Surgical and Percutaneous Image-guided Therapies of Abdominal Wall Endometriosis: a Systematic Review of Current Evidence.

OBJECTIVE: Despite various surgical and non-surgical strategies for abdominal wall endometriosis, the lack of definitive guidance on optimal treatment choice leads to clinical uncertainty. This review scrutinizes the safety and efficacy of abdominal wall endometriosis treatments to aid in decision-making. DATA SOURCES: We performed a systematic literature review of PubMed, Embase and Cochrane Library databases from 1947 until December 2023. METHODS OF STUDY SELECTION: A comprehensive literature search identified studies that assessed both surgical and nonsurgical interventions, including high-intensity focused ultrasound (HIFU), cryoablation, radiofrequency ablation (RFA), and microwave ablation (MWA). This review is registered in NIHR-PROSPERO (CRD 42023494969). Local tumor control (LTC), local pain relief (LPR) and adverse events (AE) were recorded. TABULATION, INTEGRATION, AND RESULTS: This review included 51 articles among 831 identified. All study designs were considered eligible for inclusion. A total of 2,674 patients are included: 2,219 patients (83%) undergoing surgery, and 455 (17%) undergoing percutaneous interventions (342 HIFU, 103 cryoablation, 1 RFA, 9 MWA). Follow-up length was 18 months in median, ranging from 1 to 235 months. Overall LTC rates ranged from 86% to 100%. Surgical interventions consistently demonstrated the highest rate of LTC with a median rate of 100%, and LPR with a median rate of 98.2% (95% confidence interval [CI]: 93.9-97.7). HIFU showed median LTC and LPR rates, respectively of 95.65% (95% CI, 87.7-99.9) and 76.1% (95% CI, 61.8-90.4); and cryoablation of 85.7% (95% CI, 66.0-99.9) and 79.2% (95% CI, 67.4-91.03). Minor AE were reported after surgery in 17.5% of patients (225/1284) including 15.9% (199/1284) of mesh implantation; 76.4% (239/313) after HIFU; and 8.7 % (9/103) after cryoablation. Severe AE were reported in 25 patients in the surgery group and 1 in the percutaneous group. CONCLUSION: The safety profile and efficacy of nonsurgical interventions support their clinical utility for management of abdominal wall endometriosis.

Resolution of Pain after Percutaneous Image-Guided Cryoablation of Extraperitoneal Endometriosis.

PURPOSE: To retrospectively evaluate the relief of pain after percutaneous image-guided cryoablation of symptomatic extraperitoneal endometriosis (EE). MATERIAL AND METHODS: From 2017 to 2022, cryoablation of EE was performed at a single institution on a total of 47 lesions in 42 consecutive patients (median age, 37 years; interquartile range [IQR], 33-39.5 years). Patient and procedural characteristics were reviewed retrospectively. Tolerance and outcomes in terms of pain and patient satisfaction were evaluated. RESULTS: The median follow-up duration was 13.5 months (IQR, 1.1-37.7 months) after cryoablation. The median pain-free survival rate was 93.8% (95% confidence interval [CI], 77.3-98.4) at 6 months and 82.7% (95% CI, 58.8-93.5) after 12 months. Pain decreased from a median of 8/10 (IQR, 7-9) on the visual analog scale to 0/10 (IQR, 0-1) at the last follow-up (P < .0001). The median Patient Global Impression of Change score recorded at the last follow-up was 1/7 (IQR, 1-2). The efficacy rate of cryoablation to avoid secondary surgery was 92.8% (39/42) per patient and 93.6% (44/47) per nodule treated. Four patients (9.5%, 4/42) experienced an adverse event in the days following the procedure, and 1 patient (2%) experienced a severe adverse event. CONCLUSIONS: Percutaneous cryoablation is safe and effective in significantly reducing pain and obtaining local control of EE.

Percutaneous screw fixation of pelvic bone metastases using cone-beam computed tomography navigation.

PURPOSE: The purpose of this study was to evaluate the efficacy of cone-beam computed tomography (CBCT) navigation to achieve percutaneous screw fixation (PSF) of pelvic bone metastases (PBM). MATERIALS AND METHODS: Thirty-five consecutive patients (12 men and 23 women; mean age, 62 ± 11.3 [SD]; range: 39-89 years) treated between 2019 and 2021 were retrospectively included. CBCT navigation software was systematically used. Manual drawing of the entry point (MDEP) was performed when CBCT automatic positioning failed. Influence of metastasis pattern, ablation, body mass index, number of screws, and MDEP on procedure duration (PD) and total Air Kerma (AK) was evaluated. Local pain was assessed before, one and six months after treatment. Variables were compared using Pearson correlation, Student t and Wilcoxon tests. RESULTS: Seventy-five screws were inserted successfully (mean: 2.1 ± 1.1 [SD]; range: 1-5 per patient). CBCT automatic positioning was obtained for 41 screws (55%, 41/75), whereas 34 (45%, 34/75) required MDEP. Mean procedure duration, fluoroscopy time, kerma air product and AK were 73.3 ± 44.8 (SD) min (range: 19-233 min), 13.1 ± 9.5 (SD) min (range: 1.4-38.6 min), 73.8 ± 66.3 (SD) Gy.cm2 (range: 11.6-303.7 Gy.cm2) and 301.7 ± 242.1 (SD) mGy (range: 49.4-1111.5 mGy), respectively. Procedure duration was not significantly longer in patients with mixed or blastic PBM compared to those with lytic PBM or when performing ablation, and no significant correlations were observed with the number of screws inserted (P = 0.19), MDEP (P = 0.37) and BMI (P = 0.44). No adverse events were reported during the follow-up (median: 6 months; IQR: 6-6.5 months). Thirteen patients died during the follow-up related to cancer progression. Local pain decreased from 35 ± 32 (SD) mm (range: 0-10 mm) to 11 ± 20 (SD) mm (range: 0-80 mm) at one month (P = 0.001); and to 22 ± 23 (SD) mm (range: 0-60 mm) at six months (P = 0.001). CONCLUSION: CBCT navigation allows to effectively performing PSF of PBM even in the presence of steep angulations.

Expandable Intravertebral Implant in Cancer-Related Vertebral Compression Fractures: A Retrospective Review of 36 Implantations.

The purpose of this retrospective review was to evaluate SpineJack implantation in cancer-related vertebral compression fractures in 13 consecutive patients (mean age, 62.8 years ± 18.8). A total of 36 devices were inserted at 20 levels (13 [65%] lumbar and 7 [35%] thoracic vertebrae), with a mean Spinal Instability Neoplastic Score of 9.1 ± 2.1. Vertebral height restoration was observed in 10 levels (50%), with a mean height restoration of 5.6 mm ± 2.2 (interquartile range [IQR], 4-7.5). A total of 6 cement leakages were observed in 3 (23%) patients without clinical consequences. No severe adverse events were observed. One adjacent fracture occurred. Average pain scores on the visual analog scale significantly improved from 5.5 ± 1.8 (IQR, 4-7) preoperatively to 1.5 ± 2.2 (IQR, 0-3.3) at 1 month (P < .01) and to 1.5 ± 1.3 (IQR, 0.3-2.8) at 6 months (P < .01). In this small cohort, SpineJack offered pain relief in cancer-related fractures without an observed increase in adverse events.

Percutaneous Image-Guided Vertebral Fixation in Cancer-Related Vertebral Compression Fractures: A Case Series Study.

Background and objectives: Cancer-related vertebral compression fractures (VCF) may cause debilitating back pain and instability, affecting the quality of life of cancer patients. To further drive cement deposition during vertebroplasty, the aims of this restrospective case series study were to report the feasibility, safety and short term efficacy (≤6 months) of percutaneous vertebral fixation in cancer-related vertebral compression fractures using various intravertebral implants. Methods: All consecutive cancer patients treated with percutaneous vertebral fixation for VCF were retrospectively included. Various devices were inserted percutaneously under image guidance and filled by cement. Descriptive statistics were used and a matched paired analysis of pain scores was performed to assess for changes following interventions. Results: A total of 18 consecutive patients (12 women (66.6%) and 6 men (33.3%); mean age 59.7 ± 15.5 years) were included. A total of 42 devices were inserted in 8 thoracic and 16 lumbar vertebrae. Visual analogue scale measurement significantly improved from 5.6 ± 1.8 preoperatively to 1.5 ± 1.7 at 1 week (p < 0.01) and to 1.5 ± 1.3 at 6 months (p < 0.01). No severe adverse events were observed, but three adjacent fractures occurred between 1 week and 5 months after implantation. Conclusions: Percutaneous vertebral fixation of cancer-related VCF is feasible and safe and allows pain relief.

Ergonomics in Interventional Radiology: Awareness Is Mandatory.

Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.

Limiting radiation exposure during prostatic arteries embolization: influence of patient characteristics, anatomical conditions, and technical factors.

OBJECTIVE: To assess the influence of patient characteristics, anatomical conditions, and technical factors on radiation exposure during prostatic arteries embolization (PAE) performed for benign prostatic hyperplasia. MATERIALS AND METHODS: Patient characteristics (age, body mass index (BMI)), anatomical conditions (number of prostatic arteries, anastomosis), and technical factors (use of cone beam computed tomography (CBCT), large display monitor (LDM), and magnification) were recorded as well as total air kerma (AK), dose area product (DAP), fluoroscopy time (FT), and number of acquisitions (NAcq). Associations between potential dose-influencing factors and AK using univariate analysis and a multiple linear regression model were assessed. RESULTS: Forty-one consecutive men (68 ± 8 years, min-max: 40-76) were included. LDM and CBCT decreased the use of small field of view with 13.9 and 3.8% respectively, both p < 0.001. The use of a LDM significantly reduced AK (1006.6 ± 471.7 vs. 1412 ± 754.6 mGy, p = 0.02), DAP (119.4 ± 64.4 vs. 167.9 ± 99.2, p = 0.04), FT (40.4 ± 11.5 vs. 53.6 ± 25.5 min, p = 0.01), and NAcq (16.3 ± 6.3 vs. 18.2 ± 7, p = 0.04). In multivariate analysis, AK reduction was associated with lower patient BMI (ß = 0.359, p = 0.002), shorter FT (ß = 0.664, p < 0.001) and CBCT use (ß = - 0.223, p = 0.03), and decreased NAcq (ß = 0.229, p = 0.04). CONCLUSION: LDM and CBCT are important technical dose-related factors to help reduce radiation exposure during PAE, and should be considered in standard practice. KEY POINTS: • The use of large display monitor (LDM) and cone beam computed tomography (CBCT) both decreased the need for magnification during prostatic arteries embolization (PAE). • The use of LDM reduces radiation exposure during PAE. • Total air kerma is associated with patient's body mass index, fluoroscopy time, CBCT, and the number of acquisitions.

Hepatic arterial infusion of oxaliplatin plus systemic chemotherapy and targeted therapy for unresectable colorectal liver metastases.

BACKGROUND: Hepatic arterial infusion (HAI) combined with systemic chemotherapy has shown promising results in patients with unresectable colorectal liver metastases (CRLM), even after failure to systemic therapy. Addition of systemic targeted therapies has been investigated with controversial results regarding tolerance, especially with HAI-floruxidine when combined with systemic bevacizumab. Our study aimed to analyse feasibility, safety and efficacy of HAI-oxaliplatin plus systemic chemotherapy and targeted therapies. METHODS: Between 2005 and 2016, single-centre consecutive patients with unresectable CRLM who received at least one cycle of HAI-oxaliplatin plus systemic chemotherapy and targeted therapies (cetuximab/panitumumab or bevacizumab) were analysed. RESULTS: A total of 89 patients (median age 55 years (range, 26-76 years) who previously received a median number of one systemic chemotherapy regimen (range, 0-5) including oxaliplatin in 78% of cases were included. Median number of HAI-oxaliplatin cycles was 9 (range, 1-28) combined with systemic chemotherapy and targeted therapies (LV5FU2 [63%], FOLFIRI [36%]) plus anti-EGFR (30%), or bevacizumab (70%). Grade 3/4 toxicities included neutropenia (40%), HAI-related abdominal pain (43%) and neurotoxicity (12%). The intent-to-treat objective response rate was 42%, and 45% had stable disease, allowing complete CRLM resection/ablation in 27% of patients. After a median follow-up of 72 months, median overall and progression-free survival was 20 and 9 months, respectively. CONCLUSION: Addition of targeted therapy to systemic chemotherapy combined with HAI-oxaliplatin is feasible, safe and shows promising activity, even after systemic chemotherapy failure.

Integrative Medicine in Interventional Oncology: A Virtuous Alliance.

This review aimed to identify the potential role of integrative medicine in interventional oncology. The music therapy; stress management techniques; guided imagery, including virtual reality; clinical hypnosis; and digital sedation may all be efficient on anxiety and pain during procedures performed in interventional oncology. Beyond pharmacological sedation, the implementation of integrative medicine to interventional oncology may, therefore, improve the support and care of cancer patients, which may further create a virtuous alliance.