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Chu NQ, Yariv O, Sihag S, Gomez D. Hybrid Approaches to Local Management of Pulmonary Metastatic Disease. Thorac Surg Clin 2025; 35:155-168. [PMID: 40246405 DOI: 10.1016/j.thorsurg.2024.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
With increasingly effective systemic therapies for stage IV disease, the addition of local control strategies for a subset of patients with limited metastatic disease has contributed to improved disease control and life prolongation. While surgery has been the mainstay strategy for local control, stereotactic ablative body radiation and percutaneous ablation techniques are alternate methods that have been demonstrated to be safe and effective and offer options to those patients who are unresectable, inoperable, or who do not desire surgery. A hybrid approach combining surgery and radiotherapy can maximize the ability to treat more lesions.
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Affiliation(s)
- Ngoc-Quynh Chu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Orly Yariv
- Thoracic Service, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Smita Sihag
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Daniel Gomez
- Thoracic Service, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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2
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van Dorp M, Gonzalez M, Ojanguren A, Brunelli A. Transcontinental Differences in Management of Pulmonary Metastatic Disease: Europe. Thorac Surg Clin 2025; 35:233-247. [PMID: 40246413 DOI: 10.1016/j.thorsurg.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Several international registries, including 4 from Europe-Italy, Spain, the Netherlands, and the European Society of Thoracic Surgeons-are dedicated to addressing deficiencies in pulmonary metastasectomy research. The randomized PulMiCC and SABR-COMET trials provide contradictory outcomes and new randomized trials have been initiated. Europe's metastasectomy approach transitioned from open thoracotomy to video-assisted thoracoscopic surgery, with 72% of surgeons favoring minimally invasive methods by 2023. European Society for Medical Oncology guidelines recommend surgery for completely resectable lesions and propose ablative approaches as supplementary or alternative treatments for inoperable cases due to frailty or unfavorable anatomy.
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Affiliation(s)
- Martijn van Dorp
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center - Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Michel Gonzalez
- Division of Thoracic Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Amaia Ojanguren
- Department of Thoracic Surgery, Bellvitge University Hospital, Barcelona, Spain
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK.
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3
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Zhu F, Yang C, Wang J, Zhou T, Li Q, Wang S, Zhao Z. The Value of Magnetic Resonance Imaging in Assessing Immediate Efficacy After Microwave Ablation of Lung Malignancies. J Thorac Imaging 2024; 39:392-398. [PMID: 39021208 PMCID: PMC11495527 DOI: 10.1097/rti.0000000000000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
PURPOSE To investigate the imaging performance and parametric analysis of magnetic resonance imaging (MRI) immediately after microwave ablation (MWA) of lung malignancies. MATERIALS AND METHODS We retrospectively analyzed the MRI performance immediately after MWA of 34 cases of lung malignancies. The ablation zone parameters of lung malignancies were measured, including the long diameter (L), short diameter (S), and safety margin of the ablation zone on plain computed tomography (CT), T1-weighted imaging (T1WI), and T2-weighted imaging (T2WI) after MWA. The study calculated the tumor volume (V 0 ), the ablation zone volume (V 1 ), and the ratio of V 0 to V 1 (V%). Statistical differences between the parameters were analyzed. RESULTS The ablation area of the lesion exhibited central low signal and peripheral high signal on T2WI, central high signal and peripheral equal or high signal on T1WI, and circumferential enhancement in the periphery. The safety margin measured on T2WI was greater than that measured on plain CT and T1WI. On plain CT, the L, S, and V 1 were smaller in the effective treatment group than in the ineffective treatment group ( P <0.05). On T1WI, the V% and safety margin were greater in the effective treatment group than in the ineffective treatment group ( P =0.009 and P =0.016, respectively). CONCLUSIONS MRI may be a new, valuable method to assess immediate efficacy after MWA for lung malignancies using the ablation zone parameters V% on T1WI and safety margin on T2WI.
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Affiliation(s)
- Fandong Zhu
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Chen Yang
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Jianyun Wang
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Tong Zhou
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Qianling Li
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Subo Wang
- Department of Radiology, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, China
| | - Zhenhua Zhao
- Department of Radiology, Shaoxing People’s Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
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4
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Tárnoki DL, Karlinger K, Ridge CA, Kiss FJ, Györke T, Grabczak EM, Tárnoki ÁD. Lung imaging methods: indications, strengths and limitations. Breathe (Sheff) 2024; 20:230127. [PMID: 39360028 PMCID: PMC11444493 DOI: 10.1183/20734735.0127-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/24/2024] [Indexed: 10/04/2024] Open
Abstract
Imaging methods are fundamental tools to detect and diagnose lung diseases, monitor their treatment and detect possible complications. Each modality, starting from classical chest radiographs and computed tomography, as well as the ever more popular and easily available thoracic ultrasound, magnetic resonance imaging and nuclear medicine methods, and new techniques such as photon counting computed tomography, radiomics and application of artificial intelligence, has its strong and weak points, which we should be familiar with to properly choose between the methods and interpret their results. In this review, we present the indications, strengths and main limitations of methods for chest imaging.
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Affiliation(s)
- Dávid László Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Oncologic Imaging and Invasive Diagnostic Centre and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
| | - Kinga Karlinger
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Carole A Ridge
- Department of Radiology, Royal Brompton and Harefield Hospitals, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Fanni Júlia Kiss
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Tamás Györke
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Elzbieta Magdalena Grabczak
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Ádám Domonkos Tárnoki
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
- Oncologic Imaging and Invasive Diagnostic Centre and the National Tumor Biology Laboratory, National Institute of Oncology, Budapest, Hungary
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5
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Alexander ES, Petre EN, Offin M, Zauderer M, Zhao K, Sotirchos V, Solomon SB, Ziv E. Safety and efficacy of percutaneous cryoablation for primary and metastatic pleural based tumors. Eur J Radiol 2024; 175:111465. [PMID: 38621339 PMCID: PMC11096016 DOI: 10.1016/j.ejrad.2024.111465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Assess safety and local tumor progression-free survival (LTPFS) of percutaneous cryoablation for pleural-based thoracic malignancies. MATERIALS AND METHODS Retrospective study of 46 patients (17 treated for palliation; 9 for oligoprogression; 20 for curative intent), with 62 pleural-based thoracic lesions, treated in 59 cryoablation sessions. Patients were treated from 9/2005-11/2021 with CryoCare CS (Varian, Irvine, CA) or IceFORCE (Boston Scientific, Marlborough, MA) systems. For tumors treated with curative intent and/or oligoprogression, LTPFS of the treated tumor(s) and overall survival (OS) were estimated using Kaplan-Meier method. Post-operative complications were reported for all sessions, including those with palliative intent; univariate analyses were used to calculate factors associated with increased complication risk. RESULTS Median number of tumors treated in a single treatment session was 1 (range 1-4). Largest dimension of the treated tumor was 2.1 cm [IQR:0.9-5 cm]. Of the 59 treatments, 98.3 % were technically successful. Median LTPFS was 14.4 (95 % CI: 9.4-25.6) months. Tumor size was a significant predictor of LTPFS (HR: 1.21, 95 % CI: 1.03-1.44, p = 0.023). Median OS was 52.4 (28.1-NR) months. Complications occurred in 28/59 sessions (47.5 %); 2/59 (3.4 %) were ≥ grade D by Society of Interventional Radiology adverse event criteria (death; hypoxia requiring supplemental oxygen upon discharge). Pain and pneumothorax were the most common complications. The length of lung parenchyma traversed was a significant predictor of pneumothorax: HR 0.48 (95 %CI: 0.14-0.83), p = 0.0024. CONCLUSION Percutaneous cryoablation for pleural lesions is associated with a long duration of local control and most complications were minor and self-limited.
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Affiliation(s)
- Erica S Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Michael Offin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Marjorie Zauderer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Vlasios Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA.
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Graveleau P, Frampas É, Perret C, Volpi S, Blanc FX, Goronflot T, Liberge R. Chest tube placement incidence when using gelatin sponge torpedoes after pulmonary radiofrequency ablation. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2024; 10:100047. [PMID: 39077729 PMCID: PMC11265417 DOI: 10.1016/j.redii.2024.100047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/01/2024] [Indexed: 07/31/2024]
Abstract
Purpose To assess the efficacy of the gelatin torpedoes embolization technique after lung neoplastic lesions percutaneous radiofrequency ablation (PRFA) to reduce chest tube placement rate and hospital length of stay, and the safety of this embolization technique. Materials and methods A total of 114 PRFA of lung neoplastic lesions performed in two centers between January 2017 and December 2022 were retrospectively reviewed. Two groups were compared, with 42 PRFA with gelatin torpedoes embolization technique (gelatin group) and 72 procedures without (control group). Procedures were performed by one of seven interventional radiologists using LeVeen CoAccess™ probe. Multivariate analyses were performed to identify risk factors for chest tube placement and hospital length of stay. Results There was a significantly lower chest tube placement rate in the gelatin group compared to the control group (3 [7.1 %] vs. 27 [37.5 %], p < 0,001). Multivariate analysis showed a significant association between chest tube placement and gelatin torpedoes embolization technique (OR: 0.09; 95 % CI: 0.02-0.32; p = 0.0006). No significant difference was found in hospital length of stay between the two groups. Multivariate analysis did not show a significant relationship between hospital length of stay and gelatin torpedoes embolization technique. No embolic complication occurred in the gelatin group. Conclusion Gelatin torpedoes embolization technique after PRFA of lung neoplastic lesions resulted in significantly reduced chest tube placement rate in our patient population. No significant reduction in hospital length of stay was observed. No major complication occurred in the gelatin group.
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Affiliation(s)
- Pauline Graveleau
- Department of Radiology, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - Éric Frampas
- Department of Radiology, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - Christophe Perret
- Department of Radiology, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
| | - Stéphanie Volpi
- Department of Radiology, Institut cancérologique de l'Ouest, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - François-Xavier Blanc
- Department of Pneumology, CHU de Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France
| | - Thomas Goronflot
- Nantes Université, CHU de Nantes, pôle hospitalo-universitaire 11: Santé publique, clinique des données, Iserm, CIC 1413, 44000 Nantes, France
| | - Renan Liberge
- Department of Radiology, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes, France
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Hung W, Tsai SC, Wu T, Tu H, Lin H, Su C, Wu Y, Lin L, Lin FC. Enhancing precision in lung tumor ablation through innovations in CT-guided technique and angle control. Thorac Cancer 2024; 15:867-877. [PMID: 38419563 PMCID: PMC11016418 DOI: 10.1111/1759-7714.15255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND This retrospective study aimed to evaluate the precision and safety outcomes of image-guided lung percutaneous thermal ablation (LPTA) methods, focusing on radiofrequency ablation (RFA) and microwave ablation (MWA). The study utilized an innovative angle reference guide to facilitate these techniques in the treatment of lung tumors. METHODS This study included individuals undergoing LPTA with the assistance of laser angle guide assembly (LAGA) at our hospital between April 2011 and March 2021. We analyzed patient demographics, tumor characteristics, procedure details, and complications. Logistic regressions were employed to assess risk factors associated with complications. RESULTS A total of 202 patients underwent ablation for 375 lung tumors across 275 sessions involving 495 ablations. Most procedures used RFA, especially in the right upper lobe, and the majority of ablations were performed in the prone position (49.7%). Target lesions were at a median depth of 39.3 mm from the pleura surface, and remarkably, 91.9% required only a single puncture. Complications occurred in 31.0% of ablations, with pneumothorax being the most prevalent (18.3%), followed by pain (12.5%), sweating (6.5%), fever (5.0%), cough (4.8%), hemothorax (1.6%), hemoptysis (1.2%), pleural effusion (2.0%), skin burn (0.6%), and air emboli (0.2%). The median procedure time was 21 min. Notably, smoking/chronic obstructive pulmonary disease emerged as a significant risk factor for complications. CONCLUSION The LAGA-assisted LPTA enhanced safety by improving accuracy and reducing risks. Overall, this investigation contributes to the ongoing efforts to refine and improve the clinical application of these thermal ablation techniques in the treatment of lung tumors.
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Affiliation(s)
- Wei‐Te Hung
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Stella Chin‐Shaw Tsai
- Superintendent OfficeTaichung MetroHarbor HospitalTaichungTaiwan
- Department of Post‐Baccalaureate Medicine, College of MedicineNational Chung Hsing UniversityTaichungTaiwan
| | - Tzu‐Chin Wu
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Hsien‐Tang Tu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic MedicineChung Shan Medical University HospitalTaichungTaiwan
| | - Huan‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
| | - Chun‐Lin Su
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Yu‐Chieh Wu
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Li‐Cheng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
| | - Frank Cheau‐Feng Lin
- School of MedicineChung Shan Medical UniversityTaichungTaiwan
- Department of Thoracic SurgeryChung Shan Medical University HospitalTaichungTaiwan
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8
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Yang R, Gu C, Xie F, Hong S, Herth FJF, Sun J. Potential of Thermal Ablation Combined with Immunotherapy in Peripheral Lung Tumors: A Review and Prospect. Respiration 2024; 103:295-316. [PMID: 38498991 DOI: 10.1159/000538383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Lung tumors are prevalent malignancies associated with a high mortality rate, imposing significant medical and societal burdens. Although immunotherapy shows promise in improving survival, response rates are relatively modest. Thermal ablation can not only eliminate tumor cells directly but also enhance antitumor immunity response, thus manifesting a remarkable propensity to synergize with immunotherapy. SUMMARY In this review, we provided a brief overview of the application of thermal ablation in peripheral lung tumors. We summarized the patient selection of thermal ablation. We highlighted the potential of thermal ablation to augment the antitumor immune response, offering a promising avenue for combined therapies. We summarized studies assessing the synergistic effects of thermal ablation and immunotherapy in preclinical and clinical settings. Lastly, we underscored the urgent issues that warrant in-depth exploration when applying thermal ablation and immunotherapy to lung tumor patients. KEY MESSAGES This review emphasized the prospects of using thermal ablation combined with immunotherapy in patients with peripheral lung tumors. However, further research is needed to enhance and optimize this treatment strategy.
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Affiliation(s)
- Rui Yang
- 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
| | - 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
| | - 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
| | - Siyuan Hong
- 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
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, German Center for Lung Research, Heidelberg, Germany
| | - 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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Posa A, Contegiacomo A, Ponziani FR, Punzi E, Mazza G, Scrofani A, Pompili M, Goldberg SN, Natale L, Gasbarrini A, Sala E, Iezzi R. Interventional Oncology and Immuno-Oncology: Current Challenges and Future Trends. Int J Mol Sci 2023; 24:ijms24087344. [PMID: 37108507 PMCID: PMC10138371 DOI: 10.3390/ijms24087344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Personalized cancer treatments help to deliver tailored and biologically driven therapies for cancer patients. Interventional oncology techniques are able to treat malignancies in a locoregional fashion, with a variety of mechanisms of action leading to tumor necrosis. Tumor destruction determines a great availability of tumor antigens that can be recognized by the immune system, potentially triggering an immune response. The advent of immunotherapy in cancer care, with the introduction of specific immune checkpoint inhibitors, has led to the investigation of the synergy of these drugs when used in combination with interventional oncology treatments. The aim of this paper is to review the most recent advances in the field of interventional oncology locoregional treatments and their interactions with immunotherapy.
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Affiliation(s)
- Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Francesca Romana Ponziani
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Ernesto Punzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Giulia Mazza
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Annarita Scrofani
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
| | - Maurizio Pompili
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 12000, Israel
| | - Luigi Natale
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Internal Medicine and Gastroenterology-Hepatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
| | - Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Gemelli 8, 00168 Rome, Italy
- Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168 Rome, Italy
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10
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Coelho DB, Santos AR, Rodrigues ME, Fernandes AC, Paquete J, Araújo D. A potentially life-threatening complication of lung metastasis thermal-ablation. Pulmonology 2023; 29:92-93. [PMID: 35864054 DOI: 10.1016/j.pulmoe.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 01/28/2023] Open
Affiliation(s)
- D B Coelho
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - A R Santos
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - M E Rodrigues
- Endocrinology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - A C Fernandes
- Oncology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - J Paquete
- Radiology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitario de Sao Joao, Porto, Portugal
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11
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Han Y, Yan X, Zhi W, Liu Y, Xu F, Yan D. Long-term outcome following microwave ablation of lung metastases from colorectal cancer. Front Oncol 2022; 12:943715. [PMID: 35936731 PMCID: PMC9354679 DOI: 10.3389/fonc.2022.943715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/27/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To retrospectively evaluate the safety and efficacy of percutaneous computed tomography (CT)-guided microwave ablation (MWA) in colorectal cancer (CRC) lung metastases, and to analyze prognostic factors. Materials and methods Data were collected from 31 patients with CRC lung metastases from May 2013 to September 2017. They had removed the CRC, no extrapulmonary metastases, no more than three metastases in the lung, the maximum diameter of the lesions was ≤3 cm, and all the lung metastases could be completely ablated. The ablation procedures were performed using a KY-2000 microwave multifunctional therapeutic apparatus. Efficacy is assessed two to four weeks after ablation, and follow-up are performed every three months for two years. The primary outcome was overall survival (OS). The secondary outcomes were progression-free survival (PFS), and complications. Cox regression analysis was used for the evaluation of the statistical significance of factors affecting the end result of MWA therapy. The Kaplan–Meier method was used for estimation of survival rates. Results A total of 45 metastatic lung lesions from CRC in 31 patients were treated with CT-guided MWA procedures. The median OS was 76 months. The one, two, three, and five-year survival rates were 93.5%, 80.6%, 61.3%, and 51.6%, respectively. Multivariate analysis showed that the primary tumor from the rectum (P = 0.009) and liver metastases at the diagnosis of lung metastases (P = 0.043) were risk factors affecting OS, while PFS was a protective factor. The median PFS was 13 months. The maximum diameter of lung metastases lesions (P = 0.004) was a risk factor. The interval between pulmonary metastases and MWA (P=0.031) was the protective factor. Pneumothorax was observed in 13 out of 36 procedures. Four patients developed pneumothorax requiring drainage tube insertion. No patient deaths occurred within 30 days of ablation. Three out of 31 patients (9.67%) were found to have local recurrence of the original lung metastatic ablation foci. Conclusion MWA therapy may be safely and effectively used as a therapeutic tool for the treatment of selected CRC pulmonary metastases, and the prognosis is better in patients without liver metastases at the diagnosis of lung metastases.
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Affiliation(s)
- Yue Han
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yue Han,
| | - Xue Yan
- Department of General Surgery, Cancer Hospital of Huanxing, Beijing, China
| | - Weihua Zhi
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye Liu
- London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Fei Xu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yan
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Lin R, Fang Y, Chen J, Lin Q, Chen J, Yan Y, Chen J, Lin Z. MR-Guided Microwave Ablation for Lung Malignant Tumor: A Single Center Prospective Study. Front Oncol 2022; 12:856340. [PMID: 35574351 PMCID: PMC9092249 DOI: 10.3389/fonc.2022.856340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives To prospectively investigate the feasibility and efficacy of MRI-guided MWA for lung malignant tumor in our single center. Materials and Methods 22 patients [mean age, 56.86 ± 13.05(23–73)years] with 23 malignant lung tumors were enrolled in the study. 21 patients had a single lesion and 1 patient had 2 lesions in the ipsilateral lung. The average maximum diameter of the lesion was 1.26 ± 0.65 (0.50-2.58)cm. Percutaneous MWA was guided by 1.5T MRI scanner using a MR-compatible microwave antenna to the target the lung lesions and ablation area was monitored intraoperatively by using a shielded MR-compatible microwave device and then follow-up. Results All patients were successfully treated under MR-guided MWA for lung tumors. Average operation time was 72.21 ± 24.99 (36–158) mins. T2WI signal intensity of the lesion gradually decreased over the course of MWA. The center of the ablated zones showed a short T1 and short T2 signals with the ring-like of long T1 and long T2 signals surrounded after immediately evaluation. No serious complications occurred. The average follow-up period was 12.89 ± 4.33 (2.0-19.6) months. Local recurrence occurred in one patient, representing a technical efficacy of 95.5% (21/22). Conclusion Magnetic resonance-guided microwave ablation for lung malignant tumor was feasible and demonstrated unique advantages in efficacy evaluation.
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Affiliation(s)
- Ruixiang Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Fang
- Nursing Department, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - QingFeng Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian Chen
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuan Yan
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jie Chen
- Department of Interventional Radiology, Sanming Second Hospital, Sanming, China
| | - Zhengyu Lin
- Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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13
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Schaarschmidt BM, Slama A, Collaud S, Okumus Ö, Steinberg H, Bauer S, Schildhaus HU, Theysohn J, Aigner C. Reversible occlusion of the pulmonary vasculature by transarterial embolisation with degradable starch microspheres: preclinical assessment in a human isolated lung perfusion model. Eur Radiol Exp 2022; 6:6. [PMID: 35118584 PMCID: PMC8814074 DOI: 10.1186/s41747-021-00255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transpulmonary embolisation (TPE) using degradable starch microspheres (DSM) is a potential approach to treat pulmonary metastases. However, there is a paucity of detailed information on perfusion dynamics. The aim of this study was to establish a human ex vivo isolated lung perfusion (ILP) model to observe and evaluate the effects of DSM-TPE in a near-physiologic setting. METHODS ILP was carried out on six surgically resected lung lobes. At baseline, computed tomography (CT), including CT perfusion imaging (CTPI), and histopathological sampling were performed (t30). DSM-TPE was initiated and increased stepwise (t45, t60, t75, and t90) to be followed by CT imaging, histopathological sampling, and pulmonary arterial pressure (PAP). After the last assessment (t90), alpha-amylase was injected into the pulmonary artery to allow for DSM hydrolysation and two additional assessments (t105; t120). Histopathological specimens were evaluated using a semiquantitative ordinal score. CTPI was used for time to peak (TTP) analysis. RESULTS After DSM administration, PAP and TTP increased significantly: PAP slope 95% confidence interval (CI) 0.104-0.483, p = 0.004; TTP t30 versus t45, p = 0.046. After the addition of alpha-amylase, functional parameters reverted to values comparable to baseline. In histopathological samples, embolisation grades increased significantly until t90 (slope 95% CI 0.027-0.066, p < 0.001) and decreased after addition of alpha-amylase (slope 95% CI -0.060-0.012, p = 0.165), CONCLUSIONS: The ILP model demonstrated successfully both the physiologic effect of DSM-TPE on human lungs and its reversibility with alpha-amylase. Thus, it can be used as a near-physiologic preclinical tool to simulate and assess later clinical approaches.
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Affiliation(s)
- Benedikt M Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - Alexis Slama
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Özlem Okumus
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
| | - Hannah Steinberg
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Sebastian Bauer
- Sarcoma Center, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Essen, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen-Ruhrlandklinik, Essen, Germany
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14
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Alzubaidi SJ, Liou H, Saini G, Segaran N, Scott Kriegshauser J, Naidu SG, Patel IJ, Oklu R. Percutaneous Image-Guided Ablation of Lung Tumors. J Clin Med 2021; 10:5783. [PMID: 34945082 PMCID: PMC8707332 DOI: 10.3390/jcm10245783] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/22/2022] Open
Abstract
Tumors of the lung, including primary cancer and metastases, are notoriously common and difficult to treat. Although surgical resection of lung lesions is often indicated, many conditions disqualify patients from being surgical candidates. Percutaneous image-guided lung ablation is a relatively new set of techniques that offers a promising treatment option for a variety of lung tumors. Although there have been no clinical trials to definitively compare its efficacy to those of traditional treatments, lung ablation is widely practiced and generally accepted to be safe and effective. Especially encouraging results have recently emerged for cryoablation, one of the newer ablative techniques. This article reviews the indications, techniques, contraindications, and complications of percutaneous image-guided ablation of lung tumors with special attention to cryoablation and its recent developments in protocol optimization.
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Affiliation(s)
- Sadeer J. Alzubaidi
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Harris Liou
- Alix School of Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA;
| | - Gia Saini
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
| | - Nicole Segaran
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
| | - J. Scott Kriegshauser
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Sailendra G. Naidu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Indravadan J. Patel
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
| | - Rahmi Oklu
- Department of Radiology, Mayo Clinic, Phoenix, AZ 85054, USA; (J.S.K.); (S.G.N.); (I.J.P.); (R.O.)
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, AZ 85054, USA; (G.S.); (N.S.)
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15
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Role of Thermal Ablation in Colorectal Cancer Lung Metastases. Cancers (Basel) 2021; 13:cancers13040908. [PMID: 33671510 PMCID: PMC7927065 DOI: 10.3390/cancers13040908] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary For a long time, surgery has been the only local treatment for pulmonary metastases. Percutaneous thermal ablation appeared in the early 2000s as a minimally invasive alternative technique to surgery for patients who were not eligible for surgery or wanted to preserve quality of life. In this review, we discuss the role of thermal ablation in the management of lung metastases of colorectal cancer, and present the main results of the literature concerning oncological outcomes (local tumor control, survival) based on 12 relevant original studies each involving a minimum of 50 patients, with a minimal follow-up of 12 months. Abstract Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
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16
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Eichhorn F, Winter H. How to handle oligometastatic disease in nonsmall cell lung cancer. Eur Respir Rev 2021; 30:30/159/200234. [PMID: 33650527 DOI: 10.1183/16000617.0234-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022] Open
Abstract
Patients with nonsmall cell lung cancer and limited metastatic disease have been defined as oligometastatic if local ablative therapy of all lesions is amenable. Evidence from different clinical retrospective series suggests that this subgroup harbours better prognosis than other stage IV patients. However, most reports have included patients with inconsistent numbers of metastases in different locations treated by a variety of invasive and noninvasive therapies. As long as further results from randomised clinical trials are awaited, treatment decision follows an interdisciplinary debate in each individual case. Surgery and radiotherapy should capture a dominant role in the treatment course offering the option of a curative-intended local therapy in combination with a systemic therapy based on an interdisciplinary decision. This review summarises the current treatment standard in oligometastatic lung cancer with focus on an ablative therapy for both lung primary and distant metastases in prognostically favourable locations.
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Affiliation(s)
- Florian Eichhorn
- Dept of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany.,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Hauke Winter
- Dept of Thoracic Surgery, Thoraxklinik, University Hospital Heidelberg, Heidelberg, Germany .,Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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17
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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18
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Guo R, Li Y, Bie Z, Li B, Li X. Pneumothorax triggered by EGFR-tyrosine kinase inhibitors in three microwave ablation candidates: A review of the literature. Thorac Cancer 2020; 11:2031-2035. [PMID: 32395860 PMCID: PMC7327680 DOI: 10.1111/1759-7714.13466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022] Open
Abstract
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are widely used in patients with EGFR‐mutant lung cancer. Meanwhile, thermal ablation such as microwave ablation has been an option for selected patients. Herein, we describe three cases of pneumothorax that occurred in microwave ablation (MWA) candidates treated with EGFR‐TKIs. The three patients developed pneumothorax in different periods: case 1 developed pneumothorax two months after MWA and subsequent gefitnib therapy; case 2 took osimertinib for two years and developed pneumothorax before MWA; case 3 took gefitinb for 13 months and experienced bronchopleural fistula after MWA. Although a causal relationship is uncertain, the risk of pneumothorax for these MWA candidates should be considered. Key points Microwave ablation candidates treated with epidermal growth factor receptor tyrosine kinase inhibitors are more likely to suffer pneumothorax. The risk of delayed pneumothorax or even bronchopleural fistula in patients pretreated with tyrosine kinase inhibitors should be taken into consideration when selecting patients and performing microwave ablations.
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Affiliation(s)
- Runqi Guo
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yuanming Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhixin Bie
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoguang Li
- Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Beijing, China.,Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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19
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Picchi SG, Lassandro G, Bianco A, Coppola A, Ierardi AM, Rossi UG, Lassandro F. RFA of primary and metastatic lung tumors: long-term results. Med Oncol 2020; 37:35. [PMID: 32219567 DOI: 10.1007/s12032-020-01361-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.
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Affiliation(s)
| | - Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Bianco
- Department of Pulmonology, Luigi Vanvitelli University, Naples, Italy
| | | | - Anna Maria Ierardi
- UOC Radiology Fondazione IRCSS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto G Rossi
- Department of Diagnostic Imaging - Interventional Radiology Unit - EO Galliera Hospital, Genoa, Italy
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20
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Venturini M, Cariati M, Marra P, Masala S, Pereira PL, Carrafiello G. CIRSE Standards of Practice on Thermal Ablation of Primary and Secondary Lung Tumours. Cardiovasc Intervent Radiol 2020; 43:667-683. [PMID: 32095842 DOI: 10.1007/s00270-020-02432-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/10/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Massimo Venturini
- Department of Diagnostic and Interventional Radiology, Circolo Hospital, Insubria University, Varese, Italy.
| | - Maurizio Cariati
- Department of Diagnostic and Interventional Radiology, ASST Santi Carlo e Paolo Hospital, Milan, Italy
| | - Paolo Marra
- Department of Radiology, Papa Giovanni XXIII Hospital Bergamo, Milano-Bicocca University, Milan, Italy
| | - Salvatore Masala
- Department of Radiology, San Giovanni Battista Hospital, Tor Vergata University, Rome, Italy
| | - Philippe L Pereira
- Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken GmbH, Heilbronn, Germany
| | - Gianpaolo Carrafiello
- Department of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
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21
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Piccioni F, Poli A, Templeton LC, Templeton TW, Rispoli M, Vetrugno L, Santonastaso D, Valenza F. Anesthesia for Percutaneous Radiofrequency Tumor Ablation (PRFA): A Review of Current Practice and Techniques. Local Reg Anesth 2019; 12:127-137. [PMID: 31824190 PMCID: PMC6900282 DOI: 10.2147/lra.s185765] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/14/2019] [Indexed: 12/17/2022] Open
Abstract
Percutaneous radiofrequency ablation (PRFA) of solid tumors is a minimally invasive procedure used to treat primary or metastatic cancer lesions via needle targeted thermal energy transfer. Some of the most common tumor lesions treated using PRFA include those within the liver, lungs and kidneys. Additionally, bone, thyroid, and breast lesions can also be treated. In most cases, this procedure is performed outside of the operating room in a specialized radiology suite. As a result, the clinician must adapt in many cases to the specific environmental issues attendant to providing anesthesia outside the operating room, including the lack of availability of an anesthesia machine in some cases, and frequently a lack of adequate scavenging and other specialized monitoring and equipment. At this time, routine practice and anesthetic prescriptions for PRFA can vary widely, ranging from patients receiving local anesthesia alone, to monitored anesthesia care, to regional anesthesia, to combined regional and general anesthesia. The choice of anesthetic technique will depend on tumor location and practitioner experience. This review aims to summarize the current state of the art in terms of anesthetic techniques for patients undergoing PRFA of solid tumors.
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Affiliation(s)
- Federico Piccioni
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Andrea Poli
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - T Wesley Templeton
- Department of Anesthesiology, Wake Forest University, Winston-Salem, NC, USA
| | - Marco Rispoli
- Anesthesia and Intensive Care Unit, V. Monaldi Hospital, Naples, Italy
| | - Luigi Vetrugno
- Anesthesia and Intensive Care Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | | | - Franco Valenza
- Department of Critical and Supportive Care, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
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Moussa AM, Ziv E, Solomon SB, Camacho JC. Microwave Ablation in Primary Lung Malignancies. Semin Intervent Radiol 2019; 36:326-333. [PMID: 31680724 DOI: 10.1055/s-0039-1700567] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality worldwide. Eighty-five percent of cases correspond to non-small cell lung cancer (NSCLC) and pivotal nonsurgical options for early-stage disease include percutaneous ablation and stereotactic body radiation therapy (SBRT). Microwave Ablation (MWA) is a locoregional treatment option that has many advantages over radiofrequency ablation and has been able to overcome the limitations of this technique in the treatment of early-stage NSCLC. In this review article, we highlight the current evidence supporting the use of MWA in patients with early-stage NSCLC and discuss the technical considerations of the procedure, including optimal patient selection and planning strategies, as well as the potential complications and reported outcomes. Finally, we mention future trends involving ablation in NSCLC, including its role in combination with SBRT in central tumors, management of post-SBRT local recurrence, and its potential as an adjuvant treatment option for patients with resistance to systemic therapy or in combination with checkpoint inhibitors.
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Affiliation(s)
- Amgad M Moussa
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Etay Ziv
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juan C Camacho
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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23
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Prud’homme C, Deschamps F, Moulin B, Hakime A, Al-Ahmar M, Moalla S, Roux C, Teriitehau C, de Baere T, Tselikas L. Image-guided lung metastasis ablation: a literature review. Int J Hyperthermia 2019; 36:37-45. [DOI: 10.1080/02656736.2019.1647358] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Clara Prud’homme
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Frederic Deschamps
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Benjamin Moulin
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antoine Hakime
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Marc Al-Ahmar
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Salma Moalla
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Roux
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christophe Teriitehau
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Thierry de Baere
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Interventional Radiology Unit, Medical Imaging Department, Gustave Roussy Cancer Campus, Villejuif, France
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Barabasch A, von Stillfried S, Kuhl CK, Heinzel A, Sander A, Isfort P. Toward Transpulmonary Chemoembolization with Degradable Starch Microspheres: Systematic Analysis of Local and Systemic Effects in a Porcine Model. Cardiovasc Intervent Radiol 2019; 42:1475-1482. [PMID: 31119355 DOI: 10.1007/s00270-019-02246-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate local and systemic effects of transpulmonary chemoembolization (TPCE) with degradable starch microspheres (DSM) and doxorubicin. The long-term goal is to establish DSM-TPCE as a treatment option for pulmonary malignancies. MATERIALS AND METHODS Nine pigs underwent TPCE of either the right or left lower lobe pulmonary artery (LLPA) and bland embolization (TPE) of the contralateral LLPA. Before the procedures, macroaggregated albumin (MAA) particles were injected into both LLPAs, to exclude systemic shunting. Pulmonary arterial pressure, heart rate and oxygenation were recorded immediately before and at 1, 3, 5 and 10 min after treatment. To investigate possible nontarget embolization, animals underwent cerebral MRI (cMRI). We killed the animals after a contrast-enhanced chest computed tomography (CT) and performed a pathologic examination at 12 h (3), 24 h (3) and 72 h (3) after treatment. RESULTS All experiments were technically successful. Mean injected DSM dose until stasis was similar in TPCE and TPE (4.3 ± 1.4 vs. 4.0 ± 1.4 mL). Pulmonary arterial pressure increased significantly 3 min after treatment (TPE: 17 ± 5 vs. 27 ± 7 mmHg; TPCE: 22 ± 6 vs. 36 ± 8 mmHg). No significant changes in heart rate or peripheral oxygenation levels occurred. We observed no evidence of structural lung damage or permanent perfusion disruption on CT. MAA test injection and cMRI revealed no shunting or nontarget embolization. The pathologic assessment revealed nonspecific local inflammation of the lung parenchyma. CONCLUSION In this large-animal model, TPCE and TPE appear feasible and safe. We observed a mild increase in pulmonary arterial pressure. Nontarget embolization did not occur. TPCE, as well as TPE, did not cause structural damage to the normal lung parenchyma.
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Affiliation(s)
- A Barabasch
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - S von Stillfried
- Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - C K Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Heinzel
- Department of Nuclear Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - A Sander
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - P Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
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25
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Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol 2018; 29:1483-1501.e2. [DOI: 10.1016/j.jvir.2018.06.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 02/08/2023] Open
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Garnon J, Cazzato RL, Caudrelier J, Nouri-Neuville M, Rao P, Boatta E, Ramamurthy N, Koch G, Gangi A. Adjunctive Thermoprotection During Percutaneous Thermal Ablation Procedures: Review of Current Techniques. Cardiovasc Intervent Radiol 2018; 42:344-357. [DOI: 10.1007/s00270-018-2089-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 10/01/2018] [Indexed: 12/22/2022]
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Wang Y, Liu B, Cao P, Wang W, Wang W, Chang H, Li D, Li X, Zhao X, Li Y. Comparison between computed tomography-guided percutaneous microwave ablation and thoracoscopic lobectomy for stage I non-small cell lung cancer. Thorac Cancer 2018; 9:1376-1382. [PMID: 30152596 PMCID: PMC6209786 DOI: 10.1111/1759-7714.12842] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/21/2018] [Accepted: 07/21/2018] [Indexed: 12/12/2022] Open
Abstract
Background The study was conducted to investigate the effectiveness and cost of computed tomography (CT)‐guided percutaneous microwave ablation (MWA) and thoracoscopic lobectomy for stage I non‐small cell lung cancer (NSCLC). Methods We retrospectively analyzed the data of 46 and 85 patients with stage I NSCLC treated with CT‐guided percutaneous MWA or thoracoscopic lobectomy, respectively, at our center from July 2013 to June 2015. Overall survival (OS), disease‐free survival (DFS), local control rate, hospital stay, and cost were evaluated. Survival curves were constructed using the Kaplan–Meier method and compared using the log‐rank test. Results The one and two‐year OS rates were 97.82% and 91.30% and 97.65% and 90.59% in the MWA and lobectomy groups, respectively. The one and two‐year DFS rates were 95.65% and 76.09% and 95.29% and 75.29%, respectively. No significant differences were observed in log‐rank analysis between the groups (P = 0.169). The hospital stays in the MWA and lobectomy groups were 6.62 ± 2.31 and 9.57 ± 3.19 days, respectively. The costs of MWA and lobectomy were US$3274.50 ± US$233.91 and US$4678.87 ± US$155.96, respectively. The differences were all significant (P = 0.003). Conclusion MWA and thoracoscopic lobectomy for stage I NSCLC demonstrate similar one and two‐year OS and DFS, with no significant differences between the two groups. MWA involved a shorter hospital stay and lower cost, thus should be considered a better option for patients with severe cardiopulmonary comorbidity and patients unwilling to undergo surgery.
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Affiliation(s)
- Yongzheng Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Bin Liu
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Pikun Cao
- School of Medicine, Shandong University, Jinan, China
| | - Wujie Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Wei Wang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Haiyang Chang
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
| | - Dong Li
- School of Medicine, Shandong University, Jinan, China
| | - Xiao Li
- School of Medicine, Shandong University, Jinan, China
| | - Xiaogang Zhao
- Department of Thoracic Surgery, The Second Hospital of Shandong University, Jinan, China
| | - Yuliang Li
- Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan, China.,Interventional Oncology Institute of Shandong University, Jinan, China
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Roman A, Kaltenbach B, Gruber-Rouh T, Naguib NN, Vogl TJ, Nour-Eldin NEA. The role of MRI in the early evaluation of lung microwave ablation. Int J Hyperthermia 2017; 34:883-890. [DOI: 10.1080/02656736.2017.1377354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrei Roman
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Nagy N. Naguib
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, University of Alexandria, Alexandria, Egypt
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
| | - Nour-Eldin A. Nour-Eldin
- Department of Diagnostic and Interventional Radiology, University Hospital, Frankfurt am Main, Germany
- Department of Diagnostic and Interventional Radiology, Cairo University Hospital, Cairo, Egypt
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Cornelis F. The interventional oncologist: The fourth musketeer of cancer care. Diagn Interv Imaging 2017; 98:579-581. [DOI: 10.1016/j.diii.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Choi EJ, Jin GY. Pulmonary Embolism after Percutaneous Cryoablation for Lung Cancer: A Case Report. J Vasc Interv Radiol 2017; 28:1285-1287. [PMID: 28841935 DOI: 10.1016/j.jvir.2017.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- Eun Jung Choi
- Department of Radiology and Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, 634-18 Keumam-Dong, Jeonju, Jeonbuk 561-712, South Korea
| | - Gong Yong Jin
- Department of Radiology and Research Institute of Clinical Medicine-Biomedical Research Institute, Chonbuk National University Hospital, Chonbuk National University Medical School, 634-18 Keumam-Dong, Jeonju, Jeonbuk 561-712, South Korea
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Micropapillary and/or Solid Histologic Subtype Based on Pre-Treatment Biopsy Predicts Local Recurrence After Thermal Ablation of Lung Adenocarcinoma. Cardiovasc Intervent Radiol 2017; 41:253-259. [PMID: 28770314 DOI: 10.1007/s00270-017-1760-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND To investigate whether histologic subtyping from biopsies can predict local recurrence after thermal ablation for lung adenocarcinoma. METHODS Patients treated with CT-guided thermal ablation for lung adenocarcinoma that had pre-ablation needle biopsy with analysis of histologic components were identified. Age, gender, smoking status, treatment indication (primary stage 1 tumor versus salvage), histologic subtype, ground-glass radiographic appearance, tumor size, ablation modality, and ablation margin were evaluated in relation to time to local recurrence (TTLR). Cumulative incidence of recurrence (CIR) was calculated using competing risks analysis and compared across groups using Fine and Grey method with clustering. Multivariate analysis was conducted with stepwise regression. RESULTS There were 53 patients with 57 tumors diagnosed as adenocarcinoma on pre-ablation biopsy and with histologic subtype analysis. Of these, 19% (11) had micropapillary components, 14% (8) had solid components, and 26% (15) had micropapillary and/or solid components. In the univariate analysis, solid (subdistribution hazard ratio [SHR] = 4.04, p = 0.0051, 95% confidence interval [CI] = 1.52-10.7), micropapillary (SHR = 3.36, p = 0.01, CI = 1.33-8.47), and micropapillary and/or solid components (SHR = 5.85, p = 0.00038, CI = 2.21-15.5) were significantly correlated with shorter TTLR. On multivariate analysis, the presence of micropapillary and/or solid component (SHR = 11.4, p = 0.00021, CI: 3.14-41.3) was the only independent predictor of TTLR. The 1-, 2-, and 3-year CIR in patients with micropapillary and/or solid components was 33, 49, and 66% compared to 5, 14, and 18% in patients with no micropapillary or solid components on biopsy specimens. CONCLUSION Micropapillary and/or solid histologic components identified in pre-ablation biopsy are associated with shorter TTLR after thermal ablation of lung adenocarcinoma.
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叶 欣, 范 卫, 王 徽, 王 俊, 古 善, 冯 威, 庄 一, 刘 宝, 李 晓, 李 玉, 杨 坡, 杨 霞, 杨 武, 陈 俊, 张 嵘, 林 征, 孟 志, 胡 凯, 柳 晨, 彭 忠, 韩 玥, 靳 勇, 雷 光, 翟 博, 黄 广, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创治疗分会. [Expert Consensus for Thermal Ablation of Primary and Metastatic Lung Tumors
(2017 Edition)]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2017; 20:433-445. [PMID: 28738958 PMCID: PMC5972946 DOI: 10.3779/j.issn.1009-3419.2017.07.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- 欣 叶
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 卫君 范
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 徽 王
- 130012 长春, 吉林省肿瘤医院介入治疗中心Interventional Treatment Center, Jilin Provincial Tumor Hospital, Changchun 130012, China
| | - 俊杰 王
- 100191 北京, 北京大学第三医院放射治疗科Department of Radiation Oncology, Peking University 3rd Hospital, Beijing 100191, China
| | - 善智 古
- 410013 长沙, 湖南省肿瘤医院放射介入科Department of Interventional Therapy, Hunan Provincial Tumor Hospital, Changsha 410013, China
| | - 威健 冯
- 100045 北京, 首都医科大学附属复兴医院肿瘤科Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100045, China
| | - 一平 庄
- 210009 南京, 江苏省肿瘤医院介入科Department of Interventional Therapy, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - 宝东 刘
- 100053 北京, 首都医科大学宣武医院胸外科Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical Sciences, Beijing 100053, China
| | - 晓光 李
- 100005 北京, 北京医院肿瘤微创中心Department of Tumor Minimally Invasive Therapy, Beijing Hospital, Beijing 100005, China
| | - 玉亮 李
- 250033 济南, 山东大学第二医院介入治疗中心Interventional Treatment Center, Shandong University Second Hospital, Ji'nan 250033, China
| | - 坡 杨
- 150001 哈尔滨, 哈尔滨医科大学第四人民医院介入放射科Department of Interventional Radiology, The Fourth Hospital of Harbin Medical University, Harbin 150001, China
| | - 霞 杨
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 武威 杨
- 100071 北京, 解放军307医院肿瘤微创治疗科Department of Tumor Minimally Invasive Therapy, 307 Hospital, Beijing 100071, China
| | - 俊辉 陈
- 510060 广州, 中山大学肿瘤医院影像与微创介入中心Imaging and Interventional Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - 嵘 张
- 518036 深圳, 北京大学深圳医院微创介入科Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing University, Shenzhen 518036, China
| | - 征宇 林
- 350005 福州, 福建医科大学附属第一医院介入科Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - 志强 孟
- 200032 上海, 复旦大学肿瘤医院微创治疗科Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - 凯文 胡
- 100078 北京, 北京中医药大学东方医院肿瘤科Department of Oncology, Dongfang Hospital Affiliated to Beijing University of Chinese Medicine, Beijing 100078, China
| | - 晨 柳
- 100083 北京, 北京肿瘤医院介入治疗科Department of Interventional Therapy, Beijing Cancer Hospital, Beijing 100083, China
| | - 忠民 彭
- 250014 济南, 山东省立医院胸外科Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
| | - 玥 韩
- 100021 北京, 中国医学科学院肿瘤医院介入治疗科Department of Interventional Therapy, Tumor Institute and Hospital, Chinese Academy of Medical Sciences, Beijing 100021, China
| | - 勇 靳
- 215004 苏州, 苏州大学第二附属医院介入治疗科Department of Interventional Therapy, the Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - 光焰 雷
- 710061 西安, 陕西省肿瘤医院胸外科Department of Thoracic Surgery, Shanxi Provincial Tumor Hospital, Xi'an 710061, China
| | - 博 翟
- 200127 上海, 上海交通大学仁济医院肿瘤介入治疗科Tumor Interventional Therapy Center, Shanghai Renji Hospital, Shanghai 200127, China
| | - 广慧 黄
- 250014 济南, 山东大学附属省立医院肿瘤科Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan 250014, China
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Izaaryene J, Mancini J, Louis G, Chaumoitre K, Bartoli JM, Vidal V, Gaubert JY. Embolisation of pulmonary radio frequency pathway - a randomised trial. Int J Hyperthermia 2017; 33:814-819. [PMID: 28540802 DOI: 10.1080/02656736.2017.1309578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Pneumothorax is the most common complication following a pulmonary percutaneous radiofrequency ablation (RFA), and thoracic drainages are the most frequent causes of an extended hospital stay. Our main objective was to show that the use of gelatin torpedoes may significantly decrease the number of chest tube placement. MATERIALS AND METHODS Seventy-three patients were prospectively included in this study and then randomised into two groups: 34 with embolisation and without 39 without embolisation. Each group was comparable for different pneumothorax risk factors. RESULTS There were 16 (47%) pneumothorax in Group A ("with embolisation"), which was significantly lower (p < .0001) than the 35 pneumothorax (90%) in Group B ("without embolisation"). The pneumothorax volume (p = .02) was significantly lower in Group A (22.7% average, standard deviation 15.6%) than in Group B (average 34.1%, standard deviation 17.1%). The number of drainages was significantly smaller in those with embolisation (3 drainages or 8%) than those without embolisation (25 drainages or 64%) (p < .001). CONCLUSION When using absorbable gelatin torpedoes, pulmonary RFA pathways embolisation significantly decreased the number of pneumothorax and thoracic drainages to the advantage of therapeutic abstention and exsufflation, non-invasive and functional operational techniques.
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Affiliation(s)
| | | | | | - Kathia Chaumoitre
- c Imaging Department , North Hospital, Aix Marseille Université , Marseille , France
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Akhan O, Güler E, Akıncı D, Çiftçi T, Köse IÇ. Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors. Diagn Interv Radiol 2017; 22:65-71. [PMID: 26611111 DOI: 10.5152/dir.2015.14378] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODS Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTS Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. CONCLUSION RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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Ierardi AM, Coppola A, Lucchina N, Carrafiello G. Treatment of lung tumours with high-energy microwave ablation: a single-centre experience. Med Oncol 2016; 34:5. [PMID: 27900591 DOI: 10.1007/s12032-016-0861-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
Abstract
The purpose of our study is to report safety, technical success, effectiveness, local progression-free survival (LPFS) and overall survival of percutaneous microwave ablation (MWA) to treat lung tumours unsuitable for surgery. Nineteen patients with thirty-one tumours (mean diameter 2.4 cm) underwent percutaneous MWA in 28 sessions. Microwave ablation was carried out using a 2450-MHz generator (Emprint/Covidien, Boulder, CO, USA). Procedures were performed under cone-beam CT (CBCT) and under fluoro-CT (one session) guidance. Safety, technical success, effectiveness, LPFS and overall survival (OS) were evaluated. Safety was defined as the frequency of major and minor complications. The efficacy was evaluated on the basis of imaging characteristics, using RECIST criteria. CT follow-up was performed at 1, 3 and 6 months and yearly. LPFS was defined as the interval between MWA treatment and evidence of local recurrence, if there was any. OS was defined as the percentage of patients who were still alive. We registered one major complication (purulent hydro-pneumothorax). Minor complications were spontaneously resolved (pneumothorax and perilesional haemorrhagic effusion). Technical success was 100%. Residual disease was registered in two cases, one of whom was retreated. Complete ablation was obtained in the remaining cases (90.3%). During available follow-up (mean 9.6 months), 9/31 tumours demonstrated local recurrence. Five tumours were retreated, and none of them presented residual disease during follow-up (LPFS 22.6%). Overall survival was 93.8%. Percutaneous high-energy MWA is a safe, effective and confident technique to treat lung tumours not suitable for surgery.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Andrea Coppola
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Natalie Lucchina
- Department of Radiology, Interventional Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Via A di Rudinì 8, 20142, Milan, Italy.
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Cazzato RL, Garnon J, Ramamurthy N, Koch G, Tsoumakidou G, Caudrelier J, Arrigoni F, Zugaro L, Barile A, Masciocchi C, Gangi A. Percutaneous image-guided cryoablation: current applications and results in the oncologic field. Med Oncol 2016; 33:140. [PMID: 27837451 DOI: 10.1007/s12032-016-0848-3] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/22/2016] [Indexed: 12/12/2022]
Abstract
Percutaneous imaging-guided cryoablation (PICA) is a recently developed technique, which applies extreme hypothermia to destroy tumours under close imaging surveillance. It is minimally invasive, safe, repeatable, and does not interrupt or compromise other oncologic therapies. It presents several advantages over more established heat-based thermal ablation techniques (e.g. radiofrequency ablation; RFA) including intrinsic analgesic properties, superior monitoring capability on multi-modal imaging, ability to treat larger tumours, and preservation of tissue collagenous architecture. There has been a recent large increase in reports evaluating the utility of PICA in a wide range of patients and tumours, but systematic analysis of the literature is challenging due to the rapid pace of change and predominance of extensively heterogeneous level III studies. The precise onco-therapeutic role of PICA has not been established. This narrative review outlines the available evidence for PICA in a range of tumours. Current indications include curative therapy of small T1a renal tumours; curative/palliative therapy of small primary/secondary lung tumours where RFA is unsuitable; palliation of painful bone metastases; and urologic treatment of organ-confined prostate cancer. There is growing evidence to support its use for small hepatic tumours, and encouraging results have been obtained for breast tumours, extra-abdominal desmoid tumours, and management of higher-stage tumours and oligometastatic disease. However, the overall evidence base is weak, effectively restricting PICA to cases where standard therapy and RFA are unsuitable. As the technique and evidence continue to mature, the benefits of this emerging technique will hopefully become more widely available to cancer patients in the future.
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Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France.
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
| | - Francesco Arrigoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg), 1 Place de l'Hôpital, 67000, Strasbourg, France
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The Role of Interventional Oncology in the Management of Lung Cancer. Cardiovasc Intervent Radiol 2016; 40:153-165. [PMID: 27815575 DOI: 10.1007/s00270-016-1495-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 10/26/2016] [Indexed: 12/11/2022]
Abstract
Interventional radiological procedures for diagnosis and treatment of lung cancer have become increasingly important. Imaging-guided percutaneous biopsy has become the modality of choice for diagnosing lung cancer, and in the era of target therapies, it is an useful tool to define earlier patient-specific tumor phenotypes. In functionally inoperable patients, especially the ablative procedures are potentially curative alternatives to surgery. In addition to thermally ablative treatment, selective chemoembolization by a vascular access allows localized therapy. These treatments are considered for patients in a reduced general condition which does not allow systemic chemotherapy. The present article reviews the role of interventional oncology in the management of primary lung cancer, focusing on the state of the art for each procedure.
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Abstract
The image-guided thermal ablation procedures can be used to treat a variety of benign and malignant spinal tumours. Small size osteoid osteoma can be treated with laser or radiofrequency. Larger tumours (osteoblastoma, aneurysmal bone cyst and metastasis) can be addressed with radiofrequency or cryoablation. Results on the literature of spinal microwave ablation are scarce, and thus it should be used with caution. A distinct advantage of cryoablation is the ability to monitor the ice-ball by intermittent CT or MRI. The different thermal insulation, temperature and electrophysiological monitoring techniques should be applied. Cautious pre-procedural planning and intermittent intra-procedural monitoring of the ablation zone can help reduce neural complications. Tumour histology, patient clinical-functional status and life-expectancy should define the most efficient and least disabling treatment option.
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Garnon J, Koch G, Caudrelier J, Ramamurthy N, Rao P, Tsoumakidou G, Cazzato RL, Gangi A. Percutaneous Image-Guided Cryoablation of Challenging Mediastinal Lesions Using Large-Volume Hydrodissection: Technical Considerations and Outcomes. Cardiovasc Intervent Radiol 2016; 39:1636-1643. [DOI: 10.1007/s00270-016-1396-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/26/2016] [Indexed: 12/26/2022]
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Abstract
Lung metastasectomy can prolong survival in patients with metastatic colorectal carcinoma. Thermal ablation offers a potential solution with similar reported survival outcomes. It has minimal effect on pulmonary function, or quality of life, can be repeated, and may be considered more acceptable to patients because of the associated shorter hospital stay and recovery. This review describes the indications, technique, reported outcomes, complications and radiologic appearances after thermal ablation of colorectal lung metastases.
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Affiliation(s)
- Carole A Ridge
- 1 Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland ; 2 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen B Solomon
- 1 Department of Radiology, Mater Misericordiae University Hospital, Dublin 7, Ireland ; 2 Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Ni X, Han JQ, Ye X, Wei ZG. Percutaneous CT-guided microwave ablation as maintenance after first-line treatment for patients with advanced NSCLC. Onco Targets Ther 2015; 8:3227-3235. [PMID: 26604789 PMCID: PMC4640441 DOI: 10.2147/ott.s90528] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic therapy is recommended for advanced non-small-cell lung cancer (NSCLC). However, conventional first-line treatment has generated a plateau in response rate of 25% to 35%. Few studies have shown patients benefit from microwave ablation (MWA) in combination with radiotherapy and chemotherapy. This study aims to evaluate safety and efficacy of percutaneous computed tomography-guided MWA as maintenance after first-line treatment for patients with advanced NSCLC. METHODS Patients with histologically verified NSCLC stage IIIB or IV between January 2010 and March 2014 were involved. After completion of first-line treatment with partial response or stable disease, 35 patients with 39 tumors underwent 39 MWA procedures. Complications, progression-free survival (PFS), overall survival (OS), and correlated predictors were analyzed. RESULTS During a median follow-up of 17.7 months and 10.8 months after initial MWA, local efficacy was 87.2%, median MWA-related local control time was 10.6 months, and tumor size was the only predictor (P=0.002). Median MWA-related PFS, MWA-related OS, PFS, and OS were 5.4, 10.6, 11.8 and 17.7 months, respectively. Local efficacy was significantly correlated with MWA-related PFS (P=0.003), MWA-related OS (P=0.000), and OS (P=0.001). There were no procedure-specific deaths. Total incidence of major complications was 12.8%, including pneumothorax resolved by closed pleural drainage and pneumonia controlled by antibiotics in a short time. CONCLUSION This study concluded two points, including: 1) patients benefited from MWA as maintenance both in local control and survival; 2) as maintenance MWA was superior to conventional maintenance therapy with improved survival and well-tolerated complications. Therefore, MWA was a safe and effective maintenance after first-line treatment in patients with advanced NSCLC.
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Affiliation(s)
- Xiang Ni
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Jun-Qing Han
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Xin Ye
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
| | - Zhi-Gang Wei
- Department of Oncology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, People’s Republic of China
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Kim KY, Jin GY, Han YM, Lee YC, Jung MJ. Cryoablation of a small pulmonary nodule with pure ground-glass opacity: a case report. Korean J Radiol 2015; 16:657-61. [PMID: 25995697 PMCID: PMC4435997 DOI: 10.3348/kjr.2015.16.3.657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/10/2015] [Indexed: 11/15/2022] Open
Abstract
Treatments for pure ground-glass nodules (GGNs) include limited resection; however, surgery is not always possible in patients with limited pulmonary functional reserve. In such patients, cryoablation may be a suitable alternative to treat a pure GGN. Here, we report our initial experience with cryoablation of a pure GGN that remained after repeated surgical resection in a patient with multiple GGNs. A 5-mm-sized pure GGN in the left lower lobe was cryoablated successfully without recurrence at the 6-month follow-up.
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Affiliation(s)
- Kun Yung Kim
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Gong Yong Jin
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Young Min Han
- Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Yong Chul Lee
- Department of Internal Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
| | - Myung Ja Jung
- Department of Pathology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Institute for Medical Sciences, Jeonju 561-712, Korea
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Ye X, Fan W, Chen JH, Feng WJ, Gu SZ, Han Y, Huang GH, Lei GY, Li XG, Li YL, Li ZJ, Lin ZY, Liu BD, Liu Y, Peng ZM, Wang H, Yang WW, Yang X, Zhai B, Zhang J. Chinese expert consensus workshop report: Guidelines for thermal ablation of primary and metastatic lung tumors. Thorac Cancer 2015; 6:112-121. [PMID: 26273346 PMCID: PMC4448461 DOI: 10.1111/1759-7714.12152] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/16/2014] [Indexed: 12/31/2022] Open
Abstract
Although surgical resection is the primary means of curing both primary and metastatic lung cancers, about 80% of lung cancers cannot be removed by surgery. As most patients with unresectable lung cancer receive only limited benefits from traditional radiotherapy and chemotherapy, many new local treatment methods have emerged, including local ablation therapy. The Minimally Invasive and Comprehensive Treatment of Lung Cancer Branch, Professional Committee of Minimally Invasive Treatment of Cancer of the Chinese Anti-Cancer Association has organized multidisciplinary experts to develop guidelines for this treatment modality. These guidelines aim at standardizing thermal ablation procedures and criteria for selecting treatment candidates and assessing outcomes; and for preventing and managing post-ablation complications.
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Affiliation(s)
- Xin Ye
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Weijun Fan
- Imaging and Interventional Center, Sun Yat-sen University Cancer CenterGuangzhou, China
| | - Jun-hui Chen
- Department of Minimally Invasive Interventional Therapy, Shenzhen Hospital of Beijing UniversityShenzhen, China
| | - Wei-jian Feng
- Department of Oncology, Fuxing Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Shan-zhi Gu
- Department of Interventional Therapy, Hunan Provincial Tumor HospitalChangsha, China
| | - Yue Han
- Department of Imaging, Tumor Institute and Hospital, Chinese Academy of Medical SciencesBeijing, China
| | - Guang-hui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Guang-yan Lei
- Department of Thoracic Surgery, Shanxi Provincial Tumor HospitalXi'an, China
| | - Xiao-guang Li
- Department of Radiology, Peking Union Medical College HospitalBeijing, China
| | - Yu-liang Li
- Interventional Treatment Center, Shandong University Second HospitalJinan, China
| | - Zhen-jia Li
- Research Office of CT Diagnosis and Treatment, Shandong Provincial Institute of Medical ImagingJinan, China
| | - Zheng-yu Lin
- Department of Interventional Therapy, the First Affiliated Hospital of Fujian Medical UniversityFuzhou, China
| | - Bao-dong Liu
- Department of Thoracic Surgery, Xuanwu Hospital Affiliated to the Capital University of Medical SciencesBeijing, China
| | - Ying Liu
- Department of Oncology, Armed Police Hospital of Guangdong ProvinceGuangzhou, China
| | - Zhong-min Peng
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Hui Wang
- Interventional Treatment Center, Jilin Provincial Tumor HospitalChangchun, China
| | - Wu-wei Yang
- Department of Tumor Minimally Invasive Therapy, 307 HospitalBeijing, China
| | - Xia Yang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong UniversityJinan, China
| | - Bo Zhai
- Tumor Interventional Therapy Center, Shanghai Renji HospitalShanghai, China
| | - Jun Zhang
- Center of Lung Cancer, the First Affiliated Hospital of China Medical UniversityShenyang, China
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Huang G, Liu Q, Ye X, Yang X, Wei Z, Li W, Wang J, Han X, Ni X, Meng M, Zheng A. Invasive pulmonary aspergillosis: a rare complication after microwave ablation. Int J Hyperthermia 2014; 30:412-417. [PMID: 25256895 DOI: 10.3109/02656736.2014.955064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Three cases are reported of invasive pulmonary aspergillosis (IPA) occurring after microwave ablation (MWA) for lung tumours. This is a rare complication that has not previously been described in the literature. The diagnosis of IPA was based on the following factors: host factors, clinical manifestations and mycological findings. The first case was a 63-year-old man treated for primary lung squamous carcinoma. Significant tumour regression was achieved by 18 days after MWA, medical treatment with itraconazole for 6 weeks, and postural drainage. The second case, a 65-year-old man, was confirmed with primary lung squamous cell carcinoma. Voriconazole administration using intravenous infusion combined with intracavitary lavage was therapeutically effective after MWA at 1 year follow-up. The third case was a 61-year-old woman with primary lung adenocarcinoma. Delayed pneumothorax and bronchopleural fistula secondary to IPA persisted. The patient died from secondary multiple organ function failure. Despite its very low incidence, the significance of early diagnosis and early administration of antifungal therapy should be highlighted because of the relentless severity of IPA in patients undergoing MWA.
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Affiliation(s)
- Guanghui Huang
- Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong University and
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Ridge CA, Solomon SB, Thornton RH. Thermal ablation of stage I non-small cell lung carcinoma. Semin Intervent Radiol 2014; 31:118-24. [PMID: 25053863 DOI: 10.1055/s-0034-1373786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ablation options for the treatment of localized non-small cell lung carcinoma (NSCLC) include radiofrequency ablation, microwave ablation, and cryotherapy. Irreversible electroporation is a novel ablation method with the potential of application to lung tumors in risky locations. This review article describes the established and novel ablation techniques used in the treatment of localized NSCLC, including mechanism of action, indications, potential complications, clinical outcomes, postablation surveillance, and use in combination with other therapies.
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Affiliation(s)
- Carol A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raymond H Thornton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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Corsello SM, Senes P, Iezzi R, Rufini V, Congedo MT, Paragliola RM, Pontecorvi A. Cushing's syndrome due to a bronchial ACTH-secreting carcinoid successfully treated with radiofrequency ablation (RFA). J Clin Endocrinol Metab 2014; 99:E862-5. [PMID: 24483161 DOI: 10.1210/jc.2013-4359] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The ectopic production of ACTH is responsible for approximately 10% of cases of Cushing's syndrome. Whenever possible, once hypercortisolemia is under control with medical therapy, the final treatment consists of surgical excision of the tumor. We report a case of a patient with high surgical risk and poor response to medical therapy in which hypercortisolemia has been successfully treated with radiofrequency ablation of the bronchial carcinoid tumor. CASE PRESENTATION A 43-year-old woman came to our hospital because of severe and rapidly worsening signs and symptoms of hypercortisolism over the previous 3 months. Hormonal tests suggested the presence of Cushing's syndrome due to ectopic ACTH production. Imaging studies detected an 8-mm pulmonary nodule with fluorine-18-fluorodeoxyglucose uptake localized in the middle right lobe. The patient started therapy with ketoconazole with poor response. Middle right lobectomy was indicated but, due to the patient's very high surgical risk, a thermal ablation with radiofrequency of the bronchial nodule was performed. OUTCOMES AND RESULTS After the procedure, ACTH and cortisol levels dropped and fluorine-18-fluorodeoxyglucose positron emission tomography showed complete response to treatment. Clinical conditions progressively improved, and 6 weeks later, the patient underwent middle lobectomy without complications. Histology showed a 0.7-cm ACTH-producing typical bronchial carcinoid tumor. CONCLUSIONS Thermal ablation with radiofrequency allows achieving a rapid control of hypercortisolism with subsequent improvement of symptoms. This procedure should therefore be considered as a viable therapeutic option in those cases of bronchial ACTH-secreting tumors in which the surgical approach is initially contraindicated.
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Affiliation(s)
- Salvatore M Corsello
- Units of Endocrinology (S.M.C., P.S., R.M.P., A.P.), Radiology (R.I.), Nuclear Medicine (V.R.), and Thoracic Surgery (M.T.C.), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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叶 欣, 中国抗癌协会肿瘤微创治疗专业委员会肺癌微创综合治疗分会. [Expert consensus for thermal ablation of primary and metastatic lung tumors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:294-301. [PMID: 24758903 PMCID: PMC6000017 DOI: 10.3779/j.issn.1009-3419.2014.04.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 03/24/2014] [Indexed: 02/07/2023]
Affiliation(s)
- 欣 叶
- 510060 广州,中山大学肿瘤防治中心影像介入中心Department of Oncology, Shandong Provincial Hospital Affliated to Shandong University, Ji'nan 250014, China
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Tsoumakidou G, Garnon J, Ramamurthy N, Buy X, Gangi A. Interest of electrostimulation of peripheral motor nerves during percutaneous thermal ablation. Cardiovasc Intervent Radiol 2013; 36:1624-1628. [PMID: 23665861 DOI: 10.1007/s00270-013-0641-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/08/2013] [Indexed: 12/12/2022]
Abstract
PURPOSE We present our experience of utilizing peripheral nerve electrostimulation as a complementary monitoring technique during percutaneous thermal ablation procedures; and we highlight its utility and feasibility in the prevention of iatrogenic neurologic thermal injury. METHODS Peripheral motor nerve electrostimulation was performed in 12 patients undergoing percutaneous image-guided thermal ablations of spinal/pelvic lesions in close proximity to the spinal cord and nerve roots. Electrostimulation was used in addition to existing insulation (active warming/cooling with hydrodissection, passive insulation with CO2 insufflation) and temperature monitoring (thermocouples) techniques. Impending neurologic deficit was defined as a visual reduction of muscle response or need for a stronger electric current to evoke muscle contraction, compared with baseline. RESULTS Significant reduction of the muscle response to electrostimulation was observed in three patients during the ablation, necessitating temporary interruption, followed by injection of warm/cool saline. This resulted in complete recovery of the muscle response in two cases, while for the third patient the response did not improve and the procedure was terminated. No patient experienced postoperative motor deficit. CONCLUSION Peripheral motor nerve electrostimulation is a simple, easily accessible technique allowing early detection of impending neurologic injury during percutaneous image-guided thermal ablation. It complements existing monitoring techniques and provides a functional assessment along the whole length of the nerve.
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Affiliation(s)
- Georgia Tsoumakidou
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France.
| | - Julien Garnon
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Nitin Ramamurthy
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Xavier Buy
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
| | - Afshin Gangi
- University Hospital of Strasbourg, 1 Pl. de l Hopital, 67000, Strasbourg, France
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