Navigation Improves Tumor Ablation Performance: Results From a Novel Liver Tumor Simulator Study.

BACKGROUND: The efficacy of microwave ablation in treating hepatic tumors requires advanced ultrasound skills. Failure of proper technique has the potential for either under- or over-treatment and possible harm to the patient. Emprint SX™ navigation provides surgeons with intra-operative, real-time navigation through augmented reality localization of the ablation antenna and the expected ablation zone. We hypothesize that incorporating this technology leads to improved targeting and optimizes ablation coverage. This study utilizes a simulated model to evaluate ablation outcomes using Emprint SX™ navigation vs standard ultrasound. METHODS: Surgical residents and faculty were recruited from a single institution. Using a novel tumor ablation simulator, participants performed ablations via 2 modes: standard ultrasound guidance (STD) and Emprint SX™ navigation (NAV). Primary outcome was the percentage of under-ablation. Secondary outcomes included percentage of over-ablation, time to complete trial, and number of attempts to position antenna. RESULTS: 281 trials were performed by fifteen participants, with 47% female and 60% novice ablationists. Under-ablation volume decreased by a mean of 16.3% (SEM ±12.9, P < .001) with NAV compared to STD. Over-ablation volume decreased by a mean of 14.0% (±8.2, P < .001). NAV time was faster by a mean of 32 seconds (±24.9, P < .001) and involved fewer antenna placement attempts by a mean of 1.3 (±1.0, P < .001). For novice ablationists, all outcomes were improved with NAV and novices saw larger improvements compared to experienced ablationists (P = .018). DISCUSSION: In a simulated model, NAV improves ablation efficacy and efficiency, with novices gaining the greatest benefit over standard ultrasound.

A Randomized, Single-Blind Study Evaluating the Effect of a Bone Pain Education Video on Reported Bone Pain in Patients with Breast Cancer Receiving Chemotherapy and Pegfilgrastim.

BACKGROUND: Mild-to-moderate bone pain is the most commonly reported adverse event associated with pegfilgrastim. AIMS: To investigate the effect of bone pain education on pegfilgrastim-related bone pain in patients with breast cancer receiving chemotherapy and pegfilgrastim. DESIGN: Randomized, single-blind study. SETTINGS: Forty-eight community oncology clinics throughout the United States. PARTICIPANTS: Three hundred women ≥18 years of age with newly diagnosed stage I -III breast cancer, who were planning ≥4 cycles of neoadjuvant or adjuvant chemotherapy with pegfilgrastim support starting in cycle 1. METHODS: Patients were randomized 1:1 to view a general education DVD on chemotherapy side effects (GE-DVD) or a DVD on bone pain following chemotherapy and pegfilgrastim (BP-DVD). Patients recorded severity of bone pain on a scale of 0-10, location of pain, and use of bone pain medications (i.e., analgesics, antihistamines, and nonsteroidal anti-inflammatory drugs) for 5 days, beginning on the day of pegfilgrastim administration, in each of the first four chemotherapy cycles. RESULTS: Patient-reported maximum bone pain was similar in the two groups (GE-DVD vs BP-DVD: cycle 1, 3.2 vs. 3.5, p = .3479; across all cycles, 4.1 vs. 4.6, p = .2196). Other measures of bone pain were also similar between the groups. Bone pain was highest in cycle 1 but decreased and then remained stable in subsequent cycles. Bone pain medication use was similar in both groups and was highest in cycle 1. CONCLUSIONS: The bone pain-specific education evaluated here did not improve perceptions of bone pain reported in this patient population.

Expression spectra of matrix metalloproteinases in metastatic non-small cell lung cancer.

By combining suppression subtractive hybridization and microarray to examine gene expressions between metastatic and non-metastatic non-small cell lung cancer (NSCLC), we have identified differential expression spectra of matrix metalloproteinases (MMP). Among MMPs, expressions of MMP-13, -14, -15 and -24 decreased, those of MMP-9, -11, -12, -16, -17, -19 and -23B did not change, and those of MMP-1, -2, -7, -8 and -10 increased dramatically. Overexpressions of MMP-1, -2, -7 and -10 were confirmed by reverse transcription-polymerase chain reaction. In this study we further assessed the clinical significance of MMP-1, -2, -7 and -10. Specimens from 472 patients with completely resected NSCLC were examined by immunohistochemistry. The median follow-up period was 38 months (range, 2-113 months). Overexpression of MMP-1 was observed in 72.9% (n=344) of 472 patients, that of MMP-2 was 77.9% (n=352), MMP-7 63.3% (n=299) and that of MMP-10 was 27.1% (n=128). For patients with lymph node metastasis, MMP-1 and -2 overexpressions were not only independent prognostic factors for unfavorable outcome, but also associated with decreased survival (p=0.0015, and p=0.011 respectively). The present study showed that MMP expression spectrum in NSCLC was heterogeneous: expression of some MMP increased, some unchanged, while some decreased. Therefore, it should be worth determining MMP expression pattern as a regimen reference for NSCLC patients who were scheduled to receive MMP inhibitor, which was class-specific, as adjuvant therapeutic agent.