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1.
Simon Sin-man Wong Brian Tsz-yau Yuen Ryan Ka-lok Lee Chris Siu-chun Tsai Yue Sun Cheung Kit Fai Lee Simon Chun Ho Yu 《Journal of vascular and interventional radiology : JVIR》2019,30(3):440-444
Purpose
Portal vein (PV) embolization (PVE) is traditionally performed via a PV sheath with selective embolization of PV branches. Here, the efficacy and safety of PVE with the use of only an 18-gauge needle is reported.Materials and Methods
Consecutive patients who underwent PVE from 2009 through 2017 were retrospectively reviewed. Forty-five patients (mean age, 60 y ± 7.6; 38 men) underwent 45 PVE procedures. Hepatocellular carcinoma, cholangiocarcinoma, and metastases accounted for 26 (58%), 13 (29%), and 6 (13%) patients, respectively. PVE was performed by puncturing a branch of right PV with an 18-gauge needle under US guidance. Via the same needle, direct portography was performed, followed by PVE with an N-butyl cyanoacrylate/Lipiodol mixture. Percentage increase of future liver remnant (FLR) volume and increase in ratio of FLR to total liver volume were estimated as measures of efficacy. Complications were reported according to Society of Interventional Radiology classification. Fluoroscopy time, procedure time, and dose–area product (DAP) were recorded.Results
Technical success rate was 100%. The median DAP, fluoroscopy time, and procedure time were 74,387 mGy·cm2 (IQR, 90,349 mGy·cm2), 3.5 min (IQR, 2.10 min), and 24 min (IQR, 10.5 min). Among the 23 patients with complete CT volumetry data, mean increase in the ratio of FLR to total liver volume and percentage increase of FLR volume were 12.5% ± 7.7 and 50% ± 33, respectively. There were 3 minor complications (asymptomatic nonocclusive emboli in FLR) and 3 major complications (1 hepatic vein emboli, 1 subphrenic collection, and 1 hepatic infarct).Conclusions
PVE via a sheathless 18-gauge needle approach is feasible, with satisfactory FLR hypertrophy. 相似文献2.
Ning Lyu Yanan Kong Tao Pan Luwen Mu Shaolong Li Yaru Liu Haijing Deng Jibin Li Ming Shi Li Xu Rongping Guo Minshan Chen Peihong Wu Ming Zhao 《Journal of vascular and interventional radiology : JVIR》2019,30(3):349-357.e2
Purpose
To compare treatment with hepatic arterial infusion of chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC) with both extrahepatic spread (EHS) and intrahepatic tumor and patients with intrahepatic tumor only.Materials and Methods
This single-center retrospective study comprised 116 patients with advanced HCC with both intrahepatic tumor and EHS (EHS group; n = 50) or with intrahepatic tumor only (non-EHS group; n = 66) treated with HAIC including oxaliplatin, fluorouracil, and leucovorin between June 2014 and July 2016. Overall survival (OS) and radiologic responses to treatment were determined and compared between the 2 groups.Results
Both the objective response rate and the clinical benefit rate were higher in the non-EHS group than in the EHS group (37.9% vs 16% objective response rate, P = .010; 81.8% vs 62% clinical benefit rate, P = .017). Median OS was not statistically different between the 2 groups (14.8 months vs 9.8 months, P = .068). Subgroup analysis of OS found that patients with lung metastases survived for a shorter time (OS 7 months) than patients with other metastatic sites (P = .003) and patients free of metastases (P = .001).Conclusions
HAIC is a potential treatment option for advanced HCC with limited extrahepatic metastases in a population with hepatitis B virus infection. 相似文献3.
Ron C. Gaba James T. Bui Rajyasree Emmadi Janesh Lakhoo 《Journal of vascular and interventional radiology : JVIR》2017,28(6):906-912.e1
Purpose
To test the hypothesis that a modified approach to portal vein embolization (PVE)—termed ablative liver partition (ALP) and PVE (ALP-PVE)—is feasible and results in greater future liver remnant (FLR) growth compared with PVE alone in a rabbit model.Materials and Methods
Eighteen rabbits (median weight, 2.7 kg) underwent PVE (n = 9) or ALP-PVE (n = 9). PVE to cranial liver lobes was performed with 100–300-μm microspheres and metallic coils; the caudal lobe was spared as the FLR. In the ALP-PVE cohort, a liver partition between cranial and caudal lobes was created by using microwave ablation (40 W, 1 min). Animals were euthanized and livers were harvested on postprocedure day 7. Caudal and cranial liver lobes were weighed after 4 weeks of oven drying. Ki-67 immunohistochemistry was used to quantify liver mitotic index. ALP-PVE feasibility was determined based on procedure technical success. Standardized FLR (sFLR; ie, FLR divided by whole liver weight) and mitotic index were compared between PVE and ALP-PVE groups by two-tailed independent-samples Mann–Whitney U test.Results
One PVE-group rabbit died during anesthesia induction and was excluded from technical success calculation. Eight of 8 (100%) and 8 of 9 rabbits (89%) underwent technically successful PVE and ALP-PVE, respectively. There was no difference in sex or weight distribution between groups. sFLR (0.32 vs 0.29; P = .022) and mitotic index (17.5% vs 6.2%; P = .051) were higher in ALP-PVE vs PVE caudal lobes when the first “learning-curve” case from each group was excluded.Conclusions
ALP-PVE is feasible and may stimulate greater FLR growth compared with PVE in a rabbit model. 相似文献4.
Jaehyun Yim Dongho Hyun Sung Ki Cho Kwang Bo Park Hong Suk Park Sung Wook Shin Dong Wook Choi Seonwoo Kim Sung-Young Baek Sang Yub Lee 《Journal of vascular and interventional radiology : JVIR》2019,30(1):31-37
Purpose
To retrospectively investigate the impact of hyperbilirubinemia on future liver remnant (FLR) volume after percutaneous transhepatic portal vein embolization (PVE) and incidence of post-hepatectomy liver failure in primary biliary malignancy.Materials and Methods
Eighty-seven patients (62 men, overall mean age 66.9 y) who underwent PVE, using Gelfoam and coils before major hepatectomy between January 2004 and June 2016, were included in this study and divided into a hyperbilirubinemia (serum total bilirubin level at PVE 5.80 ± 2.44 mg/dL; n = 41) group and a control group (1.09 ± 0.73 mg/dL; n = 46). Liver volume was measured from computerized tomographic data before and 18.5 days, on average, after PVE. Correlation between FLR hypertrophy (degree of hypertrophy and percentage increase in future liver remnant [%FLR]) and total bilirubin were analyzed. FLR hypertrophy and incidence of post-hepatectomy liver failure were compared. Simple and multiple regressions were used for univariable and multivariable analyses, respectively.Results
Mean FLR volumes before and after PVE were 529.1 cm3 and 640.5 cm3, respectively. Degree of hypertrophy and %FLR were 7.64 ± 4.22 and 21.77 ± 13.34, respectively. There was no significant correlation between FLR hypertrophy and total bilirubin (P > .5). FLR hypertrophy was not significantly different between the 2 groups. Planned major hepatectomy was performed in 73 patients (83.9%). Grade 3 post-hepatectomy liver failure occurred in 6 patients (8.2%; 2 in the hyperbilirubinemia group and 4 in the control group), and its incidence was not significantly different between the groups (P = .354).Conclusions
Hyperbilirubinemia at the time of PVE seems to have no effect on FLR hypertrophy. The incidence of grade 3 post-hepatectomy liver failure is not likely to be influenced, either. 相似文献5.
Christer Ruff Gerd Grözinger Roland Syha Stefanie Elser Sasan Partovi Michael Bitzer Marius Horger Konstantin Nikolaou Ulrich Grosse 《Journal of vascular and interventional radiology : JVIR》2019,30(3):380-389.e4
Purpose
To compare different imaging techniques (volume perfusion CT, cone-beam CT, and dynamic gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid–enhanced dynamic contrast–enhanced MR imaging with golden-angle radial sparse parallel MR imaging) in evaluation of transarterial chemoembolization of hepatocellular carcinoma (HCC) using radiopaque drug-eluting embolics (DEE).Materials and Methods
MR imaging and CT phantom investigation of radiopaque DEE was performed. In the clinical portion of the study, 13 patients (22 HCCs) were prospectively enrolled. All patients underwent cross-sectional imaging before and after transarterial chemoembolization using 100–300 μm radiopaque DEE. Qualitative assessment of images using a Likert scale was performed.Results
In the phantom study, CT-related beam-hardening artifacts were markedly visible at a concentration of 12% (v/v) radiopaque DEE; MR imaging demonstrated no significant detectable signal intensity changes. Imaging obtained before transarterial chemoembolization showed no significant difference regarding tumor depiction. Visualization of tumor feeding arteries was significantly improved with volume perfusion CT (P < .001) and cone-beam CT (P = .002) compared with MR imaging. Radiopaque DEE led to significant decrease in tumor depiction (P = .001) and significant increase of beam-hardening artifacts (P = .012) using volume perfusion CT before versus after transarterial chemoembolization. Greater residual arterial tumor enhancement was detected with MR imaging (10 HCCs) compared with volume perfusion CT (8 HCCs) and cone-beam CT (6 HCCs).Conclusions
Using radiopaque DEE, the imaging modalities provided comparable early treatment assessment. In HCCs with dense accumulation of radiopaque DEE, treatment assessment using volume perfusion CT or cone-beam CT may be impaired owing to resulting beam-hardening artifacts and contrast stasis. Dynamic contrast–enhanced MR imaging may add value in detection of residual arterial tumor enhancement. 相似文献6.
Kyung Ah Kim Sun Young Choi Min Uk Kim Seung Yon Baek Sang Hui Park Kwon Yoo Tae Hun Kim Hwi Young Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):358-369
Purpose
To evaluate efficacy of cone-beam CT–based liver perfusion mapping obtained immediately following conventional transarterial chemoembolization of hepatocellular carcinoma (HCC) for assessing tumor vascularity, technical success of chemoembolization, and treatment response.Materials and Methods
From July 2015 to June 2016, 35 patients with 57 HCCs who underwent cone-beam CT with post-processing software via conventional transarterial chemoembolization for HCC and follow-up examination were included. Three reviewers evaluated technical success on angiography, unenhanced cone-beam CT, contrast-enhanced cone-beam CT, and cone-beam CT–based liver perfusion mapping after transarterial chemoembolization per tumor and per patient. Parenchymal blood volume (PBV) was measured. Treatment response was determined on follow-up CT, MR imaging, or histopathology according to modified Response Evaluation Criteria In Solid Tumors. Diagnostic performance for detection of a viable tumor was evaluated using multiple logistic regression with C-statistics.Results
Treatment response was 38, 17, 2, and 0 for complete response, partial response, stable disease, and progressive disease per tumor and 18, 15, 2, and 0 per patient. In multiple logistic regression, unenhanced cone-beam CT, contrast-enhanced cone-beam CT, cone-beam CT–based liver perfusion mapping, mean value of PBV, and maximum value of PBV of tumor were significant in response assessment for per tumor and per patient (per tumor, all P < .001; per patient, P = .015, P = .001, P < .001, P = .020, and P = .032). Mean value of PBV of tumor was excellent for evaluating technical success with the highest C-statistic (0.880 and 0.920 for per tumor and per patient), followed by that of visual assessment of cone-beam CT–based liver perfusion mapping (0.864 and 0.908).Conclusions
Cone-beam CT–based liver perfusion mapping provided reliable images to evaluate technical success after transarterial chemoembolization of HCC by qualitative visual assessment and quantitative perfusion values. 相似文献7.
Jong Eun Lee Jin Woong Kim Hyoung Ook Kim Byung Chan Lee Young Hoe Hur Sung Bum Cho Yong Soo Cho Hyun Ju Seon DongHun Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):370-379.e4
Purpose
To evaluate the effects of the degree of ethiodized oil accumulation achieved by transarterial chemoembolization followed by radiofrequency (RF) ablation on the treatment efficacy for a single intermediate-sized hepatocellular carcinoma (HCC).Materials and Methods
A total of 153 consecutive patients who underwent chemoembolization and RF ablation for a single intermediate-sized HCC (2–5 cm) were included. On the basis of the degree of ethiodized oil accumulation in HCC on cone-beam CT images, patients who underwent chemoembolization and RF ablation were classified into 2 groups: compact accumulation (≥ 75%) and noncompact accumulation (< 75%). The rates of cumulative local tumor progression (LTP), disease-free survival (DFS), and overall survival (OS) were compared between groups.Results
Of the 153 patients, 89 were classified into the compact ethiodized oil accumulation group and 64 in the noncompact ethiodized oil accumulation group. There were no significant differences in patient demographic or HCC characteristics between groups except for the incidence of liver cirrhosis (P = .038) and the tumor margin morphology (P = .008). The cumulative LTP rate was significantly lower in the compact accumulation group than in the noncompact accumulation group (P = .013). There were no significant differences in the incidences of complications, DFS rates (P = .055), or OS rates (P = .184).Conclusions
The degree of ethiodized oil accumulation does not play a role in decreasing the OS or DFS rate after chemoembolization and RF ablation for intermediate-sized HCC; however, it may contribute to reducing the rate of LTP. 相似文献8.
Introduction
Incidental liver irradiation during breast radiotherapy can increase the risk of second primary malignancy and induce adverse inflammatory states. This study establishes the volume of liver irradiated during free-breathing breast radiotherapy. Novel associations between liver dose-volume data and systemic interleukin-6 soluble receptor and blood counts are evaluated.Methods
The volume of liver within the 10%, 50% and 90% isodose was determined for 100 women with stage 0 to II breast carcinoma undergoing 40Gy in 15 fractions over three weeks tangential irradiation. Blood counts and interleukin 6 soluble receptor concentration were recorded before, during and four weeks after radiotherapy. Dose-volume data for right-sided treatments was associated with longitudinal measures at bivariate and multivariable levels.Results
A maximum of 226cm3 (19%), 92 cm3 (8%) and 62 cm3 (5%) of the liver was irradiated within the 10%, 50% and 90% isodose. Liver irradiation was almost exclusively a feature of the 52 right-sided treatments and was strongly correlated with breast volume (ρ = 0.7, p < 0.0001). Liver V10% was significantly associated with interleukin-6 soluble receptor concentration four weeks post-radiotherapy (beta = 0.38, p = 0.01) after controlling for theoretical confounding variables.Conclusion
Up to 8% of the liver is irradiated within the primary beam during local right-sided breast radiotherapy. Select use of a deep inspiration breath hold technique would reduce this volume, and minimise the risk of radiation-induced malignancy and acute systemic elevation of inflammatory interleukin 6 soluble receptor. 相似文献9.
Marcelina G. Perez Magali Fassiotto Jonathan Altamirano Gloria L. Hwang Yvonne Maldonado Shellie Josephs Daniel Y. Sze Nishita Kothary 《Journal of vascular and interventional radiology : JVIR》2019,30(4):579-583
Purpose
To investigate the current state of gender diversity among invited coordinators at the Society of Interventional Radiology (SIR) Annual Scientific Meeting and to compare the academic productivity of female interventional radiologists to that of invited male coordinators.Materials and Methods
Faculty rosters for the SIR Annual Scientific Meetings from 2015 to 2017 were stratified by gender to quantify female representation among those asked to lead and coordinate podium sessions. To quantify academic productivity and merit, H-index, publications, and authorship by females over a 6-year period (2012–2017) were statistically compared to that of recurring male faculty.Results
From 2015 to 2017, women held 7.1% (9/126), 4.3%, (8/188), and 13.7% (27/197) of the available coordinator positions for podium sessions, with no representation at the plenary sessions, and subject matter expertise was concentrated in economics and education. Academic productivity of the top quartile of published female interventional radiologists was statistically similar to that of the invited male faculty (H-index P = .722; total publications P = .689; and authorship P = .662).Conclusions
This study found that senior men dominate the SIR Annual Scientific Meeting, with few women leading or coordinating the podium sessions, despite their established academic track record. 相似文献10.
Junqing Lin Han Jiang Weizhu Yang Na Jiang Qubin Zheng Ning Huang Xiaolong Wang Ang Li Jingyao Huang 《Brachytherapy》2019,18(2):233-239
Purpose
The aims of this study were to evaluate treatment responses and predictive factors for overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with iodine-125 (125I) brachytherapy.Methods and Materials
Seventy-seven HCC patients with PVTT underwent 125I brachytherapy after transcatheter arterial chemoembolization. Clinical, laboratory, and radiological evaluation were performed before and after treatment, as well as at 4–6 weeks intervals for 7 years to assess the efficacy and toxicity of therapy. Treatment response was assessed using modified response evaluation criteria in solid tumors. OS and predictive factors for each subgroup were evaluated after treatment.Results
In total, 11 patients (14.29%) achieved complete response, and 41 patients (53.25%) achieved partial response. The response rate (complete response + partial response) was 67.53% (52/77). The median OS was 9 months. The multivariable Cox regression model indicated that post-treatment tumor size with PVTT (p = 0.016, hazard ratio [HR] = 1.889, 95% confidence interval [CI]: 1.127 to 3.166) and baseline hemoglobin (p = 0.013, HR=0.518, 95% CI: 0.308 to 0.872) and alkaline phosphatase (p = 0.002, HR=2.275, 95% CI: 1.338 to 3.868) levels were significant independent predictors of OS.Conclusions
125I brachytherapy results in favorable treatment responses in HCC patients with PVTT. Notably, post-treatment tumor size and baseline hemoglobin and alkaline phosphatase levels are significant independent predictive factors for OS and provide the most predictive information regarding OS. 相似文献11.
Hyo-jae Lee Jin Woong Kim Young Hoe Hur Sung Bum Cho Byung Chan Lee Byung Kook Lee Eu Chang Hwang Yong Soo Cho Hyun Ju Seon 《Journal of vascular and interventional radiology : JVIR》2019,30(3):284-292.e1
Purpose
To retrospectively compare long-term outcomes of conventional chemoembolization plus radiofrequency (RF) ablation vs those of surgical resection in patients with a single 3–5-cm hepatocellular carcinoma (HCC).Materials and Methods
From January 2008 to December 2017, 139 of 623 patients who underwent surgical resection and 60 of 186 patients who underwent chemoembolization/RF ablation in a single center were compared with respect to local tumor progression (LTP), intrahepatic distant recurrence (IDR), disease-free survival (DFS), overall survival (OS), major complications, and hospital stay before and after propensity-score matching.Results
Mean follow-up periods were similar in the chemoembolization/RF ablation and surgical resection groups (41.9 mo vs 48.4 mo). Three (5%) and 17 (28.3%) patients in the chemoembolization/RF ablation group and 12 (8.6%) and 57 (41.0%) patients in the surgical resection group showed LTP and IDR (P = .366 and P =.114, respectively). At 1, 3, and 5 years, respective DFS rates were 88.1%, 65.3%, and 49.0% for chemoembolization/RF ablation and 84.2%, 58.2%, and 46.5% for surgical resection (P = .294). Moreover, respective OS rates were 95.0%, 73.5%, and 54.0% for chemoembolization/RF ablation and 97.1%, 87.4%, and 75.0% for surgical resection (P = .055). After matching (n = 52), therapeutic outcomes remained similar (P = .370, P = .110, P = .230, and P = .760, respectively). Surgical resection was associated with higher complication rates (P = .015) and longer hospital stays (8.4 d ± 3.7 vs 16.9 d ± 7.0; P < .001).Conclusions
Conventional chemoembolization combined with RF ablation may be feasible for single 3–5-cm HCCs, with comparable therapeutic outcomes vs surgical resection and shorter hospital stays. 相似文献12.
Anish Ghodadra Minzhi Xing Di Zhang Hyun S. Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):293-297
Purpose
To analyze the cost-effectiveness of radioembolization in the treatment of intrahepatic cholangiocarcinoma (ICC) using the Surveillance, Epidemiology, and End Results (SEER) Medicare cancer database.Materials and Methods
Cost as measured by total treatment-related reimbursement in patients diagnosed with ICC who received chemotherapy alone or chemotherapy and yttrium-90 radioembolization was assessed in the SEER Medicare cancer database (1999–2012). Survival analysis was performed, and incremental cost-effectiveness ratios were generated.Results
The study included 585 patients. Average age at diagnosis was 71 years (standard deviation: 9.9), and 52% of patients were male. Twelve percent of patients received chemotherapy with radioembolization (n = 72), and 88% of patients (n = 513) received only chemotherapy. Median survival was 1043 days (95% confidence interval [CI]: 894–1244) for chemotherapy plus radioembolization and 811 days (95% CI: 705–925) for chemotherapy alone (P = .02). Patients who received combination therapy were slightly younger (71 vs 69 years, P = .03). No significant differences were observed between treatment groups in age at treatment, sex, race, or city size. Multivariable analysis showed a hazard ratio for progression for combination therapy versus chemotherapy alone of 0.76 (95% CI: 0.59–0.97, P = .029). The incremental cost-effectiveness ratio, a measure of cost of each added year of life, was $50,058.65 per year (quartiles: $11,454.63, $52,763.28).Conclusions
Combination therapy of ICC with chemotherapy and radioembolization is associated with higher median survival and can be a cost-effective treatment, with a median cost of $50,058.65 per additional year of survival. 相似文献13.
Kichang Han Ki Woong Yoon Jin Hyoung Kim Gyoung Min Kim 《Journal of vascular and interventional radiology : JVIR》2019,30(3):428-434
Purpose
To evaluate the safety and efficacy of bronchial artery embolization (BAE) in patients with primary lung cancer-related hemoptysis and to identify factors associated with hemoptysis-free survival.Methods
Data from 84 patients with primary lung cancer (non-small cell [n = 74] and small cell [n = 10]) who underwent BAE from 1997 to 2018 for the management of hemoptysis were retrospectively reviewed. Of these, 53 patients had stage IV lung cancer. The hemoptysis volume prior to initial BAE was trivial (blood-tinged sputum) in 21 patients, moderate (< 300 mL per 24 hours) in 34 patients, and massive (> 300 mL per 24 hours) in 29 patients.Results
Technical success, defined as the ability to selectively embolize the abnormal vessel, was achieved in 83 patients (98.8%), and clinical success was achieved in 69 (82.1%) patients. Polyvinyl alcohol particles were used to embolize in 51 patients, gelfoam in 15 patients, and gelfoam plus microcoils in 17 patients. Hemoptysis recurred in 20 patients (23.8%) during follow-up. The median hemoptysis-free survival and overall survival periods were both 61 days. In the clinical-success and clinical-failure groups, the median overall survival period was 99 and 9 days, respectively (P < .001). In multivariable analysis, massive hemoptysis (P = .012) and cavitary lung mass (P = .019) were predictive factors for shortened hemoptysis-free survival.Conclusions
BAE is a safe and effective approach to control hemoptysis, although the prognosis in primary lung cancer patients presenting with hemoptysis is generally poor. Massive hemoptysis and cavitary lung mass are significant predictors of shortened hemoptysis-free survival. 相似文献14.
Rodolfo Pini Gianluca Faggioli Giuseppe Indelicato Enrico Gallitto Chiara Mascoli Andrea Stella Mauro Gargiulo 《Journal of vascular and interventional radiology : JVIR》2019,30(4):503-510
Purpose
To compare perioperative and long-term outcomes of endovascular aneurysm repair (EVAR) with flared limbs (FLs) vs iliac branch devices (IBDs) for common iliac artery aneurysm to determine possible differences in outcome.Materials and Methods
From 2012 to 2017, all patients with standard EVAR with FLs and aortoiliac anatomy fit for implantation of IBDs were retrospectively selected and compared with patients with standard EVAR and IBDs. The study included 150 patients with 162 iliac treatments: 105 (65%) FLs and 57 (35%) IBDs. Iliac complications (ICs), including internal iliac artery (IIA) loss, limb thrombosis, and type 1b or type 3 endoleak, were considered at 30 days and in the follow-up period.Results
Procedural time and volume of contrast medium were significantly higher in IBD vs FL procedures (90 min ± 33 vs 70 min ± 25, P = .01; 130 mL ± 40 vs 80 mL ± 20, P = .01). Perioperative rate of ICs was similar between IBDs and FLs (0% vs 3.8% [4 IIA loss], P = .25). During 35-month median follow-up, there were 10 ICs, all in FLs group (4 IIA perioperative loss, 4 type 1b endoleak, 2 limb occlusion). By Kaplan-Meier analysis, survival free of ICs was significantly higher in IBD group after 4 years of follow-up (1 y 100% vs 96%, P = .36; 2 y 100% vs 94%, P = .14; 3 y 100% vs 91%, P = .07; 4 y 100% vs 87%, P = .03; 5 y 100% vs 78%, P = .02).Conclusions
IBDs and FLs have similar perioperative results. IBDs require longer procedural time and greater contrast medium volume; however, they are associated with lower ICs after 4 years of follow-up. 相似文献15.
Christina Small Grant Harmon John Weaver Vince Vivirito Ramon Durazo-Arvizu William Small Matthew M. Harkenrider 《Brachytherapy》2019,18(2):141-145
Purpose
Concurrent chemoradiotherapy and brachytherapy is the standard of care for locally advanced cervical cancer. Brachytherapy is an integral part of treatment and has improved overall survival. Research is needed to ascertain the planning modalities and schedules to best use resources and optimize treatment time course. We hypothesized that MRI-based brachytherapy when delivered with the described regimen would not prolong, and potentially shorten, overall treatment time as compared with CT-based brachytherapy.Methods and Materials
This study was a single-institution retrospective review within the years 2008 through 2018. Patients with cervical cancer of any stage who underwent definitive chemoradiotherapy and either CT- or MRI-based brachytherapy were included. The primary outcome variable for this study was time (in days). Overall treatment time was defined as the number of days from the first until the last day of radiotherapy. Univariate analysis was performed using Stata statistical software.Results
External beam radiotherapy doses were generally 45–50.4 Gy. CT-based and MRI-based brachytherapy were performed in 55 and 49 patients, respectively. The median treatment time for brachytherapy with CT-based planning was 19.0 days and with MRI-based planning was 9.0 days (p < 0.001). The median treatment time for total radiation therapy with CT-based planning was 53 days, and with MRI-based planning was 50 days (p = 0.781).Conclusions
This study found that MRI-based brachytherapy, when performed with the proposed regimen, did not prolong overall treatment time and significantly decreased time to complete brachytherapy in comparison with CT-based brachytherapy on nonconsecutive days. This regimen favorably impacts timely completion of treatment and uses MRI resources well within the construct of our institution. 相似文献16.
Edward L. Sutherland Mayada M. Dabajeh Stephen Zintsmaster Dana K. Feraco Matthew J. Bassett Kien V. Tran Nathan Kolderman Syed Mir Shahab Rezvani Francisco R. Davila Mary Coffey 《Journal of the American College of Radiology》2019,16(2):178-184
Purpose
Americans with limited English proficiency (LEP) face significant barriers to health care that result in health disparities in the LEP population. LEP could delay an MRI, potentially increasing morbidity and mortality in the LEP population. This study compares the time to obtain a neurological MRI in English versus non-English language preference patients.Methods
24,219 unique patients at a single health system who underwent inpatient neurological MRI were included in the study. Bivariate and multivariate analyses were used to identify characteristics predictive of time to examination (TTE) from the set: patient-preferred language, gender, race, age, performing hospital, and order priority (routine versus stat).Results
Bivariate analysis showed a longer TTE is associated with increasing age category, non-English language preference, and routine priority. A multivariate analysis showed non-English language preference effect on TTE is reduced in magnitude and is no longer significant in a model that includes age group, priority, and hospital (P = .23, effect estimate = 4%, 95% CI: ?2.5%, 11.0%). Routine order priority (P < .0001) and increasing age (P < .0001) were associated with increased TTE. In a model that included interactions, the effect of language preference did not depend on order priority (P = .59) or age group (P = .11).Conclusion
There is no significant difference in the time to obtain a neurological MRI in English versus non-English language preference patients when age, order priority, and performing hospital are accounted for. This finding supports the effectiveness of the protocols and resources in place to support patients with LEP at the sponsoring health system. 相似文献17.
Martin T. King David D. Yang Vinayak Muralidhar Brandon Mahal Santino Butler Phillip M. Devlin Larissa J. Lee Kent. W. Mouw Neil M. Martin Anthony V. D&#x;Amico Paul L. Nguyen Peter F. Orio 《Brachytherapy》2019,18(2):186-191
Purpose
External beam radiation therapy (EBRT) with low-dose-rate (LDR) brachytherapy boost has been associated with improved biochemical progression–free survival and overall survival (OS) compared with dose-escalated EBRT (DE-EBRT) alone for unfavorable-risk prostate cancer. However, it is not known whether high-dose-rate (HDR) boost provides a similar benefit. We compare HDR boost against LDR boost and DE-EBRT with respect to OS.Methods
Using the National Cancer Database, we identified 122,896 patients who were diagnosed with National Comprehensive Cancer Network intermediate- or high-risk prostate cancer between 2004 and 2014 and treated with DE-EBRT (75.6–86.4 Gy), LDR boost, or HDR boost. We compared the OS among the three groups using multivariable Cox proportional hazards regression. Inverse probability treatment weighting was used to adjust for covariate imbalance.Results
On multivariable Cox proportional hazards regression, HDR boost was associated with a similar OS to LDR boost (adjusted hazard ratio [AHR] 1.03 [0.96, 1.11]; p = 0.38) but significantly better OS than DE-EBRT (AHR 1.36 [1.29, 1.44]; p < 0.001). Inverse probability treatment weighting analysis yielded similar results. There was no significant difference between LDR and HDR boosts for National Comprehensive Cancer Network intermediate-risk (AHR 1.05 [0.96, 1.15]; p = 0.32) and high-risk (AHR 1.00 [0.89, 1.12]; p = 0.98) subgroups (p-interaction = 0.55).Conclusions
Our results suggest that HDR brachytherapy boost yields similar OS benefits compared with LDR brachytherapy boost for unfavorable-risk prostate cancer. HDR boost may be a suitable alternative to LDR boost. 相似文献18.
Nancy M. Cappello Dorinda Richetelli Christoph I. Lee 《Journal of the American College of Radiology》2019,16(2):139-146
Objective
We conducted a national survey to understand the impact of state-level density reporting laws on women’s level of density risk awareness and their engagement in conversations with providers regarding supplemental screening.Methods
In all, 1,500 US women aged 40 to 74 years who obtained a mammogram within 2 years were surveyed in February 2018. The sampling design yielded 300 respondents in each of five groups categorized based on density reporting law features. Women were asked about their breast density-related knowledge, importance of being notified, and sources of information and if conversations with providers regarding density and supplemental screening occurred. Survey results were compared across groups and between women residing in states with versus without density laws.Results
The majority of respondents in all groups felt that it is important for women to know their breast density type (range, 85%-90%). Women were most likely informed of breast density type by a health care provider (range, 68%-72%), followed by the mammography result letter (range, 48%-68%), and then a radiologist (range, 46%-61%). Women from states with a density law were significantly more likely to have learned of their breast tissue type from a mammogram results letter (60% versus 48%, P = .011) and discuss supplemental screening (67% versus 53%, respectively; P = .008) than women from states without a law.Conclusion
State-level density reporting laws are associated with increased breast density awareness and increased likelihood of conversations between women and their providers regarding supplemental screening. 相似文献19.
Martin T. King Paul L. Nguyen Ninjin Boldbaatar David D. Yang Vinayak Muralidhar Clare M. Tempany Robert A. Cormack Mark D. Hurwitz W. Warren Suh Mark M. Pomerantz Anthony V. D&#x;Amico Peter F. Orio 《Brachytherapy》2019,18(2):198-203
Purpose
Although current Delphi Consensus guidelines do not recommend a specific definition of biochemical recurrence after partial gland therapy, these guidelines acknowledge that serial prostate-specific antigen (PSA) tests remain the best marker for monitoring disease after treatment. The purpose of this study was to determine whether PSA velocity at failure per the Phoenix (nadir + 2 ng/mL) definition is associated with metastasis and prostate cancer-specific mortality (PCSM) in a cohort of patients who experienced PSA failure after partial gland therapy.Methods
Between 1997 and 2007, 285 patients with favorable risk prostate cancer underwent partial prostate brachytherapy to the peripheral zone. PSA velocity was calculated for 94 patients who experienced PSA failure per the Phoenix (nadir + 2) definition. Fine and Gray competing risks regression was performed to determine whether PSA velocity and other clinical factors were associated with metastasis and PCSM.Results
The median time to PSA failure was 4.2 years (interquartile range: 2.2, 7.9), and the median followup time after PSA failure was 6.5 years (3.5–9.7). Seventeen patients developed metastases, and five experienced PCSM. On multivariate analysis, PSA velocity ≥3.0 ng/mL/year (adjusted hazard ratio 5.97; [2.57, 13.90]; p < 0.001) and PSA nadir (adjusted hazard ratio 0.39; [0.24, 0.64]; p < 0.001) were significantly associated with metastasis. PSA velocity ≥3.0 ng/mL/year was also associated with PCSM (HR 15.3; [1.8, 128.0]; p = 0.012) on univariate analysis.Conclusions
Rapid PSA velocity at PSA failure after partial gland treatment may be prognostic for long-term outcomes. 相似文献20.
Lisa B. Liu Mario A. Cedillo Vivian Bishay Mona Ranade Rahul S. Patel Edward Kim Scott F. Nowakowski Robert A. Lookstein Aaron M. Fischman 《Journal of vascular and interventional radiology : JVIR》2019,30(3):414-420