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1.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
2.
J Laryngol Otol ; 133(6): 520-525, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31172898

RESUMO

BACKGROUND: Tonsillectomy is one of the most common otolaryngological procedures. Nonetheless, there is still no universally approved 'gold standard' technique. OBJECTIVE: To compare the safety and efficacy of argon plasma coagulation and coblation techniques in tonsillectomy. METHODS: A multi-institutional, retrospective cohort study was conducted, comprising 283 patients who underwent bilateral tonsillectomies performed by a single surgeon between 2014 and 2017. The outcome measures included: operative time, intra-operative blood loss, post-operative pain and post-operative haemorrhage. RESULTS: In the argon plasma coagulation group, mean operative time and post-operative haemorrhage rate were significantly reduced, p = 0.0006 and p = 0.003 respectively. There was no statistically significant difference between the two groups in terms of post-operative pain and intra-operative blood loss. CONCLUSION: The argon plasma coagulation technique is easy, safe and efficacious. Argon plasma coagulation tonsillectomy seems cost-effective compared to coblation tonsillectomy: the single-use disposable electrode tip and wand used in this study cost AUD$76.50 and AUD$380 respectively. Argon plasma coagulation appears to be a favourable alternative to current modalities such as coblation.


Assuntos
Coagulação com Plasma de Argônio/métodos , Tempo de Internação , Segurança do Paciente , Tonsilectomia/métodos , Adolescente , Fatores Etários , Coagulação com Plasma de Argônio/efeitos adversos , Austrália , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Estudos de Coortes , Criocirurgia/métodos , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Lactente , Masculino , Duração da Cirurgia , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/fisiopatologia , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Tonsilectomia/efeitos adversos , Resultado do Tratamento , Adulto Jovem
3.
Surg Clin North Am ; 99(3): 555-569, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047042

RESUMO

In patients with advanced esophageal or gastric cancer, it is highly likely that palliation of symptoms will become a focus of treatment. Dysphagia and obstruction are the most common complaints, and many of these patients can be treated with endoscopic interventions to alleviate symptoms. Bleeding, perforation, and nutritional issues are common problems. Attempts at palliation should be guided by thoughtful discussions regarding patients' goals of care. Owing to the high morbidity and mortality in patients with limited life expectancy, a strategy of working from the least invasive to the most invasive interventions should be guided by the patient's goals.


Assuntos
Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Neoplasias Gástricas/terapia , Coagulação com Plasma de Argônio/métodos , Braquiterapia/métodos , Quimiorradioterapia/métodos , Criocirurgia/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Dilatação/métodos , Endoscopia Gastrointestinal/métodos , Etanol/administração & dosagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Terapia a Laser/métodos , Estadiamento de Neoplasias/métodos , Apoio Nutricional , Fotoquimioterapia/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
4.
Medicine (Baltimore) ; 98(21): e15610, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124938

RESUMO

This study aimed to compare radiofrequency ablation (RFA), cryoablation (CRA), and partial nephrectomy (PN) for renal cell carcinoma (RCC) sized ≤2 cm or 2 to 4 cm.The Surveillance, Epidemiology, and End Results (SEER) database was used to identify 17,234 patients diagnosed with T1aN0M0 RCC from 2004 to 2015. Overall survival (OS) and cancer-specific survival (CSS) were compared among patients who were treated using PN, CRA, or RFA. The Cox proportional hazards model was used to determine prognostic factors for survival.In patients with RCCs sized 2 to 4 cm, better OS and CSS were observed with PN than with CRA or RFA. On multivariable analysis, compared to PN, CRA and RFA were independently associated with poor OS and CSS in patients with RCCs sized 2 to 4 cm. In patients with RCCs sized ≤2 cm, better OS was observed with PN than with CRA or RFA; however, CSS was similar. On multivariable analysis, compared to PN, RFA was independently associated with poor OS in patients with RCCs sized ≤2 cm.CRA or RFA should not be recommended for patients with RCCs sized 2 to 4 cm; PN is an effective treatment modality in these patients. For patients with RCCs sized ≤2 cm, CRA can be an equally effective alternative to PN.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/mortalidade , Neoplasias Renais/cirurgia , Nefrectomia/mortalidade , Ablação por Radiofrequência/mortalidade , Idoso , Carcinoma de Células Renais/patologia , Criocirurgia/métodos , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrectomia/métodos , Prognóstico , Modelos de Riscos Proporcionais , Ablação por Radiofrequência/métodos , Estudos Retrospectivos , Fatores de Risco , Programa de SEER , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
5.
Cardiovasc Intervent Radiol ; 42(7): 970-978, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31044292

RESUMO

PURPOSE: The use of percutaneous cryoablation for T1b (4.1-7.0 cm) renal cell carcinoma, has not yet been widely adopted. The purpose of this study was to describe our experience in the cryoablation of stage T1b tumors with an emphasis on safety, technical results, and clinical outcomes. MATERIALS AND METHODS: A retrospective review of hospital records identified 37 patients who underwent cryoablation for T1b lesions from 2008 to 2018. Patient demographics, comorbidities, tumor characteristics, technical parameters, and outcomes were recorded and analyzed. Recurrence-free, overall, and cancer-specific survival rates were estimated using the Kaplan-Meier method. RESULTS: Thirty-seven patients (22 males, 15 females; mean age 66.5 ± 11.3) with 37 T1b tumors (mean diameter 47.3 ± 6.3 mm) were included. A median of 3 probes were used (range: 1-7). Angio-embolization was used in 3/37 (8.1%) and 2/37 patients (5.4%) required hydrodissection. The mean number of total cryoablation procedures for each patient was 1.5 (median 1; range: 1-4). Technical success was achieved in 88.2% of patients. Recurrence-free survival was 96.5%, 86.1%, and 62.6% at 1, 2, and 3 years respectively. Cancer-specific survival was 100% at 1, 2, and 3 years respectively. Overall survival was 96.7%, 91.8%, and 77.6% at 1, 2, and 3 years respectively. Complications classified as CIRSE grade 2 or higher occurred in 6/37 (16.2%) patients. CONCLUSION: T1b cryoablation is associated with high rates of technical success, excellent cancer-specific survival, and an acceptable safety profile. LEVEL OF EVIDENCE: Level 4, Case Series.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Idoso , Carcinoma de Células Renais/diagnóstico por imagem , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/cirurgia , Neoplasias Renais/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(15): e15240, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985729

RESUMO

RATIONALE: Isolated pulmonary Langerhans cell histiocytosis (PLCH) is rare in adults. The gold standard diagnosis requires surgical lung biopsy. However, few cases have been diagnosed with transbronchial cryobiopsy (TBCB) sampling in the early stages of the disease, particularly in China. PRESENTING CONCERNS: A 50-year-old man was referred for dry cough and exertional dyspnea of more than 1 week. High-resolution computed tomography (HRCT) of the chest revealed symmetric nodules and cyst lesions with upper lobe infiltrate. Further history taking indicated that he had smoked 20 cigarettes per day for more than 30 years. Therefore, PLCH was highly suspected. However, he refused surgical lung biopsy, and TBCB was attempted to complete diagnosis. DIAGNOSIS: Emission computed tomography excluded the possibility of extrapulmonary involvements, and pathological findings supported the diagnosis of isolated PLCH. INTERVENTIONS: Smoking cessation and prednisone treatment were used for patient management. OUTCOMES: The symptoms receded with significant improvement of chest HRCT during 2-months of follow-up. LESSONS: Early diagnosis contributes to the prognosis of isolated PLCH in adults, and TBCB may be an alternative to conventional surgical lung biopsy for pathological diagnosis of PLCH.


Assuntos
Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/terapia , Biópsia/métodos , Broncoscopia , Criocirurgia/métodos , Gerenciamento Clínico , Diagnóstico Precoce , Histiocitose de Células de Langerhans/patologia , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade
7.
BMC Ophthalmol ; 19(1): 96, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023285

RESUMO

BACKGROUND: To investigate the influence of different types of retinopexy on the outcome of rhegmatogenous retinal detachment (RRD) repair. METHOD: All patients with RRD who underwent pars plana vitrectomy (PPV) between January 2013 and December 2017 were included. Analysed surgical factors were types of retinopexy (cryocoagulation, endolaser, combined). Subgroup analysis was performed in patients with primary proliferative vitreoretinopathy (PVR), and/or the necessity of a primary silicone oil fill. RESULTS: A total of 1017 eyes with retinal detachment were included. The predominant type of retinopexy used during PPV was cryocoagulation in 492 eyes, followed by a combined cryocogulation/endolaser in 306 eyes and laserretinopexy in only 219 eyes. Overall, the re-detachment rate was 10.1%. In most of the cases (53.6%) the main reason for re-detachment was insufficient retinopexy, followed by a PVR-reaction in 37.3%, and new site break in 9.1%. No significant difference in the rate of re-detachment was found between the different types of retinopexy (p = 0.309). However, subgroup analysis showed a significantly higher rate of re-detachment in patients with a primary PVR (p = 0.0003), and in the group with silicone oil as the primary tamponade (p = 0.0001). CONCLUSION: The data suggests that the type of retinopexy has little relevance for the surgical outcome of PPV for the primary RRD. However, patients with primary PVR and primary silicone oil fills were at a significantly increased risk for re-detachment.


Assuntos
Criocirurgia/métodos , Terapia a Laser/métodos , Descolamento Retiniano/cirurgia , Vitrectomia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tamponamento Interno/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem
8.
J Cancer Res Ther ; 15(2): 370-374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964113

RESUMO

Context: Ground-glass opacity (GGO) is a nonspecific imaging parameter for early-stage pulmonary cancer. In these cases, a definite diagnosis and prompt surgery usually yield satisfactory outcomes. Aims: This study aimed to assess the safety and feasibility of cryoablation treatment for lung GGO. Subjects and Methods: We reviewed the clinical data of 14 patients (19 lung tumors) with lung GGO and evaluated the adverse events, lung function, and treatment efficacy after cryoablation. Statistical Analysis Used: Statistical analyses were performed using the Statistical Package for the Social Sciences software (version 13.0; SPSS Inc., Chicago, IL, USA). Results: None of the patients exhibited serious complications, and lung function recovered to >95% after 1 month. During a follow-up, computed tomography scan at 24 months, the GGO appeared to have been successfully ablated in all patients. Conclusion: Cryoablation may serve as a safe and feasible option for the treatment of GGO.


Assuntos
Criocirurgia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Cirurgia Assistida por Computador , Idoso , Biomarcadores , Criocirurgia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Testes de Função Respiratória , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
J Med Case Rep ; 13(1): 96, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31005126

RESUMO

BACKGROUND: In metastatic renal cell carcinoma, immunotherapy is the only treatment modality associated with a complete and durable response, but severe toxicity limits its usefulness. If toxicity could be eliminated, immunotherapy might be an effective treatment for metastatic renal cell carcinoma. We present a case of a patient with spinal metastatic renal cell carcinoma treated with total en bloc spondylectomy and reconstruction using a cryo-treated tumor-bearing bone graft; the patient demonstrated an antitumor cryoimmunological response. CASE PRESENTATION: A 51-year-old Japanese man presented with back pain 4 years after undergoing a left-sided total nephrectomy for renal cell carcinoma. He was diagnosed with metastases in the T1-T3 vertebrae, right adrenal gland, sternum, left clavicle, and sacrum. Total en bloc spondylectomy and reconstruction using a cryo-treated tumor-bearing bone graft was performed to treat the vertebral metastases. Sunitinib and then everolimus were also administered. Serum interferon-γ and interleukin 12 levels were measured before surgery and at 1, 3, 6, and 12 months after surgery. Serum interferon-γ and interleukin 12 levels increased 3 months after surgery; this increase was sustained for 6 months. No local recurrence or other distant metastases occurred. The bone metastases remained stable, and the adrenal metastasis progressed slowly. The duration of progression-free survival during sunitinib and everolimus treatment was 24 and 40 months, respectively, and overall survival is currently 5.5 years. CONCLUSIONS: This report demonstrates that using cryo-treated tumor-bearing tissue in a patient with metastatic renal cell carcinoma stimulated an antitumor cryoimmunological response.


Assuntos
Transplante Ósseo/métodos , Carcinoma de Células Renais/patologia , Criocirurgia/métodos , Neoplasias Renais/patologia , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias das Glândulas Suprarrenais/terapia , Carcinoma de Células Renais/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Vértebras Torácicas/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Int J Clin Oncol ; 24(6): 608-613, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30982153

RESUMO

Recently, a number of new minimally invasive image-guided percutaneous ablation treatments, including cryoablation, radiofrequency ablation, microwave ablation, high-intensity focused ultrasound, laser ablation, and irreversible electroporation have been developed. Several studies have shown the feasibility and safety of these cryoablation therapies for the treatment of benign breast tumors and small invasive breast cancer. Although the complete response rate of cryoablation for breast cancer is reported to be relatively good, most studies enrolled a small number of patients, and so reliable conclusions could not be drawn. In this review, we introduce the mechanisms of action of cryoablation, and summarize the current literature on the efficacy and safety of cryoablation for breast cancer. Cryoablation also induces an immunomodulatory effect, which is an interesting topic of research in the era of immune checkpoint inhibitors. Cryoablation for primary tumor may enhance the treatment effect of immune checkpoint inhibitors in patients with breast cancer. Further investigations of this new therapeutic strategy are needed.


Assuntos
Neoplasias da Mama/cirurgia , Criocirurgia/métodos , Neoplasias da Mama/patologia , Feminino , Humanos , Resultado do Tratamento
11.
Jpn J Radiol ; 37(6): 481-486, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30941617

RESUMO

PURPOSE: To evaluate the safety and efficacy of cryoablation for renal cell carcinoma (RCC) in patients with stage 4 or 5 non-dialysis chronic kidney disease (CKD). MATERIALS AND METHODS: This retrospective multicenter study included patients with maximum tumor diameter ≤ 4 cm, estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2, in whom cryoablation was performed percutaneously with curative intent between July 2011 and May 2016. RESULTS: Of 541 patients who underwent renal tumor cryoablation, 17 (3.1%; 4 women, 13 men; mean age 70.1 ± 10.6 years) with stage 4 or 5 non-dialysis CKD were included in this study. The pre-cryoablation eGFR was 22.5 ± 6.3 ml/min/1.73 m2. The mean tumor diameter was 2.8 ± 0.7 cm. No Grade 3 or higher adverse events occurred post-cryoablation. The eGFR at each time point was significantly lower than that before treatment. One patient required hemodialysis initiation at 21 months post-procedure. None of the patients showed residual RCC at their last follow-up. CONCLUSION: Cryoablation of RCC is safe in patients with stage 4 or 5 non-dialysis CKD and yields treatment results comparable to those in patients without CKD. This treatment could be completed without the early initiation of hemodialysis after the procedure.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Falência Renal Crônica/complicações , Neoplasias Renais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/patologia , Feminino , Taxa de Filtração Glomerular , Humanos , Rim/patologia , Rim/cirurgia , Falência Renal Crônica/patologia , Neoplasias Renais/complicações , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Medicine (Baltimore) ; 98(9): e14635, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817581

RESUMO

RATIONALE: Bronchoscopic cryotherapy has been considered as one of the optional interventions for unresectable malignant central airway obstruction (CAO). And it provides high safety and effectiveness in airway patency re-establishment. This report describes the interventional bronchoscopic cryotherapy for a patient with CAO caused by squamous cell carcinoma of the esophagus. We display a series of dramatic change of chest radiographs before and after the intervention. PATIENT CONCERNS: A 70-year-old man with squamous cell carcinoma of the middle third of the esophagus (initial staging, pT2N0M0; stage IIB; in January 2017) underwent Video-assisted esophagectomy and reconstruction with a gastric conduit via a substernal route. Following Chest computed tomography and positron emission tomography revealed disease progression with paratracheal metastases. Progressive dyspnea and chest pain lasted for a month, and he was admitted to the ER. DIAGNOSES: Blood gas analysis revealed type I respiratory failure (pH, 7.445; PaO2, 69.4 mmHg; PaCO2, 40.6 mmHg). Other laboratory data were grossly normal. Chest radiography revealed a total left lung collapse. Chest CT identified a tumor blocking the left mainstem bronchus with the consolidation of the left lung. INTERVENTIONS: Dexamethasone and epinephrine inhalation were administered for initial symptom relief. Bronchoscopy performed 4 days after admission revealed a huge tumor completely occluding the left mainstem bronchus orifice. The occlusion was completely resolved following cryotherapy. Then, the first course of palliative chemotherapy with cisplatin plus fluorouracil, followed by the second course a month later, was administered. OUTCOMES: The latest chest radiograph showed a patent airway. The patient's condition remained stable for at least the following 2 months. LESSONS: Malignant CAO is a rare but potentially life-threatening condition. Several acceptable bronchoscopy techniques exist for treatment. Cryotherapy has high safety and effectiveness in airway patency re-establishment.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Broncoscopia/métodos , Carcinoma de Células Escamosas/complicações , Criocirurgia/métodos , Neoplasias Esofágicas/complicações , Neoplasias Pulmonares/complicações , Idoso , Obstrução das Vias Respiratórias/etiologia , Carcinoma de Células Escamosas/secundário , Neoplasias Esofágicas/patologia , Humanos , Pulmão/patologia , Neoplasias Pulmonares/secundário , Masculino
13.
Gastrointest Endosc Clin N Am ; 29(2): 369-379, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30846159

RESUMO

"Endoscopic ultrasound (EUS)-guided ablative therapies have advanced significantly and have led to experimental applications in locations that have been difficult to image and/or reach with percutaneous approaches, such as the caudate and left lobe of the liver. EUS-guided treatments of the liver are under development. The literature has shown that many percutaneous ablative techniques are readily adaptable for EUS. In this review, the authors discuss the current developments on EUS-guided ablation of liver tumors, including injection of sclerosants, thermal therapy, and EUS-guided portal injection of chemotherapy."


Assuntos
Técnicas de Ablação/métodos , Endossonografia , Etanol/administração & dosagem , Neoplasias Hepáticas/terapia , Animais , Antineoplásicos/administração & dosagem , Braquiterapia , Criocirurgia/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Injeções Intralesionais , Terapia a Laser/métodos , Ablação por Radiofrequência/métodos , Ultrassonografia de Intervenção
14.
Br J Radiol ; 92(1097): 20180965, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30845821

RESUMO

OBJECTIVE: To assess the safety and oncological efficacy of percutaneous MR-guided whole-gland prostate cancer (PCa) cryoablation (CA). METHODS AND MATERIALS: Between July 2009 and January 2018, 30 patients (mean age 72.9 ± 5.13 years) with histologically proven, organ-confined (≤ T2cN0M0), predominantly low/intermediate-risk PCa (median Gleason score 7; mean prostate specific antigen 6.05 ± 3.74 ng ml-1 ) underwent MR-guided whole-gland CA. Patients were selected on the basis of prior pelvic radiotherapy (n = 16; 12 for previous PCa), or contra indication/refusal of surgery or radiotherapy. Complications, local progression-free survival (LPFS) and overall survival (OS) were retrospectively investigated. RESULTS: Eighteen [60%] patients reported procedure-related complications: 5/18 [28%] needed surgical/interventional treatments and 13 [72%] conservative or pharmacological treatment. Eleven [73%] complications were noted in the first 15 patients and 7 [47%] in the last 15 patients (p = 0.26). Mean nadir prostate specific antigen was 0.24 ± 1.5 ng ml-1 (mean follow-up 3.8 years; range: 2 - 2915 days). Seven [23%] patients developed histologically proven local progression (mean time to recurrence 775 days, range: 172 - 2014). Mean clinical follow-up was 3.8 years (range 1-2915 days). LPFS was 92.0, 75.7 and 69.4 % at 1-, 3- and 5 year follow-up, respectively. For patients in salvage treatment, LPFS was 100%, 75%, and 75% at 1-, 3- and 5 year follow-up. OS was 100%, 94.4 and 88.5 % at 1-, 3- and 5 year follow-up respectively, with no patients dying from PCa. CONCLUSION: Whole-gland PCa CA offers good oncological efficacy, particularly in post-radiotherapy cases. Although the complication rate is significant, the majority is minor and is managed with conservative or pharmacologic management. ADVANCES IN KNOWLEDGE: MRI-guided whole-gland prostate cancer cryoablation offers good oncological efficacy, particularly in post-radiotherapy cases with a contained complication rate.


Assuntos
Criocirurgia/efeitos adversos , Criocirurgia/métodos , Imagem por Ressonância Magnética , Neoplasias da Próstata/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Intervalo Livre de Progressão , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Estudos Retrospectivos , Medição de Risco , Terapia de Salvação , Análise de Sobrevida , Resultado do Tratamento
15.
BMJ Case Rep ; 12(3)2019 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-30904882

RESUMO

Cryoablation is a well-established treatment option, proven to be successful in treating local renal cell carcinoma (RCC). We treated a 67-year-old man in an outpatient setting with late onset of a 25 mm solitary soft-tissue metastasis of from RCC with cryoablation. The treatment was performed under sedation and in local anaesthesia. There were no complications during the procedure. The patient did not experience any adverse effects to the treatment. He was able to resume his normal daily routines the day after his treatment. A follow-up CT scan at 3, 8 and 12 months after treatment reported sufficient cryoablation and no sign of recurrence or other metastases.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Neoplasias Renais/patologia , Neoplasias de Tecidos Moles/cirurgia , Idoso , Carcinoma de Células Renais/secundário , Humanos , Masculino , Neoplasias de Tecidos Moles/secundário , Resultado do Tratamento
16.
Khirurgiia (Mosk) ; (1): 95-100, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30789616

RESUMO

The progressive development of medical technologies allowed the introduction of alternative methods of treatment of localized renal cell carcinoma with a tendency to organ-sparing approach. Cryoablation, radiofrequency ablation, and some experimental methods of treatment (microwave and laser ablation, therapy with high-intensity focused ultrasound) are referred to minimally invasive treatment of renal cell carcinoma. Cryoablation is highly effective alternative method of treatment of renal cell carcinoma. The main advantages of this technique are tumor visualization and formation of 'ice ball' in real time, fewer complications compared with other methods, as well as the possibility of cryotherapy in critically ill patients. Compared to other ablative technologies, cryoablation is followed by low percentage of redo treatment and good intermediate oncological results. We described the experience of one-stage cryoablation of two kidney tumors in this report.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia/métodos , Neoplasias Renais/cirurgia , Humanos
17.
Clin Cardiol ; 42(4): 438-443, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30756396

RESUMO

BACKGROUND: Cryoballoon isolation is considered a safe and effective treatment for atrial fibrillation (AF). However, recurrence of AF after first cryoballoon ablation occurs in ~30% of patients. Pre-procedurally identifying patients at risk of AF recurrence could be beneficial. HYPOTHESIS: Our aim was to determine how pulmonary vein (PV) anatomy influences the recurrence of AF using the second-generation cryoballoon in patients with paroxysmal AF. METHODS: We included 88 consecutive patients with paroxysmal AF undergoing PVI procedure with a second-generation 28-mm cryoballoon. All patients were evaluated at 3, 6 and 12 months using a 12-lead ECG and 24-hour Holter monitoring. PV anatomy was assessed by creating three-dimensional models using computed tomography (CT) segmentations of the left atrium. RESULTS: Fifty-one patients (61%) had left PVs with a shared carina, 35 patients (42%) had a shared right carina. Nine patients (11%) were classified having a right middle PV. In total 17 (20.2%) of patients had a left common PV. At 12 months, 14 patients (17%) had experienced AF recurrence. Neither PV ovality, variant anatomy, the presence of shared carina nor a common left PV was a predictor for AF recurrence. CONCLUSIONS: No specific characteristics of PV dimensions nor morphology were associated with AF recurrence after cryoballoon ablation in patients with paroxysmal AF.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Imagem Tridimensional , Tomografia Computadorizada Multidetectores/métodos , Veias Pulmonares/diagnóstico por imagem , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos
19.
BMC Pulm Med ; 19(1): 16, 2019 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-30651103

RESUMO

BACKGROUND: Standardization of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases is imminent; however, the majority of published series on cryobiopsy include a limited number of patients and are characterized by several differences in procedural technical details. METHODS: This is an observational, retrospective cohort study. Aim of the study was to suggest some sampling strategies related to transbronchial cryobiopsy in the diagnostic work-up of patients with diffuse parenchymal lung diseases. RESULTS: Six hundred ninety-nine patients with suspected diffuse parenchymal lung disease were recruited. A specific pathological diagnosis was achieved in 614/699 cases (87.8%) and a multidisciplinary diagnosis was obtained in 630/699 cases (90.1%). Diagnostic yield was significantly influenced by the number of samples taken (1 vs ≥ 2 biopsies, p < 0.005). In 60.4% of patients, biopsies were taken from one site and in 39.6% from different sites (in the same lobe or in two different lobes), with a significant increase in diagnostic yield, specifically in patients with fibrotic lung diseases (65.5% vs 93.4%, p < 0.0001). The 2.4 mm or 1.9 mm probes were used, with no differences in terms of diagnostic yield. Regarding safety, pneumothorax occurred in 19.2% and was influenced by baseline lung function; in all patients Fogarty balloon has been used and severe haemorrhage occurred in 0.7% of cases. Three patients (0.4% of cases) died within 30 days after the procedure. CONCLUSIONS: We propose some sampling strategies of cryobiopsy which seem to be associated with a higher diagnostic yield and a favorable risk/benefit ratio: sampling at least two samples in different sites, using either the 2.4 mm or the 1.9 mm probe, intubating the patients and using bronchial blockers/catheters.


Assuntos
Biópsia/métodos , Broncoscopia/métodos , Criocirurgia/métodos , Doenças Pulmonares Intersticiais/patologia , Pulmão/patologia , Idoso , Estudos de Coortes , Feminino , Humanos , Pulmão/cirurgia , Doenças Pulmonares Intersticiais/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumotórax/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Medição de Risco
20.
Chin Med J (Engl) ; 132(3): 285-293, 2019 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-30681494

RESUMO

BACKGROUND: Pulmonary vein (PV) occlusion generally depends on repetitive contrast agent injection when cryoballoon ablation for atrial fibrillation (AF). The present study was to compare the effect of cryoballoon ablation for AF guided by transesophageal echocardiography (TEE) vs. contrast agent injection. METHODS: Eighty patients with paroxysmal AF (PAF) were enrolled in the study. About 40 patients underwent cryoballoon ablation without TEE (non-TEE group) and the other 40 underwent cryoballoon ablation with TEE for PV occlusion (TEE group). In the TEE group during the procedure, PVs were displayed in 3-dimensional images to guide the balloon to achieve PV occlusion. The patients were followed up at regularly scheduled visits every 2 months. RESULTS: No differences were identified between the groups in regard to the procedure time and cryoablation time for each PV. The fluoroscopy time (6.7 ±â€Š4.2 min vs. 17.9 ±â€Š5.9 min, P < 0.05) and the amount of contrast agent (3.0 ±â€Š5.1 mL vs.18.1 ±â€Š3.4 mL, P < 0.05) in the TEE group were both less than the non-TEE group. At a mean of 13.0 ±â€Š3.3 mon follow-up, success rates were similar between the TEE group and non-TEE group (77.5% vs. 80.0%, P = 0.88). CONCLUSIONS: Cryoballoon ablation with TEE for occlusion of the PV is both safe and effective. Less fluoroscopy time and a lower contrast agent load can be achieved with the help of TEE for PV occlusion during procedure.


Assuntos
Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Idoso , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Resultado do Tratamento
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