RESUMEN
PURPOSE: To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT). MATERIALS AND METHODS: Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT. RESULTS: TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months). CONCLUSIONS: TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.
Asunto(s)
Catéteres de Permanencia , Drenaje/instrumentación , Órganos en Riesgo , Dosis de Radiación , Exposición a la Radiación/prevención & control , Traumatismos por Radiación/prevención & control , Radiocirugia , Neoplasias Retroperitoneales/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Exposición a la Radiación/efectos adversos , Traumatismos por Radiación/etiología , Radiocirugia/efectos adversos , Neoplasias Retroperitoneales/diagnóstico por imagen , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenAsunto(s)
Cateterismo Periférico/métodos , Hiperpotasemia/terapia , Fallo Renal Crónico/terapia , Extremidad Inferior/irrigación sanguínea , Vena Poplítea , Diálisis Renal , Velocidad del Flujo Sanguíneo , Circulación Colateral , Femenino , Humanos , Hiperpotasemia/diagnóstico , Hiperpotasemia/fisiopatología , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Flebografía , Vena Poplítea/diagnóstico por imagen , Vena Poplítea/fisiopatología , Flujo Sanguíneo Regional , Resultado del Tratamiento , Adulto JovenAsunto(s)
Conductos Biliares Intrahepáticos/lesiones , Conductos Biliares Intrahepáticos/cirugía , Neoplasias Colorrectales/patología , Ictericia Obstructiva/cirugía , Neoplasias Hepáticas/cirugía , Anastomosis Quirúrgica/métodos , Colangiopancreatografia Retrógrada Endoscópica , Femenino , Hepatectomía/efectos adversos , Humanos , Ictericia Obstructiva/etiología , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A new ablation modality, irreversible electroporation (IRE), has been of increasing interest in interventional radiology. Its nonthermal mechanism of action of killing tumor cells allows physicians the ability to ablate tumors in areas previously contraindicated for thermal ablation. This article reviews the current published clinical outcomes, imaging follow-up, and the current knowledge gaps in the procedure for patients treated with IRE.
