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As cases of magnesium oxide pill aspiration are rare, the associated airway proinflammatory properties and appropriate analytic strategies remain unclear. An 81-year-old woman presenting with dyspnea was diagnosed with magnesium oxide pill aspiration. Computed tomography, a "mixing test" with levodopa, and a magnesium content analysis revealed a similar density between the foreign body and her prescribed magnesium oxide pill. The patient recovered without airway complications after foreign body removal. Clinicians should be aware of magnesium oxide tablets as potential bronchial foreign bodies in elderly patients because they may not dissolve without exposure to gastric juices.
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Broncopatias , Corpos Estranhos , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Óxido de Magnésio , Broncoscopia , Brônquios/diagnóstico por imagem , Broncopatias/complicações , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgiaRESUMO
Background: Because adrenal glands are enveloped by Gerota's fascia, spontaneous hemostasis is achieved in most cases of traumatic adrenal injury. For this reason, adrenal injuries are often treated conservatively and rarely present a clinical problem. Case presentation: An 85-year-old man. He presented with right adrenal injury due to blunt trauma, fracture of the right transverse process of the 1st-4th lumbar vertebra, and fracture of the right 12th rib. A small amount of hematoma was observed around the adrenal gland, but his vital signs were stable and he was treated conservatively. However, on the 20th day of hospitalization, he developed sudden onset right-sided abdominal pain, hypotension, and restlessness. Contrast-enhanced CT scan revealed hemorrhagic shock due to delayed adrenal rupture, and emergency transcatheter arterial embolization was performed. A pseudoaneurysm formed at the time of injury was considered to have ruptured late. Conclusion: Delayed rupture after adrenal injury has never been reported in the past, and is a very rare occurrence. Prompt diagnosis and hemostatic treatment are necessary.
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We retrospectively evaluated the safety and effectiveness of an external carotid arterial sheath (ECAS) for intra-arterial chemotherapy (IACT) for locally advanced tongue cancer. Thirty-one patients with the Union for International Cancer Control's 8th TNM stage III-IV tongue cancer underwent IACT using the ECAS combined with RT and systemic chemotherapy with either cisplatin and fluorouracil (FP) or docetaxel, cisplatin, and fluorouracil (TPF) between October 2015 and February 2021. The ECAS was inserted retrogradely via the superficial temporal artery, and the tip was placed in the external carotid artery between the maxillary and facial arteries. A microcatheter was inserted into each tumor-feeding artery through the ECAS under fluoroscopy, wherein cisplatin 50 mg/m2 was administered. IACT was performed weekly with neutralization using sodium thiosulfate. Complete response of the primary lesion was achieved in 28/31 (90%) patients. The median follow-up for all patients was 39 months. The 3-year overall survival, progression-free survival, and local control rates were 81.6%, 74.2%, and 83.4%, respectively. Grade 3 and greater toxicities included oral mucositis (45%), neutropenia (39%), nausea (13%), anemia (10%), thrombocytopenia (10%), dry mouth (10%), and fever (3%). There were no severe complications associated with IACT. In conclusion, the ECAS is feasible and effective for locally advanced tongue cancer.
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Massive hemoptysis may originate from injured pulmonary arteries, such as from pulmonary artery pseudoaneurysms (PAPs). A 93-year-old man, diagnosed with pneumonia, was hospitalized; he later developed a lung abscess (controlled with intravenous antibiotics). On post-hospitalization day 29, he suddenly developed hemoptysis. Multi-detector computed tomography angiography (MDCTA) showed an enhanced nodule, diagnosed as a PAP, inside the lung abscess. The hemoptysis resolved, without recurrence, following transcatheter arterial embolization (TAE) of the PAP and its feeding arteries. PAPs should be considered in patients with lung abscesses and delayed massive hemoptysis. In these patients, MDCTA and TAE are effective diagnostic and treatment modalities.
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It remains unknown which surrogate markers can predict diagnostic test results for primary hyperaldosteronism (PA). The Secondary Hypertension Registry Investigation in Mie Prefecture (SHRIMP) study has sequentially and prospectively recruited 128 patients with hypertension with an aldosterone-to-renin ratio (ARR) greater than 20, evaluated the differences among essential hypertension (EHT), idiopathic hyperaldosteronism (IHA), and aldosterone-producing adenoma (APA), and analyzed the predictors for the confirmatory tests. The patients underwent saline-loading, captopril-challenge, and upright furosemide-loading tests. Carotid, renovascular, and cardiac echography, brachial ankle pulse wave velocity (baPWV), endothelial function, nocturnal blood pressure decline, and the apnea hypopnea index were evaluated. Multivariate regression analyses showed that the plasma aldosterone concentration (PAC) at screening was a strong predictor of the saline and captopril test results. The plasma renin activity (PRA) at screening, urine ß2-microglobulin, and left ventricular mass index (LVMI) were independent predictors for the captopril test. The estimated saline PAC and captopril 60 and 90 min ARRs predicted by the equations were highly correlated with the real values. The ROC curve analysis showed PAC at screening among each of predictors for the diagnostic tests and PAC after the saline-loading test had the highest diagnostic abilities of APA. Patients with IHA were older and had glucose intolerance and increased U-Alb/gCre and resistive indices. In patients with APA, the levels of U-Alb/gCre and urine ß2-microglobulin were increased, and levels of insulin and the HOMA-IR were decreased. In conclusion, our proposed equations may be useful for estimating saline PAC and captopril ARR. Diagnostic predictors may differ for each confirmatory test.
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Hiperaldosteronismo/diagnóstico , Hipertensão/etiologia , Sistema de Registros , Adenoma/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Adulto , Idoso , Aldosterona/sangue , Feminino , Humanos , Hiperaldosteronismo/sangue , Hiperaldosteronismo/complicações , Hiperaldosteronismo/epidemiologia , Hipertensão/sangue , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Renina/sangueRESUMO
PURPOSE: To evaluate the safety and clinical outcomes of radiofrequency (RF) ablation using a multiple-electrode switching system in patients with bone tumors > 3 cm. MATERIALS AND METHODS: This prospective study enrolled 20 subjects (15 men, 5 women; mean age 70.0 y ± 7.4 [SD]; range, 60-80 y) with malignant unresectable bone tumors. The maximum mean tumor diameter was 5.5 cm ± 2.0 (range, 3.1-10.0 cm). Two to three RF electrodes were placed into each bone tumor. Real-time CT fluoroscopic guidance was used with a multiple-electrode switching system. The primary endpoint was safety, as evaluated by Common Terminology Criteria for Adverse Events, until 12 months after bone RF ablation. As secondary endpoints, pain relief was evaluated by visual analog scale (VAS) scores before and 1 week after RF ablation; tumor response, by contrast-enhanced magnetic resonance imaging studies until 4 weeks after bone RF ablation; and survival, by Kaplan-Meier method. RESULTS: No adverse event was found in 19 of 20 patients (95%). Grade 2 fever occurred in 1 patient (5%; 1/20). VAS scores decreased by ≥ 2 in 11 of 13 patients (84.6%) who had painful bone tumors. Tumor response (complete or partial response) was achieved in 16 of 18 patients (88.9%) who underwent follow-up imaging studies. The 1-year overall survival rate was 60.9%, and the median survival time was 14.1 months. CONCLUSIONS: Bone RF ablation using this system is safe and achieves local tumor control and pain relief in patients with large bone tumors.
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Neoplasias Ósseas/cirurgia , Ablação por Cateter/instrumentação , Eletrodos , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Ablação por Cateter/efeitos adversos , Desenho de Equipamento , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Radiografia Intervencionista/métodos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga TumoralRESUMO
PURPOSE: To evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT). MATERIALS AND METHODS: For this institutional review board approved retrospective study conducted during 2002-2012, stents were placed in outflow veins in 15 patients (11.3%, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4-69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complications were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT. RESULTS: Stents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100%, 15/15). Clinical manifestations improved in 11 patients (73.3%, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7%, 4/15) who died in the hospital 1.0-3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2%, p = .405). CONCLUSION: Stenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.
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Transplante de Fígado/efeitos adversos , Fígado/irrigação sanguínea , Implantação de Prótese , Insuficiência Venosa/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Fígado/diagnóstico por imagem , Fígado/cirurgia , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Insuficiência Venosa/diagnóstico por imagem , Adulto JovemRESUMO
PURPOSE: To prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat 2.0-5.0-cm lung tumors. MATERIALS AND METHODS: The institutional review board approved this prospective phase II study. Written informed consent was obtained from all patients. Between September 2009 and July 2011, RFA using two or three radiofrequency (RF) electrodes and a multiple-electrode switching system was performed for malignant lung tumors with a maximum tumor diameter of 2.0-5.0 cm in nonsurgical candidates. The primary endpoint was safety, as evaluated using the Common Terminology Criteria for Adverse Events. Patients were observed for at least 1 year. Local tumor progression and overall survival were analyzed with the Kaplan-Meier method. RESULTS: Thirty-three patients (26 men, seven women; mean age, 70.5 years ± 10.0; age range, 46-87 years) with 35 lung tumors with a mean maximum diameter of 3.0 cm ± 0.7 (standard deviation; range, 2.0-4.4 cm) underwent treatment in 35 sessions. No procedure-related death or grade 4 adverse events (AEs) occurred. Grade 3 AEs occurred in four patients (12%), with pleural effusion requiring chest tube placement in two patients, pneumothorax requiring pleural adhesion in one patient, and pulmonary hemorrhage requiring pulmonary artery coil embolization in one patient. Grade 2 AEs were detected in 13 patients (39%). The 1-year local tumor progression and overall survival rates were 12.7% (95% confidence interval [CI]: 1.0, 25.5) and 81.2% (95% CI: 67.6, 94.8). CONCLUSION: RFA with a multiple-electrode switching system may be a safe therapeutic option with which to treat 2.0-5.0-cm lung cancer tumors.
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Ablação por Cateter/instrumentação , Neoplasias Pulmonares/cirurgia , Idoso , Progressão da Doença , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: To retrospectively evaluate the clinical outcomes of radiofrequency (RF) ablation for the treatment of unresectable adrenal metastasis. MATERIALS AND METHODS: The institutional review board approved this retrospective study, and informed consent to perform adrenal RF ablation was obtained from all patients. From February 2005 through May 2014, 35 patients (25 men and 10 women; mean age, 64.7 years ± 9.6; age range, 39-82 years) underwent RF ablation to treat 41 metastatic adrenal tumors from lung cancer (n = 15), renal cell carcinoma (n = 9), colorectal cancer (n = 5), hepatocellular carcinoma (n = 4), and other tumors (n = 2). Tumors ranged in size from 1.2 to 8.2 cm (mean, 3.3 cm ± 1.6). The diagnosis was established mainly on the basis of radiologic findings. Adrenal arterial embolization was combined with RF ablation in 12 of the 35 patients (34%). Technical success, safety, local tumor progression, and survival were evaluated. The Kaplan-Meier method and Cox proportional hazard model were used to evaluate prognostic factors. RESULTS: There were 48 completed sessions with planned procedures and treatment protocols with no mortality and a major complication rate of 8.3% (four of 48 sessions). Tumor enhancement disappeared after initial adrenal RF ablation in 33 of the 35 patients (94%). Local tumor progression developed in eight of the 35 patients (23%); two patients received repeated RF ablation, resulting in adrenal tumor control in 27 of the 35 patients (77%) at the last follow-up (mean, 30.1 months ± 27.5; range 1.2-96.8 months). The 1-, 3-, and 5-year overall survival rates were 75% (95% confidence interval [CI], 61%, 90%), 34% (95% CI: 17%, 52%), and 30% (95% CI: 13%, 48%), respectively, with a median survival time of 26.0 months. Existence of extra-adrenal tumors (P = .005) and age of 65 years or older (P = .04) were significant indicators of a poor prognosis. CONCLUSION: Adrenal RF ablation is a feasible and useful method for controlling adrenal metastases and offers patients opportunities for improved survival.
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Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/cirurgia , Ablação por Cateter/métodos , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to evaluate the efficacy of portal venous (PV) stent placement and find groups who benefit from this procedure among patients with symptomatic PV hypertension caused by malignant tumors. MATERIALS AND METHODS: From October 2001 to January 2013, 13 patients underwent PV stent placement because of PV stenosis or occlusion caused by bile duct cancer (n = 7), pancreatic cancer (n = 5), or nodal metastasis (n = 1). Technical success, changes in PV pressure gradient and palliative prognostic index (PPI) scores before and after stent placement, clinical outcomes, and complications were evaluated. RESULT: Stent was successfully placed in all patients (100 %, 13/13), lowering the mean PV pressure gradient from 12.4 ± 4.5 mmHg (range 5-20 mmHg) to 0.5 ± 0.9 mmHg (range 0-3 mmHg, p < 0.000001). Symptoms were improved in all but one patient (92.3%, 12/13). Although 10 patients (76.9%, 10/13) with pre-stent placement PPI scores lower than 6 (mean 3.5 ± 1.7, range 0-5) were discharged from the hospital, the other 3 with the pre-stent placement PPI of 6 or more (mean 7.2 ± 1.6, range 6-9.5) died within 4 weeks (range 17-28 days) without discharge. The median survival time of discharged patients was 123 days, and it was 20 days in non-discharged patients (p = 0.0001). A major procedure-related complication of intraperitoneal hemorrhage occurred in one patient (7.7%, 1/13). No significant factor was detected for the occurrence of complication. CONCLUSION: PV stent placement is a feasible, safe, and effective technique to relieve symptomatic PV hypertension caused by malignant tumors. The PPI score might be useful to stratify patients who benefit from this procedure.
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Arteriopatias Oclusivas/cirurgia , Veia Porta/cirurgia , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Constrição Patológica/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: To compare clinical outcomes of radiofrequency (RF) ablation retrospectively with those after radical nephrectomy in patients with stage T1b renal cell carcinoma (RCC). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. From June 2002 to March 2012, 60 patients (mean age, 65.2 years; age range, 39-86 years) with a single RCC measuring 4.1-7.0 cm (stage T1b) underwent RF ablation (n = 21) or radical nephrectomy (n = 39). Selective renal artery embolization was performed before RF ablation in eight patients. The overall, RCC-related, and disease-free survival rates, the percentage decrease in the glomerular filtration rate (GFR), and safety were compared by using the log-rank (survival), paired and Student t (GFR), and Fisher exact (safety) tests. RESULTS: The overall survival rate was significantly lower in the RF ablation group than in the radical nephrectomy group (48% vs 97% at 10 years, respectively; 95% confidence interval [CI]: 12.4%, 76.7% vs 78.2%, 99.5%; P < .009). The RCC-related survival rate (94% [95% CI: 62.6%, 99.1%] with RF ablation vs 100% with radical nephrectomy at 10 years) and the disease-free survival rate (88% [95% CI: 59.2%, 96.9%] with RF ablation vs 84% [95% CI: 60.6%, 94.3%] with radical nephrectomy at 10 years, P = .99) were comparable between the two groups. No treatment-related deaths occurred. Although major complication rates were similar between the two patient groups (8.0% [two of 25 patients] vs 5.1% [two of 39 patients], P = .61), the percentage decrease in the GFR was significantly lower in the RF ablation group than in the radical nephrectomy group at the last follow-up (12.5% ± 23.4 vs 32.3% ± 20.8, respectively; P < .003). CONCLUSION: RF ablation is a safe procedure for patients at substantial surgical risk for radical nephrectomy, providing comparable RCC-related and disease-free survival and preserving renal function.
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Carcinoma de Células Renais/cirurgia , Ablação por Cateter , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Embolização Terapêutica , Feminino , Taxa de Filtração Glomerular , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: To evaluate differences in the viscosity of a platinum iodized-oil suspension on the kind of platinum agent and temperature. MATERIALS AND METHODS: Viscosities of a 70 mg miriplatin and 3.5 ml iodized-oil suspension (MO suspension) and that of 100 mg cisplatin and 10 ml iodized-oil suspension (CO suspension) were evaluated at three temperatures: 25, 37, and 50 °C. Iodized-oil was used as the control. Each liquid was injected into a capillary tube and allowed to drip separately. The liquid transit time was measured, and the viscosity of each liquid was calculated at each temperature. RESULTS: The viscosity of each liquid decreased as the temperature increased: 43.3 ± 0.5, 39.2 ± 0.7, and 34.7 ± 0.6 mPa s for MO suspension, 41.3 ± 0.2, 36.9 ± 0.3, and 32.7 ± 0.9 mPa s for CO suspension, and 40.5 ± 0.2, 36.8 ± 0.2, and 33.8 ± 0.7 mPa s for iodized-oil at 25, 37, and 50 °C, respectively. The MO suspension group viscosity was significantly higher than that of the CO suspension group (p < 0.05) and the control (p < 0.05). Significant differences were found in viscosities among groups divided by temperature (25 °C-group vs. 37 °C-group, p < 0.05; 37 °C-group vs. 50 °C-group, p < 0.05). CONCLUSION: The viscosity of the platinum iodized-oil suspension can be adjusted by changing temperature.
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Antineoplásicos/farmacocinética , Cisplatino/farmacocinética , Compostos Organoplatínicos/farmacocinética , Temperatura , Viscosidade , Antineoplásicos/química , Quimioembolização Terapêutica/métodos , Cisplatino/química , Emulsões Gordurosas Intravenosas/farmacocinética , Humanos , Óleo Iodado/farmacocinética , Neoplasias Hepáticas/terapia , Compostos Organoplatínicos/química , Fatores de TempoRESUMO
PURPOSE: To report 10-year outcomes of treating hepatocellular carcinomas (HCCs) by combination therapy of chemoembolization and radiofrequency (RF) ablation. MATERIALS AND METHODS: Combination therapy was administered in 277 patients with 382 treatment-naïve HCCs. Therapeutic effects, safety, survival rate, and prognostic factors were evaluated. RESULTS: Tumor enhancement disappeared after 466 RF sessions in all tumors, resulting in a complete response rate of 100% (277 of 277) based on modified Response Evaluation Criteria In Solid Tumors. Local tumor progression developed in 15 patients (5.4%; 15 of 277) during the mean follow-up of 44.9 months±29.1 (range, 6.0-134.4 mo). Overall and recurrence-free survival rates were 56.3% (95% confidence interval [CI], 52.5%-60.2%) and 22.5% (95% CI, 19.3%-25.6%) at 5 years and 23.5% (95% CI, 17.7%-29.2%) and 9.3% (95% CI, 6.3%-12.4%) at 10 years. The Child-Pugh class was the only significant prognostic factor detected in both the univariate (P<.001) and the multivariate analyses (hazard ratio, 3.8; 95% CI, 2.5-5.6; P<.001). The 5-year and 10-year overall survival rates were 66.4% (95% CI, 62.0%-70.8%) and 30.6% (95% CI, 23.3%-37.9%) in 210 Child-Pugh class A patients. In addition to the Child-Pugh class, the maximum tumor diameter (≤3 cm vs>3 cm) and the tumor number (single vs multiple) were significant independent factors affecting recurrence-free survival. No death was related to the combination therapy. The major complication rate was 3.2% (15 of 466). CONCLUSIONS: RF ablation combined with chemoembolization is a safe and useful therapeutic option for treating HCCs. Prognostic factors detected in this study help to stratify patients who benefit from this combination therapy.
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Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/terapia , Ablação por Cateter/mortalidade , Quimioembolização Terapêutica/mortalidade , Terapia Combinada/mortalidade , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Análise de Sobrevida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
This study evaluated the safety, feasibility, and clinical utility of hyaluronic acid gel injection to separate the gastrointestinal tract from the tumor during liver radiofrequency ablation (RFA). Eleven patients with liver tumors measuring 0.9-3.5 cm (mean ± standard deviation, 2.1 ± 0.8 cm) that were adjacent to the gastrointestinal tracts received RFA after the mixture of hyaluronic acid gel and contrast material (volume, 26.4 ± 14.5 mL; range, 10-60 mL) was injected between the tumor and the gastrointestinal tract under computed tomographic-fluoroscopic guidance. Each tumor was separated from the gastrointestinal tract by 1.0-1.5 cm (distance, 1.2 ± 0.2 cm) after injection of hyaluronic acid gel, and subsequent RFA was performed without any complications in all patients. Although tumor enhancement disappeared in all patients, local tumor progression was found in a patient (9.1%, 1 of 11) during the follow-up of 5.5 ± 3.2 months (range, 0.4-9.9 months). In conclusion, hyaluronic acid gel injection is a safe and useful technique to avoid thermal injury of the adjacent gastrointestinal tract during liver RFA.
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Queimaduras por Corrente Elétrica/prevenção & controle , Carcinoma Hepatocelular/cirurgia , Ablação por Cateter/métodos , Ácido Hialurônico/farmacologia , Neoplasias Hepáticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Ablação por Cateter/efeitos adversos , Estudos de Coortes , Estudos de Viabilidade , Feminino , Seguimentos , Géis/farmacologia , Humanos , Injeções Intralesionais , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Prospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Trato Gastrointestinal Superior/lesõesRESUMO
PURPOSE: To prospectively evaluate the safety and effectiveness of radiofrequency ablation with a multiple-electrode switching system for the treatment of renal cell carcinoma (RCC). MATERIALS AND METHODS: From November 2009 to December 2010, 33 patients (mean age, 70.7 years; range, 44-86 years) with histologically proved RCCs--including 24 men (mean age, 69.5 years [range, 44-86 years]) and nine women (mean age, 74.1 years [range, 64-83 years])--were enrolled in this phase II study. The institutional review board approved the study after patients provided written informed consent. The mean maximum tumor diameter was 2.9 cm ± 1.0 (standard deviation) (range, 1.5-5.0 cm). Radiofrequency ablation was conducted with a multiple-electrode switching system. The primary endpoint was evaluated with the Common Terminology Criteria for Adverse Events. Secondary endpoints were changes in renal function, technique effectiveness, local tumor progression, and survival. Changes in renal function were evaluated by using the Mann-Whitney U test. RESULTS: No severe adverse events occurred, but three of 33 patients (9%) had grade 2 adverse events. Although the mean glomerular filtration rate at 1 year after radiofrequency ablation was similar to the baseline value in 26 patients with bilateral kidneys (P = .14), it was decreased significantly in six patients with a single kidney (P = .03). Tumor enhancement disappeared after a single radiofrequency session in 31 patients and after two radiofrequency sessions in the other two patients (rates of primary and secondary technique effectiveness, 94% [31 of 33] and 100% [33 of 33], respectively). No local tumor progression was found during the mean follow-up of 20.0 months (range, 11.6-27.6 months). The respective 1-year overall and RCC-related survival rates were 97% (95% confidence interval: 91%, 100%) and 100%. CONCLUSION: Radiofrequency ablation with a multiple-electrode switching system is safe and effective for treatment of RCCs. However, further study is warranted to determine whether this technology is superior to other previously described methods.
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Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Ablação por Cateter/instrumentação , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the feasibility, safety, and clinical outcomes of radiofrequency (RF) ablation for the treatment of liver metastases from gastrointestinal stromal tumor (GIST). MATERIALS AND METHODS: Seven consecutive patients with 21 GIST liver metastases received RF ablation under computed tomographic (CT) fluoroscopic guidance. Liver metastases were solitary in two patients and multiple in five patients, with a mean maximum tumor diameter of 2.2 cm±1.1 (range, 1.2-4.2 cm). In addition to feasibility and safety, local tumor progression and overall and GIST-related survival associated with RF ablation were assessed. RESULTS: All liver metastases were treated in 12 RF sessions, after which contrast-enhanced CT showed disappearance of tumor enhancement. No RF procedure-related complications occurred. Local tumor progression developed in one tumor (4.8%) during the mean follow-up period of 30.6 months±27.5 (range, 5.9-76.4 mo). New liver metastasis in untreated liver and lung metastasis developed in one patient each. One patient died of subarachnoid hemorrhage 5.9 months after RF ablation, but no GIST-related deaths occurred. The respective overall and GIST-related survival rates were 85.7% (95% confidence interval, 33.6%-97.8%) and 100% at 1, 3, and 5 years. CONCLUSIONS: RF ablation is a feasible, safe, and useful therapeutic option for the treatment for GIST liver metastases.
Assuntos
Ablação por Cateter , Neoplasias Gastrointestinais/patologia , Tumores do Estroma Gastrointestinal/secundário , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Estudos de Viabilidade , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/mortalidade , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga TumoralRESUMO
BACKGROUND: We aimed to evaluate therapeutic outcomes of radiofrequency (RF) ablation following intra-arterial iodized-oil injection for hepatocellular carcinomas (HCCs) invisible on ultrasonographic (US) images. MATERIALS AND METHODS: Informed consent was waived for this retrospective study approved by our institutional review board. Sixty-seven consecutive patients with 150 HCCs (mean diameter 1.3 ± 0.6 cm; range 0.5-4.2 cm) received 90 RF sessions following intra-arterial iodized-oil injection. Each patient had at least one HCC invisible on US images. Computed tomography (CT) fluoroscopy-guided RF ablation was performed within 1 week after the injection of iodized oil from feeding arteries of each tumor. Technical success was defined as a planned electrode placement and completion of ablation protocol. Technical success, complications, changes in liver function, local tumor progression, and survival were evaluated. RESULTS: All HCCs became visible on CT fluoroscopy after iodized-oil injection, and RF ablation was technically successful in all sessions (technical success rate, 100%, 90/90). Major complications occurred in 6 RF sessions (6.7%, 6/90), including hemorrhage (2.2%, 2/90), portal thrombosis (2.2%, 2/90), and pneumothorax (2.2%, 2/90). No significant deterioration in Child-Pugh score was found. The mean follow-up period was 23.2 ± 18.0 months. The cumulative local tumor progression rates and overall survival rates were, respectively, 3.9 and 82.7% at 1 year, 5.3 and 45.3% at 3 years, and 5.3 and 26.4% at 5 years. CONCLUSION: CT fluoroscopy-guided RF ablation following intra-arterial iodized-oil injection is a feasible, safe, and useful therapeutic option for HCCs invisible on US images.
Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Carcinoma Hepatocelular/patologia , Ablação por Cateter/métodos , Quimioembolização Terapêutica , Feminino , Fluoroscopia , Humanos , Injeções Intra-Arteriais , Óleo Iodado/administração & dosagem , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , UltrassonografiaRESUMO
PURPOSE: To evaluate the clinical utility of radiofrequency (RF) ablation combined with chemoembolization in treatment of hepatocellular carcinoma (HCC) located in the caudate lobe. MATERIALS AND METHODS: Between September 2000 and October 2011, 20 consecutive patients with single HCC measuring≤5 cm were treated with combination therapy of chemoembolization and RF ablation. Technical success was defined as completion of a planned electrode placement and ablation protocol. The effectiveness of the technique was defined as disappearance of tumor enhancement with an ablative margin of≥5 mm. Technical success, technique effectiveness, local tumor progression, overall and recurrence-free survival, and complications were evaluated. RESULTS: RF electrodes were placed in planned sites of each tumor, and ablation was complete in all patients (technical success rate 100%). Tumor enhancement disappeared with sufficient ablative margins after 20 RF sessions in all patients (technique effectiveness rate 100%). Major and minor complication rates were 10.0% and 15.0%. Local tumor progression was found in 2 of 20 patients (10.0%) with local tumor progression rates of 6.3% at 1 year and 13.5% at 3 years and 5 years. Six patients died during the follow-up period (mean, 40.0 months; range, 2.0-110.5 months). Overall and recurrence-free survival rates were 94.4% and 70.8% at 1 year, 86.6% and 36.9% at 3 years, and 67.5% and 45.5% at 5 years. CONCLUSIONS: RF ablation combined with chemoembolization is a safe and useful therapeutic option to treat HCCs located in the caudate lobe.
Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Recidiva Local de Neoplasia/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico , Ablação por Cateter , Terapia Combinada/métodos , Feminino , Hemostáticos/uso terapêutico , Humanos , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Resultado do TratamentoRESUMO
PURPOSE: To determine prognostic factors in patients with colorectal liver metastases who were not surgical candidates and received liver radiofrequency (RF) ablation. MATERIALS AND METHODS: RF ablation was done for 141 colorectal liver metastases in 84 patients. There were 63 (75.0 %, 63/84) males and 21 (25.0 %, 21/84) females, with a mean age of 64.6 ± 10.3. The mean maximum tumor diameter was 2.3 ± 1.4 cm (range 0.5-9.0 cm). Extrahepatic metastases were associated at the time of liver RF ablation in 23 patients (27.4 %, 23/84), and 12 (14.3 %, 12/84) had lung metastases considered controllable by planned lung RF ablation. Prognostic factors were evaluated by univariate and multivariate analyses. RESULTS: There was no procedure-related mortality. The 1-, 3-, and 5-year overall survival rates were 90.6 % (95 %CI, 83.9-97.2 %), 44.9 % (95 %CI, 31.8-57.9 %), and 20.8 % (95 %CI, 7.3-34.3 %), respectively, with a median survival of 34.9 months. The univariate analysis showed that tumor diameter larger than 3 cm, tumor multiplicity, uncontrollable extrahepatic disease, and previous chemotherapy history were significantly worse prognostic factors. The former three factors remained significant for worse prognosis in the multivariate Cox model. Extrahepatic disease was not a prognostic factor when it could be controlled. CONCLUSION: Tumor size and number, and uncontrollable extrahepatic metastases were significant prognostic factors.