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1.
Medicine (Baltimore) ; 100(34): e26681, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449453

RESUMO

RATIONALE: Recently, the number of osteosarcomas has been increasing in elderly patients due to human longevity. Lung metastases are the primary cause of death from osteosarcomas. Complete resection of lung metastases can prolong the survival. However, complete resection in elderly patients is often difficult due to high risk of operative complications. Computed tomography (CT) guided radiofrequency ablation (RFA) is a minimally invasive technique to destroy tumor nodules using heat. In this report, we present the first case older than 65 years applying RFA for lung metastases due to osteosarcoma. PATIENT CONCERNS: A 74-year-old male presented with 1-year history of heel pain. A conventional high-grade osteosarcoma in his calcaneus was diagnosed. Below-knee amputation was performed. However, lung metastases were found in both lungs 1 year after amputation. CT-guided lung RFA was chosen since surgical intervention for lung metastases was abandoned because of tumor multiplicity and medical comorbidities. A total of 18 lung metastases were treated by CT-guided RFA. The most frequent complication was pneumothoraxes in 4 of 8 (50%) procedures and chest tube drainage was required in 2 of these (2 of 8 (25%) procedures). DIAGNOSES: Six lung metastases of osteosaroma were found in both lungs at 1 year after surgery. INTERVENTIONS: CT-guided lung RFA was performed. A total of 18 lung metastases were treated in 8 lung RF procedures. OUTCOMES: The patient has been alive with disease for 5.5 years after the initial surgery. LESSONS: CT-guided lung RFA is effective for elderly patients with osteosarcoma lung metastases in spite of discouragement of lung metastasectomy due to multiplicity of metastases and medical-comorbidities.


Assuntos
Neoplasias Ósseas/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Osteossarcoma/patologia , Ablação por Radiofrequência/métodos , Idoso , Calcâneo/patologia , Humanos , Masculino , Radiografia Intervencionista , Tomografia Computadorizada por Raios X
2.
In Vivo ; 35(4): 2081-2087, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34182483

RESUMO

BACKGROUND/AIM: To develop and evaluate the accuracy of augmented reality (AR)-based patient positioning systems in radiotherapy. MATERIALS AND METHODS: AR head-mounted displays (AR-HMDs), which virtually superimpose a three-dimensional (3D) image generated by the digital imaging and communications in medicine (DICOM) data, have been developed. The AR-based positioning feasibility was evaluated. Then, the setup errors of three translational axes directions and rotation angles between the AR and the conventional laser-based positioning were compared. RESULTS: The AR-based pelvic phantom positioning was feasible. The setup errors of AR-based positioning were comparable to laser-based positioning in all translational axis directions and rotation angles. The time necessary for AR-based positioning was significantly longer than that for laser-based positioning (171.0 s vs. 47.5 s, p<0.001). CONCLUSION: AR-based positioning for radiotherapy was feasible, and showed comparable positioning errors to those of conventional line-based positioning; however, a markedly longer setup time was necessary.


Assuntos
Realidade Aumentada , Humanos , Posicionamento do Paciente , Pelve , Imagens de Fantasmas
4.
Cardiovasc Intervent Radiol ; 44(1): 150-155, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33078230

RESUMO

PURPOSE: To evaluate the coagulative performance of a 21-gauge (G) internally cooled radiofrequency (RF) electrode using ex vivo and in vivo rat liver. MATERIALS AND METHODS: We developed a prototype of 21-G internally cooled monopolar RF electrode with 5.0 mm active tip length. The ablative zone size created by this electrode was evaluated in ex vivo and in vivo rat liver. Five RF powers (3 W, 5 W, 7 W, 9 W, and 11 W) were applied with and without circulation of chilled water within the electrode. The ablation zone sizes were compared. Histopathological evaluation of the ablation zone was also performed at 24 h and at 7 days after RF ablation. RESULTS: From ex vivo experiments, the ablation volume was found to increase significantly when RF energy was applied with the chilled water circulation. Results of in vivo experiments demonstrate that the ablation volume reached its maximum value when RF power of 7 W was applied (532.3 ± 110.3 mm3). Histopathological examination showed delineated coagulation necrosis at 24 h after RF ablation, which clarified the ablation zone border. Fibrotic change was also observed at 7 days after RF ablation. CONCLUSION: RF ablation using a 21-gauge electrode produced coagulation necrosis in the rat liver. The ablation volume became maximum when RF power of 7 W was applied with chilled water circulation.


Assuntos
Ablação por Cateter/instrumentação , Eletrodos , Fígado/cirurgia , Animais , Desenho de Equipamento , Masculino , Modelos Animais , Ratos , Ratos Sprague-Dawley
5.
JGH Open ; 4(4): 722-728, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32782962

RESUMO

Background and Aim: Surgical resection is the standard local therapy for patients with colorectal liver metastases (CRLM). However, elderly and vulnerable patients sometimes have various organ dysfunctions. We have to conduct nonsurgical local therapies for those patients who might not tolerate surgery or systemic chemotherapy. Methods: We retrospectively reviewed medical records of 254 patients who underwent local therapies, including surgery, radiofrequency ablation (RFA), and stereotactic body radiation therapy (SBRT), for CRLM from January 2010 to December 2016, at seven tertiary-care institutions in Japan. This study was designed to include elderly, vulnerable patients who received local therapy for CRLM. For those undergoing liver resection, only those having one or more points of the Charlson comorbidity index (CCI) were enrolled. Results: Of the total 169 enrolled patients, 122 patients underwent surgery, 42 RFA, and 5 SBRT as the first local therapy for CRLM. Median overall survival from the first local therapy was 5.9 years for the surgery group, 2.7 years for the RFA group, and 3.8 years for the SBRT group. The proportion of the patients with CCI ≧3 was significantly higher in the group of RFA/SBRT than surgery (P < 0.0001). In selected patients with CCI ≧3, there was no difference of the median survival time between the surgery group and the RFA group. Conclusions: We could have other treatment options to provide nonsurgical local therapies (RFA/SBRT) for elderly, vulnerable CRLM patients who have risks for surgery.

6.
J Vasc Interv Radiol ; 31(9): 1475-1482.e2, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32800663

RESUMO

PURPOSE: To evaluate the effects of hepatic artery embolization (HAE) on the expression of programmed cell death 1 ligand 1 (PD-L1) in an orthotopic rat hepatocellular carcinoma (HCC) model. MATERIALS AND METHODS: A rat HCC model was established in Sprague-Dawley rats with the RH7777 cell line. Six animals each were assigned to receive HAE or sham treatment. Liver tissues were harvested 24 h after the procedure. Immunohistochemistry (IHC) was used to compare expression of PD-L1 and hypoxia-inducible factor (HIF)-1α in the intratumoral and peritumoral regions and normal liver tissue. In vitro cell culture study was performed for 24 h under normoxic and hypoxic conditions, and protein expression of PD-L1 and HIF-1α and the effects of HIF-1α inhibitors were assessed. RESULTS: IHC showed that PD-L1- and HIF-1α-positive areas were significantly larger in the HAE group vs the sham group in intratumoral (P = .006 and P < .001, respectively) and peritumoral regions (both P < .001). The expression of PD-L1 positively correlated with HIF-1α expression in the intratumoral region (r2 = 0.551; P < .001). In vitro cell culture study revealed that protein expression of PD-L1 and HIF-1α were significantly higher when cells were incubated under hypoxic vs normoxic conditions (P = .028 and P = .010, respectively). PD-L1 expression was suppressed significantly when the HIF-1α inhibitor rapamycin was added to the culture medium (P = .024). CONCLUSIONS: HAE enhances intratumoral and peritumoral PD-L1 expression in a rat HCC model. The HIF-1α pathway is a possible mechanism underlying increased intratumoral PD-L1 expression after HAE.


Assuntos
Antígeno B7-H1/metabolismo , Carcinoma Hepatocelular/terapia , Embolização Terapêutica , Artéria Hepática , Neoplasias Hepáticas Experimentais/terapia , Animais , Carcinoma Hepatocelular/metabolismo , Carcinoma Hepatocelular/patologia , Linhagem Celular Tumoral , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Neoplasias Hepáticas Experimentais/metabolismo , Neoplasias Hepáticas Experimentais/patologia , Masculino , Ratos Sprague-Dawley , Transdução de Sinais , Microambiente Tumoral , Regulação para Cima
7.
Liver Cancer ; 9(1): 63-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32071910

RESUMO

Introduction: The underlying mechanism involved in the recurrence of hepatoma after hepatic arterial embolization (HAE) is not adequately examined. An immunosuppressive cytokine, transforming growth factor ß1 (TGF-ß1), can lead to tumor progression and is affected by hypoxia in various cancers. The study aimed to assess the effect of HAE on the expression of TGF-ß1 in a rat hepatoma model. Methods: Sprague-Dawley rats bearing N1S1 hepatoma cells underwent HAE (HAE group, n = 5) or sham treatment (sham group, n = 4). The animals were euthanized at 48 h, and liver tissues were harvested. Immunohistochemistry (IHC) and quantitative polymerase chain reaction (qPCR) were performed to compare the expression of TGF-ß1 and hypoxia-inducible factor 1α (HIF-1α) between the HAE and sham groups. In vitro experiments with the N1S1 cell line were also performed under normoxic (21% O2) or hypoxic (1% O2) conditions for 48 h, and the expression of TGF-ß1 and HIF-1α was assessed with western blotting and enzyme-linked immunosorbent assay. Statistical data comparisons were performed by Student t test. Results: IHC showed that both the TGF-ß1-positive and HIF-1α-positive tumor peripheral areas were larger in the HAE group (6.59 ± 2.49 and 10.26 ± 4.14%; p < 0.001, respectively) than in the sham group (0.34 ± 0.41 and 0.40 ± 0.84% respectively). Similarly, qPCR showed that the mRNA expression levels of TGF-ß1 and HIF-1α were higher (1.95 ± 0.38-fold and 1.62 ± 0.37-fold; p < 0.001 and p = 0.002, respectively) in the HAE group than those in the sham group. TGF-ß1 expression was suppressed when HIF-1α inhibitors were added (p = 0.001), and HIF-1α expression was upregulated when exogenous TGF-ß1 was added (p = 0.033) in N1S1 cells. Conclusion: HAE enhanced local TGF-ß1 expression in a rat hepatoma model. In vitro experiments suggest that HAE-induced hypoxic stress may trigger the interdependent expression of TGF-ß1 and HIF-1α.

8.
Radiology ; 294(3): 686-695, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31934829

RESUMO

Background Although radiofrequency ablation (RFA) is widely performed for the treatment of colorectal cancer (CRC) lung metastases, its efficacy for candidates with surgically resectable disease is unclear. Purpose To evaluate the prognosis after RFA in participants with resectable CRC lung metastases. Materials and Methods For this prospective multicenter study (ClinicalTrials.gov identifier: NCT00776399), participants with five or fewer surgically resectable lung metastases measuring 3 cm or less were included. Participants with CRC and a total of 100 lung metastases measuring 0.4-2.8 cm (mean, 1.0 cm ± 0.5) were chosen and treated with 88 sessions of RFA from January 2008 to April 2014. The primary end point was the 3-year overall survival (OS) rate, with an expected rate of 55%. The local tumor progression rate and safety were evaluated as secondary end points. The OS rates were generated by using the Kaplan-Meier method. Log-rank tests and Cox proportional regression models were used to identify the prognostic factors by means of univariable and multivariable analyses. Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. Results Seventy participants with CRC (mean age, 66 years ± 10; 49 men) were evaluated. The 3-year OS rate was 84% (59 of 70 participants; 95% confidence interval [CI]: 76%, 93%). In multivariable analysis, factors associated with worse OS included rectal rather than colon location (hazard ratio [HR] = 7.7; 95% CI: 2.6, 22.6; P < .001), positive carcinoembryonic antigen (HR = 5.8; 95% CI: 2.0, 16.9; P = .001), and absence of previous chemotherapy (HR = 9.8; 95% CI: 2.5, 38.0; P < .001). Local tumor progression was found in six of the 70 participants (9%). A grade 5 adverse event was seen in one of the 88 RFA sessions (1%), and grade 2 adverse events were seen in 18 (20%). Conclusion Lung radiofrequency ablation provided a favorable 3-year overall survival rate of 84% for resectable colorectal lung metastases measuring 3 cm or smaller. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Gemmete in this issue.


Assuntos
Ablação por Cateter/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Pulmonares , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
9.
Cardiovasc Intervent Radiol ; 43(2): 311-321, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31591689

RESUMO

PURPOSE: To determine the tumor immune cell landscape after transcatheter arterial bland embolization (TAE) in a clinically relevant rat hepatocellular carcinoma (HCC) model. MATERIALS AND METHODS: Buffalo rats (n = 21) bearing syngeneic McArdle RH-7777 rat hepatoma cells implanted into the left hepatic lobe underwent TAE using 70-150 µm beads (n = 9) or hepatic artery saline infusion (n = 12). HCC nodules, peritumoral margin, adjacent non-cancerous liver, and splenic parenchyma were collected and disaggregated to generate single-cell suspensions for immunological characterization 14 d after treatment. Changes in tumor-infiltrating immune subsets including CD4 T cells (Th17 and Treg), CD8 cytotoxic T cells (IFNγ), and neutrophils were evaluated by multiparameter flow cytometry. Migration and colony formation assays were performed to examine the effect of IL-17, a signature cytokine of Th17 cells, on McArdle RH-7777 hepatoma cells under conditions simulating post-embolization environment (i.e., hypoxia and nutrient privation). Statistical significance was determined by the Student unpaired t test or one-way ANOVA. RESULTS: TAE induces increased infiltration of Th17 cells in liver tumors when compared with controls 14 d after treatment (0.29 ± 0.01 vs. 0.19 ± 0.02; p = 0.02). A similar pattern was observed in the spleen (1.41 ± 0.13 vs. 0.57 ± 0.08; p < 0.001), indicating both local and systemic effect. No significant differences in the percentage of FoxP3 + Tregs, IFNγ-producing CD4 T cells, and CD8 T cells were observed between groups (p > 0.05). In vitro post-embolization assays demonstrated that IL-17 reduces McA-RH7777 cell migration at 24-48 h (p = 0.003 and p = 0.002, respectively). CONCLUSION: Transcatheter hepatic arterial bland embolization induces local and systemic increased infiltration of Th17 cells and expression of their signature cytokine IL-17. In a simulated post-embolization environment, IL-17 significantly reduced McA-RH7777 cell migration.


Assuntos
Carcinoma Hepatocelular/terapia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Células Th17/metabolismo , Animais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/imunologia , Modelos Animais de Doenças , Humanos , Fígado/diagnóstico por imagem , Fígado/imunologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/imunologia , Imageamento por Ressonância Magnética/métodos , Masculino , Radiologia Intervencionista/métodos , Ratos , Ratos Endogâmicos BUF , Células Th17/imunologia
10.
Artigo em Japonês | MEDLINE | ID: mdl-31327772

RESUMO

In April 2011, the International Radiological Protection Committee recommended that "The equivalent dose of the crystalline lens should not exceed 20 mSv/year, averaged over defined periods of 5 years, with no single year exceeding 50 mSv". Based on this recommendation, it is predicted that the equivalent dose limit of our crystalline lens can be lowered in the near future. Therefore, it is important to grasp the current situation of radiation exposure. The purpose of this study is to measure the crystalline lens of surgeons by focusing on the CT-fluoroscopy guided interventional radiology's (IVRs). We also examined whether the exposure dose of the crystalline lens can be correctly evaluated by measuring the unequal exposure dose of the neck, which is usually used for the unequal exposure measurement. Results of the analysis of 200 CT-fluoroscopy guided IVR procedures showed that the unequal exposure dose of the neck was significantly correlated with the exposure dose of the crystalline lens which was measured near the left eye ball (R=0.83). However, the exposure dose of the crystalline was 33% lower than those of the neck. Therefore, although the individual dosimeter worn on the neck can be used as the useful index of the exposure dose of the crystalline lens, the results can be overestimated.


Assuntos
Cristalino , Exposição à Radiação , Proteção Radiológica , Cabeça , Humanos , Pescoço , Doses de Radiação , Tomografia Computadorizada por Raios X
11.
Jpn J Radiol ; 37(4): 277-282, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30671706

RESUMO

PURPOSE: To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS: Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated. RESULTS: Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14-43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients. CONCLUSION: T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.


Assuntos
Encefalomielite Aguda Disseminada/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Criança , Pré-Escolar , Meios de Contraste , Progressão da Doença , Encefalomielite Aguda Disseminada/patologia , Feminino , Humanos , Aumento da Imagem , Masculino , Estudos Retrospectivos , Adulto Jovem
13.
Jpn J Radiol ; 36(9): 551-558, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29968201

RESUMO

PURPOSE: To compare the clinical outcomes between radiofrequency ablation (RFA) and cryoablation for the treatment of clinical T1b (cT1b) renal cell carcinoma (RCC). MATERIALS AND METHODS: The data of 46 patients [(39 men and 7 women, median age; 73 years, range 39-87 years)] were gathered from 3 institutions. RFA and cryoablation were performed on 23 patients each. The median number of ablation needle was 2 (range 1-4) and 4 (range 3-5, p < 0.0001) in RFA and cryoablation, respectively. Technique efficacy defined as coverage of the tumor by ablative zone, adverse events, local tumor progression, and survival were compared between the RFA and cryoablation groups. RESULTS: The primary technique efficacy rate was significantly higher in the cryoablation group (96%, 22/23) than in the RFA group (65%, 15/23, P = 0.02). There was no significant difference in the secondary technique efficacy rate after additional RFA and cryoablation [21/23 (91%) vs. 23/23 (100%); P = 0.24]. The incidence of grade 3 or higher adverse events was similar between the 2 groups (P > 0.99). There was no significant difference between local tumor progression rate after RFA and cryoablation [3/21 (14%) vs. 2/23 (9%); P = 0.66]. The 5-year overall survival rates were comparable between RFA and cryoablation (78 vs. 82%; P =0.82). CONCLUSION: Other than primary technique efficacy, the clinical outcomes between RFA and cryoablation were similar in patients with cT1b RCC.


Assuntos
Carcinoma de Células Renais/cirurgia , Ablação por Cateter/métodos , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/cirurgia , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
J Vasc Interv Radiol ; 29(8): 1061-1067, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29934260

RESUMO

PURPOSE: To evaluate safety and efficacy of combining sorafenib with transarterial chemoembolization in patients with advanced stage hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Systemic chemotherapy-naïve patients with a Child-Pugh class A liver profile and advanced stage HCCs were enrolled. Sorafenib therapy (daily dose 800 mg) was initiated within 4 weeks after initial conventional transarterial chemoembolization with an allowance of subsequent on-demand conventional chemoembolization. The primary endpoint was rate of protocol treatment completion, which was defined as sorafenib administration for at least 2 months. Secondary endpoints included objective response rate, disease control rate, overall survival, progression-free survival, and incidence of adverse events. Thirty-one patients (24 men, 7 women; median age, 75 years; vascular invasion, n = 19; extrahepatic metastases, n = 18; both, n = 6) who met the inclusion criteria were enrolled. RESULTS: Protocol treatment was completed in 28 patients (90.3%, 28/31) with median protocol treatment duration of 7.0 months (range, 0.5-30 months) and median of 2 (range, 1-4) transarterial chemoembolization sessions. Objective response rate was 77.4% with median overall and progression-free survival of 17.3 months (95% confidence interval, 11.9-22.6 months) and 5.4 months (95% confidence interval, 4.6-6.2 months), respectively. The most common grade 3 or 4 adverse events were self-limiting elevation of aspartate aminotransferase (54.8%, 17/31) and alanine aminotransferase (45.2%, 14/31). CONCLUSIONS: This combination therapy is feasible and promising in patients with advanced stage HCCs.


Assuntos
Antineoplásicos/administração & dosagem , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Neoplasias Hepáticas/terapia , Niacinamida/análogos & derivados , Compostos de Fenilureia/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/secundário , Quimioembolização Terapêutica/efeitos adversos , Quimioembolização Terapêutica/mortalidade , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Japão , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Niacinamida/administração & dosagem , Niacinamida/efeitos adversos , Compostos de Fenilureia/efeitos adversos , Inibidores de Proteínas Quinases/efeitos adversos , Fatores de Risco , Sorafenibe , Fatores de Tempo , Resultado do Tratamento
15.
Ann Thorac Surg ; 105(6): e265-e267, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29410265

RESUMO

A 55-year-old man with malignant pleural mesothelioma underwent multimodality treatment comprising induction chemotherapy followed by extrapleural pneumonectomy and radiation therapy. After 2.5 years, focal recurrence occurred, with computed tomography revealing a tumor in the left cardiophrenic angle. Surgery was considered a problem for the patient because of the previous extrapleural pneumonectomy and difficult tumor location. Radiofrequency ablation was therefore performed; the course was uneventful, and there was no recurrence. Radiofrequency ablation should be considered an option to treat recurrence of malignant pleural mesothelioma.


Assuntos
Neoplasias Pulmonares/cirurgia , Mesotelioma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Pleurais/cirurgia , Pneumonectomia/métodos , Ablação por Radiofrequência , Humanos , Masculino , Mesotelioma Maligno , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Mol Imaging ; 17: 1536012117749726, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29480077

RESUMO

Reversible electroporation (RE) can facilitate nanoparticle delivery to tumors through direct transfection and from changes in vascular permeability. We investigated a radiolabeled liposomal nanoparticle (89Zr-NRep) for monitoring RE-mediated liposomal doxorubicin (DOX) delivery in mouse tumors. Intravenously delivered 89Zr-NRep allowed positron emission tomography imaging of electroporation-mediated nanoparticle uptake. The relative order of 89Zr-NRep injection and electroporation did not result in significantly different overall tumor uptake, suggesting direct transfection and vascular permeability can independently mediate deposition of 89Zr-NRep in tumors. 89Zr-NRep and DOX uptake correlated well in both electroporated and control tumors at all experimental time points. Electroporation accelerated 89Zr-NRep and DOX deposition into tumors and increased DOX dosing. Reversible electroporation-related vascular effects seem to play an important role in nanoparticle delivery to tumors and drug uptake can be quantified with 89Zr-NRep.


Assuntos
Doxorrubicina/análogos & derivados , Sistemas de Liberação de Medicamentos , Eletroporação/métodos , Nanopartículas/química , Neoplasias/tratamento farmacológico , Radioisótopos/química , Compostos Radiofarmacêuticos/química , Zircônio/química , Permeabilidade Capilar , Linhagem Celular Tumoral , Doxorrubicina/administração & dosagem , Doxorrubicina/farmacologia , Doxorrubicina/uso terapêutico , Humanos , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/farmacologia , Polietilenoglicóis/uso terapêutico , Tomografia por Emissão de Pósitrons
17.
Hepatol Int ; 12(Suppl 1): 102-111, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28875380

RESUMO

PURPOSE: To evaluate the recent topics of Ballloon-occluded retrograde trasnvenous obliteration(B-RTO). METHOD: We overviewed the recent scientific papers regarding B-RTO. RESULT: B-RTO is a treatment method for occluding varices retrogradely using a sclerosing agent under balloon occlusion of a major draining vein. It has been recognized as an effective treatment method for gastric varices. Hepatic function reserve is improved and liver volume is increased after B-RTO. In recent years, various technical options, such as plug-assisted retrograde transvenous obliteration, coil-assisted retrograde transvenous obliteration, or foam B-RTO, have also been reported. In performing B-RTO, portal hemodynamics must be thoroughly examined radiologically. Judging the classification of the grade of collateral venous hemodynamics is important to select the appropriate embolization technique of B-RTO and to successfully occlude varices. Finally, the word "portosystemic shunt syndrome" has been proposed and the condition should be considered while selecting a treatment for gastric varices. CONCLUSION: B-RTO is effective for gastrointestinal varices and portosystemic shunts.


Assuntos
Oclusão com Balão/métodos , Varizes Esofágicas e Gástricas/terapia , Hipertensão Portal/complicações , Derivação Portossistêmica Cirúrgica/efeitos adversos , Obturação Retrógrada/instrumentação , Elasticidade/efeitos dos fármacos , Embolização Terapêutica/métodos , Hemodinâmica , Humanos , Hipertensão Portal/fisiopatologia , Fígado/crescimento & desenvolvimento , Fígado/fisiologia , Testes de Função Hepática/métodos , Derivação Portossistêmica Transjugular Intra-Hepática/métodos , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
18.
Gastrointest Endosc ; 87(1): 300.e1-300.e6, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28501593

RESUMO

BACKGROUND AND AIMS: The aim of this study was to evaluate the feasibility and early safety of catheter-directed irreversible electroporation (IRE) of the normal common bile duct (CBD) in swine. METHODS: IRE (2000 V, 90 pulses, 100 µs pulse) was performed in the CBD of 6 Yorkshire pigs using a catheter electrode under endoscopic guidance. Ductal patency was assessed with immediate retrograde cholangiography and contrast-enhanced CT imaging at 1 or 7 days after treatment. Animals were killed at either 1 day (n = 4, 2 ablations/animal) or 7 days (n = 2, 1 ablation/animal) after treatment. The biliary tract was extracted en bloc and the length of the ablation along the CBD mucosa was measured. The depth of ablation was quantified using cross-sections of the treated CBD wall stained with hematoxylin and eosin. Single-sample hypothesis testing was performed to verify whether the depth of ablation in the CBD was a representative outcome of IRE treatment. RESULTS: IRE of the CBD did not result in perforation or obstruction of the organ at 1 or 7 days after treatment. The length of ablation along the CBD mucosa was 17.27 ± 5.55 mm on day 1 samples, and transmural ablation of the CBD wall was a representative outcome of the treatment (7/8 samples, P < .05). Day 1 samples demonstrated loss of epithelium, transmural necrosis, with preservation of lumen integrity. Day 7 samples demonstrated re-epithelialization, with diffuse transmural fibrosis of the CBD wall. These findings were absent from sham tissue samples. CONCLUSIONS: Intraluminal catheter-directed IRE is feasible and safe for full-thickness ablation of the normal porcine CBD without affecting lumen patency up to 1 week after treatment.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Ducto Colédoco/cirurgia , Eletroporação/métodos , Animais , Cateterismo , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/patologia , Estudos de Viabilidade , Feminino , Sus scrofa , Suínos , Tomografia Computadorizada por Raios X
19.
Gan To Kagaku Ryoho ; 45(13): 1794-1796, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692356

RESUMO

We experienced 2 cases of pelvic recurrence from rectal cancer. These patients received radiofrequency ablation(RFA) therapy. Case 1 was a 76-year-old man who underwent intersphincteric resection for lower rectal cancer in October 2013. In May 2015, the patient received systemic chemotherapy for multiple lung metastases and pelvic local recurrence. In January 2017, RFA was performed to reduce the pain of the pelvic recurrence. Immediately after RFA, the pain markedly reduced, and 2 months after treatment, the patient discontinued his pain therapy. Case 2 was a 48-year-old man who underwent Hartmann 's procedure for ulcerative colitis with rectal cancer in November 2011. In July 2012, we performed abdominoperineal resection for rectal cancer that developed in the remnant rectum. In November 2012, he received systemic chemotherapy for multiple lung metastases and pelvic recurrence. In addition, we performed stereotactic radiotherapy(SRT)for the pelvic recurrence. In May 2016, because he developed bilateral hydronephrosis and painful pelvic recurrence, we performed bilateral nephrostomy and RFA for the painful pelvic recurrence. After RFA, pain reduced, but he developed a pelvic abscess that was treated by CT-guided drainage. He underwent complete ablation for the recurrent pelvic mass 2 years after RFA but died of exacerbation of multiple lung metastases. CT-guided RFA for painful pelvic recurrence from rectal cancer can be considered a feasible and effective treatment to reduce pain.


Assuntos
Ablação por Radiofrequência , Neoplasias Retais , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Retais/terapia , Tomografia Computadorizada por Raios X
20.
Nagoya J Med Sci ; 79(3): 387-399, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28878443

RESUMO

The aim of this study was to compare 11C-choline PET/CT and bone scintigraphy (BS) for detection of bone metastases in patients with prostate cancer. Twenty-one patients with histologically proven prostate cancer underwent 11C-choline PET/CT and BS before (n = 4) or after (n = 17) treatment. Patient-, region-, and lesion-based diagnostic performances of bone metastasis of both 11C-choline PET/CT and BS were evaluated using a five-point scale by two experienced readers. Bone metastases were present in 11 (52.4%) of 21 patients and 48 (32.7%) of 147 regions; 111 lesions were found to have bone metastases. Region-based analysis showed that the sensitivity, specificity, accuracy, and area under the receiver-operating-characteristic curves (AUC) of 11C-choline PET/CT were 97.9%, 99.0%, 98.6%, and 0.9989, respectively; those of BS were 72.9%, 99.0%, 90.5%, and 0.8386, respectively. Sensitivity, accuracy, and AUC significantly differed between the two methods (McNemar test, p = 0.0015, p = 0.0015, and p < 0.0001, respectively). 11C-choline PET/CT detected 110/111 metastatic lesions (99.1%); BS detected 85 (76.6%) (p < 0.0001). According to the CT morphological type, the visualization rates of 11C-choline-PET/BS were 100%/90.3% for the blastic type, 91.7%/8.3% for the lytic type, 100%/100% for the mixed type, and 100%/53.3% for the invisible type, respectively. Significant differences in blastic, lytic, and invisible types were observed between the two methods (p = 0.013, p = 0.0044, and p = 0.023, respectively). In conclusion, 11C-choline PET/CT had greater sensitivity and accuracy than BS for detection of bone involvement in patients with prostate cancer.


Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Radioisótopos de Carbono/análise , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/complicações , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia
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