RESUMO
PURPOSE: To state the Society of Interventional Radiology's position on the use of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease to the lung. MATERIALS AND METHODS: A multidisciplinary writing group, with expertise in treating lung cancer, conducted a comprehensive literature search to identify studies on the topic of interest. Recommendations were drafted and graded according to the updated SIR evidence grading system. A modified Delphi technique was used to achieve consensus agreement on the recommendation statements. RESULTS: A total of 63 studies, including existing systematic reviews and meta-analysis, retrospective cohort studies, and single-arm trials were identified. The expert writing group developed and agreed on 7 recommendations on the use of image-guided thermal ablation in the lung. CONCLUSION: SIR considers image-guided thermal ablation to be an acceptable treatment option for patients with inoperable Stage I NSCLC, those with recurrent NSCLC, as well as patients with metastatic lung disease.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Neoplasias Pulmonares , Canadá , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Radiologia Intervencionista , Estudos RetrospectivosRESUMO
PURPOSE: To provide guidance on quality improvement thresholds for outcomes and complications of image-guided thermal ablation for the treatment of early stage non-small cell lung cancer, recurrent lung cancer, and metastatic disease. MATERIALS AND METHODS: A multidisciplinary writing group conducted a comprehensive literature search to identify studies on the topic of interest. Data were extracted from relevant studies and thresholds were derived from a calculation of 2 standard deviations from the weighted mean of each outcome. A modified Delphi technique was used to achieve consensus agreement on the thresholds. RESULTS: Data from 29 studies, including systematic reviews and meta-analyses, retrospective cohort studies, and single-arm trials were extracted for calculation of the thresholds. The expert writing group agreed on thresholds for local control, overall survival and adverse events associated with image-guided thermal ablation. CONCLUSION: SIR recommends utilizing the indicator thresholds to review and assess the efficacy of ongoing quality improvement programs. When performance falls above or below specific thresholds, consideration of a review of policies and procedures to assess for potential causes, and to implement changes in practices, may be warranted.
Assuntos
Carcinoma Pulmonar de Células não Pequenas , Ablação por Cateter , Neoplasias Pulmonares , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Humanos , Pulmão , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Melhoria de Qualidade , Radiologia Intervencionista , Estudos RetrospectivosAssuntos
Biópsia por Agulha/normas , Biópsia Guiada por Imagem/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Radiologia Intervencionista/normas , Fatores Etários , Biópsia por Agulha/efeitos adversos , Consenso , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Segurança do Paciente/normas , Valor Preditivo dos Testes , Fatores de RiscoAssuntos
Artérias , Ensaios Clínicos como Assunto/normas , Embolização Terapêutica/normas , Sintomas do Trato Urinário Inferior/terapia , Próstata/irrigação sanguínea , Hiperplasia Prostática/terapia , Radiografia Intervencionista/normas , Projetos de Pesquisa/normas , Terminologia como Assunto , Artérias/diagnóstico por imagem , Consenso , Embolização Terapêutica/efeitos adversos , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico por imagem , Sintomas do Trato Urinário Inferior/fisiopatologia , Masculino , Padrões de Prática Médica/normas , Hiperplasia Prostática/diagnóstico por imagem , Hiperplasia Prostática/fisiopatologia , Radiografia Intervencionista/efeitos adversos , Resultado do TratamentoRESUMO
PURPOSE: Uterine artery embolization (UAE) is an effective treatment for the management of symptomatic uterine fibroids. We aim to evaluate the efficacy of superior hypogastric nerve block (SHNB) in reducing narcotic analgesia use for postprocedural pain after UAE. METHODS: A retrospective review of 88 consecutive patients with symptomatic fibroids who underwent UAE between August 2015 and August 2018 was performed. A total of 44 patients had intraprocedural SHNB and 44 patients had no SHNB. They were placed on a morphine patient-controlled anesthesia (PCA) pump after the procedure and were admitted for overnight observation. The total amount of PCA narcotic analgesia received was recorded for each patient. Additional factors including fibroid size, fibroid location, and patient age were evaluated to determine the predictors of narcotic use reduction after SHNB. RESULTS: The mean amount of postprocedural morphine use was 51.7 mg in patients who did not receive an SHNB versus 35.9 mg in patients who did receive an SHNB (P = .008), resulting in a 47.2% reduction in narcotic analgesia use in the SHNB cohort. A significant reduction in morphine use with SHNB was associated with fibroid size greater than 5 cm (P = .009), intramural fibroid location (P = .04), and patients 45 years or younger (P = .006). CONCLUSION: The use of SHNB could significantly reduce the amount of narcotic analgesia required for pain control after UAE with larger intramural fibroids and younger patients as predictors of increased efficacy.