Concerning CT features predict outcome of treatment in patients with malignant peritoneal mesothelioma

BACKGROUND

Malignant peritoneal mesothelioma is an aggressive local-regional disease with dissemination to all parts of the abdomen and pelvis at the time of diagnosis. Recently, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has been used and improved survival was documented with this local-regional treatment strategy.

METHOD

Concerning CT features were described that were specific for malignant peritoneal mesothelioma. The incidence of concerning radiologic features and their impact on survival was determined. The prognostic assessment of concerning CT features was compared to the peritoneal cancer index (PCI) and the completeness of cytoreduction score (CC score).

RESULTS

One hundred patients with a preoperative CT were evaluated by 11 concerning CT features. The incidence of these CT features varied between 5% and 41%. Nine of the 11 CT features statistically significantly predicted a reduced survival in these patients treated in a uniform manner. When concerning radiologic features were grouped as none, a single feature or two or more features, a significant composite analysis was achieved with p < 0.001. The prognostic information from concerning CT features compared favorably with the prognostic implications of PCI and CC score.

CONCLUSIONS

The availability of the concerning CT features to predict prognosis at the initiation of treatments for malignant peritoneal mesothelioma shows that this radiologic assessment may be of great value to the clinician in planning a treatment strategy for an individual patient.

Cryoablation of cardiophrenic angle lymph node metastases: a case report

Background

Cardiophrenic angle lymph node metastases are relatively rare. Surgical resection is the main treatment for cardiophrenic angle lymph node metastasis, but it is not always possible.

Case presentation

Here, we report our initial experience with cryoablation of a cardiophrenic angle lymph node metastasis from liver cancer. As the cardiophrenic angle lymph node metastasis was located close to the heart, about 200 mL of 0.9% saline was injected into the pericardium to separate the heart from the target area. The cardiophrenic angle lymph node metastasis was successfully ablated, without any complications.

Conclusions

Cryoablation may be a suitable alternative treatment for cardiophrenic angle lymph node metastasis.

Cardiophrenic angle lymph node is an indicator of metastatic spread but not specifically peritoneal carcinomatosis in colorectal cancer patients: Results of a prospective validation study in 91 patients

BACKGROUND

The presence of cardiophrenic angle lymph node (CPALN) has been associated with the risk of peritoneal carcinomatosis (PC) in high risk colon cancer patients. Its accuracy to predict PC and its prognostic value in non-selected CRC patients has not been validated prospectively.

METHODS

From 2011 to 2013, all patients undergoing colectomy for colon cancer were included prospectively. Presence of CPALN was assessed on preoperative computed tomography scan by two radiologists. Surgical exploration was used as reference for the diagnosis of PC. Factors associated with presence of CPALN and progression-free survival were analyzed.

RESULTS

Ninety one patients fulfilled inclusion criteria. CPALN was detected in 36 patients (39.5%) on CT scan. At surgical exploration, PC was found in 6 patients (6.5%). Sensitivity, specificity, negative predictive value, positive predictive value and overall accuracy of CPALN on CT scan for predicting PC were 67%, 62%, 96%, 11% and 63% respectively. In multivariate analysis, the presence of distant metastases whatever the site was associated with the presence of CPALN (p = 0.03; hazard ratio HR = 3.8; confidence interval CI 95% = 1.1-13.3). In the multivariate analysis, only vascular involvement (p = 0.034, HR = 3.574, CI 95% = 1.10-11.60) was associated with progression-free survival whereas CPALN was not found to predict outcome (p = 0.893).

CONCLUSION

CPALN is a common finding in non-selected colon cancer patients. Although in the absence of CPALN, PC can almost be excluded, its value for the diagnosis of PC is limited. Our findings support that CPALN is mainly an indicator of metastatic spread of the tumor.