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Velayati S, Elsakka A, Zhao K, Erinjeri JP, Marinelli B, Soliman M, Chevallier O, Ziv E, Brody LA, Sofocleous CT, Solomon SB, Harding JJ, Abou-Alfa GK, D’Angelica MI, Wei AC, Kingham PT, Jarnagin WR, Yarmohammadi H. Safety and Efficacy of Hepatic Artery Embolization in Heavily Treated Patients with Intrahepatic Cholangiocarcinoma: Analysis of Clinicopathological and Radiographic Parameters Associated with Better Overall Survival. Curr Oncol 2023; 30:9181-9191. [PMID: 37887563 PMCID: PMC10605490 DOI: 10.3390/curroncol30100663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
The safety and efficacy of hepatic artery embolization (HAE) in treating intrahepatic cholangiocarcinoma (IHC) was evaluated. Initial treatment response, local tumor progression-free survival (L-PFS), and overall survival (OS) were evaluated in 34 IHC patients treated with HAE. A univariate survival analysis and a multivariate Cox proportional hazard analysis to identify independent factors were carried out. Objective response (OR) at 1-month was 79.4%. Median OS and L-PFS from the time of HAE was 13 (CI = 95%, 7.4-18.5) and 4 months (CI = 95%, 2.09-5.9), respectively. Tumor burden < 25% and increased tumor vascularity on preprocedure imaging and surgical resection prior to embolization were associated with longer OS (p < 0.05). Multivariate logistic regression analysis demonstrated that tumor burden < 25% and hypervascular tumors were independent risk factors. Mean post-HAE hospital stay was 4 days. Grade 3 complication rate was 8.5%. In heavily treated patients with IHC, after exhausting all chemotherapy and other locoregional options, HAE as a rescue treatment option appeared to be safe with a mean OS of 13 months. Tumor burden < 25%, increased target tumor vascularity on pre-procedure imaging, and OR on 1 month follow-up images were associated with better OS. Further studies with a control group are required to confirm the effectiveness of HAE in IHC.
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Affiliation(s)
- Sara Velayati
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Ahmed Elsakka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Ken Zhao
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Mohamed Soliman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Olivier Chevallier
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, 21079 Dijon, France
| | - Etay Ziv
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Lynn A. Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Constantinos T. Sofocleous
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - Stephen B. Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
| | - James J. Harding
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.J.H.); (G.K.A.-A.)
| | - Ghassan K. Abou-Alfa
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.J.H.); (G.K.A.-A.)
| | - Michael I. D’Angelica
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Alice C. Wei
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Peter T. Kingham
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - William R. Jarnagin
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.I.D.); (A.C.W.); (P.T.K.); (W.R.J.)
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.V.); (A.E.); (K.Z.); (J.P.E.); (B.M.); (M.S.); (O.C.); (E.Z.); (L.A.B.); (C.T.S.); (S.B.S.)
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Akhurst T, Gönen M, Baser RE, Schwartz LH, Tuorto S, Brody LA, Covey A, Brown KT, Larson SM, Fong Y. Prospective evaluation of 18F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases. Hepatobiliary Surg Nutr 2022; 11:539-554. [PMID: 36016741 PMCID: PMC9396102 DOI: 10.21037/hbsn-19-357] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 01/11/2021] [Indexed: 01/07/2023]
Abstract
Background Despite considerable advances in preoperative imaging, up to one-third of patients operatively explored for hepatic colorectal metastases are unexpectedly found to harbor unresectable intrahepatic or extrahepatic disease. Methods The current study is a prospective, blinded study comparing utility of [18F]2-fluoro-2-deoxyglucose positron emission tomography (18F-FDG-PET) to computed tomography (CT) and CT arterial portography (CTAP) as preoperative staging. Results The 125 planned subjects were enrolled. Findings seen on FDG-PET alone changed therapy for 23 of 125 patients (18%). FDG-PET confirmed other radiologic findings in 16 cases (13%), for an overall influence on therapy in 39 cases (31%). FDG-PET was the most sensitive diagnostic imaging test for extrahepatic cancer; it was 80-90% sensitive for extrahepatic cancer and 70-90% specific. For the 28 cases of unresectable disease due to extrahepatic disease, FDG-PET findings solely changed therapies in 16 cases (57%) and influenced therapy in seven other cases (25%). Of the 21 unresectable cases due to extent of intrahepatic disease, FDG-PET did not solely change therapy in any. Overall, FDG-PET had the lowest sensitivity for hepatic sites compared with CT or CTAP. In particular, small (<1 cm) liver tumors were particularly poorly detected by FDG-PET. The area under the receiver operating characteristic (ROC) curve for small tumors was 0.58 and for patients on chemotherapy it was 0.66, a modest improvement over no imaging. Conclusions FDG-PET is an important test for preoperative staging of patients with hepatic colorectal metastases, affecting treatment decisions in nearly one-third of patients. The high yield is due mainly to detection of extrahepatic disease. It is therefore recommended in patients with extrahepatic lesions suspected to be disseminated cancer or those with high risk for extrahepatic disease. It is not a good test for identification of small tumors in the liver.
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Affiliation(s)
- Tim Akhurst
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA;,Peter MacCallum Cancer Centre, Victoria, Australia
| | - Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Raymond E. Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lawrence H. Schwartz
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Scott Tuorto
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Lynn A. Brody
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Anne Covey
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Karen T. Brown
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Steven M. Larson
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuman Fong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Ghosn M, Kingham TP, Ridouani F, Santos E, Yarmohammadi H, Boas FE, Covey AM, Brody LA, Jarnagin WR, D'Angelica MI, Kemeny NE, Solomon SB, Camacho JC. Percutaneous liver venous deprivation: outcomes in heavily pretreated metastatic colorectal cancer patients. HPB (Oxford) 2022; 24:404-412. [PMID: 34452833 DOI: 10.1016/j.hpb.2021.08.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate liver venous deprivation (LVD) outcomes in patients with colorectal liver metastasis (CRLM) heavily pretreated with systemic and hepatic arterial infusion pump (HAIP) chemotherapies that had an anticipated insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE). METHODS PVE was performed with liquid embolics using a transsplenic or ipsilateral transhepatic approach. Simultaneously and via a trans-jugular approach, the right hepatic vein was embolized with vascular plugs. Liver volumetry was assessed on computed tomography before and 3-6 weeks after LVD. RESULTS Twelve consecutive CRLM patients that underwent LVD before right hepatectomy or trisectionectomy were included, all previously treated with systemic chemotherapy for a mean of 11.9 months. Six patients had additional HAIP. After embolization, FLR ratio increased from 28.7% ± 5.9 to 42.2% ± 9.0 (P < 0.01). Mean kinetic growth rate (KGR) was 3.56%/week ± 2.3, with a degree of hypertrophy (DH) of 13.8% ± 7.1. In the HAIP subgroup, mean KGR and DH were respectively 3.58%/week ± 2.8 and 14.3% ± 8.7. No severe complications occurred. Ten patients reached surgery after 39 days ± 7.5. CONCLUSION In heavily pretreated patients, LVD safely stimulated a rapid and effective FLR hypertrophy, with a resultant high rate of resection.
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Affiliation(s)
- Mario Ghosn
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Fourat Ridouani
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Ernesto Santos
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Franz E Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Anne M Covey
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Lynn A Brody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Michael I D'Angelica
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
| | - Juan C Camacho
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.
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Camacho JC, Brody LA, Covey AM. Treatment of Malignant Bile Duct Obstruction: What the Interventional Radiologist Needs to Know. Semin Intervent Radiol 2021; 38:300-308. [PMID: 34393340 DOI: 10.1055/s-0041-1731269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Management of malignant bile duct obstruction is both a clinically important and technically challenging aspect of caring for patients with advanced malignancy. Bile duct obstruction can be caused by extrinsic compression, intrinsic tumor/stone/debris, or by biliary ischemia, inflammation, and sclerosis. Common indications for biliary intervention include lowering the serum bilirubin level for chemotherapy, ameliorating pruritus, treating cholangitis or bile leak, and providing access for bile duct biopsy or other adjuvant therapies. In some institutions, biliary drainage may also be considered prior to hepatic or pancreatic resection. Prior to undertaking biliary intervention, it is essential to have high-quality cross-sectional imaging to determine the level of obstruction, the presence of filling defects or atrophy, and status of the portal vein. High bile duct obstruction, which we consider to be obstruction above, at, or just below the confluence (Bismuth classifications IV, III, II, and some I), is optimally managed percutaneously rather than endoscopically because interventional radiologists can target specific ducts for drainage and can typically avoid introducing enteric contents into isolated undrained bile ducts. Options for biliary drainage include external or internal/external catheters and stents. In the setting of high obstruction, placement of a catheter or stent above the ampulla, preserving the function of the sphincter of Oddi, may lower the risk of future cholangitis by preventing enteric contamination of the biliary tree. Placement of a primary suprapapillary stent without a catheter, when possible, is the procedure most likely to keep the biliary tree sterile.
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Affiliation(s)
- Juan C Camacho
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
| | - Lynn A Brody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
| | - Anne M Covey
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical Center, New York, New York
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Kurilova I, Bendet A, Petre EN, Boas FE, Kaye E, Gonen M, Covey A, Brody LA, Brown KT, Kemeny NE, Yarmohammadi H, Ziv E, D'Angelica MI, Kingham TP, Cercek A, Solomon SB, Beets-Tan RGH, Sofocleous CT. Factors Associated With Local Tumor Control and Complications After Thermal Ablation of Colorectal Cancer Liver Metastases: A 15-year Retrospective Cohort Study. Clin Colorectal Cancer 2020; 20:e82-e95. [PMID: 33246789 DOI: 10.1016/j.clcc.2020.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/03/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to identify risk factors associated with local tumor progression-free survival (LTPFS) and complications after colorectal liver metastases (CLM) thermal ablation (TA). PATIENTS AND METHODS This retrospective analysis included 286 patients with 415 CLM undergoing TA (radiofrequency and microwave ablation) in 378 procedures from January 2003 to July 2017. Prior hepatic artery infusion (HAI), bevacizumab, pre-existing biliary dilatation, ablation modality, minimal ablation margin (MM), prior hepatectomy, CLM number, and size were analyzed as factors influencing complications and LTPFS. Statistical analysis included the Kaplan-Meier method, Cox proportional hazards model, competing risk analysis, univariate/multivariate logistic/exact logistic regressions, and the Fisher exact test. Complications were reported according to modified Society of Interventional Radiology guidelines. RESULTS The median follow-up was 31 months. There was no LTP for MM > 10 mm. Smaller tumor size, increased MM, and prior hepatectomy correlated with longer LTPFS. The major complications occurred following 28 (7%) of 378 procedures. There were no biliary complications in HAI-naive patients, versus 11% in HAI patients (P < .001), of which 7% were major. Biliary complications predictors in HAI patients included biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, ablation with 6 to 10 mm and > 10 mm MM resulted in major biliary complication rates of 4% and 21% (P = .0011), with corresponding LTP rates of 24% and 0% (P = .0033). In HAI-naive patients, the LTP rates for 6 to 10 mm and > 10 mm MM were 27% and 0%, respectively. CONCLUSIONS No LTP was seen for MM > 10 mm. Biliary complications occurred only in HAI patients, especially in those with biliary dilatation, bevacizumab, and MM > 10 mm. In HAI patients, MM of 6 to 10 mm resulted in 76% local tumor control and 4% major biliary complications incidence.
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Affiliation(s)
- Ieva Kurilova
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Achiude Bendet
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Franz E Boas
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena Kaye
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anne Covey
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karen T Brown
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy E Kemeny
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hooman Yarmohammadi
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael I D'Angelica
- Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Gastrointestinal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven B Solomon
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Regina G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Constantinos T Sofocleous
- Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Ziv E, Zhang Y, Kelly L, Nikolovski I, Boas FE, Erinjeri JP, Cai L, Petre EN, Brody LA, Covey AM, Getrajdman G, Harding JJ, Sofocleous C, Abou-Alfa GK, Solomon SB, Brown KT, Yarmohammadi H. NRF2 Dysregulation in Hepatocellular Carcinoma and Ischemia: A Cohort Study and Laboratory Investigation. Radiology 2020; 297:225-234. [PMID: 32780006 DOI: 10.1148/radiol.2020200201] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Intermediate stage hepatocellular carcinomas (HCCs) are treated by inducing ischemic cell death with transarterial embolization (TAE) or transarterial chemoembolization (TACE). A subset of HCCs harbor nuclear factor E2-related factor 2 (NRF2), a major regulator of the oxidative stress response implicated in cell survival after ischemia. NRF2-mutated HCC response to TAE and/or TACE is unknown. Purpose To test whether ischemia resistance is present in individuals with NRF2-mutated HCC and if this resistance can be overcome by means of NRF2 inhibition in HCC cell lines. Materials and Methods This was a combined retrospective review of an institutional database (from January 2011 to December 2018) and prospective study (from January 2014 to December 2018) of participants with HCC who underwent TAE and a laboratory investigation of HCC cell lines. Imaging follow-up included liver CT or MRI at 1 month after the procedure followed by 3-month interval scans. Tumor radiologic response was assessed on the basis of follow-up imaging. The time to local progression after TAE for individuals with and individuals without NRF2 pathway alterations was estimated by using competing risk analysis (Gray test). The in vitro response to ischemia in four HCC cell lines with and without NRF2 overexpression was evaluated, and the combination of ischemia with NRF2 knockdown by means of short hairpin RNA or an NRF2 inhibitor was tested. Doubling time estimates, dose response curve regression, and comparison analyses were performed. Results Sixty-five individuals (median age, 69 years [range, 19-84 years]; 53 men) were evaluated. HCCs with NRF2 pathway mutation had a shorter time to local progression after TAE compared to those without mutation (6-month cumulative incidence of local progression, 56% [range, 19%-91%] vs 22% [range, 12%-34%], respectively; P < .001) and confirmed ischemia resistance in NRF2-overexpressing HCC cell lines. However, ischemia and NRF2 knock-down worked synergistically to decrease proliferation of NRF2-overexpressing HCC cell lines. Dose response curves of ML385, an NRF2 inhibitor, showed that ischemia induces addiction to NRF2 in cells with NRF2 alterations. Conclusion Hepatocellular carcinoma with nuclear factor E2-related factor 2 (NRF2) alterations showed resistance to ischemia, but ischemia simultaneously induced sensitivity to NRF2 inhibition. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Weiss and Nezami in this issue.
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Affiliation(s)
- Etay Ziv
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Yiru Zhang
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Luke Kelly
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Ines Nikolovski
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - F Edward Boas
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Joseph P Erinjeri
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Liqun Cai
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Elena N Petre
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Lynn A Brody
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Anne M Covey
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - George Getrajdman
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - James J Harding
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Constantinos Sofocleous
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Ghassan K Abou-Alfa
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Stephen B Solomon
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Karen T Brown
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
| | - Hooman Yarmohammadi
- From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.)
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Vasiniotis Kamarinos N, Vakiani E, Gonen M, Kemeny NE, Covey AM, Brown KT, Brody LA, Deipolyi AR, Camacho J, Boas FE, Yarmohammadi H, Erinjeri J, Petre EN, Kingham TP, D'Angelica MI, Saltz LB, Solomon SB, Sofocleous CT. Immediate post-thermal ablation biopsy of colorectal liver metastases to predict oncologic outcomes. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4602 Background: Thermal ablation (TA) is used as a local cure for selected colorectal liver metastases (CLM) with minimal risk. A critical limitation of TA has been early local tumor progression (LTP). The goal of this study is to establish the role of ablation zone (AZ) biopsy in predicting LTP. Methods: This institutional review board-approved prospective study included patients with CLM of 5cm or less in maximum diameter, with confined liver disease or stable, limited extrahepatic disease. Both radiofrequency(RF) and microwave(MW) ablation modalities were used. A biopsy of the center and margin of the AZ was performed immediately after ablation. The applicators were also examined for the presence of viable tumor cells. All samples containing morphologically identified tumor cells were further interrogated with immunohistochemistry to determine the proliferative and viability potential of the detected tumor cells. Ablation margin size was evaluated on the first CT scan performed 4–8 weeks after ablation and was confirmed by 3D assessment with Ablation Confirmation Software (Neuwave™). Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results: Between November 2009 and February 2019, 102 patients with 182 CLMs were enrolled. Mean tumor size was 2.0 cm (range, 0.6–4.8 cm). MW was used in 95/182 (52%) tumors and RF in 87/182 (48%). Median follow-up was 19 months. Technical effectiveness was evident in 178/182 (97%) ablated tumors on the first contrast material–enhanced CT at 4–8-weeks post-ablation. The cumulative incidence of LTP at 12 months was 19% (95% confidence interval [CI]: 14, 27). Samples from 64 (35%) of the 178 technically successful cases contained viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. In a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 4.3), and positive biopsy results (P = .02; HR, 1.8) remained significant. LTP within 12 months after TA was noted in 3% (95% CI: 1, 6) of tumor-negative biopsy CLMs with margins of at least 5 mm. Conclusions: Biopsy and pathologic examination of the AZ predicts LTP regardless of TA modality used. This can optimize ablation as a potential local cure for patients with limited CLM.
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Affiliation(s)
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | - Anne M. Covey
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Lynn A Brody
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Elena N Petre
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Leonard B. Saltz
- Department of Colorectal Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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8
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Newgard BJ, Getrajdman GI, Erinjeri JP, Covey AM, Brody LA, Sofocleous CT, Brown KT. Incidence and Consequence of Nontarget Embolization Following Bland Hepatic Arterial Embolization. Cardiovasc Intervent Radiol 2019; 42:1135-1141. [DOI: 10.1007/s00270-019-02229-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 04/19/2019] [Indexed: 12/29/2022]
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9
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Diamond EL, Durham BH, Ulaner GA, Drill E, Buthorn J, Ki M, Bitner L, Cho H, Young RJ, Francis JH, Rampal R, Lacouture M, Brody LA, Ozkaya N, Dogan A, Rosen N, Iasonos A, Abdel-Wahab O, Hyman DM. Efficacy of MEK inhibition in patients with histiocytic neoplasms. Nature 2019; 567:521-524. [PMID: 30867592 PMCID: PMC6438729 DOI: 10.1038/s41586-019-1012-y] [Citation(s) in RCA: 188] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/11/2019] [Indexed: 12/16/2022]
Abstract
Histiocytic neoplasms are a heterogeneous group of clonal hematopoietic disorders marked by diverse mutations in the mitogen-activated protein kinase (MAPK) pathway.1,2 For the 50% of histiocytosis patients with BRAFV600-mutations3–5, RAF inhibition is highly efficacious and has dramatically altered the natural history of the disease.6,7 Conversely, no standard therapy exists for the remaining 50% of patients lacking BRAFV600-mutations. While ERK dependence has been hypothesized to be a consistent feature across histiocytic neoplasms, this remains clinically unproven and many kinase mutations found in these patients have not been biologically characterized. We set out to evaluate ERK dependence in histiocytoses through a proof-of-concept clinical trial of the oral MEK1/2 inhibitor cobimetinib in patients with histiocytoses. Patients were enrolled regardless of tumor genotype. In parallel, novel MAPK alterations identified in treated patients were characterized for their ability to activate ERK. In 18 treated patients, the overall response rate (ORR) was 89% (90% CI: 73–100). Responses were durable, with no acquired resistance to date. At one year, 100% of responses were ongoing, and 94% of patients remained progression-free. Efficacy was observed regardless of genotype with responses achieved in patients with ARAF, BRAF, RAF1, NRAS, KRAS, MEK1, and MEK2 mutations. Consistent with observed responses, characterization of the novel mutations identified in treated patients confirmed them to be activating. Collectively, these data demonstrate that histiocytic neoplasms are characterized by remarkable dependence on MAPK signaling and, consequently, responsiveness to MEK inhibition. These results extend the benefits of molecularly targeted therapy to the entire spectrum of patients with histiocytosis.
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Affiliation(s)
- Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Benjamin H Durham
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary A Ulaner
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Esther Drill
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Justin Buthorn
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Ki
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian Bitner
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hana Cho
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Young
- Weill Cornell Medical College, New York, NY, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jasmine H Francis
- Ophthalmic Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raajit Rampal
- Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario Lacouture
- Weill Cornell Medical College, New York, NY, USA.,Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lynn A Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neval Ozkaya
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neal Rosen
- Weill Cornell Medical College, New York, NY, USA.,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexia Iasonos
- Weill Cornell Medical College, New York, NY, USA.,Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Omar Abdel-Wahab
- Weill Cornell Medical College, New York, NY, USA. .,Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - David M Hyman
- Weill Cornell Medical College, New York, NY, USA. .,Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Maybody M, Muallem N, Brown KT, Moskowitz CS, Hsu M, Zenobi CL, Jihad M, Getrajdman GI, Sofocleous CT, Erinjeri JP, Covey AM, Brody LA, Yarmohammadi H, Deipolyi AR, Bryce Y, Alago W, Siegelbaum RH, Durack JC, Gonzalez-Aguirre AJ, Ziv E, Boas FE, Solomon SB. Autologous Blood Patch Injection versus Hydrogel Plug in CT-guided Lung Biopsy: A Prospective Randomized Trial. Radiology 2018; 290:547-554. [PMID: 30480487 DOI: 10.1148/radiol.2018181140] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To compare the effect of autologous blood patch injection (ABPI) with that of a hydrogel plug on the rate of pneumothorax at CT-guided percutaneous lung biopsy. Materials and Methods In this prospective randomized controlled trial ( https://ClinicalTrials.gov , NCT02224924), a noninferiority design was used for ABPI, with a 10% noninferiority margin when compared with the hydrogel plug, with the primary outcome of pneumothorax rate within 2 hours of biopsy. A type I error rate of 0.05 and 90% power were specified with a target study population of 552 participants (276 in each arm). From October 2014 to February 2017, all potential study participants referred for CT-guided lung biopsy (n = 2052) were assessed for enrollment. Results The data safety monitoring board recommended the trial be closed to accrual after an interim analysis met prespecified criteria for early stopping based on noninferiority. The final study group consisted of 453 participants who were randomly assigned to the ABPI (n = 226) or hydrogel plug (n = 227) arms. Of these, 407 underwent lung biopsy. Pneumothorax rates within 2 hours of biopsy were 21% (42 of 199) and 29% (60 of 208); chest tube rates were 9% (18 of 199) and 13% (27 of 208); and delayed pneumothorax rates within 2 weeks after biopsy were 1.4% (three of 199) and 1.5% (three of 208) in the ABPI and hydrogel plug arms, respectively. Conclusion Autologous blood patch injection is noninferior to a hydrogel plug regarding the rate of pneumothorax after CT-guided percutaneous lung biopsy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Majid Maybody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Nadim Muallem
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Karen T Brown
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Chaya S Moskowitz
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Meier Hsu
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Christina L Zenobi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Marwah Jihad
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - George I Getrajdman
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Constantinos T Sofocleous
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Joseph P Erinjeri
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Anne M Covey
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Lynn A Brody
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Hooman Yarmohammadi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Amy R Deipolyi
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Yolanda Bryce
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - William Alago
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Robert H Siegelbaum
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Jeremy C Durack
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Adrian J Gonzalez-Aguirre
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Etay Ziv
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - F Edward Boas
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
| | - Stephen B Solomon
- From the Departments of Radiology (M.M., N.M., K.T.B., C.L.Z., M.J., C.I.G., C.T.S., J.P.E., A.M.C., L.A.B., H.Y., A.R.D., Y.B., W.A., R.H.S., J.C.D., A.J.G., E.Z., F.E.B., S.B.S.) and Epidemiology and Biostatistics (C.S.M., M.H.), Memorial Sloan Kettering Cancer Center, 1275 York Ave, M276C, New York, NY 10065
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11
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Ziv E, Rice SL, Filtes J, Yarmohammadi H, Boas FE, Erinjeri JP, Petre EN, Brody LA, Brown KT, Covey AM, Getrajdman GI, Maybody M, Raj N, Sofocleous CT, Solomon SB, Reidy-Lagunes D. DAXX Mutation Status of Embolization-Treated Neuroendocrine Tumors Predicts Shorter Time to Hepatic Progression. J Vasc Interv Radiol 2018; 29:1519-1526. [PMID: 30342802 DOI: 10.1016/j.jvir.2018.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/14/2018] [Accepted: 05/25/2018] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To identify common gene mutations in patients with neuroendocrine liver metastases (NLM) undergoing transarterial embolization (TAE) and establish relationship between these mutations and response to TAE. MATERIALS AND METHODS Patients (n = 51; mean age 61 y; 29 men, 22 women) with NLMs who underwent TAE and had available mutation analysis were identified. Mutation status and clinical variables were recorded and evaluated in relation to hepatic progression-free survival (HPFS) (Cox proportional hazards) and time to hepatic progression (TTHP) (competing risk proportional hazards). Subgroup analysis of patients with pancreatic NLM was performed using Fisher exact test to identify correlation between mutation and event (hepatic progression or death) by 6 months. Changes in mutation status over time and across specimens in a subset of patients were recorded. RESULTS Technical success of TAE was 100%. Common mutations identified were MEN1 (16/51; 31%) and DAXX (13/51; 25%). Median overall survival was 48.7 months. DAXX mutation status (hazard ratio = 6.21; 95% confidence interval [CI], 2.67-14.48; P < .001) and tumor grade (hazard ratio = 3.05; 95% CI, 1.80-5.17; P < .001) were associated with shorter HPFS and TTHP on univariate and multivariate analysis. Median HPFS was 3.6 months (95% CI, 1.7-5.3) for patients with DAXX mutation compared with 8.9 months (95% CI, 6.6-11.4) for patients with DAXX wild-type status. In patients with pancreatic NLMs, DAXX mutation status was associated with hepatic progression or death by 6 months (P = .024). DAXX mutation status was concordant between primary and metastatic sites. CONCLUSIONS DAXX mutation is common in patients with pancreatic NLMs. DAXX mutation status is associated with shorter HPFS and TTHP after TAE.
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Affiliation(s)
- Etay Ziv
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065.
| | - Samuel L Rice
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - John Filtes
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - F Edward Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Joseph P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Elena Nadia Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Lynn A Brody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Karen T Brown
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Anne M Covey
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - George I Getrajdman
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Majid Maybody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Nitya Raj
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
| | - Diane Reidy-Lagunes
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, Howard-118, 1275 York Avenue, New York, NY 10065
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12
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Deipolyi AR, Riedl CC, Bromberg J, Chandarlapaty S, Klebanoff CA, Sofocleous CT, Yarmohammadi H, Brody LA, Boas FE, Ziv E. Association of PI3K Pathway Mutations with Early Positron-Emission Tomography/CT Imaging Response after Radioembolization for Breast Cancer Liver Metastases: Results of a Single-Center Retrospective Pilot Study. J Vasc Interv Radiol 2018; 29:1226-1235. [PMID: 30078647 DOI: 10.1016/j.jvir.2018.04.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 03/27/2018] [Accepted: 04/05/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To describe imaging response and survival after radioembolization for metastatic breast cancer and to delineate genetic predictors of imaging responses and outcomes. MATERIALS AND METHODS This retrospective study included 31 women (average age, 52 y) with liver metastasis from invasive ductal carcinoma who underwent resin and glass radioembolization (average cumulative dose, 2.0 GBq ± 1.8) between January 2011 and September 2017 after receiving ≥ 3 lines of chemotherapy. Twenty-four underwent genetic profiling with MSK-IMPACT or Sequenom; 26 had positron-emission tomography (PET)/CT imaging before and after treatment. Survival after the first radioembolization and 2-4-month PET/CT imaging response were assessed. Laboratory and imaging features were assessed to determine variables predictive of outcomes. Unpaired Student t tests and Fisher exact tests were used to compare responders and nonresponders categorized by changes in fluorodeoxyglucose avidity. Kaplan-Meier survival analysis was used to determine the impact of predictors on survival after radioembolization. RESULTS Median survival after radioembolization was 11 months (range, 1-49 mo). Most patients (18 of 26; 69%) had complete or partial response based on changes in fluorodeoxyglucose avidity. Imaging response was associated with longer survival (P = .005). Whereas 100% of patients with PI3K pathway mutations showed an imaging response, only 45% of wild-type patients showed a response (P = .01). Median survival did not differ between PI3K pathway wild-type (10.9 mo) and mutant (undefined) patients (P = .50). CONCLUSIONS These preliminary data suggest that genomic profiling may predict which patients with metastatic breast cancer benefit most from radioembolization. PI3K pathway mutations are associated with improved imaging response, which is associated with longer survival.
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Affiliation(s)
- Amy R Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York.
| | - Christopher C Riedl
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Jacqueline Bromberg
- Department of Radiology, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Sarat Chandarlapaty
- Department of Radiology, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Christopher A Klebanoff
- Center for Cell Engineering and Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Hooman Yarmohammadi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Lynn A Brody
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - F Edward Boas
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
| | - Etay Ziv
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave., H118-A, New York, NY 10065; Weill Cornell Medical College, New York, New York
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13
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Kurilova I, Beets-Tan RGH, Ulaner GA, Boas FE, Petre EN, Yarmohammadi H, Ziv E, Deipolyi AR, Brody LA, Gonen M, Sofocleous CT. 90Y Resin Microspheres Radioembolization for Colon Cancer Liver Metastases Using Full-Strength Contrast Material. Cardiovasc Intervent Radiol 2018; 41:1419-1427. [PMID: 29766239 DOI: 10.1007/s00270-018-1985-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/07/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To assess safety and efficacy of 90Y resin microspheres administration using undiluted non-ionic contrast material (UDCM) {100% Omnipaque-300 (Iohexol)} in both the "B" and "D" lines. MATERIALS AND METHODS We reviewed all colorectal cancer liver metastases patients treated with 90Y resin microspheres radioembolization (RAE) from 2009 to 2017. As of April 2013, two experienced operators started using UDCM (study group) instead of standard sandwich infusion (control group). Occurrence of myelosuppression (leukopenia, neutropenia, erythrocytopenia or/and thrombocytopenia), stasis, nontarget delivery (NTD), median fluoroscopy radiation dose (FRD), median infusion time (IT), liver progression-free (LPFS) and overall survivals (OS) was evaluated. Complications within 6 months post-RAE were reported according to CTCAE v3.0 criteria. RESULTS Study and control groups comprised 23(28%) and 58(72%) patients, respectively. Median follow-up was 9.1 months. There was no statistically significant difference in myelosuppression incidence within 6 months post-RAE between groups. Median FRD and IT for study and control groups were 44.6 vs. 97.35 Gy/cm2 (p = 0.048) and 31 vs. 39 min (p = 0.006), respectively. A 38% lower stasis incidence in study group was not significant (p = 0.34). NTD occurred in 1/27(4%) study vs. 5/73(7%) control group procedures (p = 1). Grade 1-2 and grade 3-4 toxicities between study and control group patients were 36%(8/22) vs. 45%(26/58), p = 0.61 and 9%(2/22) vs. 16%(9/58), p = 0.72, respectively. There was no difference in LPFS and OS between groups. CONCLUSION Administration of 90Y resin microspheres using UDCM in both lines is safe and effective, resulting in lower fluoroscopy radiation dose and shorter infusion time, without evidence of myelosuppression or increased stasis incidence.
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Affiliation(s)
- I Kurilova
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - R G H Beets-Tan
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - G A Ulaner
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - F E Boas
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - E N Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Yarmohammadi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - E Ziv
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - A R Deipolyi
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - L A Brody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - M Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Deipolyi AR, Bromberg JF, Erinjeri JP, Solomon SB, Brody LA, Riedl CC. Abscopal Effect after Radioembolization for Metastatic Breast Cancer in the Setting of Immunotherapy. J Vasc Interv Radiol 2018; 29:432-433. [DOI: 10.1016/j.jvir.2017.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 10/18/2022] Open
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Gonzalez-Aguirre A, Covey AM, Brown KT, Brody LA, Boas FE, Sofocleous CT, Maybody M, Getrajdman GI, Erinjeri JP. Comparison of biliary brush biopsy and fine needle biopsy in the diagnosis of biliary strictures. MINIM INVASIV THER 2018; 27:278-283. [PMID: 29390936 DOI: 10.1080/13645706.2018.1427597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the accuracy of percutaneous fine needle biopsy (FNB) and brush biopsy (BB) at a cancer center. MATERIAL AND METHODS Retrospective analysis of all bile duct biopsies performed in Interventional Radiology between January 2000 and January 2015 was performed. FNB was performed under real-time cholangiographic guidance using a notched needle directed at the bile duct stricture. BB was performed by advancing a brush across the stricture and moving it back and forth to scrape the stricture. Biopsy results were categorized as true positive (TP), true negative (TN), false positive (FP) and false negative (FN) based on pathology reports and confirmed by surgical specimens or clinical follow-up of at least six months. Fisher's exact test was used to compare the rate of TP in FNB and BB. RESULTS One-hundred and nineteen patients underwent FNB or BB. Fifteen were censored because of lack of follow-up. The remaining 104 patients underwent a total of 117 bile duct biopsies during the study period: 34 FNB and 83 BB. There were no complications in either group. In the FNB group 22/34 (64%) biopsies were TP, 4/34(12%) were TN and there were 8(24%) FN biopsies. In the BB group, 20/83 (24%) were TP, 38/83 (46%) TN and 25/83 (30%) FN biopsies. There were no FP biopsies in either group. The sensitivity of detecting malignancy by FNB was significantly higher than that by BB (73% vs 44%, p < .0005). There were no complications associated with FNB or BB. CONCLUSIONS FNB of bile duct strictures is safe and has a higher sensitivity for detecting malignancy than BB.
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Affiliation(s)
- Adrian Gonzalez-Aguirre
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Anne M Covey
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Karen T Brown
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Lynn A Brody
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - F Edward Boas
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | | | - Majid Maybody
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - George I Getrajdman
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
| | - Joseph P Erinjeri
- a Interventional Radiology Service , Memorial Sloan-Kettering Cancer Center , New York , NY , USA
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Deipolyi AR, Covey AM, Brody LA, Bryce YC, Li D, Brown KT. Women’s Challenges in IR: #ILookLikeAnIR. J Vasc Interv Radiol 2017; 28:1195-1196. [DOI: 10.1016/j.jvir.2017.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022] Open
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Maybody M, Madoff DC, Thornton RH, Morales SA, Moskowitz CS, Hsu M, Brody LA, Brown KT, Covey AM. Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature. Clin Imaging 2017; 42:96-105. [PMID: 27936421 PMCID: PMC5499980 DOI: 10.1016/j.clinimag.2016.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE To report 3 new cases of catheter-directed endovascular application of thrombin and explore trends by analysis of published case series. MATERIALS AND METHODS Institutional Review Board approved this retrospective study. All cases of non-tumoral arterial embolization performed from January 2003 to January 2015 at our institution were retrospectively reviewed. Thrombin was used in 7 of 589 cases. In 3 cases intra arterial thrombin was injected via catheter to treat active hemorrhage. Four cases were excluded due to percutaneous injection into visceral pseudoaneurysms (n=3) and making ex vivo autologous clot to be injected via catheter (n=1). Fisher's exact and the Wilcoxon rank sum tests were used to assess for association with acute nontarget thrombosis. RESULTS Catheter-directed thrombin was used in 3/589 (0.5%) cases at our institution. All three cases were technically successful with no further bleeding (100%). Nontarget thrombosis of proximal branches occurred in 2 patients (67%) with no significant clinical consequences. Including our 3 cases, a total of 28 cases were reviewed. Of the variables examined-location (p=0.99), size (p=0.66) and etiology of vascular lesion (p=0.92), pseudoaneurysm neck anatomy (p=0.14), thrombin units (p=0.47), volume (p=0.76) or technique of use of small doses (p=0.99), use of other embolic material (p=0.67) and use of adjunct techniques (p=0.99)-none were found to be significantly associated with acute nontarget thrombosis. Technical success was 96% with no reports of reperfusion after treatment. CONCLUSIONS Catheter-directed endovascular thrombin can be an additional tool to treat pseudoaneurysms not amenable to conventional embolization. Further studies are required to optimize technique and outcomes.
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Affiliation(s)
- Majid Maybody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - David C Madoff
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Raymond H Thornton
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Steven A Morales
- University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IO 52242, USA.
| | - Chaya S Moskowitz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Meier Hsu
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Lynn A Brody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Karen T Brown
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
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Brown KT, Do R, Gönen M, Covey AM, Getrajdman GI, Sofocleous CT, Jarnagin WR, D'Angelica MI, Allen PJ, Erinjeri JP, Brody LA, O'Neill GP, Johnson K, Garcia AR, Beattie CM, Zhao B, Solomon SB, Schwartz LH, DeMatteo RP, Abou-Alfa GK. Reply to A. Braillon, M. Boulin et al, and J.-H. Zhong et al. J Clin Oncol 2017; 35:258-259. [PMID: 28056199 DOI: 10.1200/jco.2016.69.7961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Karen T Brown
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Richard Do
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Mithat Gönen
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Anne M Covey
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - George I Getrajdman
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Constantinos T Sofocleous
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William R Jarnagin
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Michael I D'Angelica
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Peter J Allen
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Joseph P Erinjeri
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lynn A Brody
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Gerald P O'Neill
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kristian Johnson
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alessandra R Garcia
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Christopher M Beattie
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Binsheng Zhao
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Stephen B Solomon
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lawrence H Schwartz
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ronald P DeMatteo
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ghassan K Abou-Alfa
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Brown KT, Richard Kinh D, Gonen M, Covey AM, Getrajdman GI, Sofocleous CT, Jarnagin WR, D’Angelica MI, Allen PJ, Erinjeri JP, Brody LA, Solomon SB, Schwartz LH, DeMatteo RP, Abou-Alfa GK. Trans-arterial embolization for hepatocellular carcinoma: doxorubicin is not necessary. Transl Cancer Res 2016. [DOI: 10.21037/tcr.2016.11.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sag AA, Brody LA, Maybody M, Erinjeri JP, Wang X, Wimmer T, Silk M, Petre EN, Solomon SB. Acute and delayed bleeding requiring embolization after image-guided liver biopsy in patients with cancer. Clin Imaging 2016; 40:535-40. [PMID: 27133700 DOI: 10.1016/j.clinimag.2015.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To report incidence of acute versus delayed presentations of bleeding requiring embolization after focal liver biopsy, in correlation with angiographic findings and treatment success rates. The available literature will be reviewed as well. MATERIALS AND METHODS Health Insurance Portability and Accountability Act-compliant institutional review board approved retrospective review of 2180 consecutive patients undergoing 2335 targeted liver biopsies at a tertiary-care cancer center. Hepatic arterial embolization episodes within 30days from biopsy were identified via radiology PACS. Electronic medical record review was performed for indication of embolization and postembolization clinical course. RESULTS The incidence of postbiopsy bleeding requiring embolization was 0.5% (12/2335 biopsies). In those with bleeding, 1/12 (8%) had no hepatic arterial findings at angiography. Angiographic hepatic arterial findings resolved after embolization in 11/11 patients (100% technical success). Bleeding ceased after embolization in 10/12 patients (83% clinical success). Complications were seen in 2/12 (17%) patients: cholecystitis and hepatic infarct, respectively. Delayed presentation of bleeding (defined as >24h postbiopsy) occurred in 5/12 (42%) patients; the longest latency was 12days. CONCLUSION The overall incidence of bleeding requiring embolization in our population was 0.5%. This complication rate compares favorably to the 0-4.2% (median: 0.29%) rate quoted in the available, heterogeneous, literature on this topic. Delayed presentation occurred in almost half of patients. Arterial embolization carries excellent technical and clinical success rates.
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Affiliation(s)
- Alan A Sag
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Division of Interventional Radiology, Department of Radiology, Koç University School of Medicine, Istanbul, Turkey.
| | - Lynn A Brody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Majid Maybody
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joseph P Erinjeri
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Xiaodong Wang
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Interventional Radiology, Peking University Cancer Hospital and Institute and Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Beijing, China
| | - Thomas Wimmer
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Department of Radiology, Medical University of Graz, Graz, Austria
| | - Mikhail Silk
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Elena N Petre
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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21
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Sotirchos VS, Petrovic LM, Gönen M, Klimstra DS, Do RKG, Petre EN, Garcia AR, Barlas A, Erinjeri JP, Brown KT, Covey AM, Alago W, Brody LA, DeMatteo RP, Kemeny NE, Solomon SB, Manova-Todorova KO, Sofocleous CT. Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome. Radiology 2016; 280:949-59. [PMID: 27010254 DOI: 10.1148/radiol.2016151005] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 6.7) and positive biopsy results (P = .008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm. Conclusion Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. (©) RSNA, 2016.
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Affiliation(s)
- Vlasios S Sotirchos
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lydia M Petrovic
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Mithat Gönen
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - David S Klimstra
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Richard K G Do
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Elena N Petre
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Alessandra R Garcia
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Afsar Barlas
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Joseph P Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Karen T Brown
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Anne M Covey
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Lynn A Brody
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Ronald P DeMatteo
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Nancy E Kemeny
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Stephen B Solomon
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Katia O Manova-Todorova
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
| | - Constantinos T Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (V.S.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., L.A.B., S.B.S., C.T.S.), Departments of Epidemiology and Biostatistics (M.G.), Pathology (D.S.K.), Radiology (R.K.G.D., A.R.G.), Molecular Cytology (A.B., K.O.M.), Surgery (R.P.D.), and Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; and Department of Pathology, University of Southern California University Hospital, Los Angeles, Calif (L.M.P.)
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Yarmohammadi H, Brody LA, Erinjeri JP, Covey AM, Boas FE, Ziv E, Maybody M, Gonzalez-Aguirre AJ, Brown KT, Sheinfeld J, Getrajdman GI. Therapeutic Application of Percutaneous Peritoneovenous (Denver) Shunt in Treating Chylous Ascites in Cancer Patients. J Vasc Interv Radiol 2016; 27:665-73. [PMID: 26965362 DOI: 10.1016/j.jvir.2015.12.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/14/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of percutaneous peritoneovenous shunt (PPVS) placement in treating intractable chylous ascites (CA) in patients with cancer. MATERIALS AND METHODS Data from 28 patients with refractory CA treated with PPVS from April 2001 to June 2015 were reviewed. Demographic characteristics, technical success, efficacy, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analysis was performed. RESULTS Technical success was 100%, and ascites resolved or symptoms were relieved in 92.3% (26 of 28) of patients. In 13 (46%) patients with urologic malignancies, whose ascites had resulted from retroperitoneal lymph node dissection, the ascites resolved, resulting in shunt removal within 128 days ± 84. The shunt provided palliation of symptoms in 13 of the remaining 15 patients (87%) for a mean duration of 198 days ± 214. Serum albumin levels increased significantly (21.4%) after PPVS placement from a mean of 2.98 g/dL ± 0.64 before the procedure to 3.62 g/dL ± 0.83 (P < .001). The complication rate was 37%, including shunt malfunction/occlusion (22%), venous thrombosis (7%), and subclinical disseminated intravascular coagulopathy (DIC) (7%). Smaller venous limb size (11.5 F) and the presence of peritoneal tumor were associated with a higher rate of shunt malfunction (P < .05). No patient developed overt DIC. CONCLUSIONS PPVS can safely and effectively treat CA in patients with cancer, resulting in significant improvement in serum albumin in addition to palliation of symptoms.
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Affiliation(s)
- Hooman Yarmohammadi
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065.
| | - Lynn A Brody
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - Joseph P Erinjeri
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - Anne M Covey
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - F Edward Boas
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - Etay Ziv
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - Majid Maybody
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | | | - Karen T Brown
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
| | - Joel Sheinfeld
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065
| | - George I Getrajdman
- Department of Interventional Radiology, 1275 York Avenue, New York, NY 10065
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23
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Brown KT, Do RK, Gonen M, Covey AM, Getrajdman GI, Sofocleous CT, Jarnagin WR, D'Angelica MI, Allen PJ, Erinjeri JP, Brody LA, O'Neill GP, Johnson KN, Garcia AR, Beattie C, Zhao B, Solomon SB, Schwartz LH, DeMatteo R, Abou-Alfa GK. Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone. J Clin Oncol 2016; 34:2046-53. [PMID: 26834067 DOI: 10.1200/jco.2015.64.0821] [Citation(s) in RCA: 277] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Transarterial chemoembolization is accepted therapy for hepatocellular carcinoma (HCC). No randomized trial has demonstrated superiority of chemoembolization compared with embolization, and the role of chemotherapy remains unclear. This randomized trial compares the outcome of embolization using microspheres alone with chemoembolization using doxorubicin-eluting microspheres. MATERIALS AND METHODS At a single tertiary referral center, patients with HCC were randomly assigned to embolization with microspheres alone (Bead Block [BB]) or loaded with doxorubicin 150 mg (LC Bead [LCB]). Random assignment was stratified by number of embolizations to complete treatment, and assignments were generated by permuted blocks in the institutional database. The primary end point was response according to RECIST 1.0 (Response Evaluation Criteria in Solid Tumors) using multiphase computed tomography 2 to 3 weeks post-treatment and then at quarterly intervals, with the reviewer blinded to treatment allocation. Secondary objectives included safety and tolerability, time to progression, progression-free survival, and overall survival. This trial is currently closed to accrual. RESULTS Between December 2007 and April 2012, 101 patients were randomly assigned: 51 to BB and 50 to LCB. Demographics were comparable: median age, 67 years; 77% male; and 22% Barcelona Clinic Liver Cancer stage A and 78% stage B or C. Adverse events occurred with similar frequency in both groups: BB, 19 of 51 patients (38%); LCB, 20 of 50 patients (40%; P = .48), with no difference in RECIST response: BB, 5.9% versus LCB, 6.0% (difference, -0.1%; 95% CI, -9% to 9%). Median PFS was 6.2 versus 2.8 months (hazard ratio, 1.36; 95% CI, 0.91 to 2.05; P = .11), and overall survival, 19.6 versus 20.8 months (hazard ratio, 1.11; 95% CI, 0.71 to 1.76; P = .64) for BB and LCB, respectively. CONCLUSION There was no apparent difference between the treatment arms. These results challenge the use of doxorubicin-eluting beads for chemoembolization of HCC.
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Affiliation(s)
- Karen T Brown
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY.
| | - Richard K Do
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Mithat Gonen
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Anne M Covey
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - George I Getrajdman
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Constantinos T Sofocleous
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - William R Jarnagin
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Michael I D'Angelica
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Peter J Allen
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Joseph P Erinjeri
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Lynn A Brody
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Gerald P O'Neill
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Kristian N Johnson
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Alessandra R Garcia
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Christopher Beattie
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Binsheng Zhao
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Stephen B Solomon
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Lawrence H Schwartz
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Ronald DeMatteo
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
| | - Ghassan K Abou-Alfa
- Karen T. Brown, Richard K. Do, Mithat Gonen, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Gerald P. O'Neill, Kristian N. Johnson, Alessandra R. Garcia, Christopher Beattie, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center; Binsheng Zhao and Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons; and Karen T. Brown, Richard K. Do, Anne M. Covey, George I. Getrajdman, Constantinos T. Sofocleous, William R. Jarnagin, Michael I. D'Angelica, Peter J. Allen, Joseph P. Erinjeri, Lynn A. Brody, Stephen B. Solomon, Ronald DeMatteo, and Ghassan K. Abou-Alfa, Weill Cornell Medical College, New York, NY
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Shady W, Petre EN, Gonen M, Erinjeri JP, Brown KT, Covey AM, Alago W, Durack JC, Maybody M, Brody LA, Siegelbaum RH, D'Angelica MI, Jarnagin WR, Solomon SB, Kemeny NE, Sofocleous CT. Percutaneous Radiofrequency Ablation of Colorectal Cancer Liver Metastases: Factors Affecting Outcomes--A 10-year Experience at a Single Center. Radiology 2015; 278:601-11. [PMID: 26267832 DOI: 10.1148/radiol.2015142489] [Citation(s) in RCA: 240] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To identify predictors of oncologic outcomes after percutaneous radiofrequency ablation (RFA) of colorectal cancer liver metastases (CLMs) and to describe and evaluate a modified clinical risk score (CRS) adapted for ablation as a patient stratification and prognostic tool. MATERIALS AND METHODS This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of data in 162 patients with 233 CLMs treated with percutaneous RFA between December 2002 and December 2012. Contrast material-enhanced CT was used to assess technique effectiveness 4-8 weeks after RFA. Patients were followed up with contrast-enhanced CT every 2-4 months. Overall survival (OS) and local tumor progression-free survival (LTPFS) were calculated from the time of RFA by using the Kaplan-Meier method. Log-rank tests and Cox regression models were used for univariate and multivariate analysis to identify predictors of outcomes. RESULTS Technique effectiveness was 94% (218 of 233). Median LTPFS was 26 months. At univariate analysis, predictors of shorter LTPFS were tumor size greater than 3 cm (P < .001), ablation margin size of 5 mm or less (P < .001), high modified CRS (P = .009), male sex (P = .03), and no history of prior hepatectomy (P = .04) or hepatic arterial infusion chemotherapy (P = .01). At multivariate analysis, only tumor size greater than 3 cm (P = .01) and margin size of 5 mm or less (P < .001) were independent predictors of shorter LTPFS. Median and 5-year OS were 36 months and 31%. At univariate analysis, predictors of shorter OS were tumor size larger than 3 cm (P = .005), carcinoembryonic antigen level greater than 30 ng/mL (P = .003), high modified CRS (P = .02), and extrahepatic disease (EHD) (P < .001). At multivariate analysis, tumor size greater than 3 cm (P = .006) and more than one site of EHD (P < .001) were independent predictors of shorter OS. CONCLUSION Tumor size of less than 3 cm and ablation margins greater than 5 mm are essential for satisfactory local tumor control. Tumor size of more than 3 cm and the presence of more than one site of EHD are associated with shorter OS.
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Affiliation(s)
- Waleed Shady
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Elena N Petre
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Mithat Gonen
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Joseph P Erinjeri
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Karen T Brown
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Anne M Covey
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William Alago
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Jeremy C Durack
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Majid Maybody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Lynn A Brody
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Robert H Siegelbaum
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Michael I D'Angelica
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - William R Jarnagin
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Stephen B Solomon
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Nancy E Kemeny
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
| | - Constantinos T Sofocleous
- From the Section of Interventional Radiology, Department of Radiology (W.S., E.N.P., J.P.E., K.T.B., A.M.C., W.A., J.C.D., M.M., L.A.B., R.H.S., S.B.S., C.T.S.), Department of Epidemiology and Biostatistics (M.G.), Department of Surgery (M.I.D., W.R.J.), and Department of Medicine (N.E.K.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065
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25
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Sofocleous CT, Violari EG, Sotirchos VS, Shady W, Gonen M, Pandit-Taskar N, Petre EN, Brody LA, Alago W, Do RK, D'Angelica MI, Osborne JR, Segal NH, Carrasquillo JA, Kemeny NE. Radioembolization as a Salvage Therapy for Heavily Pretreated Patients With Colorectal Cancer Liver Metastases: Factors That Affect Outcomes. Clin Colorectal Cancer 2015; 14:296-305. [PMID: 26277696 DOI: 10.1016/j.clcc.2015.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND In this study we assessed the efficacy and factors that affect outcomes of radioembolization (RE) using yttrium-90 resin microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastases (CLM). PATIENTS AND METHODS After an institutional review board waiver of approval, a review of a Health Insurance Portability and Accountability Act-registered, prospectively created and maintained database was performed. Data on patient demographic and disease characteristics, RE treatment parameters, and additional treatments were evaluated for significance in predicting overall survival (OS) and liver progression-free survival (LPFS). Complications were evaluated according to the National Cancer Institute Common Terminology Criteria for adverse events. RESULTS From September 2009 to September 2013, 53 patients underwent RE at a median of 35 months after CLM diagnosis. Median OS was 12.7 months. Multivariate analysis showed that carcinoembryonic antigen levels at the time of RE ≥ 90 ng/mL (P = .004) and microscopic lymphovascular invasion of the primary (P = .002) were independent predictors of decreased OS. Median LPFS was 4.7 months. At 4 to 8 and 12 to 16 weeks after RE, most patients (80% and 61%, respectively) according to Response Evaluation Criteria in Solid Tumors (RECIST) had stable disease; additional evaluation using PET Response Criteria in Solid Tumors (PERCIST) led to reclassification in 77% of these cases (response or progression). No deaths were noted within the first 30 days. Within the first 90 days after RE, 4 patients (8%) developed liver failure and 5 patients (9%) died, all with evidence of disease progression. CONCLUSION RE in the salvage setting was well-tolerated, and permitted the administration of additional therapies and led to a median OS of 12.7 months. Evaluation using PERCIST was more likely than RECIST to document response or progression compared with the baseline assessment before RE.
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Affiliation(s)
| | - Elena G Violari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S Sotirchos
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Waleed Shady
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - William Alago
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Joseph R Osborne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nancy E Kemeny
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Sofocleous CT, Petre EN, Gonen M, Reidy-Lagunes D, Ip IK, Alago W, Covey AM, Erinjeri JP, Brody LA, Maybody M, Thornton RH, Solomon SB, Getrajdman GI, Brown KT. Factors affecting periprocedural morbidity and mortality and long-term patient survival after arterial embolization of hepatic neuroendocrine metastases. J Vasc Interv Radiol 2014; 25:22-30; quiz 31. [PMID: 24365504 DOI: 10.1016/j.jvir.2013.09.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/07/2013] [Accepted: 09/23/2013] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To identify factors affecting periprocedural morbidity and mortality and long-term survival following hepatic artery embolization (HAE) of hepatic neuroendocrine tumor (NET) metastases. MATERIALS AND METHODS This single-center, institutional review board-approved retrospective review included 320 consecutive HAEs for NET metastases performed in 137 patients between September 1996 and September 2007. Forty-seven HAEs (15%) were performed urgently to manage refractory symptoms in inpatients (urgent group), and 273 HAEs (85%) were elective (elective group). Overall survival (OS) was estimated by Kaplan-Meier methodology. Complications were categorized per Common Terminology Criteria for Adverse Events, version 4.0. Univariate and multivariate analyses were performed to determine independent predictors for OS, complications, and 30-day mortality. The independent factors were combined to develop clinical risk score groups. RESULTS Urgent HAE (P = .007), greater than 50% liver replacement by tumor (P < .0001), and extrahepatic metastasis (P = .007) were independent predictors for shorter OS. Patients with all three risk factors had decreased OS versus those with none (median, 8.5 vs 86 mo; P < .001). Thirty-day mortality was significantly lower in the elective (1%) versus the urgent group (8.5%; P = .0009). There were eight complications (3%) in the elective group and five (10.6%) in the urgent group (P = .03). Male sex and urgent group were independent factors for higher 30-day mortality rate (P = .023 and P =.016, respectively) and complications (P = .012 and P =.001, respectively). CONCLUSIONS Urgent HAE, replacement of more than 50% of liver by tumor, and extrahepatic metastasis are strong independent predictors of shorter OS. Male sex and urgent HAE carry higher 30-day mortality and periprocedural morbidity risks.
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Affiliation(s)
- Constantinos T Sofocleous
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065.
| | - Elena N Petre
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Diane Reidy-Lagunes
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Ivan K Ip
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - William Alago
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Anne M Covey
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Joseph P Erinjeri
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Lynn A Brody
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Majid Maybody
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Raymond H Thornton
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Stephen B Solomon
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - George I Getrajdman
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
| | - Karen T Brown
- Section of Interventional Radiology and Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Suite H 118, New York, NY 10065
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Violari EG, Brody LA, Covey AM, Erinjeri JP, Getrajdman GI, Sofocleous CT, Reidy DL, Jarnagin WR, Brown KT. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization. Cardiovasc Intervent Radiol 2014; 38:479-83. [DOI: 10.1007/s00270-014-0894-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/14/2014] [Indexed: 12/16/2022]
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Sofocleous CT, Garcia AR, Pandit-Taskar N, Do KG, Brody LA, Petre EN, Capanu M, Longing AP, Chou JF, Carrasquillo JA, Kemeny NE. Phase I Trial of Selective Internal Radiation Therapy for Chemorefractory Colorectal Cancer Liver Metastases Progressing After Hepatic Arterial Pump and Systemic Chemotherapy. Clin Colorectal Cancer 2014; 13:27-36. [DOI: 10.1016/j.clcc.2013.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 10/09/2013] [Accepted: 11/08/2013] [Indexed: 02/08/2023]
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Erinjeri JP, Thomas CT, Samoilia A, Fleisher M, Gonen M, Sofocleous CT, Thornton RH, Siegelbaum RH, Covey AM, Brody LA, Alago W, Maybody M, Brown KT, Getrajdman GI, Solomon SB. Image-guided thermal ablation of tumors increases the plasma level of interleukin-6 and interleukin-10. J Vasc Interv Radiol 2013; 24:1105-12. [PMID: 23582441 DOI: 10.1016/j.jvir.2013.02.015] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/13/2013] [Accepted: 02/14/2013] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To identify changes in plasma cytokine levels after image-guided thermal ablation of human tumors and to identify the factors that independently predict changes in plasma cytokine levels. MATERIALS AND METHODS Whole-blood samples were collected from 36 patients at three time points: before ablation, after ablation (within 48 hours), and at follow-up (1-5 weeks after ablation). Plasma levels of interleukin (IL)-1α, IL-2, IL-6, IL-10, and tumor necrosis factor (TNF)-α were measured using a multiplex immunoassay. Univariate and multivariate analyses were performed using cytokine level as the dependent variable and sample collection, time, age, sex, primary diagnosis, metastatic status, ablation site, and ablation type as the independent variables. RESULTS There was a significant increase in the plasma level of IL-6 after ablation compared with before ablation (9.6-fold ± 31-fold, P<.002). IL-10 also showed a significant increase after ablation (1.9-fold ± 2.8-fold, P<.02). Plasma levels of IL-1α, IL-2, and TNF-α were not significantly changed after ablation. Cryoablation resulted in the largest change in IL-6 level (>54-fold), whereas radiofrequency ablation and microwave ablation showed 3.6-fold and 3.4-fold changes, respectively. Ablation of melanomas showed the largest change in IL-6 48 hours after ablation (92×), followed by ablation of kidney (26×), liver (8×), and lung (6×) cancers. Multivariate analysis revealed that ablation type (P<.0003) and primary diagnosis (P<.03) were independent predictors of changes to IL-6 after ablation. Age was the only independent predictor of IL-10 levels after ablation (P< .019). CONCLUSIONS Image-guided thermal ablation of tumors increases plasma levels of IL-6 and IL-10, without increasing plasma levels of IL-1α, IL-2, or TNF-α.
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Affiliation(s)
- Joseph P Erinjeri
- Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Elnekave E, Erinjeri JP, Brown KT, Thornton RH, Petre EN, Maybody M, Maluccio MA, Hsu M, Sofocleous CT, Getrajdman GI, Brody LA, Solomon SB, Alago W, Fong Y, Jarnagin WR, Covey AM. Long-term outcomes comparing surgery to embolization-ablation for treatment of solitary HCC<7 cm. Ann Surg Oncol 2013; 20:2881-6. [PMID: 23563960 DOI: 10.1245/s10434-013-2961-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection has been the standard of care for patients with solitary hepatocellular carcinoma (HCC). Transarterial embolization and percutaneous ablation are alternative therapies often reserved for suboptimal surgical candidates. Here we compare long-term outcomes of patients with solitary HCC treated with resection versus combined embo-ablation. METHODS We previously reported a retrospective comparison of resection and embo-ablation in 73 patients with solitary HCC<7 cm after a median follow-up of 23 months. This study represents long-term updated follow-up over a median of 134 months. RESULTS There was no difference in survival among Okuda I patients who underwent resection versus embo-ablation (66 vs 58 months, p=.39). There was no difference between the groups in the rate of distant intrahepatic (p=.35) or metastatic progression (p=.48). Surgical patients experienced more complications (p=.004), longer hospitalizations (p<.001), and were more likely to require hospital readmission within 30 days of discharge (p=.03). CONCLUSION Over a median follow up of more than 10 years, we found no significant difference in overall survival of Okuda 1 patients with solitary HCC<7 cm who underwent surgical resection versus embo-ablation. Our data suggest that there may be a greater role for primary embo-ablation in the treatment of potentially resectable solitary HCC.
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Affiliation(s)
- Eldad Elnekave
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Sofocleous CT, Garg S, Petrovic LM, Gonen M, Petre EN, Klimstra DS, Solomon SB, Brown KT, Brody LA, Covey AM, Dematteo RP, Schwartz L, Kemeny NE. Ki-67 is a prognostic biomarker of survival after radiofrequency ablation of liver malignancies. Ann Surg Oncol 2012; 19:4262-9. [PMID: 22752375 DOI: 10.1245/s10434-012-2461-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Indexed: 01/26/2023]
Abstract
PURPOSE To assess the predictive value of examinations of tissue adherent to multitined electrodes on local tumor progression-free survival (LPFS) and overall survival (OS) after liver tumor radiofrequency ablation (RFA). METHODS An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant review identified 68 liver tumors treated with RFA in 63 patients with at least 3 years' follow-up. Tissue adherent to the electrode after liver tumor RFA was evaluated with proliferation (Ki-67) and apoptotic (caspase-3) markers. LPFS and OS were evaluated by Kaplan-Meier methodology and the log-rank test. Multivariate analysis assessed the effect of tumor size, pathology, and post-RFA tissue characteristics on LPFS and OS. RESULTS Post-RFA tissue examination classified 55 of the 68 tumors as completely ablated with coagulation necrosis, with cells positive for caspase-3 and negative for Ki-67 (CN). Thirteen had viable Ki-67-positive tumor cells. Mean liver tumor size was larger in the viable (V) group versus the CN group (3.4 vs. 2.5 cm, respectively; P = .017). For the V and CN groups, respectively, local tumor progression occurred in 12 (92 %) of 13 and 23 (42 %) of 55 specimens. One, 3-, and 5-year LPFS was 8 %, 8 %, and 8 %, and 79 %, 47 %, and 47 % (P < .001) for the V and CN groups, respectively. During a 63-month median follow-up, 92 % of patients in the V group and 58 % in the CN group died, resulting in 1-, 3-, and 5-year OS of 92 %, 25 %, and 8 % vs. 92 %, 59 %, and 33 % (P = .032), respectively. CONCLUSIONS Ki-67-positive tumor cells on the electrode after liver tumor RFA is an independent predictor of LPFS and OS. Size, initially thought to be an independent risk factor for local tumor progression in tumors 3-5 cm, does not hold its significance at long follow-up.
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Affiliation(s)
- Constantinos T Sofocleous
- Section of Interventional Radiology, Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Covey AM, Toro-Pape FW, Thornton RH, Son C, Erinjeri J, Sofocleous CT, Brody LA, Brown KT, Sepkowitz KA, Septkowitz KA, Getrajdman GI. Totally implantable venous access device placement by interventional radiologists: are prophylactic antibiotics necessary? J Vasc Interv Radiol 2012; 23:358-62. [PMID: 22365295 DOI: 10.1016/j.jvir.2011.11.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/28/2011] [Accepted: 11/06/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the rate of early infection for totally implantable venous access devices (TIVADs) placed without antibiotic prophylaxis. MATERIAL AND METHODS A list of patients who underwent TIVAD placement in 2009 was obtained from the patient archiving and communication system (PACS). This list was cross-referenced to all patients who underwent TIVAD removal from January 1, 2009, through January 30, 2010, to identify TIVADs that were removed within 30 days of placement. Retrospective chart review was performed to record patient demographics, including age, sex, cancer diagnosis, and indication for removal. Concurrent antibiotic therapy, chemotherapy, and laboratory data before and within 30 days of placement were recorded. Central line-associated bloodstream infections (CLABSIs) were identified using U.S. Centers for Disease Control and Prevention (CDC) criteria. RESULTS There were 1,183 ports placed and 13 removed. CLABSIs occurred in seven (0.6%) patients within 30 days of placement. At the time of TIVAD placement, 81 (7%) patients were receiving antibiotics incidental to the procedure. One patient who received an antibiotic the day of implantation developed a CLABSI. Chemotherapy was administered to 148 (13%) patients on the day of placement. CONCLUSIONS The rate of early infection without antibiotic prophylaxis before TIVAD placement in the interventional radiology suite is < 1%. Based on these data, use of prophylactic antibiotics for TIVAD placement is not recommended.
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Affiliation(s)
- Anne M Covey
- Department of Diagnostic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Sofocleous CT, Kemeny NE, Pandit-Taskar N, Do KG, Brody LA, Garcia AR, Capanu M, Chou JF, Petre EN, Carrasquillo JA. Phase I trial of yttrium 90 resin microspheres in the treatment of colon cancer liver metastases progressing despite hepatic arterial as well as systemic chemotherapy: Preliminary results. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
625 Background: Prospective evaluation of the safety of Selective Interval Radiation Therapy (SIRT) using yttrium 90 microspheres (Y90) in patients with colon cancer liver metastases (CLM) who failed hepatic arterial (pump) and systemic chemotherapy. Methods: This prospective single center study, assessed the safety, dose limiting toxicities (DLT) and the maximum tolerated dose (MTD) of Y90 in a selected, heavily pretreated population. Upon IRB and FDA approval individualized Y90 doses were calculated according to a volumetric method and the body surface area (BSA) method as instructed by the company. SIRT treatment was administered in three escalating dose levels (cohorts): the first cohort received 70%, the second 85%, and the third 100% of the calculated dose. All patients received chemotherapy as deemed by the patients' medical oncologist post SIRT treatment. DLT was defined as new, post treatment, grade 3 toxicities, and evaluated according to the NCI Common Toxicity Criteria (NCI-CTC) 3.0. Response to treatment was evaluated by imaging (using a combination of WHO, RECIST, modified RECIST and SUV changes) and CEA levels. Kaplan Meier methodology was employed to calculate Progression Free (PFS) and Overall (OS) Survival. Results: From September 2009-2011, 19 patients received Y90. Common complaints post treatments were: grade 1-2 fatigue and grade 1 fever, which are known side effects of SIRT. No DLTs were observed. Grade 3 hyperbilirubinemia was recorded for two patients and was attributed to progressive disease; one patient in the third cohort suffered grade 3 nausea and pain. Twelve patients (70.6%) responded (defined as stable disease or better) while five (29.4%) progressed-this was based on evaluations from initial post treatment imaging. Two patients’ imaging is pending. Median PFS and OS were 6 [95%CI: 3.2-9.7] and 16 [95%CI: 5.8-17.6] months respectively. Conclusions: It is safe to administer the entire dose of Y90 in patients with CLM who progressed despite prior pump and systemic chemotherapy. Oncologic outcomes are promising.
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Affiliation(s)
| | | | | | - Kinh Gian Do
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Lynn A Brody
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | | | - Elena N Petre
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Sideras PA, Sofocleous CT, Brody LA, Siegelbaum RH, Shah RP, Taskar NP. Superselective Internal Radiation With Yttrium-90 Microspheres in the Management of a Chemorefractory Testicular Liver Metastasis. Cardiovasc Intervent Radiol 2011; 35:426-9. [DOI: 10.1007/s00270-011-0226-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 06/25/2011] [Indexed: 12/24/2022]
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Thornton RH, Erinjeri JP, Brody LA, Solomon SB. Enhancing the case log by coding the level of trainee participation in vascular interventional radiology procedures. AJR Am J Roentgenol 2011; 196:W844-8. [PMID: 21606279 PMCID: PMC6614873 DOI: 10.2214/ajr.10.5301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to describe a new method for coding trainee participation in vascular interventional radiology procedures. MATERIALS AND METHODS From July 2008 through June 2009, all interventional radiology fellows maintained an enhanced case log at our institution; 748 unique cases were logged by procedure type, supervising physician, and level of participation in the case. Level of participation was classified on a 5-point scale that included designations for observation, first assistant, performance of basic techniques, performance of advanced techniques, and primary operation. Descriptive statistics of participation scores were calculated for each quarter and were analyzed by procedure type and by teaching faculty member. RESULTS As expected, analysis by procedure type showed that average participation scores increased from one quarter to the next in most cases. By the fourth quarter, the modal participation score was 5, indicating primary operation or performance of multiple critical steps. Analysis by teaching faculty member revealed three patterns: those attending physicians facilitating increasing levels of participation in every quarter, those facilitating maximal growth within the first 6 months, and those with irregular trainee participation profiles. CONCLUSION Data from a 5-point participation scale add information to the procedure case log that could be used to quantitatively track the technical progress of trainees while providing education quality feedback to both teaching physicians and program directors.
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Affiliation(s)
- Raymond H Thornton
- Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H118, New York, NY 10065, USA.
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Sofocleous CT, Petre EN, Gonen M, Brown KT, Solomon SB, Covey AM, Alago W, Brody LA, Thornton RH, D'Angelica M, Fong Y, Kemeny NE. CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy. J Vasc Interv Radiol 2011; 22:755-61. [PMID: 21514841 DOI: 10.1016/j.jvir.2011.01.451] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/26/2011] [Accepted: 01/31/2011] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To evaluate the clinical outcomes of percutaneous radiofrequency (RF) ablation of colorectal cancer liver metastases (CLMs) that recur after hepatectomy. MATERIALS AND METHODS From December 2002 to December 2008, 71 CLMs that developed after hepatectomy were ablated in 56 patients. Medical records and imaging were reviewed to determine technique effectiveness/complete ablation (ie, ablation defect covering the entire tumor on 4-6-week postablation computed tomography [CT]), complications, and local tumor progression (LTP) at the site of ablation. LTP-free and overall survival were calculated by using Kaplan-Meier methodology. A modified clinical risk score (CRS) including nodal status of the primary tumor, time interval between diagnoses of the primary tumor and liver metastases, number of tumors, and size of the largest tumor was assessed for its effect on overall survival and LTP. RESULTS Tumor size ranged between 0.5 and 5.7 cm. Complete ablation was documented in 67 of 71 cases (94%). Complications included liver abscess (n = 1) and pleural effusion (n = 1). Median overall survival time was 31 months. One-, 2- and 3-year overall survival rates were 91%, 66%, and 41%, respectively. CRS was an independent factor for overall survival (74% for CRS of 0-2 vs 42% for CRS of 3-4 at 2 y; P = .03) and for LTP-free survival (66% for CRS of 0-2 vs 22% for CRS of 3-4 at 1 y after a single ablation; P <.01). CONCLUSIONS CT-guided RF ablation can be used to treat recurrent CLM after hepatectomy. A low CRS is associated with better clinical outcomes.
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Affiliation(s)
- Constantinos T Sofocleous
- Department of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10065, USA.
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Mezhir JJ, Fong Y, Jacks LM, Getrajdman GI, Brody LA, Covey AM, Thornton RH, Jarnagin WR, Solomon SB, Brown KT. Current management of pyogenic liver abscess: surgery is now second-line treatment. J Am Coll Surg 2010; 210:975-83. [PMID: 20510807 DOI: 10.1016/j.jamcollsurg.2010.03.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 02/26/2010] [Accepted: 03/03/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to examine the current treatment for liver abscess and to assess the factors associated with failure of percutaneous drainage. STUDY DESIGN Records of 58 patients with pyogenic hepatic abscess, from 1998 to 2009, were examined. Clinicopathologic variables were analyzed as predictors of failure of percutaneous drainage using multivariable logistic regression. The results of surgical intervention after failure of percutaneous treatment were also examined. RESULTS Fifty-one patients (88%) had a history of malignancy including pancreas (36%), cholangiocarcinoma (17%), colon (12%), and gallbladder (10%). Recent hepatic artery embolization or radiofrequency ablation preceded development of abscess in 13 patients (22%). Fifteen patients (26%) had evidence of biliary tract communication, and 14 of 15 (93%) of these patients had concomitant biliary tract obstruction. Percutaneous drainage was successful in 38 patients (66%) with a median drain dwell time of 26 days (range 3 to 319 days). Five patients (9%) required operative intervention and 2 of these patients (3% overall) died postoperatively from septic complications. Fifteen patients (26%) died with percutaneous drains in place; 9 (60%) of these patients died of cancer progression without evidence of sepsis. Independent predictors of failure of percutaneous drainage included abscesses containing yeast (p = 0.003) and communication of the abscess cavity with the biliary tree (p = 0.02). CONCLUSIONS Pyogenic hepatic abscess was treated successfully in the majority of patients with advanced malignancy, although mortality remained high. The presence of yeast and communication with an untreated obstructed biliary tree were associated with failure of percutaneous drainage. The need for surgical salvage was associated with a high mortality.
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Affiliation(s)
- James J Mezhir
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Robson PC, Heffernan N, Gonen M, Thornton R, Brody LA, Holmes R, Brown KT, Covey AM, Fleischer D, Getrajdman GI, Jarnagin W, Sofocleous C, Blumgart L, D'Angelica M. Prospective study of outcomes after percutaneous biliary drainage for malignant biliary obstruction. Ann Surg Oncol 2010; 17:2303-11. [PMID: 20358300 DOI: 10.1245/s10434-010-1045-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Percutaneous biliary drainage (PBD) is used to relieve malignant bile duct obstruction (MBO) when endoscopic drainage is not feasible. Little is known about the effects of PBD on the quality of life (QoL) in patients with MBO. The aim of this study was to evaluate changes in QoL and pruritus after PBD and to explore the variables that impact these changes. MATERIALS AND METHODS Eligible patients reported their QoL and pruritus before and after PBD using the Functional Assessment of Cancer Therapy-Hepatobiliary instrument (FACT-HS) and the Visual Analog Scale for Pruritus (VASP). Instruments were completed preprocedure and at 1 and 4 weeks following PBD. RESULTS A total of 109 (60 male/49 female) patients enrolled; 102 (94%) had unresectable disease. PBD was technically successful (hepatic ducts cannulated at the conclusion of procedure) in all patients. There were 2 procedure-related deaths. All-cause mortality was 10% (N = 11) at 4 weeks and 28% (N = 31) at 8 weeks post-PBD with a median survival of 4.74 months. The mean FACT-HS scores declined significantly (P < .01) over time (101.3, 94.8, 94.7 at baseline, 1 week, 4 weeks, respectively). The VASP scores showed significant improvement at 1 week with continued improvement at 4 weeks (P < .01). CONCLUSIONS PBD improves pruritus but not QoL in patients with MBO and advanced malignancy. There is high early mortality in this population.
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Affiliation(s)
- P C Robson
- Department of Nursing, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Thornton RH, Covey A, Petre EN, Riedel ER, Maluccio MA, Sofocleous CT, Brody LA, Getrajdman GI, D'Angelica M, Fong Y, Brown KT. A comparison of outcomes from treating hepatocellular carcinoma by hepatic artery embolization in patients younger or older than 70 years. Cancer 2009; 115:5000-6. [PMID: 19642175 DOI: 10.1002/cncr.24556] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND : The objective of this study was to compare the morbidity, mortality, and survival of patients aged <70 years and aged > or =70 years who underwent hepatic arterial embolization (HAE) for the treatment of hepatocellular carcinoma (HCC). METHODS : Between 1997 and 2007, 386 patients underwent HAE for HCC at a single center. Two hundred patients were aged <70 years (153 men; median age, 60 years), and 186 patients were aged > or =70 years (128 men; median age, 75 years). Patients underwent a total 965 embolization procedures (median, 2 procedures per patient). Patient demographics, morbidity, mortality, length of hospital stay, and survival were analyzed. Complications were categorized using Common Terminology Criteria for Adverse Events, version 3.0 guidelines. Survival was calculated by using the Kaplan-Meier method. RESULTS : There were no significant differences between younger and older groups in the incidence of infectious, hepatobiliary, renal, vascular, or miscellaneous complications (P > or = .05); complication severity (P = .82); procedural mortality (P = .63); length of hospitalization (P = .55); intensive care unit admission (P = .64); or overall survival (P = .30). There were more cardiopulmonary complications in the older group (P = .04), but the association of age and likelihood of a cardiopulmonary complication lost significance after adjusting for the presence of more cardiovascular comorbidities in the older group (P = .08). CONCLUSIONS : Survival and mortality outcomes of HAE for the treatment of HCC were similar whether patients were aged <70 years or > or =70 years. Although patients aged > or =70 years with cardiovascular comorbidities more often had a cardiopulmonary complication, other morbidity measures, including complication severity, need for intensive care unit admission, and length of hospitalization, were similar between groups. Cancer 2009. (c) 2009 American Cancer Society.
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Affiliation(s)
- Raymond H Thornton
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
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Maybody M, Brown KT, Brody LA, Covey AM, Sofocleous CT, Thornton RH, Getrajdman GI. Primary patency of Wallstents in malignant bile duct obstruction: single vs. two or more noncoaxial stents. Cardiovasc Intervent Radiol 2009; 32:707-13. [PMID: 19387728 DOI: 10.1007/s00270-009-9577-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2008] [Revised: 11/11/2008] [Accepted: 03/18/2009] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to determine the primary patency of two or more noncoaxial self-expanding metallic Wallstents (Boston Scientific, Natick, MA) and to compare this with the primary patency of a single stent in malignant bile duct obstruction. From August 2002 to August 2004, 127 patients had stents placed for malignant bile duct obstruction. Forty-five patients were treated with more than one noncoaxial self-expanding metallic stents and 82 patients had a single stent placed. Two patients in the multiple-stent group were lost to follow-up. The primary patency period was calculated from the date of stenting until the first poststenting intervention for stent occlusion, death, or the time of last documented follow-up. The patency of a single stent was significantly different from that of multiple stents (P = 0.0004). In the subset of patients with high bile duct obstruction, the patency of a single stent remained significantly different from that of multiple stents (P = 0.02). In the single-stent group, there was no difference in patency between patients with high vs. those with low bile duct obstruction (P = 0.43). The overall median patency for the multistent group and the single-stent group was 201 and 261 days, respectively. In conclusion, the patency of a single stent placed for malignant low or high bile duct obstruction is similar, and significantly longer than, that of multiple stents placed for malignant high bile duct obstruction. Given the median patency of 201 days, when indicated, percutaneous stenting of multiple bile ducts is an effective palliative measure for patients with malignant high bile duct obstruction.
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Affiliation(s)
- Majid Maybody
- Memorial Sloan-Kettering Cancer Center, Interventional Radiology Section, 1275 York Avenue, H118A, New York, NY 10065, USA.
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Sofocleous CT, Nascimento RG, Petrovic LM, Klimstra DS, Gonen M, Brown KT, Brody LA, Covey AM, Thornton RH, Fong Y, Solomon SB, Schwartz LH, DeMatteo RP, Getrajdman GI. Histopathologic and immunohistochemical features of tissue adherent to multitined electrodes after RF ablation of liver malignancies can help predict local tumor progression: initial results. Radiology 2008; 249:364-74. [PMID: 18796687 DOI: 10.1148/radiol.2491071752] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine whether histopathologic and immunohistochemical features of tissue adherent to electrodes after radiofrequency (RF) ablation of liver malignancies can help predict local tumor progression (LTP). MATERIALS AND METHODS Institutional review board waiver and informed consent were obtained. Histologic and immunohistochemical examinations of tissue adherent to electrodes after RF ablation of liver malignancies were performed, with application of proliferation (Ki-67) and apoptosis (caspase-3) markers. Clinical and technical information were prospectively collected for an HIPAA-registered database. Medical records and imaging were reviewed to determine LTP for treated tumors smaller than 5 cm in diameter. LTP-free and survival rates were assessed with Kaplan-Meier method; differences between groups assessed with permutation log-rank test. Multivariate analysis assessed with Cox regression for factors related to LTP. RESULTS Sixty-eight malignant tumors treated with RF ablation were identified. Fifty-five tissue specimens were classified as coagulation necrosis (CN), thermal artifact only, or tumor cells positive for caspase-3/negative for Ki-67; and 13 as viable tumor cells (Ki-67 positive). Mean tumor size was larger in viable (3.4 cm) than in CN (2.5 cm) group before treatment (P = .01). For viable and CN groups, LTP occurred in 12 (92%) of 13 and 16 (29%) of 55 specimens, respectively; 1-year LTP-free rates were 0% and 74%, respectively (P < .001). Multivariate analysis confirmed that viable cells comprise independent risk factor for LTP (P < .001). The odds of LTP is six times greater in viable group compared with CN group for tumors 3-5 cm (hazard ratio: 5.9, 95% confidence interval: 2.4, 14.5) and 10 times greater for tumors smaller than 3 cm (hazard ratio: 10.1, 95% confidence interval: 1.7, 57.5). Median survival was 32.7 months. CONCLUSION Evidence of Ki-67-positive tumor cells on the electrode after hepatic RF ablation is an independent predictor of LTP.
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Affiliation(s)
- Constantinos T Sofocleous
- Section of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H-118, New York, NY 10065, USA.
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Sobkin PR, Bloom AI, Wilson MW, LaBerge JM, Hastings GS, Gordon RL, Brody LA, Sawhney R, Kerlan RK. Massive abdominal wall hemorrhage from injury to the inferior epigastric artery: a retrospective review. J Vasc Interv Radiol 2008; 19:327-32. [PMID: 18295690 DOI: 10.1016/j.jvir.2007.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/28/2007] [Accepted: 11/01/2007] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To identify the etiology of inferior epigastric artery injury (IEAI) in patients referred to the interventional radiology service and determine the efficacy of diagnostic imaging and embolization in these patients. MATERIALS AND METHODS A retrospective review of patients referred to the interventional radiology departments at three university-affiliated hospitals from 1995 through 2007 was performed. Patients were identified and data were extracted from case log books and the electronic medical record. RESULTS Twenty IEAIs were identified in 19 patients. The etiology of arterial injury was paracentesis in eight (40%), surgical trauma in three (15%), percutaneous drain placement in three (15%), blunt trauma in two (10%), subcutaneous injection in one (5%), stabbing in one (5%), and unknown in two (10%). Fifteen of 19 patients (79%) had an underlying coagulopathy. The diagnosis was confirmed by contrast medium-enhanced computed tomography (CT) in 14 (70%), tagged red blood cell scan in two (10%), and noncontrast CT in one (5%). Three patients (15%) had no diagnostic imaging. Contrast medium-enhanced CT showed active extravasation in nine of 14 patients (64%) and 13 of 14 exhibited active extravasation on subsequent arteriography. The sensitivity and specificity of contrast medium-enhanced CT for demonstrating active arterial bleeding were 70% and 100%, respectively. All 20 IEAIs were treated with transcatheter embolization, with an overall success rate of 90% and no complications. CONCLUSIONS IEAI is most often an iatrogenic injury in a coagulopathic patient. Contrast medium-enhanced CT can be diagnostic for active bleeding, but in the setting of ongoing hemorrhage a negative study result should not preclude arteriography. Embolization is an effective means to control hemorrhage.
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Affiliation(s)
- Paul R Sobkin
- Department of Radiology, Section of Interventional Radiology, University of California San Francisco, California, USA
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Maluccio MA, Covey AM, Porat LB, Schubert J, Brody LA, Sofocleous CT, Getrajdman GI, Jarnagin W, DeMatteo R, Blumgart LH, Fong Y, Brown KT. Transcatheter Arterial Embolization with Only Particles for the Treatment of Unresectable Hepatocellular Carcinoma. J Vasc Interv Radiol 2008; 19:862-9. [DOI: 10.1016/j.jvir.2008.02.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Revised: 02/12/2008] [Accepted: 02/14/2008] [Indexed: 12/12/2022] Open
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Sofocleous CT, Nascimento RG, Gonen M, Theodoulou M, Covey AM, Brody LA, Solomon SM, Thornton R, Fong Y, Getrajdman GI, Brown KT. Radiofrequency ablation in the management of liver metastases from breast cancer. AJR Am J Roentgenol 2007; 189:883-9. [PMID: 17885061 DOI: 10.2214/ajr.07.2198] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Systemic chemotherapy remains the standard treatment for patients with breast cancer hepatic metastases. Resection of metastases has survival advantages in a small percentage of selected patients. Radiofrequency ablation has been used in small numbers of selected patients. This small series was undertaken to review our experience with radiofrequency ablation in the management of patients with breast cancer hepatic metastases. CONCLUSION Radiofrequency ablation of breast cancer hepatic metastases is safe and may be used to control hepatic deposits in patients with stable or no extrahepatic disease.
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Affiliation(s)
- C T Sofocleous
- Section of Interventional Radiology and Image Guided Therapies, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Rm. H118, New York, NY 10021, USA.
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White RR, Avital I, Sofocleous CT, Brown KT, Brody LA, Covey A, Getrajdman GI, Jarnagin WR, Dematteo RP, Fong Y, Blumgart LH, D'Angelica M. Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastasis. J Gastrointest Surg 2007; 11:256-63. [PMID: 17458595 DOI: 10.1007/s11605-007-0100-8] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The purpose of this study was to compare rates and patterns of disease progression following percutaneous, image-guided radiofrequency ablation (RFA) and nonanatomic wedge resection for solitary colorectal liver metastases. METHODS We identified 30 patients who underwent nonanatomic wedge resection for solitary liver metastases and 22 patients who underwent percutaneous RFA because of prior major hepatectomy (50%), major medical comorbidities (41%), or relative unresectability (9%). Serial imaging studies were retrospectively reviewed for evidence of local tumor progression. RESULTS Patients in the RFA group were more likely to have undergone prior liver resection, to have a disease-free interval greater than 1 year, and to have had an abnormal carcinoembryonic antigen (CEA) level before treatment. Two-year local tumor progression-free survival (PFS) was 88% in the Wedge group and 41% in the RFA group. Two patients in the RFA group underwent re-ablation, and two patients underwent resection to improve the 2-year local tumor disease-free survival to 55%. Approximately 30% of patients in each group presented with distant metastasis as a component of their first recurrence. Median overall survival from the time of resection was 80 months in the Wedge group vs 31 months in the RFA group. However, overall survival from the time of treatment of the colorectal primary was not significantly different between the two groups. CONCLUSIONS Local tumor progression is common after percutaneous RFA. Surgical resection remains the gold standard treatment for patients who are candidates for resection. For patients who are poor candidates for resection, RFA may help to manage local disease, but close follow-up and retreatment are necessary to achieve optimal results.
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Affiliation(s)
- R R White
- Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Maluccio MA, Covey AM, Schubert J, Brody LA, Sofocleous CT, Getrajdman GI, DeMatteo R, Brown KT. Treatment of metastatic sarcoma to the liver with bland embolization. Cancer 2006; 107:1617-23. [PMID: 16955508 DOI: 10.1002/cncr.22191] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The authors evaluated the impact of bland particle embolization on survival in patients with metastatic sarcoma to the liver. METHODS Twenty-four patients with liver-dominant metastases from sarcoma were treated with particle embolization from 1996 to 2002. Primary tumors included 16 gastrointestinal stromal tumors (GISTs), 7 intestinal leiomyosarcomas, and 1 liposarcoma. Thirteen patients had known extrahepatic disease. Embolization was performed by using polyvinyl alcohol or trisacryl microspheres to effect stasis in the target vessel(s). Follow-up images to assess response were obtained 4 weeks after the procedure. Decrease in the size of the target lesion by >25% or development of >50% necrosis on follow-up imaging was considered a treatment response. RESULTS Nineteen patients had metachronous liver metastases, and the median disease-free interval was 22 months (range 10-156 months) from resection of the primary tumor. Ten patients underwent prior liver resection for metastatic disease. Of 15 evaluable patients, 9 patients (60%) had a radiographic response. The median follow-up for all patients was 21 months. The median follow-up for surviving patients was 59 months. Overall survival from the time of initial embolization was 62% at 1 year, 41% at 2 years, and 29% at 3 years. Patients who had radiographic evidence of response survived significantly longer than patients who did not respond (63 months vs. 19 months; P < .007). Patients with GIST survived significantly longer than patients with visceral leiomyosarcoma (median, 36 months vs. 18 months; P < .03). CONCLUSIONS Bland embolization was efficacious in some patients with metastatic sarcoma to the liver. Radiographic evidence of response was correlated with improved survival. This regional therapy may enter the treatment algorithm for patients who have unresectable disease or disease that has failed conventional therapies.
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Affiliation(s)
- Mary A Maluccio
- Department of Surgery, Indiana University, Indianapolis, Indiana, USA
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Covey AM, Maluccio MA, Brody LA, Sofocleous CT, Getrajdman GI, Brown KT. Re: Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol 2006; 17:1209; author reply 1209-10. [PMID: 16868176 DOI: 10.1097/01.rvi.0000223714.14073.44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Covey AM, Maluccio MA, Schubert J, BenPorat L, Brody LA, Sofocleous CT, Getrajdman GI, Fong Y, Brown KT. Particle embolization of recurrent hepatocellular carcinoma after hepatectomy. Cancer 2006; 106:2181-9. [PMID: 16596622 DOI: 10.1002/cncr.21883] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Complete surgical resection is the mainstay of treatment for patients with hepatocellular carcinoma (HCC). Unfortunately, most patients ultimately develop disease recurrence and the median survival from the time of recurrence is <1 year. The purpose of the current study was to review the authors' experience using bland hepatic arterial embolization to treat recurrent HCC after definitive surgical resection. METHODS The authors reviewed their single-center hepatic embolization database from 1995 through 2004 to identify patients who underwent bland hepatic arterial embolization for disease recurrence. Data analyzed included patient demographics, Okuda stage and Child score, imaging findings, and embolization variables. Recurrence-free survival (from surgery to disease recurrence) and survival time (from recurrence to last follow-up) were calculated using the Kaplan-Meier method. RESULTS The authors identified 45 patients treated with bland embolization for recurrent HCC after resection. Six patients also underwent ablative therapy after embolization. Of the 45 patients, 42 (93.3%) patients had Okuda Stage 1 disease. The median time to recurrence was 13 months. The median survival after embolization was 46 months, and actuarial survival rates at 1 year, 2 years, and 5 years after recurrence were 86%, 74%, and 47%, respectively, with a median follow-up of 31 months. Patients who developed disease recurrence with a solitary lesion had a significantly improved survival (P = .03) At the time of last follow-up, 3 patients (6.6%) were alive with no evidence of viable disease. CONCLUSIONS Bland arterial embolization was found to be an effective method of salvage therapy for patients with good liver function with recurrent HCC after prior surgical resection. Patients whose disease recurred with a solitary lesion appear to have a significantly increased survival compared with patients who develop disease recurrence with multiple tumors. A small proportion of patients can be rendered without evidence of viable disease.
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Affiliation(s)
- Anne M Covey
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Brody LA, Brown KT, Covey AM, Brown AE, Getrajdman GI. Routine urine culture at the time of percutaneous urinary drainage: does every patient need one? Cardiovasc Intervent Radiol 2006; 29:595-8. [PMID: 16729231 DOI: 10.1007/s00270-005-0096-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the clinical variables associated with bacteriuria in patients undergoing primary percutaneous antegrade urinary drainage procedures in order to predict the utility of routinely obtaining urine cultures at the time of the procedure. METHODS Between October 1995 and March 1998 urine cultures were prospectively obtained in all patients undergoing a primary percutaneous antegrade urinary drainage procedure. One hundred and eighty-seven patients underwent 264 procedures. Results were available in 252 cases. Culture results were correlated with clinical, laboratory, and demographic variables. Anaerobic cultures were not uniformly performed. RESULTS Urine cultures were positive in 24 of 252 (9.5%) cases. An indwelling or recently removed ipsilateral device (catheter or stent) and a history of previous cystectomy with urinary diversion were significant predictors of a positive culture. Patients without either of these predictors, and without clinical or laboratory evidence of infection, were rarely found to have positive cultures. CONCLUSION The likelihood of a positive urine culture can be predicted on the basis of the aforementioned clinical variables. In the absence of these clinical indicators routine urine cultures are neither useful nor cost-effective.
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Affiliation(s)
- L A Brody
- Department of Radiology, Section of Interventional Radiology and Image Guided Therapy, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Sofocleous CT, Schubert J, Kemeny N, Covey AM, Brody LA, Getrajdman GI, Thornton R, Winston C, Brown KT. Arterial Embolization for Salvage of Hepatic Artery Infusion Pumps. J Vasc Interv Radiol 2006; 17:801-6. [PMID: 16687745 DOI: 10.1097/01.rvi.0000217937.81939.18] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hepatic artery infusion pumps (HAIPs) ideally provide for homogenous perfusion of the liver with chemotherapeutic agents. Perfusion of extrahepatic organs or asymmetric liver perfusion (ie, "misperfusion") is diagnosed by nuclear scintigraphy and precludes the use of HAIPs. The purpose of this study is to report experience in salvaging HAIPs with arterial embolization. MATERIALS AND METHODS A single-center HAIP database was retrospectively reviewed for cases from 1999 to 2005 to identify patients who underwent angiography to treat misperfusion documented by nuclear scintigraphy. Patient demographics, nuclear scintigraphic findings before and after embolization, angiographic findings, embolization variables, and outcomes were recorded. Technical success (defined by cessation of flow to the vessel responsible for misperfusion) and clinical success (ie, successful use of the pump) were calculated. RESULTS During the study period, 475 HAIPs were implanted. Of those, 43 (9%) had abnormal nuclear scintigraphic findings of misperfusion, but only 32 (7%) had angiographic abnormalities. In eight of 32 cases, hepatic arterial thrombosis and extravasation at the catheter tip were found, which precluded salvage by embolization. In 24 of 32 cases, a vessel presumed responsible for the misperfusion was identified and targeted for embolization. Technical success and clinical success were achieved in 21 of 24 patients (87.5%) and 19 of 24 patients (79%), respectively, who underwent 27 embolization procedures. The three technical failures (12.5%) were the result of inability to catheterize the identified vessel. CONCLUSIONS Percutaneous arterial embolization of a vessel to correct misperfusion shown by nuclear scintigraphy is safe and effective. This approach can be expected to result in HAIP salvage in the majority of patients.
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Affiliation(s)
- Constantinos T Sofocleous
- Division of Interventional Radiology and Image-Guided Therapies, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA.
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