Thermal ablation in the management of oligometastatic colorectal cancer

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

Electrochemotherapy in radiotherapy-resistant epidural spinal cord compression in metastatic cancer patients

Objective: To report efficacy and safety of percutaneous electrochemotherapy (ECT) in patients with radiotherapy-resistant metastatic epidural spinal cord compression (MESCC). Material/ methods: This retrospective study analyzed all consecutive patients treated with bleomycin-based ECT between February-2020 and September-2022 in a single tertiary referral cancer center. Changes in pain were evaluated with the Numerical Rating Score (NRS), in neurological deficit with the Neurological Deficit Scale, and changes in epidural spinal cord compression were evaluated with the epidural spinal cord compression scale (ESCCS) using an MRI. Results: Forty consecutive solid tumour patients with previously radiated MESCC and no effective systemic treatment options were eligible. With a median follow-up of 5.1 months [1-19.1], toxicities were temporary acute radicular pain (25%), prolonged radicular hypoesthesia (10%), and paraplegia (7.5%). At 1 month, pain was significantly improved over baseline (median NRS: 1.0 [0-8] versus 7.0 [1.0-10], P < .001) and neurological benefits were considered as marked (28%), moderate (28%), stable (38%), or worse (8%). Three-month follow-up (21 patients) confirmed improved over baseline (median NRS: 2.0 [0-8] versus 6.0 [1.0-10], P < .001) and neurological benefits were considered as marked (38%), moderate (19%), stable (33.5%), and worse (9.5%). One-month post-treatment MRI (35 patients) demonstrated complete response in 46% of patients by ESCCS, partial response in 31%, stable disease in 23%, and no patients with progressive disease. Three-month post-treatment MRI (21 patients) demonstrated complete response in 28.5%, partial response in 38%, stable disease in 24%, and progressive disease in 9.5%. Conclusions: This study provides the first evidence that ECT can rescue radiotherapy-resistant MESCC

Factors regulating ozone over the United States and its export to the global atmosphere

The factors regulating summertime O3 over the United States and its export to the global atmosphere are examined with a 3-month simulation using a continental scale, three-dimensional photochemical model. It is found that reducing NOx emissions by 50% from 1985 levels would decrease rural O3 concentrations over the eastern United States by about 15% under almost all meteorological conditions, while reducing anthropogenic hydrocarbon emissions by 50% would have less than a 4% effect except in the largest urban plumes. The strongly NOx-limited conditions in the model reflect the dominance of rural areas as sources of O3 on the regional scale. The correlation between O3 concentrations and temperature observed at eastern U.S. sites is attributed in part to the association of high temperatures with regional stagnation, and in part to an actual dependence of O3 production on temperature driven primarily by conversion of NOx to peroxyacetylnitrate (PAN). The net number of O3 molecules produced per molecule of NOx consumed (net O3 production efficiency, accounting for both chemical production and chemical loss of O3) has a mean value of 6.3 in the U.S. boundary layer; it is 3 times higher in the western United States than in the east because of lower NOx concentrations in the west. Approximately 70% of the net chemical production of O3 in the U.S. boundary layer is exported (the rest is deposited). Only 6% of the NOx emitted in the United States is exported out of the U.S. boundary layer as NOx or PAN, but this export contributes disproportionately to total U.S. influence on global tropospheric O3because of the high O3 production efficiency per unit NOx in the remote troposphere. It is estimated that export of U.S. pollution supplies 8 Gmol O3 d−1 to the global troposphere in summer, including 4 Gmol d−1 from direct export of O3 out of the U.S. boundary layer and 4 Gmol d−1 from production of O3 downwind of the United States due to exported NOx. This U.S. pollution source can be compared to estimates of 18–28 Gmol d−1 for the cross-tropopause transport of O3 over the entire northern hemisphere in summer

Simulation of summertime ozone over North America

The concentrations of O3 and its precursors over North America are simulated for three summer months with a three-dimensional, continental-scale photochemical model using meteorological input from the Goddard Institute for Space Studies (GISS) general circulation model (GCM). The model has 4°×5° grid resolution and represents non linear chemistry in urban and industrial plumes with a subgrid nested scheme. Simulated median afternoon O3 concentrations at rural U.S. sites are within 5 ppb of observations in most cases, except in the south central United States where concentrations are overpredicted by 15–20 ppb. The model captures successfully the development of regional high-O3 episodes over the northeastern United States on the back side of weak, warm, stagnant anticyclones. Simulated concentrations of CO and nonmethane hydrocarbons are generally in good agreement with observations, concentrations of NOx are underpredicted by 10–30%, and concentrations of peroxyacylnitrates (PANs) are overpredicted by a factor of 2 to 3. The overprediction of PANs is attributed to flaws in the photochemical mechanism, including excessive production from oxidation of isoprene, and may also reflect an underestimate of PANs deposition. Subgrid nonlinear chemistry as captured by the nested plumes scheme decreases the net O3 production computed in the United States boundary layer by 8% on average

Percutaneous Fixation of Impending Fracture of the Hip

According to the literature, prophylactic consolidation of proximal femur lytic metastasis the is recommended when the Mirels' score is above 8. Osteoplasty (cementoplasty of proximal femur) alone provides inadequate consolidation. Various mini-invasive technics, augmented osteoplasties, have been proposed for better long-term consolidation. The aim of this review is to detail the augmented osteoplasty techniques described in the literature and to report their safeties and efficacies to prevent pathological fracture of the proximal femur. A PubMed research found 8 studies that evaluated augmented osteoplasty of the proximal femur in cancer patients. All devices demonstrate adequate safety and low rate of secondary pathological fractures

Factors regulating ozone over the United States and its export to the global atmosphere

The factors regulating summertime O3 over the United States and its export to the global atmosphere are examined with a 3-month simulation using a continental scale, three-dimensional photochemical model. It is found that reducing NOx emissions by 50% from 1985 levels would decrease rural O3 concentrations over the eastern United States by about 15% under almost all meteorological conditions, while reducing anthropogenic hydrocarbon emissions by 50% would have less than a 4% effect except in the largest urban plumes. The strongly NOx-limited conditions in the model reflect the dominance of rural areas as sources of O3 on the regional scale. The correlation between O3 concentrations and temperature observed at eastern U.S. sites is attributed in part to the association of high temperatures with regional stagnation, and in part to an actual dependence of O3 production on temperature driven primarily by conversion of NOx to peroxyacetylnitrate (PAN). The net number of O3 molecules produced per molecule of NOx consumed (net O3 production efficiency, accounting for both chemical production and chemical loss of O3) has a mean value of 6.3 in the U.S. boundary layer; it is 3 times higher in the western United States than in the east because of lower NOx concentrations in the west. Approximately 70% of the net chemical production of O3 in the U.S. boundary layer is exported (the rest is deposited). Only 6% of the NOx emitted in the United States is exported out of the U.S. boundary layer as NOx or PAN, but this export contributes disproportionately to total U.S. influence on global tropospheric O3because of the high O3 production efficiency per unit NOx in the remote troposphere. It is estimated that export of U.S. pollution supplies 8 Gmol O3 d−1 to the global troposphere in summer, including 4 Gmol d−1 from direct export of O3 out of the U.S. boundary layer and 4 Gmol d−1 from production of O3 downwind of the United States due to exported NOx. This U.S. pollution source can be compared to estimates of 18–28 Gmol d−1 for the cross-tropopause transport of O3 over the entire northern hemisphere in summer