Percutaneous ablation techniques for renal cell carcinoma: current status and future trends

Percutaneous ablation is an increasingly applied technique for the treatment of localized renal tumors, especially for elderly or co-morbid patients, where co-morbidities increase the risk of traditional nephrectomy. Ablative techniques are technically suited for the treatment of tumors generally not exceeding 4 cm, which has been set as general consensus cutoff and is described as the upper threshold of T1a kidney tumors. This threshold cutoff is being challenged, but with still limited evidence. Percutaneous ablation techniques for the treatment of renal cell carcinoma (RCC) include radiofrequency ablation, cryoablation, laser or microwave ablation; the main advantage of all these techniques over surgery is less invasiveness, lower complication rates and better patient tolerability. Currently, international guidelines recommend percutaneous ablation either as intervention for frail patients or as a first line tool, provided that the tumor can be radically ablated. The purpose of this article is to describe the basic concepts of percutaneous ablation in the treatment of RCC. Controversies concerning techniques and products and the need for patient-centered tailored approaches during selection among the different techniques available will be discussed

CIRSE Standards of Practice on Thermal Ablation of Bone Tumours.

Percutaneous thermal ablation is an effective, minimally invasive means of treating a variety of focal benign and malignant osseous lesions. To determine the role of ablation in individual cases, multidisciplinary team (MDT) discussion is required to assess the suitability and feasibility of a thermal ablative approach, to select the most appropriate technique and to set the goals of treatment i.e. curative or palliative. This document will presume the indication for treatment is clear and approved by the MDT and will define the standards required for the performance of each modality. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of thermal ablation of bone tumours. The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in thermal ablation of bone tumours. The writing group reviewed the existing literature on thermal ablation of bone tumours, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects from 2009 to 2019. Selected studies published in 2020 and 2021 during the course of writing these standards were subsequently included. The final recommendations were formulated through consensus. Recommendations were produced for the performance of thermal ablation of bone tumours taking into account the biologic behaviour of the tumour and the therapeutic intent of the procedure. Recommendations are provided based on lesion characteristics and thermal modality, for the use of tissue monitoring and protection, and for the appropriately timed application of adjunctive procedures such as osseus consolidation and transarterial embolisation. Percutaneous thermal ablation has an established role in the successful management of bone lesions, with both curative and palliative intent. This Standards of Practice document provides up-to-date recommendations for the safe performance of thermal ablation of bone tumours

Avoiding complications in percutaneous osteoplasty

Percutaneous osteoplasty techniques include cement injection either solely performed or in combination to hardware such as cannulated screws, peek implants or other metallic hardware including micro-needles and Kirschner wires. Depending on bone and local forces applied, fracture and osseous defect characteristics as well as symptoms and operator's preference percutaneous osteoplasty techniques include cementoplasty, fixation by internal cemented screw and augmented osteoplasty. Literature data support efficacy and safety of these techniques, focusing mainly on the minimal invasive nature of these approaches along with minimum overall morbidity and mortality and an impressive pain reduction effect. Percutaneous osteoplasty techniques in the peripheral skeleton are indicated for pain palliation or for prevention of impeding pathologic fractures. Although safe, osteoplasty techniques are not without risk of complications and adverse events. Complications are classified based either upon clinical impact or timing of occurrence; complications’ reviewing and grading should be performed on terms of a uniform and accurate reproducible and validated categorization system. Significant factors for avoiding complications in percutaneous osteoplasty techniques include proper training, patient- and lesion-tailored approach, high-quality imaging guidance, sterility as well as appropriate selection of technique and materials. The present article reports the possible complications of percutaneous osteoplasty techniques and reviews the prerequisites necessary for avoiding and managing these adverse events. © 2022 Elsevier Inc

Pain management: The rising role of interventional oncology

Patients with early or metastatic cancer may suffer from pain of different origins. The vast majority of these patients are not adequately treated by means of systemic analgesia and radiotherapy. Percutaneous neurolysis is performed using chemical agents or thermal energy upon sympathetic nervous system plexus for pain reduction and life quality improvement. Ablation and vertebral augmentation are included in clinical guidelines for metastatic disease. As far as the peripheral skeleton is concerned bone augmentation and stabilization can be performed by means of cement injection either solely performed or in combination to cannulated screws or other metallic or peek implants. This review describes the basic concepts of interventional oncology techniques as therapies for cancer pain management. The necessity for a tailored-based approach applying different techniques for different cases and locations will be addressed. © 2017 Editions françaises de radiologi

Cardiovascular complications of metastatic colorectal cancer treatment

Colorectal cancer (CRC) is the third most common malignancy in men and the second in women and the fourth cause of cancer death. Survival rates decrease greatly according to the stage of the disease at the time of diagnosis. Approximately 50% of CRC patients will develop metastatic disease (mCRC) with survival and prognosis depending on the timing of metastatic development, and the localization and number of metastatic sites. The overall survival of patients with mCRC has been significantly improved over the last years from approximately 12 to more than 30 months with the integration of multiple cytotoxic agents and targeted therapies. The optimal therapeutic strategy depends on the general condition and performance status of the patient, the resectability or not of metastases and the mutational status of the tumor in terms of BRAF and RAS. Cardiovascular (CV) complications of mCRC treatment may develop peri-operatively and mostly during chemotherapy. During first-line treatment, 90% of patients experience more than one adverse event (AE) and 39% of them are CV. Angina, hypertension, arrhythmias, arterial and venous thrombotic events (VTEs), heart failure (HF) and death are the main CV events resulting from the applied chemotherapy regimens. Cardio-oncology consultation for identification of high-risk patients, proper monitoring during and after therapy and timely intervention would allow the successful prevention and the efficient management of cardiotoxicity, rendering the patient able to receive the indicated cancer therapy and improving the overall outcome. © Journal of Gastrointestinal Oncology. All rights reserved

A Technical Report on the Performance of Percutaneous Cryoneurolysis of Splanchnic Nerves for the Treatment of Refractory Abdominal Pain in Patients with Pancreatic Cancer: Initial Experience

Purpose: To report our preliminary results upon feasibility, efficacy and safety of percutaneous splanchnic nerves cryoneurolysis for the treatment of abdominal pain refractory to conservative medication in patients with pancreatic cancer Materials Methods: Institutional database research (retrospective review of prospectively collected data from April 2019 till August 2020) identified 5 patients with pancreatic cancer and pain refractory to conservative medication who underwent percutaneous cryoneurolysis of splanchnic nerves. In all patients, percutaneous cryoneurolysis was performed with posterolateral paravertebral approach using a 17 Gauge cryoprobe under computed tomography guidance and local anesthesia. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with visual analog scale (VAS) units. Results: Mean patient age was 63.81 years (male–female: 3–2). Mean pain score prior to cryoanalgesia of splanchnic nerves was 9.4 VAS units. This score was reduced to a mean value of 2.6, 2.6 and 3 VAS units at 1, 3 and 6 months of follow-up, respectively. All patients reported significantly reduced analgesic usage. No complication was reported according to the CIRSE classification system. The mean procedure time was 44.4 min (range 39–50 min), including local anesthesia, cryoprobe(s) placement, ablation and post-procedural CT evaluation. Conclusion: Percutaneous cryoanalgesia of the splanchnic nerves is a minimally invasive, safe and effective procedure for pancreatic cancer pain relief. A larger, randomized trial is justified to substantiate these findings. © 2021, Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)

Percutaneous cryoanalgesia for pain palliation: Current status and future trends

Cryoanalgesia, otherwise termed cryoneurolysis, refers to application of extreme cold upon peripheral nerves for palliation of pain associated to nerve lesions or biomechanical syndromes of neoplastic and non-neoplastic substrate. Application of cryoanalgesia initiates a cascade of pathophysiologic events interrupting nerve conduction of painful stimuli without irreversible nerve damage. Cryoanalgesia is considered a safe procedure with minimal risk of complications when performed with percutaneous approaches under imaging guidance. In the era of an opioid overdose crisis, cryoanalgesia can be proposed as an alternative aiming at controlling pain and improving life quality. Imaging guidance has substituted open surgical and nerve stimulation approaches in nerve identification, significantly contributing to the minimally invasive character of percutaneous approaches. Ultrasound or computed tomography can serve as low cost, ideal guiding techniques due to their abilities for precise anatomic delineation, high spatial resolution and good tissue contrast. The purpose of this review is to become familiar with the most common imaging guided percutaneous cryoanalgesia indications, to learn about different technical considerations during performance providing the current evidence. Controversies concerning products will be addressed. © 2020 Société française de radiologi

Percutaneous palliative care interventions in the cancer patient

Patients with incurable cancer face lots of problems before they expire. Complications resulting from cancer or its treatment are a significant determinant of the quality of life of cancer patients. It is of outmost importance to make use of all treatment options in order to improve their survival and quality of life. Nowadays, available are a number of Interventional Radiology procedures that are minimally invasive, can be performed under local anesthesia or conscious sedation and are indispensable in helping patient through the cancer disease process. These techniques can be broadly classified into drainage of fluid collections, decompression and relief of obstruction, pain and tumor burden reduction, vascular and gastrointestinal tract access as well as hemostasis. The purpose of this article is to describe the basic concepts of minimally invasive techniques applied as palliative care therapies in the cancer patients. Controversies concerning techniques and products and the need for patient-centered tailored approaches will be discussed. © Chinese Clinical Oncology. All rights reserved