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Fassia MK, Charalel R, Talenfeld AD. Demonstrating the Value of Interventional Radiology. Semin Intervent Radiol 2023; 40:403-406. [PMID: 37927519 PMCID: PMC10622236 DOI: 10.1055/s-0043-1774407] [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] [Indexed: 11/07/2023]
Abstract
While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.
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Affiliation(s)
- Mohammad-Kasim Fassia
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Resmi Charalel
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Adam D. Talenfeld
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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Datta S, Cramer P, Sung J, Wright D, Charalel R. Systematic Review of Use of Patient-Reported Outcomes in Interventional Radiology. J Am Coll Radiol 2023; 20:752-757. [PMID: 37390882 DOI: 10.1016/j.jacr.2023.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 01/02/2023] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 07/02/2023]
Abstract
INTRODUCTION A patient-reported outcome (PRO) is any outcome reported directly by the patient, in contradistinction to a clinician-reported outcomes, which have dominated clinical research. This systematic review evaluates the ways in which PROs have been used in the interventional radiology literature. METHODS Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was designed and conducted by a medical librarian. Studies were screened for inclusion by two independent members, with a third member as a conflict resolver. The data were extracted from each study in a consistent and structured manner. RESULTS In all, 354 studies met criteria for full-text analysis; 218 of 354 (62%) used a prospective design and most frequently provided level III (249 of 354, 70%) or level I (68 of 354, 19%) evidence. The manner in which PROs were obtained was reported in 125 of 354 (35%) of studies. Questionnaire response rate was documented in 51 of 354 (14%) studies, and questionnaire completion rate was documented in 49 of 354 (14%) studies. Of 354 studies, 281 (79%) studies used at least one independently validated questionnaire. The disease domains most commonly assessed via PRO were women's health (62 of 354, 18%) and men's health (60 of 354, 17%). DISCUSSION Wider development, validation, and systematic use of PROs in IR would enable more informed patient-centered decision making. A greater focus on PROs in clinical trials would elucidate expected outcomes from the patient's perspective, simplifying comparisons with therapeutic alternatives. To produce more convincing evidence, trials must apply validated PROs rigorously and report possible confounding factors consistently.
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Affiliation(s)
- Sanjit Datta
- New-York Presbyterian Weill Cornell Medical Center, New York, New York
| | - Peyton Cramer
- New-York Presbyterian Weill Cornell Medical Center, New York, New York
| | - Jeffrey Sung
- New-York Presbyterian Weill Cornell Medical Center, New York, New York
| | | | - Resmi Charalel
- Weill Cornell Medicine, New York, New York; ACR Appropriateness Criteria Interventional Radiology Expert Panel 2 Member.
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Lewis P, Charalel R, Andrew C, Aliaksei S, Kassin M, Dubel G, Garg T, Brooks O, Shah R, Halin N, Kleedehn M, Johnson M. Abstract No. 235 Challenges, Successes and Barriers of Structured Report Templates: A Brief Report on Survey Results. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Datta S, Cramer P, Sung J, Wright D, Charalel R. Abstract No. 591 Systematic review of use of patient-reported outcome measures in interventional radiology. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Yan J, Ying X, Malhotra A, Talenfeld A, Charalel R, Lee KS, Trost D, Kesselman A. Safety and Efficacy of Microwave Ablation for Hepatocellular Carcinoma in the Setting of Transjugular Intrahepatic Portosystemic Shunt. Cardiovasc Intervent Radiol 2021; 45:578-581. [PMID: 34859308 DOI: 10.1007/s00270-021-03012-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/07/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
This retrospective analysis reviews five patients with transjugular intrahepatic portosystemic shunt (TIPS) who underwent percutaneous microwave ablation of hepatocellular carcinoma between January 2017 and September 2020. Mean tumor diameter was 2.0 cm (range 1.3-2.9 cm), and mean tumor distance from TIPS was 2.3 cm (range 1.5-3.3 cm). There were no major adverse events, and the TIPS patency was 100% post-ablation. The technical success rate was 100%, and the complete response rate was 100%. In this small study, percutaneous microwave ablation appears safe and effective for the treatment of hepatocellular carcinoma in patients with TIPS in the short-term follow-up period.
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Affiliation(s)
- Jenny Yan
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA.
| | - Xiaohan Ying
- Weill Cornell Medical College, New York, NY, USA
| | - Anuj Malhotra
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
| | - Adam Talenfeld
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
| | - Resmi Charalel
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
| | - Kyungmouk Steve Lee
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
| | - David Trost
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
| | - Andrew Kesselman
- Department of Vascular and Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 E 68th Street, Box 141, PaysonNew York, NY, 10065, USA
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Khaja MS, Obi AT, Sharma AM, Cuker A, McCann SS, Thukral S, Matson JT, Hofmann LV, Charalel R, Kanthi Y, Meek ME, Meissner MH, White SB, Williams DM, Vedantham S. Optimal Medical Therapy Following Deep Venous Interventions: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 33:78-85. [PMID: 34563699 DOI: 10.1016/j.jvir.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/11/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022] Open
Abstract
The optimal medical management of patients following endovascular deep venous interventions remains ill-defined. As such, the Society of Interventional Radiology Foundation (SIRF) convened a multidisciplinary group of experts in a virtual Research Consensus Panel (RCP) to develop a prioritized research agenda regarding antithrombotic therapy following deep venous interventions. The panelists presented the gaps in knowledge followed by discussion and ranking of research priorities based on clinical relevance, overall impact, and technical feasibility. The following research topics were identified as high priority: 1) characterization of biological processes leading to in-stent stenosis/rethrombosis; 2) identification and validation of methods to assess venous flow dynamics and their effect on stent failure; 3) elucidation of the role of inflammation and anti-inflammatory therapies; and 4) clinical studies to compare antithrombotic strategies and improve venous outcome assessment. Collaborative, multicenter research is necessary to answer these questions and thereby enhance the care of patients with venous disease.
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Affiliation(s)
- Minhaj S Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia.
| | - Andrea T Obi
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health, Charlottesville, Virginia
| | - Adam Cuker
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sara S McCann
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Siddhant Thukral
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - John T Matson
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Lawrence V Hofmann
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Resmi Charalel
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Yogendra Kanthi
- Laboratory of Vascular Thrombosis and Inflammation, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mary E Meek
- Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mark H Meissner
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David M Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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Dinh A, Brown R, Charalel R, Sung J. Abstract No. 575 LIRADS 4/5 lesions less than 2 cm: watch or treat? Understanding the natural history. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Lamparello NA, Choi S, Charalel R, Lee KS, Kesselman A, Scherer K, Harnain CM, Browne WF, Shiffman M, Holzwanger DJ, Pua BB. Transforming Positive Pressure IR Suites to Treat COVID-19 Patients. J Vasc Interv Radiol 2020; 31:1496-1499. [PMID: 32747141 PMCID: PMC7324314 DOI: 10.1016/j.jvir.2020.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Nicole A Lamparello
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Sarah Choi
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Resmi Charalel
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Kyungmouk Steve Lee
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Kimberly Scherer
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Christopher M Harnain
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - William F Browne
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Marc Shiffman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Daniel J Holzwanger
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Bradley B Pua
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
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Al Dabhani D, Thompson M, Bolgar G, Pua B, Charalel R. 3:54 PM Abstract No. 78 New clinic workflow improves compliance for routine percutaneous nephrostomy tube exchanges. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Soliman M, Rosenblatt R, Joshi M, Chung C, Mitry M, Oh K, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. 3:27 PM Abstract No. 130 Hospitalization and complication rates following radiation segmentectomy versus microwave ablation for small hepatocellular carcinoma. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Joshi M, Rosenblatt R, Chung C, Mitry M, Soliman M, Oh K, Askin G, Talenfeld A, Samstein B, Brown R, Halazun K, Fortune B, Charalel R. Abstract No. 532 Comparative efficacy of transarterial embolization versus transarterial embolization plus microwave ablation for hepatocellular carcinoma 3 to 5 cm in size. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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12
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Ramaswamy RS, Charalel R, Guevara CJ, Tiwari T, Akinwande O, Kim SK, Salter A, Darcy M, Malone CD. Propensity-matched comparison of transjugular intrahepatic portosystemic shunt placement techniques: Intracardiac echocardiography (ICE) versus fluoroscopic guidance. Clin Imaging 2019; 57:40-44. [PMID: 31103908 DOI: 10.1016/j.clinimag.2019.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/12/2018] [Revised: 04/12/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare procedure characteristics and outcomes when TIPS is performed under intracardiac echocardiography guidance (iTIPS) compared to conventional fluoroscopic guidance (cTIPS). MATERIALS AND METHODS A retrospective propensity-matched study of 30 iTIPS and 30 cTIPS procedures from January 2014 to March 2017 at a single US high volume academic medical center was performed. iTIPS and cTIPS cases were propensity score matched using predictive variables: age, race, gender, etiology of liver disease, indication for TIPS, MELD score, and portal vein patency. Procedure characteristics and post- procedure outcomes were compared between propensity-matched groups including: total procedure time, technical success, radiation dose, contrast volume, complication rate, 30- day mortality, and revision rate within 3 months. RESULTS Radiation dose (875.3 vs 457.4 mGY, p = 0.039) and contrast volume (141 vs 103 mL, p = 0.005) were significantly decreased in the iTIPS versus the cTIPS group. There was no significant difference in procedure time (81.5 cTIPS vs 84 min iTIPS) or rate of TIPS revisions within 3 months. Average operator experience in the iTIPs group was 4.2 years and cTIPS group 11.0 years (p = 0.0004). All procedures were technically successful with no mortalities within 30 days. CONCLUSION iTIPS resulted in significantly reduced radiation dose and contrast volume. However, there was no difference in total procedure time or overall outcomes despite greater operator experience in the cTIPS group.
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Affiliation(s)
- Raja Siva Ramaswamy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America.
| | - Resmi Charalel
- Weill Cornell Medicine, Department of Radiology, 525 East 68th Street, New York, NY 10065, United States of America
| | - Carlos J Guevara
- University of Texas - Houston, Department of Diagnostic and Interventional Imaging, 6431 Fannin St, Houston, TX 77030, United States of America
| | - Tatulya Tiwari
- Veterans Affairs Medical Center - Lexington, Division of Endovascular Surgery, 1101 Veterans Drive, Lexington, KY 40502, United States of America
| | - Olaguoke Akinwande
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America
| | - Seung K Kim
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America
| | - Amber Salter
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America
| | - Michael Darcy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America
| | - Christopher D Malone
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S Kingshighway Blvd, CB 8131, Saint Louis, MO 63139, United States of America
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Xu J, Noda C, Erickson A, Mokkarala M, Charalel R, Ramaswamy R, Tao YU, Akinwande O. Radiofrequency Ablation vs. Cryoablation for Localized Hepatocellular Carcinoma: A Propensity-matched Population Study. Anticancer Res 2018; 38:6381-6386. [PMID: 30396961 DOI: 10.21873/anticanres.12997] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To compare overall survival (OS) and liver cancer-specific survival (LCSS) of Surveillance, Epidemiology and End Results (SEER) hepatocellular carcinoma (HCC) database patients treated with cryoablation (cryo) or radiofrequency ablation (RFA). MATERIALS AND METHODS This was a retrospective review of Stage I or II HCC patients from the SEER database treated with cryo and RFA from 2004-2013. Kaplan-Meier and Cox regressions were performed on pooled and propensity-matched cohort. RESULTS Out of 3,239 patients, RFA showed a significant survival advantage over cryo in liver cancer specific survival (LCSS) (HR=1.634 p=0.0004). A total of 91 propensity-matched pairs had similar OS (HR=1.006 p=0.9768), but no difference in LCSS was observed between the groups [HR=1.412 (95%CI=0.933-2.137) p=0.1023]. Survival Cox models did not reveal treatment type as an independent prognostic factor. CONCLUSION Propensity-matched cohort showed no significant difference in terms of OS and LCSS was found for patients treated with either cryo or RFA for localized HCC.
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Affiliation(s)
- Jimmy Xu
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Christopher Noda
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Abigail Erickson
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Mahati Mokkarala
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Resmi Charalel
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Raja Ramaswamy
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Y U Tao
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A
| | - Olaguoke Akinwande
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, St. Louis, MO, U.S.A.
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Chang J, Charalel R, Noda C, Ramaswamy R, Kim SK, Darcy M, Foltz G, Akinwande O. Liver-dominant Breast Cancer Metastasis: A Comparative Outcomes Study of Chemoembolization Versus Radioembolization. Anticancer Res 2018; 38:3063-3068. [PMID: 29715141 DOI: 10.21873/anticanres.12563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/08/2018] [Accepted: 04/12/2018] [Indexed: 12/25/2022]
Abstract
AIM To compare toxicity, response, and survival outcomes of patients with hepatic metastases from breast cancer who underwent transarterial chemoembolization (TACE) or radioembolization (TARE). MATERIALS AND METHODS A retrospective review was carried out of all patients who underwent TACE or TARE for liver-dominant breast cancer metastases between January 2006 and March 2016 at an academic medical center in the United States. RESULTS Seventeen patients in the TACE group and 30 patients in the TARE group received 32 TACE and 49 TARE treatments, respectively. Median follow-up was 9 months. Both groups had similar background variables. More all-grade adverse events were seen in the TACE group (71% vs. 44%; p=0.02). Median overall survival in the TACE group was 4.6 months compared to 12.9 months in the TARE group (p=0.2349). Treatment type was not an independent prognostic factor. CONCLUSION TARE is better tolerated than TACE for the treatment of liver-dominant breast cancer metastasis. There was a trend towards improved survival with TARE; however, it did not approach statistical significance. Larger studies are needed to validate these findings.
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Affiliation(s)
- Jodie Chang
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A
| | - Resmi Charalel
- Division of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, U.S.A
| | - Christopher Noda
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A
| | - Raja Ramaswamy
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A
| | - Seung Kwon Kim
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A.,Siteman Cancer Center at Washington University in St. Louis, St. Louis, MO, U.S.A
| | - Michael Darcy
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A.,Siteman Cancer Center at Washington University in St. Louis, St. Louis, MO, U.S.A
| | - Gretchen Foltz
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A
| | - Olaguoke Akinwande
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, U.S.A. .,Siteman Cancer Center at Washington University in St. Louis, St. Louis, MO, U.S.A
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Charalel R, Chang J, Noda C, Ramaswamy R, Foltz G, Darcy M, Akinwande O. 3:18 PM Abstract No. 324 Chemoembolization vs. radioembolization for the treatment of hepatic metastases from breast cancer: a comparative study. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Charalel R, Akinwande O, Picus D, Som A, Guevara C, Kavali P, Kim S, Giardina J, Darcy M, Ramaswamy R. 3:09 PM Abstract No. 283 Propensity-matched comparison of transjugular intrahepatic portosytemic shunt placement techniques: intravascular ultrasound versus fluoroscopic guidance. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Thayer D, Noda C, Charalel R, Mills A, Chang R, Tao Y, Akinwande O. Survival comparison of hepatocellular carcinoma patients treated with radioembolization versus nonoperative/interventional treatment. J Comp Eff Res 2018; 7:343-356. [PMID: 29553286 DOI: 10.2217/cer-2017-0064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM To compare the overall survival (OS) and liver cancer-specific survival of advanced-stage hepatocellular carcinoma (HCC) patients who received transarterial radioembolization (TARE) with those who received nonoperative/interventional treatment (NOT). MATERIALS & METHODS A total of 12,520 HCC patients from the Surveillance, Epidemiology and End Results database were categorized by treatment with either radioembolization or NOT. Kaplan-Meier and multivariate Cox regression were conducted. RESULTS The TARE group had both a significantly longer median overall survival than the NOT group (TARE = 9 months; NOT = 2 months; p < 0.0001) and a significantly higher probability of liver cancer-specific survival (hazard ratio = 0.474). CONCLUSION TARE appears to provide a significant survival advantage over the NOT population in advanced HCC patients.
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Affiliation(s)
- David Thayer
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Christopher Noda
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Resmi Charalel
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Abigail Mills
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Randy Chang
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Yu Tao
- Siteman Biostatistics, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
| | - Olaguoke Akinwande
- Division of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA.,Siteman Cancer Center, Washington University School of Medicine in St Louis, St Louis, MO 63110, USA
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Charalel R, Saad N, Kim S. BRTO vs PARTO for gastric variceal bleeding using sodium tetradecyl sulfate (STS) in a single U.S. medical center. J Vasc Interv Radiol 2017. [DOI: 10.1016/j.jvir.2016.12.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
PURPOSE Hairy cell leukemia (HCL) is a rare disorder that occasionally has visual symptoms after diagnosis. The authors present a case of HCL in which bilateral visual symptoms led to the initial diagnosis. METHODS Observational case report. RESULTS Bilateral decreased vision to 20/30 in the right eye and 20/40 in the left due to intraretinal and preretinal hemorrhages with no other systemic signs or symptoms prompted a hematologic evaluation in which HCL was found to be the causative disorder in a previously healthy 41-year-old man. CONCLUSIONS The authors present a rare case in which bilateral visual complaints led to the diagnosis of HCL. Thus, though uncommon, HCL should be considered in the differential diagnosis of otherwise unexplained retinal hemorrhages.
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Affiliation(s)
- Resmi Charalel
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA - USA
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