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Kastler A, Cornelis FH, Kastler B. Patient's selection and evaluation for bone stabilization. Tech Vasc Interv Radiol 2022; 25:100797. [DOI: 10.1016/j.tvir.2022.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Liu B, Wu Z, Mo H, He J, Lin X, Guan J, Wei C, Yuan Z. Safety and efficacy of microwave ablation for breast cancer thoracic metastases. Cancer Manag Res 2018; 10:5685-5689. [PMID: 30532591 PMCID: PMC6241699 DOI: 10.2147/cmar.s176743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The objective of the study was to assess the safety and efficacy of microwave ablation (MWA) for breast cancer thoracic metastasis. Materials and methods Twelve patients in our institution with a single lesion of breast cancer thoracic metastases received MWA and invasive spine surgery from August 2014 to November 2016. MWA was executed using the MWA system (2,450 MHz) at 40 W or 50 W with thermometers to control the ablation end points. The pathology of thoracic metastases was confirmed through intraoperative biopsy before ablation. The postoperative complications were recorded. The patients were followed up at 1, 3 and 6 months with contrast-enhanced computed tomography and magnetic resonance imaging to monitor for tumor recurrence. Results The average duration of follow-up for breast cancer thoracic metastases patients (mean age 52.7±8.4 years) was 10.2 months. The rate of postoperative main complications was 8.3% (1/12). The recurrence rate was 16.6% (2/12) as confirmed by persistent enhancement. Conclusion MWA may be used as the adjuvant treatment for thoracic metastases of breast cancer. Results showed that few significant complications and less local recurrence occurred during the follow-up stage. Future research should aim at discovering more about the time controls for microwave-tissue interaction and treatment parameters before widespread use.
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Affiliation(s)
- Bin Liu
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Zhenjie Wu
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Hao Mo
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Juliang He
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Xiang Lin
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Jian Guan
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Changyuan Wei
- Department of Breast Tumor Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
| | - Zhenchao Yuan
- Department of Bone and Soft Tissue Neurosurgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, People's Republic of China,
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Cornelis FH, Petitpierre F, Fabre T, Gille O, Amoretti N, Hauger O. Percutaneous low-pressure bone stenting to control cement deposition in extensive lytic lesions. Eur Radiol 2017; 27:3942-3946. [PMID: 28124748 DOI: 10.1007/s00330-016-4703-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/21/2016] [Accepted: 12/14/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate low-pressure bone stenting combined with cementoplasty in extensive lytic lesions. METHODS A single-centre study involving four consecutive patients (four women) with extensive lytic tumours was performed. The average age was 65 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under fluoroscopy guidance. Follow-up was assessed using the visual analogue scale (VAS). RESULTS Under general (n = 2) or local (n = 2) anaesthesia, five 11-gauge bone biopsy needles were advanced in four lesions. Five auto-expandable uncovered stents (10-14 mm diameter and 40-60 mm long) were inserted. In all cases, bone cement was successfully placed into the tumours. The volume of cement that was injected through the cannulas into the stents was 5-10 mL. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 after the procedure for all patients (p < 0.05). No complications occurred during the follow-up (8-19 months). CONCLUSION This study suggests that cementoplasty combined with low-pressure bone stenting could allow effective bone stabilization resulting in pain relief. KEY POINTS • Low-pressure bone stenting is possible. • This technique improves cement injection control. • The procedure allows effective bone stabilization resulting in pain relief.
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Affiliation(s)
- Francois H Cornelis
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France.
- Department of Radiology, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | - Francois Petitpierre
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Thierry Fabre
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Olivier Gille
- Department of Surgery, Hôpital Pellegrin, Place Amélie Raba Léon, 33076, Bordeaux, France
| | - Nicolas Amoretti
- Department of Radiology, Hôpital Archet 2, CHU Nice, 151 route Saint Antoine de Ginestiere, 06202, Nice, France
| | - Olivier Hauger
- Department of Radiology, Hôpital Pellegrin Place Amélie Raba Léon, 33076, Bordeaux, France
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Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours. Eur Radiol 2016; 27:1477-1485. [DOI: 10.1007/s00330-016-4528-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/08/2016] [Accepted: 07/21/2016] [Indexed: 12/12/2022]
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Récidive tumorale osseuse locale après cimentoplastie : à propos d’un cas ; discussion de l’intérêt de la radiothérapie après cimentoplastie. Cancer Radiother 2016; 20:109-14. [DOI: 10.1016/j.canrad.2015.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 09/09/2015] [Accepted: 09/11/2015] [Indexed: 12/27/2022]
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Retrograde Transpubic Approach for Percutaneous Radiofrequency Ablation and Cementoplasty of Acetabular Metastasis. Case Rep Radiol 2015; 2015:146963. [PMID: 26491595 PMCID: PMC4602320 DOI: 10.1155/2015/146963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 11/25/2022] Open
Abstract
We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure.
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Driven Around the Bend: Novel Use of a Curved Steerable Needle. Cardiovasc Intervent Radiol 2012; 36:531-5. [DOI: 10.1007/s00270-012-0482-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/02/2012] [Indexed: 10/27/2022]
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Sanou R, Bazin C, Krakowski I, Boccaccini H, Mathias J, Beot S, Marchal F, Regent D. [Radiofrequency ablation for palliation of soft tissue tumor pain]. ACTA ACUST UNITED AC 2010; 91:281-6. [PMID: 20508558 DOI: 10.1016/s0221-0363(10)70039-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the efficacy of radiofrequency (RF) ablation for palliation of soft tissue tumor pain. MATERIALS AND METHODS Retrospective study of 12 patients receiving palliative treatment for soft tissue tumors (5 primary tumors including 4 sarcomas and 1 PEComa and 7 metastatic tumors) with pain refractory to standard management. RF ablation was performed under CT or ultrasound guidance. RESULTS The efficacy was determined by using pain scores and treatment regimen modifications after RF ablation. Response was graded as absent, partial or complete. Short term symptomatic relief was observed in 100% of cases, with complete response in 43% of cases ; Mid term and long term symptomatic relief was observed in 70% and 83% of cases respectively. We also observed dosage reduction for narcotics with corresponding reduction in related side-effects and functional improvement in some patients. A single case of complication with serosanguinous collection within a region of necrosis was observed. CONCLUSION Radiofrequency ablation for palliation of soft tissue tumor pain may be a useful complement to standard management. It results in symptomatic improvement with few complications.
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Affiliation(s)
- R Sanou
- Service de Radiologie Adultes, Hôpital Brabois, CHU de Nancy, rue du Morvan, 54511 Vandoeuvre-lès-Nancy.
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Radiofrequency energy on cortical bone and soft tissue: a pilot study. Clin Orthop Relat Res 2010; 468:1157-64. [PMID: 19890682 PMCID: PMC2835580 DOI: 10.1007/s11999-009-1150-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Accepted: 10/12/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND Radiofrequency-generating energy devices have been used clinically in musculoskeletal procedures to provide hemostasis and capsular shrinkage (thermal capsulorrhaphy). However, the dose-effects are not well known. QUESTIONS/PURPOSES We therefore determined dosage effects of radiofrequency energy on bone, skin incisions, and joint capsule in sheep. METHODS Five mature sheep had six 2.5-cm(2) tibial periosteal defects and six 1.0-cm skin incisions assigned to six treatments varying by watts and fluence (f = watts . seconds/cm(2)): (1) untreated control, (2) 50 W for 9.5 seconds (190f; n = 5), (3) 110 W for 4.3 seconds (190f; n = 5), (4) 170 W for 2.8 seconds (190f; n = 5), (5) 170 W for 5.6 seconds (380f; n = 5), or (6) 170 W for 8.4 seconds (570f; n = 5). Outcomes included hemostasis, contraction, healing, and histomorphometry for inflammation and necrosis at 2 weeks. RESULTS Radiofrequency energy application on skin at 190f or greater had more than 80% hemostasis and dose-dependent contraction, inflammation, and necrosis. Radiofrequency energy application on bone had good (70%) hemostasis at 190f and complete (> 95%) hemostasis at 380f and 570f, without histologic or clinically detectable necrosis. CONCLUSIONS Hemostasis can be achieved with radiofrequency energy at 190f in skin and bone. Bone necrosis was not detected at up to 570f. Using fluence greater than 190f in skin achieved dose-dependent necrosis and incisional contraction. CLINICAL RELEVANCE Radiofrequency energy can be used on bone and skin for hemostasis, but potential incisional complications, such as necrosis and an atypical firm and desiccated surface, should be expected.
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Radiofrequency application to the growth plate in the rabbit: a new potential approach to epiphysiodesis. J Pediatr Orthop 2009; 29:629-35. [PMID: 19700996 DOI: 10.1097/bpo.0b013e3181b2bae7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radiofrequency energy is being used more and more frequently in orthopaedics, mainly in the treatment of bone tumors. We postulated that radiofrequency ablation may produce growth plate lesions similar to those observed in the bone and conducted this study to see whether radiofrequency may be used as a technique for producing epiphysiodesis. METHODS We randomized 60 8-week-old female New Zealand white rabbits into 3 groups. Group A was destined for a total epiphysiodesis at 60 degrees C, group B was destined for a total epiphysiodesis at 90 degrees C, and group C for a lateral hemiepiphysiodesis at 90 degrees C. Radiofrequency energy was delivered in 1 minute in all 3 groups. Using fluoroscopic imaging, radiofrequency was applied percutaneously to the left proximal tibial physis whereas the right growth plate received a sham procedure. A bicortical pin was used to evaluate the longitudinal growth rate at every monthly radiologic control, beginning 8 weeks after the procedure. Comparisons between the right and left side and between groups A and B were achieved using a paired t test. A histopathologic study was conducted in parallel to the radiographic study. RESULTS In a radiograph at the 8-week point, pin migration was 4.74 mm on the left side compared with 9.72 mm on the right (P<0.0001), in group A. In group B, pin migration on the left was 1.37 mm compared with 5.49 mm on the right (P<0.0001). In group C, mean angular deviation was 11.6 degrees on the left compared with 1.9 degrees on the right (P=0.0001). These differences were maintained until the end of growth. Pathology specimens revealed cellular anarchy, loss of columnar stratification, and height of the physis on the left side, which occurred earlier and were more pronounced in group B than in group A. In group C, these changes involved only the lateral half of the left physis whereas its medial counterpart remained normal. There was no evidence of articular cartilage damage. CONCLUSIONS This experimental study shows that radiofrequency can efficiently and rapidly achieve epiphysiodesis. It is one of many methods that can be used for this purpose. The development of new electrodes suitable for use on human growth plates and the elaboration of specific utilization protocols may lead to its use in children. Its simplicity and precision may lead to a quick and efficient growth arrest with little pain and postoperative disability in addition to reduced costs. CLINICAL RELEVANCE Radiofrequency has proved to be effective in producing growth arrest in rabbits with no complications. Technical improvements and adaptations may allow its use for pediatric limb inequalities or angular deformities in the near future.
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Kloos RT, Eng C, Evans DB, Francis GL, Gagel RF, Gharib H, Moley JF, Pacini F, Ringel MD, Schlumberger M, Wells SA. Medullary thyroid cancer: management guidelines of the American Thyroid Association. Thyroid 2009; 19:565-612. [PMID: 19469690 DOI: 10.1089/thy.2008.0403] [Citation(s) in RCA: 759] [Impact Index Per Article: 50.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inherited and sporadic medullary thyroid cancer (MTC) is an uncommon and challenging malignancy. The American Thyroid association (ATA) chose to create specific MTC Clinical Guidelines that would bring together and update the diverse MTC literature and combine it with evidence-based medicine and the knowledge and experience of a panel of expert clinicians. METHODS Relevant articles were identified using a systematic PubMed search and supplemented with additional published materials. Evidence-based recommendations were created and then categorized using criteria adapted from the United States Preventive Services Task Force, Agency for Healthcare Research and Quality. RESULTS Clinical topics addressed in this scholarly dialog included: initial diagnosis and therapy of preclinical disease (including RET oncogene testing and the timing of prophylactic thyroidectomy), initial diagnosis and therapy of clinically apparent disease (including preoperative testing and imaging, extent of surgery, and handling of devascularized parathyroid glands), initial evaluation and treatment of postoperative patients (including the role of completion thyroidectomy), management of persistent or recurrent MTC (including the role of tumor marker doubling times, and treatment of patients with distant metastases and hormonally active metastases), long-term follow-up and management (including the frequency of follow-up and imaging), and directions for future research. CONCLUSIONS One hundred twenty-two evidence-based recommendations were created to assist in the clinical care of MTC patients and to share what we believe is current, rational, and optimal medical practice.
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Minimal-invasive Techniken zur Behandlung metastasierter Karzinome. DER ORTHOPADE 2009; 38:343-7. [DOI: 10.1007/s00132-008-1378-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cementoplasty in the management of painful extraspinal bone metastases: our experience. Radiol Med 2008; 113:1018-28. [PMID: 18779931 DOI: 10.1007/s11547-008-0314-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Accepted: 12/10/2007] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study was to demonstrate the effectiveness of interventional techniques in the palliative management of painful extraspinal bone metastases. MATERIALS AND METHODS Cementoplasty alone or in combination with radiofrequency (RF) ablation was performed in 14 skeletal extravertebral segments in 13 patients with ages ranging from 50 to 74 (average 67) years. The primary tumours were myeloma (n=5), renal carcinoma (n=5), hepatocellular carcinoma (n=2) and bladder carcinoma (n=2). Metastases were located at the acetabulum (n=4), femur (n=5), humerus (n=1), scapula (n=2) and iliac bone (n=2). The clinical indication was a pain intensity score >4 on the visual analogue scale (VAS) partially or totally refractory to analgesic medication. Clinical evaluation was based on clinical and neurological conditions before and immediately after the procedure and during the follow-up. RESULTS Technical success was achieved in all cases. Ten patients were treated by cementoplasty alone and four cases by cementoplasty combined with RF ablation. After treatment, all patients experienced improved symptoms, as demonstrated by the VAS score, which remained constant during follow-up. All patients were followed for between 2 and 14 (average 6.1) months. We had one major complication in a patient who developed an abscess, which was treated by percutaneous drainage. CONCLUSIONS In our experience, cementoplasty alone for small lesions or combined with RF ablation in larger lesions is an effective and safe therapy in the palliative management of painful extraspinal bone metastases.
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Moser T, Buy X, Goyault G, Tok CH, Irani F, Gangi A. [Image-guided ablation of bone tumors: review of current techniques]. ACTA ACUST UNITED AC 2008; 89:461-71. [PMID: 18477952 DOI: 10.1016/s0221-0363(08)71449-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple interventional radiology techniques are available for percutaneous ablation of bone tumors: alcohol, laser, radiofrequency, microwave, ultrasound, and cryogenic ablation. Several indications have already been validated, including radiofrequency ablation of osteoid osteoma and bone metastases, with results superior to conventional treatment. More indications should be added over the coming years. The purpose of this article is to review the principles of the different ablation techniques, summarize their respective indications and results and discuss their implementation and the eventual combination with cementoplasty techniques.
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Affiliation(s)
- T Moser
- Service de Radiologie B, CHU Strasbourg, Hôpital Civil, Strasbourg Cedex, France.
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