RESUMO
PURPOSE: To assess diagnostic accuracy of (18)F-FDG PET/CT at 3 months for the detection of local recurrence after radiofrequency ablation (RFA) of lung metastases. METHODS: The PET/CT scan at 3 months was compared with a baseline PET/CT scan from a maximum of 2 months before RFA, with the reference standard as recurrence diagnosed by CT during a 12-month follow-up. Local recurrence was diagnosed on the PET/CT scan if lesional uptake was greater than the mediastinal background. Maximum standardized uptake values (SUVmax) were recorded. ROC curve analysis for SUVmax was performed. Overall survival (OS) and time to local relapse were computed from the date of RFA using the Kaplan-Meier method (www.clinicaltrials.gov: NCT 00382252). RESULTS: Between 2005 and 2009, 89 patients (mean age 65 years) underwent RFA for 115 lung metastases (mean size 16.2 ± 6.9 mm). The median SUVmax before RFA was 5.8 ± 4. PET/CT at 3 months and the reference standard were available in 77 patients and 100 lesions. Accuracy was 66.00% (95% CI 55.85-75.18%), sensitivity 90.91% (95 % CI 58.72-99.77 %), specificity 62.92% (95% CI 52.03-72.93%), PPV 23.26% (95% CI 11.76-38.63%), and NPV 98.25% (95% CI 90.61-99.96%). One-year OS was 94.2% (95% CI 86.6-97.5%) and the probability of being free of local recurrence 1 year after RFA was 84.6% (95% CI 75.0-90.8%). CONCLUSION: The specificity of PET/CT at 3 months is low because of persistent inflammation, especially when the lesion is close to the pleura. This technique is useful for its negative predictive value, but positive findings need to be confirmed by histology before new treatment is planned.
Assuntos
Técnicas de Ablação , Fluordesoxiglucose F18 , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Tomografia por Emissão de Pósitrons , Terapia por Radiofrequência , Tomografia Computadorizada por Raios X , Técnicas de Ablação/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Imagem Multimodal , Metástase Neoplásica , Recidiva Local de Neoplasia , Curva ROC , Ondas de Rádio/efeitos adversos , Padrões de Referência , Análise de Sobrevida , Resultado do TratamentoRESUMO
Technical feasibility of a computed tomography (CT)-guided transgluteal approach for salvage cryoablation of inoperable locally recurrent prostate cancer was evaluated retrospectively. Five procedures were performed under general anesthesia in five patients previously treated with radiation therapy. Median age was 64 years, and average pretreatment prostate-specific antigen (PSA) level was 2.77 ng/dL (range, 0.56-4.23 ng/dL). Each cryoablation procedure was completed in one session. No complications were reported. Mean 3-month and 6-month PSA levels were 0.35 ng/dL (range, 0.16-0.54 ng/dL) and 0.51 ng/dL (range, 0.09-0.94 ng/dL), respectively, representing mean decreases of 84% (range, 71%-92%) and 81% (range, 78%-84%), respectively. Salvage CT-guided transgluteal cryoablation of the prostate therefore appears technically feasible.
Assuntos
Criocirurgia/métodos , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Nádegas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We report the case of a systemic air embolism occurring during pulmonary radiofrequency ablation. At the end of the procedure, the patient experienced a sudden myocardial infarction, complicated by ventricular fibrillation, cardiac arrest, and cerebral infarction. Thoracic computed tomography showed an air-blood level inside the left atrium and ventricle, the aortic arch, and the coronary arteries. Cerebral computed tomography showed an infarct in the frontoparietal area. Myocardial infarction and stroke responded to resuscitation measures, including hyperbaric oxygenation. The occurrence of this life-threatening event confirms the need to train experienced anesthesiologists in these new invasive approaches to cancer treatment.
Assuntos
Ablação por Cateter/efeitos adversos , Embolia Aérea/etiologia , Neoplasias Pulmonares/cirurgia , Idoso , Embolia Aérea/terapia , Feminino , Humanos , Oxigenoterapia Hiperbárica , Neoplasias Pulmonares/complicações , Infarto do Miocárdio/complicações , Acidente Vascular Cerebral/complicações , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The objective of this study was to study survival and tolerance of prostate cancer patients treated with 125I permanent interstitial brachytherapy by automated vs. manual implantation of seeds. METHODS AND MATERIALS: Between 2002 and 2010, 349 selected patients were treated with 125I brachytherapy by the same team: from 2002 to April 2005, 65 patients with linked seeds and then 284 patients treated using Nucletron First System automated implantation. We analyzed biochemical recurrence-free survival (bRFS) rates and toxicities (univariate and multivariate analyses). RESULTS: Two hundred seventy-seven (79.4%) and 69 patients (19.8%) with low- and intermediate-risk disease were treated, respectively (median follow-up: 64 months). The 5-year bRFS rate was 93.1% (95% confidence interval 89.3-95.6) for the entire cohort. The 5-year bRFS rates were 93.4% and 91.7% for patients with low- and intermediate-risk disease, respectively (p = 0.42). In univariate and multivariate analyses, there was no statistically significant difference in the 5-year bRFS rate depending on the implantation technique (93.1% vs. 91.8%, respectively, for automated and linked seeds; p = 0.53). In univariate analysis, only D90 prostate (dose delivered to 90% of the prostate) <140 Gy (p = 0.01), lack of prostate-specific antigen bounce (p = 0.008), and nadir prostate-specific antigen >0.11 (p = 0.01) were predictive factors for bRFS. We observed Grade 3 urethritis in 7 patients (2%), urinary incontinence in 2 patients (0.7%), and Grade 4 proctitis in 2 patients (0.7%). CONCLUSIONS: In this large single-center series, brachytherapy for selected localized prostate cancer achieved excellent rates of biochemical control at 5 years (93.1%) with an acceptable toxicity profile, irrespective of the implantation technique used.
Assuntos
Braquiterapia/efeitos adversos , Braquiterapia/métodos , Neoplasias da Próstata/radioterapia , Idoso , Braquiterapia/instrumentação , Intervalo Livre de Doença , Seguimentos , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Proctite/etiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Uretrite/etiologia , Incontinência Urinária/etiologiaRESUMO
OBJECTIVES: To evaluate the performance of dynamic contrast enhanced (DCE) magnetic resonance (MR) imaging to assess the histological response after chemotherapy on bladder carcinoma. METHODS: From 2008 to 2010, 12 patients presenting localized urothelial carcinoma of the bladder were prospectively evaluated by DCE-MR imaging before and after two courses of cisplatin-based neoadjuvant chemotherapy. Size and thickness of tumours were measured. Relative enhancement at the arterial (rSI35s) and venous phases (rSI80s) of each tumour was obtained. Histological response was assessed and outcomes were recorded. RESULTS: Histological examination after neoadjuvant chemotherapy concluded as pathological complete response (pCR) for 6 out of 12 patients. Five patients developed recurrences (4/6 no pCR and 1/6 pCR). Significant differences, between before and after treatment, were found for patients with complete pathological response after chemotherapy for all MR quantitative values. Tumours decreased in size and thickness (both P=0.03). After treatment, rSI80s was significantly different between pCR and non-pCR patients (P=0.04) with a cut-off value of 40%. For this cut-off, sensitivity, specificity and accuracy were 83.33%. Similar recurrence free survivals were obtained if applying the MR cut-off value or the histopathological findings. CONCLUSION: Our results suggest that DCE-MR imaging may be a useful biomarker for patients with localized bladder carcinoma, improving selection before surgery.
Assuntos
Carcinoma de Células de Transição/patologia , Meios de Contraste , Imageamento por Ressonância Magnética , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution. MATERIALS AND METHODS: We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years. RESULTS: Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3). CONCLUSION: Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.
Assuntos
Ablação por Cateter/efeitos adversos , Neoplasias Pulmonares/cirurgia , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/anatomia & histologia , Radiologia Intervencionista/métodos , Tórax/inervação , Idoso , Idoso de 80 Anos ou mais , Ablação por Cateter/métodos , Diafragma/anatomia & histologia , Diafragma/inervação , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Traumatismos dos Nervos Periféricos/prevenção & controle , Radiografia Intervencionista/métodos , Estudos Retrospectivos , Tórax/anatomia & histologia , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: This retrospective study examined the feasibility and efficacy of bilateral lung radiofrequency ablation (RFA) performed in a single session. METHODS: From 2002-2009, patients with bilateral lung metastases were treated by RFA, where possible in a single session under general anesthesia with CT guidance. The second lung was punctured only if no complications occurred after treatment of the first lung. Five lung metastases maximum per patient were treated by RFA and prospectively followed. The primary endpoint was the evaluation of acute and delayed complications. Secondary endpoints were calculation of hospitalization duration, local efficacy, median survival, and median time to tumor progression. Local efficacy was evaluated on CT or positron emission tomography (PET) CT. RESULTS: Sixty-seven patients were treated for bilateral lung metastases with RFA (mean age, 62 years). Single-session treatment was not possible in 40 due to severe pneumothoraces (n = 24), bilateral pleural contact (n = 14), and operational exclusions (n = 2). Twenty-seven (41%) received single-session RFA of lesions in both lungs for 66 metastases overall. Fourteen unilateral and four bilateral pneumothoraces occurred (18 overall, 66.7%). Unilateral (n = 13) and bilateral (n = 2) chest tube drainage was required. Median hospitalization was 3 (range, 2-8) days. Median survival was 26 months (95% confidence interval (CI), 19-33). Four recurrences on RFA sites were observed (4 patients). Median time to tumor progression was 9.5 months (95% CI, 4.2-23.5). CONCLUSIONS: Although performing single-session bilateral lung RFA is not always possible due to pneumothoraces after RFA of first lung, when it is performed, this technique is safe and effective.
Assuntos
Ablação por Cateter/métodos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Estudos de Viabilidade , Feminino , Fluordesoxiglucose F18 , Humanos , Iohexol/análogos & derivados , Iopamidol , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Radiografia Intervencionista , Compostos Radiofarmacêuticos , Retratamento , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios XRESUMO
The purpose of this case report is to describe the potential damage to the stellate ganglion during percutaneous lung radiofrequency ablation, to analyze the consequences of these complications, and to review the location of the stellate ganglion, which is usually not visible on imaging.
Assuntos
Neoplasias da Mama/cirurgia , Ablação por Cateter/efeitos adversos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Gânglio Estrelado/lesões , Cirurgia Assistida por Computador/efeitos adversos , Blefaroptose/etiologia , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Pessoa de Meia-Idade , Miose/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
The present article describes two cases of bronchopleural fistula (BPF) occurring after radiofrequency ablation of lung tumors. Both procedures were carried out using expandable multitined electrodes, with no coagulation of the needle track. After both ablations, ground-glass opacities encompassed the nodules and abutted the visceral pleura. The first patient had a delayed pneumothorax, and the second had a recurrent pneumothorax. Both cases of BPF were diagnosed on follow-up computed tomography chest scans (i.e., visibility of a distinct channel between the lung or a peripheral bronchus and the pleura) and were successfully treated with chest tubes alone. Our goal is to highlight the fact that BPF can occur without needle-track coagulation and to suggest that minimally invasive treatment is sufficient to cure BPFs of this specific origin.
Assuntos
Fístula Brônquica/etiologia , Ablação por Cateter/efeitos adversos , Fístula/etiologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Doenças Pleurais/etiologia , Complicações Pós-Operatórias/etiologia , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adolescente , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Fístula Brônquica/diagnóstico por imagem , Fístula Brônquica/terapia , Ablação por Cateter/instrumentação , Tubos Torácicos , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Feminino , Fístula/diagnóstico por imagem , Fístula/terapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/secundário , Osteossarcoma/cirurgia , Doenças Pleurais/diagnóstico por imagem , Doenças Pleurais/terapia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Pneumotórax/terapia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Recidiva , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: To describe the morphologic evolution of lung tumors treated with radiofrequency ablation (RFA) by way of computed tomography (CT) images and to investigate patterns of incomplete RFA at the site of ablation. MATERIALS AND METHODS: One hundred eighty-nine patients with 350 lung tumors treated with RFA underwent CT imaging at 2, 4, 6, and 12 months. CT findings were interpreted separately by two reviewers with consensus. Five different radiologic patterns were predefined: fibrosis, cavitation, nodule, atelectasis, and disappearance. The appearance of the treated area was evaluated at each follow-up CT using the predefined patterns. RESULTS: At 1 year after treatment, the most common evolutions were fibrosis (50.5%) or nodules (44.8%). Differences were noted depending on the initial size of the tumor, with fibrosis occurring more frequently for tumors <2 cm (58.6% vs. 22.9%, P = 1 × 10(-5)). Cavitation and atelectasis were less frequent patterns (2.4% and 1.4%, respectively, at 1 year). Tumor location (intraparenchymatous, with pleural contact <50% or >50%) was not significantly correlated with follow-up image pattern. Local tumor progressions were observed with each type of evolution. At 1 year, 12 local recurrences were noted: 2 cavitations, which represented 40% of the cavitations noted at 1 year; 2 fibroses (1.9%); 7 nodules (7.4%); and 1 atelectasis (33.3%). CONCLUSION: After RFA of lung tumors, follow-up CT scans show that the shape of the treatment zone can evolve in five different patterns. None of these patterns, however, can confirm the absence of further local tumor progression at subsequent follow-up.
Assuntos
Ablação por Cateter , Neoplasias Pulmonares/cirurgia , Tomografia Computadorizada por Raios X , Ablação por Cateter/efeitos adversos , Progressão da Doença , Feminino , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-IdadeRESUMO
Over the last ten years, there has been much development in the treatment of bone metastases using percutaneous image-guided interventional radiology procedures. They are helpful in the management of patients resulting in stabilization of bone lysis in order to achieve additional biomechanical stability and in significant symptomatic relief. Vertebroplasty consisting in an injection of an acrylic cement into a structurally weakened or destructed bone plays a major role in the management of specific bone weakening. Advances have been made also with the application of thermoablation procedures to bone tumors (radiofrequency ablation, cryotherapy). Since conservative treatment with analgesics is often insufficient and the analgesic effect of radiation therapy is delayed and sometimes ineffective, these image-guided procedures play a beneficial role in the management of bone metastases and need more evaluation.