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Iguchi T, Matsui Y, Tomita K, Uka M, Umakoshi N, Kawabata T, Gobara H, Araki M, Hiraki T. Ablation of Kidney Tumors in Patients with Substantial Kidney Impairment: Current Status. Curr Oncol Rep 2024; 26:573-582. [PMID: 38625653 DOI: 10.1007/s11912-024-01533-6] [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] [Accepted: 04/08/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE OF REVIEW To review the current status of kidney tumor ablation in patients with substantial kidney impairment. RECENT FINDINGS Few reports of kidney tumor ablation in such patients have recently been published. The reported prevalence of patients with stage 4 or 5 chronic kidney disease (CKD) among patients undergoing ablation is 2.0%-10%. In patients with stage 4 or 5 CKD, local tumor control rates were 88%-100%. The effect of ablation on CKD stage is unclear, and the observed deteriorations in kidney function are consistent with both the effect of cryoablation and the natural course of advanced CKD. According to guidelines, active surveillance may be selected. The goals of treatment are complete tumor removal and maintenance of kidney function, both of which can be met by ablation. Given the limited treatment options, ablation may play a pivotal role in the management of patients with advanced CKD.
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Affiliation(s)
- Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama, 700-8558, Japan.
- Department of Radiology, Okayama University Hospital, Okayama, Japan.
| | - Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Hideo Gobara
- Department of Radiology, Okayama University Hospital, Okayama, Japan
- Division of Medical Informatics, Okayama University Hospital, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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2
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Huang ML, Lane DL, Bomar H, Kuerer H. Breast cryoablation for the palliative treatment of indolent subtype of multicentric triple-negative breast cancer. BMJ Case Rep 2024; 17:e259465. [PMID: 38627044 PMCID: PMC11029424 DOI: 10.1136/bcr-2023-259465] [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: 04/19/2024] Open
Abstract
Breast cryoablation for palliative and curative treatment of breast cancer has been performed for decades. Although there is a recent resurgence of interest in breast cryoablation with curative intent for unifocal, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, this report highlights the essential role that cryoablation can play in the palliative treatment of multicentric oestrogen and progesterone receptor-negative and human epidermal growth factor receptor 2-negative (triple-negative) breast cancer, meeting the select pretreatment objectives such as breast or nipple pain relief and prevention of tumour erosion through the skin or nipple in patients who have failed or cannot tolerate the standard of care treatment.
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Affiliation(s)
- Monica L Huang
- Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Deanna L Lane
- Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hannah Bomar
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Henry Kuerer
- Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Andrade JG, Moss JWE, Kuniss M, Sadri H, Wazni O, Sale A, Ismyrloglou E, Chierchia GB, Kaplon R, Mealing S, Bainbridge J, Bromilow T, Lane E, Khaykin Y. The Cost-Effectiveness of First-Line Cryoablation vs First-Line Antiarrhythmic Drugs in Canadian Patients With Paroxysmal Atrial Fibrillation. Can J Cardiol 2024; 40:576-584. [PMID: 38007219 DOI: 10.1016/j.cjca.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND The EARLY-AF (NCT02825979), STOP AF First (NCT03118518), and Cryo-FIRST (NCT01803438) randomised controlled trials (RCTs) demonstrated that cryoballoon pulmonary vein isolation reduces atrial fibrillation (AF) recurrence compared with antiarrhythmic drugs (AADs) in patients with symptomatic paroxysmal atrial fibrillation (PAF). The present study developed a cost-effectiveness model (CEM) of first-line cryoablation compared with first-line AADs for PAF, from the Canadian health care payer's perspective. METHODS Data from the 3 RCTs were analysed to estimate key CEM parameters. The model structure used a decision tree for the first 12 months and a Markov model with a 3-month cycle length for the remaining lifetime time horizon. Costs were set at 2023 Canadian dollars, health benefits were expressed as quality-adjusted life years (QALYs), and both were discounted 3% annually. Probabilistic sensitivity analysis (PSA) considered parameter uncertainty. RESULTS The statistical analysis estimated that first-line cryoablation generates a 47% reduction (P < 0.001) in the rate of AF recurrence, a 73% reduction in the rate of subsequent ablation (P < 0.001), and a 4.3% (P = 0.025) increase in health-related quality of life, compared with first-line AADs. The PSA indicates that an individual treated with first-line cryoablation accrues less costs (-$3,862) and more QALYs (0.19) compared with first-line AADs. Cryoablation is cost-saving in 98.4% of PSA iterations and has a 99.9% probability of being cost-effective at a cost-effectiveness threshold of $50,000 per QALY gained. Cost-effectiveness results were robust to changes in key model parameters. CONCLUSIONS First-line cryoballoon ablation is cost-effective when compared with AADs for patients with symptomatic PAF.
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Affiliation(s)
- Jason G Andrade
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joe W E Moss
- York Health Economics Consortium, York, United Kingdom
| | - Malte Kuniss
- Kerckhoff Clinic Heart Centrum, Department of Cardiology, Bad Nauheim, Germany
| | | | | | | | | | | | | | | | | | - Tom Bromilow
- York Health Economics Consortium, York, United Kingdom
| | - Emily Lane
- York Health Economics Consortium, York, United Kingdom
| | - Yaariv Khaykin
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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Pena OD, Harrison MR, Kim CY. Cryoablation of a Large Diaphragmatic Metastasis with Long-Term Follow-Up. Cardiovasc Intervent Radiol 2024; 47:524-526. [PMID: 38409558 DOI: 10.1007/s00270-024-03668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Affiliation(s)
| | - Michael R Harrison
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Charles Y Kim
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC, 27710, USA.
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Penfold MP, Cannon BC, Wackel PL. Empiric Slow Pathway Cryoablation in Symptomatic Children Without Documented Supraventricular Tachycardia. Pediatr Cardiol 2024; 45:921-925. [PMID: 36462026 DOI: 10.1007/s00246-022-03065-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
In symptomatic children without documented supraventricular tachycardia (SVT) and non-inducible atrioventricular nodal reentry tachycardia (AVNRT) the benefit of empiric slow pathway (SP) ablation is unknown. We evaluated 62 symptomatic patients without documented SVT that underwent electrophysiology study (EPS). The purpose of this study was to determine if symptoms improved after empiric SP ablation in children without documented SVT and without inducible AVNRT. Sixty-two symptomatic patients without previously documented SVT underwent EPS; 31 (50%) had inducible AVNRT and underwent SP ablation, 20 (32%) were non-inducible and underwent empiric SP ablation, 11 (18%) were non-inducible and had no ablation. After a mean follow-up of 23 ± 18 months there was no significant difference in freedom from symptoms within the non-inducible cohort regardless of whether empiric SP ablation was performed (p = 0.135). There was a significant improvement in symptoms at follow-up after SP ablation when comparing inducible and non-inducible patients (p = 0.020). During follow-up no patients had documented SVT. Symptomatic children without documented SVT do not benefit from empiric SP ablation when AVNRT cannot be induced.
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Affiliation(s)
- Michael P Penfold
- Department of Pediatrics, Mayo Clinic, Rochester, MN, 200 1st SW55901, USA.
| | - Bryan C Cannon
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
| | - Philip L Wackel
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, 200 1 st SW55901, USA
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Das G, Singam A, Chakole V, Das S, Sharma V. Efficacy and Safety of Cryoablation Compared with Cooled Radiofrequency Ablation of Genicular Nerves in Advanced Osteoarthritis of the Knee: A Study Protocol of Single-Centric, Assessor-Blinded, Randomized, Parallel-Group, Non-inferiority Study. Cardiovasc Intervent Radiol 2024; 47:508-514. [PMID: 38528172 DOI: 10.1007/s00270-024-03703-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/29/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE In patients with symptomatic osteoarthritis knee (OAK), cryoneurolysis (CRYO) and cooled radiofrequency ablation (C-RFA) are reported to be effective and safe; however, they have not been compared directly. The objective of this study is to compare CRYO and C-RFA of the genicular nerve (GN) in terms of efficacy and safety profile in patients with Kellgren and Lawrence (KL) grade ≥ 3 OAK. METHODS This single-centric, assessor-blinded, randomized, parallel-group, non-inferiority study will include 80 patients with KL grade ≥ 3 OAK. The patients with ≥ 50% pain relief on diagnostic block of three GNs will be randomized to one of the two groups, i.e., CRYO (n = 40) or C-RFA (n = 40). The three target GNs for the interventions will include: superior medial, superior lateral, and inferior medial. The primary outcome will be efficacy of CRYO or C-RFA at 2, 12, and 24 weeks post-procedure based on the 11-point Numerical Pain Rating Scale. The secondary outcomes will be functional improvement based on 12-item Oxford Knee Score and safety of both the procedures. The study is registered in the Clinical Trials Registry-India. CONCLUSION CRYO and C-RFA provide pain relief and improve functional outcome by preventing transmission of pain signals, though by distinct mechanisms. While C-RFA is an established treatment modality, recent evidence supports CRYO in patients with OAK. This study intends to demonstrate non-inferiority of CRYO against C-RFA, thereby supporting the use of CRYO as an additional treatment modality in patients with KL grade ≥ 3 OAK.
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Affiliation(s)
- Gautam Das
- Department of Pain Medicine, Daradia: The Pain Clinic, Kolkata, West Bengal, 700067, India
| | - Amol Singam
- Department of Anesthesia & Pain Medicine, JNMC, Wardha, Maharashtra, 442005, India
| | - Vivek Chakole
- Department of Anesthesia & Pain Medicine, JNMC, Wardha, Maharashtra, 442005, India
| | - Sushpa Das
- Department of Pain Medicine, Daradia: The Pain Clinic, Kolkata, West Bengal, 700067, India
| | - Vikas Sharma
- Department of Academic Research, Maverick Medicorum®, 601, Shiv Ganga Apartment, Beltarodi, Nagpur, Maharashtra, 440034, India.
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Jensen CG, Dybdahl M, Valtersson J, Mussmann BR, Duus LA, Junker T, Pietersen PI, Lund L, Welch BT, Graumann O. Percutaneous Image-Guided Cryoablation of Endophytic Renal Cell Carcinoma. Cardiovasc Intervent Radiol 2024; 47:453-461. [PMID: 38483602 PMCID: PMC10997531 DOI: 10.1007/s00270-023-03633-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 04/07/2024]
Abstract
PURPOSE Endophytic renal cancer treatment is a challenge. Due to difficulties in endophytic tumor visualization during surgical extirpation, image-guided percutaneous cryoablation (PCA) is an attractive alternative. The minimally invasive nature of PCA makes it favorable for comorbid patients as well as patients in which surgery is contraindicated. Oncological outcomes and complications after PCA of endophytic biopsy-proven renal cell carcinoma (RCC) were reviewed in this study. MATERIALS AND METHODS Patients were included after a multidisciplinary team conference from January 2015 to November 2021. Inclusion criteria were endophytic biopsy-proven T1 RCC treated with PCA with one year of follow-up. Complications were reported according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification system and the Clavien-Dindo classification (CDC) system. Major complications were defined as a grade ≥ 3 according to the CDC. RESULTS Fifty-six patients were included with a total of 56 endophytic tumors treated during 61 PCA sessions. The median RENAL nephrometry score was 9 (IQR 2), and the mean tumor size was 25.7 mm (SD ± 8.9 mm). Mean hospitalization time was 0.39 (SD ± 1.1) days. At a mean follow-up of 996 days (SD ± 559), 86% of tumors were recurrence free after one PCA. No patients progressed to metastatic disease. According to the CIRSE classification, 10.7% (n = 6) had grade 3 complications, and 5.4% (n = 3) had CDC major complications. CONCLUSION This study demonstrates that PCA of endophytic biopsy-proven T1 RCC is safe with few major complications and excellent local tumor control rates at almost three-year mean follow-up. LEVEL OF EVIDENCE 3: Retrospective cohort study.
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Affiliation(s)
- Christian Greve Jensen
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Marco Dybdahl
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - John Valtersson
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
| | - Bo Redder Mussmann
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Louise Aarup Duus
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Theresa Junker
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Urology, OUH, Odense, Denmark
| | - Pia Iben Pietersen
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark
- Department of Radiology, OUH, Odense, Denmark
| | - Lars Lund
- Department of Urology, OUH, Odense, Denmark
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Ole Graumann
- Faculty of Health Sciences, Medicine, University of Southern Denmark (SDU), Odense, Denmark.
- Research and Innovation Unit of Radiology - UNIFY, SDU, Odense, Denmark.
- Department of Radiology, Aarhus University, Arhus, Denmark.
- Aarhus University, Arhus, Denmark.
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Clark R, Reznik SI. An Order of Ice to Go. Ann Thorac Surg 2024; 117:837-838. [PMID: 37302453 DOI: 10.1016/j.athoracsur.2023.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Rachael Clark
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Scott I Reznik
- Division of General Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MC 8879, Dallas, TX 75390.
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Kataoka N, Imamura T. How to assess left atrial wall thickness and clinical outcomes in the candidates of cryoballoon ablation for atrial fibrillation. J Interv Card Electrophysiol 2024; 67:435. [PMID: 38078992 DOI: 10.1007/s10840-023-01712-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 04/14/2024]
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
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Liu Y, Ye F, Yang C, Jiang H. Use of in vivo Raman spectroscopy and cryoablation for diagnosis and treatment of bladder cancer. Spectrochim Acta A Mol Biomol Spectrosc 2024; 308:123707. [PMID: 38043292 DOI: 10.1016/j.saa.2023.123707] [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] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
Transurethral resection of bladder tumor (TURBT) is the first-line treatment option for non-muscle invasive bladder cancer (NMIBC), but residual tumor often remains after TURBT, thereby leading to cancer recurrence. Here, we introduce combined use of in vivo Raman spectroscopy and in vivo cryoablation as a new approach to detect and remove residual bladder tumor during TURBT. Bladder cancer (BCa) patients treated with TURBT at our urological department between Dec 2019 and Jan 2021 were collected. First, Raman signals were collected from 74 BCa patients to build reference spectra of normal bladder tissue and of bladder cancers of different pathological types. Then, another 53 BCa patients were randomly categorized into two groups, 26 patients accepted traditional TURBT, 27 patients accepted TURBT followed by Raman scanning and cryoablation if Raman detected existence of residual tumor. The recurrence rates of the two groups until Oct 2022 were compared. Raman was capable of discriminating normal bladder tissue and BCa with a sensitivity and specificity of 90.5% and 80.8 %; and discriminating invasive (T1, T2) and noninvasive (Ta) BCa with a sensitivity and specificity of 83.3 % and 87.3 %. During follow-up, 2 in 27 patients had cancer recurrence in Raman-Cryoablation group, while 8 in 26 patients had cancer recurrence in traditional TURBT group. Combined use of Raman and cryoablation significantly reduced cancer recurrence (p = 0.0394). Raman and cryoablation can serve as an adjuvant therapy to TURBT to improve therapeutic effects and reduce recurrence rate.
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Affiliation(s)
- Yufei Liu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.
| | - Fangdie Ye
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai 200040, China.
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Shen L, Tan H, Nie J, Jiang Y, Nuerhashi G, Qi H, Cao F, Wen C, Chen S, Zhang T, Zheng W, Liu P, Liu Y, Huang T, Li D, Zhang X, Fan W. Size selection of intrahepatic lesions for cryoablation contributes to abscopal effect and long-term survival in patients with liver metastatic melanoma receiving PD-1 blockade therapy. Cancer Immunol Immunother 2024; 73:68. [PMID: 38430269 PMCID: PMC10908608 DOI: 10.1007/s00262-024-03637-1] [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: 12/10/2023] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES In this study, we aimed to examine parameters of cryoablation, tumor characteristics, and their correlations with distant tumor response and survival of liver metastatic melanoma patients receiving cryoablation and PD-1 blockade (cryo-PD-1) combination treatment. MATERIALS AND METHODS A retrospective study was conducted among 45 melanoma patients who received combined PD-1 blockade therapy and cryoablation for liver metastasis from 2018 to 2022. Cox regression was utilized to determine the associations between factors and overall survival (OS). Changes in cytokines and immune cell compositions in peripheral blood samples following the combined treatment were investigated, along with their correlations with treatment response. RESULTS The mean cycle of cryo-PD-1 combination treatment was 2.2 (range, 1-6), and the 3-month overall response rate (RECIST 1.1 criteria) was 26.7%. Of the 21 patients who failed previous PD-1 blockade therapy after diagnosis of liver metastasis, 4 (19.0%) achieved response within 3 months since combination treatment. The diameter of ablated lesion ≤ 30 mm, metastatic organs ≤ 2, and pre-treatment LDH level ≤ 300 U/L were independent prognostic factors for favorable OS. Further analysis showed patients with intrahepatic tumor size of 15-45 mm, and ablated lesion size of ≤ 30 mm had significantly higher 3-month response rate (42.9% vs 12.5%; P = 0.022) and survival time (30.5 vs 14.2 months; P = 0.045) than their counterparts. The average increase in NLR among patients with ablated tumor size of ≤ 3 cm and > 3 cm were 3.59 ± 5.01 and 7.21 ± 12.57, respectively. The average increase in serum IL-6 levels among patients with ablated tumor size of ≤ 3 cm and > 3 cm were 8.62 ± 7.95 pg/ml and 15.40 ± 11.43 pg/ml, respectively. CONCLUSION Size selection of intrahepatic lesions for cryoablation is important in order to achieve abscopal effect and long-term survival among patients with liver metastatic melanoma receiving PD-1 blockade therapy.
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Affiliation(s)
- Lujun Shen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Hongtong Tan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Juan Nie
- Department of Research & Education, Guangzhou Concord Cancer Center, Guangzhou, 510054, People's Republic of China
| | - Yiquan Jiang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Gulijiayina Nuerhashi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Han Qi
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Fei Cao
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Chunyong Wen
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Shuanggang Chen
- Department of Oncology, Yuebei People's Hospital, Shaoguan, 511100, People's Republic of China
| | - Tianqi Zhang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Wei Zheng
- Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, 400000, People's Republic of China
| | - Peng Liu
- Department of Oncology, General Hospital of Southern Theater Command, Guangzhou, 510060, People's Republic of China
| | - Ying Liu
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Tao Huang
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Dandan Li
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
- Department of Biological Therapy Center, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China
| | - Xiaoshi Zhang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- Department of Biological Therapy Center, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
| | - Weijun Fan
- Department of Minimally Invasive Interventional Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People's Republic of China.
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Cheng O, Postlewait LM. De-Escalation of Multidisciplinary Breast Cancer Care with Cryoablation Therapy: Navigating Novel Therapeutics, Ethics, and Outcomes. Ann Surg Oncol 2024; 31:1433-1435. [PMID: 38185731 DOI: 10.1245/s10434-023-14784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Olivia Cheng
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA
| | - Lauren M Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
- Breast Cancer Program, Georgia Cancer Center for Excellence, Grady Health System, Atlanta, GA, USA.
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13
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Marcelin C, Brun JL, Caprais J, Molina-Andreo I, Jambon E, Le Bras Y, Hocké C, Grenier N. Percutaneous cryoablation of symptomatic uterine adenomyomas: Initial experience. J Gynecol Obstet Hum Reprod 2024; 53:102727. [PMID: 38237806 DOI: 10.1016/j.jogoh.2024.102727] [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] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 01/14/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVE To assess the efficacy and safety of percutaneous image-guided cryoablation of adenomyomas MATERIAL AND METHODS: Five symptomatic women who wanted to preserve their uterus and fertility underwent a single session of percutaneous image-guided cryoablation of adenomyoma. Three to six 17-gauge cryoprobes were introduced percutaneously into the adenomyoma under ultrasound and laparoscopy guidance. Clinical efficacy was defined as the diminution of the Visual Analogue Scale of pain (VAS), the decrease in uterine bleeding and the improvement of quality of life assessed by the endometriosis health profile 5 (EHP-5) 12 months after treatment. Technical efficacy was defined by the reduction in volume of each treated adenomyoma on MRI. Complications were classified using the Clavien-Dindo classification system. Hysterosonography was performed at least 3 months after the procedure. RESULTS Compared to the baseline, all symptom scores had decreased after 12 months: median VAS 8/10 (range, 5-10) to 4/10 (range, 0-7); median dyspareunia score 7/10 (range, 0-10) to 2/10 (range, 0-8); median bleeding score 335 (range, 102-920) to 76 (range, 0-88); median EHP-5 score 60/100 (range, 50-75) to 50/100 (range, 32-55). The median volume of adenomyosis decreased from 57 cm3 (range, 8-87) to 9 cm3 (range, 2-45) at 12 months. No postoperative complications occurred. Two patients had incomplete intrauterine adhesions that were easily removed hysteroscopically. CONCLUSION Cryoablation may be a promising alternative treatment for symptomatic adenomyoma in women who want to preserve their uterus.
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Affiliation(s)
- Clément Marcelin
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Jean-Luc Brun
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France.
| | - Julie Caprais
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Isabelle Molina-Andreo
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Eva Jambon
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Yann Le Bras
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Claude Hocké
- Service de chirurgie gynécologique, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Nicolas Grenier
- Service d'imagerie diagnostique et thérapeutique de l'adulte, Hôpital Pellegrin, place Amélie-Raba-Léon, 33076, Bordeaux, France
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14
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Yamasaki T, Hattori T, Pak M, Kakita K. Left atrial roof region ablation using a visually guided laser balloon. Pacing Clin Electrophysiol 2024; 47:429-432. [PMID: 37221909 DOI: 10.1111/pace.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
Balloon-based catheter ablation including visually guided laser balloon (VGLB) has been adopted a first line therapeutic strategy for the patients with atrial fibrillation (AF). Recently, the roof area ablation beyond pulmonary vein (PV) isolation (PVI) using cryoballoon has been described as an effective therapy for the patients with persistent AF. However, the roof area ablation performed with a VGLB remains unknown. In this case, we report the case of roof area ablation for the patient with persistent AF using a VGLB.
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Affiliation(s)
| | | | - Misen Pak
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
| | - Ken Kakita
- Arrhythmia Care Center, Koseikai Takeda Hospital, Kyoto, Japan
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15
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Maehara Y, Hayashi N, Hirota T, Yamada K, Miura H, Yokota T, Yamada K. Hydrodissection During Computed Tomography-Guided Cryoablation for Renal Tumors: Where is the Effective Fluid Accumulation Space in the Retroperitoneum? Cardiovasc Intervent Radiol 2024; 47:337-345. [PMID: 38351370 DOI: 10.1007/s00270-023-03641-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/01/2023] [Indexed: 03/09/2024]
Abstract
PURPOSE This study was performed to investigate the effectiveness of hydrodissection during computed tomography-guided renal cryoablation by evaluation of the fluid distribution based on the retroperitoneal anatomy with the interfascial plane. MATERIALS AND METHODS Between March 2014 and March 2021, 52 renal tumors were treated by cryoablation with hydrodissection (36 men; mean age 72.5 years). The hydrodissection needle was located in perirenal space. The spreading fluid space based on the retroperitoneal anatomy with the interfascial plane was retrospectively evaluated. The fluid space that most effectively separated the tumor from the adjacent organs was defined. The relationship of the needle tip position in the perirenal space (renal capsule or fascia side) and the most effective fluid space was also evaluated. RESULTS Cryoablation was successfully completed in all cases with no major complications. Hydrodissection was effective in all cases. The distance between the tumors and the adjacent organs was significantly longer after hydrodissection (from 7.50 ± 7.43 to 22.6 ± 9.86 mm) (P < 0.0001). Although fluid spreading through multiple retroperitoneal spaces was frequently observed, the retromesenteric plane was observed more frequently as the most effective fluid space (67.3%) than the perirenal space (21.2%) (P < 0.0001). Regardless of the needle tip position, the most effective fluid space was also commonly the retromesenteric plane. CONCLUSIONS The retromesenteric plane could be the most effective fluid space to separate the tumor from the adjacent organ, regardless of where the hydrodissection needle tip is positioned in the perirenal space. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Yosuke Maehara
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Natsuko Hayashi
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tatsuya Hirota
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kaori Yamada
- Department of Radiology, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan
| | - Hiroshi Miura
- Department of Radiology, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobicho,Kamanza-dori Marutamachi-agaru, Kamigyo-ku, Kyoto, 602-8026, Japan
| | - Tatsuya Yokota
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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16
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Som A, Rosenboom JG, Wehrenberg-Klee E, Chandler A, Ndakwah G, Chen E, Morimoto J, Kim J, Mustafa AR, Marcos-Vidal A, Fintelmann FJ, Basu A, Langer R, Traverso G, Mahmood U. Percutaneous Intratumoral Immunoadjuvant Gel Increases the Abscopal Effect of Cryoablation for Checkpoint Inhibitor Resistant Cancer. Adv Healthc Mater 2024; 13:e2301848. [PMID: 37870153 PMCID: PMC10922912 DOI: 10.1002/adhm.202301848] [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: 06/10/2023] [Revised: 09/30/2023] [Indexed: 10/24/2023]
Abstract
Percutaneous cryoablation is a common clinical therapy for metastatic and primary cancer. There are rare clinical reports of cryoablation inducing regression of distant metastases, known as the "abscopal" effect. Intratumoral immunoadjuvants may be able to augment the abscopal rate of cryoablation, but existing intratumoral therapies suffer from the need for frequent injections and inability to confirm target delivery, leading to poor clinical trial outcomes. To address these shortcomings, an injectable thermoresponsive gel-based controlled release formulation is developed for the FDA-approved Toll-like-receptor 7 (TLR7) agonist imiquimod ("Imigel") that forms a tumor-resident depot upon injection and contains a contrast agent for visualization under computed tomography (CT). The poly-lactic-co-glycolic acid-polyethylene glycol-poly-lactic-co-glycolic acid (PLGA-PEG-PLGA)-based amphiphilic copolymer gel's underlying micellar nature enables high drug concentration and a logarithmic release profile that is additive with the neo-antigen release from cryoablation, requiring only a single injection. Rheological testing demonstrated the thermoresponsive increase in viscosity at body temperature and radio-opacity via microCT. Its ability to significantly augment the abscopal rate of cryoablation is demonstrated in otherwise immunotherapy resistant metastatic tumors in two aggressive colorectal and breast cancer dual tumor models with an all or nothing response, responders generally demonstrating complete regression of bilateral tumors in 90-day survival studies.
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Affiliation(s)
- Avik Som
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Jan-Georg Rosenboom
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
- Department of Chemical Engineering, Massachusetts Institute of Technology
- Department of Medicine, Division of Gastroenterology, Brigham and Women’s Hospital
| | - Eric Wehrenberg-Klee
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
| | - Alana Chandler
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Gabrielle Ndakwah
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Eric Chen
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Joshua Morimoto
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Jonathan Kim
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
| | - Abdul Rehman Mustafa
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
| | - Asier Marcos-Vidal
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
| | - Florian J. Fintelmann
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
| | - Arijit Basu
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
| | - Robert Langer
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
- Department of Chemical Engineering, Massachusetts Institute of Technology
- Department of Mechanical Engineering, Massachusetts Institute of Technology
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology
- Department of Mechanical Engineering, Massachusetts Institute of Technology
- Department of Medicine, Division of Gastroenterology, Brigham and Women’s Hospital
| | - Umar Mahmood
- Department of Radiology, Division of Interventional Radiology, Massachusetts General Hospital
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17
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Li B, Ren ZW, Zhang C, Yu XX, Xu XX, Du Y, Yang HF. Computed tomography-guided percutaneous cryoablation and microwave ablation in the treatment of perivascular hepatocellular carcinoma: A comparative study with propensity score matching. Clin Res Hepatol Gastroenterol 2024; 48:102298. [PMID: 38367802 DOI: 10.1016/j.clinre.2024.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/13/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of cryoablation (CYA) and microwave ablation (MWA) in the treatment of patients with perivascular hepatocellular carcinoma (HCC). METHODS Patients with perivascular HCC who underwent computed tomography (CT)-guided percutaneous CYA or MVA treatment in our hospital from August 2009 to March 2019 were included. Propensity score matching (PSM) was performed to adjust for potential baseline differences in the two groups. The technical success rate (TS), complications, and visual analog scale (VAS) were analyzed. The overall survival (OS) was evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS After PSM, 32 patients from each group were selected. The technical success rate was 94 % for CYA and 91 % for MWA, and 13 patients developed recurrence (CYA, n = 5, 2 local, 3 distant; MWA, n = 8, 6 local, 2 distant). There were no significant differences in OS (36-months OS: CYA 53.1 % vs, MWA 40.6 %; P = 0.191). No intraoperative deaths or complication-related deaths were observed, and 19 patients (CYA, n = 8; MWA, n = 11) experienced complications (P = 0.435). The VAS in the MWA group (5.38 ± 1.21) was significantly higher than that in the CYA group (2.22 ± 0.87; P < 0.001). CONCLUSIONS While CYA has equal safety and high primary efficacy as MWA in the treatment of perivascular HCC, it is associated with less periprocedural pain.
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Affiliation(s)
- Bing Li
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Zi Wang Ren
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Chuan Zhang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xuan Yu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Xiao Xue Xu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Yong Du
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
| | - Han Feng Yang
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China.
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18
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Ruwald MH, Haugdal M, Worck R, Johannessen A, Hansen ML, Sørensen SK, Hansen J. Characterization of durability and reconnection patterns at time of repeat ablation after single-shot pulsed field pulmonary vein isolation. J Interv Card Electrophysiol 2024; 67:379-387. [PMID: 37776356 PMCID: PMC10902076 DOI: 10.1007/s10840-023-01655-0] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel method of cardiac ablation where there is insufficient knowledge on the durability and reconnection patterns after pulmonary vein isolation (PVI). The aim of this study was to characterize the electrophysiological findings at time of repeat procedure in real-world atrial fibrillation (AF) patients. METHODS Patients who underwent a repeat procedure (n=26) for symptomatic recurrent arrhythmias after index first-time treatment with single-shot PFA PVI (n=266) from July 2021 to June 2023 were investigated with 3D high-density mapping and ad-hoc re-ablation by radiofrequency or focal PFA. RESULTS Index indication for PVI was persistent AF in 17 (65%) patients. The mean time to repeat procedure was 292 ± 119 days. Of the 26 patients (104 veins), complete durable PVI was observed in 11/26 (42%) with a durable vein isolation rate of 72/104 (69%). Two patients (8%) had all four veins reconnected. The posterior wall was durably isolated in 4/5 (80%) of the cases. The predominant arrhythmia mechanism was AF in 17/26 (65%) patients and regular atrial tachycardia (AT) in 9/26 (35%). Reconnection was observed 9/26 (35%) in right superior, 11/26 (42%) in right inferior, 7/26 (27%) in left superior, 5/26 (19%) in left inferior, p=0.31 between veins. The gaps were significantly clustered in the right-sided anterior carina compared to other regions (P=0.009). CONCLUSIONS Durable PVI was observed in less than half of the patients at time of repeat procedure. No significant difference in PV reconnection pattern was observed, but the gap location was preferentially located at the anterior aspects of the right-sided PVs. Predominant recurrence was AF. More data is needed to establish lesion formation and durability and AT circuits after PFA.
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Affiliation(s)
- Martin H Ruwald
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark.
| | - Martin Haugdal
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Rene Worck
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Arne Johannessen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Morten Lock Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Samuel K Sørensen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Jim Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
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19
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Younes H, Rao S, Marrouche N. Deciphering connections: how is cryoablation interlinking with disease progression in atrial fibrillation ablation? Eur Heart J 2024; 45:519-521. [PMID: 38267267 DOI: 10.1093/eurheartj/ehad872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Affiliation(s)
- Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Swati Rao
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, LA 70112, USA
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discovery, Tulane University School of Medicine, New Orleans, LA 70112, USA
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20
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Shewarega A, Santana JG, Nam D, Berz A, Tefera J, Kahl V, Mishra SK, Coman D, Duncan J, Roberts SJ, Wetter A, Madoff DC, Chapiro J. Effect of Incomplete Cryoablation and Matrix Metalloproteinase Inhibition on Intratumoral CD8 + T-Cell Infiltration in Murine Hepatocellular Carcinoma. Radiology 2024; 310:e232365. [PMID: 38349244 PMCID: PMC10902598 DOI: 10.1148/radiol.232365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/09/2023] [Accepted: 12/27/2023] [Indexed: 02/15/2024]
Abstract
Background Image-guided tumor ablation is the first-line therapy for early-stage hepatocellular carcinoma (HCC), with ongoing investigations into its combination with immunotherapies. Matrix metalloproteinase (MMP) inhibition demonstrates immunomodulatory potential and reduces HCC tumor growth when combined with ablative treatment. Purpose To evaluate the effect of incomplete cryoablation with or without MMP inhibition on the local immune response in residual tumors in a murine HCC model. Materials and Methods Sixty 8- to 10-week-old female BALB/c mice underwent HCC induction with use of orthotopic implantation of syngeneic Tib-75 cells. After 7 days, mice with a single lesion were randomized into treatment groups: (a) no treatment, (b) MMP inhibitor, (c) incomplete cryoablation, and (d) incomplete cryoablation and MMP inhibitor. Macrophage and T-cell subsets were assessed in tissue samples with use of immunohistochemistry and immunofluorescence (cell averages calculated using five 1-μm2 fields of view [FOVs]). C-X-C motif chemokine receptor type 3 (CXCR3)- and interferon γ (IFNγ)-positive T cells were assessed using flow cytometry. Groups were compared using unpaired Student t tests, one-way analysis of variance with Tukey correction, and the Kruskal-Wallis test with Dunn correction. Results Mice treated with incomplete cryoablation (n = 6) showed greater infiltration of CD206+ tumor-associated macrophages (mean, 1.52 cells per FOV vs 0.64 cells per FOV; P = .03) and MMP9-expressing cells (mean, 0.89 cells per FOV vs 0.11 cells per FOV; P = .03) compared with untreated controls (n = 6). Incomplete cryoablation with MMP inhibition (n = 6) versus without (n = 6) led to greater CD8+ T-cell (mean, 15.8% vs 8.29%; P = .04), CXCR3+CD8+ T-cell (mean, 11.64% vs 8.47%; P = .004), and IFNγ+CD8+ T-cell infiltration (mean, 11.58% vs 5.18%; P = .02). Conclusion In a mouse model of HCC, incomplete cryoablation and systemic MMP inhibition showed increased cytotoxic CD8+ T-cell infiltration into the residual tumor compared with either treatment alone. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Annabella Shewarega
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Jessica G. Santana
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - David Nam
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Antonia Berz
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Jonathan Tefera
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Vinzent Kahl
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Sandeep K. Mishra
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Daniel Coman
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - James Duncan
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Scott J. Roberts
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Axel Wetter
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - David C. Madoff
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
| | - Julius Chapiro
- From the Department of Radiology and Biomedical Imaging (A.S.,
J.G.S., D.N., J.T., S.K.M., D.C., J.D., D.C.M., J.C.), Section of Digestive
Diseases, Department of Internal Medicine (S.J.R., J.C.), Section of Medical
Oncology, Department of Medicine (D.C.M.), and Section of Surgical Oncology,
Department of Surgery (D.C.M.), Yale University School of Medicine, 300 Cedar
St, The Anlyan Center, N312A, New Haven, CT 06520; Department of Diagnostic and
Interventional Radiology and Neuroradiology, University Hospital Essen, Essen,
Germany (A.S., A.W.); Department of Radiology,
Charité-Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin and Humboldt-Universität, Berlin, Germany
(A.B., V.K.); Department of Biomedical Engineering, School of Engineering
& Applied Science, Yale University, New Haven, Conn (D.C., J.D., J.C.);
and Department of Diagnostic and Interventional Radiology and Neuroradiology,
Asklepios Clinic Altona, Hamburg, Germany (A.W.)
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21
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Gemmete JJ. Partial Cryoablation and Matrix Metalloproteinase Inhibition May Be a Possible Treatment Option for Hepatocellular Carcinoma. Radiology 2024; 310:e240015. [PMID: 38349243 DOI: 10.1148/radiol.240015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Affiliation(s)
- Joseph J Gemmete
- From the Department of Radiology, University of Michigan Hospitals, 1500 E Medical Center Dr, UH B1D 328, Ann Arbor, MI 48109
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22
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Gu C, Wang X, Wang K, Xie F, Chen L, Ji H, Sun J. Cryoablation triggers type I interferon-dependent antitumor immunity and potentiates immunotherapy efficacy in lung cancer. J Immunother Cancer 2024; 12:e008386. [PMID: 38272564 PMCID: PMC10824009 DOI: 10.1136/jitc-2023-008386] [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] [Accepted: 01/11/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Cryoablation is a minimally invasive option for patients with medically inoperable non-small cell lung cancer (NSCLC) and can trigger abscopal immune-regulatory effects. However, it remains unclear how cryoablation affects the host-level immune response in NSCLC. In this study, we investigated the local and systemic immunological effects of cryoablation and the potential of combining cryoablation with programmed cell death protein 1 (PD-1) blockade to boost immunotherapy efficacy in NSCLC. METHODS We first investigated systemic immunological effects induced by cryoablation in patients with early-stage NSCLC. Subsequently, we explored cryoablation-induced antitumor immunity and the underlying biological mechanisms using KP (Kras G12D/+, Tp53 -/-) mutant lung cancer cell allograft mouse models. Moreover, the synergistic efficacy of cryoablation and PD-1 blockade was explored in both mouse models and patients with unresectable NSCLC. RESULTS We found that cryoablation significantly increased circulating CD8+ T cell subpopulations and proinflammatory cytokines in patients with early-stage NSCLC. In lung cancer cell allograft mouse models, we demonstrated that cryoablation resulted in abscopal growth inhibition of contralateral, non-ablated tumors. Integrated analysis of bulk, single-cell RNA and T cell receptor (TCR) sequencing data revealed that cryoablation reprogrammed the intratumoral immune microenvironment and increased CD8+ T cell infiltration with higher effector signature, interferon (IFN) response, and cytolytic activity. Mechanistically, cryoablation promoted antitumor effect through the STING-dependent type I IFN signaling pathway, and type I IFN signaling blockade attenuated this antitumor effect. We also found that the combination of PD-1 blockade with cryoablation further inhibited tumor growth compared with either treatment alone in an allograft mouse model. Moreover, the combination therapy induced notable tumor suppression and CD8+ T cell infiltration in patients with unresectable NSCLC. CONCLUSIONS Our results provide mechanistic insights into how cryoablation triggers the antitumor immune effect in lung cancer, thereby potentiating programmed cell death ligand 1 (PD-L1)/PD-1 blockade efficacy in the clinical treatment of NSCLC.
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Affiliation(s)
- Chuanjia Gu
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xue Wang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
| | - Kaiyu Wang
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Luonan Chen
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou, China
- Guangdong Institute of Intelligence Science and Technology, Hengqin, Zhuhai, Guangdong, China
| | - Hongbin Ji
- State Key Laboratory of Cell Biology, Shanghai Institute of Biochemistry and Cell Biology, CAS Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
- Key Laboratory of Systems Health Science of Zhejiang Province, School of Life Science, Hangzhou Institute for Advanced Study, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Hangzhou, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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23
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Liu Y, Wang L, Bao EH, Wang L, Wang JH, Yang L, Zhu PY. Perioperative, functional, and oncological outcomes after cryoablation or partial nephrectomy for small renal masses in solitary kidneys: a systematic review and meta-analysis. BMC Urol 2024; 24:19. [PMID: 38268005 PMCID: PMC10809601 DOI: 10.1186/s12894-024-01406-x] [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] [Received: 06/29/2023] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
AIM This study aims to compare the perioperative, functional, and oncological outcomes of cryoablation (CA) and partial nephrectomy (PN) for managing small renal masses in patients with solitary kidneys. The study seeks to assess the efficacy and safety of both interventions, evaluating their impact on kidney function and their ability to mitigate cancer recurrence. METHODS Searches were systematically conducted on PubMed, Scopus, EMBASE, SinoMed, and Google Scholar, identifying seven observational studies. Statistical analysis was performed using Stata v.12.0 and Review Manager version 5.2. Results for dichotomous variables are expressed using odds ratios, and weighted mean differences are used for continuous variables. RESULTS Our findings revealed that patients undergoing CA experienced significantly shorter operative time (p < 0.0001), reduced estimated blood loss (p < 0.00001), a shorter length of stay (p = 0.0001), and fewer postoperative complications (p = 0.02) compared to those undergoing PN. Although the CA group exhibited a lower transfusion rate (p = 0.69) compared with the PN group, the difference was not statistically significant. The combined data analysis demonstrated a significantly lower increase in serum creatinine levels after surgery in the CA group compared with the PN group (p = 0.003). Similarly, there was a noteworthy decrease in the estimated glomerular filtration rate after surgery in the PN group compared with the CA group (p < 0.0001). While not statistically significant, the CA group showed a lower postoperative dialysis rate (p = 0.11). Regarding oncological outcomes, the analysis revealed no significant differences between CA and PN concerning local recurrence (p = 0.2) and distant metastasis (p = 0.12), respectively. CONCLUSIONS Our analysis indicates comparable efficacy between PN and CA in controlling tumour recurrence and metastasis. However, CA is associated with superior preservation of renal function, significantly enhanced perioperative outcomes, and fewer postoperative complications. Based on our data, it can be inferred that the scope for applying CA might be expanded to encompass more patients seeking a less invasive treatment option.
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Affiliation(s)
- Ying Liu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Li Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Er-Hao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lei Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jia-Hao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lin Yang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ping-Yu Zhu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
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24
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Huang X, Xu X, Du H, Sun Q, Wu M. Meta-analysis of cryoablation versus radiofrequency ablation in the treatment of malignant liver tumors. Int J Hyperthermia 2024; 41:2300347. [PMID: 38190758 DOI: 10.1080/02656736.2023.2300347] [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] [Received: 10/05/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE A meta-analysis was conducted to assess the efficacy and safety of cryoablation (CRA) compared with radiofrequency ablation (RFA). METHODS A systematic search of PubMed, EMBASE, Cochrane Library, Wanfang, CNKI, and VIP databases was conducted to identify clinical controlled studies comparing CRA versus RFA for hepatic malignancies up to July 2022. The meta-analysis was performed using RevMan 5.3. RESULTS A comprehensive analysis was conducted on 8 clinical controlled studies involving a total of 943 patients. There were no significant differences in the incidence of complications, complete ablation of lesions, local recurrence, and 1-year survival between the CRA and RFA groups (OR = 0.98, 95%CI: 0.61-1.55, p = 0.92; OR = 1.08, 95%CI: 0.62-1.90, p = 0.78; OR = 1.28, 95%CI: 0.49-3.36, p = 0.61; and OR = 1.14, 95%CI: 0.63-2.06, p = 0.66, respectively). CONCLUSION The efficacy and safety profile of CRA was comparable to that of RFA in the context of ablation therapy for hepatic malignancies. These findings suggested that CRA may be a valuable alternative to RFA in the treatment of hepatic malignancies.
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Affiliation(s)
- Xiangzhong Huang
- Department of Interventional Radiology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin City, Jiangsu Province, China
| | - Xinjian Xu
- Department of Interventional Radiology, Jiangyin Hospital Affiliated to Nantong University, Jiangyin City, Jiangsu Province, China
| | - Hongtao Du
- Department of Radiology, Xuzhou Central Hospital, Xuzhou City, Jiangsu Province, China
| | - Qiulian Sun
- Department of Radiology, The Fifth People's Hospital of Suzhou, Suzhou City, Jiangsu Province, China
| | - Minyu Wu
- Department of Radiology, The Fifth People's Hospital of Suzhou, Suzhou City, Jiangsu Province, China
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25
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Lepor H, Rapoport E, Gogaj R, Hernandez H, Wysock JS. Patient-reported prostate cancer treatment regret following primary partial gland cryoablation. Urol Oncol 2024; 42:20.e1-20.e7. [PMID: 38065805 DOI: 10.1016/j.urolonc.2023.10.003] [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] [Received: 06/23/2023] [Revised: 09/26/2023] [Accepted: 10/16/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Prostate cancer treatment-related regret (TRR) incorporates the myriad effects of diagnosis and treatment with associated behavioral, emotional, and interpersonal changes within the context of patient values and expectations. We aimed to investigate TRR following primary partial gland cryoablation (PPGCA). METHODS Men with prostate cancer undergoing PPGCA since 3/2017 enrolled in a prospective outcome registry. Between June and August 2022, a validated prostate cancer related TRR decision scale was distributed. TRR score ≥40 was considered significant TRR. Men were considered potent if they reported ability to have penetration at least half the time sexual intercourse was initiated. Associations between significant TRR and baseline characteristics and longitudinal outcomes were assessed using logistic regressions. RESULTS Of 245 men who met inclusion criteria, 163 (67%) completed the survey with median time since cryoablation 2.3 years (IQR: 1.3, 3.6). Overall, the mean composite TRR score was 12.4/100. Significant TRR was expressed by 14% of men. Among those who were potent/had erectile function at baseline, loss of potency and erectile function were associated with higher probability of significant TRR, respectively. No associations were identified between TRR and recurrence of clinically significant prostate cancer or salvage treatment. CONCLUSIONS The overwhelming majority of men do not express TRR following PPGCA. The loss of potency or development of erectile dysfunction predisposes to TRR. It is imperative to elucidate short-, intermediate- and long-term functional and oncological outcomes in order to define factors associated with TRR to improve counseling and reduce patient regret.
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Affiliation(s)
- Herbert Lepor
- Department of Urology, NYU Grossman School of Medicine, New York, NY.
| | - Eli Rapoport
- Department of Urology, NYU Grossman School of Medicine, New York, NY
| | - Rozalba Gogaj
- Department of Urology, NYU Grossman School of Medicine, New York, NY
| | - Hunter Hernandez
- Department of Urology, NYU Grossman School of Medicine, New York, NY
| | - James S Wysock
- Department of Urology, NYU Grossman School of Medicine, New York, NY
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26
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Goto K, Miyazaki S, Nishimura T, Takamiya T, Tao S, Takigawa M, Sasano T. Can phrenic nerve injury be anticipated by larger cryoballoons? Pacing Clin Electrophysiol 2024; 47:124-126. [PMID: 37864811 DOI: 10.1111/pace.14859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
Recently, a novel size-adjustable cryoballoon has been introduced in clinical practice, which can be inflated to two different diameters (28 and 31 mm). The 31 mm cryoballoon is specifically designed to achieve better contact with remodeled pulmonary veins (PVs) that have wider ostia while avoiding deep cannulation, thereby potentially reducing the risk of phrenic nerve injury (PNI) associated with deep balloon cannulation. However, we encountered two cases of PNI during cryoballoon ablation using the novel system among our initial 25 consecutive case series. Herein, we present two cases that exhibited PNI during freezing of the right superior PV with a size-adjustable balloon. While larger balloons are expected to create a larger area of isolation, the safety of this novel balloon system needs to be evaluated in a large-scale clinical study.
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Affiliation(s)
- Kentaro Goto
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Nishimura
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Takamiya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Susumu Tao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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27
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Chen M, Zhou A, Khachemoune A. Photodynamic Therapy in Treating a Subset of Basal Cell Carcinoma: Strengths, Shortcomings, Comparisons with Surgical Modalities, and Potential Role as Adjunctive Therapy. Am J Clin Dermatol 2024; 25:99-118. [PMID: 38042767 DOI: 10.1007/s40257-023-00829-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2023] [Indexed: 12/04/2023]
Abstract
Basal cell carcinoma (BCC) is the most common skin cancer, for which there are multiple treatment options, including the gold standard Mohs micrographic surgery (MMS), surgical excision, electrodesiccation and curettage, radiation therapy, cryosurgery, and photodynamic therapy (PDT). While PDT is currently approved for treating actinic keratosis, it has been used off-label to treat BCC patients who may not tolerate surgery or other treatment modalities. We present a review of the efficacy of these modalities and describe important considerations that affect the usage of PDT and MMS. ALA-PDT and MAL-PDT are both efficacious treatment options for lower-risk BCC that can serve as non-invasive alternatives to surgical excision with favorable cosmetic outcomes in patients unsuitable to undergo surgery. In particular, PDT may be considered an adjuvant for the prevention and treatment of BCC lesions in patients with some genetic syndromes such as Gorlin syndrome, and in combination with surgical excision in lesions presenting in certain locations. Limitations to PDT include lack of margin control to prevent recurrence, pain, and cost of certain photosensitizers. Future studies should investigate the role of PDT as adjunctive therapy, standardization of protocols, and causes and ways to address recurrence following PDT treatment.
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Affiliation(s)
- Maggie Chen
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Albert Zhou
- Department of Dermatology, University of Connecticut, Farmington, CT, USA
| | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate and Veterans Affairs Medical Center, 800 Poly Pl, Brooklyn, NY, 11209, USA.
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Melkus MW, Khan SY, Cole J, Layeequr Rahman R. ASO Author Reflections: Achieving Surgical De-Escalation of Breast Cancer Through Cryoablation. Ann Surg Oncol 2024; 31:384-385. [PMID: 37755562 PMCID: PMC10695867 DOI: 10.1245/s10434-023-14335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Michael W Melkus
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sonia Y Khan
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jaclyn Cole
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rakhshanda Layeequr Rahman
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Segal O, Benady A, Pickholz E, Ovadia JE, Druckmann I, Dadia S, Rath E, Albagli A, Efrima B. MRI-based navigated cryosurgery of extra-abdominal desmoid tumors using skin fiducial markers: a case series of 15 cases. BMC Musculoskelet Disord 2023; 24:969. [PMID: 38102608 PMCID: PMC10722811 DOI: 10.1186/s12891-023-07074-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Precision surgery is becoming increasingly important in the field of Orthopaedic Oncology. Image-guided percutaneous cryosurgery (CRA) has emerged as a valid treatment modality for extra-abdominal desmoid tumors (EDTs). To date, most CRA procedures use CT-based guidance which fails to properly characterize tumor segments. Computer-guided MRI navigation can address this issue however, the lack of a fixed landmark for registration remains a challenge. Successful CRA correlates directly with precision approaches facilitated by intraoperative imaging guidance. This is the first study that attempts to assess the feasibility and efficacy of a novel approach of using skin fiducial markers to overcome the challenge of a MRI-based navigation CRA for symptomatic or progressive EDTs. METHODS In this retrospective study conducted between 2018 and 2020, 11 patients at a single center with symptomatic or progressive EDTs were treated with CRA using intraoperative MRI navigation. Fifteen cryosurgery procedures were performed, each adhering to a personalized pre-operative plan. Total tumor size, viable and non-viable portions pre- and post-operation, and SF-36 questionnaire evaluating subjective health were recorded. RESULTS All CRAs demonstrated 100% adherence to the predetermined plan. Overall, tumor size decreased Median= -56.9% [-25.6, -72.4]) with a reduction in viable tissue, (Median= -80.4% [-53.3, -95.2]). Four patients required additional CRAs. Only one patient's tumor did not reduce in size. One patient suffered from local muscle necrosis. Pre-operation, the average physical and mental scores 41.6 [29.4, 43] and 26.3 [17.6, 40.9] respectively. Post-operation, the average physical and mental scores were 53.4[38, 59.7] and 38 [31.2, 52.7] respectively. CONCLUSION These findings provide an early indication of the feasibility and efficacy of performing percutaneous cryosurgery using skin fiducial marker registration for MRI-computed navigation to treat EDTs safely. Larger cohorts and multicenter evaluations are needed to determine the efficacy of this technique.
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Affiliation(s)
- Ortal Segal
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Benady
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliana Pickholz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joshua E Ovadia
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Druckmann
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Solomon Dadia
- National Department of Orthopedic Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Levin Center for Surgical Innovation and 3D printing, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ehud Rath
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assaf Albagli
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Efrima
- Division of Orthopaedic Surgery, Tel Aviv Medical Center, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Sidhu GDS, Wissner E. Pulmonary vein isolation using the cryoballoon: is "real-time" really important? J Interv Card Electrophysiol 2023; 66:1967-1968. [PMID: 37338612 DOI: 10.1007/s10840-023-01592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Affiliation(s)
| | - Erik Wissner
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA.
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Nazarali S, Sajic D. Cryosurgery and 5-Fluorouracil Combination Therapy for Treatment of Bowen's Disease and Superficial Basal Cell Carcinoma. J Drugs Dermatol 2023; 22:1166-1171. [PMID: 38051856 DOI: 10.36849/jdd.7378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Non-melanoma skin cancer (NMSC), which includes both Bowen's disease (BD) and superficial basal cell carcinoma (sBCC), is the most commonly diagnosed cancer in Canada. BD and sBCC are amenable to minimally invasive treatments however, large-scale studies assessing long-term outcomes are lacking, particularly regarding the timing and duration of non-invasive combination treatments. OBJECTIVE Examine the clinical cure rate of BD and sBCC using a combination treatment consisting of a single cycle of cryotherapy followed by a three to four-week course of topical 5-fluorouracil (5-FU). METHODS Retrospective chart review at a single center. Inclusion criteria included histology-proven sBCC or BD treated with either a combination protocol, cryosurgery, or 5-FU alone. RESULTS 310 biopsy-confirmed cases of BD and 176 biopsy-confirmed cases of sBCC were analyzed. Of these, 229 cases of BD and 61 cases of sBCC were treated with cryosurgery and immediate 5-FU application, yielding a clearance rate of 90% and 86.9% at 6 months from initial treatment. CONCLUSION Cryosurgery followed by immediate 5-FU use may be an effective mode of treatment for BD and sBCC, negating the need for invasive procedures and allowing for increased accessibility. Further studies with longer follow-up intervals, comparisons with other non-invasive treatments, and evidence of histologic cure are required. J Drugs Dermatol. 2023;22(12):1166-1171. doi:10.36849/JDD.7378.
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De Greef Y, Sofianos D, Tijskens M, Schwagten B, Wolf M, Buysschaert I, Abugattas JP. The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection : Insights from the Middelheim-PVI Registry 2. J Interv Card Electrophysiol 2023; 66:2091-2101. [PMID: 37067765 DOI: 10.1007/s10840-023-01538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15-40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI. METHODS Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (N = 252 [31.4%]), 1 (N = 255 [31.8%]), 2 (N = 159 [19.8%]), and 3-4 (N = 137 [17.1]). RESULTS At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134-1.433; p < 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584-2.738; p < 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028-1.072; p < 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000-1.005; p = 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3-4 veins (p < 0.001). At repeat ablation (N = 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (p = 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (p = 0.047). CONCLUSION The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.
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Affiliation(s)
- Y De Greef
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium.
- Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium.
| | - D Sofianos
- Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - M Tijskens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - B Schwagten
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - M Wolf
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - I Buysschaert
- Department of Cardiology, Heart Centre AZ Sint Jan, Brugge, Belgium
| | - J P Abugattas
- Department of Cardiology, ULB Erasmus Hospital, Brussels, Belgium
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Khan SY, Cole J, Habrawi Z, Melkus MW, Layeequr Rahman R. ASO Visual Abstract: Cryoablation Allows the Ultimate De-escalation of Surgical Therapy in Select Breast Cancer Patients. Ann Surg Oncol 2023; 30:8476-8477. [PMID: 37821787 DOI: 10.1245/s10434-023-14381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Sonia Y Khan
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jaclyn Cole
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Zaina Habrawi
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michael W Melkus
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rakhshanda Layeequr Rahman
- Breast Center of Excellence and Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
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Asanuma K, Ishihara M, Nakamura T, Uchida K, Hagi T, Kageyama S, Shiku H, Sudo A. Histological Assessment of Synovial Sarcoma Before and After TCR-T Cell Therapy and Cryoablation: A Case Report. Anticancer Res 2023; 43:5737-5748. [PMID: 38030212 DOI: 10.21873/anticanres.16780] [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] [Received: 10/13/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND/AIM Cancer/testis antigens (CTAs) are well-known molecular targets with expression restricted to testicular germ cells and malignant tumors. T-cell receptor (TCR)-engineered T-cell (TCR-T) therapy against CTAs in patients with sarcoma has shown substantial progress, but resistance to TCR-T therapy remains a critical problem. In this report, we present a case of synovial sarcoma treated with TCR-T therapy targeting the New York-esophageal squamous cell carcinoma (NY-ESO)-1 protein. Histological findings were compared before and after TCR-T therapy and before and immediately after cryoablation. CASE REPORT A 68-year-old man received additional wide resection for synovial sarcoma in the left leg. Due to multiple metastases, he was enrolled in a clinical trial of TCR-T therapy for NY-ESO-1. The tumor demonstrated a 34.9% reduction in diameter. However, disease progression occurred by day 84 after TCR-T therapy. Six months after disease progression, cryoablation was performed for right posterior rib lesion and tumor specimens were obtained by needle biopsy both before and immediately after cryoablation. Ten months after the diagnosis of disease progression, the patient died. Expression levels of NY-ESO-1, human leukocyte antigen, and immune checkpoint proteins remained unchanged before and after TCR-T therapy. Beta catenin was up-regulated in recurrent tumor tissues after TCR-T therapy compared to levels observed before TCR-T therapy. Immediately after cryoablation, immunoreactivity for NY-ESO-1 showed a slightly reduction. CONCLUSION Up-regulation of beta-catenin in synovial sarcoma with recurrence after TCR-T therapy may be involved in T-cell exclusion and resistance to TCR-T therapy. Needle biopsy after cryoablation can be performed with sufficient pathological diagnostic accuracy including immunostaining.
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Affiliation(s)
- Kunihiro Asanuma
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan;
| | | | - Tomoki Nakamura
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | | | - Tomohito Hagi
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
| | - Shinichi Kageyama
- Departments of Immuno-Gene Therapy and Personalized Cancer Immunotherapy, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Shiku
- Departments of Immuno-Gene Therapy and Personalized Cancer Immunotherapy, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Sudo
- Department of Orthopedic Surgery, Mie University School of Medicine, Tsu, Japan
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Gowda PC, Dunlap RH, Ahlawat S, Gross JM, Morris CD, Lyons GR. Recurrent chondromyxoid fibroma of the distal femur treated with percutaneous cryoablation. Skeletal Radiol 2023; 52:2497-2501. [PMID: 37544967 DOI: 10.1007/s00256-023-04414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/28/2023] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
Chondromyxoid fibroma is a rare, benign tumor of the bone with excellent prognosis but a high rate of recurrence. We report a patient presenting with pain and a history of chondromyxoid fibroma of the distal left femur previously treated with multiple prior curettage and bone graft procedures. Magnetic resonance imaging and histopathology indicated a recurrence of tumor. Due to the small size of the tumor recurrence and challenges associated with prior open surgery, the patient underwent cryoablation of the lesion with computed tomography guidance. Follow-up 18 months later indicated a resolution of pain and improvement on magnetic resonance imaging, and no concerns after 20 months. To our knowledge, this is the first reported case of chondromyxoid fibroma treated with cryoablation. This case suggests cryoablation could be considered in the setting of recurrent chondromyxoid fibroma for local tumor control.
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Affiliation(s)
- Prateek C Gowda
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Robert H Dunlap
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Shivani Ahlawat
- Division of Musculoskeletal Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - John M Gross
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Carol D Morris
- Department of Orthopedic Surgery, Memorial-Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Gray R Lyons
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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Yang H, Xiang J, Shen J, Tang B, Zhang L. Global Research Trends of Cryoablation for Atrial Fibrillation from 2002 to 2022: A Bibliometric Analysis. Anatol J Cardiol 2023; 27:688-696. [PMID: 37791771 DOI: 10.14744/anatoljcardiol.2023.3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Atrial fibrillation is a common arrhythmia. Cryoablation is a treatment for atrial fibrillation, which has achieved remarkable results. But there are still many problems worthy of improvement and discussion. We aim to evaluate the scientific outputs of global cryoablation of atrial fibrillation research, providing new ideas and directions for further research. METHODS The data were retrieved from the Web of Science Core Collection on July 28, 2022. Bibliometrics tools-CiteSpace V, Microsoft Excel 2019, and the Online Analysis Platform of Literature Metrology-were used for bibliometric analysis of the published outputs. RESULTS A total of 1676 research articles were obtained from the Web of Science Core Collection published between 2002 and 2022, and the number of annual publications has gradually increased, with a slight decline in 2006-2008, 2011-2012, and 2021, reaching a peak in 2020. The institution with the highest number of research publications in this field was Asklepios Klin St. Georg, followed by Vrije Univ Brussel. The most productive researchers were Carlo De Asmundis, Gianbattista Chierchia, Pedro Brugada, Karlheinz Kuck, and Andreas Metzner. The most prolific journal has been the US publication Journal of Cardiovascular Electrophysiology, and Europace from England ranked second. The article 'Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation' ranked first among all cited articles. Burst detection analysis of top keywords suggested that follow-up, task force, trial, phrenic nerve injury, and radiofrequency ablation were research hotspots. CONCLUSION This study provides a comprehensive overview of cryoablation in atrial fibrillation research using bibliometric and visual methods, which will help researchers better understand the development status and trends in this field.
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Affiliation(s)
- Hang Yang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jie Xiang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jun Shen
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Baopeng Tang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Ling Zhang
- Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China; Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Ayerra Perez H, Barba Abad JF, Extramiana Cameno J. An Update on Focal Therapy for Prostate Cancer. Clin Genitourin Cancer 2023; 21:712.e1-712.e8. [PMID: 37258359 DOI: 10.1016/j.clgc.2023.04.013] [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] [Received: 10/11/2022] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 06/02/2023]
Abstract
Radical treatments and active surveillance are valid therapeutic approaches for low-risk prostate cancer. The oncologic effectiveness and morbidity of Radical Prostatectomy (RP) and radiotherapy have been broadly validated. Focal therapies pursue to reduce the morbidity observed after radical treatments, while preserving the oncologic effectiveness. This study aims to review the state-of-the-art about principles, oncologic effectiveness, morbidity, and side-effects associated with leading focal therapies. We review and summarize articles related with Cryotherapy, High-Intensity Focal Ultrasound (HIFU), Photodynamic Therapy (PDT), and Irreversible Electroporating (IRE) published in MEDLINE from 2000 to 2022. There is a wide heterogeneity in terms of the measurement of effectiveness and morbidity. Hence, comparing different energies, strategies and protocols seem to be unprecise and controversial. Cryosurgery and HIFU have reported more clinical experience than PDT and IRE. Biochemical recurrence rate after the first session varied from 4.5% to 23%, and up to 20% of patients underwent a salvage radical treatment. The reported incidence of erectile disfunction and urinary incontinence ranges from 3% to 50% and 0% to 34%, respectively. None randomized clinical trial comparing any focal therapy to any radical treatment has been published. We conclude that the expansion of focal therapies requires the consolidation of MRI-guided fusion biopsies in everyday clinical practice. Short-term oncologic effectiveness has been proved and supports their usefulness in low-risk patients unfit for surgical treatment. However, long-term effects and the clinical experience in intermediate and high-risk patients remains limited. Currently none of the focal therapies can be considered the Gold Standard for low-risk patients.
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Affiliation(s)
- Hector Ayerra Perez
- Department of Urology, Araba University Hospital. OSI Araba, Osakidetza, Vitoria-Gasteiz, Spain.
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de Baere T, Bonnet B, Tselikas L, Deschamps F. The percutaneous management of pulmonary metastases. J Med Imaging Radiat Oncol 2023; 67:870-875. [PMID: 37742316 DOI: 10.1111/1754-9485.13588] [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] [Received: 06/15/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Local treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non-resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image-guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five-years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one-year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.
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Affiliation(s)
- Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Baptiste Bonnet
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
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Schlageter V, Badertscher P, Luca A, Krisai P, Spies F, Kueffer T, Osswald S, Vesin JM, Kühne M, Sticherling C, Knecht S. A single-beat algorithm to discriminate farfield from nearfield bipolar voltage electrograms from the pulmonary veins. J Interv Card Electrophysiol 2023; 66:2047-2054. [PMID: 37014482 PMCID: PMC10694100 DOI: 10.1007/s10840-023-01535-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Superimposition of farfield (FF) and nearfield (NF) bipolar voltage electrograms (BVE) complicates the confirmation of pulmonary vein (PV) isolation after catheter ablation of atrial fibrillation. Our aim was to develop an automatic algorithm based on a single-beat analysis to discriminate PV NF from atrial FF BVE from a circular mapping catheter during the cryoballoon PV isolation. METHODS During freezing cycles in cryoablation PVI, local NF and distant FF signals were recorded, identified and labelled. BVEs were classified using four different machine learning algorithms based on four frequency domain (high-frequency power (PHF), low-frequency power (PLF), relative high power band, PHF ratio of neighbouring electrodes) and two time domain features (amplitude (Vmax), slew rate). The algorithm-based classification was compared to the true identification gained during the PVI and to a classification by cardiac electrophysiologists. RESULTS We included 335 BVEs from 57 consecutive patients. Using a single feature, PHF with a cut-off at 150 Hz showed the best overall accuracy for classification (79.4%). By combining PHF with Vmax, overall accuracy was improved to 82.7% with a specificity of 89% and a sensitivity of 77%. The overall accuracy was highest for the right inferior PV (96.6%) and lowest for the left superior PV (76.9%). The algorithm showed comparable accuracy to the classification by the EP specialists. CONCLUSIONS An automated farfield-nearfield discrimination based on two simple features from a single-beat BVE is feasible with a high specificity and comparable accuracy to the assessment by experienced cardiac electrophysiologists.
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Affiliation(s)
- Vincent Schlageter
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Adrian Luca
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jean-Marc Vesin
- Applied Signal Processing Group, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland.
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Costea A, Diaz JC, Osorio J, Matos CD, Hoyos C, Goyal S, Te C, D'Souza B, Rastogi M, Lopez-Cabanillas N, Ibanez LC, Thorne C, Varley AL, Zei PC, Sauer WH, Romero JE. 50-W vs 40-W During High-Power Short-Duration Ablation for Paroxysmal Atrial Fibrillation: A Multicenter Prospective Study. JACC Clin Electrophysiol 2023; 9:2573-2583. [PMID: 37804258 DOI: 10.1016/j.jacep.2023.08.005] [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] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND High-power short-duration (HPSD) radiofrequency ablation of atrial fibrillation (AF) increases first-pass pulmonary vein isolation (PVI) and freedom from atrial arrhythmias while decreasing procedural time. However, the optimal power setting in terms of safety and efficacy has not been determined. OBJECTIVES This study compared the procedural characteristics and clinical outcomes of 50-W vs 40-W during HPSD ablation of paroxysmal AF. METHODS Patients from the REAL-AF prospective multicenter registry (Real-World Experience of Catheter Ablation for Treatment of Symptomatic Paroxysmal and Persistent Atrial Fibrillation) undergoing HPSD ablation of paroxysmal AF, either using 50-W or 40-W, were included. The primary efficacy outcome was freedom from all-atrial arrhythmias. The primary safety outcome was the occurrence of any procedural complication at 12 months. Secondary outcomes included procedural characteristics, AF-related symptoms, and the occurrence of transient ischemic attack or stroke at 12 months. RESULTS A total of 383 patients were included. Freedom from all-atrial arrhythmias at 12 months was 80.7% in the 50-W group and 77.3% in the 40-W group (Log-rank P = 0.387). The primary safety outcome occurred in 3.7% of patients in the 50-W group vs 2.8% in the 40-W group (P = 0.646). The 50-W group had a higher rate of first-pass PVI (82.3% vs 76.2%; P = 0.040) as well as shorter procedural (67 minutes [IQR: 54-87.5 minutes] vs 93 minutes [IQR: 80.5-111 minutes]; P < 0.001) and radiofrequency ablation times (15 minutes [IQR: 11.4-20 minutes] vs 27 minutes [IQR: 21.5-34.6 minutes]; P < 0.001) than the 40-W group. CONCLUSIONS There was no significant difference in freedom from all-atrial arrhythmias or procedural safety outcomes between 50-W and 40-W during HPSD ablation of paroxysmal AF. The use of 50-W was associated with a higher rate of first-pass PVI as well as shorter procedural times.
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Affiliation(s)
- Alexandru Costea
- Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Ohio, USA
| | - Juan Carlos Diaz
- Cardiac Arrhythmia Center, Division of Cardiology, Las Vegas, Medellin, Colombia
| | - Jose Osorio
- Arrhythmia Institute at Grandview, Birmingham, Alabama, USA; Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Carlos D Matos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Hoyos
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Charles Te
- Oklahoma Heart Hospital, Oklahoma City, Oklahoma, USA
| | - Benjamin D'Souza
- Cardiac Arrythmia Program, Cardiology Service, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Mohit Rastogi
- Electrophysiology Department, Heart and Vascular Service, University of Maryland Capital Region Health, Lake Arbor, Maryland, USA
| | | | - Laura C Ibanez
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Allyson L Varley
- Heart Rhythm Clinical Research Solutions, Birmingham, Alabama, USA
| | - Paul C Zei
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - William H Sauer
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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41
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DeMartini WB. Calcifications, Cryoablation, and Much More. J Breast Imaging 2023; 5:633-634. [PMID: 38141242 DOI: 10.1093/jbi/wbad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Indexed: 12/25/2023]
Affiliation(s)
- Wendy B DeMartini
- Stanford University School of Medicine, Department of Radiology, Stanford, CA, USA
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42
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Nayak T, Peigh G, Chicos AB, Arora R, Kim S, Lin A, Verma N, Pfenniger A, Patil KD, Knight BP, Passman RS. Validation of the SCALE-CryoAF risk model to predict very late return of atrial fibrillation after cryoballoon ablation. J Interv Card Electrophysiol 2023; 66:1859-1865. [PMID: 36754907 PMCID: PMC9908502 DOI: 10.1007/s10840-023-01494-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND To date, few risk models have been validated to predict recurrent atrial fibrillation (AF) >1 year after ablation. The SCALE-CryoAF score was previously derived to predict very late return of AF (VLRAF) >1 year following cryoballoon ablation (CBA), with strong predictive ability. In this study, we aim to validate the SCALE-CryoAF score for VLRAF after CBA in a novel patient cohort. METHODS Retrospective analysis of a prospectively maintained single-center database was performed. Inclusion criteria were pulmonary vein isolation using CBA 2017-2020. Exclusion criteria included prior ablation, <1-year follow-up, lack of pre-CBA echocardiogram, additional ablation lesion sets, and documented AF recurrence 90-365 days post-CBA. The area under the curve (AUC) of SCALE-CryoAF was compared to the derivation value and other established risk models. RESULTS Among 469 CBA performed, 241 (61% male, 62.8 ±11.7 years old) cases were included in analysis. There were 37 (15.4%) patients who developed VLRAF. Patients with VLRAF had a higher SCALE-CryoAF score (VLRAF 5.4 ± 2.7; no VLRAF 3.1 ± 2.9; p<0.001). SCALE-CryoAF was linearly associated with VLRAF (y=14.35x-11.72, R2=0.99), and a score > 5 had a 32.7% risk of VLRAF. The SCALE-CryoAF risk model predicted VLRAF with an AUC of 0.74, which was similar to the derivation value (AUCderivation: 0.73) and statistically superior to MB-LATER, CHA2DS2-VASc, and CHADS2 scores. CONCLUSIONS The current analysis validates the ability of SCALE-CryoAF to predict VLRAF after CBA in a novel patient cohort. Patients with a high SCALE-CryoAF score should be monitored closely for recurrent AF >1 year following CBA.
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Affiliation(s)
- Tanvi Nayak
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Graham Peigh
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alexandru B Chicos
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rishi Arora
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Susan Kim
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Albert Lin
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nishant Verma
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anna Pfenniger
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kaustubha D Patil
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bradley P Knight
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rod S Passman
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Chiang J, Lee JYY, Jheng BJ, Wong TW. Cryosurgery provides a long-term disease-free survival in a patient with stage IIB acral lentiginous melanoma. Asian J Surg 2023; 46:5009-5011. [PMID: 37349174 DOI: 10.1016/j.asjsur.2023.06.051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
| | | | - Bo-Jia Jheng
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tak-Wah Wong
- Department of Dermatology, National Cheng Kung University Hospital, Taiwan; Department of Biochemistry and Molecular Biology, College of Medicine, Taiwan; Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan.
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44
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Parvinian A, Morris JM, Johnson-Tesch BA, Kurup AN. Thermoprotection of Neural Structures During Musculoskeletal Ablation. Cardiovasc Intervent Radiol 2023; 46:1495-1503. [PMID: 36944852 DOI: 10.1007/s00270-023-03407-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/25/2023] [Indexed: 03/23/2023]
Abstract
Percutaneous thermal ablation is widely used for local control and palliation of a variety of lesions throughout the musculoskeletal system. In this setting, safe ablation is predicated on the avoidance of unintentional injury to vulnerable neural structures that are often in proximity to ablation targets. This article highlights key periprocedural considerations in musculoskeletal ablation and reviews the array of active and passive thermoprotective measures that are critical to safe and successful treatment.
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Affiliation(s)
- Ahmad Parvinian
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA.
| | - Jonathan M Morris
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | | | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Bethea J, Lodhi T, Peine B, Mendes J, Sutton T, Celio A, Allman R, Nifong LW. Robotic Resection of Left Atrial Myxoma With Cryoablation of Tumor Stalk. Innovations (Phila) 2023; 18:592-594. [PMID: 37794743 DOI: 10.1177/15569845231199736] [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: 10/06/2023]
Abstract
The purpose of this report is to demonstrate robotic cryoablation of an atrial myxoma stalk as a method to prevent recurrence and preserve atrial tissue. A 38-year-old female patient was taken to the operating room, and an atrial myxoma abutting the left inferior pulmonary vein was resected robotically. This was followed by cryoablation of the tumor stalk instead of a full-thickness resection to prevent an extensive reconstruction. The operation resulted in the successful resection of an atrial myxoma with minimal length of stay. Follow-up at 3 months has shown no evidence of residual or recurrent tumor. Follow-up at 1 year is planned. Cryoablation of an atrial myxoma stalk, when resection would require complex reconstruction, is a useful tool in the armamentarium of a minimally invasive cardiac surgeon.
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Affiliation(s)
- Joseph Bethea
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Taha Lodhi
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Brandon Peine
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Jesse Mendes
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Tia Sutton
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Adam Celio
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - Robert Allman
- Division of Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA
| | - L Wiley Nifong
- Division of Cardiac Surgery, Department of Cardiovascular Sciences, East Carolina Heart Institute, Greenville, NC, USA
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46
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Zhai JW, Lv LL, Wu JJ, Zhang YX, Shen Y, Qu QX, Chen C. Combining local cryoablation with PD-L1 blockade synergistically eradicates established murine lung cancer by modulating mitochondrial in PD-1+CD8+ T cell. Immunol Lett 2023; 263:61-69. [PMID: 37805094 DOI: 10.1016/j.imlet.2023.10.002] [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] [Received: 03/20/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
Immune checkpoint blockade (ICB) has shown improvement in overall survival for lung cancer in clinical trials. However, monotherapies have limited efficacy in improving outcomes and benefit only a subset of patients. Combination therapies targeting multiple pathways can augment an immune response to improve survival further. Here, we demonstrate that combinatorial anti-PD-L1/cryoablation therapy generated a synergistic antitumor activity in the established lung cancer model. Importantly, it was observed that this favorable antitumor immune response comes predominantly from the PD-1+CD8+ T cells generated after the combination therapy, referred as improvement of IFN-γ production and mitochondrial metabolism, which resembled highly functional effectors CD8+ T cells. Notably, the cellular levels of mitochondrial reactive oxygen and mitochondria mass excessively coincided with alteration of IFN-γ secretion in PD-1+CD8+T cell subset. So far, anti-PD-L1/cryoablation therapy selectively derived the improvement of depolarized mitochondria in PD-1+CD8+T cell subset, subsequently rebuild the anti-tumor function of the exhausted CD8+ T cells. Collectively, there is considerable interest in anti-PD-L1 plus cryoablation combination therapy for patients with lung cancer, and defining the underlying mechanisms of the observed synergy.
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Affiliation(s)
- Jia-Wei Zhai
- Respiratory Department, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou 215006, China
| | - Lei-Lei Lv
- Respiratory Department, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou 215006, China
| | - Jia-Juan Wu
- Clinical Immunology Laboratory, the First Affiliated Hospital of Soochow University, 178 Ganjiang East Road, Suzhou 215006, China
| | - Yao-Xin Zhang
- Respiratory Department, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou 215006, China
| | - Yu Shen
- Clinical Immunology Laboratory, the First Affiliated Hospital of Soochow University, 178 Ganjiang East Road, Suzhou 215006, China
| | - Qiu-Xia Qu
- Clinical Immunology Laboratory, the First Affiliated Hospital of Soochow University, 178 Ganjiang East Road, Suzhou 215006, China.
| | - Cheng Chen
- Respiratory Department, the First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou 215006, China.
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47
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Lin WC, Chen PJ, Yim S, Wang HH, Liao PA, Tai CY, Yen MH. The safety and response of CT guided percutaneous cryoablation for lung nodules by 17-gauge needles. BMC Med Imaging 2023; 23:151. [PMID: 37814246 PMCID: PMC10561456 DOI: 10.1186/s12880-023-01110-6] [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] [Received: 01/15/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The safety and efficacy of 17-gauge needles used in CT-guided percutaneous cryoablation for lung nodules were explored in this study. The purpose of the study was to compare the findings with earlier research and multi-center clinical trials that used various needle sizes. METHODS Between 2016 and 2020, a retrospective study was conducted with approval from the institutional review board. A total of 41 patients were enrolled, and 71 lung nodules were treated in 63 cryoablation procedures using local anesthesia. Complication rates were recorded, and overall survival rates as well as tumor progression-free rates were calculated using the Kaplan-Meier method. RESULTS Self-limited hemoptysis was caused by 12.9% of the procedures, and drainage was required for pneumothoraces resulting from 11.3% of them. The overall survival rates at one, two, three, and four years were 97%, 94%, 82%, and 67%, respectively. The tumor progression-free rates at one, two, three, and four years were 86.2%, 77%, 74%, and 65%, respectively. CONCLUSION Cryoablation for lung nodules using 17-Gauge needles can achieve similar rates of survival and tumor control rates, similar or even lower complication rates as compared with other studies and multi-center trials using mixed sized needles.
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Affiliation(s)
- Wei-Chan Lin
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan.
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan.
| | - Po-Ju Chen
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
| | - Shelly Yim
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
| | - Hsueh-Han Wang
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Pen-An Liao
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Chia-Yu Tai
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Radiology, Cathay General Hospital, No.280 Sec 4 Ren-Ai Rd, Taipei, 10630, Taiwan
| | - Ming-Hong Yen
- School of Medicine, Fu-Jen Catholic University, New Taipei City, 24205, Taiwan
- Department of Chest Surgery, Cathay General Hospital, Taipei City, 10630, Taiwan
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48
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Sardela de Miranda F, Castro M, Remmert N, Singh SP, Layeequr Rahman R, Melkus MW. Leveraging cryoablation and checkpoint inhibitors for high-risk triple negative breast cancer. Front Immunol 2023; 14:1258873. [PMID: 37860001 PMCID: PMC10582696 DOI: 10.3389/fimmu.2023.1258873] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Breast cancer is the second most common cancer among women in the United States in which the standard of care treatment is surgery with adjunctive therapy. Cryoablation, which destroys the tumor using extremely cold temperatures while preserving the potential tumor antigens, is a promising alternative to surgical resection. It is less invasive, cosmetically appeasing, cost-effective, and capable of contributing to the abscopal effect - the immune response targeting potential distant metastasis. However, to maximize the immunologic benefit of cryoablation in biologically high-risk breast cancers, combination with therapies that enhance immune activation, such as immune checkpoint inhibitors (ICIs) may be necessary. This mini review describes the fundamentals of cryoablation and treatment with ICIs, as well as discuss the caveats in both strategies and current clinical trials aimed to improve this approach to benefit patients.
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Affiliation(s)
- Flávia Sardela de Miranda
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Department of Immunology and Molecular Microbiology, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Maribel Castro
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Nicole Remmert
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Sharda P. Singh
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Department of Internal Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Rakhshanda Layeequr Rahman
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Michael W. Melkus
- Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
- Breast Center of Excellence, Texas Tech University Health Sciences Center, Lubbock, TX, United States
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49
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Mekary W, Merchant FM. Pulsed field ablation for atrial fibrillation: Moving the field forward? J Cardiovasc Electrophysiol 2023; 34:2027-2028. [PMID: 37746920 DOI: 10.1111/jce.16078] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Wissam Mekary
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Faisal M Merchant
- Section of Cardiac Electrophysiology, Emory University School of Medicine, Atlanta, Georgia, USA
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50
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Schipper JH, Steven D, Lüker J, Wörmann J, van den Bruck JH, Filipovic K, Dittrich S, Scheurlen C, Erlhöfer S, Pavel F, Sultan A. Comparison of pulsed field ablation and cryoballoon ablation for pulmonary vein isolation. J Cardiovasc Electrophysiol 2023; 34:2019-2026. [PMID: 37682001 DOI: 10.1111/jce.16056] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) remains the cornerstone in the treatment of atrial fibrillation (AF). PVI using cryoballoon (CB) technology has emerged as a standard procedure in many centers. Recently, pulsed field ablation (PFA) has been introduced and used to achieve PVI. First data show high acute and favorable long-term outcomes. So far, data comparing these new "single shot" devices are sparse. We sought to compare procedural and outcome data for first time PFA users versus CB in patients undergoing de novo PVI. Furthermore, potentially postprocedural discomfort and affection of autonomic ganglia were assessed. METHODS AND RESULTS A retrospective analysis and comparison of all de novo PVIs with PFA and CB was performed. Furthermore, PFA PVI learning curve was evaluated. During follow-up, repeat outpatient visits and Holter electrocardiogram were performed to analyze arrhythmia-free survival. Discomfort analysis was obtained by prescribed analgesic medication within first 48 h after PVI. Potential changes in heart rate (HR) between baseline and at 3-month follow-up were evaluated. A total of 108 patients (54 PFA and 54 CB; PFA; 33 (30%) female) with paroxysmal and persistent AF were analyzed. Type of AF was comparable (Patients suffering from PAF: PFA: 16 (30%), CB: 17 (31%), p = 1.0). In 107 (99%) patients, successful PVI was achieved. Transient phrenic palsy omitted complete PVI in one CB patient. A trend for a shorter overall procedure duration was observed in the PFA group (PFA: 64.5 ± 17.5 min; CB: 73.0 ± 24.8 min; p = 0.07). Excluding LA mapping time (first 14 cases), procedure time was significantly shorter using PFA (PFA: 58.0 ± 12.5 min, CB: 73.0 ± 24.8 min, p = 0.0001). Fluoroscopy time was significantly longer for PFA (PFA: 15.3 ± 4.7 min, CB: 12.3 ± 5.3 min; p = 0.001), but significantly less contrast medium was used (PFA: 12 ± 6 mL; CB: 51 ± 29 mL, p < 0.0001). Subgroup analysis of the PFA group revealed a significant shortening of procedure duration over time (first tertile: 72.7 ± 13.5 min, second tertile: 67.3 ± 21.7 min, third tertile: 53.4 ± 9.8 min, first vs. third tertile p < 0.0001). Two cardiac tamponades occurred in the PFA group (p = 0.495), of which one was most likely related to complex transseptal puncture. In the first 48 h after PVI, the number of prescribed analgesics due to postprocedural pain was equal between both groups (PFA: 7 (13%) patients, CB: 10 (19%) patients, p = 0.598). After a FU of 273 ± 129 days, 35 of 47 patients (74%) after PFA and 36 of 50 patients (72%) after CB PVI were free of any atrial arrhythmia (HR: 0.98, p = 0.88). Only in the PFA group, a significant increase in HR 3 months after PVI was observed (pre-PVI: 61 ± 8 beats/min, post-PVI: 65 ± 9 beats/min, p = 0.008). CONCLUSION The new PFA technology is equally effective and safe as compared to CB for complete PVI with potentially shorter procedure time and significantly less contrast medium. However, AF recurrence rates after PFA PVI seem to be comparable to CB PVI.
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Affiliation(s)
- Jan-Hendrik Schipper
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Daniel Steven
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Jakob Lüker
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Jonas Wörmann
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | | | - Karlo Filipovic
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Sebastian Dittrich
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Cornelia Scheurlen
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Susanne Erlhöfer
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Friederike Pavel
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
| | - Arian Sultan
- Department of Electrophysiology, Heart Center, University of Cologne, Köln, Germany
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