Viseth Kuoch

Radio Frequency Ablation of Renal Cell Carcinoma: Preliminary Clinical Experience

PURPOSE We assess the feasibility, safety and efficacy of radio frequency ablation of small peripheral renal cell carcinomas. MATERIALS AND METHODS Five patients with a histologically proven renal cell carcinoma 30 to 40 mm. in diameter were treated with radio frequency ablation. A triple needle electrode was percutaneously advanced into each tumor under sonographic (4 cases) or computerized tomography (CT) (1) guidance. The radio frequency generator was activated for 15 minutes in each location where the electrode had been placed. Patients were then followed with CT and blood tests every 2 months for 6 months and every 3 months thereafter. RESULTS Four tumors required 1 radio frequency delivery and 1 required 2 applications during the same session. No complications were encountered except for a subcapsular hematoma in 1 patient, which resolved spontaneously. Two patients experienced transient hematuria. Of the patients 4 were discharged from the hospital after 2 days and 1 after 1 day. After 6 to 18 months (median 9) all patients were tumor-free on CT without suppress additional treatment. CONCLUSIONS In this small preliminary study radio frequency ablation of small peripheral renal cell carcinomas appears to be a feasible, safe and promising technique.

Malignant Gastroduodenal Obstruction: Palliation with Self-expanding Metallic Stents

PURPOSE To evaluate the feasibility, efficacy, and tolerance of self-expanding metallic stent insertion under fluoroscopic guidance for palliation of symptoms related to malignant gastroduodenal obstruction. MATERIALS AND METHODS Seventy-two patients (38 men, 34 women) aged 25-98 years (mean, 62 years) with duodenal (n = 43), antropyloric (n = 13), surgical gastrojejunostomy (n = 10), or pyloroduodenal (n = 6) malignant obstruction were referred for insertion of self-expanding metallic stents over a 6-year period. Stent insertion was performed with use of a peroral or transgastric approach when necessary (n = 11). RESULTS Stents were successfully inserted in 70 of the 72 patients (97%) and provided symptom relief in 65 patients (90%). Inserted stents were mainly uncovered vascular (n = 55) or enteral (n = 10) Wallstents. One hundred eight stents were initially inserted: one, two, three, or four stents were indicated in 43, 17, nine, and one patient, respectively. Mean follow-up was 119 days (range, 4-513 days). Mean stent patency was 113 days (range, 4-513 days). Mean survival of patients was 120 days. During follow-up, stent obstruction occurred in seven patients as a result of tumoral overgrowth (n = 5) or ingrowth (n = 2). Complications occurred in 12 of the 72 patients (17%), including stent migration (n = 8), stent fracture (n = 1), duodenal perforation (n = 1), and death related to general anesthesia (n = 1). CONCLUSION Despite a significant complication rate, self-expanding metallic stent insertion under fluoroscopic guidance appears to be a feasible and useful technique in the palliative management of malignant gastroduodenal obstruction.

TRANSCATHETER ETHANOL RENAL ABLATION IN 20 PATIENTS WITH PERSISTENT URINE LEAKS: AN ALTERNATIVE TO SURGICAL NEPHRECTOMY

PURPOSE We evaluate the efficacy of transcatheter ethanol renal ablation for destruction of a unilateral, poorly functioning kidney with persistent urinary leaks from fistulas or a nephrostomy tube. MATERIALS AND METHODS From January 1992 to January 1999, 19 females and 1 male with a history of pelvic neoplasms, which were responsible for ureteral leaks through the nephrostomy tube in 13 cases or fistulas in 7, were treated with transcatheter ethanol renal ablation. Serum creatinine ranged from 60 to 140 micromol./l. (mean 90), and function of the involved kidney determined by diethylenetetraminepentaacetic acid scintigraphy in 16 patients or by morphological imaging in 4 was low. Drainage of the renal cavities and antibiotic therapy preceded renal ablation. After epidural anesthesia or intravenous sedation renal ablation was performed by catheterization of the renal artery and injection of 1. 5 to 12 ml. (mean 4.6) absolute ethanol, and completed by proximal occlusion with coils and absorbable gelatin sponge. RESULTS Arterial flow was interrupted in all cases. Urinary flow ceased in 2 days in 18 of 20 patients, and drains were removed. Two patients had residual urine that was successfully treated with additional embolization. No complications occurred. CONCLUSIONS Transcatheter ethanol renal ablation is safe and effective, and permits an in situ nephrectomy that can replace surgical nephrectomy for treatment of urinary leaks.

Hyperselective intra-arterial preoperative chemotherapy in patients with squamous cell carcinoma of the oral cavity: preliminary results

OBJECTIVES To investigate radiological response and findings after Intra Arterial Chemotherapy (IAC) for patients with Squamous Cell Carcinoma (SCC) of the oral cavity. MATERIALS AND METHODS Patients received 1-2 cycles of IAC. Radiological assessment was performed on day 7 and day 21 after each cycle using CT scan and MRI. RESULTS Six patients (median age: 52, ranging 46-60; male/female: 5/1) received 10 cycles (4 patients received 2 cycles). Primary tumors were floor of the mouth (4 patients) and oral tongue (2 patients). TNM classification was T2N0-2b in 3 patients and T4N0-1 in 3 patients. All patients had good locoregional/systemic tolerance and 3 showed clinical objective response (OR). Four patients were evaluable on both CT and MRI, 1 patient on MRI only and 1 patient did not tolerate imaging. Three patients showed OR both on CT and MRI, 1 patient showed stable disease (SD) on CT and OR on MRI and 1 patient showed SD on MRI. Contrast-enhancement of hemiperfused tongue was reported in all evaluable patients. Two patients presented intratumoral necrosis and 5 patients displayed local edema (MRI). One patient had modification of the sternocleidomastoid muscle after IAC. CONCLUSION Radiological modifications were observed in the infused area and correlated well with clinical response. This study is ongoing.

DIG-WP-43 Complications de la radiofrequence hepatique

Objectifs pedagogiques Connaitre les complications classiques et specifiques de la radiofrequence des tumeurs hepatiques. Reconnaitre l’imagerie des complications de la radiofrequence hepatique. Reconnaitre les signes d’echec ou de recidive locale. Savoir prevenir et eviter les complications de la radiofrequence hepatique. Messages a retenir Entre janvier 2004 et mars 2007,200 radiofrequences ont ete realisees. Un scanner et une IRM a 1 et 3 mois puis tous les 6 mois ont ete realises de facon systematique. En cas de localization dangereuse, un scanner dans les 24 heures etait realise. L’imagerie a permis de faire le diagnostic d’epanchement pleural, d’hemothorax, de plaie diaphragmatique, de dissemination tumorale sur le trajet de l’aiguille, de stenose biliaire, de thrombus porte, d’abces hepatique, de fistule, d’infarctus hepatique et de perforation colique.

L’hypertrophie hepatique apres embolisation portale pre-operatoire est inversement proportionnelle au volume du foie non embolise

Objectifs Analyser les facteurs predictifs d’hypertrophie du futur foie restant (FFR) apres embolisation portai pre-operatoire (EPP) avant hepatectomie droite elargie. Materiels et methodes Parmi 142 EPP, 113 etaient realises avant hepatectomie droite (n = 75) ou droite elargie (n = 38) pour tumeur primitive (n = 12) ou metastatique (n = 101). Le cyanoacrylate etait l’embol le plus souvent utilise, sauf debut de notre experience (gelatine hemostatique) ou cas techniquement difficiles (coils+particules). Le degre d’hypertrophie du foie non embolise etait analyse retrospectivement en fonction de la pathologie initiale, de l’etendue de l’embolisation, du type d’embole utilise, le pourcentage initial futur foie restant/foie total (FFR/FT). Resultats L’hypertrophie etait respectivement de 101 %, 61 %, et 45 % pour un FFR/FT de 30 % (P Conclusion L’hypertrophie du foie non embolise etant d’autant plus importante que le volume FFR est petit nous amene a penser qu’il serait eventuellement possible de realiser une hepatectomie etendue ne laissant en place qu’un seul segment hepatique.