ABSTRACT
PURPOSE: To assess the primary safety and oncological outcome of percutaneous cryoablation in patients with non-visceral metastases of the abdominal cavity after prior surgery. METHODS: All patients with non-visceral metastases after prior abdominal surgery, treated with percutaneous cryoablation, and at least one year of follow-up were retrospectively identified. Technical success was achieved if the ice-ball had a minimum margin of 10 mm in three dimensions on the per-procedural CT images. Complications were recorded using the Society of Interventional Radiology (SIR) classification system. Time until disease progression was monitored with follow-up CT and/or MRI. Local control was defined as absence of recurrence at the site of ablation. RESULTS: Eleven patients underwent cryoablation for 14 non-visceral metastases (mean diameter 20 ± 9 mm). Primary tumor origin was renal cell (n = 4), colorectal (n = 3), granulosa cell (n = 2), endometrium (n = 1) and appendix (n = 1) carcinoma. Treated metastases were localized retroperitoneal (n = 8), intraperitoneal (n = 2), or in the abdominal wall (n = 4). Technical success was achieved in all procedures. After a median follow-up of 27 months (12-38 months), all patients were alive. Local control was observed in 10/14 non-visceral metastases, and the earliest local progression was detected after ten months. No major adverse events occurred. One patient suffered a minor asymptomatic adverse event. CONCLUSION: This proof-of-concept study suggests that cryoablation can be a minimal invasive treatment option in a selected group of patients with non-visceral metastases in the abdominal cavity after prior surgery.
Subject(s)
Abdominal Cavity , Cryosurgery , Kidney Neoplasms , Abdominal Cavity/pathology , Cryosurgery/methods , Female , Humans , Kidney Neoplasms/pathology , Retrospective Studies , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
International guidelines dictate that magnetic resonance imaging (MRI) should be part of the primary standard work up of patients with rectal cancer because MRI can accurately identify the main risk factors for local recurrence and stratify patients into a differentiated treatment. The role of endoscopic ultrasound (EUS) is restricted to staging of superficial tumors because EUS is able to differentiate between T1 and T2 rectal cancer. Recent guidelines recommend the addition of diffusion-weighted (DWI) MRI to clinical and endoscopic assessment of response to preoperative radiochemotherapy (RCT). MRI is able to identify significant tumor regression which may alter the surgical approach.
Subject(s)
Neoplasm Recurrence, Local , Rectal Neoplasms , Endosonography , Humans , Magnetic Resonance Imaging , Neoplasm Staging , Rectal Neoplasms/diagnostic imagingABSTRACT
International guidelines dictate that magnetic resonance imaging (MRI) should be part of the primary standard work up of patients with rectal cancer because MRI can accurately identify the main risk factors for local recurrence and stratify patients into a differentiated treatment. The role of endoscopic ultrasound (EUS) is restricted to staging of superficial tumors because EUS is able to differentiate between T1 and T2 rectal cancer. Recent guidelines recommend the addition of diffusion-weighted (DWI) MRI to clinical and endoscopic assessment of response to preoperative radiochemotherapy (RCT). MRI is able to identify significant tumor regression which may alter the surgical approach.
Subject(s)
Neoplasm Recurrence, Local , Rectal Neoplasms , Endosonography/methods , Humans , Magnetic Resonance Imaging , Neoplasm Staging/standards , Rectal Neoplasms/diagnostic imagingABSTRACT
Objetivo. Comparar la efectividad, supervivencia y coste de la quimioembolización transarterial con partículas liberadoras de doxorrubicina (DEB-TACE) y la quimioembolización convencional (cTACE) en pacientes con carcinoma hepatocelular (CHC) irresecable. Material y métodos. Estudio unicéntrico, observacional y retrospectivo que comparó 60 pacientes con CHC irresecable separados en dos grupos comparables de 30 pacientes tratados con DEB-TACE y otros 30 con cTACE. Se realizaron las pruebas de χ2 y t de Student, y se utilizó el método de Kaplan Meier. Resultados. La supervivencia fue menor en hombres y en pacientes con hepatitis C (p = 0,014 y p = 0,003, respectivamente). No hubo diferencias estadísticamente significativas en la supervivencia global a los 5 años (29,99 meses; IC del 95%: 21,38-38,60 y 30,67 meses; IC del 95%: 22,65-38,70; p = 0,626) y la supervivencia libre de progresión (mediana: 11,57 meses; IC del 95%: 0,97-22,18 y 12,80 meses; IC del 95%: 0,00-32,37; p = 0,618). El tiempo medio de ingreso fue de 2,6 y 5,4 días (p < 0,001) para DEB-TACE y cTACE, respectivamente. La toxicidad grado 2-4 fue superior en el grupo cTACE (54 y 31; p < 0,001). El coste del tratamiento fue de 1.581 Euros con DEB-TACE y de 514,63 Euros con cTACE. El coste total medio fue de 3.134 Euros y 3.694,35 Euros, respectivamente (p = 0,173). Conclusión. La quimioembolización en pacientes con CHC irresecable tiene una supervivencia global cercana a 30 meses a los 5 años, independientemente de la técnica empleada. Los costes globales son similares, aunque la mejor tolerancia de la DEB-TACE justifica el mayor coste del procedimiento (AU)
Objectives. To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. Material and methods. This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ2 test, Student t-test, and Kaplan Meier method. Results. Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p = 0.014 and p = 0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p = 0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p = 0.618). The median length of hospital admission were 2.6 and 5.4 days (p < 0.001) for DEB-TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p < 0.001). The cost of the treatment was 1581 Euros for DEB-TACE and 514.63 Euros for cTACE. The overall mean cost of intervention was 3134 Euros and 3694.35 Euros, respectively (p = 0.173). Conclusions. Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure (AU)
Subject(s)
Female , Humans , Male , Chemoembolization, Therapeutic/methods , Chemoembolization, Therapeutic , Doxorubicin/therapeutic use , Carcinoma, Hepatocellular/economics , Carcinoma, Hepatocellular , Ondansetron , Evaluation of the Efficacy-Effectiveness of Interventions , Survivorship , Retrospective Studies , Kaplan-Meier Estimate , CisplatinABSTRACT
OBJECTIVES: To compare the effectiveness, survival and cost in patients with unresectable hepatic cell carcinoma (HCC) treated with trans-arterial chemoembolization using doxorubicin-eluting beads (DEB-TACE) versus conventional TACE (cTACE) in clinical practice. MATERIAL AND METHODS: This single-centered retrospective observational study compared 60 consecutive HCC unresectable patients: 30 were treated with DEB-TACE and 30 used cTACE. Comparisons were with χ(2) test, Student t-test, and Kaplan Meier method. RESULTS: Of the 60 patients with HCC in non-curative stage, baseline characteristics were similar for both groups of treatment, and of these we observed lower survival in male patients and those who had hepatitis C virus (p=0.014 and p=0.003, respectively). No statistically significant differences were observed as a function of treatment employed with respect to overall survival (OS) at 5 years (29.99 months; 95%CI: 21.38-38.60 versus 30.67 months; 95%CI:22.65-38.70; p=0.626) and progression free survival (PFS) median of 11.57 months (95%CI: 0.97-22.18) versus 12.80 months (95%CI:0.00-32.37; p=0.618). The median length of hospital admission were 2.6 and 5.4 days (p<0.001) for DEB(-)TACE and cTACE, respectively. Toxicities grade 2-4 were higher in cTACE group (54 versus 31; p<0.001). The cost of the treatment was 1581 for DEB(-)TACE and 514.63 for cTACE. The overall mean cost of intervention was 3134 and 3694.35 , respectively (p=0.173). CONCLUSIONS: Chemoembolization in patients with unresectable HCC achieved OS close to 30 months at 5 years, independent of the technique employed. Similar overall costs but better tolerance of the DEB-TACE justified the higher costs of the procedure.