41 research outputs found
A Unique Case of Hepatocellular Carcinoma Treated with Radiofrequency Ablation with More than 12 Years Overall Survival: A Case Report
The case of a 72-year-old male patient with HCC is presented in whom percutaneous RFA was used as the sole first-line anticancer treatment, since he denied having partial hepatectomy. The patient underwent RFA two more times, at 1.5 years for treating a local tumor progression at the initial ablation site and at 11 years after the first session for treating a new remote intrahepatic recurrence. He revealed a long-term survival of more than 12 years so far and still remains in excellent clinical status
Interventional oncology procedures for breast cancer metastatic disease: current role and clinical applications
Worldwide, breast cancer constitutes the most common malignant neoplasm among females, impacting 2.1 million women annually. Interventional oncology techniques have been recently added as an additional therapeutic and palliative alternative in breast cancer metastatic disease, concerning mainly osseous, liver, and lung metastasis. In the current literature, there are reports of promising results and documented efficacy regarding the ablation of liver and lung metastasis from breast carcinoma, transarterial embolization or radioembolization, as well as the treatment of osseous metastatic disease. These literature studies are limited by the heterogeneity of breast cancer disease, the evaluation of variable different parameters, as well as the retrospective nature in most of the cases. Consequently, dedicated prospective series and randomized studies are required to identify the role of minimally invasive local therapies of interventional oncology armamentarium. The present review paper focuses upon the current role of interventional oncology techniques for the curative or palliative treatment of metastatic breast cancer disease. The purpose of this review paper is to present the current minimally invasive procedures in the treatment of metastatic breast disease, including local control rates and survival rates
Vertebral Augmentation: Is It Time to Get Past the Pain? A Consensus Statement from the Sardinia Spine and Stroke Congress
Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below
Computed Tomography and Ultrasounds for the Follow-up of Hepatocellular Carcinoma Ablation: What You Need to Know
Image-guided tumor ablation provides curative treatment in properly selected patients or appropriate therapeutic options whenever surgical techniques are precluded. Tumor response assessment post ablation is important in determining treatment success and future therapy. Accurate interpretation of post-ablation imaging findings is crucial for therapeutic and follow-up strategies. Computed Tomography (CT) and Ultrasound (US) play important roles in patients’ follow-up post liver thermal ablation therapies. Contrast-enhanced ultrasound (CEUS) can provide valuable information on the ablation effects faster and at a lower cost than computed tomography or magnetic resonance imaging. However, a disadvantage is that the technique cannot examine total liver parenchyma for disease progression as CT and Magnetic Resonance (MR) imaging can. Follow-up strategies for assessment of tumor response includes contrast enhanced multiphasic (non-contrast, arterial, portal, delayed phases) imaging with Computed Tomography at three, six, and 12 months post ablation session and annually ever since in order to prove sustained effectiveness of the ablation or detect progression
Percutaneous bipolar radiofrequency ablation for spine metastatic lesions
PurposeThe purpose of this review is to become familiar with the most
common indications for imaging guided percutaneous bipolar
radiofrequency ablation, to learn about different technical
considerations during performance providing the current evidence.
Controversies concerning products will be addressed.MethodsWe performed
a literature review excluding non-English studies and case reports. All
references of the obtained articles were also evaluated for any
additional information.ResultsRFA achieves cytotoxicity by raising
target area temperatures above 60 degrees C, and may be used to achieve
total necrosis of lesions smaller than 3 cm in diameter, to debulk and
reduce the pain associated with larger lesions, to prevent pathological
fractures due to progressive osteolysis or for cavity creation aiming
for targeted cement delivery in case of posterior vertebral wall
breaching. Protective ancillary techniques should be used in order to
increase safety and augment efficacy of RFA in the
spine.ConclusionPercutaneous radiofrequency ablation of vertebral
lesions is a reproducible, successful and safe procedure. Ablation
should be combined with vertebral augmentation in all cases. In order to
optimize maximum efficacy a patient- and a lesion-tailored approach
should both be offered focusing upon clinical and performance status
along with life expectancy of the patient as well as upon lesion
characteristics
Percutaneous, Imaging-Guided Biopsy of Bone Metastases
Approximately 70% of cancer patients will eventually develop bone metastases. Spine, due to the abundance of red marrow in the vertebral bodies and the communication of deep thoracic-pelvic veins with valve-less vertebral venous plexuses, is the most common site of osseous metastatic disease. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. Indications for percutaneous bone biopsy include lesion characterization, optimal treatment and tumor recurrence identification, as well as tumor response and recurrence rate prediction. Predicting recurrence in curative cases could help in treatment stratification, identification, and validation of new targets. The overall accuracy of percutaneous biopsy is 90–95%; higher positive recovery rates govern biopsy of osteolytic lesions. The rate of complications for percutaneous biopsy approaches is <5%. The purpose of this review is to provide information about performing bone biopsy and what to expect from it as well as choosing the appropriate imaging guidance. Additionally, factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed
Percutaneous Bone and Soft Tissue Biopsies: An Illustrative Approach
Even in pandemic times cancer remains one of the leading causes of death
worldwide. Spine and peripheral skeleton constitute a common location
for metastatic disease whilst numerous sarcomatous and other primary
cancers may be depicted in the musculoskeletal system. Tissue sampling
is necessary for histopathological identification as well as for
molecular profiling in order to personalize cancer prevention, diagnosis
and treatment; in addition cultures of bone and soft tissue sampling
contribute to identifying pathogens in order to provide the most
appropriate systemic therapy. Performing an open surgical biopsy
increases morbidity and mortality while at the same time runs the risk
of destabilizing a pathologic segment. Imaging guidance ensures high
safety and efficacy rates and contributes to the minimally invasive
character of percutaneous biopsy by providing immediate confirmation of
correct needle location in the area of interest. Selecting the imaging
guidance method which will visualize the target lesion and the needle
trajectory as well as the largest possible needle biopsy that can
maximize the diagnostic yield is of outmost importance for high safety
and efficacy rates. The purpose of the present review is to provide a
comprehensive, current overview of percutaneous, imaging guided biopsy
in the spine and peripheral skeleton, to become familiar with the most
common indications, to learn about different technical considerations
during performance and to provide the current evidence. Controversies
concerning products will be addressed. (C) 2021 Elsevier Inc. All rights
reserved
Clinical Outcome and Safety of Multilevel Vertebroplasty: Clinical Experience and Results
To compare safety and efficacy of percutaneous vertebroplasty (PVP) when
treating up to three vertebrae or more than three vertebrae per session.
We prospectively compared two groups of patients with symptomatic
vertebral fractures who had no significant response to conservative
therapy. Pathologic substrate included osteoporosis (n = 77), metastasis
(n = 24), multiple myeloma (n = 13), hemangioma (n = 15), and lymphoma
(n = 1). Group A patients (n = 94) underwent PVP of up to three treated
vertebrae (n = 188). Group B patients (n = 36) underwent PVP with more
than three treated vertebrae per session (n = 220). Decreased pain and
improved mobility were recorded the day after surgery and at 12 and 24
months after surgery per clinical evaluation and the use of numeric
visual scales (NVS): the Greek Brief Pain Inventory, a linear analogue
self-assessment questionnaire, and a World Health Organization
questionnaire.
Group A presented with a mean pain score of 7.9 +/- A 1.1 NVS units
before PVP, which decreased to 2.1 +/- A 1.6, 2.0 +/- A 1.5 and 2.0 +/-
A 1.5 NVS units the day after surgery and at 12 and 24 months after
surgery, respectively. Group B presented with a mean pain score of 8.1
+/- A 1.3 NVS units before PVP, which decreased to 2.2 +/- A 1.3, 2.0
+/- A 1.5, and 2.1 +/- A 1.6 NVS units the day after surgery and at 12
and 24 months after surgery, respectively. Overall pain decrease and
mobility improvement throughout the follow-up period presented no
statistical significance neither between the two groups nor between
different underlying aetiology. Reported cement leakages presented no
statistical significance between the two groups (p = 0.365).
PVP is an efficient and safe technique for symptomatic vertebral
fractures independently of the vertebrae number treated per session