Derek Glenn

Radiologic appearance and complications of percutaneous computed tomography-guided radiofrequency-ablated pulmonary metastases from colorectal carcinoma.

Objectives To describe the morphologic appearance over time of percutaneously radiofrequency-ablated pulmonary metastases from colorectal cancer and to focus on the occurrence of the most common complications. Methods Twenty patients have been treated with computed tomography (CT)–guided radiofrequency ablation (RFA) for 41 pulmonary metastases using the expandable 14-gauge StarBurst XL RF electrode along with the 1500 generator (RITA Medical Systems, Mountain View, CA). The average number of lesions per patient was 2.05, ranging from 1 to 4 lesions. Results The typical feature of the radiofrequency-ablated site immediately after the procedure was a light bulb–shaped opacification surrounding the probe. This became a more spherically shaped feature over time and steadily decreased in size. At 3 months after RFA, the lesion was approximately the same size as at baseline. The lesion subsequently shrank within the following 3 months, usually with a small scar remaining. Pneumothorax occurred in 50% of the patients, and a chest tube was required in 50% of the patients affected. Cavitation occurred in 24% of the lesions. Intraparenchymal hemorrhage was observed in 7.5% of the cases. Conclusions Image-guided pulmonary RFA is a safe minimally invasive therapy modality with acceptable morbidity. Ablated lesion size usually exceeds the dimensions of the initial tumor for the first 3 months after ablation and continuously shrinks thereafter.

Percutaneous imaging-guided radiofrequency ablation in patients with colorectal pulmonary metastases: 1-year follow-up.

AbstractBackground: We assessed the safety and evidence of efficacy of radiofrequency ablation (RFA) for colorectal lung metastases with follow-up to 1 year. Methods: Twenty-three patients had percutaneous RFA for 52 colorectal pulmonary metastases under fluoro-computed tomography (CT). Patients received intravenous conscious sedation and local analgesia with routine hospitalization and monitoring for 24 hours after RFA. Patients had CT scanning at 1 month and then every 3 months, with serum carcinoembryonic antigen assessment monthly and every 3 months. Results: All ablations were technically successful. Tumor diameter ranged from .3 to 4.2 cm. Pneumothorax occurred in 43% (10 of 23) of patients. Six patients required intercostal chest drain placement. Six patients had a second RFA, four for new lesions and two for re-treatment of a previously treated lesion. The median admission was 2.0 days (range, 1–9 days). The median follow-up was 428 days (range, 173–829 days); data are reported to 1 year in this article. Five patients died at 5, 6, 8, 8, and 12 months after RFA from extrapulmonary (n = 1) or widespread (n = 4) disease. One patient developed a malignant pleural effusion at 6 months after RFA. Cavitation was seen in nine treated lesions (17%); all resolved with scar tissue contraction by 12 months. Eighteen patients with CT scan follow-up at 1 year have 40 lesions classified as disappeared (n = 17), decreased (n = 5), stable/same size (n = 4), or increased (n = 14). Conclusions: Percutaneous imaging–guided RFA of multiple colorectal pulmonary metastases is a minimally invasive treatment option with modest morbidity. A significant proportion of patients show good evidence of successful local control at 1 year.

Percutaneous radiofrequency ablation of pulmonary metastases in patients with colorectal cancer

This study aimed to assess the safety and efficacy of imaging‐guided percutaneous radiofrequency ablation (RFA) for local control of lung metastases from colorectal cancer (CRC).

Cytoreductive surgery and perioperative intraperitoneal chemotherapy for pseudomyxoma peritonei from appendiceal mucinous neoplasms.

Cytoreductive surgery (CRS) combined with perioperative intraperitoneal chemotherapy (PIC) has been used to treat pseudomyxoma peritonei. The aim of this prospective study was to evaluate survival outcome and treatment‐related prognostic markers in patients who underwent CRS and PIC for pseudomyxoma peritonei from appendiceal mucinous neoplasms.

Long-term outcome of image-guided percutaneous radiofrequency ablation of lung metastases: an open-labeled prospective trial of 148 patients

BACKGROUND Image-guided percutaneous radiofrequency ablation (RFA) has been proposed as an efficacious local therapy for lung metastases in nonsurgical candidates. Reports of long-term outcome from this treatment have been limited. METHODS A prospective open-labeled trial of RFA was initiated in November 2000 for treatment of lung metastases in nonsurgical candidates. RFA was carried out under fluoroscopic computed tomography. Treatment complications and survival parameters were analyzed. RESULTS Of 148 patients treated, 66 patients (46%) had a complete response, 38 patents (26%) had a partial response, 57 patients (39%) had stable disease and 23 patients (16%) had progressive disease. The median progression-free survival was 11 months [95% confidence interval (CI) 9-14]. The median overall survival and 3- and 5-year survivals were 51 months (95% CI 19-83) and 60% and 45%, respectively. Disease-free interval (P = 0.013) and response to treatment (P = 0.002) were independent predictors for overall survival. Complications occurred in up to 45% of patients, of which 45 patients (30%) required chest tube placement. CONCLUSION This analysis confirms that RFA of lung metastases may achieve long-term survival in nonsurgical candidates with an acceptable complication rate hence supporting its incorporation into the oncosurgical management of lung metastases for the purposes of cure, stabilization and disease prolongation.

Treatment Failure After Percutaneous Radiofrequency Ablation for Nonsurgical Candidates With Pulmonary Metastases From Colorectal Carcinoma

BackgroundThis study critically evaluated the local and overall treatment failure rates after percutaneous radiofrequency ablation (RFA) of pulmonary metastases from colorectal carcinoma.MethodsFifty-five nonsurgical candidates underwent RFA of colorectal pulmonary metastases. The primary end points of this study were local progression-free survival (PFS) and overall PFS. Univariate and multivariate analyses were performed to identify significant prognostic parameters for local and overall PFS.ResultsThe local recurrence rate was 38%. For local PFS, univariate analysis demonstrated that the largest size of lung metastasis, the location of lung metastases, the post-RFA carcinoembryonic antigen level at 1 month, and the post-RFA carcinoembryonic antigen level at 3 months were significant prognostic indicators. In multivariate analysis, a largest size of lung metastasis of >3 cm and a post-RFA carcinoembryonic antigen level of >5 ng/mL at 1 month were independently associated with a reduced local PFS. The overall recurrence rate was 66%. For overall PFS, univariate analysis demonstrated that sex and the largest size of lung metastasis were significant prognostic indicators. In multivariate analysis, a largest size of lung metastasis of >3 cm was independently associated with a reduced overall PFS.ConclusionsRFA of colorectal pulmonary metastases may have a useful role in local disease control for nonsurgical candidates, but its efficacy in patients with a lung metastasis of >3 cm is limited.

Systematic review of neoadjuvant transarterial chemoembolization for resectable hepatocellular carcinoma.

Resection of hepatocellular carcinoma (HCC) offers the only hope for cure. However, in patients undergoing resection, recurrences, in particular, intrahepatic recurrence are common. The effectiveness of transarterial chemoembolization (TACE) as a neoadjuvant therapy for unresectable HCC was exploited by numerous liver units and employed preoperatively in the setting of resectable HCC with an aim to prevent recurrence and prolong survival. A systematic literature search of databases (Medline and PubMed) to identify published studies of TACE administered preoperatively as a neoadjuvant treatment for resectable HCC was undertaken. A systematic review by tabulation of the results was performed with disease‐free survival (DFS) as the primary endpoint. Overall survival (OS), rate of pathological response, impact on surgical morbidity and mortality and pattern of recurrences were secondary endpoints of this review. Eighteen studies; three randomized trials and 15 observational studies were evaluated. This comprised of 3927 patients, of which, 1293 underwent neoadjuvant TACE. The median DFS in the TACE and non‐TACE group ranged from 10 to 46 and 8 to 52 months, respectively, with 67% of studies reporting similar DFS between groups despite higher extent of tumour necrosis from the resected specimens indicating a higher rate of pathological response (partial TACE 27–72% vs. non‐TACE 23–52%; complete TACE 0–28% vs. non‐TACE zero), with no difference in surgical morbidity and mortality outcome. No conclusion could be drawn with respect to OS. Both randomized and non‐randomized trials suggest the use of TACE preoperatively as a neoadjuvant treatment in resectable HCC is a safe and efficacious procedure with high rates of pathological responses. However, it does not appear to improve DFS.

Radiofrequency ablation of lung tumors: feasibility and safety.

BACKGROUND Percutaneous image-guided radiofrequency ablation is being promoted as a novel technique with a low morbidity rate in the treatment of inoperable lung tumors. The purpose of this study was to assess the incidence and risk factors of various complications after radiofrequency ablation of pulmonary neoplasms. METHODS The clinical and treatment-related data regarding 129 consecutive percutaneous radiofrequency ablation treatment sessions for 100 patients with inoperable lung tumors were collected prospectively. Univariate and multivariate analyses were conducted to identify significant risk factors associated with postprocedural overall morbidity, pleuritic chest pain, hemoptysis, pneumothorax, pleural effusions, and chest drain requirement. RESULTS There was no postprocedural mortality. The overall morbidity rate was 43% (n = 55 of 129). The most common adverse effect was pneumothorax, occurring in 32% (n = 41 of 129) of treatment sessions. Other significant complications included pleuritic chest pain (18%, n = 23 of 129), hemoptysis (7%, n = 9 of 129), pleural effusions (12%, n = 15 of 129), and chest drain insertion (20%, n = 26 of 129). Both univariate and multivariate analyses identified more than two lesions ablated per session as a significant risk factor for overall morbidity, pneumothorax, and chest drain insertion, but not for pleuritic pain, hemoptysis, and pleural effusions. Length of the ablation probe trajectory greater than 3 cm was an additional independent risk factor for overall morbidity and pneumothorax. Hilar location of lung tumor/s was the only independent risk factor associated with the increased incidence of hemoptysis. CONCLUSIONS Radiofrequency ablation for lung tumors can be considered as a safe and technically feasible procedure with acceptable incidence of complications.

Radiofrequency ablation as an adjunct to systemic chemotherapy for colorectal pulmonary metastases.

Radiofrequency ablation (RFA) is an alternative to local treatment for pulmonary metastases in patients who are nonsurgical candidates. Based on previously documented efficacy of this treatment, the authors retrospectively studied the prognostic factors for long‐term survival.

Learning curve for percutaneous radiofrequency ablation of pulmonary metastases from colorectal carcinoma: a prospective study of 70 consecutive cases.

BackgroundPercutaneous radiofrequency ablation (RFA) for inoperable colorectal pulmonary metastases is associated with a morbidity rate of 30% to 40%. A learning curve in this treatment approach has not been documented before.MethodsThe clinical and treatment-related data regarding 70 consecutive percutaneous RFA procedures for inoperable colorectal pulmonary metastases were collected prospectively. A comparison between the initial 35 cases (group 1) and the subsequent 35 cases (group 2) was performed. Univariate and multivariate analyses were conducted to identify the significant risk factors for overall morbidity, pneumothorax, and chest drain requirement.ResultsThere was no hospital mortality. The overall morbidity rate was 37%. The rate of pneumothorax was 27%. Twelve patients (17%) required chest drain insertion for pneumothorax. There was a significant decline in the incidence of overall morbidity, pneumothorax, and chest drain requirement in group 2 as compared with group 1. Both the number of lung metastases ablated and the RFA treatment period (group 1 vs. group 2) were independent risk factors for overall morbidity, pneumothorax, and chest drain requirement. Distribution of lung metastases (unilateral vs. bilateral) was an independent risk factor for overall morbidity and pneumothorax, but not for chest drain requirement.ConclusionsThere is a learning curve for percutaneous lung RFA. With accumulated experience in this procedure, a low morbidity rate can be achieved.