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1.
Waleed Shady Elena N. Petre Kinh Gian Do Mithat Gonen Hooman Yarmohammadi Karen T. Brown Nancy E. Kemeny Michael D&#x;Angelica Peter T. Kingham Stephen B. Solomon Constantinos T. Sofocleous 《Journal of vascular and interventional radiology : JVIR》2018,29(2):268-275.e1
Purpose
To identify and compare predictors of local tumor progression (LTP)-free survival (LTPFS) after radiofrequency (RF) ablation and microwave (MW) ablation of colorectal liver metastases (CLMs).Materials and Methods
This is a retrospective review of CLMs ablated from November 2009 to April 2015 (110 patients). Margins were measured on contrast-enhanced computed tomography (CT) 6 weeks after ablation. Clinical and technical predictors of LTPFS were assessed using a competing risk model adjusted for clustering.Results
Technique effectiveness (complete ablation) was 93% (79/85) for RF ablation and 97% (58/60) for MW ablation (P = .47). The median follow-up period was significantly longer for RF ablation than for MW ablation (56 months vs. 29 months) (P < .001). There was no difference in the local tumor progression (LTP) rates between RF ablation and MW ablation (P = 0.84). Significant predictors of shorter LTPFS for RF ablation on univariate analysis were ablation margins 5 mm or smaller (P < .001) (hazard ratio [HR]: 14.6; 95% confidence interval [CI]: 5.2–40.9) and perivascular tumors (P = .021) (HR: 2.2; 95% CI: 1.1–4.3); both retained significance on multivariate analysis. Significant predictors of shorter LTPFS on univariate analysis for MW ablation were ablation margins 5 mm or smaller (P < .001) (subhazard ratio: 11.6; 95% CI: 3.1–42.7) and no history of prior liver resection (P < .013) (HR: 3.2; 95%: 1.3–7.8); both retained significance on multivariate analysis. There was no LTP for tumors ablated with margins over 10 mm (median LTPFS: not reached). Perivascular tumors were not predictive for MW ablation (P = .43).Conclusions
Regardless of the thermal ablation modality used, margins larger than 5 mm are critical for local tumor control, with no LTP noted for margins over 10 mm. Unlike RF ablation, the efficiency of MW ablation was not affected for perivascular tumors. 相似文献2.
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3.
Antonio Saviano Roberto Iezzi Felice Giuliante Lucia Salvatore Caterina Mele Alessandro Posa Francesco Ardito Anna Maria De Gaetano Maurizio Pompili 《Journal of vascular and interventional radiology : JVIR》2017,28(11):1512-1519
Purpose
To compare liver resection (LR) with single-step, balloon-occluded radiofrequency (RF) ablation plus drug-eluting embolics transarterial chemoembolization in cirrhotic patients with single hepatocellular carcinoma (HCC) ≥ 3 cm.Materials and Methods
From 2010 to 2014, 25 patients with compensated cirrhosis and single HCC ≥ 3 cm (median size 4.5 cm; range, 3.0–6.8 cm) not suitable for LR or liver transplantation were treated with RF ablation plus transarterial chemoembolization in a prospective observational single-center pilot study; all patients had complete tumor necrosis after treatment. A retrospective control group included 29 patients (median HCC size 4.0 cm; range, 3.0–7.4 cm) who underwent LR. RF ablation plus transarterial chemoembolization group included more patients with severe portal hypertension (65.5% vs 35.0%, P = .017). Primary endpoints were overall survival (OS) and tumor recurrence (TR) rates.Results
One death and 1 major complication (4%) were observed in LR group. No major complications were reported in RF ablation plus transarterial chemoembolization group (P = .463). OS rates at 1 and 3 years were 91.8% and 79.3% in LR group and 89.4% and 48.2% in RF ablation plus transarterial chemoembolization group (P = 0.117). TR rates at 1 and 3 years were 29.5% and 45.0% in LR group and 42.4% and 76.0% in RF ablation plus transarterial chemoembolization group (P = .034). Local tumor progression (LTP) rates at 3 years were significantly lower in LR group (21.8% vs 58.1%, P = .005). Similar results were found in patients with HCC ≤ 5 cm (TR rates 35.4% vs 75.1%, P = .016; LTP 16.0% vs 55.7%, P = .013).Conclusions
LR achieved lower TR and LTP rates than RF ablation plus transarterial chemoembolization, but 3-years OS rates were not statistically different between the 2 groups. RF ablation plus transarterial chemoembolization is an effective treatment option in patients with compensated cirrhosis and solitary HCC ≥ 3 cm unsuitable for LR. 相似文献4.
Erica M. Knavel Chelsey M. Green Annette Gendron-Fitzpatrick Christopher L. Brace Paul F. Laeseke 《Journal of vascular and interventional radiology : JVIR》2018,29(7):1050-1056
Purpose
To quantify the effect of transarterial embolization on microwave (MW) ablations in an in vivo porcine liver model.Materials and Methods
Hepatic arteriography and cone-beam computed tomography (CT) scans were performed in 6 female domestic swine. Two lobes were embolized to an endpoint of substasis with 100–300-μm microspheres. MW ablations (65 W, 5 min) were created in embolized (n = 15) and nonembolized (n = 12) liver by using a 2.45-GHz system and single antenna. Cone-beam CT scans were obtained to monitor the ablations, document gas formation, and characterize arterial flow. Ablation zones were excised and sectioned. A mixed-effects model was used to compare ablation zone diameter, length, area, and circularity.Results
Combined transarterial embolization and MW ablation zones had significantly greater area (mean ± standard deviation, 11.8 cm2 ± 2.5), length (4.8 cm ± 0.5), and diameter (3.1 cm ± 0.6) compared with MW only (7.1 cm2 ± 1.9, 3.7 cm ± 0.6, and 2.4 cm ± 0.3, respectively; P = .0085, P = .0077, and P = .0267, respectively). Ablation zone circularity was similar between groups (P = .9291). The larger size of the combined ablation zones was predominantly the result of an increase in size of the peripheral noncharred zone of coagulation (1.3 cm ± 0.4 vs 0.8 cm ± 0.2; P = .0104). Cone-beam CT scans demonstrated greater gas formation during combined ablations (1.8 cm vs 1.1 cm, respectively). Mean maximum temperatures 1 cm from the MW antennas were 86.6°C and 68.7°C for the combined embolization/ablation and MW-only groups, respectively.Conclusions
Combining transarterial embolization and MW ablation increased ablation zone diameter and area by approximately 27% and 66%, respectively, in an in vivo non–tumor-bearing porcine liver model. This is largely the result of an increase in the size of the peripheral ablation zone, which is most susceptible to local blood flow. 相似文献5.
Hyo-jae Lee Jin Woong Kim Young Hoe Hur Sang Soo Shin Suk Hee Heo Sung Bum Cho Yang Joon Kang Hyo Soon Lim Hyun Ju Seon Yong Yeon Jeong 《Journal of vascular and interventional radiology : JVIR》2017,28(9):1240-1247.e3
Purpose
To compare therapeutic outcomes of radiofrequency (RF) ablation combined with transcatheter arterial chemoembolization vs surgical resection (SR) for single 2–3 cm hepatocellular carcinoma (HCC).Materials and Methods
Seventy patients underwent combined chemoembolization/RF ablation therapy and 84 underwent SR. Local tumor progression (LTP), intrahepatic distant recurrence (IDR), disease-free survival (DFS), and overall survival (OS) rates, as well as major complications and duration of hospital stay, were compared between groups before and after propensity-score matching.Results
LTP and IDR had developed in 9 (12.9%) and 24 (34.3%) patients in the combined treatment group and in 7 (8.3%) and 24 (28.6%) patients in the SR group (P = .262 and P = .252, respectively). The 1-, 3-, 4-, and 5-year DFS rates were similar between groups (82.6%, 53.2%, 53.2%, and 37.6%, respectively, vs 84.5%, 63.6%, 59.2%, and 52.1%, respectively; P = .278), and 1-, 3-, 4-, and 5-year OS rates were also comparable (94.2%, 81.2%, 74.1%, and 59.4%, respectively, vs 95.2%, 86.3%, 84.0%, and 80.3%, respectively; P = .081). After matching (n = 98), LTP, IDR, DFS, and OS rates were still similar (P = .725, P = .826, P = .484, and P = .578, respectively). Major complication rate was not significantly different (2.9% vs. 6.0%; P = .596); however, after matching, major complication rate was higher in SR group (2.0% vs. 6.1%; P < .001). Hospital stays were significantly longer in the SR group (16.6 ± 6.7 d vs 8.5 ± 4.1 d; P < .001).Conclusions
Before and after matching, there were no significant differences in long-term therapeutic outcomes between combined chemoembolization/RF ablation and SR groups. Therefore, combined chemoembolization/RF ablation therapy may be an alternative treatment for single 2–3 cm HCCs. 相似文献6.
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7.
Siddharth A. Padia Guy E. Johnson Kathryn J. Horton Christopher R. Ingraham Matthew J. Kogut Sharon Kwan Sandeep Vaidya Wayne L. Monsky James O. Park Renuka Bhattacharya Daniel S. Hippe William P. Harris 《Journal of vascular and interventional radiology : JVIR》2017,28(6):777-785.e1
Purpose
To compare segmental radioembolization with segmental chemoembolization for localized, unresectable hepatocellular carcinoma (HCC) not amenable to ablation.Materials and Methods
In a single-center, retrospective study (2010–2015), 101 patients with 132 tumors underwent segmental radioembolization, and 77 patients with 103 tumors underwent segmental doxorubicin-based drug-eluting embolic or conventional chemoembolization. Patients receiving chemoembolization had worse performance status (Eastern Cooperative Oncology Group 0, 76% vs 56%; P = .003) and Child-Pugh class (class A, 65% vs 52%; P = .053); patients receiving radioembolization had larger tumors (32 mm vs 26 mm; P < .001), more infiltrative tumors (23% vs 9%; P = .01), and more vascular invasion (18% vs 1%; P < .001). Toxicity, tumor response, tumor progression, and survival were compared. Analyses were weighted using a propensity score (PS).Results
Toxicity rates were low, without significant differences. Index and overall complete response rates were 92% and 84% for radioembolization and 74% and 58% for chemoembolization (P = .001 and P < .001). Index tumor progression at 1 and 2 years was 8% and 15% in the radioembolization group and 30% and 42% in the chemoembolization group (P < .001). Median progression-free and overall survival were 564 days and 1,198 days in the radioembolization group and 271 days and 1,043 days in the chemoembolization group (PS-adjusted P = .002 and P = .35; censored by transplant PS-adjusted P < .001 and P = .064).Conclusions
Segmental radioembolization demonstrates higher complete response rates and local tumor control compared with segmental chemoembolization for HCC, with similar toxicity profiles. Superior progression-free survival was achieved. 相似文献8.
Jason Chiang Kwang Nickel Randall J. Kimple Christopher L. Brace 《Journal of vascular and interventional radiology : JVIR》2017,28(7):1053-1058
Purpose
To evaluate potential biologic and thermal mechanisms of the observed differences in thrombosis rates between hepatic vessels during microwave (MW) ablation procedures.Materials and Methods
MW ablation antennae were placed in single liver lobes of 2 in vivo porcine liver models (n = 3 in each animal; N = 6 total) in the proximity of a large (> 5 mm) portal vein (PV) and hepatic veins (HVs). Each ablation was performed with 100 W for 5 minutes. Conventional ultrasound imaging and intravascular temperature probes were used to evaluate vessel patency and temperature changes during the ablation procedure. Vascular endothelium was harvested 1 hour after ablation and used to characterize genes and proteins associated with thrombosis in PVs and HVs.Results
Targeted PVs within the MW ablation zone exhibited thrombosis at a significantly higher rate than HVs (54.5% vs 0.0%; P = .0046). There was a negligible change in intravascular temperature in PVs and HVs during the ablation procedure (0.2°C ± 0.4 vs 0.6°C ± 0.9; P = .46). PVs exhibited significantly higher gene expression than HVs in terms of fold differences in thrombomodulin (2.9 ± 2.0; P = .0001), von Willebrand factor (vWF; 7.6 ± 1.5; P = .0001), endothelial protein C receptor (3.50 ± 0.49; P = .0011), and plasminogen activator inhibitor (1.46 ± 0.05; P = .0014). Western blot analysis showed significantly higher expression of vWF (2.32 ± 0.92; P = .031) in PVs compared with HVs.Conclusions
Large PVs exhibit thrombosis more frequently than HVs during MW ablation procedures. Biologic differences in thrombogenicity, rather than heat transfer, between PVs and HVs may contribute to their different rates of thrombosis. 相似文献9.
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10.
Hae Jin Kim Byung Kwan Park In Sun Chung 《Journal l'Association canadienne des radiologistes》2018,69(1):24-29
Purpose
Percutaneous radiofrequency ablation is so painful that this treatment requires pain control such as conscious sedation or general anesthesia. It is still unclear which type of anesthesia is better for treatment outcomes of renal cell carcinoma. This study aimed to compare general anesthesia and conscious sedation in treating patients with renal cell carcinoma with radiofrequency ablation.Methods
Between 2010 and 2015, 51 patients with biopsy-proven renal cell carcinomas (<4 cm) were treated with computed tomography–guided radiofrequency ablation. General anesthesia was performed in 41 and conscious sedation was performed in 10 patients. Tumour size, local tumour progression, metastasis, major complication, effective dose, glomerular filtration rate difference, and recurrence-free survival rate were compared between these groups.Results
The mean tumour size was 2.1 cm in both groups (P = .673). Local tumour progression occurred in 0% (0 of 41) of the general anesthesia group, but in 40% (4 of 10) of the conscious sedation group (P = .001). Metastases in these groups occurred in 2.4% (1 of 41) of the general anesthesia group and 20% (2 of 10) of the conscious sedation group (P = .094). No major complications developed in either group after the first radiofrequency ablation session. The mean effective doses in these groups were 21.7 mSv and 21.2 mSv, respectively (P = .868). The mean glomerular filtration rate differences in the general anesthesia and conscious sedation groups were -13.5 mL/min/1.73 m2 and -19.1 mL/min/1.73 m2, respectively (P = .575). Three-year recurrence-free survival rates in these groups were 97.6% and 60.0%, respectively (P = .001).Conclusions
General anesthesia may provide better intermediate outcomes than conscious sedation in treating small renal cell carcinomas with radiofrequency ablation. 相似文献11.
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12.
J. Ricardo Rivero Jose De La Cerda Hanzhang Wang Michael A. Liss Ann M. Farrell Ronald Rodriguez Rajeev Suri Dharam Kaushik 《Journal of vascular and interventional radiology : JVIR》2018,29(1):18-29
Purpose
A systematic review and meta-analysis of clinical trials was undertaken to compare percutaneous thermal ablation versus partial nephrectomy (PN) for stage T1 renal tumors.Materials and Methods
A comprehensive search of major databases was conducted from October 2000 to July 2016. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Incidences of all-cause mortality (ACM), cancer-specific mortality (CSM), local recurrence (LR), and metastases, as well as complication rates and changes in estimated glomerular filtration rate (eGFR), were evaluated.Results
Inclusion criteria were met by 15 of 961 papers. These studies represented 3,974 patients who had undergone an ablative procedure (cryoablation or radiofrequency ablation; n = 1,455; 37%) or PN (n = 2,519; 63%). ACM and CSM rates were higher for ablation than for PN (hazard ratio [HR], 2.11; 95% confidence interval [CI], 1.54–2.87 [P < .05]; HR, 3.84; 95% CI, 1.66–8.88 [P < .05], respectively). No statistically significant difference in LR rate or risk of metastasis was seen between ablation and PN (HR, 1.32; 95% CI, 0.79–2.22 [P = .22]; HR, 1.83; 95% CI, 0.67–5.01 [P = 0.23], respectively). Complication rates were lower for ablation than for PN (13% vs 17.6%; odds ratio, 0.49; 95% CI, 0.25–0.94; P < .05). A significantly greater decrease in eGFR was observed after PN (13.09 mL/min/1.73 m2) vs ablation therapy (4.47 mL/min/1.73 m2).Conclusions
Thermal ablation showed no significant difference in LR or metastases compared with PN. Thermal ablation was associated with a lower morbidity rate and a lesser reduction in eGFR compared with PN, but with higher ACM and CSM rates. 相似文献13.
Wenhui Zhou Ronald S. Arellano 《Journal of vascular and interventional radiology : JVIR》2018,29(7):943-951
Purpose
To evaluate perioperative outcomes of thermal ablation with microwave (MW), radiofrequency (RF), and cryoablation for stage T1c renal cell carcinoma (RCC).Materials and Methods
A retrospective analysis of 384 patients (mean age, 71 y; range, 22–88 y) was performed between October 2006 and October 2016. Mean radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines; preoperative aspects and dimensions used for anatomic classification; and centrality index scores were 6.3, 7.9, and 2.7, respectively. Assessment of pre- and postablation serum blood urea nitrogen, creatinine, and estimated glomerular filtration rate was performed to assess functional outcomes. Linear regression analyses were performed to compare sedation medication dosages among the three treatment cohorts. Univariable and multivariable logistic regression analyses were performed to compare rates of residual disease and complications among treatment modalities.Results
A total of 437 clinical stage T1N0M0 biopsy-proven RCCs measuring 1.2–6.9 cm were treated with computed tomography (CT)–guided MW ablation (n = 44; 10%), RF ablation (n = 347; 79%), or cryoablation (n = 46; 11%). There were no significant differences in patient demographic or tumor characteristics among cohorts. Complication rates and immediate renal function changes were similar among the three ablation modalities (P = .46 and P = .08, respectively). MW ablation was associated with significantly decreased ablation time (P < .05), procedural time (P < .05), and dosage of sedative medication (P < .05) compared with RF ablation and cryoablation.Conclusions
CT-guided percutaneous MW ablation is comparable to RF ablation or cryoablation for the treatment of stage T1N0M0 RCC with regard to treatment response and is associated with shorter treatment times and less sedation than RF ablation or cryoablation. In addition, the safety profile of CT-guided MW ablation is noninferior to those of RF ablation or cryoablation. 相似文献14.
15.
Mustafa M. Haddad Grant D. Schmit A. Nicholas Kurup John J. Schmitz Stephen A. Boorjian Jennifer Geske R. Houston Thompson Matthew R. Callstrom Thomas D. Atwell 《Journal of vascular and interventional radiology : JVIR》2018,29(8):1122-1126
Purpose
To evaluate treatment outcomes with percutaneous cryoablation (PCA) based on renal cell carcinoma (RCC) histology.Methods and Materials
Patients treated with PCA for a solitary, sporadic stage T1a RCC from 2003 to 2016 were identified from a single institution’s renal ablation registry. Patients with multiple tumors, history of RCC, or genetic syndromes associated with RCC (n = 60); no specific RCC subtype determined from core biopsy (n = 66); RCC subtype other than clear-cell or papillary (n = 7); or less than 3 mo of follow-up imaging (n = 5) were excluded. In total, 173 patients met study inclusion criteria. Oncologic outcomes, clinical outcomes, and complications were evaluated based on tumor subtype.Results
Of the 173 patients who underwent PCA for a stage T1a RCC, 130 (75%) had clear-cell RCC (ccRCC) and 43 (25%) had papillary RCC (pRCC). Median tumor size was 2.9 cm (range, 1.3–4.0 cm). Technically successful cryoablation was achieved in all 173 patients. Local tumor recurrence developed in 6 patients with ccRCC (4.6%), new renal tumors developed in 1 patient (0.8%), and metastatic RCC developed in 1 patient (0.8%) who also had local tumor recurrence. No patients with pRCC showed local tumor recurrence, new renal tumors, or metastatic disease. The 5-year disease-free survival rate in patients with ccRCC was 88%, compared with 100% in patients with pRCC (P = .48). Nine patients (5.2%), all with ccRCC, experienced major complications (P = .11).Conclusions
Percutaneous ablation is a viable treatment option for patients with clinical stage T1a pRCC and ccRCC. Percutaneous ablation may be a very favorable treatment strategy particularly for pRCC. 相似文献16.
Ece Meram Colin Longhurst Chris L. Brace Paul F. Laeseke 《Journal of vascular and interventional radiology : JVIR》2018,29(10):1447-1454
Purpose
To compare cone-beam computed tomography (CT) with conventional CT for assessing the growth and postprocedural appearance of pulmonary microwave ablation zones.Materials and Methods
A total of 17 microwave ablations were performed in porcine lung in vivo by applying 65 W for 5 minutes through a single 17-gauge antenna. Either CT (n = 8) or CBCT (n = 9) was used for guidance and ablation zone monitoring at 1-minute intervals. Postprocedural noncontrast images were acquired with both modalities. Three independent readers measured the length, width, cross-sectional area, and circularity of the ablation zones on gross tissue samples and CT and cone-beam CT images. The measurements were compared via linear mixed-effects models for postprocedural appearance and with a polynomial mixed effects model for ablation zone growth curves.Results
On postprocedural images, the differences between cone-beam CT and CT in mean length (3.84 vs 3.86 cm; Δ = ?0.02; P = .70), width (2.61 vs 2.56 cm; Δ = 0.06; P = .46), area (7.84 vs 7.65 cm2; Δ = 0.19; P = .35), and circularity (0.85 vs 0.85; Δ = 0.01; P = .62) were not statistically significant after accounting for intersubject and interrater variability. Also, there was no significant difference between CT and cone-beam CT growth curves of the ablation zones during monitoring in terms of length (pInt. = 1.00; pLin.Slope = 0.52; pQuad.Slope = 0.69); width (pInt. = 0.83; pLin.Slope = 0.98; pQuad.Slope = 0.79), area (pInt. = 0.47; pLin.Slope = 0.27; pQuad.Slope = 0.57), or circularity (pInt. = 0.54; pLin.Slope = 0.74; pQuad.Slope = 0.80). Both CT and cone-beam CT overestimated gross pathologic observations of ablation length, width, and area (P < .001 for all).Conclusions
Cone-beam CT was similar to conventional CT when assessing the growth, final size, and shape of pulmonary microwave ablation zones and may be useful for monitoring and evaluating microwave ablations in the lung. 相似文献17.
Nathan E. Frenk Dania Daye Kemal Tuncali Ronald S. Arellano Paul B. Shyn Stuart G. Silverman Florian J. Fintelmann Raul N. Uppot 《Journal of vascular and interventional radiology : JVIR》2018,29(2):276-284
Purpose
To evaluate local control and survival after image-guided ablation of adrenal gland metastases.Materials and Methods
Image-guided ablations of adrenal metastases measuring < 5 cm performed at 2 academic medical centers between July 2002 and June 2016 were analyzed. There were 51 procedures performed on 46 tumors (mean diameter 2.8 cm ± 1.1; range, 0.7–4.9 cm) in 38 patients (mean age 66 y; range, 41–80 y) with renal cell carcinoma (n = 17 patients; 45%), non–small cell lung cancer (n = 10 patients; 26%), and other primary malignancies (n = 11 patients; 29%). Treatment modalities included cryoablation (n = 30 procedures; 59%), radiofrequency ablation (n = 12 procedures; 24%) and microwave ablation (n = 9 procedures; 18%). Technical success, primary and secondary efficacy, local progression rate, local progression-free survival, and overall survival were assessed. Mean follow-up was 37 months (range, 2–128 months). Statistical analysis was performed with univariate Cox hazards regression and Kaplan-Meier analyses.Results
Technical success, primary efficacy, and secondary efficacy were 96%, 72%, and 76%. Local progression rate during all follow-up was 25%. Local tumor progression-free survival at 1, 3, and 5 years was 82%, 69%, and 55%. Overall survival at 1, 3, and 5 years was 82%, 44%, and 34%. In 16 patients with isolated adrenal metastasis, median disease-free survival was 8 months; 4 patients had no evidence of disease during follow-up. Lung cancer was associated with decreased survival (hazard ratio 4.41, P = .002).Conclusions
Image-guided ablation can achieve local control for adrenal metastases < 5 cm. 相似文献18.
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19.
Jian Shen Wan-Sheng Wang Xiao-Li Zhu Cai-Fang Ni 《Journal of vascular and interventional radiology : JVIR》2018,29(12):1678-1684
Purpose
To assess the role of epithelial cell adhesion molecule (EpCAM)–positive circulating tumor cell (CTC) count in predicting survival outcomes of transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma (HCC).Materials and Methods
EpCAM-positive CTC counts were prospectively determined via CellSearch in peripheral blood of 97 patients with unresectable HCC treated with chemoembolization. The impact of each CTC cutoff point on overall survival (OS) was evaluated by univariate Cox regression analysis. Based on hazard ratio, patients were divided into 3 groups with low (CTC count 0/1), moderate (CTC count 2–5), and high (CTC count ≥ 6) levels. Correlation of CTC counts with survival was assessed by Cox proportional-hazards model.Results
Eighty-nine patients met inclusion criteria and were enrolled. On multivariate Cox regression analysis, CTC count was found to be an independent predictor of OS (P = .049) and progression-free survival (PFS; P = .007) in patients treated with chemoembolization. After adjustment for confounding factors, mortality risks in the high- and moderate-level groups were 2.819 times (95% confidence interval [CI], 1.218–6.526; P = .016) and 1.301 times (95% CI, 0.630–2.685; P = .477) greater, respectively, than in the low-level group. The risk of progression was 3.705 fold higher in the high-level group (95% CI, 1.628–8.433; P = .002) and 1.648 fold higher in the moderate-level group (95% CI, 0.843–3.223; P = .144) vs the low-level group.Conclusions
High EpCAM-positive CTC count predicts poor survival of patients with unresectable HCC treated with chemoembolization. 相似文献20.
Hussein D. Aoun Peter J. Littrup Mohamed Jaber Fatima Memon Barbara Adam Mark Krycia Matthew Prus Elisabeth Heath Edson Pontes 《Journal of vascular and interventional radiology : JVIR》2017,28(10):1363-1370