Correlation of EGFR or KRAS mutation status with 18F-FDG uptake on PET-CT scan in lung adenocarcinoma.

BACKGROUND: 18F-fluoro-2-deoxy-glucose (18F-FDG) positron emission tomography (PET) is a functional imaging modality based on glucose metabolism. The correlation between EGFR or KRAS mutation status and the standardized uptake value (SUV) of 18F-FDG PET scanning has not been fully elucidated. METHODS: Correlations between EGFR or KRAS mutation status and clinicopathological factors including SUVmax were statistically analyzed in 734 surgically resected lung adenocarcinoma patients. Molecular causal relationships between EGFR or KRAS mutation status and glucose metabolism were then elucidated in 62 lung adenocarcinomas using cap analysis of gene expression (CAGE), a method to determine and quantify the transcription initiation activities of mRNA across the genome. RESULTS: EGFR and KRAS mutations were detected in 334 (46%) and 83 (11%) of the 734 lung adenocarcinomas, respectively. The remaining 317 (43%) patients had wild-type tumors for both genes. EGFR mutations were more frequent in tumors with lower SUVmax. In contrast, no relationship was noted between KRAS mutation status and SUVmax. CAGE revealed that 4 genes associated with glucose metabolism (GPI, G6PD, PKM2, and GAPDH) and 5 associated with the cell cycle (ANLN, PTTG1, CIT, KPNA2, and CDC25A) were positively correlated with SUVmax, although expression levels were lower in EGFR-mutated than in wild-type tumors. No similar relationships were noted with KRAS mutations. CONCLUSIONS: EGFR-mutated adenocarcinomas are biologically indolent with potentially lower levels of glucose metabolism than wild-type tumors. Several genes associated with glucose metabolism and the cell cycle were specifically down-regulated in EGFR-mutated adenocarcinomas.

Multimodality therapy using brachytherapy for caval tumor of hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) invading the inferior vena cava will expose patients to a risk of sudden death. Effective therapeutic approaches have not been established for caval tumor. This pilot study was conducted to evaluate the feasibility, safety, and clinical efficacy of multimodality therapy using endovascular brachytherapy with iridium-192 for caval tumor. METHODOLOGY: Six consecutive patients underwent endovascular high-dose-rate brachytherapy. An iridium-192 source was placed adjacent to the caval tumor through a vascular sheath introduced via the femoral vein. The total dose of brachytherapy ranged from 10 to 14Gy (5-7Gy per fraction). Hepatic arterial infusion chemotherapy was used in combination in all patients and external-beam radiotherapy was performed in 5 patients. RESULTS: Endovascular brachytherapy was technically successful in all patients. There were no complications related to brachytherapy. The median period of follow-up was 14.5 months (range, 3-29 months). Complete response and partial response were achieved in 2 (33%) and 4 (67%) patients, respectively. The 1- and 2-year survival rates were 50% and 17%, respectively, with a median survival of 14 months. CONCLUSIONS: Multimodality therapy using endovascular brachytherapy was a feasible, safe, and effective treatment for patients with advanced HCC invading the inferior vena cava.

Radiofrequency ablation combined with renal arterial embolization for the treatment of unresectable renal cell carcinoma larger than 3.5 cm: initial experience.

The purpose of the study was to evaluate the feasibility, safety, and therapeutic effects of the combination of renal arterial embolization and radiofrequency (RF) ablation to reinforce the anticancer effect on renal cell carcinomas (RCCs) measuring 3.5 cm or larger. This study was undertaken to evaluate this combined therapy on large RCCs-based tumor geometry. Eleven patients with 12 RCCs 3.5 cm or larger in diameter (3.5-9.0 cm) underwent combined therapy. Two were exophytic tumors, and the remaining 10 tumors had components extending into the renal sinus fat. Tumor vessels were selectively embolized in nine patients and the renal artery was completely embolized in two patients with polyvinyl alcohol or ethanol mixed with iodized oil. RF ablation was percutaneously done under the computed tomographic (CT)-fluoroscopic guidance. Response to treatment was evaluated by dynamic contrast-enhanced CT and magnetic resonance (MR) imaging. Tumor enhancement was eliminated after a single RF session in nine tumors (75%), after two sessions in two tumors (17%), and after four sessions in one tumor (8%). Both exophytic tumors (100%) and 7 of 10 tumors having components in the renal sinus fat (70%) were completely ablated with a single RF session. All tumors remained controlled during a mean follow-up period of 13 months and showed significant reduction in tumor sizes (5.2 +/- 1.7 cm to 3.6 +/- 1.4 cm, p < 0.001). A delayed abscess developed in the ablated lesion in a patient, which was percutaneously drainaged. Combined therapy as described in this report is a feasible, relatively safe, and promising treatment method for large RCCs regardless of tumor geometry.

Percutaneous radiofrequency ablation for the treatment of liver neoplasms in the caudate lobe left of the vena cava: electrode placement through the left lobe of the liver under CT-fluoroscopic guidance.

Five hepatocellular carcinomas and one liver metastasis located in the caudate lobe left of the inferior vena cava were successfully treated by radiofrequency (RF) ablation by placing the RF electrode into each tumor through the left lobe of the liver under the CT-fluoroscopic guidance. All tumors were free of enhancement on dynamic contrast-enhanced CT during the mean follow-up period of 6.3 months. There were no major complications related to the procedures.

Tumor seeding following lung radiofrequency ablation: a case report.

Lung radiofrequency (RF) ablation was performed for the treatment of a primary lung cancer measuring 2.5 cm in maximum diameter in a 78-year-old man. A contrast-enhanced computed tomography (CT) study performed 3 months after RF ablation showed incomplete ablation of the lung tumor and the appearance of a chest wall tumor 4.0 cm in maximum diameter that was considered to be the result of needle-tract seeding. RF ablation was performed for the treatment of both the lung and the chest wall tumors. Although tumor enhancement was eradicated in both of the treated tumors, follow-up CT studies revealed diffuse intra-pulmonary metastases in both lungs 2 months after the second RF session. He is currently receiving systemic chemotherapy.

Lung radiofrequency ablation with and without bronchial occlusion: experimental study in porcine lungs.

PURPOSE: This study was undertaken to compare the thermal lesion volumes in normal pig lungs when radiofrequency (RF) ablation is performed with and without airway occlusion. MATERIALS AND METHODS: RF ablation was performed in six pigs. A straight 17-gauge internally cooled-tip electrode with a 2-cm exposed tip was inserted into the center of the lower lobe of the lung under biplane fluoroscopic guidance. In each animal, RF ablation was performed for 12 minutes with balloon occlusion of the main bronchus in one lung and without balloon occlusion in the contralateral lung. The tissue temperature around the electrode tip was measured immediately after RF application. The volumes of the thermal lesions were compared by histologic examination of the groups of lungs ablated with and without airway occlusion. RESULTS: Tissue temperature was significantly higher in the bronchial occlusion group than in the group with normal ventilation (51 degrees C +/- 7 vs. 44 degrees C +/- 2; P < .05). RF ablation with bronchial occlusion resulted in the creation of a significantly greater thermal lesion volume compared with RF ablation with normal ventilation (6,535 mm(3) +/- 1,114 vs 3,368 mm(3) +/- 676; P < .03). CONCLUSION: Prevention of ventilation in the normal swine lung via bronchial balloon occlusion during RF ablation increases the thermal ablation lesion volume, suggesting that active ventilation is a significant cause of in vivo heat loss.

Hepatic arterial infusion chemotherapy with use of an implanted port system in patients with advanced hepatocellular carcinoma: prognostic factors.

PURPOSE: This study was retrospectively undertaken to identify prognostic factors in patients with advanced hepatocellular carcinoma (HCC) treated by hepatic arterial infusion chemotherapy with a percutaneously implantable port system inserted. MATERIALS AND METHODS: Eighty-eight patients underwent arterial infusion chemotherapy for portal venous invasion (n = 39), severe liver dysfunction (n = 6), or tumor regrowth after chemoembolization, percutaneous ethanol injection therapy, and surgery (n = 77). Twenty-five variables representing patients' characteristics, previous treatments, tumor characteristics, liver profiles, various staging systems, and therapeutic effect were analyzed with univariate and multivariate analyses. RESULTS: The 1- and 3-year survival rates were 55% and 24%, respectively, with a mean survival period of 19.5 months +/- 1.9 in all patients. Cancer of the Liver Italian Program (CLIP) score, Okuda stage, therapeutic effect, tumor extension, alkaline phosphatase and aspartate aminotransferase levels, ascites, and portal venous invasion were identified as significant prognostic factors by univariate analysis. Multivariate analysis identified CLIP score, Okuda stage, and therapeutic effect as significant independent prognostic factors. CONCLUSION: Although our results should be confirmed in future prospective studies, the prognostic factors identified in the present study should prove helpful in classifying patients with advanced HCC who are treated by arterial infusion chemotherapy and should serve as useful guidelines on arterial infusion chemotherapy in clinical practice.

Radiofrequency ablation combined with bone cement injection for the treatment of bone malignancies.

PURPOSE: To evaluate the feasibility, safety, and effectiveness of combined treatment with radiofrequency (RF) ablation followed by bone cement injection in patients with malignant bone neoplasms. MATERIALS AND METHODS: Seventeen patients with 23 bone tumors were treated. The tumors, measuring 1.2-15 cm (mean, 4.9 +/- 3.5 cm), were located in the spine (n = 17), iliac bone (n = 3), sacrum (n = 2), and ischial bone (n = 1). All procedures were performed with computed tomographic (CT) fluoroscopic guidance. An electrode with an internally cooled tip was placed in the bone tumor through a biopsy needle and RF energy was applied, followed by cement injection. Pain relief was evaluated with use of the visual analogue scale score (VAS score). Local therapeutic effects were evaluated by contrast-enhanced MR imaging. Lack of tumor enhancement was considered to indicate necrosis. RESULTS: The procedures were technically successful in all patients except for one patient with an osteoblastic ischial lesion (22 of 23 patients; 96%). Pain was relieved within 1 week in all 13 patients who reported pain (13 of 13 patients; 100%), with a significant decrease in the VAS score from 8.4 to 1.1 (P <.001). Tumor necrosis was observed in 71% +/- 24% of the tumor volume (range, 14%-100%). Neural damage occurred in four patients in whom the tumor had invaded the posterior cortex of the vertebral body and pedicle. CONCLUSION: The combined therapy described here is both feasible and useful for the treatment of malignant bone neoplasms. The safety of the procedure depends on the tumor location. When the tumor is adjacent to the spinal cord, there is a risk of nerve injury.

Percutaneous radiofrequency ablation of lung neoplasms: initial therapeutic response.

PURPOSE: To evaluate the feasibility, safety, and initial therapeutic effect of radiofrequency (RF) ablation in the treatment of unresectable malignant lung tumors. MATERIALS AND METHODS: Fifty-four lung neoplasms in 31 patients were treated with RF ablation. Thirteen tumors were primary lung cancers and 41 were pulmonary metastases. Tumor sizes ranged from 0.7 to 6.0 cm, with a mean size of 2.7 +/- 1.3 cm. After the RF electrode was placed in the tumor with computed tomographic (CT) fluoroscopic guidance, RF energy was applied. Initial therapeutic response was evaluated by (18) F fluorodeoxyglucose positron emission tomography (FDG-PET) and contrast-enhanced CT. The disappearance of FDG uptake on PET images and tumor enhancement on CT images were considered to indicate complete tumor necrosis. Complete necrosis rates were evaluated according to tumor size and type (primary or secondary lung neoplasm). RESULTS: RF ablation was technically successful in all lesions. Complete necrosis was achieved in 32 of the 54 tumors (59%) after initial RF session. There was a significant difference in the rate of complete tumor necrosis between tumors 3 cm or less and tumors larger than 3 cm (69% vs. 39%; P <.05). Tumor type did not influence complete necrosis rates. Lung abscesses developed in two patients with large tumors. CONCLUSION: Lung RF ablation is a feasible, relatively safe, and promising treatment for unresectable lung neoplasms. Tumor size is an important factor in achieving complete tumor necrosis.

Combination therapy with radiofrequency ablation and transcatheter chemoembolization for the treatment of hepatocellular carcinoma: Short-term recurrences and survival.

To evaluate short-term clinical results of radiofrequency (RF) ablation combined with transcatheter chemoembolization for the treatment of hepatocellular carcinoma (HCC) and to identify factors having influence on early intrahepatic recurrence. Sixty-four patients with 92 HCC lesions underwent RF ablation within 2 weeks after chemoembolization. The maximum tumor size was small (5 cm) were significantly linked with higher probability of early intrahepatic recurrence. In the multivariate analysis, tumor number was the only independent factor having significant impact on early intrahepatic recurrence. The estimated 1- and 2-year survival rates were 100% and 93%, respectively. This combined therapy showed good early therapeutic effects on treated lesions and survival. Tumor number and maximum tumor size are important factors for early intrahepatic recurrence.

Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition.

A hepatocellular carcinoma compressing the duodenum and a metastatic liver tumor adherent to the stomach were treated by radiofrequency ablation after a balloon was percutaneously placed between the tumor and the gastrointestinal tract to avoid bowel perforation. Neither tumor showed enhancement on dynamic contrast material-enhanced CT after radiofrequency ablation. There were no complications related to the procedures.