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Palmieri LJ, Belaroussi Y, Huchet N, Fonck M, Bellara C, Brouste V, Milhade N, Bechade D, Lena J, Ayache L, Buy X, Pernot S, Palussière J. Impact on survival without chemotherapy of local treatments of lung metastasis of colorectal cancers: Analysis on REPULCO cohort. Dig Liver Dis 2024; 56:1930-1937. [PMID: 38763795 DOI: 10.1016/j.dld.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The impact of local management of pulmonary metastases on the disease course of patients with metastatic colorectal cancer is poorly assessed. METHODS REPULCO database was a retrospective cohort on 18 years that included all patients treated for lung metastases from colorectal cancer who received local and/or systemic treatments. AIMS Primary objective was overall survival, secondary were progression-free survival and survival without chemotherapy. RESULTS Three hundred and fifteen patients were analyzed, 157 with only systemic treatments, 78 with only local treatments, and 80 with local and systemic treatments. Overall survival at 5 years was 26.9% (IC95%: [17.7-36.9]) for systemic treatments only, 61.0% (IC95%: [40.8-76.1]) for local treatments only, and 77.8% (IC95%: [60.1-88.3]) for local and systemic treatments. Progression-free survival at 2 years was 4.8% (IC95%: [2.1-9.2]) for systemic treatment only, 28.3% (IC95%: [17.7-39.9]) for local treatments only, and 21.8% (IC95%: [13.1-31.9]) for local and systemic treatments. Median survival without chemotherapy was 2.99 months (IC95%: [2.33-3.68]) for systemic treatments, 33.97 months (IC95%: [19.06-NA]) for local treatments, and 12.85 months (IC95%: [8.18-21.06]) for local and systemic treatments. CONCLUSION Local treatments of lung metastasis led to prolonged survival and allowed long periods of time without chemotherapy in this cohort.
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Affiliation(s)
- Lola-Jade Palmieri
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France.
| | - Yaniss Belaroussi
- Department of Thoracic Surgery, CHU Haut Leveque, 1 avenue Magellan, 33600, Pessac, France; Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Noémie Huchet
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Marianne Fonck
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Carine Bellara
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Veronique Brouste
- Department of Clinical and Epidemiological Research, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Nicolas Milhade
- Department of Radiotherapy, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Dominique Bechade
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Jeanne Lena
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Leila Ayache
- Department of Interventional Radiology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Simon Pernot
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
| | - Jean Palussière
- Department of Interventional Radiology, Institut Bergonié, 229 Cours de L'Argonne, 33000, Bordeaux, France
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Chan PS, Chang LK, Malwade S, Chung WY, Yang SM. Cone Beam CT Derived Laser-Guided Percutaneous Lung Ablation: Minimizing Needle-Related Complications Under General Anesthesia with Lung Separation. Acad Radiol 2024; 31:4676-4686. [PMID: 38862349 DOI: 10.1016/j.acra.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/17/2024] [Accepted: 04/29/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES Percutaneous lung tumor ablations are mostly performed in computed tomography (CT) rooms under local anesthesia with conscious sedation. However, maintaining the breath-hold phase during this can be challenging, affecting image quality and increasing complications. With the advent of hybrid operating rooms (HORs), this procedure can be performed with endotracheal tube (ETGA) intubation under general anesthesia with lung separation, ensuring precise imaging in a single-stage setting. Lung separation provides surgical exposure of one lung while ensuring ample gas exchange with the other. This study evaluated tumor ablations performed in an HOR equipped with cone beam CT and laser guidance. MATERIALS AND METHODS This retrospective study included patients who underwent lung tumor ablation under general anesthesia with an ETGA in an HOR between July 2020 and May 2023. Anesthesia considerations, perioperative management, and postoperative follow-ups were evaluated. RESULTS 65 patients (78 tumors) underwent ablation using two types of lung ventilation methods including a single-lumen tube with a blocker (SLT/BL) (n = 15) and double-lumen tube (DLT) (n = 50). Most patients experienced desaturation during the apnea phase of dynamic CT and needling. The average SpO2 value was significantly lower in the DLT group than in the SLT/BL group during the procedure (81.1% versus 88.7%, P = 0.033). Five, three, and two patients developed pneumothorax, subcutaneous emphysema, and pleural effusion, respectively. CONCLUSION Percutaneous ablation under general anesthesia with endotracheal intubation and lung separation performed in HORs was feasible and safe. The setup minimized complication risks and maintained a balance between patient safety and successful procedures.
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Affiliation(s)
- Pak-Si Chan
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Ling-Kai Chang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | | | - Wen-Yuan Chung
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan
| | - Shun-Mao Yang
- Interventional Pulmonology Center, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan; Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
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Miller SR, Chang DT. Local-Regional Therapy for Oligometastatic Colorectal Cancer. Cancer J 2024; 30:272-279. [PMID: 39042779 DOI: 10.1097/ppo.0000000000000729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
ABSTRACT Colorectal cancer is one of the most common malignancies in the United States as well as a leading cause of cancer-related death. Upward of 30% of patients ultimately develop metastatic disease, most commonly to the liver and lung. Untreated, patients have poor survival. Historically, patients with oligometastatic disease were treated with resection leading to long-term survival; however, there are many patients who are not surgical candidates. Innovations in thermal ablation, hepatic artery infusions, chemoembolization and radioembolization, and stereotactic ablative radiation have led to an expansion of patients eligible for local therapy. This review examines the evidence behind each modality for the most common locations of oligometastatic colorectal cancer.
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Affiliation(s)
- Sean R Miller
- From the Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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Lau KK, Lau RW, Baranowski R, Krzykowski J, Ng CS. Transbronchial Microwave Ablation of Peripheral Lung Tumors: The NAVABLATE Study. J Bronchology Interv Pulmonol 2024; 31:165-174. [PMID: 37747275 PMCID: PMC10984635 DOI: 10.1097/lbr.0000000000000950] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Image-guided thermal ablation is a minimally invasive local therapy for lung malignancies. NAVABLATE characterized the safety and performance of transbronchial microwave ablation (MWA) in the lung. METHODS The prospective, single-arm, 2-center NAVABLATE study (NCT03569111) evaluated transbronchial MWA in patients with histologically confirmed lung malignancies ≤30 mm in maximum diameter who were not candidates for, or who declined, both surgery and stereotactic body radiation therapy. Ablation of 1 nodule was allowed per subject. The nodule was reached with electromagnetic navigation bronchoscopy. Cone-beam computed tomography was used to verify the ablation catheter position and to evaluate the ablation zone postprocedure. The primary end point was composite adverse events related to the transbronchial MWA device through 1-month follow-up. Secondary end points included technical success (nodule reached and ablated according to the study protocol) and technique efficacy (satisfactory ablation based on 1-month follow-up imaging). RESULTS Thirty subjects (30 nodules; 66.7% primary lung, 33.3% oligometastatic) were enrolled from February 2019 to September 2020. The pre-procedure median nodule size was 12.5 mm (range 5 to 27 mm). Procedure-day technical success was 100% (30/30), with a mean ablative margin of 9.9±2.7 mm. One-month imaging showed 100% (30/30) technique efficacy. The composite adverse event rate related to the transbronchial MWA device through 1-month follow-up was 3.3% (1 subject, mild hemoptysis). No deaths or pneumothoraces occurred. Four subjects (13.3%) experienced grade 3 complications; none had grade 4 or 5. CONCLUSION Transbronchial microwave ablation is an alternative treatment modality for malignant lung nodules ≤30 mm. There were no deaths or pneumothorax. In all, 13.3% of patients developed grade 3 or above complications.
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Affiliation(s)
- Kelvin K.W. Lau
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | - Rainbow W.H. Lau
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ralitsa Baranowski
- Department of Thoracic Surgery, Barts Thorax Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
| | | | - Calvin S.H. Ng
- Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
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Marcinak CT, Schwartz PB, Basree MM, Hurst N, Bassetti M, Kratz JD, Uboha NV. Treatment of Oligometastatic GI Cancers. Am Soc Clin Oncol Educ Book 2024; 44:e430152. [PMID: 38190577 DOI: 10.1200/edbk_430152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Oligometastatic state is believed to potentially represent a transitional stage between early, locoregional state disease and widely metastatic disease. Historically, locoregional approaches, particularly in advanced colorectal cancers, have demonstrated efficacy in select patients with limited burden of metastatic disease. Recent strides in systemic therapies, including biomarker-based treatments and immunotherapy, alongside innovations in surgical techniques and novel locoregional approaches such as stereotactic radiotherapy and ablation, have ushered in a new era of therapeutic possibilities across all oligometastatic GI cancers. Despite these advancements, there remains a significant gap in high-quality prospective evidence guiding patient selection and treatment decisions across various disease types. Ongoing clinical trials are anticipated to provide crucial insights into oligometastatic states, fostering the refinement of disease-specific oligometastatic state definitions and treatment algorithms. This article reviews existing data on the management of oligometastatic GI cancer, summarizes current state of knowledge for each disease state, and provides updates on ongoing studies in this space.
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Affiliation(s)
- Clayton T Marcinak
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Patrick B Schwartz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health University of Wisconsin-Madison, Madison, WI
| | - Mustafa M Basree
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Newton Hurst
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Jeremy D Kratz
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
- Center for Human Genomics and Precision Medicine, University of Wisconsin, Madison, WI
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Nataliya V Uboha
- University of Wisconsin-Madison, Madison, WI
- University of Wisconsin Carbone Cancer Center, University of Wisconsin, Madison, WI
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de Baere T, Bonnet B, Tselikas L, Deschamps F. The percutaneous management of pulmonary metastases. J Med Imaging Radiat Oncol 2023; 67:870-875. [PMID: 37742316 DOI: 10.1111/1754-9485.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/03/2023] [Indexed: 09/26/2023]
Abstract
Local treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non-resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image-guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five-years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one-year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.
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Affiliation(s)
- Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Baptiste Bonnet
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
- University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France
- Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - Frederic Deschamps
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France
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Ergun O, Birgi E, Hekimoğlu A, Eraslan Ö, Durmaz HA, Karaçin C, İmamoğlu Gİ, Eren T, Yazılıtaş D, Hekimoğlu B. Percutaneous ablation treatment in metastatic lung tumors: a single-center experience. Acta Radiol 2023; 64:2416-2423. [PMID: 37246396 DOI: 10.1177/02841851231175657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND In recent years, many studies have proven that percutaneous thermal ablation is an effective second-line treatment method with low complication rates in early-stage non-small cell lung carcinoma and lung metastases. Radiofrequency ablation and microwave ablation are commonly used for this purpose. PURPOSE To evaluate the factors affecting the success of the percutaneous thermal ablation treatment with technical success, complication rates, and long-term follow-up results in metastatic lung lesions. MATERIAL AND METHODS Computed tomography (CT)-guided percutaneous ablation was performed for 70 metastatic lung lesions in 35 patients (22 men, 13 women; mean age = 61.34 years; age range = 41-75 years). Radiofrequency ablation was performed in 53/70 (75.7%) lesions and microwave ablation in 17/70 (24.3%) lesions. RESULTS The technical success rate was 98.6%. Median overall survival, progression-free survival, and local recurrence-free survival of the patients were 33.9 months (range=25.6-42.1 months), 12 months (range=4.9-19.2 months), and 24.2 months (range=8.2-40.1 months), respectively. One- and two-year overall survival rates were 84% and 74%, respectively. Median progression-free survival times were 20.3 months and 11.4 months, respectively, according to the number of metastatic lung lesions being single and multiple, and the difference was statistically significant (P = 0.046). According to the number of lesions ≤3 and >3, the difference was also found statistically significant (P = 0.024) (14.3 months and 5.7 months, respectively). CONCLUSION In conclusion, CT-guided percutaneous thermal ablation is a safe and effective treatment method in metastatic lung lesions. The number of lesions is the most important factor in predicting treatment success.
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Affiliation(s)
- Onur Ergun
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Erdem Birgi
- Department of Radiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Azad Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Önder Eraslan
- Department of Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Hasan Ali Durmaz
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Cengiz Karaçin
- Department of Medical Oncology, Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gökşen İnanç İmamoğlu
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tülay Eren
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Doğan Yazılıtaş
- Department of Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Baki Hekimoğlu
- Department of Radiology, Diskapi Yildirim Beyazit Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Yoshino T, Cervantes A, Bando H, Martinelli E, Oki E, Xu RH, Mulansari NA, Govind Babu K, Lee MA, Tan CK, Cornelio G, Chong DQ, Chen LT, Tanasanvimon S, Prasongsook N, Yeh KH, Chua C, Sacdalan MD, Sow Jenson WJ, Kim ST, Chacko RT, Syaiful RA, Zhang SZ, Curigliano G, Mishima S, Nakamura Y, Ebi H, Sunakawa Y, Takahashi M, Baba E, Peters S, Ishioka C, Pentheroudakis G. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer. ESMO Open 2023; 8:101558. [PMID: 37236086 PMCID: PMC10220270 DOI: 10.1016/j.esmoop.2023.101558] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/28/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with metastatic colorectal cancer (mCRC), published in late 2022, were adapted in December 2022, according to previously established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with mCRC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with mCRC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and the Japanese Society of Medical Oncology (JSMO). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different Asian countries. The latter are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with mCRC across the different countries of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices, molecular profiling and age and stage at presentation, coupled with a disparity in the drug approvals and reimbursement strategies, between the different countries.
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Affiliation(s)
- T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - H Bando
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E Martinelli
- Oncology Unit, Department of Precision Medicine, Università degli Studi della Campania 'L. Vanvitelli', Naples, Italy
| | - E Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - R-H Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center and State Key Laboratory of Oncology in South China, Guangzhou, China
| | - N A Mulansari
- Hematology-Medical Oncology Division, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital/Universitas Indonesia, Jakarta, Indonesia
| | - K Govind Babu
- Department of Medical Oncology, HCG Hospital and St. John's Medical College, Bengaluru, India
| | - M A Lee
- Division of Medical Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - C K Tan
- Department of Oncology and Nuclear Medicine, Thomson Hospital Kota Damansara, Selangor, Malaysia
| | - G Cornelio
- Department of Medical Oncology, University of the Philipppines-Philippine General Hospital, St. Lukes Cancer Institute-Global City, The Philippines
| | - D Q Chong
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - L-T Chen
- Department of Internal Medicine, Kaohsiung Medical University Hospital and Centre for Cancer Research, Kaohsiung Medical University, Kaohsiung; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
| | - S Tanasanvimon
- Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok
| | - N Prasongsook
- Division of Medical Oncology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - K-H Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - C Chua
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - M D Sacdalan
- Department of Surgery, University of the Philippines-College of Medicine and University of the Philippines-Philippine General Hospital, Manila, The Philippines
| | - W J Sow Jenson
- Department of Radiotherapy & Oncology, Aurelius Hospital, Nilai, Malaysia
| | - S T Kim
- Division of Hematology-Oncology, Department of Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Centre, Seoul, South Korea
| | - R T Chacko
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - R A Syaiful
- Department of Surgery, Dr Cipto Mangunkusumo National General Hospital, University of Indonesia, Jakarta, Indonesia
| | - S Z Zhang
- Department of Colorectal Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Haematology, University of Milano, Milan, Italy
| | - S Mishima
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Y Nakamura
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - H Ebi
- Division of Molecular Therapeutics, Aichi Cancer Center Research Institute, Nagoya
| | - Y Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki
| | - M Takahashi
- Department of Clinical Oncology, Tohoku University Graduate School of Medicine, Sendai
| | - E Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - C Ishioka
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
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Cervantes A, Adam R, Roselló S, Arnold D, Normanno N, Taïeb J, Seligmann J, De Baere T, Osterlund P, Yoshino T, Martinelli E. Metastatic colorectal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2023; 34:10-32. [PMID: 36307056 DOI: 10.1016/j.annonc.2022.10.003] [Citation(s) in RCA: 738] [Impact Index Per Article: 369.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - R Adam
- AP-HP Hôpital Paul Brousse, Université Paris-Saclay, ER "Chronothérapie, Cancers, Transplantation", Villejuif, France
| | - S Roselló
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - D Arnold
- Department of Oncology and Hematology, Asklepios Tumourzentrum Hamburg, AK Altona, Hamburg, Germany
| | - N Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumouri, 'Fondazione G. Pascale'-IRCCS, Naples, Italy
| | - J Taïeb
- Department of Gastroenterology and GI Oncology, Georges Pompidou European Hospital, Assitance Publique-Hôpitaux de Paris AP-HP Paris Centre, Paris, France; Paris Cancer Institute SIRIC CARPEM, Centre de Recherche des Cordeliers, Université Paris-Cité, Paris, France
| | - J Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - T De Baere
- Department of Interventional Radiology, Gustave Roussy, Villejuif, France; University of Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin-Bicêtre, France; Centre d'Investigation Clinique BIOTHERIS, INSERM CIC1428, Villejuif, France
| | - P Osterlund
- Tampere University Hospitals and University, Tampere, Finland; Tema Cancer/GI-oncology, Karolinska Comprehensive Cancer Centre, Karolinska Institute, Solna, Sweden
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - E Martinelli
- Department of Precision Medicine, Oncology Unit, Università della Campania "L. Vanvitelli", Naples, Italy
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10
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Zhong J, Gilbert A. Report forms. TRANSLATIONAL INTERVENTIONAL RADIOLOGY 2023:373-377. [DOI: 10.1016/b978-0-12-823026-8.00087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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11
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Kinota N, Takaki H, Kobayashi K, Kako Y, Kodama H, Ogasawara A, Maruyama M, Takahagi M, Taniguchi J, Moriyama T, Yokoyama H, Komoto H, Kunimoto R, Yoshimura N, Yamakado K. Clinical Experience of Percutaneous Radiofrequency Ablation Using an arfa RF ABLATION SYSTEM Ⓡ in Various Organs. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2022; 7:93-99. [PMID: 36483664 PMCID: PMC9719816 DOI: 10.22575/interventionalradiology.2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/28/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To evaluate the feasibility, safety, and efficacy of radiofrequency (RF) ablation using an ablation system (arfa RF ABLATION SYSTEMⓇ; Japan Lifeline Co. Ltd.) for treating solid tumors in various organs. MATERIAL AND METHODS Between October 2019 and August 2021, 80 patients (29 women, 51 men; median age, 70.0 yr) underwent 107 RF ablation sessions using the ablation system to treat 151 tumors in the liver (n = 86), lung (n = 51), adrenal gland (n = 4), pleura (n = 4), bone (n = 3), lymph node (n = 2), and kidney (n = 1). The maximum tumor diameter was 2-40 mm (median, 11 mm). This study evaluated technical success (defined as the completion of planned RF ablation), technique efficacy (defined as the complete tumor ablation on follow-up images), and adverse events. Local tumor progression in 146 curatively treated malignant tumors was evaluated. RESULTS The technical success rate was 100% (107/107). Ablation zones in two tumors were insufficient. Therefore, the primary technique efficacy rate was 98.1% (105/107). Grade 3 hepatic infarction (1.6%, 1/64) and grade 4 pleuritis (3.4%, 1/29) occurred respectively after liver and lung RF ablation. During the median follow-up period of 10.2 months (Interquartile range, 4.2 and 16.4 months), local tumor progression developed in two tumors (1.4%, 2/146). CONCLUSIONS The arfa RF ABLATION SYSTEMⓇ is a feasible, safe, and effective RF ablation device for managing solid tumors in various organs.
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Affiliation(s)
- Naoya Kinota
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Japan
| | | | | | - Yasukazu Kako
- Department of Radiology, Hyogo College of Medicine, Japan
| | - Hiroshi Kodama
- Department of Radiology, Hyogo College of Medicine, Japan
| | | | | | | | | | - Taiki Moriyama
- Department of Radiology, Hyogo College of Medicine, Japan
| | | | - Hisashi Komoto
- Department of Radiology, Hyogo College of Medicine, Japan
| | - Ryo Kunimoto
- Department of Radiology, Hyogo College of Medicine, Japan
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12
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Matsui Y, Tomita K, Uka M, Umakoshi N, Kawabata T, Munetomo K, Nagata S, Iguchi T, Hiraki T. Up-to-date evidence on image-guided thermal ablation for metastatic lung tumors: a review. Jpn J Radiol 2022; 40:1024-1034. [PMID: 35778630 PMCID: PMC9529706 DOI: 10.1007/s11604-022-01302-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/02/2022] [Indexed: 11/30/2022]
Abstract
The aim of this review was to summarize the latest evidence on image-guided thermal ablation therapies for lung metastases. PubMed was used to search for relevant articles that reported the oncological outcomes of thermal ablation for metastatic lung tumors, and those published in 2010 or later were selected for review. Ablative therapies were applied for lung metastases from various types of primary tumors, but most commonly colorectal ones. Radiofrequency ablation (RFA) was the most evaluated technique, followed by microwave ablation (MWA). The local control rates of ablative therapies were generally favorable, approximately 80–90% in many studies. Representative studies demonstrated promising overall survival rates of approximately 50% or higher 5 years after ablation for lung metastases from colorectal cancer or mixed types of primary tumors. Nevertheless, the survival outcomes varied depending on the type of primary tumor and background factors of patients such as other metastases and comorbidities. Several studies had aimed to compare the outcomes of various ablative therapies such as RFA, MWA, and cryoablation; however, conclusive data are not yet available to determine the most appropriate ablation modality for lung metastases. Further data accumulation is needed, especially for long-term outcomes and comparisons with other therapies.
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Affiliation(s)
- Yusuke Matsui
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Koji Tomita
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Mayu Uka
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Noriyuki Umakoshi
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Takahiro Kawabata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Kazuaki Munetomo
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Shoma Nagata
- Department of Radiology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Iguchi
- Department of Radiological Technology, Faculty of Health Sciences, Okayama University, Okayama, Japan
| | - Takao Hiraki
- Department of Radiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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13
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Hung CM, Tai CC. Liver tumor ablation enhancement by induction-heating system with bitter-like deep magnetic field coil. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2022; 93:054107. [PMID: 35649808 DOI: 10.1063/5.0066308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 04/23/2022] [Indexed: 06/15/2023]
Abstract
The heated metal needle used for tumor thermotherapy is considered crucial for enhancing the practicality of cauterization using electromagnetic induction-heating techniques. In this study, a novel coil capable of producing a deep magnetic field is designed. In the proposed design, the coil structure is improved to enhance the intensity of the coil's deep magnetic field and its suitability for deep-tissue cauterization. Furthermore, a series of experiments are conducted using a single and consistent input current. The heating experiments are conducted at varying depths by placing the needle beneath the coil. The proposed coil significantly increases the induction-heating temperature and provides a solution to the long-standing problem of insufficient needle temperature. This research has also improved the usability of the induction-heating equipment in the field of deep tumor ablation.
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Affiliation(s)
- Chia-Ming Hung
- Department of Electrical Engineering, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Cheng-Chi Tai
- Department of Electrical Engineering, National Cheng Kung University, Tainan City 70101, Taiwan
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14
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De Baere T, Tselikas L, Delpla A, Roux C, Varin E, Kobe A, Yevich S, Deschamps F. Thermal ablation in the management of oligometastatic colorectal cancer. Int J Hyperthermia 2022; 39:627-632. [PMID: 35477367 DOI: 10.1080/02656736.2021.1941311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To review available evidence on thermal ablation of oligometastatic colorectal cancer. METHODS Technical and cancer specific considerations for percutaneous image-guided thermal ablation of oligometastatic colorectal metastases in the liver and lung were reviewed. Ablation outcomes are compared to surgical and radiation therapy literature. RESULTS The application of thermal ablation varies widely based on tumor burden, technical expertise, and local cancer triage algorithms. Ablation can be performed in combination or in lieu of other cancer treatments. For surgically non-resectable liver metastases, a randomized trial has demonstrated the superiority of thermal ablation combined with chemotherapy compared to systemic chemotherapy alone in term of progression-free survival and overall survival (OS), with 5-, and 8-year OS of 43.1% and 35.9% in the combined arm vs. 30.3% and 8.9% in the chemotherapy alone arm. As ablation techniques and technology improve, the role of percutaneous thermal ablation may expand even into surgically resectable disease. Many of the prognostic factors for better OS after local treatment of lung metastases are the same for surgery and thermal ablation, including size and number of metastases, disease-free interval, complete resection/ablation, negative carcinoembryonic antigen, neoadjuvant chemotherapy, and controlled extra-pulmonary metastases. When matched for these factors, thermal ablation for lung and liver metastases appears to provide equivalent overall survival as surgery, in the range of 50% at 5 years. Thermal ablation has limitations that should be respected to optimize patient outcomes and minimize complications including targets that are well-visualized by image guidance, measure <3cm in diameter, and be located at least 3mm distance from prominent vasculature or major bronchi. CONCLUSIONS The routine incorporation of image-guided thermal ablation into the therapeutic armamentarium for the treatment of oligometastatic colorectal cancer can provide long survival and even cure.
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Affiliation(s)
- Thierry De Baere
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Lambros Tselikas
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Alexandre Delpla
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Charles Roux
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Eloi Varin
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Adrian Kobe
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - Steven Yevich
- Interventional Radiology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Frederic Deschamps
- Departement d'anesthésie, de chirurgie, et de radiologie interventionnelle, Gustave Roussy, Villejuif, France.,Université Paris-Saclay, UFR Médecine Le Kremlin-Bicêtre, Le Kremlin Bicêtre, France
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15
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Mimmo A, Pegoraro F, Rhaiem R, Montalti R, Donadieu A, Tashkandi A, Al-Sadairi AR, Kianmanesh R, Piardi T. Microwave Ablation for Colorectal Liver Metastases: A Systematic Review and Pooled Oncological Analyses. Cancers (Basel) 2022; 14:cancers14051305. [PMID: 35267612 PMCID: PMC8909068 DOI: 10.3390/cancers14051305] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Liver resection for colorectal liver metastases (CRLM) represents the best curative option; however, few patients are candidates for surgery. Microwave ablation (MWA) can be a valid alternative in selected patients. This systematic review reports the oncological results of MWA for CRLM. The literature available on the Web was analyzed for reports concerning MWA for resectable CRLM, published before January 2021. Finally, 12 papers concerning MWA complications, recurrence-free (RF) cases, patients free from local recurrence (FFLR), and overall survival rates (OS) were selected. Global RF rates at 1, 3, and 5 years were 65.1%, 44.6%, and 34.3%, respectively. Global FFLR at 3, 6, and 12 months were 96.3%, 89.6%, and 83.7%, respectively. Global OS rates at 1, 3, and 5 years were 86.7%, 59.6%, and 44.8%, respectively. A better FFLR was achieved with an MWA surgical approach at 3, 6, and 12 months, with 97.1%, 92.7%, and 88.6%, respectively. Surgical MWA for CRLM smaller than 3 cm was a safe and valid option. MWA can be entered as part of the flowchart decision of CRLM curative treatment, especially for use in the parenchyma-sparing strategy and as a complement to surgery. Abstract (1) Background: colorectal liver metastases (CRLM) are the most common extra-lymphatic metastases in colorectal cancer; however, few patients are fit for curative surgery. Microwave ablation (MWA) showed promising outcomes in this cohort of patients. This systematic review and pooled analysis aimed to analyze the oncological results of MWA for CRLM. (2) Methods: Following PRISMA guidelines, PubMed, Scopus, EMBASE, Google Scholar, Science Direct, and the Wiley Online Library databases were searched for reports published before January 2021. We included papers assessing MWA, treating resectable CRLM with curative intention. We evaluated the reported MWA-related complications and oncological outcomes as being recurrence-free (RF), free from local recurrence (FFLR), and overall survival rates (OS). (3) Results: Twelve out of 4822 papers (395 patients) were finally included. Global RF rates at 1, 3, and 5 years were 65.1%, 44.6%, and 34.3%, respectively. Global FFLR rates at 3, 6, and 12 months were 96.3%, 89.6%, and 83.7%, respectively. Global OS at 1, 3, and 5 years were 86.7%, 59.6%, and 44.8%, respectively. A better FFLR was reached using the MWA surgical approach at 3, 6, and 12 months, with reported rates of 97.1%, 92.7%, and 88.6%, respectively. (4) Conclusions: Surgical MWA treatment for CRLM smaller than 3 cm is a safe and valid option. This approach can be safely included for selected patients in the curative intent approaches to treating CRLM.
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Affiliation(s)
- Antonio Mimmo
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
- Correspondence:
| | - Francesca Pegoraro
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy;
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
| | - Roberto Montalti
- Division of Hepato-Bilio-Pancreatic, Minimally Invasive and Robotic Surgery, Department of Clinical Medicine and Surgery, Federico II University Hospital, Via S. Pansini 5, 80131 Naples, Italy;
| | - Alix Donadieu
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
| | - Ahmad Tashkandi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
| | - Abdul Rahman Al-Sadairi
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
| | - Reza Kianmanesh
- Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France; (F.P.); (R.R.); (A.D.); (A.T.); (A.R.A.-S.); (R.K.)
| | - Tullio Piardi
- Research Unit Ea3797 VieFra, Department of Hepatobiliary, Pancreatic and Digestive Oncological Surgery, Reims Medical Faculty, Robert Debré University Hospital, University of Reims Champagne-Ardenne, Rue du Général Koenig, 51100 Reims, France;
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16
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Yuan Z, Liu B, Hu C, Li Z, Zheng J, Li W. Clinical outcomes of percutaneous thermal ablation for pulmonary metastases from hepatocellular carcinoma: a retrospective study. Int J Hyperthermia 2021; 37:651-659. [PMID: 32546040 DOI: 10.1080/02656736.2020.1775899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: To determine the effectiveness of ablation for pulmonary metastases (PM) from hepatocellular carcinoma (HCC).Methods: Between 2010 and 2017, the study analyzed 39 patients who had a median age of 59 years. Primary HCC was under control and the number of PM was less than 5 (median: 2), with a maximum diameter of ≤60 mm (median: 15 mm). The primary endpoints were overall survival (OS) and local tumor progression-free survival (LTPFS). Secondary endpoints included technique success (TS), complication and tumor response. TS referred to PM treated using the treatment protocol. Multivariate analysis using the Cox proportional hazard model was conducted on the potential risk factors (univariate: p < 0.5) to determine the independent factors (multivariate: p < 0.05).Results: The TS rate was 100%. Major complications included pneumothorax (n = 3) requiring chest tube placement and pleural effusion requiring drainage (n = 2). Complete ablation was achieved in 32/38 patients (valid percent: 84.2%) at 1 month after ablation. The 1-, 3- and 5-year OS rates were 79.8, 58 and 30.9%, respectively. The 1-, 3- and 5-year LTPFS rates were 60.7, 34.2 and 22.8%, respectively. The extent (unilateral vs. bilateral) of PM (hazard ratio (HR): 0.197, 95% confidence interval (CI): 0.043-0.890, p = 0.035) and the number (≤2 vs. >2) of PM (HR: 0.555, 95% CI: 0.311-0.991, p = 0.047) were found to be the independent risk factors for predicting OS.Conclusion: Percutaneous thermal ablation is a safe and effective treatment for PM from HCC.
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Affiliation(s)
- Zhuhui Yuan
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Bozhi Liu
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Caixia Hu
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Zhen Li
- Department of Critical Care Medicine of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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17
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Role of Thermal Ablation in Colorectal Cancer Lung Metastases. Cancers (Basel) 2021; 13:cancers13040908. [PMID: 33671510 PMCID: PMC7927065 DOI: 10.3390/cancers13040908] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary For a long time, surgery has been the only local treatment for pulmonary metastases. Percutaneous thermal ablation appeared in the early 2000s as a minimally invasive alternative technique to surgery for patients who were not eligible for surgery or wanted to preserve quality of life. In this review, we discuss the role of thermal ablation in the management of lung metastases of colorectal cancer, and present the main results of the literature concerning oncological outcomes (local tumor control, survival) based on 12 relevant original studies each involving a minimum of 50 patients, with a minimal follow-up of 12 months. Abstract Background: Consensus guidelines of the European Society for Medical Oncology (ESMO) (2016) provided recommendations for the management of lung metastases. Thermal ablation appears as a tool in the management of these secondary pulmonary lesions, in the same manner as surgical resection or stereotactic ablative radiotherapy (SABR). Methods: Indications, technical considerations, oncological outcomes such as survival (OS) or local control (LC), prognostic factors and complications of thermal ablation in colorectal cancer lung metastases were reviewed and put into perspective with results of surgery and SABR. Results: LC rates varied from 62 to 91%, with size of the metastasis (<2 cm), proximity to the bronchi or vessels, and size of ablation margins (>5 mm) as predictive factors of LC. Median OS varied between 33 and 68 months. Pulmonary free disease interval <12 months, positive carcinoembryonic antigen, absence of neoadjuvant chemotherapy and uncontrolled extra-pulmonary metastases were poor prognostic factors for OS. While chest drainage for less than 48 h was required in 13 to 47% of treatments, major complications were rare. Conclusions: Thermal ablation of a selected subpopulation of patients with colorectal cancer lung metastases is safe and can provide excellent LC and delay systemic chemotherapy.
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18
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Najafi A, de Baere T, Purenne E, Bayar A, Al Ahmar M, Delpla A, Roux C, Madani K, Assouline J, Deschamps F, Tselikas L. Risk factors for local tumor progression after RFA of pulmonary metastases: a matched case-control study. Eur Radiol 2021; 31:5361-5369. [PMID: 33474569 DOI: 10.1007/s00330-020-07675-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/22/2020] [Accepted: 12/28/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Curative treatment of oligometastatic pulmonary disease aims at eradication of all metastases. Radiofrequency ablation (RFA) has been shown to be an efficient method and the frequency of local tumor progression (LTP) should be minimized. The objective of this study was to determine the morphological and treatment-related risk factors for LTP after RFA of pulmonary metastases. MATERIALS AND METHODS All patients treated with RFA for pulmonary metastases from 2002 to 2014 were reviewed. All LTPs from 2011 to 2014 were individually matched on the basis of tumor size, number, and histology. In total, 48 LTPs and 112 controls were blindly analyzed for morphological factors including vicinity of bronchus and vessels as well as treatment-related factors such as the size of the ablation zone and ablation margins. RESULTS In the simple regression analysis, the significant predictive variables were ≤ 5-mm distance to a large bronchus (OR = 4.94; p = 0.0095) or large vessel (OR = 7.09; p < 0.001), minimal ablation margin (≤ 5 mm (OR = 42.67; p < 0.001), and a central-peripheral ablation offset/ablation zone size > 0.36 (OR = 13.83; p = 0.013). In the multiple regression model, only a minimal ablation margin ≤ 5 mm remained a significant risk factor for LTP. CONCLUSION Only the minimal ablation margin remains significant in the multiple regression analysis; the other factors are presumably surrogates of an insufficient ablation margin. Improvement of lung RFA outcomes can probably be obtained by immediate post RFA evaluation of ablation margins to ensure a minimal ablation margin of at least 5 mm. KEY POINTS • A distance < 5 mm to a bronchus or vessel of over 3 mm diameter is associated with insufficient ablation margin and thus risk factors for local tumor progression after pulmonary radiofrequency ablation. • A minimal ablation margin of > 5 mm after pulmonary RFA is associated with significantly less local tumor progression and should be looked for at the end of treatment session before needle removal in order to decrease local tumor progression. • Tumor location, pleural contact, occurrence of intra-alveolar hemorrhage, pulmonary atelectasis, and pneumothorax are not associated with an increased risk of local tumor progression.
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Affiliation(s)
- Arash Najafi
- Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur, Switzerland. .,Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Thierry de Baere
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Edouard Purenne
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Amine Bayar
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Marc Al Ahmar
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexandre Delpla
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Charles Roux
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Khaled Madani
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Jessica Assouline
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Frederic Deschamps
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Lambros Tselikas
- Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
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19
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Tselikas L, Garzelli L, Mercier O, Auperin A, Lamrani L, Deschamps F, Yevich S, Roux C, Mussot S, Delpla A, Varin F, Hakime A, Teriitehau C, Le Péchoux C, Pradère P, Caramella C, Besse B, Fadel E, de Baere T. Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease. Diagn Interv Imaging 2020; 102:19-26. [PMID: 33020025 DOI: 10.1016/j.diii.2020.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease. MATERIALS AND METHODS This retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates. RESULTS Among 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3±14.9 [SD]; age range: 15-81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2±10.8 [SD]; age range: 33-80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P<0.0001), with more extra-thoracic localisation (P=0.015) and bilateral tumour burden (P=0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P=0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P=0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P>0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P=0.07). Tumour size>2cm was associated with a significantly higher local tumor progression in the RFA group (P=0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR=2 days; range: 2-12 days) than in the surgery group (median of 9 days; IQR=2 days; range: 6-21 days) (P<0.01). CONCLUSION RFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4cm in diameter without associated pleural involvement or thoracic lymphadenopathy.
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Affiliation(s)
- L Tselikas
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France.
| | - L Garzelli
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - O Mercier
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - A Auperin
- Biostatistics and Epidemiology Unit, Gustave-Roussy INSERM 1018, 94805 Villejuif, France
| | - L Lamrani
- Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - F Deschamps
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - S Yevich
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; Interventional Radiology, MD-Anderson, 77030 Houston, TX, USA
| | - C Roux
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - S Mussot
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - A Delpla
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - F Varin
- Department of Anesthesiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - A Hakime
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - C Teriitehau
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - C Le Péchoux
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Radiation Therapy, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - P Pradère
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - C Caramella
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Radiology Department, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - B Besse
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Cancer Medicine, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - E Fadel
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - T de Baere
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France
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Long-Term Outcomes in Percutaneous Radiofrequency Ablation for Histologically Proven Colorectal Lung Metastasis. Cardiovasc Intervent Radiol 2020; 43:1900-1907. [PMID: 32812121 PMCID: PMC7649179 DOI: 10.1007/s00270-020-02623-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
Introduction To evaluate the long-term outcome of image-guided radiofrequency ablation (RFA) when treating histologically confirmed colorectal lung metastasis in terms of overall survival (OS), progression-free survival (PFS) and local tumour control (LTC). Materials and Methods Retrospective single-centre study. Consecutive RFA treatments of histologically proven lung colorectal metastases between 01/01/2008 and 31/12/14. The primary outcome was patient survival (OS and PFS). Secondary outcomes were local tumour progression (LTP) and complications. Prognostic factors associated with OS/ PFS were determined by univariate and multivariate analyses. Results Sixty patients (39 males: 21 females; median age 69 years) and 125 colorectal lung metastases were treated. Eighty percent (n = 48) also underwent lung surgery for lung metastases. Mean metastasis size (cm) was 1.4 ± 0.6 (range 0.3–4.0). Median number of RFA sessions was 1 (1–4). During follow-up (median 45.5 months), 45 patients died (75%). The estimated OS and PFS survival rates at 1, 3, 5, 7, 9 years were 96.7%, 74.7%, 44.1%, 27.5%, 16.3% (median OS, 52 months) and 66.7%, 31.2%, 25.9%, 21.2% and 5.9% (median PFS, 19 months). The LTC rate was 90% with 6 patients developing LTP with 1-, 2-, 3- and 4-year LTP rates of 3.3%, 8.3%, 10.0% and 10.0%. Progression-free interval < 1 year (P = 0.002, HR = 0.375) and total number of pulmonary metastases (≥ 3) treated (P = 0.037, HR = 0.480) were independent negative prognostic factors. Thirty-day mortality rate was 0% with no intra-procedural deaths.
Conclusion The long-term OS and PFS following RFA for the treatment of histologically confirmed colorectal lung metastases demonstrate comparable oncological durability to surgery. Electronic supplementary material The online version of this article (10.1007/s00270-020-02623-1) contains supplementary material, which is available to authorized users.
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21
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Najafi A, Baere TD, Madani K, Al-Ahmar M, Roux C, Delpla A, Deschamps F, Tselikas L. Lung Ablation - How I Do It. Tech Vasc Interv Radiol 2020; 23:100673. [PMID: 32591189 DOI: 10.1016/j.tvir.2020.100673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Interventional oncology and the value of thermal ablation of small tumors is increasingly recognized by the oncological community. Primary lung cancers and lung metastases have been one of the most researched applications of percutaneous ablation and as interventional oncologists gain more experience and confidence, it is becoming a more effective treatment with expanding indications. Importantly, the current literature does not demonstrate major differences in survival between ablation, sublobar resection, and stereotactic body radiation. The advantages of percutaneous ablation over other local therapies like surgery or SBRT are significantly lower morbidity, mortality, and repeatability of treatments. The focus of this essay is to highlight technical and procedural aspects of lung ablation as well as management and follow-up in a practical fashion.
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Picchi SG, Lassandro G, Bianco A, Coppola A, Ierardi AM, Rossi UG, Lassandro F. RFA of primary and metastatic lung tumors: long-term results. Med Oncol 2020; 37:35. [PMID: 32219567 DOI: 10.1007/s12032-020-01361-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/10/2020] [Indexed: 12/27/2022]
Abstract
The aim of our study is a retrospective evaluation of effectiveness and safety of Computed Tomography (CT)-guided radiofrequency ablation (RFA) therapy of primary and metastatic lung lesions in patients that cannot be considered surgical candidates. From February 2007 to September 2017, we performed 264 CT-guided ablation sessions on 264 lesions in 174 patients (112 M and 62 F; mean age, 68 years; range 36-83 years) affected by primary and metastatic lung lesions. The 45% of patients was affected by primary lung cancer, with size range lesion of 10-50 mm, and the 55% by metastatic lung lesions with size range of 5-49 mm. All patients had no more than three metastases in the lung and pulmonary relapses were treated up to three times. Overall Survival (OS), Progression-Free Survival (PFS), Local Progression-Free Survival (LPFS) and Cancer-specific survival (CSS) at 1, 3 and 5 years were calculated both in primary lung tumors and in metastatic patients. Immediate and late RFA-related complications were reported. Pulmonary function tests were evaluated after the procedures. The effectiveness of RFA treatment was evaluated by contrast-enhanced CT. In patients affected by primary lung lesions, the OS rates were 66.73% at 1 year, 23.13% at 3 years and 16.19% at 5 years. In patients affected by metastatic lung lesions, the OS rates were 85.11%, 48.86% and 43.33%, respectively, at 1, 3 and 5 years. PFS at 1, 3 and 5 years were 79.8%, 60.42%, 15.4% in primary lung tumors and 78.59%, 51.8% and 6.07% in metastatic patients. LPFS at 1, 3 and 5 years were 79.8%, 64.69%, 18.87% in primary lung tumors and 86.29%, 69.15% and 44.45% in metastatic patients. CSS at 1, 3 and 5 years was 95.56%, 71.84%, 56.72% in primary lung tumors and 94.07%, 71% and 71% in metastatic patients. Immediate RFA-related complications (pneumothorax, pleural effusion and subcutaneous emphysema) were observed, respectively, in 42, 53 and 13 of 264 procedures (15.9%, 20% and 5%). There also occurred one major complication (lung abscess, 0.36%). No significant worsening of pulmonary function was noted. Our retrospective evaluation showed long-term effectiveness, safety and imaging features of CT-guided RFA in patients affected by primary and metastatic lung cancer as an alternative therapy in non-surgical candidates.
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Affiliation(s)
| | - Giulia Lassandro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Bianco
- Department of Pulmonology, Luigi Vanvitelli University, Naples, Italy
| | | | - Anna Maria Ierardi
- UOC Radiology Fondazione IRCSS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto G Rossi
- Department of Diagnostic Imaging - Interventional Radiology Unit - EO Galliera Hospital, Genoa, Italy
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Effectiveness and safety in radiofrequency ablation of pulmonary metastases from HCC: a five years study. Med Oncol 2020; 37:25. [PMID: 32166529 DOI: 10.1007/s12032-020-01352-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
Hepatocellular carcinoma (HCC) is a frequent tumor that may be treated with radiofrequency thermal ablation (RFA). RFA has been used with success also in treatment of pulmonary metastases from a wide range of primitive tumors, especially colorectal. Previous studies have shown that RFA con be used in treating HCC pulmonary metastases. Purpose of our study was a retrospective evaluation of overall survival and complication rates of percutaneous CT-guided radiofrequency ablation of pulmonary metastases from hepatocellular carcinoma (HCC). Data were collected from 40 CT-guided ablation sessions performed on 42 lesions in 26 patients (16 M and 10 F; mean age 62.5 years) with pulmonary metastases from HCC (size range 0.3-4 cm, mean diameter 1.4 ± 0.98 cm) from February 2012 to December 2017. All patients, as in advanced stage of illness (stage C), were treated according to Barcelona Clinic Liver Cancer (BCLC) criteria, with Sorafenib. They had no active HCC foci in the liver and no more than three metastases in the lung. Patients did not discontinue medical therapy with Sorafenib and pulmonary relapses were treated up to three times. In two patients two lesions were treated during the same procedure. Each lesion was ablated under CT guidance. Follow-up contrast-enhanced CT at 1, 3, 6, 12-month and every 6 months after treatment were reviewed. A total of 42 metastatic lung lesions from HCC in 26 patients (57% male, 43% female) were treated with CT-guided radiofrequency thermal ablation procedures. Immediate radiofrequency ablation-related complications (subtle pneumothorax) were observed in 9 of 40 procedures (22.5%). Only one patient developed a pneumothorax requiring drainage tube insertion (2.5%). No other major complications occurred. Moreover, no significant worsening of pulmonary function was observed. In all patients the overall survival rates were 88.5% at 1 year, 69.8% at 3 years and 26.2% at 5 years. Our retrospective assessment confirmed that percutaneous CT-guided radiofrequency thermal ablation in 23 patients with pulmonary metastases from HCC represents an effective and safe alternative treatment option in patients not considerable as potential candidates to surgery.
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Hasegawa T, Takaki H, Kodama H, Yamanaka T, Nakatsuka A, Sato Y, Takao M, Katayama Y, Fukai I, Kato T, Tokui T, Tempaku H, Adachi K, Matsushima Y, Inaba Y, Yamakado K. Three-year Survival Rate after Radiofrequency Ablation for Surgically Resectable Colorectal Lung Metastases: A Prospective Multicenter Study. Radiology 2020; 294:686-695. [PMID: 31934829 DOI: 10.1148/radiol.2020191272] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although radiofrequency ablation (RFA) is widely performed for the treatment of colorectal cancer (CRC) lung metastases, its efficacy for candidates with surgically resectable disease is unclear. Purpose To evaluate the prognosis after RFA in participants with resectable CRC lung metastases. Materials and Methods For this prospective multicenter study (ClinicalTrials.gov identifier: NCT00776399), participants with five or fewer surgically resectable lung metastases measuring 3 cm or less were included. Participants with CRC and a total of 100 lung metastases measuring 0.4-2.8 cm (mean, 1.0 cm ± 0.5) were chosen and treated with 88 sessions of RFA from January 2008 to April 2014. The primary end point was the 3-year overall survival (OS) rate, with an expected rate of 55%. The local tumor progression rate and safety were evaluated as secondary end points. The OS rates were generated by using the Kaplan-Meier method. Log-rank tests and Cox proportional regression models were used to identify the prognostic factors by means of univariable and multivariable analyses. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. Results Seventy participants with CRC (mean age, 66 years ± 10; 49 men) were evaluated. The 3-year OS rate was 84% (59 of 70 participants; 95% confidence interval [CI]: 76%, 93%). In multivariable analysis, factors associated with worse OS included rectal rather than colon location (hazard ratio [HR] = 7.7; 95% CI: 2.6, 22.6; P < .001), positive carcinoembryonic antigen (HR = 5.8; 95% CI: 2.0, 16.9; P = .001), and absence of previous chemotherapy (HR = 9.8; 95% CI: 2.5, 38.0; P < .001). Local tumor progression was found in six of the 70 participants (9%). A grade 5 adverse event was seen in one of the 88 RFA sessions (1%), and grade 2 adverse events were seen in 18 (20%). Conclusion Lung radiofrequency ablation provided a favorable 3-year overall survival rate of 84% for resectable colorectal lung metastases measuring 3 cm or smaller. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Gemmete in this issue.
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Affiliation(s)
- Takaaki Hasegawa
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Haruyuki Takaki
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hiroshi Kodama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Takashi Yamanaka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Atsuhiro Nakatsuka
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yozo Sato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Motoshi Takao
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshihiko Katayama
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Ichiro Fukai
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshio Kato
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Toshiya Tokui
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Hironori Tempaku
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Katsutoshi Adachi
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yasushi Matsushima
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Yoshitaka Inaba
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
| | - Koichiro Yamakado
- From the Department of Diagnostic and Interventional Radiology, Aichi Cancer Center, 1-1 Chikusa-ku, Kanokoden, Nagoya, Aichi 464-8681, Japan (T.H., Y.S., Y.I.); Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan (H. Takaki, H.K., K.Y.); Department of Radiology, Mie University School of Medicine, Tsu, Japan (T.H., H. Takaki, H.K., T.Y., A.N., K.Y.); Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Tsu, Japan (M.T.); Department of Thoracic Surgery, Matsusaka Chuo General Hospital, Matsusaka, Japan (Y.K.); Department of Respiratory Surgery, Suzuka Chuo General Hospital, Suzuka, Japan (I.F.); Department of Surgery, Tohyama Hospital, Tsu, Japan (T.K.); Department of Respiratory Surgery, Japanese Red Cross Ise Hospital, Ise, Japan (T.T.); Department of Respiratory Surgery, Mie Prefectural General Medical Center, Yokkaichi, Japan (H. Tempaku); Department of Respiratory Surgery, Mie Chuo Medical Center, Tsu, Japan (K.A.); and Department of Thoracic Surgery, Suzuka Kaisei Hospital, Suzuka, Japan (Y.M.)
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Eiken PW, Welch BT. Cryoablation of Lung Metastases: Review of Recent Literature and Ablation Technique. Semin Intervent Radiol 2019; 36:319-325. [PMID: 31680723 DOI: 10.1055/s-0039-1697002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews the current indications for image-guided thermal ablation of pulmonary metastatic disease. It also summarizes data regarding the efficacy and complications of lung cryoablation and present techniques for performing lung cryoablation as informed by the recent literature.
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Affiliation(s)
| | - Brian T Welch
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Winkelmann MT, Clasen S, Pereira PL, Hoffmann R. Local treatment of oligometastatic disease: current role. Br J Radiol 2019; 92:20180835. [PMID: 31124700 DOI: 10.1259/bjr.20180835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The presence of distant metastases has long been a predictor of poor outcome in solid cancer. However, in an oncologic situation called oligometastatic disease (OMD), multiple studies have revealed a survival benefit with aggressive treatment of these metastases. Besides surgery and radiation therapy, local thermal therapies have developed into a treatment option for OMD. Most studies concerning local therapy of OMD are available for colorectal cancer, which is therefore the focus of this article. Furthermore, this review gives a basic overview of the most popular ablation techniques for treatment of OMD.
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Affiliation(s)
- Moritz T Winkelmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Stephan Clasen
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
| | - Philippe L Pereira
- 2 Department of Radiology, SLK-Hospital Heilbronn GmbH, Am Gesundbrunnen, Heilbronn, Germany
| | - Rüdiger Hoffmann
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Hoppe-Seyler-Strasse, Tuebingen, Germany
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27
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Li W, Jiang H, Yu Y, Wang Y, Wang Z, Cui Y, Shen K, Shen Z, Fang Y, Liu T. Outcomes of gastrectomy following upfront chemotherapy in advanced gastric cancer patients with a single noncurable factor: a cohort study. Cancer Manag Res 2019; 11:2007-2013. [PMID: 30881125 PMCID: PMC6407509 DOI: 10.2147/cmar.s192570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Chemotherapy is the standard care for patients with incurable advanced gastric cancer. Whether or when the addition of gastrectomy to chemotherapy improves survival of advanced gastric cancer patients with a single noncurable factor remains controversial. We aimed to evaluate the superiority of gastrectomy following chemotherapy vs chemotherapy alone regarding overall survival (OS) in these patients. Patients and methods Patients with advanced gastric cancer from January 2008 to December 2014 were retrieved from our prospectively acquired database and retrospectively analyzed. The patients with a single noncurable factor were grouped in terms of cancer treatment: chemotherapy alone or gastrectomy following chemotherapy. Results Four hundred and fourteen patients (333 chemotherapy alone and 81 gastrectomy following chemotherapy) were included in this study. Kaplan–Meier survival curve showed a significant difference on median OS between chemotherapy-alone group and the gastrectomy plus chemotherapy group (10.9 vs 15.9 months, P<0.01). After propensity score analysis (n=126), chemotherapy plus surgery (81 patients) also showed survival benefit over chemotherapy alone (35 patients) (15.9 vs 10.0 months, P<0.01). Furthermore, stratified analyses indicated that patients with liver metastasis, <65 years of age, male, having normal level of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA199) upon diagnosis, or having nongastro-esophageal junction tumor benefited from surgery. Conclusion This study suggests that gastrectomy after chemotherapy could lead to survival benefit over chemotherapy alone in advanced gastric cancer patients with a single nonresectable factor if the disease was controllable by chemotherapy.
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Affiliation(s)
- Wei Li
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Huiqin Jiang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yiyi Yu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yan Wang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Zhiming Wang
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Yuehong Cui
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China,
| | - Kuntang Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenbin Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianshu Liu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, China, .,Center of Evidence-Based Medicine, Fudan University, Shanghai, China,
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Hiyoshi Y, Miyamoto Y, Kiyozumi Y, Sawayama H, Eto K, Nagai Y, Iwatsuki M, Iwagami S, Baba Y, Yoshida N, Kawanaka K, Yamashita Y, Baba H. CT-guided percutaneous radiofrequency ablation for lung metastases from colorectal cancer. Int J Clin Oncol 2018; 24:288-295. [PMID: 30328530 DOI: 10.1007/s10147-018-1357-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) can be a minimally invasive therapeutic option in patients with lung metastasis from colorectal caner. We aimed to elucidate the safety and survival benefit of computed tomography (CT)-guided percutaneous RFA for lung metastasis from colorectal cancer. METHODS A total 188 lesions were ablated in 43 patients from 2005 to 2017. The clinicopathological and survival data of patients were collected retrospectively. The short- and long-term outcomes and prognostic factors were analyzed. RESULTS Eight patients (18.6%) had viable extrapulmonary metastasis at RFA treatment. The median number of treated lung tumors was 2, and the median maximum diameter was 12 mm. Complications, such as pneumothorax, pleural effusion and subcutaneous emphysema, occurred in 24 (55.8%) patients. Although chest tube drainage for pneumothorax was needed in 6 patients (14.0%), there were no mortalities. Repeated RFA for lung recurrence after primary RFA was performed in 14 patients (32.6%). In a median follow-up of 24.3 months, the median progression-free and overall survival (OS) were 6.8 months and 52.7 months, respectively. The presence of extrapulmonary metastasis and a maximum tumors size of > 15 mm were independently associated with a worse disease-free survival and OS. The OS of patients who underwent repeated RFA was significantly better than that of patients who underwent RFA only once. CONCLUSION CT-guided percutaneous RFA for lung metastasis from colorectal cancer is a safe and effective procedure in patients not eligible for surgery, particularly for lesions smaller than 1.5 cm without extrapulmonary metastasis.
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Affiliation(s)
- Yukiharu Hiyoshi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuji Miyamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yuki Kiyozumi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Sawayama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kojiro Eto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yohei Nagai
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Masaaki Iwatsuki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Shiro Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Naoya Yoshida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Koichi Kawanaka
- Department of Diagnostic Imaging, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Imaging, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
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Pulmonary Thermal Ablation Enables Long Chemotherapy-Free Survival in Metastatic Colorectal Cancer Patients. Cardiovasc Intervent Radiol 2018; 41:1727-1734. [DOI: 10.1007/s00270-018-1939-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/17/2018] [Indexed: 12/17/2022]
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de Baere T, Tselikas L, Gravel G, Hakime A, Deschamps F, Honoré C, Mir O, Lecesne A. Interventional radiology: Role in the treatment of sarcomas. Eur J Cancer 2018; 94:148-155. [DOI: 10.1016/j.ejca.2018.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 02/08/2018] [Indexed: 02/06/2023]
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Radiofrequency and Microwave Ablation Compared to Systemic Chemotherapy and to Partial Hepatectomy in the Treatment of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2018; 41:1189-1204. [PMID: 29666906 PMCID: PMC6021475 DOI: 10.1007/s00270-018-1959-3] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/05/2018] [Indexed: 12/18/2022]
Abstract
Purpose To assess safety and outcome of radiofrequency ablation (RFA) and microwave ablation (MWA) as compared to systemic chemotherapy and partial hepatectomy (PH) in the treatment of colorectal liver metastases (CRLM). Methods MEDLINE, Embase and the Cochrane Library were searched. Randomized trials and comparative observational studies with multivariate analysis and/or matching were included. Guidelines from National Guideline Clearinghouse and Guidelines International Network were assessed using the AGREE II instrument. Results The search revealed 3530 records; 328 were selected for full-text review; 48 were included: 8 systematic reviews, 2 randomized studies, 26 comparative observational studies, 2 guideline-articles and 10 case series; in addition 13 guidelines were evaluated. Literature to assess the effectiveness of ablation was limited. RFA + systemic chemotherapy was superior to chemotherapy alone. PH was superior to RFA alone but not to RFA + PH or to MWA. Compared to PH, RFA showed fewer complications, MWA did not. Outcomes were subject to residual confounding since ablation was only employed for unresectable disease. Conclusion The results from the EORTC-CLOCC trial, the comparable survival for ablation + PH versus PH alone, the potential to induce long-term disease control and the low complication rate argue in favour of ablation over chemotherapy alone. Further randomized comparisons of ablation to current-day chemotherapy alone should therefore be considered unethical. Hence, the highest achievable level of evidence for unresectable CRLM seems reached. The apparent selection bias from previous studies and the superior safety profile mandate the setup of randomized controlled trials comparing ablation to surgery. Electronic supplementary material The online version of this article (10.1007/s00270-018-1959-3) contains supplementary material, which is available to authorized users.
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Smith S, Jennings P. Thoracic intervention and surgery to cure lung cancer: image-guided thermal ablation in primary lung cancer. J R Soc Med 2018. [PMID: 29532709 DOI: 10.1177/0141076818763335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Qi H, Fan W. Value of ablation therapy in the treatment of lung metastases. Thorac Cancer 2018; 9:199-207. [PMID: 29193688 PMCID: PMC5792733 DOI: 10.1111/1759-7714.12567] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
Tumor metastases are the basic biological characteristics of malignant tumors, and the lungs are the second most prominent metastatic organs in which these develop after the liver. Currently, with the rapid development of ablation technology, ablation therapy as a local treatment is playing an increasingly important role in the treatment of lung metastases. Whether alone or in combination with other treatments, ablation therapy has achieved good therapeutic effects for the treatment of partial lung metastases. This article briefly summarizes the results of current and previous ablation treatments for lung metastases, and focuses on the value of ablation therapy for different kinds of lung metastases.
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Affiliation(s)
- Han Qi
- Minimally Invasive Interventional Division, Medical Imaging CenterSun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Weijun Fan
- Minimally Invasive Interventional Division, Medical Imaging CenterSun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
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Arnolli MM, Buijze M, Franken M, de Jong KP, Brouwer DM, Broeders IAMJ. System for CT-guided needle placement in the thorax and abdomen: A design for clinical acceptability, applicability and usability. Int J Med Robot 2017; 14. [PMID: 29205787 DOI: 10.1002/rcs.1877] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Various systems exist for CT-guided needle placement in the thorax and abdomen, but widespread adoption is lacking. The goal of this work is to develop a system for precise needle placement with a design focus on clinical acceptability, applicability and usability. METHODS A system was outlined incorporating a needle guide on a mechanism with a remote centre of motion, manually placeable around the patient at the desired entry point and lockable by push-button to the CT table. System and patient are scanned for system-to-CT registration and target specification. The needle guide is automatically aimed at the target, for manual needle insertion to specified depth. RESULTS A fully functional prototype was realized, achieving 1.2±0.6 mm placement error at 79.0±8.4 mm depth and 2.1±0.7 mm at 156.0±6.9 mm for 2×12 in- and out-of-plane punctures in a gelatin phantom. CONCLUSIONS The system enables precise needle placement in a single insertion and is ready for its first clinical deployment.
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Affiliation(s)
- Maarten M Arnolli
- DEMCON Advanced Mechatronics, the Netherlands.,Precision Engineering, Science-based Engineering, University of Twente, the Netherlands
| | | | | | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery & Liver Transplantation, University Medical Center Groningen, the Netherlands
| | - Dannis M Brouwer
- Precision Engineering, Science-based Engineering, University of Twente, the Netherlands
| | - Ivo A M J Broeders
- Minimally Invasive Surgery & Robotics, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, the Netherlands
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Bin Traiki T, Fisher O, Valle S, Parikh R, Kozman M, Glenn D, Power M, Liauw W, Alzahrani N, Morris D. Percutaneous lung ablation of pulmonary recurrence may improve survival in selected patients undergoing cytoreductive surgery for colorectal cancer with peritoneal carcinomatosis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2017; 43:1939-1948. [PMID: 28888800 DOI: 10.1016/j.ejso.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/16/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022]
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Palussière J, Catena V, Buy X. Percutaneous thermal ablation of lung tumors – Radiofrequency, microwave and cryotherapy: Where are we going? Diagn Interv Imaging 2017; 98:619-625. [DOI: 10.1016/j.diii.2017.07.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 12/23/2022]
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Microwave Ablation of Lung Tumors Near the Heart: A Retrospective Review of Short-Term Procedural Safety in Ten Patients. Cardiovasc Intervent Radiol 2017; 40:1401-1407. [DOI: 10.1007/s00270-017-1660-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/21/2017] [Indexed: 12/27/2022]
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38
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Yang Q, Qi H, Zhang R, Wan C, Song Z, Zhang L, Fan W. Risk Factors for Local Progression after Percutaneous Radiofrequency Ablation of Lung Tumors: Evaluation Based on a Review of 147 Tumors. J Vasc Interv Radiol 2017; 28:481-489. [DOI: 10.1016/j.jvir.2016.11.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 10/25/2016] [Accepted: 11/21/2016] [Indexed: 02/07/2023] Open
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de Baere T, Tselikas L, Yevich S, Boige V, Deschamps F, Ducreux M, Goere D, Nguyen F, Malka D. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 75:231-242. [DOI: 10.1016/j.ejca.2017.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
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Akhan O, Güler E, Akıncı D, Çiftçi T, Köse IÇ. Radiofrequency ablation for lung tumors: outcomes, effects on survival, and prognostic factors. Diagn Interv Radiol 2017; 22:65-71. [PMID: 26611111 DOI: 10.5152/dir.2015.14378] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to evaluate the survival benefit achieved with radiofrequency (RF) ablation of primary and metastatic lung tumors and determine significant prognostic factors for recurrence-free survival. METHODS Forty-nine patients with lung cancer (10 primary and 39 metastatic) underwent computed tomography-guided percutaneous RF ablation between June 2005 and October 2013. A total of 112 tumors (101 metastatic and 11 primary non-small cell lung cancer) were treated with RF ablation. Tumor diameter ranged from 0.6 to 4 cm (median 1.5 cm). Effectiveness of treatment, complications, and survival were analyzed. RESULTS Primary success rate was 79.5% and local tumor progression occurred in 23 tumors. Among tumors showing progression, 10 were re-treated with RF ablation and secondary success rate was 87.5%. One-, two-, and three-year overall survival rates of 10 patients with primary lung cancer were 100%, 86%, and 43%, respectively. One-, two-, three-, four-, and five-year overall survival rates for 39 patients with metastatic lung tumors were 90%, 73%, 59%, 55%, and 38%, respectively. One-, two-, three-, and four-year overall survival rates for 16 patients with colorectal pulmonary metastases were 94%, 80%, 68%, and 23%, respectively. Complications occurred in 30 sessions (24.6%). Pneumothorax occurred in 19 sessions with seven requiring image-guided percutaneous chest tube drainage. Tumor status (solitary or multiple) and presence of extrapulmonary metastasis at initial RF ablation were significant prognostic factors in terms of recurrence-free survival. CONCLUSION RF ablation is a safe and effective treatment with a survival benefit for selected patients with primary and secondary lung tumors.
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Affiliation(s)
- Okan Akhan
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
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Hou X, Zhuang X, Zhang H, Wang K, Zhang Y. Artificial pneumothorax: a safe and simple method to relieve pain during microwave ablation of subpleural lung malignancy. MINIM INVASIV THER 2017; 26:220-226. [PMID: 28281366 DOI: 10.1080/13645706.2017.1287089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Microwave ablation has been extensively used for eliminating pulmonary tumors; however, it is usually associated with severe pain under local anesthesia. Decreasing the power and shortening the ablation time can help to relieve the pain; however, this leads to incomplete ablation and an increasing recurrence rate. This research aims to employ an artificial pneumothorax to increase both the curative effect and pain relief during the ablation procedure. MATERIAL AND METHODS From July 2013 to January 2015, nine patients presenting with 10 subpleural lung tumors (age: 44-78 years) with a high possibility of severe pain underwent the artificial pneumothorax during microwave ablation. The pain assessment scores and complications induced by the artificial pneumothorax were recorded and analyzed by a CT scan follow-up. RESULTS The tumors of the nine patients were eliminated successfully using microwave ablation with artificial pneumothorax under local anesthesia. The pain caused by the ablation was relieved to a great extent with an average rate of 94.66% (range: 63.3%-100%) and all tumors were ablated completely. No severe complications occurred after the operation. CONCLUSIONS The artificial pneumothorax is a reliable therapy to improve the curative effect of microwave ablation under local anesthesia by relieving the pain of the patients.
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Affiliation(s)
- Xiaowei Hou
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Xingjun Zhuang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Haiwen Zhang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Kai Wang
- a Department of Oncology , PLA 401 Hospital , Qingdao , China
| | - Yuanxin Zhang
- b Department of Anesthesiology , PLA 401 Hospital , Qingdao , China
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Huo YR, Glenn D, Liauw W, Power M, Zhao J, Morris DL. Evaluation of carcinoembryonic antigen (CEA) density as a prognostic factor for percutaneous ablation of pulmonary colorectal metastases. Eur Radiol 2017; 27:128-137. [PMID: 27165139 DOI: 10.1007/s00330-016-4352-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/18/2016] [Accepted: 04/05/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the prognostic value of carcinoembryonic antigen (CEA) density and other clinicopathological factors for percutaneous ablation of pulmonary metastases from colorectal cancer. METHODS CEA density was calculated as: "absolute serum CEA pre-ablation/volume of all lung metastases [mm3]". Median CEA density was the cut-off for high and low groups. Cox-regression was used to determine prognostic factors for survival. RESULTS A total of 85 patients (102 ablation sessions) were followed for a median of 27 months. High CEA density was significantly associated with worse overall survival compared to low CEA density (adjusted HR: 2.12; 95 % CI: 1.22-3.70, p=0.002; median survival: 25.7 vs. 44.3 months). The interval between primary resection of the colorectal carcinoma and first ablation was also a prognostic factor, a duration >24 months being associated with better survival compared to a shorter interval (0-24 months) (adjusted HR: 0.55; 95 % CI: 0.31-0.98, p=0.04). Moreover, a disease-free interval >24 months was significantly associated with low CEA density compared to a shorter interval (0-24 months) (adjusted OR: 0.29; 95 % CI: 0.11-0.77, p=0.01). CONCLUSIONS Serum CEA density and interval between primary resection of a colorectal carcinoma and pulmonary ablation are independent prognostic factors for overall survival. In two patients with identical CEA serum levels, the patient with the lower/smaller pulmonary tumour load would have a worse prognosis than the one with the higher/larger pulmonary metastases. KEY POINTS • CEA density is an independent prognostic factor for colorectal pulmonary metastases. • A lower CEA density is associated with better overall survival. • CEA may play a functional role in tumour progression. • High CEA density is associated with smaller tumours. • Interval between pulmonary ablation and primary colorectal carcinoma is a prognostic factor.
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Affiliation(s)
- Ya Ruth Huo
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Level 3, Pitney Building, Kogarah, NSW, 2217, Australia
- St George Hospital Clinical School, UNSW Australia, Kensington, NSW, Australia
| | - Derek Glenn
- St George Hospital Clinical School, UNSW Australia, Kensington, NSW, Australia
- Department of Radiology, St George Hospital, Kogarah, NSW, Australia
| | - Winston Liauw
- St George Hospital Clinical School, UNSW Australia, Kensington, NSW, Australia
- Cancer Care Centre, St George Hospital, Kogarah, NSW, Australia
| | - Mark Power
- Department of Radiology, St George Hospital, Kogarah, NSW, Australia
| | - Jing Zhao
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Level 3, Pitney Building, Kogarah, NSW, 2217, Australia
| | - David L Morris
- Hepatobiliary and Surgical Oncology Unit, UNSW Department of Surgery, St George Hospital, Level 3, Pitney Building, Kogarah, NSW, 2217, Australia.
- St George Hospital Clinical School, UNSW Australia, Kensington, NSW, Australia.
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Zhang B, Moser MAJ, Zhang EM, Luo Y, Zhang W. A new approach to feedback control of radiofrequency ablation systems for large coagulation zones. Int J Hyperthermia 2016; 33:367-377. [DOI: 10.1080/02656736.2016.1263365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Bing Zhang
- CISR Lab, East China University of Science and Technology, Shanghai, China
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
| | | | - Edwin M. Zhang
- Division of Vascular & Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Yigang Luo
- Department of Surgery, University of Saskatchewan, Saskatoon, Canada
| | - Wenjun Zhang
- CISR Lab, East China University of Science and Technology, Shanghai, China
- Division of Biomedical Engineering, University of Saskatchewan, Saskatoon, Canada
- Department of Mechanical Engineering, University of Saskatchewan, Saskatoon, Canada
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Treasure T. Surgery and ablative techniques for lung metastases in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) trial: is there equivalence? J Thorac Dis 2016; 8:S649-S651. [PMID: 28066664 DOI: 10.21037/jtd.2016.06.50] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Thermal Ablation of Colorectal Lung Metastases: Retrospective Comparison Among Laser-Induced Thermotherapy, Radiofrequency Ablation, and Microwave Ablation. AJR Am J Roentgenol 2016; 207:1340-1349. [PMID: 27680945 DOI: 10.2214/ajr.15.14401] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The purpose of this study is to retrospectively evaluate local tumor control, time to tumor progression, and survival rates among patients with lung metastatic colorectal cancer who have undergone ablation therapy performed using laser-induced thermotherapy (LITT), radiofrequency ablation (RFA), or microwave ablation (MWA). MATERIALS AND METHODS Data for this retrospective study were collected from 231 CT-guided ablation sessions performed for 109 patients (71 men and 38 women; mean [± SD] age, 68.6 ± 11.2 years; range, 34-94 years) from May 2000 to May 2014. Twenty-one patients underwent LITT (31 ablations), 41 patients underwent RFA (75 ablations), and 47 patients underwent MWA (125 ablations). CT scans were acquired 24 hours after each therapy session and at follow-up visits occurring at 3, 6, 12, 18, and 24 months after ablation. Survival rates were calculated from the time of the first ablation session, with the use of Kaplan-Meier and log-rank tests. Changes in the volume of the ablated lesions were measured using the Kruskal-Wallis method. RESULTS Local tumor control was achieved in 17 of 25 lesions (68.0%) treated with LITT, 45 of 65 lesions (69.2%) treated with RFA, and 91 of 103 lesions (88.3%) treated with MWA. Statistically significant differences were noted when MWA was compared with LITT at 18 months after ablation (p = 0.01) and when MWA was compared with RFA at 6 months (p = 0.004) and 18 months (p = 0.01) after ablation. The overall median time to local tumor progression was 7.6 months. The median time to local tumor progression was 10.4 months for lesions treated with LITT, 7.2 months for lesions treated with RFA, and 7.5 months for lesions treated with MWA, with no statistically significant difference noted. New pulmonary metastases developed in 47.6% of patients treated with LITT, in 51.2% of patients treated with RFA, and in 53.2% of patients treated with MWA. According to the Kaplan-Meier test, median survival was 22.1 months for patients who underwent LITT, 24.2 months for those receiving RFA, and 32.8 months for those who underwent MWA. The overall survival rate at 1, 2, and 4 years was 95.2%, 47.6%, and 23.8%, respectively, for patients treated with LITT; 76.9%, 50.8%, and 8.0%, respectively, for patients treated with RFA; and 82.7%, 67.5%, and 16.6%, respectively, for patients treated with MWA. The log-rank test revealed no statistically significant difference among LITT, RFA, and MWA. The progression-free survival rate at 1, 2, 3, and 4 years was 96.8%, 52.7%, 24.0%, and 19.1%, respectively, for patients who underwent LITT; 77.3%, 50.2%, 30.8%, and 16.4%, respectively, for patients who underwent RFA; and 54.6%, 29.1%, 10.0%, and 1.0%, respectively, for patients who underwent MWA, with no statistically significant difference noted among the three ablation methods. CONCLUSION LITT, RFA, and MWA can be used as therapeutic options for lung metastases resulting from colorectal cancer. Statistically significant differences in local tumor control revealed a potential advantage in using MWA. No differences in time to tumor progression or survival rates were detected when the three different ablation methods were compared.
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A review of radiofrequency ablation: Large target tissue necrosis and mathematical modelling. Phys Med 2016; 32:961-71. [PMID: 27461969 DOI: 10.1016/j.ejmp.2016.07.092] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/06/2016] [Accepted: 07/18/2016] [Indexed: 12/15/2022] Open
Abstract
Radiofrequency ablation (RFA) is an effective clinical method for tumour ablation with minimum intrusiveness. However, the use of RFA is mostly restricted to small tumours, especially those <3cm in diameter. This paper discusses the state-of-the-art of RFA, drawn from experimental and clinical results, for large tumours (i.e. ⩾3cm in diameter). In particular, the paper analyses clinical results related to target tissue necrosis (TTN) and mathematical modelling of the RFA procedure to understand the mechanism whereby the TTN is limited to under 3cm with RFA. This paper also discusses a strategy of controlling of the temperature of target tissue in the RFA procedure with the state-of-art device, which has the potential to increase the size of TTN. This paper ends with a discussion of some future ideas to solve the so-called 3-cm problem with RFA.
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Omae K, Hiraki T, Gobara H, Iguchi T, Fujiwara H, Matsui Y, Toyooka S, Nagasaka T, Kanazawa S. Long-Term Survival after Radiofrequency Ablation of Lung Oligometastases from Five Types of Primary Lesions: A Retrospective Evaluation. J Vasc Interv Radiol 2016; 27:1362-1370. [PMID: 27461589 DOI: 10.1016/j.jvir.2016.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/11/2016] [Accepted: 05/12/2016] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To conduct a retrospective evaluation of long-term survival after radiofrequency (RF) ablation for lung oligometastases from 5 types of primary lesions. MATERIALS AND METHODS The study population consisted of 123 patients with lung oligometastases from colorectal cancer (CRC), non-small-cell lung cancer, hepatocellular carcinoma, esophageal cancer, and renal-cell carcinoma treated with RF ablation. Lung oligometastases were defined as 1-5 metastases confined to the lung while the primary cancer and other metastases were eradicated. Overall survival (OS) and recurrence-free survival (RFS) were estimated for the overall study population and for patients with each type of primary lesion. The OS and RFS rates were compared with those of the patients with any of the other four primary lesion types. Finally, various variables were analyzed to determine what factors influenced OS and RFS. RESULTS The median follow-up was 45.7 months, and the 5-year OS and RFS rates for all 123 patients were 62% and 25%, respectively. The OS time for patients with metastases from CRC was significantly longer (P = .042); it was significantly shorter (P = .022) in patients with metastases from esophageal cancer. Longer disease-free interval was significantly (P = .015) associated with better OS. There was no variable significantly associated with OS and RFS on multivariate analyses. CONCLUSIONS Data from this single-center study appear promising in terms of long-term survival after RF ablation of lung oligometastases from 5 primary lesions.
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Affiliation(s)
- Kenichi Omae
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Takao Hiraki
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Hideo Gobara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Toshihiro Iguchi
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Hiroyasu Fujiwara
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Yusuke Matsui
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Takeshi Nagasaka
- Department of Gastroenterological Surgery, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
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Ziv E, Erinjeri JP, Yarmohammadi H, Boas FE, Petre EN, Gao S, Shady W, Sofocleous CT, Jones DR, Rudin CM, Solomon SB. Lung Adenocarcinoma: Predictive Value of KRAS Mutation Status in Assessing Local Recurrence in Patients Undergoing Image-guided Ablation. Radiology 2016; 282:251-258. [PMID: 27440441 DOI: 10.1148/radiol.2016160003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Purpose To establish the relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Materials and Methods This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of 56 primary lung adenocarcinomas in 54 patients (24 men, 30 women; median age, 72 years; range, 54-87 years) treated with percutaneous image-guided ablation and with available genetic mutational analysis. KRAS mutation status and additional clinical and technical variables-Eastern Cooperative Oncology Group (ECOG) status, smoking history, stage at diagnosis, status (new primary or not), history of radiation, history of surgery, prior systemic treatment, modality of ablation, size of nodule, ablation margin, and presence of ground-glass appearance-were recorded and evaluated in relation to time to local recurrence, which was calculated from the time of ablation to the first radiographic evidence of recurrence. Predictors of outcome were identified by using a proportional hazards model for both univariate and multivariate analysis, with death as a competing risk. Results Technical success was 100%. Of the 56 ablated tumors, 37 (66%) were wild type for KRAS and 19 (34%) were KRAS mutants. The 1-year and 3-year cumulative incidences of recurrence were 20% and 35% for wild-type KRAS compared with 40% and 63% for KRAS mutant tumors. KRAS mutation status was a significant predictor of local recurrence at both univariate (P = .05; subdistribution hazard ratio [sHR], 2.32) and multivariate (P = .006; sHR, 3.75) analysis. At multivariate analysis, size (P = .026; sHR, 2.54) and ECOG status (P = .012; sHR, 2.23) were also independent significant predictors, whereas minimum margin (P = .066) was not. Conclusion The results of this study show that there is a relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Specifically, KRAS mutation status of the ablated lesion is a significant predictor of time to local recurrence, independent of size and margin. © RSNA, 2016.
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Affiliation(s)
- Etay Ziv
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Joseph P Erinjeri
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Hooman Yarmohammadi
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - F Edward Boas
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Elena N Petre
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Song Gao
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Waleed Shady
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Constantinos T Sofocleous
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - David R Jones
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Charles M Rudin
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
| | - Stephen B Solomon
- From the Interventional Radiology Service, Department of Radiology (E.Z., J.P.E., H.Y., F.E.B., E.N.P., S.G., W.S., C.T.S., S.B.S.), Thoracic Service, Department of Surgery (D.R.J.), and Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine (C.M.R.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Howard-118, New York, NY 10065; and the Interventional Therapy Department, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China (S.G.)
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Smith SL, Bowers D, Jennings P, Soomal R. Pulmonary radiofrequency ablation in a district general hospital: is it a safe and effective treatment? Clin Radiol 2016; 71:939.e1-8. [PMID: 27157314 DOI: 10.1016/j.crad.2016.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/07/2016] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
Abstract
AIM To analyse the technical success of ablation therapy and the incidence of complications in patients treated with pulmonary ablation and to assess factors affecting local disease control and patient survival in a subgroup with metastatic colorectal cancer. MATERIALS AND METHODS Technical success and complications in all patients undergoing lung ablation between June 2009 and July 2015 were recorded. Overall survival and local disease control in a subgroup with metastases from a colorectal primary were calculated. Factors influencing outcome were explored. RESULTS Two hundred and seven pulmonary ablations were performed in 86 patients at 156 attendances. Technical success was achieved in 207/207 (100%). Thirty and 90-day mortality was 0%. The major complication rate was 13/86 (15%). One hundred and one metastases were treated in 46 patients with a colorectal primary. This group had a mean ± standard error survival time of 53.58±3.47 months with a 1, 2, 3, 4, and 5-year survival rate of 97.4%, 91.3%, 81.5%, 59.8%, and 48%. There was no statistically significant difference in survival regarding time to development of metastatic disease, the total number of lesions ablated, the initial number of lesions ablated, the maximum size of lesion treated, or unilateral versus bilateral disease. Patients with extrapulmonary disease were found to have a shorter survival from the primary diagnosis. Seventy-eight (77.2%) of the 101 lesions were stable after first RFA. Local relapse was more likely when a metastasis was close to a large (>3 mm) vessel. CONCLUSION RFA is a safe and effective procedure that can be performed without on-site cardiothoracic support. Good outcomes depend upon careful patient selection. This study supports its use in oligometastatic disease.
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Affiliation(s)
- S L Smith
- Department of Radiology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK.
| | - D Bowers
- Department of Science and Technology, University Campus Suffolk, Neptune Quay, Ipswich, Suffolk IP4 1QJ, UK
| | - P Jennings
- Department of Radiology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - R Soomal
- Department of Oncology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
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Systemic Versus Local Therapies for Colorectal Cancer Pulmonary Metastasis: What to Choose and When? J Gastrointest Cancer 2016; 47:223-31. [DOI: 10.1007/s12029-016-9818-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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