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Wang Y, He XH, Xu LC, Huang HZ, Li GD, Wang YH, Li WT, Wang GZ. CT-guided cryoablation for unresectable pelvic recurrent colorectal cancer: a retrospective study. Onco Targets Ther 2019; 12:1379-1387. [PMID: 30863104 PMCID: PMC6389010 DOI: 10.2147/ott.s189897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective The study aimed to investigate the efficacy of computed tomography (CT)-guided cryoablation debulking of unresectable pelvic recurrent colorectal cancer (CRC). Patients and methods From January 2013 to April 2016, 30 patients (18 males and 12 females; aged 57.8±10.5 years) with unresectable pelvic recurrent CRC who had previously received radiotherapy or chemotherapy were included. A total of 35 tumors ranging from 1.2 to 6.3 cm underwent cryoablation. Tumor response was evaluated 1 month after cryoablation according to the Modified Response Evaluation Criteria in Solid Tumors. Logistic regression was used to analyze the risk factors for tumor response. Degree of pain palliation was also determined using the Numerical Rating Scale. Cox proportional hazard models were used to identify predictors of outcomes. Results Cryoablation was successfully performed in all patients. Complete response (CR) was achieved for 27 tumors in 23 patients and partial response was achieved for eight tumors in seven patients 1 month after cryoablation. The rate of CR was 77.14%, and tumor size was an independent risk factor for CR. Pain relief was satisfactory in 21 symptomatic patients (P<0.001), and the median duration of pain relief was 6.0 months (95% CI: 2.67–9.33). Serum carcinoembryonic antigen (CEA) was significantly decreased after cryoablation in 15 patients with elevated CEA (P=0.005). The median progression-free survival (PFS) was 10.0 months (95% CI: 4.43–15.67). Multivariate analysis revealed that tumor size (HR =3.089, P<0.001), sex (HR =0.089, P=0.002), and elevated CEA (HR =7.015, P=0.002) were independent predictors of PFS. Conclusion CT-guided cryoablation is a safe and effective therapeutic option for pelvic recurrent CRC. Tumor size is an important predictor of poor outcomes.
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Affiliation(s)
- Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Xin-Hong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Li-Chao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Hao-Zhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Guo-Dong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Yao-Hui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Wen-Tao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China, .,Department of Medical Oncology, Fudan University Shanghai Cancer Center, Xuhui, Shanghai 200032, People's Republic of China,
| | - Guang-Zhi Wang
- Department of Medical Imaging Center, Affiliated Hospital, Weifang Medical University, Weifang 261053, People's Republic of China,
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Vroomen LGPH, Scheffer HJ, Melenhorst MCAM, van Grieken N, van den Tol MP, Meijerink MR. Irreversible Electroporation to Treat Malignant Tumor Recurrences Within the Pelvic Cavity: A Case Series. Cardiovasc Intervent Radiol 2017; 40:1631-1640. [PMID: 28470395 PMCID: PMC5581368 DOI: 10.1007/s00270-017-1657-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To describe the initial experience with irreversible electroporation (IRE) to treat pelvic tumor recurrences. METHODS A retrospective single-center analysis was performed. Adverse events were recorded using Common Terminology Criteria of Adverse Events (CTCAE) 4.0. Clinical outcome was determined using pain- and general- symptom assessment, including Seddon's peripheral nerve injury (PNI) types. Radiological outcome was evaluated by comparing baseline with three-month 18F-FDG PET-CT follow-up. RESULTS Eight patients (nine tumors [recurrences of primary rectal (n = 4), anal (n = 1), sigmoid (n = 1), cervical (n = 1), and renal cell carcinoma (n = 1)]) underwent percutaneous IRE as salvage therapy. Median longest tumor diameter was 3.7 cm (range 1.2-7.0). One CTCAE grade III adverse event (hemorrhage) and eight CTCAE grade II complications occurred in 6/8 patients: vagino-tumoral fistula (n = 1), lower limb motor loss (n = 3; PNI type II) with partial recovery in one patient, hypotonic bladder (n = 2; PNI types I and II) with complete recovery in one patient, and upper limb motor loss (n = 2; PNI type II) with partial recovery in both patients. No residual tumor tissue was observed at 3-month follow-up. After a median follow-up of 12 months, local progression was observed in 5/9 lesions (4/5 were >3 cm pre-IRE); one lesion was successfully retreated. Debilitating preprocedural pain (n = 3) remained unchanged (n = 1) or improved (n = 2). CONCLUSION IRE may represent a suitable technique to treat pelvic tumor recurrences, although permanent neural function loss can occur. Complete ablation seems realistic for smaller lesions; for larger lesions symptom control should be the focus.
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Affiliation(s)
- L G P H Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - H J Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M C A M Melenhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - N van Grieken
- Department of Pathology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M P van den Tol
- Department of Surgical Oncology, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M R Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Ablative therapies for colorectal polyps and malignancy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:986352. [PMID: 25089281 PMCID: PMC4095981 DOI: 10.1155/2014/986352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/23/2014] [Accepted: 06/09/2014] [Indexed: 12/23/2022]
Abstract
Endoscopic techniques are gaining popularity in the management of colorectal polyps and occasionally superficial cancers. While their use is in many times palliative, they have proven to be curative in carefully selected patients with polyps or malignancies, with less morbidity than radical resection. However, one should note that data supporting local and ablative therapies for colorectal cancer is scarce and may be subject to publication bias. Therefore, for curative intent, these techniques should only be considered in highly select cases as higher rates of local recurrences have also been reported. The aim of this review is to explain the different modalities of local and ablative therapies specific to colorectal neoplasia and explain the indications and circumstances where they have been most successful.
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Colosio A, Fornès P, Soyer P, Lewin M, Loock M, Hoeffel C. Local colorectal cancer recurrence: pelvic MRI evaluation. ACTA ACUST UNITED AC 2013; 38:72-81. [PMID: 22484342 DOI: 10.1007/s00261-012-9891-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Surveillance of colorectal cancer is currently based on dosage of tumoral markers, colonoscopy and multidetector row computed tomography. However, pelvic magnetic resonance imaging (MRI) and PET-CT are two second-line useful imaging modalities to assess colorectal cancer local recurrence (LR). The anatomical information derived from MRI combined to the functional information provided by diffusion-weighted imaging currently remain of value. Pelvic MRI is accurate not only for detection of pelvic colorectal recurrence but also for the prediction of absence of tumoral invasion in pelvic structures, and it may thus provide a preoperative road map of the recurrence to allow for appropriate surgical planning. As always, correlation of imaging and clinical findings in the multidisciplinary forum is paramount. MRI can also be used to follow-up LR treated with radiofrequency ablation. The aim of this review is to discuss clinical practice and application of MRI in the assessment or pelvic recurrence from colorectal cancer.
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Affiliation(s)
- A Colosio
- Pôle d'imagerie, Department of Radiology, Hôpital Robert Debré, CHU de Reims, 51092, Reims Cedex, France.
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Srimathveeravalli G, Wimmer T, Monette S, Gutta NB, Ezell PC, Maybody M, Weiser MR, Solomon SB. Evaluation of an endorectal electrode for performing focused irreversible electroporation ablations in the Swine rectum. J Vasc Interv Radiol 2013; 24:1249-56. [PMID: 23796856 DOI: 10.1016/j.jvir.2013.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/19/2013] [Accepted: 04/22/2013] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To study the feasibility of a novel endorectal electrode for the creation of focal ablations of the rectal wall with the use of irreversible electroporation (IRE). MATERIALS AND METHODS A monopolar electrode with a grounding pad (10 ablations in five pigs) and a bipolar electrode (two ablations in one pig) were evaluated in healthy swine rectum. A two-dimensional model of the electrode in the rectum was created and used to solve the Laplace equation to determine field strength. Simulation was used to identify treatment settings for superficial ablation (mucosal layers) or transmural ablation of rectal wall. Animals were euthanized within 4 hours after treatment. RESULTS Treatment was successfully completed without treatment-related complications. Eleven of 12 lesions were successfully located and extracted for pathologic analysis. All lesions were characterized by necrotic cell death with mild inflammation and hyperemia, with a sharp demarcation between ablated and adjacent normal tissue. Depth of lesions corresponded with numeric simulation. Histologic analysis and measurements indicated that lesion creation with the superficial treatment setting resulted in ablation of mucosal and submucosal layers with superficial or no injury to the muscularis propria (9.97 mm ± 0.31 length, 3.3 mm ± 2.92 depth), and that lesion creation with the transmural treatment setting resulted in full-thickness ablation (12.43 mm ± 3.85 length, 4.97 mm ± 2.89 depth) of the rectal wall. CONCLUSIONS An endorectal electrode can be used to deliver IRE and create limited focal ablations in the rectal wall. Treatment parameters can be determined through numeric modeling to control the depth of penetration of ablation.
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Affiliation(s)
- Govindarajan Srimathveeravalli
- Radiochemistry and Imaging Science Service and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Pusceddu C, Sotgia B, Melis L, Fele RM, Meloni GB. Painful pelvic recurrence of rectal cancer: percutaneous radiofrequency ablation treatment. ACTA ACUST UNITED AC 2013; 38:1225-33. [PMID: 23736888 DOI: 10.1007/s00261-013-0012-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To retrospectively evaluate the feasibility and efficacy of computed tomography (CT)-guided radiofrequency thermal ablation (RFA) in reducing the pain in patients with painful pelvic recurrence of rectal cancer ineligible for surgical resection. MATERIAL AND METHODS Twelve consecutive patients (10 men and 2 women; mean age 67 ± 10 years) with painful pelvic recurrence of rectal cancer underwent CT-guided RFA treatments under conscious sedation. At baseline, in all patients pelvic-sacral pain was classified as severe by Visual Analog Scale (VAS; VAS score ≥75 mm). The tumor density and carcinoembryionic antigen (CEA) serum level averages were 46 ± 7 HU and 15.7 ± 9.3 ng/mL, respectively. Clinical outcome was evaluated by VAS with a mean follow-up period of 23 months. RESULTS All RFA sessions were completed and well tolerated. Morbidity consisted of recto-vesical fistula (8 %) and rectal abscess (8 %). 1 month after RFA procedure, complete lack of enhancement was obtained in 7 cases (58 %). A significant difference in HU and CEA serum level averages between baseline and 1 month post-RFA was revealed (p < 0.000 and p < 0.002, respectively). A significant reduction in pain was obtained: VAS score was significantly different between baseline and the clinical evaluations at week 1 and month 3, 6, 12, and 22) (p < 0.000). At the end of follow-up, 11 patients (92 %) were symptom free. CONCLUSIONS CT-guided RFA of painful pelvic recurrence of rectal cancer can be considered as a feasible and effective treatment for reducing the pain in selected cases.
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Affiliation(s)
- Claudio Pusceddu
- Division of Interventional Radiology, Department of Oncologic Radiology, Businco Hospital, Regional Referral Center for Oncologic Disease, 09100, Cagliari, Italy,
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Ripley RT, Gajdos C, Reppert AE, MacDermott T, McCarter MD, Pearlman NW. Sequential radiofrequency ablation and surgical debulking for unresectable colorectal carcinoma: Thermo-surgical ablation. J Surg Oncol 2012; 107:144-7. [DOI: 10.1002/jso.23211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/11/2012] [Indexed: 11/06/2022]
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Mylona S, Karagiannis G, Patsoura S, Galani P, Pomoni M, Thanos L. Palliative treatment of rectal carcinoma recurrence using radiofrequency ablation. Cardiovasc Intervent Radiol 2011; 35:875-82. [PMID: 22167304 DOI: 10.1007/s00270-011-0320-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 11/14/2011] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of CT-guided radiofrequency (RF) ablation for the palliative treatment of recurrent unresectable rectal tumors. MATERIALS AND METHODS Twenty-seven patients with locally recurrent rectal cancer were treated with computed tomography (CT)-guided RF ablation. Therapy was performed with the patient under conscious sedation with a seven- or a nine-array expandable RF electrode for 8-10 min at 80-110°C and a power of 90-110 W. All patients went home under instructions the next day of the procedure. Brief Pain Inventory score was calculated before and after (1 day, 1 week, 1 month, 3 months, and 6 months) treatment. RESULTS Complete tumor necrosis rate was 77.8% (21 of a total 27 procedures) despite lesion location. BPI score was dramatically decreased after the procedure. The mean preprocedure BPI score was 6.59, which decreased to 3.15, 1.15, and 0.11 at postprocedure day 1, week 1, and month 1, respectively, after the procedure. This decrease was significant (p < 0.01 for the first day and p < 0.001 for the rest of the follow-up intervals (paired Student t test; n - 1 = 26) for all periods during follow-up. Six patients had partial tumor necrosis, and we were attempted to them with a second procedure. Although the necrosis area showed a radiographic increase, no complete necrosis was achieved (secondary success rate 65.6%). No immediate or delayed complications were observed. CONCLUSION CT-guided RF ablation is a minimally invasive, safe, and highly effective technique for treatment of malignant rectal recurrence. The method is well tolerated by patients, and pain relief is quickly achieved.
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Affiliation(s)
- Sophia Mylona
- Hellenic Red Cross Hospital "Korgialenio-Benakio", Athens, Greece.
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Wang Z, Lu J, Liu L, Liu T, Chen K, Liu F, Huang G. Clinical application of CT-guided (125)I seed interstitial implantation for local recurrent rectal carcinoma. Radiat Oncol 2011; 6:138. [PMID: 22004599 PMCID: PMC3214185 DOI: 10.1186/1748-717x-6-138] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 10/18/2011] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The present study aimed to explore the safety profile and clinical efficacy of CT-guided radioactive seed implantation in treating local recurrent rectal carcinoma. MATERIALS AND METHODS CT-guided ¹²⁵I seed implantation was carried out in 20 patients with locally recurrent rectal carcinoma. 14 of the 20 patient had prior adjuvant external-beam radiation therapy (EBRT). The treatment planning system (TPS) was used preoperatively to reconstruct three dimensional images of the tumor and to calculate the estimated seed number and distribution. The median matched peripheral dose (MPD) was 120 Gy (range, 100-160 Gy). RESULTS Of the 20 patients, 12 were male, 8 were female, and ages ranged from 38 to 78, with a median age of 62. Duration of follow-up was 3-34 months. The response rate of pain relief was 85% (17/20). Repeat CT scan 2 months following the procedure revealed complete response (CR) of the tumor in 2 patients, partial response (PR) in 13 patients, stable disease (SD) in 3 patients, and progressive disease (PD) in 2 patients. 75% of patients had either CR or PR. Median survival time was 18.8 months (95% CI: 3.5-22.4 months). 1 and 2 year survival rates were 75% and 25%, respectively. 4 patients died of recurrent tumor; 4 patients died of distant metastases; 9 patients died of recurrent tumor and distant metastases. 3 patients survived after 2 year follow up. Two patients were found to have mild hematochezia, which was reversible with symptomatic management. CONCLUSION CT-guided ¹²⁵I seed implantation appeared to be a safe, useful and less complicated interventional treatment option for local recurrent rectal carcinoma.
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Affiliation(s)
- Zhongmin Wang
- Department of Nuclear Medicine, Renji hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Lin Liu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Tao Liu
- Department of General Surgery, Shanghai Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, 200020, China
| | - Kemin Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
| | - Fenju Liu
- School of Radiation Medicine and Public Health, Soochow University, Suzhou, 215123, China
| | - Gang Huang
- Department of Nuclear Medicine, Renji hospital, Shanghai Jiaotong University School of Medicine, 1630 Dongfang Road, Shanghai, 200127, China
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Gajdos C, MacDermott T, McCarter MD, Pearlman NW. Combined Thermal–Surgical Ablation of Locally Advanced Abdominopelvic Malignancies. Ann Surg Oncol 2010; 18:1267-73. [DOI: 10.1245/s10434-010-1467-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Indexed: 11/18/2022]
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Sabharwal T, Katsanos K, Buy X, Gangi A. Image-guided ablation therapy of bone tumors. Semin Ultrasound CT MR 2009; 30:78-90. [PMID: 19358439 DOI: 10.1053/j.sult.2008.12.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A wide range of thermal and cryoablation methods is currently available for the curative eradication or palliative treatment of a variety of bone and soft-tissue tumors. Radiofrequency ablation has been developed as a multipurpose tool for the skeletal system. Cryoablation has the added advantages of direct computed tomography or magnetic resonance visualization and monitoring of treatment outcome with less peri- and postoperative pain. Use of appropriate thermo-sensors and insulation techniques, like carbon dioxide insufflation, results in enhanced safety and efficacy. Ablation of weight-bearing bones has to be supplemented with cement consolidation. The authors present an overview of the current status of percutaneous image-guided ablation therapy of bone and soft-tissue tumors, analyze the merits and limitations of the various systems available, and discuss possible new applications for the future.
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Affiliation(s)
- Tarun Sabharwal
- Department of Interventional Radiology, Guy's and St. Thomas' Hospital, 1st Floor, Lambeth Wing, Lambeth Palace Road, London SE1 7EH, UK
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