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Abstract
OBJECTIVE The goal of this study was to examine a multi-institutional experience with adrenal metastases to describe survival outcomes and identify subpopulations who benefit from adrenal metastasectomy. BACKGROUND Adrenalectomy for metastatic disease is well-described, although indications and outcomes are incompletely defined. METHODS A retrospective cohort study was performed of patients undergoing adrenalectomy for secondary malignancy (2002-2015) at 6 institutions. The primary outcomes were disease free survival (DFS) and overall survival (OS). Analysis methods included Kaplan-Meier and Cox proportional hazards. RESULTS Of 269 patients, mean age was 60.1 years; 50% were male. The most common primary malignancies were lung (n = 125, 47%), renal cell (n = 38, 14%), melanoma (n = 33, 12%), sarcoma (n = 18, 7%), and colorectal (n = 12, 5%). The median time to detection of adrenal metastasis after initial diagnosis of the primary tumor was 17 months (interquartile range: 6-41). Post-adrenalectomy, the median DFS was 18 months (1-year DFS: 54%, 5-year DFS: 31%). On multivariable analysis, lung primary was associated with longer DFS [hazard ratio (HR): 0.49, P = 0.008). Extra-adrenal oligometastatic disease at initial presentation (HR: 1.84, P = 0.016), larger tumor size (HR: 1.07, P = 0.013), chemotherapy as treatment of the primary tumor (HR: 2.07 P = 0.027) and adjuvant chemotherapy (HR: 1.95, P = 0.009) were associated with shorter DFS. Median OS was 53 months (1-year OS: 83%, 5-year OS: 43%). On multivariable analysis, extra-adrenal oligometastatic disease at adrenalectomy (HR: 1.74, P = 0.031), and incomplete resection of adrenal metastasis (R1 margins; HR: 1.62, P = 0.034; R2 margins; HR: 5.45, P = 0.002) were associated with shorter OS. CONCLUSIONS Durable survival is observed in patients undergoing adrenal metastasectomy and should be considered for subjects with isolated adrenal metastases.
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Onishi Y, Arai Y, Sone M, Sugawara S, Itou C, Kimura S. Percutaneous Transhepatic Biopsy for Extrahepatic Lesions. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1731127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Purpose The purpose was to assess the diagnostic accuracy and safety of percutaneous transhepatic biopsy for extrahepatic lesions.
Materials and Methods Between January 2008 and December 2019, 26 patients (17 men and 9 women; median age, 60 years) underwent percutaneous transhepatic needle biopsy for extrahepatic lesions at our institution. Transhepatic biopsy was deemed appropriate compared with other biopsy routes or methods (i.e., endoscopic or surgical). The lesions were in the porta hepatis (n = 9), retroperitoneum (n = 6), right adrenal gland (n = 4), right kidney (n = 3), lesser omentum (n = 2), duodenum (n = 1), pleura (n = 1), and inferior vena cava (n = 1). The median maximal diameter of the lesions was 45.5 mm (range, 18–148 mm). Core-needle biopsy was performed in all patients. Eighteen-gauge and 21-G needles were used in 25 and one patient, respectively. Ultrasound was used for biopsy in 21 patients, and CT fluoroscopy was used in five patients. Postbiopsy tract embolization was performed in three patients. Technical success and diagnostic accuracy of the biopsy were evaluated. Complications were recorded using the systemic inflammation response (SIR) criteria.
Results The pathological results of biopsy were carcinoma (n = 10), lymphoma (n = 9), and other diagnoses (n = 7). Technical success was obtained in all patients. The accurate diagnosis was achieved in 24 of the 26 patients (92.3%). A major complication, a bladder tamponade, was observed in one patient (3.8%) after biopsy of a right kidney lesion. A hematoma caused by iatrogenic renal injury likely obstructed the bladder outlet. Minor complications were observed in three patients (11.5%).
Conclusions Percutaneous transhepatic biopsy for extrahepatic lesions is feasible with acceptable safety.
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Affiliation(s)
- Yasuyuki Onishi
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Yasuaki Arai
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Miyuki Sone
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shunsuke Sugawara
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Chihiro Itou
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Shintaro Kimura
- Department of Diagnostic Radiology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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Daye D, Staziaki PV, Furtado VF, Tabari A, Fintelmann FJ, Frenk NE, Shyn P, Tuncali K, Silverman S, Arellano R, Gee MS, Uppot RN. CT Texture Analysis and Machine Learning Improve Post-ablation Prognostication in Patients with Adrenal Metastases: A Proof of Concept. Cardiovasc Intervent Radiol 2019; 42:1771-1776. [PMID: 31489473 DOI: 10.1007/s00270-019-02336-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/30/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION To assess the performance of pre-ablation computed tomography texture features of adrenal metastases to predict post-treatment local progression and survival in patients who underwent ablation using machine learning as a prediction tool. MATERIALS AND METHODS This is a pilot retrospective study of patients with adrenal metastases undergoing ablation. Clinical variables were collected. Thirty-two texture features were extracted from manually segmented adrenal tumors. A univariate cox proportional hazard model was used for prediction of local progression and survival. A linear support vector machine (SVM) learning technique was applied to the texture features and clinical variables, with leave-one-out cross-validation. Receiver operating characteristic analysis and the area under the curve (AUC) were used to assess performance between using clinical variables only versus clinical variables and texture features. RESULTS Twenty-one patients (61% male, age 64.1 ± 10.3 years) were included. Mean time to local progression was 29.8 months. Five texture features exhibited association with progression (p < 0.05). The SVM model based on clinical variables alone resulted in an AUC of 0.52, whereas the SVM model that included texture features resulted in an AUC 0.93 (p = 0.01). Mean overall survival was 35 months. Fourteen texture features were associated with survival in the univariate model (p < 0.05). While the trained SVM model based on clinical variables resulted in an AUC of 0.68, the SVM model that included texture features resulted in an AUC of 0.93 (p = 0.024). DISCUSSION Pre-ablation texture analysis and machine learning improve local tumor progression and survival prediction in patients with adrenal metastases who undergo ablation.
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Affiliation(s)
- Dania Daye
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA.
| | - Pedro V Staziaki
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | | | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
| | - Florian J Fintelmann
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
| | - Nathan Elie Frenk
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
| | - Paul Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kemal Tuncali
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart Silverman
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
| | - Raul Nirmal Uppot
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRB #290, Boston, MA, 02114, USA
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Liang KW, Jahangiri Y, Tsao TF, Tyan YS, Huang HH. Effectiveness of Thermal Ablation for Aldosterone-Producing Adrenal Adenoma: A Systematic Review and Meta-Analysis of Clinical and Biochemical Parameters. J Vasc Interv Radiol 2019; 30:1335-1342.e1. [PMID: 31375447 DOI: 10.1016/j.jvir.2019.04.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/20/2019] [Accepted: 04/28/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To assess the effectiveness of thermal ablation for aldosterone-producing adrenal adenoma. MATERIALS AND METHODS A systematic search of the PubMed and CINAHL databases was performed to identify studies of thermal ablation for adrenal adenomas. Random effects meta-analysis models were used to compare pre- and post-treatment values of the following outcomes: systolic blood pressure (SBP), diastolic blood pressure (DBP), use of antihypertensive medications, and biochemical parameters (plasma aldosterone levels, aldosterone-to-renin ratio, and potassium levels). The rate of hypertension (HTN) resolution and improvement were also evaluated. RESULTS A total of 89 patients from 7 studies were included in the analysis. The mean postablation follow-up duration was 45.8 months. Pooled data analysis revealed a statistically significant decrease in SBP (-29.06 mm Hg; 95% confidence interval [CI], -33.93 to -24.19), DBP (-16.03 mm Hg; 95% CI, -18.33 to -13.73), and the number of antihypertensive medications used (-1.43; 95% CI, -1.97 to -0.89) after ablation. Biochemical parameters had returned to normal ranges after ablation in all studies. The cumulative rate of resolution or improvement in HTN status was 75.3%. On metaregression analysis, there was no statistically significant association between postablation blood pressure changes or serum aldosterone levels and study follow-up duration. CONCLUSIONS Thermal ablation for aldosterone-producing adrenal adenoma can be effective in controlling blood pressure, reducing the need for antihypertensive medications, and normalizing hormone secretion. Further higher-quality evidence is needed to confirm these results.
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Affiliation(s)
- Keng-Wei Liang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Younes Jahangiri
- Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, Oregon
| | - Teng-Fu Tsao
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C
| | - Hsin-Hui Huang
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taiwan, R.O.C; School of Medical Imaging and Radiological Sciences, Chung Shan Medical University, No.110, Sec.1, Chien-Kuo N. Road, Taichung (402), Taiwan, R.O.C.
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Huang J, Xie X, Lin J, Wang W, Zhang X, Liu M, Li X, Huang G, Liu B, Xie X. Percutaneous radiofrequency ablation of adrenal metastases from hepatocellular carcinoma: a single-center experience. Cancer Imaging 2019; 19:44. [PMID: 31242934 PMCID: PMC6595611 DOI: 10.1186/s40644-019-0231-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prognosis of adrenal metastases (AM) from hepatocellular carcinoma (HCC) with surgical contraindication was poor. This study evaluated the feasibility, safety and treatment efficacy of percutaneous ultrasound (US)-guided radiofrequency ablation (RFA) for the local treatment of AM originated from HCC. METHODS A retrospective study was carried out on 22 patients (21 male and 1 female, mean age, 53.0 ± 13.0 years) who had single AM (mean diameter, 4.0 ± 1.8 cm, range, 1.7-8.0 cm) originated from HCC and received US-guided percutaneous RFA at our institution. The diagnosis was established on typical radiologic findings. The primary technical success was defined as the tumour being completely ablated in the first RFA session. The secondary technical success was defined as tumour residual left from the first ablation was completely ablated by a second ablation session. Local tumour progression (LTP) and overall survival (OS) were estimated by using Kaplan-Meier analysis. RESULTS A total of 25 ablation sessions were performed. The primary technical success and the secondary technical success were 77.3% (17 of 22) and 86.4% (19 of 22), respectively, with the major complication rate at 4.5% (1 of 22). The median follow-up period after RFA was 10 months (3-55 months). During the follow-up period, five patients were detected LTP. The LTP at 3, 6, and 12 months were 15.8, 26.3, and 26.3%, respectively. Nine patients died of distant extra-adrenal metastases and another five of liver failure due to HCC. The OS at 6, 12, 24 months after RFA for AM were at 79.7, 52.6, and 32.9%, respectively. CONCLUSION Percutaneous US-guided RFA in the treatment of AM originated from HCC is feasible, safe and effective.
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Affiliation(s)
- Jingzhi Huang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaohua Xie
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Jinhua Lin
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Wei Wang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaoer Zhang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Ming Liu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Xiaoju Li
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Guangliang Huang
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Baoxian Liu
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
| | - Xiaoyan Xie
- Department of Medical Ultrasound, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan 2nd Road, Guangzhou, 510080, China.
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Yan L, Yang J, Zhou X, He G, Zheng Y, Zhu Y, Liu W, Luo W, Qin H, Liu H, Yi X, Zhou Y. Ultrasound-Guided Intratumoral Radiofrequency Ablation Coagulation to Facilitate Meningioma Resection: Preliminary Experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:577-583. [PMID: 28887861 DOI: 10.1002/jum.14365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study aimed to explore the feasibility and safety of intratumoral radiofrequency ablation (RFA) in meningioma resection. METHODS This study was approved by the Xijing Ethics Committee, and informed consent was obtained from all of the patients. Thirteen patients with meningiomas were recruited in the Neurosurgery Department of Xijing Hospital. These patients were treated with intratumoral RFA and surgery. We also chose 13 patients with meningiomas treated with traditional surgery as the control group. Two-dimensional ultrasound, color Doppler flow imaging, contrast-enhanced ultrasound, and magnetic resonance imaging were used to identify the location, border, and blood supply of the meningiomas preoperatively and to assess the therapeutic effect intraoperatively. Finally, the meningiomas were dissected and removed by surgery. RESULTS All procedures were technically successful without serious complications. Intraoperative ultrasound was able to provide a clear display of the location, shape, size, and boundary of the tumor and its relationship with other tissues and reveal the vascular distribution in and around the tumors. With intratumoral RFA, coagulative necrosis was induced, and the meningiomas became hard in texture with a decreased blood supply. Blood loss was significantly lower in the RFA group versus control group (320.0 ± 24.8 versus 390.4 ± 36.8 mL; P < .001). The RFA group spent fewer days in the hospital (6.0 ± 0.9 versus 7.0 ± 1.2 days; P = .022). However, the surgical time of the RFA group was relatively longer (3.5 ± 0.5 versus 3.0 ± 0.3 hours, P = .007). CONCLUSIONS The application of intratumoral RFA in meningioma resection is effective and safe. It may be a useful adjunct for meningioma treatment.
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Affiliation(s)
- Li Yan
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Ultrasound Diagnostics, Xi'an Central Hospital, the Third Affiliated Hospital of Jiao Tong University, Xi'an, Shaanxi, China
| | - Junle Yang
- Department of CT & MRI, Xi'an Central Hospital, the Third Affiliated Hospital of Jiao Tong University, Xi'an, Shaanxi, China
| | - Xiaodong Zhou
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
- Department of Neurosurgery, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Guangbin He
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yu Zheng
- Department of Ultrasound Diagnostics, Xi'an Central Hospital, the Third Affiliated Hospital of Jiao Tong University, Xi'an, Shaanxi, China
| | - Yali Zhu
- Department of Ultrasound Diagnostics, Xi'an Central Hospital, the Third Affiliated Hospital of Jiao Tong University, Xi'an, Shaanxi, China
| | - Weiping Liu
- Department of Neurosurgery, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wen Luo
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haiying Qin
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haijing Liu
- Department of Ultrasound Diagnostics, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xicai Yi
- Department of Neurosurgery, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yin Zhou
- Department of Ultrasound Diagnostics, Xi'an Central Hospital, the Third Affiliated Hospital of Jiao Tong University, Xi'an, Shaanxi, China
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Frenk NE, Daye D, Tuncali K, Arellano RS, Shyn PB, Silverman SG, Fintelmann FJ, Uppot RN. Local Control and Survival after Image-Guided Percutaneous Ablation of Adrenal Metastases. J Vasc Interv Radiol 2018; 29:276-284. [DOI: 10.1016/j.jvir.2017.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/21/2017] [Accepted: 07/23/2017] [Indexed: 12/11/2022] Open
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Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy. Strahlenther Onkol 2017; 193:612-619. [DOI: 10.1007/s00066-017-1120-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023]
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Akiyama S, Imamura T, Koyama R, Tamura T, Koizumi Y, Takeuchi K. Adrenal Metastasis and Hemorrhage Secondary to Hepatocellular Carcinoma. Intern Med 2015; 54:1513-1517. [PMID: 26073241 DOI: 10.2169/internalmedicine.54.4115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
A 66-year-old man was admitted to undergo treatment for the sudden onset of hypogastric pain radiating to the left flank. Based on the clinical presentation and radiological findings, left adrenal hemorrhage secondary to hepatocellular carcinoma was diagnosed. Although the patient was hemodynamically stable, anemia progressed over the first four days after admission and a blood transfusion was subsequently initiated, which was effective. According to the results of interval imaging with computed tomography, elective transcatheter embolization (TAE) was performed nine days after admission to treat the bleeding from the adrenal tumor. After TAE, the patient's abdominal pain resolved, with no further progression of anemia.
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Hasegawa T, Yamakado K, Nakatsuka A, Uraki J, Yamanaka T, Fujimori M, Miki M, Sasaki T, Sakuma H, Sugimura Y. Unresectable Adrenal Metastases: Clinical Outcomes of Radiofrequency Ablation. Radiology 2015; 277:584-93. [PMID: 25997031 DOI: 10.1148/radiol.2015142029] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To retrospectively evaluate the clinical outcomes of radiofrequency (RF) ablation for the treatment of unresectable adrenal metastasis. MATERIALS AND METHODS The institutional review board approved this retrospective study, and informed consent to perform adrenal RF ablation was obtained from all patients. From February 2005 through May 2014, 35 patients (25 men and 10 women; mean age, 64.7 years ± 9.6; age range, 39-82 years) underwent RF ablation to treat 41 metastatic adrenal tumors from lung cancer (n = 15), renal cell carcinoma (n = 9), colorectal cancer (n = 5), hepatocellular carcinoma (n = 4), and other tumors (n = 2). Tumors ranged in size from 1.2 to 8.2 cm (mean, 3.3 cm ± 1.6). The diagnosis was established mainly on the basis of radiologic findings. Adrenal arterial embolization was combined with RF ablation in 12 of the 35 patients (34%). Technical success, safety, local tumor progression, and survival were evaluated. The Kaplan-Meier method and Cox proportional hazard model were used to evaluate prognostic factors. RESULTS There were 48 completed sessions with planned procedures and treatment protocols with no mortality and a major complication rate of 8.3% (four of 48 sessions). Tumor enhancement disappeared after initial adrenal RF ablation in 33 of the 35 patients (94%). Local tumor progression developed in eight of the 35 patients (23%); two patients received repeated RF ablation, resulting in adrenal tumor control in 27 of the 35 patients (77%) at the last follow-up (mean, 30.1 months ± 27.5; range 1.2-96.8 months). The 1-, 3-, and 5-year overall survival rates were 75% (95% confidence interval [CI], 61%, 90%), 34% (95% CI: 17%, 52%), and 30% (95% CI: 13%, 48%), respectively, with a median survival time of 26.0 months. Existence of extra-adrenal tumors (P = .005) and age of 65 years or older (P = .04) were significant indicators of a poor prognosis. CONCLUSION Adrenal RF ablation is a feasible and useful method for controlling adrenal metastases and offers patients opportunities for improved survival.
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Affiliation(s)
- Takaaki Hasegawa
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Koichiro Yamakado
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Atsuhiro Nakatsuka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Junji Uraki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takashi Yamanaka
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Masashi Fujimori
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Manabu Miki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Takeshi Sasaki
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Hajime Sakuma
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yoshiki Sugimura
- From the Departments of Radiology (T.H., K.Y., A.N., J.U., T.Y., M.F., H.S.) and Urology (M.M., T.S., Y.S.), Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Lee RK, Liu SY, Tong CS, Lee PS, Ng EK, Ahuja AT. Morphologic Change in Computed Tomography of Aldosterone-Producing Adenoma after Radiofrequency Ablation. Can Assoc Radiol J 2014; 65:86-90. [DOI: 10.1016/j.carj.2012.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 10/26/2022] Open
Abstract
Objective To evaluate the morphologic changes of aldosterone-producing adenoma (APA) on computed tomography (CT) before and after radiofrequency ablation (RFA) and to assess the factors that are important in determining successful complete ablation of these tumours. Method Between August 2004 and August 2011, 24 consecutive patients with APA undergoing CT-guided percutaneous RFA were identified from our prospective database. The pre-RFA and post-RFA CT appearances of these APAs that showed positive biochemical response were reviewed retrospectively for their 3-dimensional size, tumour volume, and CT attenuation in terms of Hounsfield units (HU). A comparison of these parameters before and after RFA was performed. Results In this study, there were 23 APAs in these 24 patients that showed biochemical cure of primary aldosteronism after RFA. When comparing post-RFA to pre-RFA CTs, there was no significant change in tumour size (14.5 mm vs 14.6 mm: P = .83) and tumour volume (1.55 cm3 vs 1.59 cm3; P = .41) after RFA. In nonenhanced CT images, there was no significant reduction in HU from pre-RFA to post-RFA measurements (4.4 HU vs 7.9 HU; P = .52). In contrast-enhanced CTs, there was a significant drop in HU after RFA (from 48.3 HU to 14.7 HU; P = .03). None of the included cases showed a focal region of contrast enhancement to suggest residual tumour. Conclusion A change in tumour size, tumour volume, and HU in nonenhanced CT were unreliable in defining radiologic treatment success. Only changes in HU in contrast-enhanced CT was useful in confirming a positive treatment response after RFA for APA.
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Affiliation(s)
- Ryan K.L. Lee
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
| | | | - Cina S.L. Tong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
| | - Paul S.F. Lee
- Department of Radiology, North District Hospital, Hong Kong
| | - Enders K.W. Ng
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Anil T. Ahuja
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Hong Kong/Chinese University of Hong Kong, Hong Kong
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Chen CC, Yeh HZ, Chang CS, Ko CW, Lien HC, Wu CY, Hung SW. Transarterial embolization of metastatic mediastinal hepatocellular carcinoma. World J Gastroenterol 2013; 19:3512-3516. [PMID: 23801848 PMCID: PMC3683694 DOI: 10.3748/wjg.v19.i22.3512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/05/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023] Open
Abstract
This paper introduces an innovative treatment for extra-hepatic metastasis of hepatocellular carcinoma. A 71-year-old patient had a stable liver condition following treatment for hepatocellular carcinoma, but later developed symptomatic mediastinal metastasis. This rapidly growing mediastinal mass induced symptoms including cough and hoarseness. Serial sessions of transarterial embolization (TAE) successfully controlled this mediastinal mass with limited side effects. The patient’s survival time since the initial diagnosis of the mediastinal hepatocellular carcinoma was 32 mo, significantly longer than the 12 mo mean survival period of patients with similar diagnoses: metastatic hepatocellular carcinoma and a liver condition with a Child-Pugh class A score. Currently, oral sorafenib is the treatment of choice for metastatic hepatocellular carcinoma. Recent studies indicate that locoregional treatment of extra-hepatic metastasis of hepatocellular carcinomas might also significantly improve the prognosis in patients with their primary hepatic lesions under control. Many effective locoregional therapies for extrahepatic metastasis, including radiation and surgical resection, may provide palliative effects for hepatocellular carcinoma-associated mediastinal metastasis. This case report demonstrates that TAE of metastatic mediastinal hepatocellular carcinoma provided this patient with tumor control and increased survival time. This finding is important as it can potentially provide an alternative treatment option for patients with similar symptoms and diagnoses.
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Pua BB, Solomon SB. Ablative therapies in adrenal tumors: primary and metastatic. J Surg Oncol 2012; 106:626-31. [PMID: 22806550 DOI: 10.1002/jso.23191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/17/2012] [Indexed: 02/05/2023]
Abstract
A large number of adrenal tumors are now identified either incidentally or associated with a metastatic workup for cancer. While the vast majority of these lesions are benign, those that prove to be primary or secondary cancers are traditionally treated with surgical resection. A wide variety of alternative, less invasive therapies exist. One of these, thermal ablation, is examined herein.
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Affiliation(s)
- Bradley B Pua
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York 10021, USA
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Torok J, Wegner RE, Burton SA, Heron DE. Stereotactic body radiation therapy for adrenal metastases: a retrospective review of a noninvasive therapeutic strategy. Future Oncol 2011; 7:145-51. [PMID: 21174545 DOI: 10.2217/fon.10.165] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The role of radiation therapy in the treatment of adrenal metastases has traditionally been a palliative one, achieving excellent pain control with very limited toxicity. Recent studies have focused on the potential role of stereotactic body radiation therapy (SBRT) with curative intent in limited metastatic disease, its potential to reduce tumor burden and to prevent symptomatic progression. This study reports the single-institution outcomes of SBRT utilizing both single fraction and hypofractionated regimens in the treatment of adrenal metastases. METHODS A total of seven patients with nine adrenal metastases treated with SBRT at the University of Pittsburgh Cancer Institute were retrospectively studied. The primary malignancies consisted of non-small-cell lung cancer (n = 4), small-cell lung cancer (n = 1) and hepatocellular carcinoma (n = 2). RESULTS Five lesions were treated in a single fraction to a median prescription dose of 16 Gy (range: 10-22 Gy) to the 80% isodose line. The remaining four lesions were treated over three fractions to a median prescription dose of 27 Gy (range: 24-36 Gy), with a median prescription isodose line of 94% (range: 80-94%). Median follow-up from the primary diagnosis was 38 months (range: 7-88 months) and from SBRT was 14 months (range: 1-60 months). Follow-up imaging for six patients, and eight metastatic lesions, revealed one complete response, two partial responses and five stable lesions. Five of the lesions eventually failed locally, with a median time to failure of 12 months and actuarial local control of 63% at 1 year. The median overall survival was 8 months from SBRT. CONCLUSION SBRT can be safely delivered in single fraction, or hypofractionated, regimens for the treatment of adrenal metastases.
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Affiliation(s)
- Jordan Torok
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA
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Uchino K, Tateishi R, Shiina S, Kanda M, Masuzaki R, Kondo Y, Goto T, Omata M, Yoshida H, Koike K. Hepatocellular carcinoma with extrahepatic metastasis: clinical features and prognostic factors. Cancer 2011; 117:4475-83. [PMID: 21437884 DOI: 10.1002/cncr.25960] [Citation(s) in RCA: 320] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Revised: 12/27/2010] [Accepted: 01/03/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND Despite significant advances in the treatment of intrahepatic lesions, the prognosis for patients with hepatocellular carcinoma (HCC) who have extrahepatic metastasis remains poor. The objective of this study was to further elucidate the clinical course and prognostic determinants of patients with this disease. METHODS In total, 342 patients who had HCC with extrahepatic metastasis were enrolled. The metastases were diagnosed at initial presentation with HCC in 28 patients and during follow-up in the remaining patients. The authors analyzed clinical features, prognoses, and treatments and established a scoring system to predict prognosis using a split-sample method with a testing set and a training set. RESULTS The most frequent site of extrahepatic metastasis was the lung followed by lymph nodes, bone, and adrenal glands. These metastases were related directly to death in only 23 patients (7.6%). The median survival after diagnosis of extrahepatic metastasis was 8.1 months (range, 0.03-108.7 months). In univariate analysis of the training set (n = 171), performance status, Child-Pugh classification, the number and size of intrahepatic lesions, macroscopic vascular invasion, symptomatic extrahepatic metastases, α-fetoprotein levels, and complete responses to treatment were associated significantly with prognosis. On the basis of multivariate analysis, a scoring system was developed to predict prognosis that assessed uncontrollable intrahepatic lesions, extent of vascular invasion, and performance status. This scoring system was validated in the testing set (n = 171) and produced a concordance index of 0.73. CONCLUSIONS The controllability of intrahepatic lesions and performance status were identified as important prognostic factors in patients with advanced HCC who had extrahepatic metastasis.
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Affiliation(s)
- Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Elhawary H, Oguro S, Tuncali K, Morrison PR, Tatli S, Shyn PB, Silverman SG, Hata N. Multimodality non-rigid image registration for planning, targeting and monitoring during CT-guided percutaneous liver tumor cryoablation. Acad Radiol 2010; 17:1334-44. [PMID: 20817574 DOI: 10.1016/j.acra.2010.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 06/06/2010] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to develop non-rigid image registration between preprocedure contrast-enhanced magnetic resonance (MR) images and intraprocedure unenhanced computed tomographic (CT) images, to enhance tumor visualization and localization during CT imaging-guided liver tumor cryoablation procedures. MATERIALS AND METHODS A non-rigid registration technique was evaluated with different preprocessing steps and algorithm parameters and compared to a standard rigid registration approach. The Dice similarity coefficient, target registration error, 95th-percentile Hausdorff distance, and total registration time (minutes) were compared using a two-sided Student's t test. The entire registration method was then applied during five CT imaging-guided liver cryoablation cases with the intraprocedural CT data transmitted directly from the CT scanner, with both accuracy and registration time evaluated. RESULTS Selected optimal parameters for registration were a section thickness of 5 mm, cropping the field of view to 66% of its original size, manual segmentation of the liver, B-spline control grid of 5 × 5 × 5, and spatial sampling of 50,000 pixels. A mean 95th-percentile Hausdorff distance of 3.3 mm (a 2.5 times improvement compared to rigid registration, P < .05), a mean Dice similarity coefficient of 0.97 (a 13% increase), and a mean target registration error of 4.1 mm (a 2.7 times reduction) were measured. During the cryoablation procedure, registration between the preprocedure MR and the planning intraprocedure CT imaging took a mean time of 10.6 minutes, MR to targeting CT image took 4 minutes, and MR to monitoring CT imaging took 4.3 minutes. Mean registration accuracy was <3.4 mm. CONCLUSIONS Non-rigid registration allowed improved visualization of the tumor during interventional planning, targeting, and evaluation of tumor coverage by the ice ball. Future work is focused on reducing segmentation time to make the method more clinically acceptable.
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Laparoscopic Radiofrequency Thermal Ablation of Adrenal Tumors: Technical Details. Surg Laparosc Endosc Percutan Tech 2010; 20:58-62. [DOI: 10.1097/sle.0b013e3181cd44fc] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Adrenal metastasis from hepatocellular carcinoma: radiofrequency ablation combined with adrenal arterial chemoembolization in six patients. AJR Am J Roentgenol 2009; 192:W300-5. [PMID: 19457793 DOI: 10.2214/ajr.08.1752] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical utility of adrenal radiofrequency ablation combined with adrenal arterial chemoembolization in the treatment of patients with adrenal metastasis of hepatocellular carcinoma. MATERIALS AND METHODS This retrospective study was conducted at two institutions. Adrenal radiofrequency ablation and chemoembolization were performed on the same day. Safety, local tumor progression, and survival were evaluated. RESULTS Six patients with eight adrenal metastatic lesions were treated. The mean maximum diameter of the lesions was 5.2 +/- 1.8 cm (range, 3.5-8.0 cm). During initial combination therapy, an adrenal metastatic lesion was isolated in one patient. The other five patients had four associated intrahepatic lesions and three extraadrenal distant metastatic lesions. On contrast-enhanced CT scans, tumor enhancement of all eight adrenal tumors ceased after combination therapy. No major complications were related to combination therapy. During the mean follow-up period of 37.7 +/- 27.6 months (range, 4.0-70.9 months), two of eight adrenal tumors (25%) had undergone local tumor progression. The median survival time was 24.9 months. Three patients treated for both intrahepatic and extrahepatic lesions survived longer than 4 years. CONCLUSION The combination therapy described is a safe multidisciplinary therapeutic option that can lengthen survival among patients with adrenal metastasis from hepatocellular carcinoma.
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Radiofrequency Ablation of Abdominal Wall Endometrioma. Cardiovasc Intervent Radiol 2009; 32:1300-3. [DOI: 10.1007/s00270-008-9500-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 12/01/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
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