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WCIO Newsbriefs
June 25, 2015
WCIO 2016: Dr. Sofocleous is Saving the Date. Are You?

Program Chair Constantinos T. Sofocleous, MD, PhD, FSIR is hard at work preparing for WCIO 2016, which will take place 9-12 June at the Seaport Boston Hotel & World Trade Center.

Read Dr. Sofocleous's recent blog post about his planning process and what exciting things he hopes to incorporate into the event schedule for next year.
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News from IO Central and Partners


WCIO 2015 Conference Recordings Now Available

WCIO 2015 on Demand gives you access to recordings of WCIO 2015 sessions presented at the conference 6-9 May in New York, New York, USA. Session listings include the sub-sessions for each session title and the presenters for each topic. View speaker slides, videos, and pointer movements so you can follow along with the recorded presentations.

Learn more and purchase access now.
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IO University Featured in Interventional News

Michael Soulen, WCIO past chair, was recently interviewed by Interventional News for an article about IO University, WCIO's developing online interventional oncology curriculum.

The World Conference on Interventional Oncology (WCIO) is developing an online interventional oncology curriculum called IO University. Michael Soulen, immediate past chair of the WCIO, told Interventional News: “One of the gaps in interventional radiology training is in oncology education. If you do an interventional radiology fellowship, you receive very little education in oncology; you learn how to do procedures, but you do not learn about cancer or what the other specialists do. You do not learn to be an effective participant in the oncology scene. The IO University is designed to address these gaps.”

Read the full article here.
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Get Featured! Submit Your Pictures for the WCIO Snapshot Contest

Our members are consistently making strides in interventional oncology and WCIO wants to highlight those endeavors and accomplishments.

Submit your photos today for spotlight consideration. WCIO will select the top ten images to be featured on our website and in IO Insights.

Images should be of the highest quality possible. Don't forget to submit photo credit and any additional information you'd like included if your picture is chosen.

For more information, please email info@IO-central.org.
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Case of the Week: Hepatic Microwave Ablation and the Risk of Non-Target Injury

A recent case comes from Ronald S. Arellano, MD, FSIR, of Massachusetts General Hospital in Boston, Massachusetts.

A 57-year old patient presented with a 3.4 centimeter cholangiocarcinoma in segment III. Past medical history included COPD, ETOH cirrhosis and hypertension.

A coronal gadolinium enhanced MRI showed the cholangiocarcinoma. Physicians noted the proximity of adjacent transverse colon. Microwave ablation was used with balloon displacement of transverse colon.


After the treatment, a coronal gadolinium enhanced MRI showed improvement in the cholangiocarcinoma. Physicians noted that the adjacent transverse colon appeared normal.


Discussion:
  • What is the risk of bowel injury following image-guided thermal ablation?Overall, the risk of bowel injury is approximately one percent, but the results can be devastating.
  • What organ displacement methods have been described for use with image-guided percutaneous thermal ablation of hepatic tumors?Several organ displacement methods have been described for thermal ablation, including creation of artificial ascites, hydrodissection and balloon displacement of adjacent organs.
What are your takeaways from this case? Log into IO Central to participate in the discussions for this and other cases of the week.
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Lead Study


Radiofrequency Ablation Using a Multiple-Electrode Switching System for Lung Tumors With 2.0–5.0-cm Maximum Diameter

A study of the safety and effectiveness of radiofrequency ablation with a multiple-electrode switching system suggests that this may be a safe therapeutic method for treating lung cancer tumors 2.0-5.0 cm in size. In this Phase II study, 33 patients with 35 lung tumors with a mean maximum diameter of 3.0 cm underwent 35 treatment sessions. No patients experienced procedure-related death or grade-4 adverse events. The 1-year local tumor progression and overall survival rates were 12.7% and 81.2%, respectively.
From the article of the same title. Radiology (06/09/15) Kodama, Hiroshi; Yamakado, Koichiro; Hasegawa, Takaaki; et al.
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Clinical Practice


Dosimetric Comparison of Brachyablation and Stereotactic Ablative Body Radiotherapy in the Treatment of Liver Metastasis

The dosimetry of brachyablation (BA) and stereotactic ablative radiotherapy (SABR) were compared in the treatment of liver metastases in a study involving 10 consecutive liver metastasis patients. BA treatment was planned using five 12 Gy fractions to the same planning target volume (PTV) employed for SABR. Dosimetric parameters were compared with a Student's paired t test. BA and SABR plans exhibited similar average volume receiving 100 percent of the prescribed dose. Average volume receiving 150 percent of the prescribed dose for BA was 63.6 percent, while for SABR it was 0. The minimum dose to the PTV was 65.8 percent for BA and 87.4 percent for SABR. Liver volume receiving =15 Gy showed similarity for BA and SABR. Small bowel mean dose, as percent prescription dose, was higher for BA. Stomach mean dose was similar, and right kidney mean dose was greater for BA. BA led to a higher target dose, similar dose to organs at risk, but potentially with lower target coverage versus SABR.
From the article of the same title. Brachytherapy (08/15) Pennington, J. Daniel; Park, Sang June; Abgaryan, Narine; et al.
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Drug and Device


Open-Label Single-Arm Phase II Trial of Sorafenib Therapy With Drug-Eluting Bead Transarterial Chemoembolization

A study found that combined continuous sorafenib therapy and drug-eluting bead (DEB) transarterial chemoembolization (TACE) provided excellent local disease control in patients with unresectable hepatocellular carcinoma (HCC). This treatment also did not lead to multiplicative toxicities. Continuous sorafenib therapy (400 mg twice daily) was started 1 week before the first round of DEB TACE, which was performed in 6-week cycles, in 50 patients. Patients received up to four rounds of DEB TACE therapy on demand within 6 months. The primary end point was safety, while secondary end points included time to progression (TTP), response rate, and overall survival (OS). Among the patients, who underwent a median of three cycles of therapy, the 6-month disease control rate was 94 percent. Median TTP and OS were 13.9 and 20.4 months, respectively, and 81 percent of toxicities were grades 1–2. One death was possibly treatment related. The researchers concluded that long-term administration of sorafenib therapy with DEB TACE may benefit patients with advanced HCC.
From the article of the same title. Radiology (06/11/15) Cosgrove, David P.; Reyes, Diane K.; Pawlik, Timothy M.; et al.
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Other Top Studies


Image-Guided Percutaneous Renal Cryoablation for Stage 1 Renal Cell Carcinoma With High Surgical Risk

A study was conducted to evaluate the feasibility, safety, and therapeutic effects of percutaneous renal cryoablation under local anesthesia with conscious sedation for patients who have unresectable stage 1 renal cell carcinoma in high surgical risk. Eighteen patients who were not candidates for surgery underwent primary cryosurgery guided by gray-scale ultrasound. Contrast-enhanced ultrasonography and contrast-enhanced computed tomography were performed to evaluate treatment at completion. Seventeen tumors remained free of enhancement during follow-up period. No major complications associated with cryoablation procedures were found though two instances of subcapsular hematomas, one of retroperitoneal errhysis and one of nausea, were seen after cryoablation. Researchers concluded that percutaneous cryoablation can be recommended as a feasible, safe, and promising therapy for the treatment of renal tumor, especially those unresectable stage 1 RCC, with a low risk of complications.
From the article of the same title. World Journal of Surgical Oncology (06/10/15) Yan, Xiang; Zhang, Mingxin; Chen, Xiaoxiang; et al.
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Intra-Arterial Hepatic SPECT/CT Imaging Using Technetium-99m Macro-Aggregated Albumin in Preparation for Radioembolization

Research was conducted to retrospectively compare nuclear medicine imaging (NMI) with that of mapping angiography in the detection and localization of extra-hepatic technicium-99m macro-aggregated albumin (MAA) and to assess the typical and atypical findings of NMI in relation to catheter placement. A total of 174 patients underwent diagnostic angiography in preparation for radioembolization. MAA was administered to the liver via a microcatheter positioned in the desired hepatic artery. Planar scintigraphy imaging followed by single-photon emission computed tomography/computed tomography imaging was acquired within two hours. Intrahepatic lobe shunting was identified on NMI in only 2.9 percent of cases but present in 62.5 percent of the patients with PVT. Extra-hepatic distributions included lungs, the gallbladder if present, and sites involving hepaticoenteric arterial anatomy recognized on angiograms. Free pertechnetate was detected on 38 percent of the NMI, and 3 percent NMI demonstrated alternative findings such as a thyroid nodule or metallic artifact.
From the article of the same title. Journal of Nuclear Medicine (06/15) Gates, Vanessa L.; Singh, Nimarta; Lewandowski, Robert; et al.
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Transcatheter Arterial Chemoembolization Plus CT-Guided Percutaneous Thermal Ablation Versus Hepatectomy in Treatment of Hepatocellular Carcinoma

A study was conducted to compare outcomes in transcatheter arterial chemoembolization (TACE) plus percutaneous thermal ablation with those of hepatectomy in patients with hepatocellular carcinoma (HCC). The clinical data of 137 HCC patients who sequentially underwent TACE and computed tomography (CT)-guided percutaneous thermal ablation as an initial curative treatment and 148 matched HCC patients who received hepatectomy between 2004 and 2011 was collected and analyzed. Following TACE, multiphase contrast-enhanced CT was conducted to identify the total number of tumors and lipiodol deposition in the liver. Of the total 285 patients, 79 percent exhibited cancerous lesions?about 5 cm in diameter. In preoperative contrast-enhanced CT or magnetic resonance imaging, the number of tumors was between one and four for each patient. The one-, three-, and five-year overall survival rates were 95 percent, 74 percent, and 67 percent in the combination group and 88 percent, 66 percent, and 47 percent in the surgery group, respectively. The corresponding recurrence-free survival rates for the two groups were 92 percent, 69 percent, and 61 percent and 75 percent, 58 percent, and 44 percent, respective. Multivariate analysis showed treatment allocation was an independent prognostic factor for survival. Only 60 patients in the combination group had enough imaging data, and 135 new lesions with lipiodol deposition were diagnosed as malignancies in 22 of those patients. Twenty new lesions were discovered in 11 of 148 patients in the surgery cohort.
From the article of the same title. Chinese Journal of Cancer (06/01/15) Vol. 34, No. 22 Li, Sheng; Zhang, Liang; Huang, Zhi-Mei; et al.
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