Percutaneous ablation for bone and soft tissue
metastases—why cryoablation?
http://www.springerlink.com/content/n27 ... lltext.pdf
cryoablation supportive articles
Re: cryoablation supportive articles
An excellent article on cryoblation and RFA of liver tumor studies
Percutaneous Imaging-Guided Cryoablation of Liver Tumors: Predicting Local Progression on 24-Hour MRI
OBJECTIVE. The purpose of this study was to determine which MRI features observed 24 hours after technically successful percutaneous cryoablation of liver tumors predict subsequent local tumor progression and to describe the evolution of imaging findings after cryoablation.
MATERIALS AND METHODS. Thirty-nine adult patients underwent technically successful imaging-guided percutaneous cryoablation of 54 liver tumors (hepatocellular carcinoma, 8; metastases, 46). MRI features pertaining to the tumor, ablation margin, and surrounding liver 24 hours after treatment were assessed independently by two readers. Fisher exact or Wilcoxon rank sum tests (significant p values < 0.05) were used to compare imaging features in patients with and without subsequent local tumor progression. Imaging features of the ablation margin, treated tumor, and surrounding liver were evaluated on serial MRI in the following year.
RESULTS. A minimum ablation margin of 3 mm or less was observed in 11 (78.6%) of 14 tumors with and 15 of 40 (37.5%) without progression (p = 0.012). A blood vessel bridging the ablation margin was noted in 11 of 14 (78.6%) tumors with and nine of 40 (22.5%) without progression (p < 0.001). The incidence of tumor enhancement 24 hours after cryoablation was similar for tumors with (10/14, 71.4%) or without (25/40, 62.5%) local progression (p = 0.75). MRI enabled assessment of the entire cryoablation margin in 49 of 54 (90.7%) treated tumors.
CONCLUSION. MRI features at 24 hours after liver cryoablation that were predictive of local tumor progression included a minimum ablation margin less than or equal to 3 mm and a blood vessel bridging the ablation margin. Persistent tumor enhancement is common after liver cryoablation and does not predict local tumor progression.
Keywords: ablation procedures, cancer, gastrointestinal imaging, hepatobiliary system, MRI, vascular and interventional imaging
https://www.ajronline.org/doi/10.2214/AJR.13.10747
Percutaneous Imaging-Guided Cryoablation of Liver Tumors: Predicting Local Progression on 24-Hour MRI
OBJECTIVE. The purpose of this study was to determine which MRI features observed 24 hours after technically successful percutaneous cryoablation of liver tumors predict subsequent local tumor progression and to describe the evolution of imaging findings after cryoablation.
MATERIALS AND METHODS. Thirty-nine adult patients underwent technically successful imaging-guided percutaneous cryoablation of 54 liver tumors (hepatocellular carcinoma, 8; metastases, 46). MRI features pertaining to the tumor, ablation margin, and surrounding liver 24 hours after treatment were assessed independently by two readers. Fisher exact or Wilcoxon rank sum tests (significant p values < 0.05) were used to compare imaging features in patients with and without subsequent local tumor progression. Imaging features of the ablation margin, treated tumor, and surrounding liver were evaluated on serial MRI in the following year.
RESULTS. A minimum ablation margin of 3 mm or less was observed in 11 (78.6%) of 14 tumors with and 15 of 40 (37.5%) without progression (p = 0.012). A blood vessel bridging the ablation margin was noted in 11 of 14 (78.6%) tumors with and nine of 40 (22.5%) without progression (p < 0.001). The incidence of tumor enhancement 24 hours after cryoablation was similar for tumors with (10/14, 71.4%) or without (25/40, 62.5%) local progression (p = 0.75). MRI enabled assessment of the entire cryoablation margin in 49 of 54 (90.7%) treated tumors.
CONCLUSION. MRI features at 24 hours after liver cryoablation that were predictive of local tumor progression included a minimum ablation margin less than or equal to 3 mm and a blood vessel bridging the ablation margin. Persistent tumor enhancement is common after liver cryoablation and does not predict local tumor progression.
Keywords: ablation procedures, cancer, gastrointestinal imaging, hepatobiliary system, MRI, vascular and interventional imaging
https://www.ajronline.org/doi/10.2214/AJR.13.10747
Debbie
Re: cryoablation supportive articles
Survival rate in patients with hepatocellular carcinoma: a retrospective analysis of 389 patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361778/
Coming full circle with my thought in that sarcomas, I feel ,can have collateral damage from chemo as much as some primary liver cancers have been found to of been damaged by toxins / alcohol hereditary etc . Bother ASPS and liver cancer travels via blood primarily .
So the efforts to use cyroablation with sarcomas should be truly considered .
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361778/
Coming full circle with my thought in that sarcomas, I feel ,can have collateral damage from chemo as much as some primary liver cancers have been found to of been damaged by toxins / alcohol hereditary etc . Bother ASPS and liver cancer travels via blood primarily .
So the efforts to use cyroablation with sarcomas should be truly considered .
Last edited by D.ap on Fri Feb 07, 2020 5:06 pm, edited 1 time in total.
Debbie
Re: cryoablation supportive articles
“Local Ablative Therapies to Metastatic Soft Tissue Sarcoma”
ABSTRACT
The approach to metastatic soft tissue sarcoma is complex and depends upon several factors, such as the extent of the disease, the histologic subtype of the primary tumor, the disease-free interval, patient status and comorbidities, and previous treatments. The effect of systemic chemotherapy is suboptimal, therefore local ablative therapies are often considered when the disease is limited, especially if confined to a single site/organ. Historically, surgery has been considered the treatment of choice for isolated lung metastases. This approach also has been extended to metastases in the liver, although a formal demonstration of its benefit has never been provided. Radiation therapy instead has been mainly used to obtain pain control and to reduce the risk of bone fracture and cord compression. Advances in techniques, such as the development of more precise conformational modalities and the employment of particles, may change the role of this modality in the strategic approach to metastatic soft tissue sarcoma. Recently, the use of interventional radiology in this scenario has expanded. Ablative approaches, such as radiofrequency ablation and cryoablation, have shown durable eradication of tumors. Catheter-directed therapies, such as hepatic artery embolization, are potential techniques for treating the patient who has multiple unresectable liver metastases. Understanding the timing and role of these three different modalities in the multidisciplinary approach to metastatic soft tissue sarcoma is critical to provide better care and to personalize the approach to the single patient.
KEY POINTS
The initial metastatic spread of soft tissue sarcoma is often confined to a single organ (predominantly the lung, but also the liver and soft tissues), making the use of locoregional therapies attractive.
Surgery may be the treatment of choice or may complement systemic therapy in patients affected by isolated oligometastatic disease with favorable prognostic factors (long disease-free interval, limited disease, site of metastasis).
Radiation therapy can be an effective palliative intervention in metastatic sarcoma. More research is warranted into whether highly conformal, ablative radiation therapy can prolong disease-specific survival in select patients with metastatic sarcoma.
Interventional radiology therapies like ablation play a role to control oligometastatic disease in patients with sarcoma who cannot tolerate surgery.
Liver-directed interventional radiology therapies, like hepatic artery embolization, chemoembolization, and radioembolization, may prolong life in patients with liver-dominant metastatic disease.
https://ascopubs.org/doi/full/10.1200/EDBK_157450
ABSTRACT
The approach to metastatic soft tissue sarcoma is complex and depends upon several factors, such as the extent of the disease, the histologic subtype of the primary tumor, the disease-free interval, patient status and comorbidities, and previous treatments. The effect of systemic chemotherapy is suboptimal, therefore local ablative therapies are often considered when the disease is limited, especially if confined to a single site/organ. Historically, surgery has been considered the treatment of choice for isolated lung metastases. This approach also has been extended to metastases in the liver, although a formal demonstration of its benefit has never been provided. Radiation therapy instead has been mainly used to obtain pain control and to reduce the risk of bone fracture and cord compression. Advances in techniques, such as the development of more precise conformational modalities and the employment of particles, may change the role of this modality in the strategic approach to metastatic soft tissue sarcoma. Recently, the use of interventional radiology in this scenario has expanded. Ablative approaches, such as radiofrequency ablation and cryoablation, have shown durable eradication of tumors. Catheter-directed therapies, such as hepatic artery embolization, are potential techniques for treating the patient who has multiple unresectable liver metastases. Understanding the timing and role of these three different modalities in the multidisciplinary approach to metastatic soft tissue sarcoma is critical to provide better care and to personalize the approach to the single patient.
KEY POINTS
The initial metastatic spread of soft tissue sarcoma is often confined to a single organ (predominantly the lung, but also the liver and soft tissues), making the use of locoregional therapies attractive.
Surgery may be the treatment of choice or may complement systemic therapy in patients affected by isolated oligometastatic disease with favorable prognostic factors (long disease-free interval, limited disease, site of metastasis).
Radiation therapy can be an effective palliative intervention in metastatic sarcoma. More research is warranted into whether highly conformal, ablative radiation therapy can prolong disease-specific survival in select patients with metastatic sarcoma.
Interventional radiology therapies like ablation play a role to control oligometastatic disease in patients with sarcoma who cannot tolerate surgery.
Liver-directed interventional radiology therapies, like hepatic artery embolization, chemoembolization, and radioembolization, may prolong life in patients with liver-dominant metastatic disease.
https://ascopubs.org/doi/full/10.1200/EDBK_157450
Debbie