P. Rao

Transarterial Chemoembolization of Liver Metastases from Well Differentiated Gastroenteropancreatic Endocrine Tumors with Doxorubicin-eluting Beads: Preliminary Results

PURPOSEnTo evaluate the feasibility, safety, and efficacy of transarterial chemoembolization (TACE) of progressive liver metastases from well differentiated gastroenteropancreatic endocrine (GEP) tumors with drug-eluting beads (DEBs).nnnMATERIALS AND METHODSnFrom June 2004 to July 2005, eight men and 12 women aged 34 to 75 years (mean +/- SD, 59 y +/- 12), including 13 patients with bilobar disease and seven with unilobar disease, underwent 34 sessions of TACE with DEBs (500-700 mum) loaded with doxorubicin. Morphologic response was evaluated with computed tomography (CT) at 1 and 3 months according to Response Evaluation Criteria In Solid Tumors. Clinical and laboratory data were also assessed.nnnRESULTSnThe complete dose of 4 mL of DEBs loaded with 100 mg doxorubicin was injected during 22 TACE sessions and 1-3.5 mL of DEBs was injected during 12 TACE sessions. Three months after TACE, 16 of 20 patients (80%) exhibited a partial response, three (15%) had stable disease, and one (5%) had progressive disease. The mean size of the largest metastasis in each patient decreased from 42 mm +/- 24 before treatment (median, 39.5 mm) to 33 mm +/- 23 (median, 29 mm) 1 month after treatment and 30 mm +/- 21 (median, 26.5 mm) 3 months after treatment. After a median follow-up of 15 months (range, 6-24 months), nine patients disease remained controlled without tumor progression and 10 patients had progressive disease. The median time to progression was 15 months. Postembolization syndrome lasted less than 7 days in 23 sessions (67%) and more than 7 days in seven sessions (22%), and no symptoms at all were observed in four sessions (11%). Peak aspartate aminotransferase, alanine aminotransferase, and bilirubin levels after TACE were 35-490 IU (mean, 125 IU +/- 77; normal, <35 IU), 20-440 IU (mean, 149 IU +/- 155; normal, <45 IU), and 8-90 mol/L (mean, 26 IU +/- 25; normal, <17 IU), respectively, at 2-3 days. In five patients, follow-up CT at 1 month revealed TACE-induced peripheral liver necrosis.nnnCONCLUSIONSnTACE with DEBs is well tolerated and appears effective. A comparative study with a standard TACE or transarterial embolization regimen is warranted to define the best protocol for transarterial treatment of GEP liver metastases.

Predictive Factors for Hypertrophy of the Future Remnant Liver After Selective Portal Vein Embolization

BackgroundTo analyze predictive factors of hypertrophy of the nonembolized future remnant liver (FRL) after transhepatic preoperative portal vein embolization (PVE) of the liver to be resected.Materials and MethodsAge, gender, indocyanin green clearance test, chemotherapy before PVE, type of chemotherapy, operators, extent of PVE, radiofrequency ablation (RFA) associated with PVE, time delay between PVE and surgery, and platelet count were retrospectively evaluated as predictive factors for hypertrophy of FRL in 107 patients with malignant disease in noncirrhotic liver. PVE targeted the right liver lobe [nxa0=xa070] or the right liver lobe and segment IV [nxa0=xa037] when FRL/total liver volume ratio was below 25% in healthy liver or 40% in altered liver.ResultsAfter PVE, FRL volume significantly increased by 69%, from 344xa0±xa0156xa0cm3 to 543xa0±xa0192xa0cm3 (Pxa0<xa0.0001). The degree of hypertrophy was negatively correlated with FRL volume (correlation coefficientxa0=xa0−0.55, Pxa0<xa0.0001) and FRL/TFL ratio (correlation coefficientxa0=xa0−0.52, Pxa0<xa0.0001) before PVE. Patients, who have undergone chemotherapy with platin agents prior to PVE, demonstrated lower hypertrophy (Pxa0=xa0.048).ConclusionHypertrophy after PVE is inversely correlated to initial FRL volume. Hypertrophy of the liver might be influenced by the systemic chemotherapeutic received before PVE.

Computed Analysis of Three-Dimensional Cone-Beam Computed Tomography Angiography for Determination of Tumor-Feeding Vessels During Chemoembolization of Liver Tumor: A Pilot Study

The purpose of this study was to evaluate computed analysis of three-dimensional (3D) cone-beam computed tomography angiography (CTA) of the liver for determination of subsegmental tumor-feeding vessels (FVs). Eighteen consecutive patients underwent transarterial chemoembolization (TACE) from January to October 2008 for 25 liver tumors (15 hepatocellular carcinomas [HCCs] and 10 neuroendocrine metastases). Anteroposterior projection angiogram (two-dimensional [2D]) and 3D cone-beam CTA images were acquired by injection of the common hepatic artery. Retrospectively, FVs were independently identified by three radiology technologists using a software package (S) that automatically determines FVs by analysis of 3D images. Subsequently, three interventional radiologists (IRs) independently identified FVs by reviewing the 2D images followed by examination of the 3D images. Finally, the “ground truth” for the number and location of FVs was obtained by consensus among the IRs, who were allowed to use any imaging―including 2D, 3D, and all oblique or selective angiograms―for such determination. Sensitivities, durations, and degrees of agreement for review of 2D, 3D, and S results were evaluated. Sensitivity of 3D (73%) was higher than 2D (64%) images for identification of FVs (Pxa0=xa00.036). The sensitivity of S (93%) was higher than 2D (Pxa0=xa00.02) and 3D (Pxa0=xa00.005) imaging. The duration for review of 3D imaging was longer than that for 2D imaging (187 vs. 94xa0s, Pxa0=xa00.0001) or for S (135xa0s, Pxa0=xa00.0001). The degree of agreement between the IRs using 2D and 3D imaging were 54% and 62%, respectively, whereas it was 82% between the three radiology technologists using S. These preliminary data show that computed determination of FVs is both accurate and sensitive.

Lung tumors treated with percutaneous radiofrequency ablation: computed tomography imaging follow-up.

PurposeTo describe the morphologic evolution of lung tumors treated with radiofrequency ablation (RFA) by way of computed tomography (CT) images and to investigate patterns of incomplete RFA at the site of ablation.Materials and MethodsOne hundred eighty-nine patients with 350 lung tumors treated with RFA underwent CT imaging at 2, 4, 6, and 12 months. CT findings were interpreted separately by two reviewers with consensus. Five different radiologic patterns were predefined: fibrosis, cavitation, nodule, atelectasis, and disappearance. The appearance of the treated area was evaluated at each follow-up CT using the predefined patterns.ResultsAt 1 year after treatment, the most common evolutions were fibrosis (50.5%) or nodules (44.8%). Differences were noted depending on the initial size of the tumor, with fibrosis occurring more frequently for tumors <2 cm (58.6% vs. 22.9%, Pxa0=xa01xa0×xa010−5). Cavitation and atelectasis were less frequent patterns (2.4% and 1.4%, respectively, at 1 year). Tumor location (intraparenchymatous, with pleural contact <50% or >50%) was not significantly correlated with follow-up image pattern. Local tumor progressions were observed with each type of evolution. At 1 year, 12 local recurrences were noted: 2 cavitations, which represented 40% of the cavitations noted at 1 year; 2 fibroses (1.9%); 7 nodules (7.4%); and 1 atelectasis (33.3%).ConclusionAfter RFA of lung tumors, follow-up CT scans show that the shape of the treatment zone can evolve in five different patterns. None of these patterns, however, can confirm the absence of further local tumor progression at subsequent follow-up.

Spontaneous Regression of Multiple Pulmonary Metastases After Radiofrequency Ablation of a Single Metastasis

We report two cases of spontaneous regression of multiple pulmonary metastases occurring after radiofrequency ablation (RFA) of a single lung metastasis. To the best of our knowledge, these are the first such cases reported. These two patients presented with lung metastases progressive despite treatment with interleukin-2, interferon, or sorafenib but were safely ablated with percutaneous RFA under computed tomography guidance. Percutaneous RFA allowed control of the targeted tumors for >1xa0year. Distant lung metastases presented an objective response despite the fact that they received no targeted local treatment. Local ablative techniques, such as RFA, induce the release of tumor-degradation product, which is probably responsible for an immunologic reaction that is able to produce a response in distant tumors.

In Vivo Evaluation of Lung Microwave Ablation in a Porcine Tumor Mimic Model

PurposeTo evaluate the microwave ablation of created tumor mimics in the lung of a large animal model (pigs), with examination of the ablative synergy of multiple antennas.MethodsFifty-six tumor-mimic models of various sizes were created in 15 pigs by using barium-enriched minced collected thigh muscle injected into the lung of the same animal. Tumors were ablated under fluoroscopic guidance by single-antenna and multiple-antenna microwaves.ResultsThirty-five tumor models were treated in 11 pigs with a single antenna at 75xa0W for 15xa0min, with 15 measuring 20xa0mm in diameter, 10 measuring 30xa0mm, and 10 measuring 40xa0mm. Mean circularity of the single-antenna ablation zones measured 0.64xa0±xa00.12, with a diameter of 35.7xa0±xa08.7xa0mm along the axis of the antenna and 32.7xa0±xa012.8xa0mm perpendicular to the feeding point. Multiple-antenna delivery of 75xa0W for 15xa0min caused intraprocedural death of 2 animals; modified protocol to 60xa0W for 10xa0min resulted in an ablation zone with a diameter of 43.0xa0±xa07.7 along the axis of the antenna and 54.8xa0±xa08.5xa0mm perpendicular to the feeding point; circularity was 0.70xa0±xa00.10ConclusionsA single microwave antenna can create ablation zones large enough to cover lung tumor mimic models of ≤4xa0cm with no heat sink effect from vessels of ≤6xa0mm. Synergic use of 3 antennas allows ablation of larger volumes than single-antenna or radiofrequency ablation, but great caution must be taken when 3 antennas are used simultaneously in the lung in clinical practice.

Radiofrequency Ablation of Lung Metastases Close to Large Vessels during Vascular Occlusion: Preliminary Experience

PURPOSEnTo report an initial prospective evaluation of the technical feasibility, efficacy, and safety of combining percutaneous temporary balloon occlusion (PBO) of a large pulmonary artery adjacent to a metastatic lung tumor treated with percutaneous radiofrequency (RF) ablation.nnnMATERIALS AND METHODSnIn six patients, lung RF ablation with a multitined, expandable electrode with simultaneous PBO via femoral access was attempted with the use of digital angiography and multidetector computed tomography (CT). Follow-up imaging was obtained immediately after treatment, at 1-2 days, and at 2, 6, 9, and 12 months; positron emission tomography/CT was performed at 4 months.nnnRESULTSnMetastases targeted measured 17-37 mm (22 ± 8) and were in contact with a pulmonary artery 3-5 mm. Temporary occlusion of the pulmonary arterial branch in contact with the tumor was technically possible in five of six patients. Postablation CT scans obtained within 2 days of the procedure showed ablation zones measuring 37-57 mm (47 ± 8) in their shortest diameter. Three patients developed lung infarction within 1 month after RF ablation, and two had to be readmitted. At 3 months after the procedure, four patients had persistent occlusion of the balloon-occluded vessel. No uptake was demonstrated 4 months after ablation; at 12 months, all tumors showed complete ablation on CT.nnnCONCLUSIONSnRF ablation of lung tumors with PBO is a feasible technique, but it induces atelectasia and long-lasting vascular occlusion responsible for a high rate of readmission. The results of this small study warrant careful further exploration of the benefits of the technique, compared with RF ablation without PBO or other methods of ablative therapy.

Evaluation des modes d’administration d’irinotecan sur modeles VX2 lapin : etude de pharmacocinetique et reponse tumorale

Objectifs Evaluation et comparaison des pharmacocinetique et reponse tumorales apres d’administration d’Irinotecan par chimioem-bolisation avec les billes charges avec Irinotecan (DEBIRI), infusion intra-arterielle (IA), infusion et intra-veineuse (IV) sur modele VX2 lapin. Materiels et methodes Quarante sept lapins porteurs de VX2 hepatique ont recu soit DEBIRI (100-300m, moyenne dose 9,4xa0mg, nxa0=xa017), IA (nxa0=xa017) ou IV (nxa0=xa013) avec 12xa0mg d’Irinotecan sur lh. La concentration d’Irinotecan et de son principal metabolite a ete mesuree a 1H, 6H, et 24H apres injection. La quantite de drogue restant dans les billes a ete evaluee en FTIR microspectroscopie (FTIR-MS). La necrose tumorale a ete quantifiee par etude anatomopathologique. Resultats La concentration serique maximale d’Irinotecan est signi-ficativement plu faible apres DEBIRI (1746xa0±xa0756 ng/mL), qu’apres IA (4194xa0±xa0805 ng/mL) ou IV (4088xa0±xa01171 ng/mL) (pxa0=xa00,005). Dans la tumeur, a 6h et 24h, les concentrations de drogue et SN 38 sont plus elevees dans le groupe DEBIRI versus IA et IV. A 24h le FTIR-MS montre la persistance de drogue dans les billes. A 24h, il y existent une difference statistiquement significative de necrose pour DEBIRI (83xa0±xa019%) que pour IA (57xa0±xa026%) et IV (22xa0±xa011%) (pxa0=xa00,018). Conclusion A 24xa0h, la concentration de drogue, le metabolite et la necrose tumorale sont plus eleves dans le groupe traite avec DEBIRI que dans les groupes IA et IV. La concentration systemique de drogue est plus faible avec DEBIRI.

Interet du scanner de perfusion apres chimioembolisation aux microparticules chargees des metastases hepatiques endocrines

Objectifs Le scanner de perfusion permet une quantification de la perfusion tissulaire. Le but de notre etude etait d’evaluer son efficacite dans le suivi precoce de la chimioembolisation aux microparticules chargees (DEB) pour les metastases hepatiques de tumeurs endocrines gastro-entero-pancreatiques. Materiels et methodes Entre 2004 et 2008, 25 patients ont eu un scanner de perfusion avant (JO) et deux jours apres (J2) chimioembolisation. Cinq parametres ont ete evalues : flux sanguin (BF), volume sanguin (BV), temps de transit moyen (MTT), surface de permeabilite (PS) et index arteriel hepatique (HAF) et compares aux criteres RECIST et EASL a 3 mois. Resultats Les parametres de perfusion ont significativement change apres le traitement (pxa0 Conclusion Le scanner de perfusion est une technique prometteuse dans l’evaluation precoce du traitement par chimioembolisation aux DEB des metastases hepatiques de tumeur endocrine. Le scanner de perfusion avant le traitement pourrait predire la reponse au traitement avant sa realisation.

RI-WS-7 Traitement par prothese couverte des ruptures d’artere carotide extra-cranienne dans les cancers ORL

Objectifs Evaluer l’efficacite et la tolerance des protheses couvertes dans le traitement des ruptures d’artere carotide extra-crânienne chez les patients atteints de cancers ORL. Materiels et methodes Les donnees medicales et radiologiques de 7 patients suivis pour neoplasie ORL compliquee d’une rupture carotidienne et traitee par pose d’une prothese couverte ont ete recueillies retrospectivement : faisabilite, efficacite immediate et survenue d’eventuelles recidives hemorragiques et complications ont ete evaluees. Resultats Cinq patients ont ete traites pour rupture aigue et deux patients preventivement suite a la detection d’une lesion a risque hemorragique. La pose de prothese couverte a ete possible et a stoppe le saignement dans tous les cas. Le saignement a recidive precocement chez 3 des 5 patients traites pour rupture aigue et tous sont decedes. Aucun des 2 patients traite preventivement n’a developpe de saignement. Aucune complication thromboembolique ou infectieuse n’a ete recensee. Conclusion Cette technique permet de conserver l’axe vasculaire avec la meme efficacite d’hemostase immediate que l’occlusion permanente mais la recidive hemorragique complique souvent l’histoire naturelle. Les bons resultats decrits chez les patients traites preventivement justifient la recherche systematique de lesions vasculaires a risque potentiellement hemorragique.