RESUMEN
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.
Asunto(s)
Dolor en Cáncer/terapia , Medicina Integrativa/métodos , Oncología Médica/métodos , Neoplasias/terapia , Grupo de Atención al Paciente , HumanosRESUMEN
Two patients underwent percutaneous image-guided electrochemotherapy on blastic spine metastases involving posterior walls of the lumbar vertebral bodies with epidural extension. These treatments were performed safely under cone beam computed tomography. Local tumor control was obtained on the subsequent follow-up as well as pain relief and disability improvement. Electrochemotherapy might be considered for patients with thus far no other alternative in order to obtain tumor control and improvement in patients' quality of life.
Asunto(s)
Tomografía Computarizada de Haz Cónico/métodos , Electroquimioterapia/métodos , Radiografía Intervencional/métodos , Neoplasias de la Columna Vertebral/tratamiento farmacológico , Neoplasias de la Columna Vertebral/secundario , Femenino , Humanos , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Resultado del TratamientoRESUMEN
The rise in incidentally discovered small renal neoplasms has focused attention on nephron-sparing treatment strategies including partial nephrectomy and percutaneous ablation as well as active surveillance. As all treatment modality, renal ablation has matured technically. Radiofrequency ablation, microwave ablation or cryoablation are now performed in many institutions under imaging guidance. The long-term results allow them to be now recommended as a therapeutic option whatever the patients' condition if complete ablation can reliably be achieved.
Asunto(s)
Carcinoma de Células Renales/cirugía , Ablación por Catéter , Neoplasias Renales/cirugía , Nefrectomía , Cirugía Asistida por Computador , Carcinoma de Células Renales/epidemiología , Carcinoma de Células Renales/patología , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Supervivencia sin Enfermedad , Humanos , Neoplasias Renales/epidemiología , Neoplasias Renales/patología , Nefrectomía/efectos adversos , Nefrectomía/métodos , Selección de Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Embolization and percutaneous ablations became well-established therapeutic options for hepatocellular carcinomas (HCC). All are performed under minimally invasive conditions using imaging guidance. Selection of a technique over another follows guidelines but also patient's status and availability of the techniques. The aim of this review is to present these techniques performed in routine to treat HCC and to report the outcomes.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Ablación por Catéter/métodos , Neoplasias Hepáticas/cirugía , Cirugía Asistida por Computador/métodos , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/patología , Ablación por Catéter/efectos adversos , Ablación por Catéter/estadística & datos numéricos , Terapia Combinada , Embolización Terapéutica/efectos adversos , Embolización Terapéutica/métodos , Humanos , Hígado/irrigación sanguínea , Hígado/patología , Hígado/cirugía , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/patología , Radioterapia Guiada por Imagen/efectos adversos , Radioterapia Guiada por Imagen/métodos , Cirugía Asistida por Computador/efectos adversos , Cirugía Asistida por Computador/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Background and objectives: Tumor-related vertebral compression fractures often result in severe back pain as well as progressive neurologic impairment and additional morbidities. The fixation of these fractures is essential to obtain good pain relief and to improve the patients' quality of life. Thus far, several spine implants have been developed and studied. The aims of this review were to describe the implants and the techniques proposed to treat cancer-related vertebral compression fractures and to compile their safety and efficacy results. Materials and Methods: A systematic MEDLINE/PubMed literature search was performed, time period included articles published between January 2000 and March 2019. Original articles were selected based on their clinical relevance. Results: Four studies of interest and other cited references were analyzed. These studies reported significant pain and function improvement as well as kyphotic angle and vertebral height restoration and maintain for every implant and technique investigated. Conclusions: Although good clinical performance is reported on these devices, the small numbers of studies and patients investigated draw the need for further larger evaluation before drawing a definitive treatment decision tree to guide physicians managing patients presenting with neoplastic vertebral compression fracture.
Asunto(s)
Fracturas por Compresión/etiología , Neoplasias/complicaciones , Prótesis e Implantes/normas , Fracturas de la Columna Vertebral/cirugía , Fracturas por Compresión/fisiopatología , Humanos , Neoplasias/fisiopatología , Prótesis e Implantes/tendencias , Calidad de Vida/psicología , Fracturas de la Columna Vertebral/fisiopatología , Columna Vertebral/fisiopatología , Columna Vertebral/cirugía , Resultado del TratamientoRESUMEN
Although rare, unintended thermal injury to organs surrounding the ablation zone can lead to severe complications. Over the past 15 years, different protective methods have been developed to limit risk of complications, and expand indications to include more challenging lesions in various locations including liver, kidney, lung and bone. The most frequently used techniques include hydrodissection, carbodissection, balloon interposition and probe torqueing. In most cases, tumours can be physically separated from sensitive structures, reducing risk of thermal injury. Endoluminal cooling/warming is an alternative option for complex ablations close to the ureter or major bile ducts. Different techniques may be combined to achieve successful protection in locations with complex anatomy. The purpose of this review is to provide an overview of available protective measures and discuss respective advantages/drawbacks.
Asunto(s)
Técnicas de Ablación/efectos adversos , Técnicas de Ablación/métodos , Quemaduras/etiología , Quemaduras/prevención & control , Disección/métodos , HumanosRESUMEN
OBJECTIVE: To report a technique of percutaneous retrohepatic hydrodissection, highlighting its potential to physically separate liver tumours from the inferior vena cava (IVC) and the ostia of the hepatic veins (HV). MATERIALS AND METHODS: Between December 2017 and April 2018, hydrodissection of the retrohepatic IVC was performed in 5 patients (5 females; mean age 64.5 years) undergoing percutaneous ablation of 5 liver metastases (mean size: 3.6 cm) located adjacent to the IVC. Number of hydrodissection needles, volume of hydrodissection, separation of tumour/liver parenchyma from IVC/HV post-hydrodissection; technical success of ablation; and complications were tabulated. RESULTS: Two to three 22G spinal needles were required per case for adequate dissection. Mean volume to obtain sufficient hydrodissection was 410 ml on average. Physical separation of the IVC and tumour/hepatic parenchyma was successful in all cases, by 9 mm on average (range 5-12 mm). It also leaded to physical separation of the ostia of the right and middle HV in all cases. There was no early or delayed complication, notably no venous thrombosis in the post-operative period. All lesions but one were completely ablated after one session at 3-month follow-up. The patient with residual tumour was successfully retreated. CONCLUSION: Retrohepatic hydrodissection is a feasible technique to separate a tumour from the IVC and/or ostia of the HV. This could potentially limit the heat-sink effect/reduce the risk of thrombosis. Larger follow-up studies are required to assess efficacy on a long-term basis.