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Yu B, Kwak K, Lewandowski RJ, Kim DH. Integration of Ethanol and the Immune Modulator Curcumin for Immuno-Ablation of Hepatocellular Carcinoma. J Vasc Interv Radiol 2024:S1051-0443(24)00233-1. [PMID: 38513753 DOI: 10.1016/j.jvir.2024.03.014] [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] [Received: 09/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Immuno-ethanol ablation using an ethanol and immune adjuvant formulation is investigated as a potent immuno-ablation approach that can achieve an enhanced anti-cancer effect in the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS Ethanol concentration- and exposure time-dependent cellular responses were investigated. Curcumin was combined with ethanol as an immuno-ablation agent. Cellular uptake of curcumin, cancer cell killing, and inflammatory markers of ethanol-curcumin treatment were characterized. To evaluate the potential in vivo anti-cancer immunity of ethanol-curcumin treatment, each right and left lobe of rat liver was concurrently inoculated with N1S1 HCC cells and a mixture of treated N1S1 cells (ethanol only or ethanol-curcumin) in Sprague Dawley rats (Each group: 5 rats, Control: non-treated N1S1 cells). Tumor growth and immune response were characterized with 7T MRI, flowcytometry analysis, and immunohistology. RESULTS An optimized ethanol-curcumin (10% ethanol and 0.5% w/v curcumin solution) treatment contributed to an enhanced cellular uptake of curcumin, increased cancer cell killing, and decreased inflammatory reaction. Ethanol-curcumin treated N1S1 cell implantation in the rat liver demonstrated N1S1 HCC tumor rejection. The secondary tumor growth by non-treated N1S1 cell inoculation was significantly suppressed at the same time. Activated anti-cancer immunity was evidenced by significantly increased CD8+ T cell infiltration (3.5-fold) and CD8+/Treg ratio (4.5-fold) in the experimental group compared to the control group. CONCLUSION Enhanced anti-cancer effect of immuno-ethanol ablation could be achieved with ethanol-curcumin agent. The results underscore the importance of optimized immuno-ablation therapeutic procedures for the enhanced therapeutic outcomes.
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Affiliation(s)
- Bo Yu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States
| | - Kijung Kwak
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States
| | - Robert J Lewandowski
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, United States; Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois 60611, United States; Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL 60208, United States; Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, United States.
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Park BC, Johnson DB, Lewandowski RJ. Radiology in the immune checkpoint inhibitor era. Clin Imaging 2024; 107:110080. [PMID: 38271899 DOI: 10.1016/j.clinimag.2024.110080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/12/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024]
Abstract
The field of oncology has undergone rapid changes following the introduction of immunotherapies and biologics. However, these changes have also created new roles for radiology in both diagnosis and treatment. Our article addresses the evolving role of radiology in the immune checkpoint inhibitor era of oncology. With the progression of new immunotherapies for cancer, imaging paradigms and image guided therapy options have changed. Multidisciplinary oncology teams should be aware of these opportunities for collaboration.
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Affiliation(s)
- Benjamin C Park
- Department of General Surgery, Vanderbilt University Medical Center Nashville, TN, United States of America.
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Robert J Lewandowski
- Department of Radiology, Northwestern Memorial Hospital, Chicago, IL, United States of America
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Serhal M, Rangwani S, Seedial SM, Thornburg B, Riaz A, Nemcek AA, Sato KT, Perry KT, Choy B, Lewandowski RJ, Gordon AC. Safety and Diagnostic Efficacy of Image-Guided Biopsy of Small Renal Masses. Cancers (Basel) 2024; 16:835. [PMID: 38398226 PMCID: PMC10887197 DOI: 10.3390/cancers16040835] [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] [Received: 10/24/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses. METHODS A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at p ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups. RESULTS A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26-87) and 51% were male. The median renal mass size was 2.6 cm (range: one-four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one-nine). The overall complication rate was 5%. Grade A complications were seen in 4% (n = 7), consisting of perinephric hematoma (n = 6) and retroperitoneal hematoma (n = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm (p = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy. CONCLUSION This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3-4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients.
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Affiliation(s)
- Muhamad Serhal
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Sean Rangwani
- Northwestern University Feinberg School of Medicine, Chicago Campus, Chicago, IL 60611, USA;
| | - Stephen M. Seedial
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Bartley Thornburg
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Albert A. Nemcek
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Kent T. Sato
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Kent T. Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Bonnie Choy
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Robert J. Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
| | - Andrew C. Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (M.S.); (S.M.S.); (B.T.); (A.R.); (A.A.N.J.); (K.T.S.); (R.J.L.)
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Serhal M, Dadrass F, Kim E, Lewandowski RJ. Radiation Segmentectomy for Hepatocellular Carcinoma. Curr Oncol 2024; 31:617-628. [PMID: 38392039 PMCID: PMC10888093 DOI: 10.3390/curroncol31020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
The application of trans-arterial radioembolization (TARE) with Yttrium-90, historically a palliative treatment option for patients with advanced hepatocellular carcinoma (HCC), is evolving. Radiation segmentectomy (RADSEG), the segmental delivery of an ablative radiation dose, is a treatment option for patients with earlier-stage HCC. This review presents an in-depth exploration of RADSEG, emphasizing its technical considerations, dosimetry advancements, and patient selection. The integration of RADSEG into the Barcelona Clinic Liver Cancer (BCLC) paradigm will be highlighted. RADSEG outcomes concerning safety and efficacy will be explored and compared with traditional locoregional cancer treatments like trans-arterial chemoembolization (TACE), percutaneous thermal ablation, and surgical resection, with an eye on future directions and considerations.
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Affiliation(s)
- Muhamad Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
| | - Farnaz Dadrass
- Department of Radiology, Mount Sinai Health System, New York, NY 10029, USA; (F.D.); (E.K.)
| | - Edward Kim
- Department of Radiology, Mount Sinai Health System, New York, NY 10029, USA; (F.D.); (E.K.)
| | - Robert J. Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA;
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Janczewski LM, Joung RH, Borhani AA, Lewandowski RJ, Velichko YS, Mulcahy MF, Mahalingam D, Law J, Bowman C, Keswani RN, Poylin VY, Bentrem DJ, Merkow RP. Safety and feasibility of establishing an adjuvant hepatic artery infusion program. HPB (Oxford) 2023:S1365-182X(23)02013-0. [PMID: 38383208 DOI: 10.1016/j.hpb.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/30/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Hepatic artery infusion (HAI) is less frequently used in the adjuvant setting for resectable colorectal liver metastasis (CRLM) due to concerns regarding toxicity. Our objective was to evaluate the safety and feasibility of establishing an adjuvant HAI program. METHODS Patients who underwent HAI pump placement between January 2019 and February 2023 for CRLM were identified. Complications and HAI delivery were compared between patients who received HAI in the unresectable and adjuvant settings. RESULTS Of 51 patients, 23 received HAI for unresectable CRLM and 28 in the adjuvant setting. Patients with unresectable CRLM more commonly had bilobar disease (n = 23/23 vs n = 18/28, p < 0.01) and more preoperative liver metastases (median 10 [IQR 6-15] vs 4 [IQR 3-7], p < 0.01). Biliary sclerosis was the most common complication (n = 2/23 vs n = 4/28); however, there were no differences in postoperative or HAI-specific complications. In the most recent two years, 0 patients in the unresectable group vs 2 patients in the adjuvant group developed biliary sclerosis. All patients were initiated on HAI with no difference in treatment times or dose reductions. CONCLUSION Adjuvant HAI is safe and feasible for patients with resectable CRLM. HAI programs can carefully consider including patients with resectable CRLM if managed by an experienced multidisciplinary team with quality assurance controls in place.
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Affiliation(s)
- Lauren M Janczewski
- Department of Surgery, Northwestern University Feinberg School of Medicine, University, Chicago, IL, USA
| | - Rachel H Joung
- Department of Surgery, Northwestern University Feinberg School of Medicine, University, Chicago, IL, USA
| | - Amir A Borhani
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yury S Velichko
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary F Mulcahy
- Department of Medicine, Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Devalingam Mahalingam
- Department of Medicine, Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Law
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - Caitlin Bowman
- Department of Pharmacy, Northwestern Medicine, Chicago, IL, USA
| | - Rajesh N Keswani
- Department of Medicine, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Vitaliy Y Poylin
- Department of Surgery, Northwestern University Feinberg School of Medicine, University, Chicago, IL, USA
| | - David J Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, University, Chicago, IL, USA; Department of Surgery, Jesse Brown Veterans' Affairs Medical Center, Chicago, IL, USA
| | - Ryan P Merkow
- Department of Surgery, Division of Surgical Oncology, University of Chicago, Chicago, IL, USA.
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Serhal M, Gordon AC, Brown DB, Toskich BB, Lewandowski RJ. Transarterial Radioembolization: Overview of Radioembolic Devices. Semin Intervent Radiol 2023; 40:461-466. [PMID: 37927522 PMCID: PMC10622244 DOI: 10.1055/s-0043-1772814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Muhamad Serhal
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Andrew C. Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Daniel B. Brown
- Division of Interventional Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Beau B. Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
| | - Robert J. Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, Illinois
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Kim H, Choi B, Mouli SK, Choi H, Harris KR, Kulik LM, Lewandowski RJ, Kim DH. Preclinical Development and Validation of Translational Temperature Sensitive Iodized Oil Emulsion Mediated Transcatheter Arterial Chemo-Immuno-Embolization for the Treatment of Hepatocellular Carcinoma. Adv Healthc Mater 2023; 12:e2300906. [PMID: 37163283 PMCID: PMC10592544 DOI: 10.1002/adhm.202300906] [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: 03/21/2023] [Revised: 05/02/2023] [Indexed: 05/11/2023]
Abstract
Herein a practical strategy for augmenting immune activation in transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) is presented. Pluronic F127 (PF127) is incorporated with Lipiodol (LPD) to achieve safe and effective delivery of therapeutic agents during transcatheter intra-arterial (IA) local delivery. Enhanced emulsion stability, IA infusion, embolic effect, safety, pharmacokinetics, and tumor response of Doxorubicin loaded PF127-LPD (Dox-PF127-LPD) for TACE in both in vitro and in vivo preclinical VX2 liver cancer rabbit model and N1S1 HCC rat model are demonstrated. Then, transcatheter arterial chemo-immuno-embolization (TACIE) combining TACE and local delivery of immune adjuvant (TLR9 agonist CpG oligodeoxynucleotide) is successfully performed using CpG-loaded Dox-PF127-LPD. Concurrent and safe local delivery of CpG and TACE during TACIE demonstrate leveraged TACE-induced immunogenic tumor microenvironment and augment systemic anti-tumor immunity in syngeneic N1S1 HCC rat model. Finally, the broad utility and enhanced therapeutic efficacy of TACIE are validated in the diethylnitrosamine-induced rat HCC model. TACIE using clinically established protocols and materials shall be a convenient and powerful therapeutic approach that can be translated to patients with HCC. The robust anti-cancer immunity and tumor regression of TACIE, along with its favorable safety profile, indicate its potential as a novel localized combination immunotherapy for HCC treatment.
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Affiliation(s)
- Heegon Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Bongseo Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Samdeep K. Mouli
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Hyunjun Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Kathleen R. Harris
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Laura M. Kulik
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Robert J. Lewandowski
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, IL 60607, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL 60208, USA
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Lee S, Ghosh A, Xiao N, Gordon AC, Heidarpour N, Funaki B, Lewandowski RJ. Embolic Agents: Particles. Semin Intervent Radiol 2023; 40:315-322. [PMID: 37565087 PMCID: PMC10410675 DOI: 10.1055/s-0043-1769744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Sean Lee
- Touro College of Osteopathic Medicine, New York City, New York
| | - Abheek Ghosh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicholas Xiao
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C. Gordon
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | | | - Brian Funaki
- Division of Vascular and Interventional Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Robert J. Lewandowski
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Gordon AC, Lewandowski RJ, Li W, Zhong X, Kannengiesser SAR, Miller FH, Salem R, Rilling WS, Larson AC, White SB. Chemical Shift MRI Monitoring of Chemoembolization Delivery for Hepatocellular Carcinoma: Multicenter Feasibility of Initial Clinical Translation. Radiol Imaging Cancer 2023; 5:e220019. [PMID: 37233207 DOI: 10.1148/rycan.220019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Purpose To demonstrate the feasibility of using chemical shift fat-water MRI methods to visualize and measure intrahepatic delivery of ethiodized oil to liver tumors following conventional transarterial chemoembolization (cTACE). Materials and Methods Twenty-eight participants (mean age, 66 years ± 8 [SD]; 22 men) with hepatocellular carcinoma (HCC) treated with cTACE were evaluated with follow-up chemical shift MRI in this Health Insurance Portability and Accountability Act-compliant prospective, institutional review board-approved study. Uptake of ethiodized oil was evaluated at 1-month follow-up chemical shift MRI. Measurements of tumor size (MRI and CT), attenuation and enhancement (CT), fat content percentage, and tumor:normal ratio (MRI) were compared by lesion for responders versus nonresponders, as assessed with modified Response Evaluation Criteria in Solid Tumors and European Association for the Study of the Liver (EASL) criteria. Adverse events and overall survival by the Kaplan-Meier method were secondary end points. Results Focal tumor ethiodized oil retention was 46% (12 of 26 tumors) at 24 hours and 47% (18 of 38 tumors) at 1 month after cTACE. Tumor volume at CT did not differ between EASL-defined responders and nonresponders (P = .06). Tumor ethiodized oil volume measured with chemical shift MRI was statistically significantly higher for EASL-defined nonresponders (P = .02). Doxorubicin dosing (P = .53), presence of focal fat (P = .83), and a combined end point of focal fat and low doxorubicin dosing (P = .97) did not stratify overall survival after cTACE. Conclusion Chemical shift MRI allowed for assessment of tumor delivery of ethiodized oil out to 1 month after cTACE in participants with HCC and demonstrated tumor ethiodized oil volume as a potential tool for stratification of tumor response by EASL criteria. Keywords: MRI, Chemical Shift Imaging, CT, Hepatic Chemoembolization, Ethiodized Oil Clinicaltrials.gov registration no.: NCT02173119 Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Andrew C Gordon
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Robert J Lewandowski
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Weiguo Li
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Xiaodong Zhong
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Stephan A R Kannengiesser
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Frank H Miller
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Riad Salem
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - William S Rilling
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Andrew C Larson
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
| | - Sarah B White
- From the Department of Radiology (A.C.G., R.J.L., W.L., F.H.M., R.S., A.C.L.), Department of Medicine-Hematology/Oncology (R.J.L., R.S., A.C.L.), and Department of Surgery-Organ Transplantation (R.J.L., R.S.), Northwestern University Feinberg School of Medicine, Chicago, Ill; Siemens Medical Solutions USA, Los Angeles, Calif (X.Z.); MR Application Predevelopment, Siemens Healthcare, Erlangen, Germany (S.A.R.K.); and Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226 (W.S.R., S.B.W.)
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10
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Chiu AM, Savoor R, Gordon AC, Riaz A, Sato KT, Hohlastos E, Salem R, Lewandowski RJ. Yttrium-90 Radiation Segmentectomy in Oligometastatic Secondary Hepatic Malignancies. J Vasc Interv Radiol 2023; 34:362-368. [PMID: 36526074 DOI: 10.1016/j.jvir.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/23/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of yttrium-90 (90Y) radiation segmentectomy (RS) in the treatment of oligometastatic secondary hepatic malignancies. MATERIALS AND METHODS This institutional review board-approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The median patient age was 61.9 years (range, 38.6-85.7 years). Of the 16 patients, 11 (68.8%) presented with solitary lesions. The median index tumor size was 3.1 cm (95% CI, 2.3-3.9). Primary outcomes were evaluation of clinical and biochemical toxicities using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and imaging response using Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary outcomes were time to progression (TTP) and overall survival (OS) as estimated by the Kaplan-Meier method. RESULTS Clinical Grade 3 toxicities were limited to 1 (6.7%) patient who experienced fatigue, abdominal pain, nausea, and vomiting. Biochemical Grade 3 toxicities occurred in 1 (6.7%) patient who experienced lymphopenia. No Grade 4 clinical or biochemical toxicities were identified. Disease control was achieved in 14 (93.3%) of 15 patients. The median TTP of the treated tumor was 72.9 months (95% CI, 11.2 to no estimate). The median OS was 60.9 months (95% CI, 24.7 to no estimate). CONCLUSIONS 90Y RS displayed an excellent safety profile and was effective in achieving a high disease control rate in the treatment of oligometastatic secondary hepatic malignancies.
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Affiliation(s)
- Andrew M Chiu
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rohan Savoor
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ahsun Riaz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kent T Sato
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elias Hohlastos
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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11
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Johnson MS, Spies JB, Scott KT, Kato BS, Mu X, Rectenwald JE, White RA, Lewandowski RJ, Khaja MS, Zuckerman DA, Casciani T, Gillespie DL. Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months. J Vasc Surg Venous Lymphat Disord 2023; 11:573-585.e6. [PMID: 36872169 DOI: 10.1016/j.jvsv.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/11/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To determine the safety and effectiveness of vena cava filters (VCFs). METHODS A total of 1429 participants (62.7 ± 14.7 years old; 762 [53.3% male]) consented to enroll in this prospective, nonrandomized study at 54 sites in the United States between October 10, 2015, and March 31, 2019. They were evaluated at baseline and at 3, 6, 12, 18, and 24 months following VCF implantation. Participants whose VCFs were removed were followed for 1 month after retrieval. Follow-up was performed at 3, 12, and 24 months. Predetermined composite primary safety (freedom from perioperative serious adverse events [AEs] and from clinically significant perforation, VCF embolization, caval thrombotic occlusion, and/or new deep vein thrombosis [DVT] within 12-months) and effectiveness (composite comprising procedural and technical success and freedom from new symptomatic pulmonary embolism [PE] confirmed by imaging at 12-months in situ or 1 month postretrieval) end points were assessed. RESULTS VCFs were implanted in 1421 patients. Of these, 1019 (71.7%) had current DVT and/or PE. Anticoagulation therapy was contraindicated or had failed in 1159 (81.6%). One hundred twenty-six (8.9%) VCFs were prophylactic. Mean and median follow-up for the entire population and for those whose VCFs were not removed was 243.5 ± 243.3 days and 138 days and 332.6 ± 290 days and 235 days, respectively. VCFs were removed from 632 (44.5%) patients at a mean of 101.5 ± 72.2 days and median 86.3 days following implantation. The primary safety end point and primary effectiveness end point were both achieved. Procedural AEs were uncommon and usually minor, but one patient died during attempted VCF removal. Excluding strut perforation greater than 5 mm, which was demonstrated on 31 of 201 (15.4%) patients' computed tomography scans available to the core laboratory, and of which only 3 (0.2%) were deemed clinically significant by the site investigators, VCF-related AEs were rare (7 of 1421, 0.5%). Postfilter, venous thromboembolic events (none fatal) occurred in 93 patients (6.5%), including DVT (80 events in 74 patients [5.2%]), PE (23 events in 23 patients [1.6%]), and/or caval thrombotic occlusions (15 events in 15 patients [1.1%]). No PE occurred in patients following prophylactic placement. CONCLUSIONS Implantation of VCFs in patients with venous thromboembolism was associated with few AEs and with a low incidence of clinically significant PEs.
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Affiliation(s)
- Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
| | - James B Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | - John E Rectenwald
- Section of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rodney A White
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Heart and Vascular Institute, Long Beach Memorial Care, Long Beach, CA
| | | | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, University of Michigan, Ann Arbor, MI; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Thomas Casciani
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - David L Gillespie
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Brockton, MA
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12
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Johnson MS, Spies JB, Scott KT, Kato BS, Mu X, Rectenwald JE, White RA, Lewandowski RJ, Khaja MS, Zuckerman DA, Casciani T, Gillespie DL. Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE): Outcomes at 12 months. J Vasc Interv Radiol 2023; 34:517-528.e6. [PMID: 36841633 DOI: 10.1016/j.jvir.2022.12.009] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/05/2022] [Accepted: 11/20/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE To determine the safety and effectiveness of vena cava filters (VCFs). METHODS A total of 1429 participants (62.7 ± 14.7 years old; 762 [53.3% male]) consented to enroll in this prospective, nonrandomized study at 54 sites in the United States between October 10, 2015, and March 31, 2019. They were evaluated at baseline and at 3, 6, 12, 18, and 24 months following VCF implantation. Participants whose VCFs were removed were followed for 1 month after retrieval. Follow-up was performed at 3, 12, and 24 months. Predetermined composite primary safety (freedom from perioperative serious adverse events [AEs] and from clinically significant perforation, VCF embolization, caval thrombotic occlusion, and/or new deep vein thrombosis [DVT] within 12-months) and effectiveness (composite comprising procedural and technical success and freedom from new symptomatic pulmonary embolism [PE] confirmed by imaging at 12-months in situ or 1 month postretrieval) end points were assessed. RESULTS VCFs were implanted in 1421 patients. Of these, 1019 (71.7%) had current DVT and/or PE. Anticoagulation therapy was contraindicated or had failed in 1159 (81.6%). One hundred twenty-six (8.9%) VCFs were prophylactic. Mean and median follow-up for the entire population and for those whose VCFs were not removed was 243.5 ± 243.3 days and 138 days and 332.6 ± 290 days and 235 days, respectively. VCFs were removed from 632 (44.5%) patients at a mean of 101.5 ± 72.2 days and median 86.3 days following implantation. The primary safety end point and primary effectiveness end point were both achieved. Procedural AEs were uncommon and usually minor, but one patient died during attempted VCF removal. Excluding strut perforation greater than 5 mm, which was demonstrated on 31 of 201 (15.4%) patients' computed tomography scans available to the core laboratory, and of which only 3 (0.2%) were deemed clinically significant by the site investigators, VCF-related AEs were rare (7 of 1421, 0.5%). Postfilter, venous thromboembolic events (none fatal) occurred in 93 patients (6.5%), including DVT (80 events in 74 patients [5.2%]), PE (23 events in 23 patients [1.6%]), and/or caval thrombotic occlusions (15 events in 15 patients [1.1%]). No PE occurred in patients following prophylactic placement. CONCLUSIONS Implantation of VCFs in patients with venous thromboembolism was associated with few AEs and with a low incidence of clinically significant PEs.
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Affiliation(s)
- Matthew S Johnson
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN.
| | - James B Spies
- Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | - John E Rectenwald
- Section of Vascular Surgery, Department of Surgery, University of Wisconsin, Madison, WI
| | - Rodney A White
- Division of Vascular Surgery, Harbor-UCLA Medical Center, Torrance, CA; Heart and Vascular Institute, Long Beach Memorial Care, Long Beach, CA
| | | | - Minhaj S Khaja
- Division of Vascular and Interventional Radiology, University of Michigan, Ann Arbor, MI; Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Thomas Casciani
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - David L Gillespie
- Department of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Brockton, MA
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13
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Ranganathan S, Gabr A, Entezari P, Riaz A, Desai K, Thornburg B, Kulik L, Kalyan A, Salem R, Lewandowski RJ. Radioembolization for Intermediate Stage Hepatocellular Carcinoma Maintains Liver Function and Permits Systemic Therapy at Progression. J Vasc Interv Radiol 2023; 34:968-975. [PMID: 36791957 DOI: 10.1016/j.jvir.2022.11.036] [Citation(s) in RCA: 6] [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: 07/25/2022] [Revised: 11/02/2022] [Accepted: 11/19/2022] [Indexed: 02/16/2023] Open
Abstract
PURPOSE To assess the liver function trends in intermediate-stage (BCLC B) patients undergoing Y90-radioembolization (TARE) in response to a growing concern that that liver-directed therapies negatively impact liver function and prevent HCC patients from systemic therapy candidacy. METHODS A prospectively acquired HCC/TARE database (2004-2017) was retrospectively reviewed. BCLC B/Child-Pugh (CP)-A patients with laboratory tests/imaging at baseline and for at least 1-month post-TARE were included. Follow-ups were at 3-month intervals. CP was assessed at each timepoint. Endpoints included time-to-persistent CP-B, time-to-CP-C, and median overall survival (OS). Time-to-endpoint analyses were performed using Kaplan-Meier method. RESULTS 74 patients (80% males with mean age 63 years) with mostly (62%) bilobar disease underwent 186 TARE treatments (median 2 (range[r]: 1-8)). Median time-to-2nd TARE was 2.3 months (r: 1.7-6.4), median time-to-3rd and 4th TARE was 11.7 (r: 7.5 - 15) and 17.3 (r: 11.5-23.1) months, respectively. 43 patients (58%) developed persistent CP-B at median time-to-persistent CP-B of 15.4 Months (CI: 9.2 - 25.3) months. 17 (23%) became CP-C at a median time-to-CP-C of 87.2 (CI: 39.8 - 136.1) months. Median OS censored to transplantation was 30.4 (CI: 22.7-37.4) months. On univariate and multivariate analyses baseline albumin was significant prognosticator of OS, while baseline albumin and bilirubin were significant prognosticators of time-to-persistent CP-B, and time-to-CP-C. CONCLUSION In CP-A patients undergoing TARE for BCLC B HCC, the median time-to persistent CP-B is 15.4 months. These findings indicate that patients would be candidates for systemic therapy at progression if indicated.
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Affiliation(s)
- Srirajkumar Ranganathan
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL
| | - Laura Kulik
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | - Aparna Kalyan
- Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL.
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14
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Caldwell BM, Gabr A, Entezari P, Sher A, Kim E, Johnson GE, Salem R, Lewandowski RJ. Radioembolization for recurrent hepatocellular carcinoma after liver transplantation: A multicenter exploratory analysis. Liver Transpl 2023; 29:229-232. [PMID: 37160067 DOI: 10.1002/lt.26573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/04/2022] [Accepted: 08/27/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Brandon M Caldwell
- Department of Radiology, Section of Interventional Radiology , Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center , Chicago , Illinois , USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology , Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center , Chicago , Illinois , USA
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology , Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center , Chicago , Illinois , USA
| | - Alex Sher
- Department of Radiology, Section of Interventional Radiology , Mount Sinai University Hospitals , New York , New York , USA
| | - Edward Kim
- Department of Radiology, Section of Interventional Radiology , Mount Sinai University Hospitals , New York , New York , USA
| | - Guy E Johnson
- Department of Radiology, Section of Interventional Radiology , University of Washington , Seattle , Washington , USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology , Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center , Chicago , Illinois , USA
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology , Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center , Chicago , Illinois , USA
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15
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Jacobs G, Boyle DA, El‐Serag HB, Lewandowski RJ, Stein SM, Lazure P, McFadden P. Clinical care in hepatocellular carcinoma: A mixed methods assessment of experiences and challenges of oncology professionals. Cancer Med 2023; 12:3670-3683. [PMID: 36106593 PMCID: PMC9939175 DOI: 10.1002/cam4.5216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/15/2022] [Accepted: 08/24/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Healthcare providers (HCPs) may face numerous dilemmas in optimally screening, diagnosing, and treating patients with, and/or at risk for, hepatocellular carcinoma (HCC). This study aimed to achieve a greater understanding of the challenges in HCC care which in turn could delineate HCP educational opportunities within this oncologic sub-specialty. METHODS A mixed-methods approach was used to identify practice gaps and clinical barriers experienced by US-based medical oncologists, hepatologists, oncology physician assistants, oncology nurse practitioners, and interventional radiologists involved in HCC care. The qualitative (semi-structured interview) and quantitative (survey) data collection approaches were deployed sequentially with findings subsequently triangulated. RESULTS A total of 214 HCPs participated in this study. Analysis revealed challenges related to screening and diagnosing HCC, specifically in applying appropriate screening guidelines, and the optimal use and decisions related to diagnostic imaging and biopsy. Issues related to treatment selection included the application of existing HCC guidelines in treatment decision-making, weighing risk/benefit ratios of various antineoplastics regimens (i.e., tyrosine kinase inhibitors-TKIs, immunotherapy agents, chemotherapy), sequencing therapies, potential toxicity management, and optimally educating patients about their HCC. CONCLUSION These findings highlight the educational needs of those involved in HCC care and provide a starting point for clinicians to both reflect on their practice and identify opportunities to enhance communication within the HCC team and between provider and patient. There is an opportunity to optimize continuing professional development interventions that address the identified gaps in clinical practice specifically related to teamwork and interdisciplinary communication.
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Desai KR, Kaufman J, Truong P, Lindquist JD, Ahmed O, Flanagan SM, Garcia MJ, Ram R, Gao YR, Lewandowski RJ, Ryu RK. Safety and Success Rates of Excimer Laser Sheath-Assisted Retrieval of Embedded Inferior Vena Cava Filters. JAMA Netw Open 2022; 5:e2248159. [PMID: 36542378 PMCID: PMC9856719 DOI: 10.1001/jamanetworkopen.2022.48159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Despite historically high rates of use, most inferior vena cava (IVC) filters are not retrieved. The US Food and Drug Administration safety communications recommended retrieval when the IVC filter is no longer indicated out of concern for filter-related complications. However, failure rates are high when using standard techniques for retrieval of long-dwelling filters, and until recently, there have been no devices approved for retrieval of embedded IVC filters. OBJECTIVE To evaluate the safety and success of excimer laser sheath-assisted retrieval of embedded IVC filters. DESIGN, SETTING, AND PARTICIPANTS A retrospective, multicenter, clinical cohort study of excimer laser sheath-assisted IVC filter retrievals from 7 US sites was conducted between March 1, 2012, and February 28, 2021, among 265 patients who underwent IVC filter retrieval using the laser. Patients were substratified between a high-volume single center and a multicenter data set. A blinded physician committee adjudicated reported complications and their association with use of the laser. EXPOSURES Retrieval of IVC filters using excimer laser sheath. MAIN OUTCOMES AND MEASURES The primary safety end point was device-related major complication rate (Society of Interventional Radiology categories C to F, which included any adverse event associated with morbidity or disability that increases the level of care, results in hospital admission, or substantially lengthens the hospital stay). The primary success end point was technical success of IVC filter retrieval. The primary end points were compared with literature-derived, meta-analysis-suggested target performance goals. RESULTS The single-center experience included 139 participants (mean [SD] age, 52 [16] years; 78 female participants [56.1%]), and the multicenter experience included 126 participants (mean [SD] age, 52 [16] years; 75 female participants [59.5%]). The device-related major complication rate was 2.9% (4 of 139; 95% CI, 0.8%-7.2%; P = .001) for the single-center experience and 4.0% (5 of 126; 95% CI, 1.3%-9.0%; P = .01) for the multicenter experience, both of which were significantly lower than the primary safety performance goal (10%). No major complications were considered to be definitively associated with use of the laser. The technical success rate was 95.7% (133 of 139; 95% CI, 90.8%-98.4%; P = .007) for the single-center experience and 95.2% (120 of 126; 95% CI, 89.9%-98.2%; P = .02) for the multicenter experience, both of which were significantly higher than the primary performance goal (89.4%). CONCLUSIONS AND RELEVANCE This cohort study demonstrated high technical success and low complication rates of excimer laser sheath-assisted retrieval of embedded IVC filters in centers with variable case volume and experience, which suggests a wide applicability of the technique with proper training. The excimer laser sheath offers physicians a valuable tool for retrieval of challenging embedded IVC filters.
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Affiliation(s)
- Kush R. Desai
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - John Kaufman
- Department of Interventional Radiology, Oregon Health & Science University, Portland
| | - Parker Truong
- Department of Interventional Radiology, Oklahoma Heart Hospital, Oklahoma City
| | - Jonathan D. Lindquist
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Colorado Anschutz Medical Center, Aurora
| | - Osman Ahmed
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Siobhan M. Flanagan
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Minnesota Medical Center, Minneapolis
| | - Mark J. Garcia
- EndoVascular Consultants, Wilmington, Delaware
- Department of Radiology, Trinity Health, Saint Francis Healthcare, Wilmington, Delaware
| | - Rashmi Ram
- Department of Clinical & Medical Affairs, Philips North America LLC, Cambridge, Massachusetts
| | - Yu-Rong Gao
- Department of Clinical & Medical Affairs, Philips North America LLC, Cambridge, Massachusetts
| | | | - Robert K. Ryu
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles
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17
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Riaz A, Entezari P, Malik A, Badar W, Scheller S, Gabr A, Thornburg B, Seedial S, Boike J, Resnick S, Sato K, Ladner D, Moore C, Ganger D, Donaldson J, Kulik L, Lewandowski RJ, Funaki BS, Ahmed O, Caicedo JC, Salem R. Impact of Portal Hypertension on Adverse Events after Splenic Arterial Aneurysm Embolization. J Vasc Interv Radiol 2022; 33:1519-1526.e1. [PMID: 35985557 DOI: 10.1016/j.jvir.2022.08.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate the outcomes of splenic artery aneurysm (SAA) embolization and compare adverse event (AE) rates after embolization in patients with and without portal hypertension (PHTN). MATERIALS AND METHODS A retrospective review of all patients who underwent embolization of SAAs at 2 institutions was performed (34 patients from institution 1 and 7 patients from institution 2). Baseline demographic characteristics, preprocedural imaging, procedural techniques, and postprocedural outcomes were evaluated. Thirty-day postprocedural severe and life-threatening AEs were evaluated using the Society of Interventional Radiology guidelines. Thirty-day mortality and readmission rates were also evaluated. t test, χ2 test, and/or Fisher exact test were used for the statistical analysis. RESULTS There was no statistically significant difference between patients with and without PHTN in the location, number, and size of SAA(s). All procedures were technically successful. There were 13 (32%) patients with and 28 (68%) patients without PHTN. The 30-day mortality rate (31% vs 0%; P = .007), readmission rates (61% vs 7%; P < .001), and severe/life-threatening AE rates (69% vs 0%; P < .001) were significantly higher in patients with PHTN than in those without PHTN. CONCLUSIONS There was a significantly higher mortality and severe/life-threatening AE rate in patients with PHTN than in those without PHTN. SAAs in patients with PHTN need to be managed very cautiously, given the risk of severe/life-threatening AEs after embolization.
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Affiliation(s)
- Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois.
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Asad Malik
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Wali Badar
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Stephen Scheller
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Stephen Seedial
- Department of Radiology, St Joseph Mercy Oakland Hospital, Pontiac, Michigan
| | - Justin Boike
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Scott Resnick
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kent Sato
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniela Ladner
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Christopher Moore
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - James Donaldson
- Department of Radiology, Section of Interventional Radiology, Lurie Children's Hospital, Chicago, Illinois
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Brian S Funaki
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, Section of Interventional Radiology, University of Chicago, Chicago, Illinois
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, Illinois
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Entezari P, Toskich BB, Kim E, Padia S, Christopher D, Sher A, Thornburg B, Hohlastos ES, Salem R, Collins JD, Lewandowski RJ. Promoting Surgical Resection through Future Liver Remnant Hypertrophy. Radiographics 2022; 42:2166-2183. [PMID: 36206182 DOI: 10.1148/rg.220050] [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: 11/11/2022]
Abstract
An inadequate future liver remnant (FLR) can preclude curative-intent surgical resection for patients with primary or secondary hepatic malignancies. For patients with normal baseline liver function and without risk factors, an FLR of 20% is needed to maintain postsurgical hepatic function. However, the FLR requirement is higher for patients who are exposed to systemic chemotherapy (FLR, >30%) or have cirrhosis (FLR, >40%). Interventional radiologic and surgical methods to achieve FLR hypertrophy are evolving, including portal vein ligation, portal vein embolization, radiation lobectomy, hepatic venous deprivation, and associating liver partition and portal vein ligation for staged hepatectomy. Each technique offers particular advantages and disadvantages. Knowledge of these procedures can help clinicians to choose the suitable technique for each patient. The authors review the techniques used to develop FLR hypertrophy, focusing on technical considerations, outcomes, and the advantages and disadvantages of each approach. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Pouya Entezari
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Beau B Toskich
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Edward Kim
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Siddharth Padia
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Derrick Christopher
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Alex Sher
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Bartley Thornburg
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Elias S Hohlastos
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Riad Salem
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Jeremy D Collins
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
| | - Robert J Lewandowski
- From the Department of Radiology, Section of Interventional Radiology (P.E., B.T., E.S.H., R.S., R.J.L.), and Department of Surgery, Division of Transplant Surgery (D.C.), Northwestern University, 676 N Saint Clair St, Chicago, IL 60611-2927; Department of Radiology, Section of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Fla (B.B.T.); Department of Radiology, Section of Interventional Radiology, Mount Sinai University Hospitals, New York, NY (E.K., A.S.); Department of Radiology, Section of Interventional Radiology, University of California-Los Angeles, Los Angeles, Calif (S.P.); and Department of Radiology, Mayo Clinic Rochester, Rochester, Minn (J.D.C.)
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19
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Ghosh A, Xiao N, Gordon AC, Funaki B, Lewandowski RJ. Embolic Agents: Vascular Plugs. Semin Intervent Radiol 2022; 39:526-532. [PMID: 36561938 PMCID: PMC9767762 DOI: 10.1055/s-0042-1758112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Abheek Ghosh
- Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nicholas Xiao
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Andrew C. Gordon
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Brian Funaki
- Division of Vascular and Interventional Radiology, University of Chicago Medicine, Chicago, Illinois
| | - Robert J. Lewandowski
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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20
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Lewandowski RJ, Salem R. Implementation of radiation segmentectomy for early-stage hepatocellular carcinoma. Lancet Gastroenterol Hepatol 2022; 7:783-784. [PMID: 35617979 DOI: 10.1016/s2468-1253(22)00161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, USA; Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA.
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, USA; Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL, USA
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21
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Lewandowski RJ, Toskich BB, Brown DB, El-Haddad G, Padia SA. Role of Radioembolization in Metastatic Neuroendocrine Tumors. Cardiovasc Intervent Radiol 2022; 45:1590-1598. [PMID: 35918431 DOI: 10.1007/s00270-022-03206-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/23/2021] [Accepted: 06/14/2022] [Indexed: 11/24/2022]
Abstract
The liver is the most common site of metastasis for neuroendocrine tumors originating from the gastrointestinal tract. Neuroendocrine liver metastases (NELMs) portend a worsening clinical course, making local management important. Local treatment options include surgery, thermal ablation, and trans-catheter intra-arterial therapies, such as radioembolization. Radioembolization is generally preferred over other embolotherapies in patients with colonized biliary systems. Current best practice involves personalized treatment planning, optimizing tumor radiation absorbed dose and minimizing radiation to the normal hepatic parenchyma. As part of a multidisciplinary approach, radioembolization is a versatile embolotherapy offering neoadjuvant, palliative, and ablative treatment options for patients with NELMs.
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Affiliation(s)
| | | | - Daniel B Brown
- Division of Interventional Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ghassan El-Haddad
- Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Siddharth A Padia
- Division of Interventional Radiology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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22
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Soliman M, Malik A, Auffenberg G, Lewandowski RJ, Salem R, Riaz A. Primary retrograde urinary drainage using image and endoscopy guidance via urostomies. Clin Radiol 2022; 77:553-557. [PMID: 35550302 DOI: 10.1016/j.crad.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022]
Abstract
AIM To report the technical success of image and endoscopy-guided retrograde trans-urostomy urinary drainage as a primary catheter placement method performed by interventional radiology (IR). MATERIALS AND METHODS Nine patients (15 attempted drain placements) with ureteric obstruction following radical cystectomy and urostomy creation were included. The patients were referred to IR for urinary drainage. All patients underwent primary image and endoscopy-guided retrograde trans-urostomy urinary drainage. RESULTS Primary image and endoscopy-guided retrograde trans-urostomy urinary drainage was successful in 13/15 (86.6%) attempts. The proposed technique had a limited complication rate omitting the percutaneous nephrostomy access step. CONCLUSION Primary image and endoscopy guided retrograde trans-urostomy urinary drainage should be considered before percutaneous nephrostomy in all patients with a urostomy.
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Affiliation(s)
- M Soliman
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - A Malik
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - G Auffenberg
- Department of Urology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - R J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - R Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - A Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA.
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23
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Entezari P, Gabr A, Salem R, Lewandowski RJ. Yttrium-90 for colorectal liver metastasis - the promising role of radiation segmentectomy as an alternative local cure. Int J Hyperthermia 2022; 39:620-626. [DOI: 10.1080/02656736.2021.1933215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - Robert J. Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Chicago, IL, USA
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
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24
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Affiliation(s)
- Nicholas Xiao
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Robert J. Lewandowski
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois,Address for correspondence Robert J. Lewandowski, MD, FSIR Department of Radiology676 N. St. Clair, Suite 800, Chicago, IL 60611
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25
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Kwak K, Yu B, Lewandowski RJ, Kim DH. Recent progress in cryoablation cancer therapy and nanoparticles mediated cryoablation. Theranostics 2022; 12:2175-2204. [PMID: 35265206 PMCID: PMC8899563 DOI: 10.7150/thno.67530] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
With rapid advances in modern imaging, minimally invasive ablative procedures have emerged as popular alternatives to surgical removal of tumors. Tumor ablation modalities currently offered in clinical practice include microwave ablation, radiofrequency ablation, cryoablation, high-intensity focused ultrasound, and irreversible electroporation. Cryoablation, a non-heat-based method of ablation, is increasingly being used for treating various solid tumors. Accumulated comparative data of cryoablation versus heat-based ablation techniques (e.g., radiofrequency and microwave ablation) shows superior tumor response and quicker recovery time. Evolving research has demonstrated that nanocarriers may serves as excellent catalysts for the cryoablation therapy, imaging guidance, and the co-delivery of therapeutics for minimally invasive, precise, and complete treatment of cancer with immune modulation. This review article focuses on the current status of cryoablation in clinical practice, considers opportunities for enhancing therapeutic outcomes from cryoablation, and discusses new research in the field, including theranostic nanoparticles-mediated cryotherapy and combinational cryo-based immunotherapies.
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Mulcahy MF, Mahvash A, Pracht M, Montazeri AH, Bandula S, Martin RCG, Herrmann K, Brown E, Zuckerman D, Wilson G, Kim TY, Weaver A, Ross P, Harris WP, Graham J, Mills J, Yubero Esteban A, Johnson MS, Sofocleous CT, Padia SA, Lewandowski RJ, Garin E, Sinclair P, Salem R. Radioembolization With Chemotherapy for Colorectal Liver Metastases: A Randomized, Open-Label, International, Multicenter, Phase III Trial. J Clin Oncol 2021; 39:3897-3907. [PMID: 34541864 PMCID: PMC8660005 DOI: 10.1200/jco.21.01839] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To study the impact of transarterial Yttrium-90 radioembolization (TARE) in combination with second-line systemic chemotherapy for colorectal liver metastases (CLM). METHODS In this international, multicenter, open-label phase III trial, patients with CLM who progressed on oxaliplatin- or irinotecan-based first-line therapy were randomly assigned 1:1 to receive second-line chemotherapy with or without TARE. The two primary end points were progression-free survival (PFS) and hepatic PFS (hPFS), assessed by blinded independent central review. Random assignment was performed using a web- or voice-based system stratified by unilobar or bilobar disease, oxaliplatin- or irinotecan-based first-line chemotherapy, and KRAS mutation status. RESULTS Four hundred twenty-eight patients from 95 centers in North America, Europe, and Asia were randomly assigned to chemotherapy with or without TARE; this represents the intention-to-treat population and included 215 patients in the TARE plus chemotherapy group and 213 patients in the chemotherapy alone group. The hazard ratio (HR) for PFS was 0.69 (95% CI, 0.54 to 0.88; 1-sided P = .0013), with a median PFS of 8.0 (95% CI, 7.2 to 9.2) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. The HR for hPFS was 0.59 (95% CI, 0.46 to 0.77; 1-sided P < .0001), with a median hPFS of 9.1 (95% CI, 7.8 to 9.7) and 7.2 (95% CI, 5.7 to 7.6) months, respectively. Objective response rates were 34.0% (95% CI, 28.0 to 40.5) and 21.1% (95% CI, 16.2 to 27.1; 1-sided P = .0019) for the TARE and chemotherapy groups, respectively. Median overall survival was 14.0 (95% CI, 11.8 to 15.5) and 14.4 months (95% CI, 12.8 to 16.4; 1-sided P = .7229) with a HR of 1.07 (95% CI, 0.86 to 1.32) for TARE and chemotherapy groups, respectively. Grade 3 adverse events were reported more frequently with TARE (68.4% v 49.3%). Both groups received full chemotherapy dose intensity. CONCLUSION The addition of TARE to systemic therapy for second-line CLM led to longer PFS and hPFS. Further subset analyses are needed to better define the ideal patient population that would benefit from TARE.
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Affiliation(s)
- Mary F Mulcahy
- Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Armeen Mahvash
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, TX
| | - Marc Pracht
- Centre Eugene Marquis, Medical Oncology, Rennes, France
| | - Amir H Montazeri
- Clatterbridge Cancer Center NHS Foundation Trust, Liverpool, United Kingdom
| | - Steve Bandula
- University College London Hospital, London, United Kingdom
| | | | | | - Ewan Brown
- Western General Hospital, Edinburgh, Scotland
| | | | - Gregory Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tae-You Kim
- Seoul National University, Seoul, South Korea
| | - Andrew Weaver
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Paul Ross
- Guy's Hospital, London, United Kingdom
| | | | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jamie Mills
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | | | | | | | | | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Etienne Garin
- Centre Eugene Marquis, Nuclear Medicine, Rennes, France
| | | | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
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27
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Gordon AC, Gates VL, White SB, Harris KR, Mouli SK, Kim DH, Omary RA, Salem R, Lewandowski RJ, Larson AC. Yttrium-90 Radioembolization in the VX2 Rabbit Model: Radiation Safety and Factors Influencing Delivery Efficiency. J Vasc Interv Radiol 2021; 32:1569-1574.e11. [PMID: 34717835 DOI: 10.1016/j.jvir.2021.08.008] [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] [Received: 04/02/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to define the optimal infusion parameters and operator radiation exposure for yttrium-90 (90Y) radioembolization in the VX2 rabbit model of liver cancer. Forty-one rabbits with VX2 were treated with glass microspheres with vial sizes of 1, 3, and 5 GBq. The mean administered activity was 51.5 MBq (95% CI, 39.1-63.9). Delivery efficiency improved with 1 GBq versus with 3 GBq (residual 11.0% vs 46.4%, respectively; P = .0013) and improved with 1 GBq versus with 5 GBq (residual 11.0% vs 33.8%, respectively; P = .0060). The mean operator extremity exposure was 41.7 μSv/infusion. The optimal minimum infusion volume and rate was 49 mL and 21 mL/min, respectively. Fecal elimination occurred with microsphere uptake in the gallbladder at 1 and 2 weeks. 90Y radioembolization can be safely and efficiently performed in the VX2 rabbit model. Methodological considerations as a "how-to" for the setup of a preclinical 90Y laboratory are included to support future translational research.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.
| | - Vanessa L Gates
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah B White
- Department of Radiology, Division of Vascular & Interventional Radiology, Vanderbilt University Medical Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathleen R Harris
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K Mouli
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dong-Hyun Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Reed A Omary
- Department of Radiology, Division of Vascular & Interventional Radiology, Vanderbilt University Medical Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Larson
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
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Gordon AC, Lewandowski RJ. CBCT-guided TACE-MWA for HCC Measuring up to 5 cm. Acad Radiol 2021; 28 Suppl 1:S71-S72. [PMID: 34154903 DOI: 10.1016/j.acra.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
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Swersky A, Kulik L, Kalyan A, Grace K, Caicedo JC, Lewandowski RJ, Salem R. Contemporary Algorithm for the Management of Hepatocellular Carcinoma in 2021: The Northwestern Approach. Semin Intervent Radiol 2021; 38:432-437. [PMID: 34629710 DOI: 10.1055/s-0041-1735528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/08/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major cause of cancer-related morbidity and mortality around the world. Frequently, concurrent liver dysfunction and variations in tumor burden make it difficult to design effective and standardized treatment pathways. Contemporary treatment guidelines designed for an era of personalized medicine should consider these features in a more clinically meaningful way to improve outcomes for patients across the HCC spectrum. Given the heterogeneity of HCC, we propose a detailed clinical algorithm for selecting optimal treatment using an evidence-based and practical approach, incorporating liver function, tumor burden, the extent of disease, and ultimate treatment intent, with the goal of individualizing clinical decision making.
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Affiliation(s)
- Adam Swersky
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Laura Kulik
- Division of Hepatology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Aparna Kalyan
- Division of Medical Oncology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Karen Grace
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Juan Carlos Caicedo
- Division of Transplantation, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Entezari P, Gabr A, Kennedy K, Salem R, Lewandowski RJ. Radiation Lobectomy: An Overview of Concept and Applications, Technical Considerations, Outcomes. Semin Intervent Radiol 2021; 38:419-424. [PMID: 34629708 DOI: 10.1055/s-0041-1735530] [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: 10/20/2022]
Abstract
Surgical resection has long been considered curative for patients with early-stage hepatocellular carcinoma (HCC). However, inadequate future liver remnant (FLR) renders many patients not amenable to surgery. Recently, lobar administration of yttrium-90 (Y90) radioembolization has been utilized to induce FLR hypertrophy while providing disease control, eventually facilitating resection in patients with hepatic malignancy. This has been termed "radiation lobectomy (RL)." The concept is evolving, with modified approaches combining RL and high-dose curative-intent radioembolization (radiation segmentectomy) to achieve tumor ablation. This article provides an overview of the concept and applications of RL, including technical considerations and outcomes in patients with hepatic malignancies.
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Affiliation(s)
- Pouya Entezari
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Kristie Kennedy
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois.,Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois.,Division of Transplantation, Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, Illinois
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Murali N, Mouli SK, Riaz A, Lewandowski RJ, Salem R. Extrahepatic Applications of Yttrium-90 Radioembolization. Semin Intervent Radiol 2021; 38:479-481. [PMID: 34629717 DOI: 10.1055/s-0041-1735573] [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: 10/20/2022]
Abstract
While initially described and now accepted as treatment for primary and secondary malignancies in the liver, radioembolization therapy has expanded to include treatment for other disease pathologies and other organ systems. Advantages and limitations for these treatments exist and must be compared against more traditional treatments for these processes. This article provides an overview of the current applications for radioembolization outside of the liver, for both malignant and nonmalignant disease.
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Affiliation(s)
- Nikitha Murali
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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32
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Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, Salem R, Lewandowski RJ. Evolution of Radioembolization in Treatment of Hepatocellular Carcinoma: A Pictorial Review. Radiographics 2021; 41:1802-1818. [PMID: 34559587 DOI: 10.1148/rg.2021210014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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
Transarterial radioembolization (TARE) with yttrium 90 has increasingly been performed to treat hepatocellular carcinoma (HCC). TARE was historically used as a palliative lobar therapy for patients with advanced HCC beyond surgical options, ablation, or transarterial chemoembolization, but recent advancements have led to its application across the Barcelona Clinic Liver Cancer staging paradigm. Newer techniques, termed radiation lobectomy and radiation segmentectomy, are being performed before liver resection to facilitate hypertrophy of the future liver remnant, before liver transplant to bridge or downstage to transplant, or as a definite curative treatment. Imaging assessment of therapeutic response to TARE is challenging as the intent of TARE is to deliver local high-dose radiation to tumors through microembolic microspheres, preserving blood flow to promote radiation injury to the tumor. Because of the microembolic nature, early imaging assessment after TARE cannot rely solely on changes in size. Knowledge of the evolving methods of TARE along with the tools to assess posttreatment imaging and response is essential to optimize TARE as a therapeutic option for patients with HCC. ©RSNA, 2021.
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Affiliation(s)
- Frank H Miller
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahmed Gabr
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Linda C Kelahan
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Ahsun Riaz
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Riad Salem
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Ste 800, Chicago, IL 60611
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Abstract
Percutaneous biliary and gallbladder drainage is routinely performed by interventional radiology. These pathologies and techniques are well described in the literature and in this issue. The purpose of this review is to focus on the recognition and management of complications. Percutaneous biliary drains can have a variety of complications which can range from minor skin issues to more serious and complex bleeding issues. Advancements in imaging and techniques improve the safety profile of percutaneous biliary and gallbladder interventions.
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Affiliation(s)
- Heather Molina
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Maye M Chan
- Division of Vascular and Interventional Radiology, Department of Radiology, M Health Fairview University of Minnesota, Minneapolis, Minnesota
| | - Robert J Lewandowski
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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34
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Gordon AC, White SB, Gates VL, Procissi D, Harris KR, Yang Y, Zhang Z, Li W, Lyu T, Huang X, Omary RA, Salem R, Lewandowski RJ, Larson AC. Yttrium-90 Radioembolization and Tumor Hypoxia: Gas-challenge BOLD Imaging in the VX2 Rabbit Model of Hepatocellular Carcinoma. Acad Radiol 2021; 28:849-858. [PMID: 32522403 PMCID: PMC7719607 DOI: 10.1016/j.acra.2020.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 03/21/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES To use a rapid gas-challenge blood oxygen-level dependent magnetic resonance imaging exam to evaluate changes in tumor hypoxia after 90Y radioembolization (Y90) in the VX2 rabbit model. MATERIALS AND METHODS White New Zealand rabbits (n = 11) provided a Y90 group (n = 6 rabbits) and untreated control group (n = 5 rabbits). R2* maps were generated with gas-challenges (O2/room air) at baseline, 1 week, and 2 weeks post-Y90. Laboratory toxicity was evaluated at baseline, 24 hours, 72 hours, 1 hours, and 2 weeks. Histology was used to evaluate tumor necrosis on hematoxylin and eosin and immunofluorescence imaging was used to assess microvessel density (CD31) and proliferative index (Ki67). RESULTS At baseline, median tumor volumes and time to imaging were similar between groups (p = 1.000 and p = 0.4512, respectively). The median administered dose was 50.4 Gy (95% confidence interval:44.8-55.9). At week 2, mean tumor volumes were 5769.8 versus 643.7 mm3 for control versus Y90 rabbits, respectively (p = 0.0246). At two weeks, ΔR2* increased for control tumors to 12.37 ± 12.36sec-1 and decreased to 4.48 ± 9.00sec-1 after Y90. The Pearson correlation coefficient for ΔR2* at baseline and percent increase in tumor size by two weeks was 0.798 for the Y90 group (p = 0.002). There was no difference in mean microvessel density for control versus Y90 treated tumors (p = 0.6682). The mean proliferative index was reduced in Y90 treated tumors at 30.5% versus 47.5% for controls (p = 0.0071). CONCLUSION The baseline ΔR2* of tumors prior to Y90 may be a predictive imaging biomarker of tumor response and treatment of these tumors with Y90 may influence tumor oxygenation over time.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois.
| | - Sarah B White
- Department of Radiology, Division of Vascular & Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Vanessa L Gates
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Daniel Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kathleen R Harris
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yihe Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Weiguo Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tianchu Lyu
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Xiaoke Huang
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew C Larson
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
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Mouli SK, Raiter S, Harris K, Mylarapu A, Burks M, Li W, Gordon AC, Khan A, Matsumoto M, Bailey KL, Pasciak AS, Manupipatpong S, Weiss CR, Casalino D, Miller FH, Gates VL, Hohlastos E, Lewandowski RJ, Kim DH, Dreher MR, Salem R. Yttrium-90 Radioembolization to the Prostate Gland: Proof of Concept in a Canine Model and Clinical Translation. J Vasc Interv Radiol 2021; 32:1103-1112.e12. [PMID: 33839262 DOI: 10.1016/j.jvir.2021.01.282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/28/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate the feasibility, safety, and absorbed-dose distribution of prostatic artery radioembolization (RE) in a canine model. MATERIALS AND METHODS Fourteen male castrated beagles received dihydroandrosterone/estradiol to induce prostatic hyperplasia for the duration of the study. Each dog underwent fluoroscopic prostatic artery catheterization. Yttrium-90 (90Y) microspheres (TheraSphere; Boston Scientific, Marlborough, Massachusetts) were delivered to 1 prostatic hemigland (dose escalation from 60 to 200 Gy), with the contralateral side serving as a control. Assessments for adverse events were performed throughout the follow-up (Common Terminology Criteria for Adverse Events v5.0). Positron emission tomography/magnetic resonance (MR) imaging provided a confirmation after the delivery of absorbed-dose distribution. MR imaging was performed before and 3, 20, and 40 days after RE. Tissue harvest of the prostate, rectum, bladder, urethra, penis, and neurovascular bundles was performed 60 days after RE. RESULTS All the animals successfully underwent RE. Positron emission tomography/MR imaging demonstrated localization to and good coverage of only the treated hemigland. No adverse events occurred. The MR imaging showed a significant dose-dependent decrease in the treated hemigland size at 40 days (25%-60%, P < .001). No extraprostatic radiographic changes were observed. Necropsy demonstrated no gross rectal, urethral, penile, or bladder changes. Histology revealed RE-induced changes in the treated prostatic tissues of the highest dose group, with gland atrophy and focal necrosis. No extraprostatic RE-related histologic findings were observed. CONCLUSIONS Prostate 90Y RE is safe and feasible in a canine model and leads to focal dose-dependent changes in the gland without inducing unwanted extraprostatic effects. These results suggest that an investigation of nonoperative prostate cancer is warranted.
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Affiliation(s)
- Samdeep K Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL.
| | - Simone Raiter
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Kathleen Harris
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Amrutha Mylarapu
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Malcolm Burks
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Weiguo Li
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Andrew C Gordon
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Ali Khan
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Monica Matsumoto
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Keith L Bailey
- Veterinary Diagnostic Laboratory, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Alexander S Pasciak
- Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sasicha Manupipatpong
- Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifford R Weiss
- Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Casalino
- Department of Radiology, Section of Body Imaging, Northwestern University, Chicago, IL
| | - Frank H Miller
- Department of Radiology, Section of Body Imaging, Northwestern University, Chicago, IL
| | - Vanessa L Gates
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Elias Hohlastos
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
| | - Dong-Hyun Kim
- Department of Radiology, Section of Body Imaging, Northwestern University, Chicago, IL
| | | | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
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Matsumoto MM, Mouli S, Saxena P, Gabr A, Riaz A, Kulik L, Ganger D, Maddur H, Boike J, Flamm S, Moore C, Kalyan A, Desai K, Thornburg B, Abecassis M, Hickey R, Caicedo J, Grace K, Lewandowski RJ, Salem R. Comparing Real World, Personalized, Multidisciplinary Tumor Board Recommendations with BCLC Algorithm: 321-Patient Analysis. Cardiovasc Intervent Radiol 2021; 44:1070-1080. [PMID: 33825060 DOI: 10.1007/s00270-021-02810-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate hepatocellular carcinoma (HCC) treatment allocation, deviation from BCLC first-treatment recommendation, and outcomes following multidisciplinary, individualized approach. METHODS Treatment-naïve HCC discussed at multidisciplinary tumor board (MDT) between 2010 and 2013 were included to allow minimum 5 years of follow-up. MDT first-treatment recommendation (resection, transplant, ablation, transarterial radioembolization (Y90), transarterial chemoembolization, sorafenib, palliation) was documented, as were subsequent treatments. Overall survival (OS) analyses were performed on an intention-to-treat (ITT) basis, stratified by BCLC stage. RESULTS Three hundred and twenty-one patients were treated in the 4-year period. Median age was 62 years, predominantly male (73%), hepatitis C (41%), and Y90 initial treatment (52%). There was a 76% rate of BCLC-discordant first-treatment. Median OS was not reached (57% alive at 10 years), 51.0 months, 25.4 months and 13.4 months for BCLC stages A, B, C and D, respectively. CONCLUSION Deviation from BCLC guidelines was very common when individualized, MDT treatment recommendations were made. This approach yielded expected OS in BCLC A, and exceeded general guideline expectations for BCLC B, C and D. These results suggest that while guidelines are helpful, implementing a more personalized approach that incorporates center expertise, patient-specific characteristics, and the known multi-directional treatment allocation process, improves patient outcomes.
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Affiliation(s)
- Monica M Matsumoto
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Samdeep Mouli
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Priyali Saxena
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Laura Kulik
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel Ganger
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Haripriya Maddur
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin Boike
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Steven Flamm
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher Moore
- Division of Hepatology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Aparna Kalyan
- Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Kush Desai
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Bartley Thornburg
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | | | - Ryan Hickey
- Section of Interventional Radiology, Department of Radiology, New York University, New York, NY, USA
| | - Juan Caicedo
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Karen Grace
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA.,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. .,Division of Medical Oncology, Department of Medicine, Northwestern University, Chicago, IL, USA. .,Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA.
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Gabr A, Kulik L, Mouli S, Riaz A, Ali R, Desai K, Mora RA, Ganger D, Maddur H, Flamm S, Boike J, Moore C, Thornburg B, Alasadi A, Baker T, Borja-Cacho D, Katariya N, Ladner DP, Caicedo JC, Lewandowski RJ, Salem R. Liver Transplantation Following Yttrium-90 Radioembolization: 15-Year Experience in 207-Patient Cohort. Hepatology 2021; 73:998-1010. [PMID: 32416631 DOI: 10.1002/hep.31318] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 01/31/2020] [Revised: 03/31/2020] [Accepted: 05/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/downstaged by Y90. APPROACH AND RESULTS Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM), and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4-10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three-year, 5-year, and 10-year OS rates were 84%, 77%, and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69-150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P < 0.0001). For patients with UNOS T2 treated during the study period, 5.2% dropped out because of disease progression. CONCLUSIONS Y90 is an effective treatment for HCC in the setting of bridging/downstaging to LT. Patients who achieved extensive or complete necrosis had better RFS, supporting the practice of neoadjuvant treatment before LT.
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Affiliation(s)
- Ahmed Gabr
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Laura Kulik
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Samdeep Mouli
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ahsun Riaz
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Rehan Ali
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Kush Desai
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ronald A Mora
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Daniel Ganger
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Haripriya Maddur
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Steven Flamm
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Justin Boike
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Christopher Moore
- Department of MedicineDivision of HepatologyNorthwestern UniversityChicagoIL
| | - Bartley Thornburg
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Ali Alasadi
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL
| | - Talia Baker
- Department of SurgeryDivision of TransplantationUniversity of ChicagoChicagoIL
| | - Daniel Borja-Cacho
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Nitin Katariya
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Daniela P Ladner
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Juan Carlos Caicedo
- Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Robert J Lewandowski
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
| | - Riad Salem
- Department of RadiologySection of Interventional RadiologyNorthwestern Memorial HospitalRobert H. Lurie Comprehensive Cancer CenterChicagoIL.,Department of SurgeryDivision of TransplantationComprehensive Transplant CenterNorthwestern UniversityChicagoIL
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Gordon AC, Gupta AN, Gabr A, Thornburg BG, Kulik LM, Ganger DR, Maddur H, Flamm SL, Boike JR, Moore CM, Borja-Cacho D, Christopher DA, Katariya NN, Ladner DP, Caicedo-Ramirez JC, Riaz A, Salem R, Lewandowski RJ. Safety and Efficacy of Segmental Yttrium-90 Radioembolization for Hepatocellular Carcinoma after Transjugular Intrahepatic Portosystemic Shunt Creation. J Vasc Interv Radiol 2021; 32:211-219. [PMID: 33349507 DOI: 10.1016/j.jvir.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate safety and efficacy of segmental yttrium-90 (Y90) radioembolization for hepatocellular carcinoma (HCC) after transjugular intrahepatic portosystemic shunt (TIPS) placement. The hypothesis was liver sparing segmental Y90 for HCC after TIPS would provide high antitumor response with a tolerable safety profile. MATERIALS AND METHODS This single-arm retrospective study included 39 patients (16 women, 23 men) with ages 49-81 years old who were treated with Y90. Child-Pugh A/B liver dysfunction was present in 72% (28/39) with a median Model for End-stage Liver Disease score of 18 (95% confidence interval, 16.4-19.4). Primary outcomes were clinical and biochemical toxicities and antitumor imaging response by World Health Organization (WHO) and European Association for the Study of the Liver (EASL) criteria. Secondary outcomes were orthotopic liver transplantation (OLT), time to progression (TTP), and overall survival (OS) estimates by the Kaplan-Meier method. RESULTS The 30-day mortality was 0%. Grade 3+ clinical adverse events and grade 3+ hyperbilirubinemia occurred in 5% (2/39) and 0% (0/39), respectively. Imaging response was achieved in 58% (22/38, WHO criteria) and 74% (28/38, EASL criteria), respectively. Median TTP was 16.1 months for any cause and 27.5 months for primary index lesions. OLT was completed in 88% (21/24) of listed patients at a median time of 6.1 months (range, 0.9-11.7 months). Median OS was 31.6 months and 62.9 months censored and uncensored to OLT, respectively. CONCLUSIONS Segmental Y90 for HCC appears safe and efficacious in patients after TIPS. Preserved transplant eligibility suggests that Y90 is a useful tool for bridging these patients to liver transplantation.
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Affiliation(s)
- Andrew C Gordon
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Aakash N Gupta
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Bartley G Thornburg
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Laura M Kulik
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Daniel R Ganger
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Haripriya Maddur
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Steven L Flamm
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Justin R Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Christopher M Moore
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel Borja-Cacho
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Derrick A Christopher
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Nitin N Katariya
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Daniela P Ladner
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Juan C Caicedo-Ramirez
- Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Ahsun Riaz
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois; Division of Transplant Surgery, Department of Surgery, Northwestern University, Chicago, Illinois; Division of Hematology and Oncology, Department of Medicine, Northwestern University, Chicago, Illinois.
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Park W, Cho S, Ji J, Lewandowski RJ, Larson AC, Kim DH. Development and Validation of Sorafenib-eluting Microspheres to Enhance Therapeutic Efficacy of Transcatheter Arterial Chemoembolization in a Rat Model of Hepatocellular Carcinoma. Radiol Imaging Cancer 2021; 3:e200006. [PMID: 33575658 DOI: 10.1148/rycan.2021200006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 12/17/2022]
Abstract
Purpose To validate the therapeutic efficacy of sorafenib-eluting embolic microspheres (SOR-EMs) used in combination with transarterial chemoembolization (TACE) for treatment of hepatocellular carcinoma (HCC) in a preclinical animal model. Materials and Methods SOR-EMs were prepared with poly(d,l-lactide-co-glycolide), iron oxide nanoparticles, and sorafenib. The morphology of the prepared SOR-EMs was confirmed by using optical microscopy. Drug release from the SOR-EMs was quantified in vitro by using high-performance liquid chromatography. In an orthotopic rat model of HCC, embolic doxorubicin-Lipiodol (ethiodized oil) emulsion (DLE) and SOR-EMs were sequentially injected into the hepatic artery of the rats: The rats in group 1 were injected with DLE; group 2 was injected with DLE plus unloaded embolic microspheres (DLE + EM); group 3, with DLE plus SOR-EMs (DLE + SOR-EM); and group 4, with saline solution. The SOR-EM and tumor size changes in each group (of six rats each) over time were measured by using MRI. Tissues were assessed by using immunohistochemistry, with hematoxylin-eosin and terminal deoxynucleotidyl transferase-mediated dUTP (2'-deoxyuridine 5'-triphosphate) nick-end labeling staining used for dead cells and CD34 staining used for new microvessel formation. Results The SOR-EMs were a mean size of 6.6 μm ± 2.3 (standard deviation) and showed 53.7% ± 8.3 sorafenib loading efficiency with T2-weighted MRI capability. In the HCC rat model, the intra-arterially injected SOR-EMs were successfully monitored by using MRI. The DLE + SOR-EM-treated rats showed a superior tumor growth-inhibitory effect compared with the rats treated with DLE only (P < .05). Immunohistochemical assessment of tissue specimens showed that compared with the other treatment groups, the DLE + SOR-EM treatment group had the lowest number of microvessels, as quantified by using the percentage of CD34-positive stained area (P < .01 for all comparisons). Conclusion In a preclinical rat HCC model, SOR-EMs used in combination with DLE TACE were effective in treating HCC.Keywords: Chemoembolization, Experimental Investigations, Laboratory Tests, Liver, Technology Assessment Supplemental material is available for this article. © RSNA, 2021See also the commentary by Yamada and Gayed in this issue.
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Affiliation(s)
- Wooram Park
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
| | - Soojeong Cho
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
| | - Jingran Ji
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
| | - Robert J Lewandowski
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
| | - Andrew C Larson
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine (W.P., S.C., J.J., R.J.L., A.C.L., D.H.K.), and Robert H. Lurie Comprehensive Cancer Center (R.J.L., A.C.L., D.H.K.), Northwestern University, 737 N Michigan Ave, Suite 1600, Chicago, IL 60611; Department of Biomedical Engineering (A.C.L., D.H.K.); and Department of Electrical Engineering and Computer Science (A.C.L.) and International Institute of Nanotechnology (A.C.L.), Northwestern University, Evanston, Ill
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Yang B, Huang X, Li W, Mouli S, Lewandowski RJ, Larson AC. Duramycin radiosensitization of MCA-RH 7777 hepatoma cells through the elevation of reactive oxygen species. J Cancer Res Ther 2021; 17:543-546. [PMID: 34121705 DOI: 10.4103/jcrt.jcrt_284_18] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The objective of this study is to explore the radiosensitization effects of duramycin against the liver cancer hepatoma cells and relationship to reactive oxygen species (ROS) generation. Materials and Methods MCA-RH 7777 cells were treated with various combinations of duramycin concentrations and radiation doses. After the treatment, cell viabilities were determined by a cell proliferation assay; intracellular ROS levels were detected with the flow cytometric method. Results MCA-RH 7777 cell viability was found significantly reduced after combining duramycin and radiation exposure (comparing to that of either treatment alone). Increased intracellular ROS levels were observed in cells treated with combinations of duramycin and radiation. Conclusion Duramycin increased the intracellular ROS generation and also increased the radiosensitivity of MCA-RH 7777 cells.
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Affiliation(s)
- Bowen Yang
- Department of Medicine, Shanxi Medical University, Taiyuan, Shanxi, China; Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Xiaoke Huang
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
| | - Weiguo Li
- Department of Radiology, Northwestern University; Research Resource Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Samdeep Mouli
- Department of Radiology, Northwestern University, Chicago, Illinois, USA
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Padia SA, Johnson GE, Lewandowski RJ, Gabr A, Toskich BB. Transarterial Yttrium-90 Radioembolization of Hepatocellular Carcinoma Perfused by the Cystic Artery: Multi-institutional Feasibility Study. J Vasc Interv Radiol 2020; 31:2022-2027. [PMID: 33187861 DOI: 10.1016/j.jvir.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To assess the safety and efficacy of transarterial yttrium-90 radioembolization via the cystic artery for patients with hepatocellular carcinoma (HCC) adjacent to the gallbladder with cystic artery supply. MATERIALS AND METHODS This retrospective study included 17 patients treated at 4 institutions. Patients with HCC perfused by the cystic artery who received ablative-dose radioembolization were included. Median tumor size was 3.8 cm (range, 2.0-8.8 cm). Fourteen patients (82%) had Child-Pugh class A cirrhosis and 3 (18%) had class B cirrhosis. Adverse events, tumor response, and time to progression were analyzed. RESULTS Median dose to the tissue perfused by the cystic artery was 340 Gy (range, 200-720 Gy). There were no occurrences of acute cholecystitis warranting invasive intervention. Four patients (24%) experienced transient right upper quadrant pain, with symptom resolution within 3 mo. Six patients (35%) exhibited gallbladder wall edema on follow-up imaging. Two (12%) and 0 grade 3/4 increases in alkaline phosphatase and bilirubin were observed, respectively. Follow-up imaging demonstrated complete response in 13 target tumors (76%) and partial response in 4 (24%). There were no cases of target tumor progression during a median follow-up of 9 mo (range, 3-72 mo). CONCLUSIONS Direct infusion of 90Y microspheres via the cystic artery appears to have an acceptable safety profile, without resulting in acute cholecystitis warranting invasive intervention. In selected patients with HCC in whom other treatments may be contraindicated and the tumor is supplied via the cystic artery, treatment with selective ablative radioembolization can be considered.
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Affiliation(s)
- Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, 757 Westwood Plaza, Room 2125, Los Angeles, CA 90095.
| | - Guy E Johnson
- Section of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Robert J Lewandowski
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Section of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
| | - Beau B Toskich
- Division of Interventional Radiology, Mayo Clinic Florida, Jacksonville, Florida
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Lewandowski RJ, Salem R. Radioembolisation with personalised dosimetry: improving outcomes for patients with advanced hepatocellular carcinoma. Lancet Gastroenterol Hepatol 2020; 6:2-3. [PMID: 33166498 DOI: 10.1016/s2468-1253(20)30306-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, USA; Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL 60611, USA.
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, IL 60611, USA; Department of Medicine, Division of Hematology and Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, IL 60611, USA
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Gordon AC, White SB, Yang Y, Gates VL, Procissi D, Harris KR, Zhang Z, Lyu T, Huang X, Dreher MR, Omary RA, Salem R, Lewandowski RJ, Larson AC. Feasibility of Combination Intra-arterial Yttrium-90 and Irinotecan Microspheres in the VX2 Rabbit Model. Cardiovasc Intervent Radiol 2020; 43:1528-1537. [PMID: 32533312 PMCID: PMC7529870 DOI: 10.1007/s00270-020-02538-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the combination of 90Y radioembolization (Y90) and drug-eluting bead irinotecan (DEBIRI) microspheres in the VX2 rabbit model. MATERIALS AND METHODS An initial dose finding study was performed in 6 White New Zealand rabbits to identify a therapeutic but subcurative dose of Y90. In total, 29 rabbits were used in four groups: Y90 treatment (n = 8), DEBIRI treatment (n = 6), Y90 + DEBIRI treatment (n = 7), and an untreated control group (n = 8). Hepatic toxicity was evaluated at baseline, 24 h, 72 h, 1 week, and 2 weeks. MRI tumor volume (TV) and enhancing tumor volume were assessed baseline and 2 weeks. Tumor area and necrosis were evaluated on H&E for pathology. RESULTS Infused activities of 84.0-94.4 MBq (corresponding to 55.1-72.7 Gy) were selected based on the initial dose finding study. Infusion of DEBIRI after Y90 was technically feasible in all cases (7/7). Overall, 21/29 animals survived to 2 weeks, and the remaining animals had extrahepatic disease on necropsy. Liver transaminases were elevated with Y90, DEBIRI, and Y90 + DEBIRI compared to control at 24 h, 72 h, and 1 week post-treatment and returned to baseline by 2 weeks. By TV, Y90 + DEBIRI was the only treatment to show statistically significant reduction at 2 weeks compared to the control group (p = 0.012). The change in tumor volume (week 2-baseline) for both Y90 + DEBIRI versus control (p = 0.002) and Y90 versus control (p = 0.014) was significantly decreased. There were no statistically significant differences among groups on pathology. CONCLUSION Intra-arterial Y90 + DEBIRI was safe and demonstrated enhanced antitumor activity in rabbit VX2 tumors. This combined approach warrants further investigation.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yihe Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Vanessa L Gates
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Daniel Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Kathleen R Harris
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Tianchu Lyu
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Xiaoke Huang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | | | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew C Larson
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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Choi H, Choi B, Yu B, Li W, Matsumoto MM, Harris KR, Lewandowski RJ, Larson AC, Mouli SK, Kim DH. On-demand degradable embolic microspheres for immediate restoration of blood flow during image-guided embolization procedures. Biomaterials 2020; 265:120408. [PMID: 32992115 DOI: 10.1016/j.biomaterials.2020.120408] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 03/18/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022]
Abstract
Degradable embolic agents that provide transient arterial occlusion during embolization procedures have been of interest for many years. Ideally, embolic agents are visible with standard imaging modalities and offer on-demand degradability, permitting physicians to achieve desired arterial occlusion tailored to patient and procedure indication. Subsequent arterial recanalization potentially enhances the overall safety and efficacy of embolization procedures. Here, we report on-demand degradable and MRI-visible microspheres for embolotherapy. Embolic microspheres composed of calcium alginate and USPIO nanoclusters were synthesized with an air spray atomization and coagulation reservoir equipped with a vacuum suction. An optimized distance between spray nozzle and reservoir allowed uniform size and narrow size distribution of microspheres. The fabricated alginate embolic microspheres crosslinked with Ca2+ demonstrated highly responsive on-demand degradation properties in vitro and in vivo. Finally, the feasibility of using the microspheres for clinical embolization and recanalization procedures was evaluated with interventional radiologists in rabbits. Digital subtraction angiography (DSA) guided embolization of hepatic arteries with these embolic microspheres was successfully performed and the occlusion of artery was confirmed with DSA images and contrast enhanced MRI. T2 MRI visibility of the microspheres allowed to monitor the distribution of intra-arterial (IA) infused embolic microspheres. Subsequent on-demand image-guided recanalization procedures were also successfully performed with rapid degradation of microspheres upon intra-arterial infusion of an ion chelating agent. These instant degradable embolic microspheres will permit effective on-demand embolization/recanalization procedures offering great promise to overcome limitations of currently available permanent and biodegradable embolic agents.
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Affiliation(s)
- Hyunjun Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA
| | - Bongseo Choi
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Bo Yu
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Weiguo Li
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Monica M Matsumoto
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Kathleen R Harris
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Robert J Lewandowski
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Andrew C Larson
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA; Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL, 60208, USA; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, 60611, USA
| | - Samdeep K Mouli
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, 60607, USA; Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL, 60208, USA; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, 60611, USA.
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Riaz A, Entezari P, Ganger D, Gabr A, Thornburg B, Russell E, Ladner D, Katariya N, Caicedo JC, Boike J, Lewandowski RJ, Keswani R, Aadam AA, Abecassis M, Salem R. Percutaneous Access of the Modified Hutson Loop for Retrograde Cholangiography, Endoscopy, and Biliary Interventions. J Vasc Interv Radiol 2020; 31:2113-2120.e1. [PMID: 32948389 DOI: 10.1016/j.jvir.2020.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The purpose of this study was to present the institutional experience of performing endoscopy, cholangiography, and biliary interventions through the modified Hutson loop by interventional radiology. MATERIALS AND METHODS A total of 61 of 64 modified Hutson loop access procedures were successful. This single-center retrospective study included 61 successful procedures of biliary interventions using existing modified Hutson loops (surgically affixed subcutaneous jejunal limb adjacent to biliary anastomosis or anastomoses) for diagnostic or therapeutic purposes in 21 patients. Seventeen of 21 patients (81%) had undergone liver transplantation. Indications included biliary strictures (n = 18) and biliary leaks (n = 3). The clinical success and complications were evaluated. RESULTS There were 3 of 26 modified Hutson loop retrograde biliary intervention failures (12%) before introduction of endoscopy and no failures (0 of 38 [0%]) subsequently (P = .06). Endoscopy or cholangioscopy was performed in 19 procedures by interventional radiologists. Retrograde biliary interventions included diagnostic cholangiography (n = 26), cholangioplasty (n = 25), stent placement (n = 29), stent retrieval (n = 25), and biliary drainage catheter placement (n = 5). No procedure-related mortality occurred. There was 1 major complication (duodenal perforation) (1.6%) and 12 minor complications (19%). In the 9 patients undergoing therapeutic interventions for biliary strictures, there was a significant decrease in median alkaline phosphatase (288.5 to 174.5 U/L; P = .03). There was a trend toward decrease in median bilirubin levels (1.7 to 1 mg/dL; P = .06) at 1 month post-intervention. CONCLUSIONS The modified Hutson loop provided interventional radiologists a safe and effective alternative access to manage biliary complications in patients with biliary-enteric anastomoses. Introduction of the endoscope in interventional radiology has improved the success rate of these procedures.
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Affiliation(s)
- Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois.
| | - Pouya Entezari
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Daniel Ganger
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Elliott Russell
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Daniela Ladner
- Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, Illinois
| | - Nitin Katariya
- Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, Illinois
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplant Surgery, Northwestern University, Chicago, Illinois
| | - Justin Boike
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
| | - Rajesh Keswani
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Abdul Aziz Aadam
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois
| | - Michael Abecassis
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
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Gabr A, Entezari P, Riaz A, Salem R, Lewandowski RJ. Contemporary Techniques and Applications of Radioembolization in Patients with Hepatocellular Carcinoma. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.yacr.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Background Numerous reports have shown that inferior vena cava filters are associated with clinically significant adverse events. Complicating factors, such as caval incorporation, may lead to technical challenges at retrieval. The use of advanced techniques including the laser sheath have increased technical success rates; however, the data are limited on which filter types necessitate and benefit from its use. Methods and Results From October 2011 to September 2019, patients with inferior vena cava filter dwell times >6 months or with prior failed retrievals were considered for laser sheath-assisted retrieval. Standard and nonlaser advanced retrieval techniques were attempted first; if the filter could not be safely or successfully detached from the caval wall using these techniques, the laser sheath was used. Technical success, filter type, necessity for laser sheath application based on "open" versus "closed-cell" filter design, dwell times, and adverse events were evaluated. A total of 441 patients (216 men; mean age, 54 years) were encountered. Mean dwell times for all filters was 56.6 months, 54.4 among closed-cell filters and 58.5 among open-cell filters (P=0.63). Technical success of retrieval was 98%, with the laser sheath required in 143 cases (40%). Successful retrieval of closed-cell filters required laser sheath assistance in 60% of cases as compared with 7% of open-cell filters (odds ratio, 20.1; P<0.01). In closed-cell inferior vena cava filters, dwell time was significantly associated with need for laser, requiring it in 64% of retrievals with dwell times >6 months (P=0.01). One major adverse event occurred among laser sheath retrievals when a patient required a 2-day inpatient admission for a femoral access site hemorrhage. Conclusions Closed-cell filters may necessitate the use of the laser sheath for higher rates of successful and safe retrieval.
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Affiliation(s)
- Kush R Desai
- Department of Radiology Northwestern University Chicago IL
| | - Nicholas Xiao
- Department of Radiology Northwestern University Chicago IL
| | - Riad Salem
- Department of Radiology Northwestern University Chicago IL
| | | | - Robert K Ryu
- Department of Radiology University of Southern California Los Angeles CA
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Gordon AC, White SB, Gates VL, Li W, Procissi D, Zhang Z, Harris KR, Kim DH, Mouli SK, Omary RA, Salem R, Larson AC, Lewandowski RJ. Yttrium-90 Portal Vein Radioembolization in Sprague-Dawley Rats: Dose-Dependent Imaging and Pathological Changes in Normal Liver. Cardiovasc Intervent Radiol 2020; 43:1925-1935. [PMID: 32803285 DOI: 10.1007/s00270-020-02614-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/09/2020] [Accepted: 08/02/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Portal vein embolization (PVE) is an established neoadjuvant method to induce future liver remnant hypertrophy prior to surgical resection of hepatic tumors. The purpose of our study was to examine the feasibility of PVE with glass 90Y microspheres (Y90 PVE) in Sprague-Dawley rats. We tested the hypothesis that increased doses of Y90 PVE would increase target lobe fibrosis and atrophy. METHODS Twenty-two rats were assigned to four groups for Y90 PVE to the right median lobe: very high- (273.8 MBq; n = 2), high- (99.9 MBq; n = 10), medium- (48.1 MBq; n = 5), and low-dose (14.8 MBq; n = 5). An untreated control group included seven rats. 90Y PET/CT of 90Y distributions confirmed lobar targeting. MRI volumes were measured at baseline, 2-, 4-, 8- and 12-weeks. Explanted hepatic lobes were weighed, sectioned, and stained for H&E and immunohistochemistry. Digitized slides allowed quantitative measurements of fibrosis (20 foci/slide). RESULTS Ex vivo measurements confirmed 91-97% activity was localized to the target lobe (n = 4). The percent growth of the target lobe relative to baseline was - 5.0% (95% CI - 17.0-6.9%) for high-, medium dose rats compared to + 18.6% (95% CI + 7.6-29.7%) in the low-dose group at 12-weeks (p = 0.0043). Radiation fibrosis increased in a dose-dependent fashion. Fibrotic area/microsphere was 22,893.5, 14,946.2 ± 2253.3, 15,304.5 ± 4716.6, and 5268.8 ± 2297.2 μm2 for very high- (n = 1), high- (n = 4), medium- (n = 3), and low-dose groups (n = 5), respectively. CONCLUSION Y90 PVE was feasible in the rat model, resulted in target lobe atrophy, and dose-dependent increases in hepatic fibrosis at 12 weeks. The onset of imaging-based volumetric changes was 8-12 weeks.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - Sarah B White
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vanessa L Gates
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Weiguo Li
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Daniel Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Kathleen R Harris
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Dong-Hyun Kim
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Samdeep K Mouli
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA
| | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew C Larson
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA. .,Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Xiao N, Gordon AC, Thornburg B, Sato KT, Lewandowski RJ. Impact of COVID-19 on IR Fellowship. J Vasc Interv Radiol 2020; 31:1492-1494. [PMID: 32771280 PMCID: PMC7330558 DOI: 10.1016/j.jvir.2020.06.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Nicholas Xiao
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Andrew C Gordon
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Bartley Thornburg
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Kent T Sato
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611
| | - Robert J Lewandowski
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University, 676 N. Saint Clair Street, Suite 800, Chicago, IL 60611
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50
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Gabr A, Ranganathan S, Mouli SK, Riaz A, Gates VL, Kulik L, Ganger D, Maddur H, Moore C, Hohlastos E, Katariya N, Caicedo JC, Kalyan A, Lewandowski RJ, Salem R. Streamlining radioembolization in UNOS T1/T2 hepatocellular carcinoma by eliminating lung shunt estimation. J Hepatol 2020; 72:1151-1158. [PMID: 32145255 DOI: 10.1016/j.jhep.2020.02.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 12/09/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIMS Pre-treatment Tc-99m macroaggregated albumin (MAA) scans are routinely performed prior to transarterial radioembolization (TARE) to estimate lung shunt fraction (LSF) and lung dose. In this study, we investigate LSF observed in early hepatocellular carcinoma (HCC) and provide the scientific rationale for eliminating this step from routine practice. METHODS Patients with HCC who underwent Y90 from 2004 to 2018 were reviewed. Inclusion criteria were early stage HCC (UNOS T1/T2/Milan criteria: solitary ≤5 cm, 3 nodules ≤3 cm). LSF was determined using MAA in all patients. Associations between LSF and baseline characteristics were investigated. A "no-MAA" paradigm was then proposed based on a homogenous group that expressed very low LSF. RESULTS Of 1,175 patients with HCC treated with TARE, 448 patients met inclusion criteria. Mean age was 65.6 years and 303 (68%) were males. A total of 352 (79%) had solitary lesions and 406 (91%) unilobar disease. Two-hundred and forty-three (54%), 178 (40%) and 27 (6%) patients were Child-Pugh class A, B and C, respectively. Median LSF was 3.9% (IQR 2.4-6%). Median administered activity was 0.9 GBq (IQR 0.6-1.4), for a median segmental volume of 170 cm3 (range: 60-530). Median lung dose was 1.9 Gy (IQR: 1.0-3.3). The presence of a transjugular intrahepatic portosystemic shunt (TIPS; n = 38) was associated with LSF >10% (odds ratio 12.2; 95% CI 5.2-28.6; p <0.001). Median LSF was 3.8% (IQR: 2.4-5.7%) and 6% (IQR: 3.8-15.3%) in no-TIPS vs. TIPS patients (p <0.001). CONCLUSION LSF is clinically negligible in patients with UNOS T1/T2 HCC without TIPS. When segmental injections are planned, this step can be eliminated, thereby reducing time-to-treatment, number of procedures, and improving convenience for patients traveling from faraway. LAY SUMMARY Transarterial radioembolization is a microembolic transarterial treatment for hepatocellular carcinoma. In our study, we found that early stage patients, where segmental injections are planned, exhibited low lung shunting, effectively eliminating the risk of radiation pneumonitis. We propose that the lung shunt study be eliminated in this subgroup, thus leading to fewer procedures, a cost reduction and improved convenience for patients.
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Affiliation(s)
- Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Srirajkumar Ranganathan
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Samdeep K Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Vanessa L Gates
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Laura Kulik
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Daniel Ganger
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Haripriya Maddur
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Christopher Moore
- Department of Medicine, Division of Hepatology, Northwestern University, Chicago, IL
| | - Elias Hohlastos
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL
| | - Nitin Katariya
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Juan Carlos Caicedo
- Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Aparna Kalyan
- Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL; Department of Surgery, Division of Transplantation, Comprehensive Transplant Center, Northwestern University, Chicago, IL; Department of Medicine, Division of Medical Oncology, Northwestern University, Chicago, IL.
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