Multimodal therapy with intravenous biweekly leucovorin, 5-fluorouracil and irinotecan combined with hepatic arterial infusion pirarubicin in non-resectable hepatic metastases from colorectal cancer (a European Association for Research in Oncology trial).

BACKGROUND: The purpose of this study was to evaluate the tolerance and efficacy of combining i.v. irinotecan, 5-fluorouracil (5-FU) and leucovorin (LV) with hepatic arterial infusion (HAI) of pirarubicin in non-resectable liver metastases from colorectal cancer. PATIENTS AND METHODS: Thirty-one patients were included in a phase II trial with i.v. irinotecan/5-FU/LV administered every 2 weeks, combined with HAI pirarubicin 60 mg/m(2) on day 1 every 4 weeks. In most cases HAI was administered via a percutaneous catheter. RESULTS: The main grade 3/4 toxicity was neutropenia, encountered in 78% of the patients. When all patients were considered in the analysis, tumour response rate was 15 out of 31 [48%; 95% confidence interval (CI) 32% to 65%]. Liver resection was made possible in 11 patients (35%; 95% CI 21% to 53%). There were no toxic death. Median overall survival was 20.5 months, and median progression-free survival was 9.1 months. In patients with completely resected metastases, median overall survival was not reached and median progression-free survival was 20.2 months. CONCLUSION: The multimodality approach used in the present study was well-tolerated and yielded dramatic responses. An aggressive approach combining i.v. and HAI chemotherapy deserves further investigation.     

Normal spinal bone marrow in adults: dynamic gadolinium-enhanced MR imaging

PURPOSE: To determine the patterns of dynamic enhancement of normal spinal bone marrow in adults at gadolinium-enhanced magnetic resonance (MR) imaging and the changes that occur with aging. MATERIALS AND METHODS: Dynamic contrast material-enhanced MR imaging of the thoracolumbar spine was performed in 71 patients. The maximum percentage of enhancement (Emax), enhancement slope, and enhancement washout were determined from bone marrow enhancement time curves (ETCs). The bone marrow signal intensity on T1-weighted spin-echo MR images was qualitatively classified into three grade categories. Quantitative ETC values were correlated with patient age and bone marrow fat content grade. Statistical analysis included mean t test comparison, analysis of variance, and regression analysis of the correlations between age and quantitative MR parameters. RESULTS: Emax, slope, and washout varied widely among the patients. Emax values were obtained within 1 minute after contrast material injection and ranged from 0% to 430%. Emax values were significantly higher in patients younger than 40 years than in those aged 40 years or older (P <.001). These values decreased with increasing age in a logarithmic relationship (r = 0.71). Emax values decreased as fat content increased, but some overlap among the fat content grades was noted. Analysis of variance revealed that Emax was significantly related to age (younger than 40 years vs 40 years or older) (P <.001) and fat content grade (P <.001) but not significantly related to sex. CONCLUSION: Dynamic contrast-enhanced MR imaging patterns of normal spinal bone marrow are dependent mainly on patient age and fat content.     

Acute occlusion of popliteal and/or tibial arteries: the value of percutaneous treatment.

OBJECTIVES: to describe early and mid-term results with a percutaneous therapeutic protocol including thromboaspiration, thrombolysis, and correction of the underlying lesion by PTA. METHODS: thirty-three consecutive selected patients with recent (<1 month) reversible acute ischaemia associated with popliteal and/or tibial occlusion were studied. The primary endpoints were technical success (defined as residual mural thrombus less than 20% of the lumen and the presence of at least one tibial artery on angiogram), patient survival and limb salvage at 1 and 12 months. Secondary endpoints included complications, primary, assisted primary and secondary patency determined by duplex scan at 1, 6 and 12 months. RESULTS: technical success was achieved in 27 patients (82%). Twenty patients were treated by thrombo- aspiration+/-thrombolysis only, and seven required additional PTA (26%). In six patients (18%), percutaneous techniques failed, and embolectomy was performed in two, bypass in one and major amputations in three (9%). For the entire series, the survival rate was 100% at 1 month and 94% at 1 year. The limb salvage rate was 91% at 1 month and 1 year. The cumulative primary patency, assisted primary patency and secondary patency rates were 81%, 81% and 86% respectively at 1 month and 66%, 72% and 77%, respectively, at 12 months. Early complications occurred in 10 patients (30%): five groin haematomas (15%), four compartment syndromes (12%) and one haemoglobinuria (3%). CONCLUSION: percutaneous techniques offer excellent early and mid-term results in selected patients presenting with acute ischaemia with popliteal and/or tibial arteries occlusion.     

Transarterial chemoembolization (TACE) in the management of hepatocellular carcinoma: Results of a French national survey on current practices

Purpose

To report current practices of transarterial chemoembolization (TACE) by interventional radiologists (IR) for hepatocellular carcinoma (HCC) through a French national survey.

Targeted transarterial therapy of Vx-2 rabbit liver tumor with Yttrium-90 labeled ferromagnetic particles using an external magnetic field

BACKGROUND: Our goal was to study the efficacy of liver cancer embolization with magnetically targeted Yttrium-90 labeled ferromagnetic particles and establish the biodistribution profile of these particles. MATERIALS AND METHODS: Of twenty rabbits, nine underwent transarterial radioembolization of implanted Vx-2 tumor with increasing 90Y-MTC doses, three were treated with carrier particles alone, four remained untreated and four were sacrificed early to document biodistribution. At various intervals, animals were sacrificed and biodistribution, liver cancer viability and toxicity were measured. RESULTS: There was a dose related degree of tumor necrosis, with greater than 90 Gy yielding 100% necrosis (baseline 50%). Blood radioactivity one hour post-radioembolization was less than 0.0275 microCi/g. No hematological toxicity was observed. Except for the non-targeted right liver lobe, organ radioactivity levels were within tolerance levels. Significant left (targeted) hepatic lobe necrosis was seen in subjects receiving high doses. CONCLUSION: Hepatic arterial radioembolization with 9Y-MTC bolstered by external magnetic field has significant tumoricidal effect and a favorable biodistribution profile.     

IRM cardiaque dans le dépistage des complications

Cardiac magnetic resonance (CMR) imaging can detect subtle variations of cardiac volumes and left ventricular ejection fraction during chemotherapy and is therefore helpful to detect subclinical cardiotoxicity. CMR also provides parameters for predicting major adverse cardiovascular events such as indexed left ventricular mass and early global enhancement. Parametric imaging with mapping sequences allows to calculate T1 and T2 relaxation times of myocardium, which seems to be promising in detecting early cardiac toxicity.     

Accuracy of a Cone-Beam CT Virtual Parenchymal Perfusion Algorithm for Liver Cancer Targeting during Intra-arterial Therapy

Purpose

To evaluate accuracy of virtual parenchymal perfusion (VPP) algorithm developed for targeting liver cancer during intra-arterial therapy (IAT) using cone-beam CT guidance.

C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications

C-arm cone-beam computed tomography (CBCT) is a new imaging technology integrated in modern angiographic systems. Due to its ability to obtain cross-sectional imaging and the possibility to use dedicated planning and navigation software, it provides an informed platform for interventional oncology procedures. In this paper, we highlight the technical aspects and clinical applications of CBCT imaging and navigation in the most common loco-regional oncological treatments.     

Midterm survival after endovascular versus open repair of infrarenal aortic aneurysms.

PURPOSE: To report the midterm survival after endovascular repair (ER) of infrarenal aortic aneurysms and to compare the outcomes to contemporaneous patients treated with open repair (OR). METHODS: Between January 1995 and December 2001, 498 patients were treated for abdominal aortic aneurysm: 289 (52%) underwent OR and 209 (48%) underwent ER at a single center. Preoperative risk factors were graded according to the SVS/AAVS risk stratification. A computerized database was used to record demographic, clinical, and follow-up data. RESULTS: Significant benefits (p<0.0001) were observed in the ER group in terms of mean procedural time (163+/-66 versus 132+/-61 minutes), mean blood loss (1268+/-923 versus 122.5+/-284 mL), and mean hospital length of stay (16.24+/-13.3 versus 9.3+/-11.6 days). The perioperative mortality for OR and ER patients were, respectively, 5.1% and 1.5% (p=0.04). The mean follow-up was 40 months in the OR group (range 0-85) and 19 months in the ER group (range 2-80). Contact was lost with 31 (6%) patients during the study. No overall survival advantage was observed for OR over ER, and comparison of OR and ER according the risk classifications did not yield any significant differences. No patients died of aneurysm rupture, but 7 ER patients had to be converted to open surgery. The cumulative freedoms from reinterventions at 4 years for the OR and ER groups, respectively, were 87% and 63% (p=0.001). Patients treated by OR had better clinical success (p=0.001). Patients in the ER group without iliac artery aneurysm showed a significant improvement (p=0.035) over patients with aneurysmal iliac arteries. CONCLUSIONS: Over the 7 years of this study, ER realized its goal: prevention of aneurysm rupture. Despite a greater number of reinterventions for ER patients, no overall survival difference was observed.