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1.
Jiahe Zheng Zubin Irani Donald Lawrence Keith Flaherty Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1369-1375
Purpose
To evaluate the safety and efficacy of yttrium-90 (90Y) transarterial radioembolization (TARE) around immunotherapy in patients with unresectable hepatic metastases from uveal melanoma (UM).Materials and Methods
From March 2013 to December 2017, 11 patients with unresectable hepatic metastases from UM were treated with TARE around immunotherapy. Two patients received TARE as a first-line treatment followed by immunotherapy. Nine patients received immunotherapy before TARE, and 6 of these patients received additional immunotherapy after TARE. Retrospective review of the clinical data was performed to assess hepatic progression-free survival (hPFS), overall survival (OS), treatment response, and toxicities. The median follow-up period from TARE was 10.5 months (range 1–35.5 months).Results
The median OS from diagnosis of hepatic metastases was 35.5 months (95% confidence interval [CI] 10.0–55.0 months). The median hPFS and OS from the start of TARE were 15.0 months (95% CI 5.9–24.1 months) and 17.0 months (95% CI 1.8–32.2 months), respectively. Complete response was observed in 1 patient (9.1%), partial response in 2 (18.2%), stable disease in 4 (36.4%), and progressive disease in 4 (36.4%). Ten patients had grade 1 or 2 clinical toxicities, and 1 had grade 3 with a peptic ulcer. Six patients had grade 1 or 2 biochemical toxicities and 1 had grade 3, which was related to tumor progression.Conclusions
The present results suggest that TARE around immunotherapy is safe and effective. The combined treatment may improve hPFS and OS in patients with hepatic metastases from UM. 相似文献2.
Ahmed Gabr Nadine Abouchaleh Rehan Ali Talia Baker Juan Caicedo Nitin Katariya Michael Abecassis Ahsun Riaz Robert J. Lewandowski Riad Salem 《Journal of vascular and interventional radiology : JVIR》2018,29(11):1502-1510.e1
Purpose
To longitudinally study clinical and radiologic outcomes of patients with hepatocellular carcinoma (HCC) who underwent yttrium-90 transarterial radioembolization (TARE) as a bridge to surgical resection.Materials and Methods
TARE was performed in 31 patients with HCC before resection. Of patients, 25 underwent major hepatic resection (16 received right hepatectomy and 9 received trisegmentectomy), and 6 underwent partial hepatectomy. Clinical outcomes after TARE and after resection were recorded. Future liver remnant (FLR) was calculated before and after TARE, and actual liver remnant volume was calculated after resection. Radiologic response after TARE and pathologic necrosis were assessed. Overall and recurrence-free survivals after resection were estimated.Results
Median time between TARE and resection was 2.9 months (interquartile range [IQR]: 2–5 months). Median FLR hypertrophy after TARE (and before resection) was 23.3% (IQR:10%–48%) for patients who had radiation lobectomy and 9% (IQR: 6%–25%) for patients who had radiation segmentectomy (P = .037). Median augmented hypertrophy of the liver remnant 3 months after resection was 72% (IQR:45%–88%) in patients who had radiation lobectomy and 94% (IQR: 72%–146%) in patients who had radiation segmentectomy. Complete, 50%–99%, and < 50% pathologic tumor necrosis was identified in 14 (45%), 10 (32%), and 7 (23%) tumors. Disease control was achieved in all 31 patients. Survival rates at 1 and 3 years were 96% and 86%, respectively. Median recurrence-free survival was 34.2 months (95% confidence interval,18.7–34.2).Conclusions
TARE can serve as a safe bridge to resection providing FLR hypertrophy and disease control. 相似文献3.
Yuki Tomozawa Younes Jahangiri Priya Pathak Kenneth J. Kolbeck Ryan C. Schenning John A. Kaufman Khashayar Farsad 《Journal of vascular and interventional radiology : JVIR》2018,29(6):858-865
Purpose
To evaluate long-term effects of yttrium-90 (90Y) transarterial radioembolization (TARE) for unresectable hepatic metastases of neuroendocrine tumors (NETs).Materials and Methods
Retrospective analysis of 93 patients (47 women, 46 men; mean age 59 y) who underwent resin-based 90Y TARE was performed. Variables associated with overall survival were analyzed using univariate and multivariate models. Changes in serologic values and imaging characteristics were assessed with long-term follow-up.Results
Unilobar TARE was performed in 48 patients, and staged bilobar TARE was performed in 45 patients. In multivariate analysis, ascites (P = .002) and extrahepatic metastases (P = .038) at baseline were associated with poor survival. Among 52 patients who had > 1 year of follow-up, significant increases in alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were observed; however, only 4 patients experienced grade 3 serologic toxicities. Imaging signs of cirrhosis-like morphology and portal hypertension were observed in 15 of 52 patients, more frequently in patients treated with bilobar TARE compared with unilobar TARE. Patients treated with bilobar TARE exhibited significantly increased hepatobiliary enzymes and decreased platelet count. Sustained increases in liver enzymes were observed in patients with > 4 years of follow-up. No radioembolization-related liver failure or grade 4 toxicity was observed.Conclusions
90Y radioembolization using resin microspheres demonstrated a high safety profile for NET liver metastases, with low-grade, although sustained, long-term liver toxicity evident > 4 years after treatment. Bilobar treatment suggested a trend for treatment-related portal hypertension. Ongoing research will help define parameters for optimizing durable safety and efficacy of radioembolization in this setting. 相似文献4.
Samer Tohme Patrick Bou Samra Christof Kaltenmeier Alexis P. Chidi Patrick R. Varley Allan Tsung 《Journal of vascular and interventional radiology : JVIR》2018,29(7):912-919.e2
Purpose
To examine the US nationwide experience with transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) in the years 2003–2012 and the prognostic factors associated with overall survival.Materials and Methods
A retrospective cohort study from the National Cancer Database included 110,139 adult patients with HCC between 2003 and 2012, of whom 1,222 received TARE. Primary outcome of interest was mortality after treatment. Univariate and multivariate analyses for factors predicting mortality were performed for 961 patients treated between 2003 and 2011. Overall survival was estimated by Kaplan-Meier method.Results
There was a steady increase in utilization of TARE in the past decade. Most patients were white men with median age of 64 years. Of those patients, 67% received treatment at an academic institution, 42% were American Joint Committee on Cancer stage I or II, and 10% had metastatic disease at the time of treatment. Median overall survival was 13.3 months. Overall survival varied by patient and tumor characteristics. Female patients with tumors < 5 cm or stage I or II disease benefited the most from treatment. Outcomes were the same across all age groups. Patients who were African American or had metastatic disease tended to have worse outcomes.Conclusions
Use of TARE in patients with HCC has been increasing. Several factors are significantly associated with a less favorable outcome after TARE, including male sex, large tumors, and extrahepatic disease. These data can be used for designing future radioembolization trials. 相似文献5.
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6.
Alexandra Gangi Jehan Shah Nathan Hatfield Johnna Smith Jennifer Sweeney Junsung Choi Ghassan El-Haddad Benjamin Biebel Nainesh Parikh Bulent Arslan Sarah E. Hoffe Jessica M. Frakes Gregory M. Springett Daniel A. Anaya Mokenge Malafa Dung-Tsa Chen Yunyun Chen Richard D. Kim Bela Kis 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1101-1108
Purpose
To evaluate the efficacy and safety of transarterial yttrium-90 glass microsphere radioembolization in patients with unresectable intrahepatic cholangiocarcinoma (ICC).Materials and Methods
Retrospective review of 85 consecutive patients (41 men and 44 women; age, 73.4 ± 9.3 years) was performed. Survival data were analyzed by the Kaplan-Meier method, Cox regression models, and the log-rank test.Results
Median overall survival (OS) from diagnosis was 21.4 months (95% confidence interval [CI]: 16.6–28.4); median OS from radioembolization was 12.0 months (95% CI: 8.0–15.2). Seven episodes of severe toxicity occurred. At 3 months, 6.2% of patients had partial response, 64.2% had stable disease, and 29.6% had progressive disease. Median OS from radioembolization was significantly longer in patients with Eastern Cooperative Oncology Group (ECOG) scores of 0 and 1 than patients with an ECOG score of 2 (18.5 vs 5.5 months, P = .0012), and median OS from radioembolization was significantly longer in patients with well-differentiated histology than patients with poorly differentiated histology (18.6 vs 9.7 months, P = .012). Patients with solitary tumors had significantly longer median OS from radioembolization than patients with multifocal disease (25 vs. 6.1 months, P = .006). The absence of extrahepatic metastasis was associated with significantly increased median OS (15.2 vs. 6.8 months, P = .003). Increased time from diagnosis to radioembolization was a negative predictor of OS. The morphology of the tumor (mass-forming or infiltrative, hyper- or hypo-enhancing) had no effect on survival. Post-treatment increased cancer antigen 19-9 level, increased international normalized ratio, decreased albumin, increased bilirubin, increased aspartate aminotransferase, and increased Model for End-Stage Liver Disease score were significant predictors of decreased OS.Conclusions
These data support the therapeutic role of radioembolization for the treatment of unresectable ICC with good efficacy and an acceptable safety profile. 相似文献7.
Alexander Lam Emi J. Yoshida Kevin Bui Dayantha Fernando Kari Nelson Nadine Abi-Jaoudeh 《Journal of vascular and interventional radiology : JVIR》2018,29(9):1211-1217.e1
Purpose
To compare overall survival (OS) after radiofrequency (RF) ablation and stereotactic body radiotherapy (SBRT) at high-volume centers in patients with early-stage non–small cell lung cancer (NSCLC).Materials and Methods
Cases in the National Cancer Database of stage 1a and 1b NSCLC treated with primary RF ablation or SBRT from 2004 to 2014 were included. Patients treated at low-volume centers, defined as facilities below the 95th percentile in volume of cases performed, were excluded. Outcomes measured include OS and rate of 30-day readmission. The Kaplan-Meier method was used to estimate OS. The log-rank test was used to compare survival curves. Propensity score matched cohort analysis was performed. P < .05 was considered statistically significant.Results
The final cohort comprised 4,454 cases of SBRT and 335 cases of RF ablation. Estimated median survival and follow-up were 38.8 months and 42.0 months, respectively. Patients treated with RF ablation had significantly more comorbidities (P < .001) and higher risk for an unplanned readmission within 30 days (hazard ratio = 11.536; P < .001). No difference in OS for the unmatched groups was found on multivariate Cox regression analysis (P = .285). No difference was found in the matched groups with 1-, 3-, and 5-year OS of 85.5%, 54.3%, and 31.9% in the SBRT group vs 89.3%, 52.7%, and 27.1% in the RF ablation group (P = .835).Conclusions
No significant difference in OS was seen between patients with early-stage NSCLC treated with RF ablation and SBRT. 相似文献8.
Alexander Lam Emi J. Yoshida Kevin Bui James Katrivesis Dayantha Fernando Kari Nelson Nadine Abi-Jaoudeh 《Journal of vascular and interventional radiology : JVIR》2018,29(11):1535-1541.e2
Purpose
To determine facility and patient demographics associated with survival in early-stage non-small cell lung cancer (NSCLC) treated with radiofrequency (RF) ablation.Materials and Methods
The National Cancer Database was queried for cases of stage 1a NSCLC treated with RF ablation without chemotherapy or radiotherapy from 2004 to 2014. High-volume centers (HVCs) were defined as the top 95th percentile of facilities by number of procedures performed. Overall survival (OS) was estimated with the Kaplan-Meier method, and comparisons between survival curves were performed with the log-rank test. Propensity score-matched cohort analysis was performed. P values less than .05 were considered statistically significant.Results
In the final cohort, 967 cases were included. Estimated median survival and follow-up were 33.1 and 62.5 months, respectively. Of 305 facilities, 15 were determined to be HVCs, treating 13 or more patients from 2004 to 2014. A total of 335 cases (34.6%) were treated at HVCs. On multivariate Cox regression analysis, treatment at an HVC was independently associated with improved OS (hazard ratio [HR] = 0.766; P = .006). After propensity score adjustment, 1-, 3-, and 5-year OS was 89.8%, 51.2%, and 27.7%, respectively, for patients treated at HVCs, compared to 85.2%, 41.5%, and 19.6%, respectively, for patients treated at non-HVCs (P = .015). Increasing age (HR = 1.012; P = .013) and higher T-classification (HR = 1.392; P < .001) were independently associated with worse OS.Conclusion
Patients with early-stage NSCLC treated with RF ablation at HVCs experienced a significant increase in OS, suggesting regionalization of lung cancer management as a means of improving outcomes. 相似文献9.
Ashley A. Weiner Bin Gui Neil B. Newman John L. Nosher Fady Yousseff Shou-En Lu Gretchen M. Foltz Darren Carpizo Jonathan Lowenthal Darryl A. Zuckerman Ben Benson Jeffrey R. Olsen Salma K. Jabbour Parag J. Parikh 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1094-1100
Purpose
To identify clinical parameters that are prognostic for improved overall survival (OS) after yttrium-90 radioembolization (RE) in patients with liver metastases from colorectal cancer (CRC).Materials and Methods
A total of 131 patients who underwent RE for liver metastases from CRC, treated at 2 academic centers, were reviewed. Twenty-one baseline pretreatment clinical factors were analyzed in relation to OS by the Kaplan-Meier method along with log-rank tests and univariate and multivariate Cox regression analyses.Results
The median OS from first RE procedure was 10.7 months (95% confidence interval [CI], 9.4–12.7 months). Several pretreatment factors, including lower carcinoembryonic antigen (CEA; ≤20 ng/mL), lower aspartate transaminase (AST; ≤40 IU/L), neutrophil-lymphocyte ratio (NLR) <5, and absence of extrahepatic disease at baseline were associated with significantly improved OS after RE, compared with high CEA (>20 ng/mL), high AST (>40 IU/L), NLR ≥5, and extrahepatic metastases (P values of <.001, <.001, .0001, and .04, respectively). On multivariate analysis, higher CEA, higher AST, NLR ≥5, extrahepatic disease, and larger volume of liver metastases remained independently associated with risk of death (hazard ratios of 1.63, 2.06, 2.22, 1.48, and 1.02, respectively).Conclusions
The prognosis of patients with metastases from CRC is impacted by a complex set of clinical parameters. This analysis of pretreatment factors identified lower AST, lower CEA, lower NLR, and lower tumor burden (intra- or extrahepatic) to be independently associated with higher survival after hepatic RE. Optimal selection of patients with CRC liver metastases may improve survival rates after administration of yttrium-90. 相似文献10.
Bruno C. Odisio Suguru Yamashita Steven Y. Huang Scott E. Kopetz Kamran Ahrar Takashi Mizuno Claudius Conrad Thomas A. Aloia Yun Shin Chun Sanjay Gupta Jean-Nicolas Vauthey 《Journal of vascular and interventional radiology : JVIR》2018,29(3):395-403.e1
Purpose
To test the hypothesis that, given the current resection eligibility criteria for colorectal liver metastasis (CLM), prior hepatectomy would be associated with improved local tumor control and survival after percutaneous ablation of CLMs.Materials and Methods
This single-institution retrospective study included 82 consecutive patients with 97 CLMs treated with ablation (radiofrequency ablation, microwave ablation, or cryoablation) from January 2005 to December 2014. Local tumor progression-free survival (LTPFS), recurrence-free survival (RFS) at any organ, and overall survival (OS) were calculated using the Kaplan-Meier method from the time of ablation and compared between patients with (n = 49) and without (n = 33) prior hepatectomy. Cox regression models were used to identify LTPFS predictors.Results
Median overall follow-up period was 28 months (range, 4.5–132 months). Three-year actuarial LTPFS (patient level: 73% vs 34%, P < .001) was significantly higher in patients with than without prior hepatectomy, respectively. Similarly, 3-year RFS (23% vs 9.1%, P = .026) and OS (78% vs 48%, P = .003) were improved in patients with prior hepatectomy. At multivariate analysis, predictors of worse LTPFS were: no prior hepatectomy (hazard ratio [HR] 2.35, 95% confidence interval [CI] 1.02–5.45; P = .045), minimal ablation margin < 5 mm (HR 2.4, 95% CI 1.18–4.87; P = .016), and RAS-mutant tumor (HR 2.65, 95% CI 1.18–5.94; P = .019).Conclusions
Prior hepatectomy for CLMs is associated with improved local tumor control after percutaneous ablation of post-resection-developed CLMs. 相似文献11.
Yuqian Huang Qin Shen Harrison X. Bai Jing Wu Cong Ma Quanliang Shang Steven J. Hunt Giorgos Karakousis Paul J. Zhang Zishu Zhang 《Journal of vascular and interventional radiology : JVIR》2018,29(9):1218-1225.e2
Purpose
To compare survival outcome of radiofrequency (RF) ablation and surgical resection (SR) for treatment of hepatocellular carcinoma (HCC) ≤ 2 cm.Materials and Methods
In this retrospective study, patients from the US National Cancer Database with HCC ≤ 2 cm received RF ablation or SR as sole treatment. Overall survival (OS) was compared using log-rank test, multivariable Cox proportional hazard regression, and propensity score matched analysis.Results
Of 833 patients included, 620 received RF ablation and 213 received SR. The 1-, 3-, and 5-year OS rates were 90%, 64%, and 47% for RF ablation and 89%, 75%, and 62% for SR. On univariate analyses, patients who received SR had longer OS than patients who received RF ablation, but this did not achieve statistical significance (P = .113). On multivariate analyses, female sex (HR = 0.700; 95% CI, 0.501–0.979; P = .037), African American (HR = 0.611; 95% CI, 0.398–0.938; P = .024) and Asian ethnicity (HR = 0.427; 95% CI, 0.230–0.790; P = .007), and median income ≥ $48,000 (HR = 0.695; 95% CI, 0.518–0.932; P = .015) were associated with longer OS, whereas higher Model for End-stage Liver Disease (MELD) scores (HR = 1.023; 95% CI, 1.009–1.037; P = .001) were associated with shorter OS. After matching on age, sex, ethnicity, MELD score, and income, there was no significant difference in OS between the 2 treatment groups (log-rank P = .646).Conclusions
There was no significant difference in OS between RF ablation and SR in treatment of HCC measuring ≤ 2 cm. 相似文献12.
Reto Bale Michael Richter Martina Dünser Elliot Levy Wolfgang Buchberger Peter Schullian 《Journal of vascular and interventional radiology : JVIR》2018,29(2):262-267
Purpose
To evaluate outcomes in patients with liver metastases from breast cancer treated with stereotactic radiofrequency (RF) ablation.Materials and Methods
A retrospective analysis of 29 stereotactic RF ablation treatment sessions in 26 consecutive patients with 64 biopsy-proven breast cancer liver metastases (BCLMs) was conducted. Patients were included only if systemic treatment failed and all visible BCLMs were treatable.Results
Primary and secondary technical success rates were 96.9% (62 of 64) and 100%, respectively. There were no perioperative mortalities. Local recurrence was identified in 5 tumors (7.8%), with no significant differences among tumor sizes (P = .662): < 3 cm (9.3%), 3–5 cm (0%), and > 5 cm (8.3%). Median estimated overall survival (OS) from first stereotactic ablation treatment was 29.3 months ± 8.9 (95% confidence interval [CI], 11.9–46.8 mo; mean, 28.7 mo) after a median follow-up of 23.1 months (mean, 31.3 mo; range, 0.1–100.8 mo). No significant differences in OS (P = .223) were observed among tumor volumes < 50 cm3 (median, 84.9 mo ± 53.1; mean, 58.4 mo), 50–100 cm3 (median, 37.8 mo ± 5.7; mean, 36.3 mo), and > 100 cm3 (median, 17.1 mo ± 3.5; mean, 21.8 mo). Numbers of metastases did not affect estimated OS, with a median OS of 32.7 months ± 10.4 (mean, 35.8 mo) for single lesions vs 17.7 months ± 3.2 (mean, 25.9 mo) for 2/3 lesions and a mean of 68.4 months ± 17.23 for > 3 lesions (P = .113).Conclusions
Multiple-electrode stereotactic RF ablation proved to be a safe minimally invasive alternative to surgical liver resection in selected patients with BCLMs. 相似文献13.
Norifumi Kennoki Shinichi Hori Takeo Yuki Atsushi Hori 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1386-1394
Purpose
To evaluate safety and feasibility of transcatheter arterial chemoembolization with superabsorbent polymer microspheres (SAP-MS) for patients with pulmonary or mediastinal metastasis from breast cancer.Methods
Between November 2002 and January 2015, 14 patients with 29 unresectable pulmonary or mediastinal breast cancer metastases underwent transcatheter arterial chemoembolization using SAP-MS (50–100 μm) after injection of a combination of 2–4 types of anticancer drugs (eg, cisplatin [30 mg] + fluorouracil [500 mg], or epirubicin [40 mg] + mitomycin C [4 mg] + fluorouracil [500 mg]). As a primary endpoint, local tumor response and adverse events were evaluated 1 month after the first transcatheter arterial chemoembolization, according to Response Evaluation Criteria In Solid Tumors Version 1.1 and Common Terminology Criteria for Adverse Events Version 4 criteria. Transcatheter arterial chemoembolization was repeated as needed. Overall survival was analyzed as a secondary endpoint.Results
Response rate was 28.6% (partial response, 4 patients; stable disease, 10 patients). Median progression rate was ?12.7%. No cases of hematologic toxicity of grade 3 or higher were observed. A grade 3 maculopapular rash was observed in 1 patient. After the first transcatheter arterial chemoembolization sessions, 63 additional transcatheter arterial chemoembolization sessions were performed (average, 5.5 sessions per patient; range, 2–10 sessions). The median overall survival time after the first session was 29 months, and the 5-year survival rate was 49.5%.Conclusions
Transcatheter arterial chemoembolization with SAP-MS is a well-tolerated and feasible palliative treatment option for patients with pulmonary or mediastinal metastasis from breast cancer. 相似文献14.
Chunyu Jiang Jianbo Wang Yonggang Wang Jungong Zhao Yueqi Zhu Xu Ma Jia Zhou Xuebing Yan 《Cardiovascular and interventional radiology》2016,39(10):1420-1428
Purpose
Transarterial chemoembolization (TACE) is used to treat unresectable bone and soft tissue sarcoma (STS) and as a pre-surgical adjuvant treatment. However, its efficiency for advanced STS is undetermined. This study evaluated TACE’s efficiency in treating advanced STS and prognostic factors for patient survival.Materials and Methods
We enrolled 39 patients with unresectable STS who underwent TACE as an alternative treatment during 2010–2014, with overall survival (OS) as the primary end point. Cancer pain was evaluated by visual analogue scores (VAS) before and after TACE procedures. Factors that affect survival were evaluated by multivariate analyses (Cox proportional hazard model).Results
Mean OS after TACE was 23.7 ± 2.1 months, with 1-year OS 71.5 %, 2-year OS 45.8 %, and 3-year OS 32.5 %. Lesion number and tumor stage were key predictors of survival. TACE was found to decrease cancer pain VAS and increase relapse interval. Size of polyvinyl alcohol (PVA) particle diameter (P = 0.03) and imaging response (P = 0.044) were also found to affect relapse interval.Conclusion
TACE was an effective treatment for advanced STS, with a 32.5 % 3-year OS rate, and led to lower cancer pain VAS and longer relapse intervals than chemoinfusion only. Smaller PVA particles are preferable during the TACE procedure.15.
Etay Ziv Samuel L. Rice John Filtes Hooman Yarmohammadi F. Edward Boas Joseph P. Erinjeri Elena Nadia Petre Lynn A. Brody Karen T. Brown Anne M. Covey George I. Getrajdman Majid Maybody Nitya Raj Constantinos T. Sofocleous Stephen B. Solomon Diane Reidy-Lagunes 《Journal of vascular and interventional radiology : JVIR》2018,29(11):1519-1526
Purpose
To identify common gene mutations in patients with neuroendocrine liver metastases (NLM) undergoing transarterial embolization (TAE) and establish relationship between these mutations and response to TAE.Materials and Methods
Patients (n = 51; mean age 61 y; 29 men, 22 women) with NLMs who underwent TAE and had available mutation analysis were identified. Mutation status and clinical variables were recorded and evaluated in relation to hepatic progression-free survival (HPFS) (Cox proportional hazards) and time to hepatic progression (TTHP) (competing risk proportional hazards). Subgroup analysis of patients with pancreatic NLM was performed using Fisher exact test to identify correlation between mutation and event (hepatic progression or death) by 6 months. Changes in mutation status over time and across specimens in a subset of patients were recorded.Results
Technical success of TAE was 100%. Common mutations identified were MEN1 (16/51; 31%) and DAXX (13/51; 25%). Median overall survival was 48.7 months. DAXX mutation status (hazard ratio = 6.21; 95% confidence interval [CI], 2.67–14.48; P < .001) and tumor grade (hazard ratio = 3.05; 95% CI, 1.80–5.17; P < .001) were associated with shorter HPFS and TTHP on univariate and multivariate analysis. Median HPFS was 3.6 months (95% CI, 1.7–5.3) for patients with DAXX mutation compared with 8.9 months (95% CI, 6.6–11.4) for patients with DAXX wild-type status. In patients with pancreatic NLMs, DAXX mutation status was associated with hepatic progression or death by 6 months (P = .024). DAXX mutation status was concordant between primary and metastatic sites.Conclusions
DAXX mutation is common in patients with pancreatic NLMs. DAXX mutation status is associated with shorter HPFS and TTHP after TAE. 相似文献16.
Joshua Loewenstern Colton Welch Safet Lekperic Vivian Bishay Mona Ranade Rahul S. Patel Edward Kim F. Scott Nowakowski Robert A. Lookstein Aaron M. Fischman 《Journal of vascular and interventional radiology : JVIR》2018,29(7):936-942
Purpose
To compare differences in patient radiation exposure (PRE) during transarterial yttrium-90 (90Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA).Materials and Methods
A total of 810 consecutive first-time TARE procedures in patients from 2013 to 2017 were retrospectively reviewed. A propensity score–matching (PSM) analysis matched TRA and TFA groups on the basis of patient age, sex, weight, height, cancer type, 90Y microsphere type, and number of previous procedures from the same and opposite approaches. Matched groups were then compared by PRE measures fluoroscopy time (FT), dose-area product (DAP), and cumulative air kerma (AK). Effect size for each PRE measure was calculated.Results
Before PSM, TRA and TFA groups differed significantly in mean age, weight, and number of previous procedures from the same and opposite approach (all P < .05). After PSM, each group consisted of 302 procedures (overall, n = 604) and no longer differed in any procedure performed before surgery measure. TRA did not differ from the matched TFA group regarding median FT (9.50 vs 9.40 minutes, P = .095), median DAP (67,066 vs 67,219 mGy·cm2; P = .19), or median AK (323.63 vs 248.46 mGy; P = .16). Effect sizes were 0.068, 0.054, and 0.110 for FT, DAP, and AK, respectively.Conclusions
No statistical differences were found for PRE measures between the matched TRA and TFA approach groups. Furthermore, practical effect sizes were considered to be small for AK and less than small for FT and DAP, and therefore, any differences in PRE between the radial and femoral approaches for TARE are minor and unlikely to be noticeable in everyday clinical practice. 相似文献17.
Jennifer M.J. Jongen Charlotte E.N.M. Rosenbaum Manon N.G.J.A. Braat Maurice A.A.J. van den Bosch Daniel Y. Sze Onno Kranenburg Inne H.M. Borel Rinkes Marnix G.E.H. Lam Andor F. van den Hoven 《Journal of vascular and interventional radiology : JVIR》2018,29(2):244-253.e2
Purpose
To assess applicability of metabolic tumor response assessment on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) after radioembolization (RE) in patients with colorectal liver metastases (CRLM) by comparison with one-dimensional size-based response assessment on MR imaging.Materials and Methods
This prospective cohort study comprised 38 patients with CRLM undergoing RE. MR imaging and 18F-FDG PET/CT imaging were performed at baseline, 1 month (n = 38), and 3 months (n = 21). Longest tumor diameter (LTD) reduction on MR imaging at these time points was compared with reduction in total lesion glycolysis (TLG) on 18F-FDG PET/CT. Hepatic response was compared between RECIST and total liver TLG and correlated with overall survival (OS).Results
TLG and LTD were positively correlated in 106 analyzed metastases (38 patients) at 1 month and 58 metastases (22 patients) at 3 months. Agreement was poor, with LTD underestimating TLG response. A significant association with prolonged OS was found in total liver TLG at 1 month (HR 0.64, P < .01) and 3 months (HR 0.43, P < .01). For LTD, a significant association with OS was found at 3 months (HR 0.10, P < .01). Important differences in liver response classification were found, with total liver TLG identifying more patients and situations where there appeared to be treatment benefit compared with RECIST.Conclusions
TLG response assessment on 18F-FDG PET/CT appears to be more sensitive and accurate, especially at early follow-up, than size-based response assessment on MR imaging in patients with CRLM treated by RE. Semiautomated liver response assessment with total liver TLG is objective, reproducible, rapid, and prognostic. 相似文献18.
Mauro Loi Marloes Duijm Sarah Baker Linda Rossi Dirk Grunhagen Cornelis Verhoef Joost Nuyttens 《La Radiologia medica》2018,123(11):871-878
Background
Stereotactic body radiotherapy (SBRT) is emerging as a novel treatment option in metastatic soft tissue sarcoma (STS). The aim of our study was to evaluate the effectiveness of exclusive SBRT on disease control and survival in oligometastatic (≤?3 synchronous lesions) STS.Materials and methods
In total, 16 consecutive patients, accounting for 26 metastases (including 21 lung and 5 lymph node or soft tissue metastases), were treated at our institution with SBRT. Patient- and treatment-related characteristics were collected. Local control (LC), overall survival (OS), distant metastases-free survival (DMFS), and time to initiation of chemotherapy or best supportive care (corrected disease-free survival, cDFS) were assessed.Results
Four-year OS was 54% and median OS was 69 months [95% confidence interval (CI) 20–118 months]. LC of 26 lesions at 4 years was 78%. Median DMFS and cDFS were 17 (95% CI 5–30 months) and 28 months (95% CI 5–52 months), respectively. Disease-free interval <?24 months from primary tumor treatment to first metastasis was the only predictor of reduced LC, cDFS, and OS (p?=?0.022, 0.023, and 0.028, respectively). No acute or chronic grade ≥?3 toxicity was observed. Median follow-up was 36 months (IQR 18–71 months).Conclusions
In patients with oligometastatic STS, SBRT yields satisfying local control with minimal toxicity. Median OS was 69 months. Repeated SBRT may be considered to extend disease-free and systemic therapy-free interval. Increased time from primary tumor to first metastasis identifies patients with potentially greater benefit from SBRT.19.
Geert Maleux Ward Vander Mijnsbrugge Denis Henroteaux Annouschka Laenen Sandra Cornelissen Kathleen Claes Inge Fourneau Nicolas Verbeeck 《Journal of vascular and interventional radiology : JVIR》2018,29(4):470-475.e3
Purpose
To investigate the potential added value of paclitaxel-coated balloon (PCB) angioplasty to reduce fistula dysfunction related to recurrent stenoses in patients undergoing hemodialysis.Materials and Methods
A prospective, randomized study was conducted in 3 dialysis referral centers. From January 2013 to October 2015, 64 patients (22 female, 42 male) with dysfunctional autologous dialysis fistulae were randomized to undergo conventional percutaneous balloon angioplasty (n = 31) or PCB angioplasty (n = 33). Procedural and postprocedural data were assessed. Primary patency of the fistula was evaluated at 3, 6, and 12 months following the procedure. Statistical analysis was based on the Fisher exact test and independent t test.Results
There were no procedural or postprocedural complications. After 3, 6, and 12 months of follow-up, primary patency rates after PCB angioplasty and percutaneous transluminal angioplasty (PTA) were 88% and 80% (P = .43), 67% and 65% (P = .76), and 42% and 39% (P = .95), respectively.Conclusions
Although primary patency rates after PCB angioplasty in autologous dialysis fistulae at 3, 6, and 12 months of follow-up are slightly better than those after PTA, the difference is not statistically significant. 相似文献20.
Ying-Qiang Zhang Li-Juan Jiang Jia Wen Di-Min Liu Gui-Hua Huang Yu Wang Wen-Zhe Fan Jia-Ping Li 《Journal of vascular and interventional radiology : JVIR》2018,29(12):1654-1661