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1.
Radiofrequency Ablation Therapy Combined with Cementoplasty for Painful Bone Metastases: Initial Experience 总被引:4,自引:0,他引:4
Toyota N Naito A Kakizawa H Hieda M Hirai N Tachikake T Kimura T Fukuda H Ito K 《Cardiovascular and interventional radiology》2005,28(5):578-583
The purpose of this study was to assess the efficacy and safety of percutaneous radiofrequency (RF) ablation therapy combined
with cementoplasty under computed tomography and fluoroscopic guidance for painful bone metastases. Seventeen adult patients
with 23 painful bone metastases underwent RF ablation therapy combined with cementoplasty during a 2-year period. The mean
tumor size was 52 × 40 × 59 mm. Initial pain relief, reduction of analgesics, duration of pain relief, recurrence rate of
pain, survival rate, and complications were analyzed. The technical success rate was 100%. Initial pain relief was achieved
in 100% of patients (n = 17). The mean VAS scores dropped from 63 to 24 (p < 0.001) (n = 8). Analgesic reduction was achieved in 41% (7 out of 17 patients). The mean duration of pain relief was 7.3 months (median:
6 months). Pain recurred in three patients (17.6%) from 2 weeks to 3 months. Eight patients died and 8 patients are still
alive (a patient was lost to follow-up). The one-year survival rate was 40% (observation period: 1–30 months). No major complications
occurred, but one patient treated with this combined therapy broke his right femur 2 days later. There was transient local
pain in most cases, and a hematoma in the psoas muscle (n = 1) and a hematoma at the puncture site (n = 1) occurred as minor complications. Percutaneous RF ablation therapy combined with cementoplasty for painful bone metastases
is effective and safe, in particular, for bulky tumors extending to extraosseous regions. A comparison with cementoplasty
or RF ablation alone and their long-term efficacies is needed. 相似文献
2.
The local effectiveness and clinical usefulness of multipolar radiofrequency (RF) ablation of liver tumours was evaluated.
Sixty-eight image-guided RF sessions were performed using a multipolar device with bipolar electrodes in 53 patients. There
were 45 hepatocellular carcinomas (HCC) and 42 metastases with a diameter ≤3 cm (n = 55), 3.1–5 cm (n = 29) and >5 cm (n = 3); 26 nodules were within 5 mm from large vessels. Local effectiveness and complications were evaluated after RF procedures.
Mean follow-up was 17 ± 10 months. Recurrence and survival rates were analysed by the Kaplan-Meier method. The primary and
secondary technical effectiveness rate was 82% and 95%, respectively. The major and minor complication rate was 2.9%, respectively.
The local tumour progression at 1- and 2-years was 5% and 9% for HCC nodules and 17% and 31% for metastases, respectively;
four of 26 nodules (15%) close to vessels showed local progression. The survival at 1 year and 2 years was 97% and 90% for
HCC and 84% and 68% for metastases, respectively. Multipolar RF technique creates ablation zones of adequate size and tailored
shape and is effective to treat most liver tumours, including those close to major hepatic vessels. 相似文献
3.
This paper analyses the factors associated with successful radiofrequency ablation (RFA) of lung metastases. The study group
comprised 37 patients [19 female, mean age 61 (34–83)] with 72 metastases who had follow-up CT scans available for analysis
and for those with no recurrence >6 months follow-up. Internally cooled electrodes were used in 64 and expandable electrodes
in 8. The tumour size and location, electrode type, number of ablations, duration of ablation, year of treatment and tumour
contact with vessels larger than 3 mm were recorded. The mean tumour diameter was 1.8 cm (0.4–6.6 cm). Mean follow-up in those
without recurrence was 13.1 months (6–48). Recurrence was common in larger tumours, occurring in 7/7 (100%) tumours >3.5 cm
compared with 18/65 (28%) ≤ 3.5 cm (P < 0.01). Recurrence occurred in 14/24 (58%) tumours in direct contact with large vessels compared with 11/48 (23%) of the
remainder (P = 0.04). On multivariate analysis, size was the dominant feature (P = 0.013); vessel contact and peripheral location did not reach significance (P = 0.056 and 0.054 respectively). Peripheral tumours less than 3.5 cm with no large vessel contact are the optimal tumours
for RFA. 相似文献
4.
Jakobs TF Hoffmann RT Schrader A Stemmler HJ Trumm C Lubienski A Murthy R Helmberger TK Reiser MF 《Cardiovascular and interventional radiology》2009,32(1):38-46
The purpose of this study was to evaluate technical success, technique effectiveness, and survival following radiofrequency
ablation for breast cancer liver metastases and to determine prognostic factors. Forty-three patients with 111 breast cancer
liver metastases underwent CT-guided percutaneous radiofrequency (RF) ablation. Technical success and technique effectiveness
was evaluated by performing serial CT scans. We assessed the prognostic value of hormone receptor status, overexpression of
human epidermal growth factor receptor 2 (HER2), and presence of extrahepatic tumor spread. Survival rates were calculated
using the Kaplan–Meier method. Technical success was achieved in 107 metastases (96%). Primary technique effectiveness was
96%. During follow-up local tumor progression was observed in 15 metastases, representing a secondary technique effectiveness
of 86.5%. The overall time to progression to the liver was 10.5 months. The estimated overall median survival was 58.6 months.
There was no significant difference in terms of survival probability with respect to hormone receptor status, HER2 overexpression,
and presence of isolated bone metastases. Survival was significantly lower among patients with extrahepatic disease, with
the exception of skeletal metastases. We conclude that CT-guided RF ablation of liver metastases from breast cancer can be
performed with a high degree of technical success and technique effectiveness, providing promising survival rates in patients
with no visceral extrahepatic disease. Solitary bone metastases did not negatively affect survival probability after RF ablation.
Drs. Jakobs and Hoffmann contributed equally to this article. 相似文献
5.
This retrospective study compared the long-term results of percutaneous radiofrequency (RF) ablation for high-grade dysplastic
nodules (DNs) and well-differentiated hepatocellular carcinomas (HCCs). Between April 1999 and December 2006, 20 patients
with 21 high-grade DNs (range, 1.2–3.0 cm; mean, 1.9 cm) (group 1) and 49 with a well-differentiated HCC (range, 1.0–5.0 cm;
mean, 2.3 cm) (group 2) underwent RF ablation. The technique effectiveness, local tumor progression, cancer-free and cumulative
survivals using the Kaplan-Meier method were compared. The technique effectiveness rates at 1 year after RF ablation were
100% (19/19) and 94.1% (32/34) in groups 1 and 2, respectively (P > 0.05). The local tumor progression rates in groups 1 and 2 were 0% and 20.6% (7/34), respectively (P = 0.041). The local tumor progression in group 2 was seen on follow-up computed tomography 4–58 months (mean, 17 months)
after RF ablation. The 1-, 3-, and 5-year cancer-free survival rates in groups 1 and 2 were 95.0% and 76.9%, 56.2% and 44.6%,
and 38.5% and 24.8%, respectively (P > 0.05). The 1-, 3-, and 5-year cumulative survival rates in groups 1 and 2 were 100% and 97.9%, 73.0% and 68.0%, and 63.8%
and 51.1%, respectively (P > 0.05). Percutaneous RF ablation is effective for treating high-grade DNs and well-differentiated HCCs. The long-term results
after RF ablation of high-grade DNs may be improved compared with those of well-differentiated HCCs. 相似文献
6.
Hamada A Yamakado K Nakatsuka A Uraki J Kashima M Takaki H Yamanaka T Inoue Y Kusunoki M Takeda K 《Japanese journal of radiology》2012,30(7):567-574
Purpose
To determine prognostic factors in patients with colorectal liver metastases who were not surgical candidates and received liver radiofrequency (RF) ablation.Materials and methods
RF ablation was done for 141 colorectal liver metastases in 84 patients. There were 63 (75.0?%, 63/84) males and 21 (25.0?%, 21/84) females, with a mean age of 64.6?±?10.3. The mean maximum tumor diameter was 2.3?±?1.4?cm (range 0.5?C9.0?cm). Extrahepatic metastases were associated at the time of liver RF ablation in 23 patients (27.4?%, 23/84), and 12 (14.3?%, 12/84) had lung metastases considered controllable by planned lung RF ablation. Prognostic factors were evaluated by univariate and multivariate analyses.Results
There was no procedure-related mortality. The 1-, 3-, and 5-year overall survival rates were 90.6?% (95?%CI, 83.9?C97.2?%), 44.9?% (95?%CI, 31.8?C57.9?%), and 20.8?% (95?%CI, 7.3?C34.3?%), respectively, with a median survival of 34.9?months. The univariate analysis showed that tumor diameter larger than 3?cm, tumor multiplicity, uncontrollable extrahepatic disease, and previous chemotherapy history were significantly worse prognostic factors. The former three factors remained significant for worse prognosis in the multivariate Cox model. Extrahepatic disease was not a prognostic factor when it could be controlled.Conclusion
Tumor size and number, and uncontrollable extrahepatic metastases were significant prognostic factors. 相似文献7.
The objective of this paper is to report our results from a prospective study of 167 patients with colorectal liver metastases treated with radio-frequency ablation (RFA). Three hundred fifty-four treatments were performed in 167 patients, 99 males, mean age 57 years (34–87). The mean number of metastases was 4.1 (1–27). The mean maximum diameter was 3.9 cm (1–12). Fifty-one (31%) had stable/treated extra-hepatic disease. Treatments were performed under general anaesthesia using US and CT guidance and single or cluster water-cooled electrodes (Valleylab, Boulder, CO). All patients had been rejected for or had refused surgical resection. Eighty percent received chemotherapy. Survival data were stratified by tumour burden at the time of first RFA. The mean number of RFA treatments was 2.1 (1–7). During a mean follow-up of 17 months (0–89), 72 developed new liver metastases and 71 developed progressive extra-hepatic disease. There were 14/354 (4%) major local complications and 22/354 (6%) minor local complications. For patients with 5 metastases, maximum diameter 5 cm and no extra-hepatic disease, the 5-year survival from the time of diagnosis was 30% and from the time of first thermal ablation was 26%. Given that the 5-year survival for operable patients is a median of 32%, our 5-year survival of 30% is promising. 相似文献
8.
G. P. Schmidt A. Baur-Melnyk A. Haug S. Utzschneider C. R. Becker R. Tiling M. F. Reiser K. A. Hermann 《European radiology》2009,19(6):1366-1378
The purpose of this study was to assess the diagnostic accuracy of whole-body MRI (WB-MRI) at 1.5 T or 3 T compared with FDG-PET-CT
in the follow-up of patients suffering from colorectal cancer. In a retrospective study, 24 patients with a history of colorectal
cancer and suspected tumour recurrence underwent FDG-PET-CT and WB-MRI with the use of parallel imaging (PAT) for follow-up.
High resolution coronal T1w-TSE and STIR sequences at four body levels, HASTE imaging of the lungs, contrast-enhanced T1w-
and T2w-TSE sequences of the liver, brain, abdomen and pelvis were performed, using WB-MRI at either 1.5 T (n = 14) or 3 T (n = 10). Presence of local recurrent tumour, lymph node involvement and distant metastatic disease was confirmed using radiological
follow-up within at least 5 months as a standard of reference. Seventy seven malignant foci in 17 of 24 patients (71%) were
detected with both WB-MRI and PET-CT. Both investigations concordantly revealed two local recurrent tumours. PET-CT detected
significantly more lymph node metastases (sensitivity 93%, n = 27/29) than WB-MRI (sensitivity 63%, n = 18/29). PET-CT and WB-MRI achieved a similar sensitivity for the detection of organ metastases with 80% and 78%, respectively
(37/46 and 36/46). WB-MRI detected brain metastases in one patient. One false-positive local tumour recurrence was indicated
by PET-CT. Overall diagnostic accuracy for PET-CT was 91% (sensitivity 86%, specificity 96%) and 83% for WB-MRI (sensitivity
72%, specificity 93%), respectively. Examination time for WB-MRI at 1.5 T and 3 T was 52 min and 43 min, respectively; examination
time for PET-CT was 103 min. Initial results suggest that differences in accuracy for local and distant metastases detection
using FDG-PET-CT and WB-MRI for integrated screening of tumour recurrence in colorectal cancer depend on the location of the
malignant focus. Our results show that nodal disease is better detected using PET-CT, whereas organ disease is depicted equally
well by both investigations. 相似文献
9.
PURPOSE: Radiofrequency (RF) ablation is an increasingly accepted treatment for nonsurgical candidates with a limited number of colorectal hepatic metastases. RF ablation is most effective in tumors smaller than 4.0 cm. This report describes 5-year survival in patients with single tumors with a maximum diameter of 4 cm. MATERIALS AND METHODS: Forty of 291 patients (14%; 24 men, 16 women; mean age, 67 years; age range, 34-86 y) with no or treated extrahepatic disease were identified who were not candidates for resection and who had a minimum follow-up of 6 months. Sixteen had undergone hepatic resection and two had undergone lung resection and lung ablation. Thirty-two (80%) received chemotherapy. Thirty-five were treated under general anesthesia and five under conscious sedation. Our standard ablation protocol used internally water-cooled electrodes introduced percutaneously with ultrasonography and computed tomography guidance and monitoring. Follow-up data were obtained from primary care physicians or oncologists. RESULTS: Mean tumor diameter was 2.3 cm (range, 0.8-4.0 cm). There were two successfully treated systemic complications: a chest infection and an exacerbation of asthma. There were no local complications. Mean follow-up was 38 months (range, 6-132 months). The median survival duration and 1-, 3-, and 5-year survival rates were 59 months and 97%, 84%, 40%, respectively, after ablation; and 63 months, 100%, 88%, and 54%, respectively, from the diagnosis of liver metastases. History of liver resection did not impact survival. CONCLUSIONS: RF ablation of solitary liver metastases 4 cm or smaller can be performed with minimal morbidity and results in excellent long-term survival, approaching that of surgical resection, even in patients who are not surgical candidates. 相似文献
10.
Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy
The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled
laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age
65.0 years; range 58.7–75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising
colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated
power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time
monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months).
All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators
per tumour: 1.9 (range 1–4); mean applied laser energy 33 kJ (range 15.3–94.6 kJ), mean diameter of the laser-induced coagulation
necrosis 4.5 cm (range 2.5–7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was
detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is
a safe, minimally invasive and promising procedure for treating adrenal metastases. 相似文献
11.
Comparison of MRI (including SS SE-EPI and SPIO-enhanced MRI) and FDG-PET/CT for the detection of colorectal liver metastases 总被引:1,自引:0,他引:1
Coenegrachts K De Geeter F ter Beek L Walgraeve N Bipat S Stoker J Rigauts H 《European radiology》2009,19(2):370-379
Fluoro-18-deoxyglucose positron emission tomography computed tomography (FDG-PET/CT) and magnetic resonance imaging (MRI),
including unenhanced single-shot spin-echo echo planar imaging (SS SE-EPI) and small paramagnetic iron oxide (SPIO) enhancement,
were compared prospectively for detecting colorectal liver metastases. Twenty-four consecutive patients suspected for metastases
underwent MRI and FDG-PET/CT. Fourteen patients (58%) had previously received chemotherapy, including seven patients whose
chemotherapy was still continuing to within 1 month of the PET/CT study. The mean interval between PET/CT and MRI was 10.2 ± 5.2 days.
Histopathology (n = 18) or follow-up imaging (n = 6) were used as reference. Seventy-seven metastases were detected. In nine patients, MRI and PET/CT gave concordant results.
Sensitivities for unenhanced SS SE-EPI, MRI without SS SE-EPI and FDG-PET/CT were, respectively, 100% (p = 9 × 10−10 vs PET, p = 8 × 10−3 vs MRI without SS SE-EPI), 90% (p = 2 × 10−7 vs PET) and 60%. PET/CT sensitivity dropped significantly with decreasing size, from 100% in lesions larger than 20 mm (identical
to MRI), over 54% in lesions between 10 and 20 mm (p = 3 × 105 versus unenhanced SS SE-EPI), to 32% in lesions under 10 mm (p = 6 × 10−5 versus unenhanced SS SE-EPI). Positive predictive value of PET was 100% (identical to MRI). MRI, particularly unenhanced
SS SE-EPI, has good sensitivity and positive predictive value for detecting liver metastases from colorectal carcinoma. Its
sensitivity is better than that of FDG-PET/CT, especially for small lesions. 相似文献
12.
Rodrigues M Gabriel M Heute D Putzer D Griesmacher A Virgolini I 《European journal of nuclear medicine and molecular imaging》2008,35(10):1796-1802
Purpose Somatostatin receptor scintigraphy (SRS) and chromogranin A (CgA) assay have successfully been implemented in the clinical
work-up and management of neuroendocrine tumour (NET) patients. However, there is still a lack of studies comparing results
in these patients. Our aim was to compare directly in NET patients SRS and CgA assay results with special regard to tumour
features such as grade of malignancy, primary origin, disease extent and function.
Methods One hundred twenty consecutive patients with histological confirmed NETs were investigated with 111In-DOTA-DPhe1-Tyr3-octreotide (111In-DOTA-TOC) SRS and CgA immunoradiometric assay. Tumours were classified by cell characteristics [well-differentiated NETs,
well-differentiated neuroendocrine carcinomas, poorly differentiated neuroendocrine carcinomas (PDNECs)], primary origin (foregut,
midgut, hindgut, undetermined), disease extent (limited disease, metastases, primary tumour and metastases) and functionality
(secretory, nonsecretory).
Results SRS was positive in 107 (89%) patients; CgA levels were increased in 95 (79%) patients. Overall, concordance between SRS and
CgA results was found in 84 patients. Positive SRS but normal CgA level were found in 24 patients, with higher prevalence
(p < 0.05) in patients with nonsecretory tumours. Conversely, negative SRS but CgA level increased were seen in 12 patients,
with higher proportion (p < 0.05) in patients with PDNECs and tumours of hindgut origin.
Conclusions Overall, 111In-DOTA-TOC SRS proved to be more sensitive than CgA in NETs patients. Tumour differentiation, disease extent and presence
of liver metastases impact both SRS and CgA results, whereas nonsecretory activity is a negative predictor of only CgA increase.
PDNECs and hindgut origin of tumours predispose to discrepancies with negative SRS but increased CgA levels. 相似文献
13.
Radiofrequency Ablation of Colorectal Liver Metastases: Small Size Favorably Predicts Technique Effectiveness and Survival 总被引:2,自引:2,他引:0
Veltri A Sacchetto P Tosetti I Pagano E Fava C Gandini G 《Cardiovascular and interventional radiology》2008,31(5):948-956
The objective of this study was to analyze long-term results of radiofrequency thermal ablation (RFA) for colorectal metastases
(MTS), in order to evaluate predictors for adverse events, technique effectiveness, and survival. One hundred ninety-nine
nonresectable MTS (0.5–8 cm; mean, 2.9 cm) in 122 patients underwent a total of 166 RFA sessions, percutaneously or during
surgery. The technique was “simple” or “combined” with vascular occlusion. The mean follow-up time was 24.2 months. Complications,
technique effectiveness, and survival rates were statistically analyzed. Adverse events occurred in 8.1% of lesions (major
complication rate: 1.1%), 7.1% with simple and 16.7% with combined technique (p = 0.15). Early complete response was obtained in 151 lesions (81.2%), but 49 lesions (26.3%) recurred locally after a mean
of 10.4 months. Sustained complete ablation was achieved in 66.7% of lesions ≤3 cm versus 33.3% of lesions >3 cm (p < 0.0001). Survival rates at 1, 3, and 5 years were 91%, 54%, and 33%, respectively, from the diagnosis of MTS and 79%, 38%,
and 22%, respectively, from RFA. Mean survival time from RFA was 31.5 months, 36.2 in patients with main MTS ≤3 cm and 23.2
in those with at least one lesion >3 cm (p = 0.006). We conclude that “simple” RFA is safe and successful for MTS ≤3 cm, contributing to prolong survival when patients
can be completely treated.
Presented at CIRSE 2006. 相似文献
14.
Veltri A Guarnieri T Gazzera C Busso M Solitro F Fora G Racca P 《La Radiologia medica》2012,117(7):1139-1151
PURPOSE: The aim of this study was to review some prognostic factors for survival after radiofrequency ablation (RFA) of metastases from colorectal cancer (CRC). MATERIALS AND METHODS: From 1996 to 2009, 262 patients with metastases from CRC were treated with RFA. Fourteen were lost to follow-up. The following predictors were analysed in the remaining 248: synchronous/metachronous metastases, single/multiple metastases, diameter of largest metastasis and absence/presence of extrahepatic metastases. Survival was measured from the date of metastasis diagnosis and from the date of RFA. RESULTS: Survival at 1, 2, 3 and 5 years was 93%, 78%, 62% and 35% from metastasis diagnosis, and 84%, 59%, 43% and 23% from the date of RFA. Median survival was 41 months in patients with largest metastasis ≤3 cm and 21.7 months for those with metastases >3 cm (p=0.0001); survival increased to 45.2 months in patients with largest metastasis ≤2.5 cm and fell to 18.5 months in those with metastasis >3.5 cm. Median survival of patients with extrahepatic metastases was significantly lower than that of patients without extrahepatic disease (23.3 vs. 32.6 months, p=0.018). CONCLUSIONS: In light of our long-term results obtained with commonly used equipment, small lesion size (diameter of largest lesion ≤3 or 2.5 cm) proved to be the most favourable prognostic factor for survival in patients with CRC metastases to the liver treated with RFA. This conclusion is probably related to the possibility of obtaining radical ablation and points to the usefulness of devices allowing ablation of larger volumes. In the presence of extrahepatic metastases, RFA has less impact on survival, even though it is potentially useful in patients at a higher risk of death due to hepatic rather than extrahepatic metastases. 相似文献
15.
Roberto Cianni Carlo Urigo Ermanno Notarianni Adelchi Saltarelli Rita Salvatori Valerio Pasqualini Tracie Dornbusch Enrico Cortesi 《Cardiovascular and interventional radiology》2009,32(6):1179-1186
The purpose of this study was to evaluate the effectiveness of colorectal cancer (CRC) liver metastasis radioembolization
with yttrium-90 (Y90), assessing toxicity and survival rates in patients with no response to chemotherapy through our 3-year
experience. From February 2005 to January 2008, we treated 41 patients affected by CRC from a cohort of selective internal
radiation therapy patients treated at our institution. All patients examined showed disease progression and arrived for our
observation with an abdominal CT, a body PET, and a hepatic angiography followed by gastroduodenal artery coiling previously
performed by us. We excluded patients with a bilirubin level >1.8 mg/dl and pulmonary shunt >20% but not patients with minor
extrahepatic metastases. On treatment day, under fluoroscopic guidance, we implanted a dose of Y90 microspheres calculated
on the basis of liver tumoral involvement and the body surface area formula. All patients were discharged the day after treatment.
We obtained, according to Response Evaluation Criteria on Solid Tumors, a complete response in 2 patients, a partial response
in 17 patients, stable disease in 14 patients, and progressive disease in 8 patients. In all cases, we obtained a carcinoembryonic
antigen level decrease, especially in the week 8 evaluation. Technical success rate was 98% and technical effectiveness estimated
at 3 months after treatment was 80.5%. Side effects graded by Common Terminology Criteria on Adverse Events were represented
by one grade 4 hepatic failure, two grade 2 gastritis, and one grade 2 cholecystitis. The median survival and the progression-free
survival calculated by Kaplan–Meier analysis were 354 and 279 days, respectively. In conclusion, according to our 3-year experience,
Y90 SIR-Spheres radioembolization is a feasible and safe method to treat CRC liver metastases, with an acceptable level of
complications and a good response rate. 相似文献
16.
Kleis M Daldrup-Link H Matthay K Goldsby R Lu Y Schuster T Schreck C Chu PW Hawkins RA Franc BL 《European journal of nuclear medicine and molecular imaging》2009,36(1):23-36
Objective The objective of this retrospective study was to compare the diagnostic value of 2-[18F]fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET)/CT versus 18F-FDG PET and CT alone for staging and restaging of pediatric solid tumors.
Methods Forty-three children and adolescents (19 females and 24 males; mean age, 15.2 years; age range, 6–20 years) with osteosarcoma
(n = 1), squamous cell carcinoma (n = 1), synovial sarcoma (n = 2), germ cell tumor (n = 2), neuroblastoma (n = 2), desmoid tumor (n = 2), melanoma (n = 3), rhabdomyosarcoma (n = 5), Hodgkin’s lymphoma (n = 7), non-Hodgkin-lymphoma (n = 9), and Ewing’s sarcoma (n = 9) who had undergone 18F-FDG PET/CT imaging for primary staging or follow-up of metastases were included in this study. The presence, location, and
size of primary tumors was determined separately for PET/CT, PET, and CT by two experienced reviewers. The diagnosis of the
primary tumor was confirmed by histopathology. The presence or absence of metastases was confirmed by histopathology (n = 62) or clinical and imaging follow-up (n = 238).
Results The sensitivities for the detection of solid primary tumors using integrated 18F-FDG PET/CT (95%), 18F-FDG PET alone (73%), and CT alone (93%) were not significantly different (p > 0.05). Seventeen patients showed a total of 153 distant metastases. Integrated PET/CT had a significantly higher sensitivity
for the detection of these metastases (91%) than PET alone (37%; p < 0.05), but not CT alone (83%; p > 0.05). When lesions with a diameter of less than 0.5 cm were excluded, PET/CT (89%) showed a significantly higher specificity
compared to PET (45%; p < 0.05) and CT (55%; p < 0.05). In a sub-analysis of pulmonary metastases, the values for sensitivity and specificity were 90%, 14%, 82% and 63%,
78%, 65%, respectively, for integrated PET/CT, stand-alone PET, and stand-alone CT. For the detection of regional lymph node
metastases, 18F-FDG PET/CT, 18F-FDG PET alone, and CT alone were diagnostically correct in 83%, 61%, and 42%. A sub-analysis focusing on the ability of
PET/CT, PET, and CT to detect osseous metastases showed no statistically significant difference between the three imaging
modalities (p > 0.05).
Conclusion Our study showed a significantly increased sensitivity of PET/CT over that of PET for the detection of distant metastases
but not over that of CT alone. However, the specificity of PET/CT for the characterization of pulmonary metastases with a
diameter > 0.5 cm and lymph node metastases with a diameter of <1 cm was significantly increased over that of CT alone. 相似文献
17.
Actual role of radiofrequency ablation of liver metastases 总被引:2,自引:0,他引:2
Pereira PL 《European radiology》2007,17(8):2062-2070
The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour.
More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality.
Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20%
of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional
therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected
patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective
(versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation
can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy
and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour
or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal
ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement
in patients with liver metastases. 相似文献
18.
Yen TC See LC Lai CH Tsai CS Chao A Hsueh S Hong JH Chang TC Ng KK 《European journal of nuclear medicine and molecular imaging》2008,35(3):493-501
Purpose We sought to identify prognostic factors—including positron emission tomography (PET) parameters—in patients with previously
untreated squamous carcinoma of the uterine cervix and MRI- or CT-defined pelvic or para-aortic lymph node (PLN or PALN) metastasis.
Materials and methods Patients with untreated squamous cell cervical cancer and PLN or PALN metastasis detected by CT/MRI were enrolled. FDG-PET
scans were performed for primary staging. Prognostic variables were investigated by univariate and multivariate analyses.
Five-year recurrence-free and 5-year overall survivals (RFS and OS) were evaluated using the Kaplan–Meier method.
Results A total of 70 patients [54 patients with International Federation of Gynecology and Obstetrics (FIGO) stage I or II, and 16
patients with stage III or IV] were eligible. Follow-up ranged from 26.1 to 71.6 months. In multivariate analysis, FIGO stage
≥III (5-year RFS, p = 0.008; 5-year OS, p = 0.008) was a significant prognostic factor for both RFS and OS. In addition, SUVmax for PALN (dichotomized by 3.3) was significantly associated with OS (p = 0.012) and marginally with RFS (p = 0.078). The presence of SUVmax ≥ 3.3 at PALN or FIGO stage ≥III were significantly associated with both recurrence [5-year RFS; HR = 4.52, 95% confidence
interval (CI) = 1.73–11.80] and death (5-year OS; HR = 6.04, 95% CI = 1.97–18.57).
Conclusion SUVmax ≥ 3.3 for PALN and FIGO stage ≥III were significant adverse factors in patients with primary squamous cervical carcinoma
and PLN or PALN metastasis detected by CT/MRI.
This study was presented in part at the 42nd American Society of Clinical Oncology Annual Meeting, 2006, Atlanta, GA, USA. 相似文献
19.
Matthias Schmidt Elfriede Bollschweiler Markus Dietlein Stefan P. Mönig Carsten Kobe Daniel Vallböhmer Wolfgang Eschner Arnulf Hölscher Harald Schicha 《European journal of nuclear medicine and molecular imaging》2009,36(5):880-744
Purpose To evaluate the potential of [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) for the assessment of histopathological response and survival
after neoadjuvant radiochemotherapy in patients with oesophageal cancer.
Patients and methods In 2005 and 2006, 55 patients (43 men, 12 women; median age 60 years) with locally advanced oesophageal cancer (cT3-4 Nx M0;
24 with squamous cell carcinoma, 31 with adenocarcinoma) underwent transthoracic en bloc oesophagectomy after completion of
treatment with cisplatin, 5-fluorouracil, and radiotherapy ad 36 Gy in a prospective clinical trial. Of the 55 patients, 21
(38%) were classified as histopathological responders (<10% vital residual tumour cells) and 34 (62%) as nonresponders. FDG-PET
was performed before (PET 1) and 3–4 weeks after the end (PET 2) of radiochemotherapy with assessment of maximum and average
standardized uptake values (SUV) for correlation with histopathological response and survival.
Results Histopathological responders had a slightly higher baseline SUV than nonresponders (p<0.0001 between PET 1 and PET 2 for responders and nonresponders) and the decrease was more prominent in responders. Except
for SUVmax in patients with squamous cell carcinoma neither baseline nor preoperative SUV nor percent SUV reduction correlated
significantly with histopathological response. Histopathological responders had a 2-year overall survival of 91 ± 9% and nonresponders
a survival of 53 ± 10% (p = 0.007).
Conclusion Our study does not support recent reports that FDG-PET predicts histopathological response and survival in patients with locally
advanced oesophageal cancer treated by neoadjuvant radiochemotherapy.
An erratum to this article can be found at 相似文献
20.
Dick EA Joarder R de Jode M Taylor-Robinson SD Thomas HC Foster GR Gedroyc WM 《Clinical radiology》2003,58(2):112-120
AIM: To test the hypothesis that magnetic resonance (MR)-guided hepatic tumour ablation is (i) safe and feasible, (ii) is associated with favourable patient survival, and (iii) decreases viable tumour. MATERIALS AND METHODS: One hundred and twenty-five MR-guided laser thermal ablations (LTA) were performed on 35 patients with hepatocellular carcinoma (HCC, n=19), hepatic metastases (n=11, mainly colorectal) and carcinoid liver tumours (n=5). RESULTS: Mean overall survival was 14.8 months (HCCs 14.6 months, metastases 15.2 months). Near real-time T1-weighted colourized thermal maps correlated moderately with follow-up gadolinium-enhanced MR imaging in predicting ablated tumour area (Pearson correlation coefficient=0.5). There was a significant difference in percentage enhancing pre- and post-LTA (Wilcoxon signed ranks test=0.0001). An average of 50.7% of tumour was ablated by each treatment. In patients with multiple liver tumours ablated tumours grew significantly less than untreated tumours (108%compared with 196% growth, follow-up period 5.8 months, WSRTp=0.07). CONCLUSION: MR- guided LTA of primary and secondary liver tumours is safe, feasible, and significantly decreased amount of enhancing or viable tumour. MR-guided LTA produces a better survival in patients with HCC than would be expected in untreated patients, and has a mean survival in patients with metastases at least equal to the longest median survival in untreated patients. 相似文献