore; this manuscript reviews the status of CEUS/fusion imaging guidance in ablation therapy of poor conspicuous HCC.
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Affiliation(s)
- Yasunori Minami
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
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Yamamoto M, Yoshida M, Furuse J, Sano K, Ohtsuka M, Yamashita S, Beppu T, Iwashita Y, Wada K, Nakajima TE, Sakamoto K, Hayano K, Mori Y, Asai K, Matsuyama R, Hirashita T, Hibi T, Sakai N, Tabata T, Kawakami H, Takeda H, Mizukami T, Ozaka M, Ueno M, Naito Y, Okano N, Ueno T, Hijioka S, Shikata S, Ukai T, Strasberg S, Sarr MG, Jagannath P, Hwang TL, Han HS, Yoon YS, Wang HJ, Luo SC, Adam R, Gimenez M, Scatton O, Oh DY, Takada T. Clinical practice guidelines for the management of liver metastases from extrahepatic primary cancers 2021. J Hepatobiliary Pancreat Sci 2020; 28:1-25. [PMID: 33200538 DOI: 10.1002/jhbp.868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hepatectomy is standard treatment for colorectal liver metastases; however, it is unclear whether liver metastases from other primary cancers should be resected or not. The Japanese Society of Hepato-Biliary-Pancreatic Surgery therefore created clinical practice guidelines for the management of metastatic liver tumors. METHODS Eight primary diseases were selected based on the number of hepatectomies performed for each malignancy per year. Clinical questions were structured in the population, intervention, comparison, and outcomes (PICO) format. Systematic reviews were performed, and the strength of recommendations and the level of quality of evidence for each clinical question were discussed and determined. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess evidence and make recommendations. RESULTS The eight primary sites were grouped into five categories based on suggested indications for hepatectomy and consensus of the guidelines committee. Fourteen clinical questions were devised, covering five topics: (1) diagnosis, (2) operative treatment, (3) ablation therapy, (4) the eight primary diseases, and (5) systemic therapies. The grade of recommendation was strong for one clinical question and weak for the other 13 clinical questions. The quality of the evidence was moderate for two questions, low for 10, and very low for two. A flowchart was made to summarize the outcomes of the guidelines for the indications of hepatectomy and systemic therapy. CONCLUSIONS These guidelines were developed to provide useful information based on evidence in the published literature for the clinical management of liver metastases, and they could be helpful for conducting future clinical trials to provide higher-quality evidence.
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Affiliation(s)
- Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Ichikawa, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, Kumamoto, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Keita Wada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.,Kyoto Innovation Center for Next Generation Clinical Trials and iPS Cell Therapy, Kyoto University Hospital, Kyoto, Japan
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Koichi Hayano
- Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Asai
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ryusei Matsuyama
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokoama, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Taizo Hibi
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
| | - Nozomu Sakai
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Tabata
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Hiroyuki Takeda
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Makoto Ueno
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoichi Naito
- Department of Breast and Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Tomohiko Ukai
- Division of Public Health, Osaka Institute of Public Health, Higashinari, Japan
| | - Steven Strasberg
- Section of HPB Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | | | | | - Tsann-Long Hwang
- Division of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo-Seok Yoon
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | | | - Shao-Ciao Luo
- Taichung Veterans General Hospital, Taichung, Taiwan
| | - René Adam
- AP HP Paul Brousse Hospital, University Paris Sud, Villejuif, France
| | - Mariano Gimenez
- Docencia Asistencia Investigación en Cirugía Invasiva Mínima Foundation, General and Minimally Invasive Surgery, University of Buenos Aires, Viamonte, Argentina.,Institute of Image-Guided Surgery, Strasbourg, France
| | - Olivier Scatton
- Department of Hepatobiliary Surgery and Liver Transplantation, APHP Pitié-Salpêtrière Hospital, Sorbonne Université, CRSA, Paris, France
| | - Do-Youn Oh
- Division of Medical Oncology, Department of Internal Medicine, Seoul National University Hospital Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tadahiro Takada
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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18
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Ma LX, Craig KM, Mosquera JM, Robinson BD, Scherr DS, Pizzo JD, McClure TD, Khani F. Contemporary Results and Clinical Utility of Renal Mass Biopsies in the Setting of Ablative Therapy: A single center experience. Cancer Treat Res Commun 2020; 25:100209. [PMID: 32979705 DOI: 10.1016/j.ctarc.2020.100209] [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] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/27/2020] [Accepted: 09/08/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Clinical guidelines have recently included renal mass biopsy (RMB) in management algorithms, especially in the setting of small renal masses ≤ 4 cm (SRM) and ablative therapy. We sought to evaluate the diagnostic rates of RMB, factors associated with a non-diagnostic biopsy, its clinical utility, and its safety profile in the setting of ablative therapy. MATERIALS AND METHODS A total of 174 RMB from 167 patients, performed in a tertiary academic center from 01/2015 to 01/2019, were included. Patient demographics, radiographic mass size, RMB diagnoses, subsequent clinical management, and complications were retrospectively reviewed. RMBs were classified as diagnostic or non-diagnostic based on set criteria. RESULTS The mean mass size was 3.0 cm (range: 0.5-15.3 cm) and 140 biopsies (80%) were SRM. Among all RMB, 159 (91%) were diagnostic and 15 (9%) were non-diagnostic. Non-diagnostic biopsies were associated with small mass size, the presence of a cystic component (p < 0.00001) and fewer number of cores submitted (p = 0.0046). All non-diagnostic biopsies occurred in SRMs, where the mean mass size was significantly smaller than diagnostic biopsies (1.3 versus 3.2 cm, p = 0.001). RMB with concurrent ablation yielded non-diagnostic results more frequently than isolated RMBs (15% vs 2%, respectively). CONCLUSIONS RMB is useful for definitive diagnosis and clinical management in the setting of ablative therapy. Small mass size, cystic lesions, and fewer number of passes obtained are associated with non-diagnostic biopsies. When a renal mass diagnosis is particularly critical, a separate biopsy procedure prior to ablative therapy is recommended.
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Affiliation(s)
- Lucy X Ma
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | | | - Juan Miguel Mosquera
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Brian D Robinson
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Departments of Urology, Weill Cornell Medicine, New York, NY
| | | | | | - Timothy D McClure
- Departments of Urology, Weill Cornell Medicine, New York, NY; Departments of Radiology, Weill Cornell Medicine, New York, NY
| | - Francesca Khani
- Departments of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY; Departments of Urology, Weill Cornell Medicine, New York, NY.
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19
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Zhang L, Tan S, Huang S, Zhong C, Lü M, Peng Y, Tang X. The safety and efficacy of endoscopic ultrasound-guided ablation therapy for solid pancreatic tumors: a systematic review. Scand J Gastroenterol 2020; 55:1121-1131. [PMID: 32730715 DOI: 10.1080/00365521.2020.1797870] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Recently, endoscopic ultrasound (EUS)-guided ablation therapy, as a minimally invasive technique, has shown its potential to substitute surgery in treating solid pancreatic tumors, such as small potential malignant pancreatic tumors, small insulinomas and locally advanced pancreatic ductal adenocarcinoma (LAPDAC). Therefore, we conducted this systematic review to assess the safety and efficacy of EUS-guided ablation therapy for solid pancreatic tumors. METHODS We conducted a comprehensive search of PubMed, Embase, Cochrane library and Web of Science databases from inception to February 2020. The endpoints were clinical success and complications rates. The pooled event rate was calculated using Comprehensive Meta Analysis software. RESULTS Fourteen studies with a total of 158 patients were included in our final analysis. The major types of solid pancreatic tumors were nonfunction pancreatic neuroendocrine tumors (n = 78, 49.4%), LAPDAC (n = 48, 30.4%) and insulinomas (n = 26, 16.5%). Overall, the pooled clinical success rate was 85.9% (95% confidence interval (CI): 75.4-92.4%, I 2 = 25.18%), pooled complications rate was 29.1% (95% CI: 18.6-42.3%, I 2 = 50.40%). Subgroup analysis was performed based on ablation methods, which showed clinical success rate for radiofrequency ablation (RFA) was 83.5% (95% CI: 67.9-92.4%), and 87.9% (95% CI: 66.2-96.4%) for ethanol ablation (EA). In terms of complications rate, it was 32.2% (95% CI: 19.4-48.4%) for RFA, and 21.2% (95% CI: 6.8-49.9%) for EA. CONCLUSIONS EUS-guided ablation therapy is a promising alternative treatment for solid pancreatic tumors, especially for p-NETs and insulinomas < 2 cm, with rarely severe complications. Further prospective studies with long-term follow-up are warranted in future.
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Affiliation(s)
- Lu Zhang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shali Tan
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Shu Huang
- Department of Gastroenterology, The People's Hospital of Lianshui, Huaian, China
| | - Chunyu Zhong
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Muhan Lü
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yan Peng
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiaowei Tang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, China
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20
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Masuda T, Beppu T, Okabe H, Nitta H, Imai K, Hayashi H, Chikamoto A, Yamamoto K, Ikeshima S, Kuramoto M, Shimada S, Baba H. Predictive factors of pathological vascular invasion in hepatocellular carcinoma within 3 cm and three nodules without radiological vascular invasion. Hepatol Res 2016; 46:985-91. [PMID: 26670198 DOI: 10.1111/hepr.12637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 09/18/2015] [Revised: 11/30/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to determine the predictive factors of pathological vascular invasion as contra-indicators for ablation therapy in patients with hepatocellular carcinoma (HCC) within 3 cm and three nodules without radiological vascular invasion. METHODS Two hundred and seventeen patients with HCC within 3 cm and three nodules without radiological vascular invasion who underwent hepatic resection were retrospectively investigated. RESULTS Pathological vascular invasion was positive in 46 patients, consisting of 38 portal vein invasions, three hepatic vein invasions, two hepatic artery invasions, one hepatic duct invasion and two with portal and hepatic vein invasions. In univariate analysis, patients with α-fetoprotein (AFP) of more than 100 ng/mL had higher rates of pathological vascular invasion than those without. In addition, patients with protein induced by vitamin K absence (PIVKA-II) of more than 100 mAU/mL had higher rates of pathological vascular invasion than those without. Multivariate analysis revealed that AFP of more than 100 ng/mL and PIVKA-II of more than 100 mAU/mL were independent predictive factors for pathological vascular invasion. As these patients were treated with hepatic resection, cumulative 5-year recurrence-free and overall survivals were not significantly different between the pathological vascular invasion negative and positive cases. CONCLUSION AFP of more than 100 ng/mL and PIVKA-II of more than 100 mAU/mL can predict pathological vascular invasion in patients with HCC within 3 cm and three nodules without radiological vascular invasion. In treating such cases, hepatic resection rather than local ablation therapy is recommended.
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Affiliation(s)
- Toshiro Masuda
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan.,Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirohisa Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidetoshi Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichiro Yamamoto
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, Japan
| | - Satoshi Ikeshima
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, Japan
| | - Masafumi Kuramoto
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, Japan
| | - Shinya Shimada
- Department of Surgery, Kumamoto General Hospital, Japan Community Health Care Organization, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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21
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Garikipati NV, Hummel JD. Removing the Blindfold: Cardiac MRI Prior to Repeat Ablation of Ventricular Tachycardia. J Cardiovasc Electrophysiol 2015; 27:190-1. [PMID: 26572238 DOI: 10.1111/jce.12880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Naga V Garikipati
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - John D Hummel
- Section of Clinical Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
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22
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Kwong RY, Farzaneh-Far A. Assessment of LV Myocardial Scar Before Atrial Fibrillation Ablation. JACC Cardiovasc Imaging 2015; 8:801-3. [PMID: 26183553 DOI: 10.1016/j.jcmg.2015.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
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23
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Doussot A, Nardin C, Takaki H, Litchman TD, D'angelica MI, Jarnagin WR, Postow MA, Erinjeri JP, Kingham TP. Liver resection and ablation for metastatic melanoma: A single center experience. J Surg Oncol 2015; 111:962-8. [PMID: 26073980 PMCID: PMC5170874 DOI: 10.1002/jso.23929] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/11/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The median survival for patients with stage IV metastatic melanoma is usually limited to approximately 1 year. In the case of liver metastasis, resection and ablation can achieve long-term survival. This study aimed to describe the outcomes after liver resection or ablation for metastatic melanoma to the liver and identify preoperative prognostic factors. METHODS Forty eight patients who underwent liver resection (n = 32) or percutaneous ablation (n = 16) were identified from the 1,523 patients with melanoma liver metastases evaluated between January1993 and January 2013. RESULTS Median OS was 25.9 months. Median OS was not different after ablation (18 months) and resection (26 months; P > 0.2). Patients in the ablation group more often presented with extrahepatic disease (EHD) (P = 0.008) and received more frequently systemic therapy before ablation (P = 0.005). Patients without EHD tended to have longer OS (26.5 vs. 12 months; P = 0.076) and PFS (13 vs. 5 months; P = 0.11) in the whole cohort. EHD was significantly associated with a worse OS in the resection group (P = 0.034). CONCLUSION Liver resection is associated to prolonged survival over 24 months and should be considered only in selected patients with metastatic disease confined to the liver. In patients not candidate for surgery, tumor ablation can be considered.
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Affiliation(s)
- Alexandre Doussot
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charlée Nardin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Haruyuki Takaki
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tess D. Litchman
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - William R. Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A. Postow
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical College, New York, New York
| | - Joseph P. Erinjeri
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Leung JHY, Yu SCH, Cheung ECW, Wong ASW, Tong MMB, Ho SSY, Leung VYF, Ahuja AT. Safety and efficacy of sonographically guided high-intensity focused ultrasound for symptomatic uterine fibroids: preliminary study of a modified protocol. J Ultrasound Med 2014; 33:1811-1818. [PMID: 25253828 DOI: 10.7863/ultra.33.10.1811] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES We aimed to assess the safety and efficacy of sonographically guided high-intensity focused ultrasound for treating patients with symptomatic uterine fibroids using a modified protocol. METHODS This work was part of an ongoing prospective phase 1 study. Twenty patients with 22 symptomatic fibroids were treated with sonographically guided high-intensity focused ultrasound under no anesthesia. The modified protocol consisted of repeated and shortened (<25 minutes) treatment sessions of high-input acoustic intensity (1000-1500 W/cm(2)) and intensified sonication pulses (1500-2000) at each spot. The primary end points were periprocedural complications. The secondary end points were symptomatic improvement and radiologic evidence of treatment responses, including the degree of fibroid infarction and volume shrinkage 3 months after treatment. Symptomatic improvement was assessed by a pain score, a pictorial chart menstrual score, the Urogenital Distress Inventory short form, and the Incontinence Impact Questionnaire short form. The degree of fibroid infarction was assessed by the nonperfused ratio on contrast-enhanced magnetic resonance imaging, defined as the ratio of the nonperfused fibroid volume to the total fibroid volume. RESULTS Nineteen patients tolerated the treatment well, with no major adverse events. One patient who received treatment for a fibroid located within 6 cm from the skin had third-degree skin burns at 2 sites of 1 cm in diameter. Fibroid-related abdominal pain, pictorial chart, Urogenital Distress Inventory, and Incontinence Impact Questionnaire scores were significantly improved (P < .05). The median nonperfused ratio at 3 months was 20% (95% confidence interval, 5%-32.5%). Median volume shrinkage at 3 months was 17.2% (95% confidence interval, 4.3%-26.6%). CONCLUSIONS Sonographically guided high-intensity focused ultrasound using a modified protocol may be safe and effective for symptomatic uterine fibroids in selected patients to avoid skin burns.
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Affiliation(s)
- Joyce H Y Leung
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Simon C H Yu
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Eva C W Cheung
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alyssa S W Wong
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mabel M B Tong
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Stella S Y Ho
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vivian Y F Leung
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Anil T Ahuja
- Departments of Imaging and Interventional Radiology (J.H.Y.L., S.C.H.Y., M.M.B.T., S.S.Y.H., V.Y.F.L., A.T.A.) and Obstetrics and Gynecology (E.C.W.C., A.S.W.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
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Mo CQ, Yu Z, Tan WL, Mao XP, Chen X, Liu JC, Qiu SP. Comparison between laparoscopic partial nephrectomy and laparoscopic ablation therapy: a meta-analysis. MINIM INVASIV THER 2014; 23:317-25. [PMID: 25180534 DOI: 10.3109/13645706.2014.925930] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To conduct a meta-analysis of the literature evaluating comparisons on the peri-operative and oncological outcomes between laparoscopic partial nephrectomy (LPN) and laparoscopic ablation therapy (LAT) in the treatment of small renal masses (SRMs). MATERIAL AND METHODS MEDLINE, EMBASE, Google Scholar, Cochrane Library, and CNKI were searched for clinical trials comparing LPN with LAT. Data of peri-operative and follow-up outcomes were extracted and compared. Publication bias was identified and sensitivity analysis was also performed. RESULTS Data from 11 studies including 928 patients (525 patients in the LPN group and 403 in the LAT group) were collected. Baseline characteristics were compared and differences were found in age, preoperative renal function and proportion of solitary kidney (p < 0.05 respectively). For peri-operative outcomes, the LPN group had greater estimated blood loss, longer operative duration and length of hospital stay, and more peri-operative complications (p < 0.05, respectively). The LAT group had a significantly higher local recurrence (p < 0.05). There was no significant difference in postoperative change of renal function (p = 0.21). CONCLUSION In comparison with LPN, LAT provides better peri-operative outcomes, but a higher local recurrence rate. LAT does not seem to provide an obvious advantage in protecting renal function. Further clinical trials with randomized design and long-term follow-up are needed.
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Affiliation(s)
- Cheng-Qiang Mo
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University , Guangzhou , China
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Gutsche JT, Riha H, Patel P, Sahota GS, Valentine E, Ghadimi K, Silvay G, Augoustides JG. Major themes for 2013 in cardiothoracic and vascular anaesthesia and intensive care. Heart Lung Vessel 2014; 6:79-87. [PMID: 25024989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There has been significant progress throughout 2013 in cardiothoracic and vascular anaesthesia and intensive care. There has been a revolution in the medical and interventional management of atrial fibrillation. The medical advances include robust clinical risk scoring systems, novel oral anticoagulants, and growing clinical experience with a new antiarrhythmic agent. The interventional advances include left atrial appendage occlusion for stroke reduction, generalization of ablation techniques in cardiac surgery, thoracoscopic ablation techniques, and the emergence of the hybrid ablation procedure. Recent European guidelines have defined the organization and practice of two subspecialties, namely general thoracic surgery and grown-up congenital heart disease. The pivotal role of an effective multidisciplinary milieu is a central theme in both these clinical arenas. The anaesthesia team features prominently in each of these recent guidelines aimed at harmonizing delivery of perioperative care for these patient cohorts across Europe. Web-Enabled Democracy-Based Consensus is a system that allows physicians worldwide to agree or disagree with statements and expert consensus meetings and has the potential to increase the understanding of global practice and to help clinicians better define research priorities. This "Democratic based medicine", firstly used to assess the interventions that might reduce perioperative mortality has been applied in 2013 to the setting of critically ill patient with acute kidney injury. These advances in 2013 will likely further improve perioperative outcomes for our patients.
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Arienti V, Pretolani S. Complication rates of ablation therapies for hepatocellular carcinoma: a difficult comparison with an easy solution. Gut 2006; 55:1211-2. [PMID: 16849356 PMCID: PMC1856271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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