Sequential combination treatment (arterial embolization and percutaneous radiofrequency ablation) of inoperable renal cell carcinoma: single-center pilot study.

BACKGROUND: Potential drawbacks of percutaneous radiofrequency ablation (RFA) for renal cell carcinoma (RCC) include local recurrence after RFA due to a limited ablation area, massive hemorrhage induced by kidney puncture, and difficulty in visualizing the tumor at CT-guided puncture. PURPOSE: To evaluate retrospectively the technical success, effectiveness, and complications elicited in patients with unresectable RCC following single-session sequential combination treatment consisting of renal arterial embolization followed by RFA. MATERIAL AND METHODS: Ten patients (12 RCCs) who were not candidates for surgery were included in this pilot study. All tumors ranged from 18-66 mm in size (mean 31 ± 3.9 mm), and were percutaneously ablated several hours after embolization of the tumor vessels with iodized oil and gelatin sponges. We evaluated the technical success, effectiveness, effect on renal function, and complications of this treatment. Effectiveness was judged on CT and/or MR images obtained every three months after RFA. The effect on renal function was assessed based on the creatinine level and glomerular filtration rate (GFR) before, one week, and three months after the procedure. RESULTS: Renal arterial embolization followed by percutaneous RFA was technically successful in all patients. On contrast CT and/or MR images obtained one week and three months after RFA we observed necrosis in the embolized segment of all RCCs. There were no major complications during and after the procedure. All patients reported tolerable pain and a burning sensation during RFA. After the procedure, five patients (50%) experienced back pain, one each manifested fluid collection, subcapsular hematomas, hematuria, or nausea. There were no instances of recurrence during a mean follow-up period of 47 ± 3.8 months. We noted no significant difference in serum creatinine and GFR before and after treatment. CONCLUSION: Our pilot study suggests that sequential combination treatment by renal arterial embolization followed by percutaneous RFA is feasible in patients with inoperable RCC. The treatment complications were acceptable and excellent effects were obtained.

Effect of sodium thiosulfate on cisplatin removal after intra-arterial embolization with a lipiodol-platinum suspension for hepatocellular carcinoma.

BACKGROUND: Cisplatin is one of the most effective chemotherapeutic agents against a variety of human cancers. Its usefulness is limited by its toxicity to normal tissues, including cells of kidney proximal tubules. PURPOSE: To evaluate the effect of sodium thiosulfate (STS) on cisplatin clearance after transcatheter embolization (TAE) with a lipiodol-platinum suspension (LPS) in patients with hepatocellular carcinoma (HCC). MATERIAL AND METHODS: The study was performed prospectively in a randomized manner. HCC patients underwent intra-arterial LPS embolization with (n=17) and without (n=15) an intravenous STS infusion. Renal toxicity was estimated and free and total platinum concentrations were assessed for 7 days after treatment. RESULTS: After treatment without STS, there was a mild elevation of serum creatinine and a decrease in creatinine clearance. With STS, there was no significant difference before and after treatment in mean serum creatinine and creatinine clearance; free platinum disappeared completely within 120 min. In patients treated without STS, free platinum decreased rapidly within 120 min; this was followed by a gradual decrease during the next 7 days. CONCLUSION: STS seems effective against the renal toxicity of cisplatin. However, in the presence of STS, the anticancer effect of cisplatin may be decreased due to the accelerated disappearance of platinum.

Effect of lactulose on calcium and magnesium absorption: a study using stable isotopes in adult men.

To evaluate the effect of lactulose on calcium (Ca) and magnesium (Mg) absorption, we performed a clinical trial with a double-blind, randomized, crossover design in 24 healthy adult male volunteers. The absorptions of Ca and Mg were evaluated by a single-labeling method using stable isotopes. The test foods, containing lactulose at a dose of 0 g (placebo), 2 g (low-dose), or 4 g (high-dose) together with 300 mg of Ca containing 20 mg of 44Ca, and 150 mg of Mg containing 28 mg of 25Mg, were administered orally. Urine samples were collected for 8 h after the ingestion of the test food. The ratios of stable isotopes in urine (44Ca/40Ca and 25Mg/24Mg) were measured by ICP-MS (inductively coupled plasma-mass spectrometry). The urinary stable-isotopes ratios (44Ca/40Ca and 25Mg/24Mg) increased with lactulose dosage. Significant differences were observed in the Ca ratio between placebo and high-dose lactulose (p<0.01), and in the Mg ratio between placebo and low-dose lactulose and between placebo and high-dose lactulose (p<0.01). Lactulose ingestion did not change the levels of bone-resorption markers (type I collagen cross-linked N-telopeptide and deoxypyridinoline) in urine. The test foods did not cause any side effects. This study demonstrates that lactulose enhances the absorptions of Ca and Mg in adult men.