Covered Stent Graft for Treatment of Carotid Blowout Syndrome in Patients With Head and Neck Cancer.

Importance: Carotid blowout syndrome (CBS) is a rare life-threatening complication of head and neck cancer that requires either surgical or endovascular treatment such as a carotid occlusion procedure or stent-graft placement. CBS outcomes and complications of its management using endovascular stent-graft placement remain unclear due to limited published data. Given that this treatment approach is increasingly used, understanding its efficacy and associated risks is paramount. Objective: To evaluate the periprocedural and postprocedural complications and outcomes associated with stent-graft treatment for CBS in patients with head and neck cancer. Design, Setting, and Participants: This case series study conducted at the Institut Gustave Roussy (Villejuif, France) between January 2006 and December 2021 included all eligible patients with head and neck cancer who experienced CBS and were referred for endovascular treatment. Risk factors and periprocedural and postprocedural data were collected retrospectively from medical records. Data analyses were performed from July 2022 to July 2024. Exposure: Endovascular stent-graft placement for the treatment of CBS in patients with head and neck cancer. Main Outcomes and Measures: Periprocedural and postprocedural complications of stent-graft placement. Secondary outcomes were technical success, defined as immediate control of hemorrhage; 30-day and overall survival rates; and risk factors for mortality and rebleeding. Risk factors considered were body mass index (BMI), CBS presentation, hemodynamic status, tumor stage, and radiation dose. Results: In all, 67 CBS-related stent-graft procedures were performed in 62 patients (mean [SD] age, 55.4 [10.1] years; 10 [16.1%] females and 52 [83.9%] males), most with advanced-stage head and neck cancer, over 15 years. The most frequently observed clinical complications were rebleeding (16 patients [38.8%]) and stroke (9 patients [13.4%]). Immediate hemostasis was achieved in 100% of cases. The survival rate was 77.3% (51 participants) at 30 days postprocedure, with a median (IQR) overall survival time of 59 (32-141.5) days. Acute CBS presentation (risk ratio, 4.30; 95% CI, 1.11-28.23) and BMI (risk ratio, 0.88; 95% CI, 0.77-0.99) showed a statistically significant association with 30-day mortality in univariate analysis. Conclusions and Relevance: The findings of the case-series study indicate that CBS can be safely managed with endovascular stent-graft placement that preserves carotid patency; however, it carries significant risks of ischemia and rebleeding. These findings suggest that stent grafts should be used only in specific clinical scenarios. Despite achieving a high rate of technical success in controlling hemorrhage, the overall and 30-day survival outcomes underscore the critical implications of CBS in patients with cancer and its associated therapeutic challenges.

Safety and efficacy of percutaneous arterial port Implantation for Hepatic Arterial Infusion Chemotherapy.

OBJECTIVES: Approximately 40% of patients with colorectal cancer will develop liver metastases. Hepatic arterial infusion chemotherapy (HAIC) represents a valuable treatment option, with curative, palliative, or adjuvant intent. The aim of our study was to describe technical considerations, safety, and oncological outcomes of patients receiving HAIC. MATERIALS AND METHODS: All patients who underwent percutaneous hepatic arterial port placement in our institution between 2004 and 2021 were included in this retrospective analysis. Demographic, anatomical and technical data were collected. Tumor response was assessed using RECIST 1.1. Kaplan-Meier estimates were used for overall survival (OS) and hepatic progression-free survival (PFS). Adverse events (AEs) were graded using the Clavien-Dindo classification. RESULTS: A total of 360 patients (median age, 58.6 years [interquartile range (IQR): 49.5-65.4]; 208 men [57.8%]) were included. Percutaneous hepatic arterial port placement was successful in 87.9% of cases, resulting in 379 port placements (431 attempts). Overall, 394 HAIC courses were delivered, mostly oxaliplatin-based (94.7%), with a median of 6 cycles per course (IQR: 3-8). AEs (all grades) were observed in 42.0% of ports (grade IIIb-V: 1.1%). Most port dysfunctions could be resolved, resulting in a 73.1% rate of HAIC resumption, without impact on OS. Median OS was 22 months (IQR: 18-24), and median hepatic PFS was 11 months (IQR: 9.5-13). Tumor downstaging allowed surgery in 35.6% of patients, with significantly longer median OS than non-operated patients (39 months [IQR: 33-79] versus 14 months [IQR: 12-16], p < 0.001). CONCLUSION: This retrospective cohort study demonstrates the feasibility, safety, and efficacy of percutaneous hepatic arterial port placement with an impact on survival for selected patients. CLINICAL RELEVANCE STATEMENT: Percutaneous hepatic arterial port placement is feasible, safe and effective with an impact on the survival of selected patients. KEY POINTS: Hepatic arterial infusion chemotherapy provides promising tumor response and overall survival, especially in cases of resection/ablation. Total complication rate of hepatic arterial infusion chemotherapy port use is high, but serious complications are rare. Port revision is often necessary but allows the resumption of hepatic arterial infusion chemotherapy without affecting overall survival.

Musculoskeletal disorders of fishermen in the artisanal and coastal sector.

BACKGROUND: The aim of this study was to screen for musculoskeletal disorders (MSD) complaints, to analyse the activity and to identify their risk factors. MATERIALS AND METHODS: This cross-sectional epidemiological study involved 903 men aged > 20 years and with a seniority > 2 years. It included a questionnaire and an ergonomic analysis of the activity. The questionnaire included: socio-demographic and occupational characteristics, health status and life habits, stress and items from the Nordic questionnaire. The observation of work situations required video recordings and the use of three methods: Occupational Safety and Health Administration (OSHA), Rapid Upper Limb Assessment (RULA) and the Gesture Tracking and Assessment Tool (Outil de Repérage et d'Évaluation des Gestes: OREGE). RESULTS: The prevalence of MSDs was 61.9%. It was significantly higher among deckhands than among other professionals (65.6% vs 27.4%; p < 0.001) and in seasonal workers than in permanent workers (67.8% vs 43.1%; p < 0.001). A positive correlation was noted between MSDs and daily work duration. Stress was an aggravating factor, whereas leisure activities were protective. The prevalence of MSDs was 40.5% (lower back), 40.4% (wrist/hand joints), 34.6% (neck) and 31.7% (shoulders). The ergonomic analysis of the workstation was performed on a deckhand who unloaded the fish crates out of the hold of a trawler. OSHA score = 12 (normal < 5); significant risk of upper limb MSD. RULA total score = 7 (acceptable between 1 and 2); immediate modification. OREGE scores evaluating effort, repetitiveness and joint positions indicate that the actions were not recommended or to be avoided. CONCLUSIONS: The analysis made it possible to evaluate the difficulty of the job and to note a high risk of MSDs requiring ergonomic and organizational improvements.

The Added Value of Transcatheter CT Hepatic Angiography (CTHA) Image Guidance in Percutaneous Thermal Liver Ablation: An Experts' Opinion Pictorial Essay.

With the rapidly evolving field of image-guided tumor ablation, there is an increasing demand and need for tools to optimize treatment success. Known factors affecting the success of (non-)thermal liver ablation procedures are the ability to optimize tumor and surrounding critical structure visualization, ablation applicator targeting, and ablation zone confirmation. A recent study showed superior local tumor progression-free survival and local control outcomes when using transcatheter computed tomography hepatic angiography (CTHA) guidance in percutaneous liver ablation procedures. This pictorial review provides eight clinical cases from three institutions, MD Anderson (Houston, TX, USA), Gustave Roussy (Paris, France), and Amsterdam UMC (Amsterdam, The Netherlands), with the intent to demonstrate the added value of real-time CTHA guided tumor ablation for primary liver tumors and liver-only metastatic disease. The clinical illustrations highlight the ability to improve the detectability of the initial target liver tumor(s) and identify surrounding critical vascular structures, detect 'vanished' and/or additional tumors intraprocedurally, differentiate local tumor progression from non-enhancing scar tissue, and promptly detect and respond to iatrogenic hemorrhagic events. Although at the cost of adding a minor but safe intervention, CTHA-guided liver tumor ablation minimizes complications of the actual ablation procedure, reduces the number of repeat ablations, and improves the oncological outcome of patients with liver malignancies. Therefore, we recommend adopting CTHA as a potential quality-improving guiding method within the (inter)national standards of practice.

A thermally conductive Martian core and implications for its dynamo cessation.

Mars experienced a dynamo process that generated a global magnetic field ~4.3 (or earlier) to 3.6 billion years ago (Ga). The cessation of this dynamo strongly affected Mars' history and is expected to be linked to thermochemical evolution of Mars' iron-rich liquid core, which is strongly influenced by its thermal conductivity. Here, we directly measured thermal conductivities of solid iron-sulfur alloys to pressures relevant to the Martian core and temperatures to 1023 Kelvin. Our results show that a Martian core with 16 weight % sulfur has a thermal conductivity of ~19 to 32 Watt meter-1 Kelvin-1 from its top to the center, much higher than previously inferred from electrical resistivity measurements. Our modeled thermal conductivity profile throughout the Martian deep-mantle and core indicates a ~4- to 6-fold discontinuity across the core-mantle boundary. The core's efficient cooling resulting from the depth-dependent, high conductivity diminishes thermal convection and forms thermal stratification, substantially contributing to cessation of Martian dynamo.

Thermal Ablation Combined with Immune Checkpoint Blockers: A 10-Year Monocentric Experience.

PURPOSE: We report a 10-year experience in cancer therapy with concomitant treatment of percutaneous thermal ablation (PTA) and immune checkpoint blockers (ICBs). MATERIAL AND METHODS: This retrospective cohort study included all patients at a single tertiary cancer center who had received ICBs at most 90 days before, or 30 days after, PTA. Feasibility and safety were assessed as the primary outcomes. The procedure-related complications and immune-related adverse events (irAEs) were categorized according to the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Efficacy was evaluated based on overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) according to the indication, ablation modality, neoplasm histology, and ICB type. RESULTS: Between 2010 and 2021, 78 patients (57% male; median age: 61 years) were included. The PTA modality was predominantly cryoablation (CA) (61%), followed by radiofrequency ablation (RFA) (31%). PTA indications were the treatment of oligo-persistence (29%), oligo-progression (14%), and palliation of symptomatic lesions or prevention of skeletal-related events (SREs) (56%). Most patients received anti-PD1 ICB monotherapy with pembrolizumab (n = 35) or nivolumab (n = 24). The feasibility was excellent, with all combined treatment performed and completed as planned. Ten patients (13%) experienced procedure-related complications (90% grade 1-2), and 34 patients (44%) experienced an irAE (86% grade 1-2). The only factor statistically associated with better OS and PFS was the ablation indication, favoring oligo-persistence (p = 0.02). Tumor response was suggestive of an abscopal effect in four patients (5%). CONCLUSIONS: The concomitant treatment of PTA and ICBs within 2-4 weeks is feasible and safe for both palliative and local control indications. Overall, PTA outcomes were found to be similar to standards for patients not on ICB therapy. While a consistently reproducible abscopal effect remains elusive, the safety profile of concomitant therapy provides the framework for continued assessment as ICB therapies evolve.

Robotic-assisted CT-guided percutaneous thermal ablation of abdominal tumors: An analysis of 41 patients.

PURPOSE: Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors. MATERIALS AND METHODS: Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate. RESULTS: Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41). CONCLUSION: These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors.

Local and distant response to intratumoral immunotherapy assessed by immunoPET in mice.

BACKGROUND: Despite the promising efficacy of immune checkpoint blockers (ICB), tumor resistance and immune-related adverse events hinder their success in cancer treatment. To address these challenges, intratumoral delivery of immunotherapies has emerged as a potential solution, aiming to mitigate side effects through reduced systemic exposure while increasing effectiveness by enhancing local bioavailability. However, a comprehensive understanding of the local and systemic distribution of ICBs following intratumoral administration, as well as their impact on distant tumors, remains crucial for optimizing their therapeutic potential.To comprehensively investigate the distribution patterns following the intratumoral and intravenous administration of radiolabeled anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and to assess its corresponding efficacy in both injected and non-injected tumors, we conducted an immunoPET imaging study. METHODS: CT26 and MC38 syngeneic colorectal tumor cells were implanted subcutaneously on both flanks of Balb/c and C57Bl/6 mice, respectively. Hamster anti-mouse CTLA-4 antibody (9H10) labeled with zirconium-89 ([89Zr]9H10) was intratumorally or intravenously administered. Whole-body distribution of the antibody was monitored by immunoPET imaging (n=12 CT26 Balb/c mice, n=10 MC38 C57Bl/6 mice). Tumorous responses to injected doses (1-10 mg/kg) were correlated with specific uptake of [89Zr]9H10 (n=24). Impacts on the tumor microenvironment were assessed by immunofluorescence and flow cytometry. RESULTS: Half of the dose was cleared into the blood 1 hour after intratumoral administration. Despite this, 7 days post-injection, 6-8% of the dose remained in the intratumoral-injected tumors. CT26 tumors with prolonged ICB exposure demonstrated complete responses. Seven days post-injection, the contralateral non-injected tumor uptake of the ICB was comparable to the one achieved through intravenous administration (7.5±1.7% ID.cm-3 and 7.6±2.1% ID.cm-3, respectively) at the same dose in the CT26 model. This observation was confirmed in the MC38 model. Consistent intratumoral pharmacodynamic effects were observed in both intratumoral and intravenous treatment groups, as evidenced by a notable increase in CD8+T cells within the CT26 tumors following treatment. CONCLUSIONS: ImmunoPET-derived pharmacokinetics supports intratumoral injection of ICBs to decrease systemic exposure while maintaining efficacy compared with intravenous. Intratumoral-ICBs lead to high local drug exposure while maintaining significant therapeutic exposure in non-injected tumors. This immunoPET approach is applicable for clinical practice to support evidence-based drug development.

Burnout syndrome of coastal fishermen.

BACKGROUND: Coastal fishermen are particularly affected by occupational stress and burnout because they are exposed to high psychosocial factors at work and organizational constraints related to difficult working conditions. MATERIALS AND METHODS: This survey aimed to assess the prevalence of burnout syndrome (BOS) of fishermen and its relationship with sociodemographic and occupational parameters. This cross-sectional study involved a representative sample of 761 fishermen. We used an individual questionnaire including socio-demographic and occupational parameters, the Karasek's Job Content Questionnaire, and Maslach BO Inventory. BOS includes three dimensions: emotional exhaustion, depersonalisation, and loss of self-efficacy. The positive diagnosis of BOS is retained if the scores of the three dimensions are abnormal (high for the first two and low for the third). RESULTS: Five hundred and twenty-six people agreed to answer the questionnaire. Of these, 16.1% had a high emotional exhaustion, 13.9% high depersonalisation, and 11.2% low personal accomplishment. Furthermore, 37.1% had at least one abnormal dimension of BOS: 16.9% had one abnormal dimension, 12.2% two, and 8% three (BOS). The prevalence of abnormal dimensions of BOS was significantly higher in pilots-copilots (67.9%), and in mechanics (63.5%) than in sailors (27.8%). It was higher in fishermen living alone (44.4%), having seasonal job (57.9%), suffering of job strain (42.1%) or isostrain (57.9%), and sleep disorders (55.4%). The multivariate logistic regression showed that job strain, isostrain, fatigue, sleep disorders, seasonal job and daily working > 14 h constituted a major risk factor of abnormal dimension of BOS. CONCLUSIONS: It is imperative to identify priority actions to improve the working conditions of fishermen, and to develop a genuine prevention policy.

The percutaneous management of pulmonary metastases.

Local treatment of lung metastases has been in the front scene since late 90s when an international registry of thoracic surgery reported a median overall survival of 35 months in resected patients versus 15 months in non-resected patients. Today, other local therapies are available for patients with oligometastatic lung disease, including image guided thermal ablation, such as ablation, microwave ablation, and cryoablation. Image-guided ablation is increasingly offered, and now recommended in guidelines as option to surgery. Today, the size of the target tumour remains the main driver of success and selection of patients with limited tumour size allowing for local tumour control in the range of 90% in most recent and larger series targeting lung metastases up to 3.5 cm. Overall survival exceeding five-years in large series of thermal ablation for lung metastases from colorectal origin are align with outcome of same patients treated with surgical resection. Moreover, thermal ablation in such population allows for one-year chemotherapy holidays in all comers and over 18 months in lung only metastatic patients, allowing for improved patient quality of life and preserving further lines of systemic treatment when needed. Tolerance of thermal ablation is excellent and better than surgery with no lost in respiratory function, allowing for repeated treatment when needed. In the future, it is likely that practice of lung surgery for small oligometastatic lung disease will decrease, and that minimally invasive techniques will replace surgery in such indications. Randomized study will be difficult to obtain as demonstrated by discontinuation of many studies testing the hypothesis of surgery versus observation, or surgery versus SBRT.

Alkylating Agent-Induced High Tumor Mutational Burden in Medullary Thyroid Cancer and Response to Immune Checkpoint Inhibitors: Two Case Reports.

Background: Patients with metastatic medullary thyroid cancer (MTC) who progressed under tyrosine kinase inhibitors can benefit from an alkylating agent such as dacarbazine or temozolomide. Patient Findings: We describe two patients with metastatic MTC who developed a hypermutant phenotype after alkylating agent treatment. This phenotype was characterized by a high tumor mutational burden (TMB) and a mutational signature indicative of alkylating agent mutagenesis (single-base substitution 11). Both patients received immune checkpoint inhibitors, with partial morphological responses, clinical benefit, and progression-free survival of 6 and 9 months, respectively. Summary and Conclusions: Based on the described observations, we suggest that a hypermutant phenotype may be induced after alkylating agent treatment for MTC and the sequential use of immunotherapy should be further explored as a treatment option for MTC patients with increased TMB.

[French recommendations for malignant pheochromocytomas and paragangliomas by the national ENDOCAN-COMETE network]. / Recommandations du réseau national ENDOCAN-COMETE pour la prise en charge des phéochromocytomes et paragangliomes métastatiques.

Pheochromocytomas and paragangliomas are rare neuroendocrine tumors, developed respectively in the adrenal medulla and in extra-adrenal locations. Their malignancy is defined by the presence of distant metastases. Forty percent of them are inherited and can be part of different hereditary syndromes. Their management is ensured in France by the multidisciplinary expert centers of the ENDOCAN-COMETE national network "Cancers of the Adrenal gland", certified by the National Cancer Institute and discussed within multidisciplinary team meetings. The diagnostic and therapeutic work-up must be standardized, based on an expert analysis of clinical symptoms, hormonal biological secretions, genetics, morphological and specific metabolic imaging. In the context of a heterogeneous survival sometimes beyond seven to ten years, therapeutic intervention must be justified. This is multidisciplinary and relies on surgery, interventional radiology, external or internal radiotherapy and medical treatments such as sunitinib or dacarbazine and temodal chemotherapy. The personalized approach based on functional imaging fixation status and genetics is progressing despite the extreme rarity of this disease.

Safety and Efficacy of Percutaneous Liver Microwave Ablation Using a Fully Water-Cooled Choke Ring Antenna: First Multicenter Clinical Report.

INTRODUCTION: The safety and efficacy of a microwave ablation (MWA) system for the liver with novel technologies in field control, antenna cooling through the inner part of the choke ring, and dual temperature monitoring were evaluated in this multicenter retrospective study. MATERIAL AND METHODS: Ablation characteristics and efficacy were assessed on follow-up imaging (computed tomography or magnetic resonance imaging). Safety was evaluated according to CTCAE classification. RESULTS: Eighty-seven liver tumors (65 metastases and 22 hepatocellular carcinomas) measuring 17.8 ± 7.9 mm were treated in 68 patients. Ablation zones measured 35.6 ± 11 mm in longest diameter. The coefficients of variation of the longest and shortest ablation diameters were 30.1% and 26.4%, respectively. The mean sphericity index of the ablation zone was 0.78 ± 0.14. Seventy-one ablations (82%) had a sphericity index above 0.66. At 1 month, all tumors demonstrated complete ablation with margins of 0-5 mm, 5-10 mm, and greater than 10 mm achieved in 22%, 46%, and 31% of tumors, respectively. After a median follow-up of 10 months, local tumor control was achieved in 84.7% of treated tumors after a single ablation and in 86% after one patient received a second ablation. One grade 3 complication (stress ulcer) occurred, but was unrelated to the procedure. Ablation zone size and geometry in this clinical study were in accordance with previously reported in vivo preclinical findings. CONCLUSION: Promising results were reported for this MWA device. The high spherical index, reproducibility, and predictability of the resulting treatment zones translated to a high percentage of adequate safety margins, providing good local control rate.

Intratumoral Immunotherapy: Is It Ready for Prime Time?

PURPOSE OF REVIEW: This review presents the rationale for intratumoral immunotherapy, technical considerations and safety. Clinical results from the latest trials are provided and discussed. RECENT FINDINGS: Intratumoral immunotherapy is feasible and safe in a wide range of cancer histologies and locations, including lung and liver. Studies mainly focused on multi-metastatic patients, with some positive trials such as T-VEC in melanoma, but evidence of clinical benefit is still lacking. Recent results showed improved outcomes in patients with a low tumor burden. Intratumoral immunotherapy can lower systemic toxicities and boost local and systemic immune responses. Several studies have proven the feasibility, repeatability, and safety of this approach, with some promising results in clinical trials. The clinical benefit might be improved in patients with a low tumor burden. Future clinical trials should focus on adequate timing of treatment delivery during the course of the disease, particularly in the neoadjuvant setting.

[Guidelines of the French National ENDOCAN-COMETE, Association of Endocrine Surgery, Society of Urology for the management of adrenocortical carcinoma]. / Recommandations conjointes du réseau National ENDOCAN-COMETE, de l'Association francophone de chirurgie endocrinienne et de la Société française d'urologie pour la prise en charge du carcinome corticosurrénalien.

The adrenocortical carcinoma (ACC) is a primary malignant tumor developed from the adrenal cortex, defined by a Weiss score≥3. Its prognosis is poor and depends mainly on the stage of the disease at diagnosis. Care is organized in France by the multidisciplinary expert centers of the national ENDOCAN-COMETE "Adrenal Cancers" network, certified by the National Cancer Institute. This document updates the guidelines for the management of ACC in adults based on the most robust data in the literature. It's divided into 11 chapters: (1) circumstances of discovery; (2) pre-therapeutic assessment; (3) diagnosis of ACC; (4) oncogenetics; (5) prognostic classifications; (6) treatment of hormonal hypersecretion; (7) treatment of localized forms; (8) treatment of relapses; (9) treatment of advanced forms; (10) follow-up; (11) the particular case of ACC and pregnancy. R0 resection of all localized ACC remains an unmet need and it must be performed in expert centers. Flow-charts for the therapeutic management of localized ACC, relapse or advanced ACC are provided. It was written by the experts from the national ENDOCAN-COMETE network and validated by all French Societies involved in the management of these patients (endocrinology, medical oncology, endocrine surgery, urology, pathology, genetics, nuclear medicine, radiology, interventional radiology).

Electrochemotherapy in radiotherapy-resistant epidural spinal cord compression in metastatic cancer patients.

OBJECTIVE: To report efficacy and safety of percutaneous electrochemotherapy (ECT) in patients with radiotherapy-resistant metastatic epidural spinal cord compression (MESCC). MATERIAL/ METHODS: This retrospective study analyzed all consecutive patients treated with bleomycin-based ECT between February-2020 and September-2022 in a single tertiary referral cancer center. Changes in pain were evaluated with the Numerical Rating Score (NRS), in neurological deficit with the Neurological Deficit Scale, and changes in epidural spinal cord compression were evaluated with the epidural spinal cord compression scale (ESCCS) using an MRI. RESULTS: Forty consecutive solid tumour patients with previously radiated MESCC and no effective systemic treatment options were eligible. With a median follow-up of 5.1 months [1-19.1], toxicities were temporary acute radicular pain (25%), prolonged radicular hypoesthesia (10%), and paraplegia (7.5%). At 1 month, pain was significantly improved over baseline (median NRS: 1.0 [0-8] versus 7.0 [1.0-10], P < .001) and neurological benefits were considered as marked (28%), moderate (28%), stable (38%), or worse (8%). Three-month follow-up (21 patients) confirmed improved over baseline (median NRS: 2.0 [0-8] versus 6.0 [1.0-10], P < .001) and neurological benefits were considered as marked (38%), moderate (19%), stable (33.5%), and worse (9.5%). One-month post-treatment MRI (35 patients) demonstrated complete response in 46% of patients by ESCCS, partial response in 31%, stable disease in 23%, and no patients with progressive disease. Three-month post-treatment MRI (21 patients) demonstrated complete response in 28.5%, partial response in 38%, stable disease in 24%, and progressive disease in 9.5%. CONCLUSIONS: This study provides the first evidence that ECT can rescue radiotherapy-resistant MESCC.

Thermal ablation of ultrasound and non-contrast computed tomography invisible primary and secondary liver tumors: targeting by selective intra-arterial lipiodol injection.

PURPOSE: To evaluate the technical feasibility and outcomes of thermal ablation following selective intra-arterial lipiodol injection (SIALI) for targeting primary and secondary liver tumors invisible on ultrasound (US) and non-contrast computed tomography (CT). METHODS: This retrospective study included 18 patients with 20 tumors (67% male, mean age 60.8 ± 12.1 years). The 20 tumors included 15 liver metastases and 5 hepatocellular carcinomas. All patients underwent single-session SIALI and subsequent CT-guided thermal ablation. The primary outcome was a technical success, defined as visualization of the tumor after SIALI and successful thermal ablation. Secondary outcomes were local recurrence rate and procedure-related complications. RESULTS: The median tumor size was 1.5 (1-2.5) cm. In addition, SIALI was performed with a median volume of 3 (1-10) mL of lipiodol resulting in intra-tumoral iodized oil accumulation in 19 tumors and negative imprint with iodized oil accumulation of the surrounding liver parenchyma in 1 tumor. The technical success rate was 100%. No local occurrence was observed at a mean follow-up time of 3 ± 2.5 years. CONCLUSION: SIALI to tag liver tumors not visible with US and non-contrast CT before percutaneous ablation is highly feasible and has a high success rate for the treatment of both primary and secondary liver tumors.

Semiautomatic Cone-Beam Computed Tomography Virtual Hepatic Volumetry for Intra-Arterial Therapies.

PURPOSE: To evaluate a software simulating the perfused liver volume from virtual selected embolization points on proximal enhanced cone-beam computed tomography (CT) liver angiography data set using selective cone-beam CT as a reference standard. MATERIALS AND METHODS: Seventy-eight selective/proximal cone-beam CT couples in 46 patients referred for intra-arterial liver treatment at 2 recruiting centers were retrospectively included. A reference selective volume (RSV) was calculated from the selective cone-beam CT by manual segmentation and was used as a reference standard. The virtual perfusion volume (VPV) was then obtained using Liver ASSIST Virtual Parenchyma software on proximal cone-beam CT angiography using the same injection point as for selective cone-beam CT. RSV and VPV were then compared as absolute, relative, and signed volumetric errors (ABSErr, RVErr, and SVErr, respectively), whereas their spatial correspondence was assessed using the Dice similarity coefficient. RESULTS: The software was technically successful in automatically computing VPV in 74 of 78 (94.8%) cases. In the 74 analyzed couples, the median RSV was not significantly different from the median VPV (394 mL [196-640 mL] and 391 mL [192-620 mL], respectively; P = .435). The median ABSErr, RVErr, SVErr, and Dice similarity coefficient were 40.9 mL (19.9-97.7 mL), 12.8% (5%-22%), 9.9 mL (-49.0 to 40.4 mL), and 80% (76%-84%), respectively. No significant ABSErr, RVErr, SVErr, and Dice similarity coefficient differences were found between the 2 centers (P = .574, P = .612, P = .416, and P = .674, respectively). CONCLUSIONS: Perfusion hepatic volumes simulated on proximal enhanced cone-beam CT using the virtual parenchyma software are numerically and spatially similar to those manually obtained on selective cone-beam CT.