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The Insider summarizes important, recent and pertinent publications to the SIO community.
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For patients with malignant biliary obstruction, intraductal radiofrequency ablation plus biliary stent (RFA+S) boosted overall survival (OS) when compared to treatment with biliary stent alone (S-alone), according to new research. The systematic review and meta-analysis included six randomized controlled trials with a total of 439 patients that compared RFA+S with S-alone, with outcomes evaluating OS, stent patency, and adverse events (AEs). The mean difference (MD) in patients who received RFA+S vs. S-alone was 85.80 days, while the pooled MD for total stent patency was 22.25 days. There were similar rates of AEs between the two treatment groups. Subgroup analyses indicates that RFA+S was linked to improved stent patency and OS for cholangiocarcinoma, and it was associated with improved stent patency for hilar structures.
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Endoscopy International Open (01/01/24) Vol. 1, No. 12, P. E23 M de Oliveira Veras; Diogo Turiani Hourneaux de Moura; Thomas R. McCarty; et al.
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With limited available data on dose thresholds for transarterial radioembolization (TARE) in intrahepatic cholangiocarcinoma (ICC), a recent study assessed the relationship between tumoral dose and radiologic response in this setting. The retrospective study included 20 patients with 26 tumors (17 treated with glass only and 9 treated with resin only), evaluating their radiologic response at 3 months and post Yttrium-90 bremsstrahlung single-photon-emission-computerized tomography (SPECT), computed-tomography (CT) for tumor dose. Based on European Association for the Study of Liver criteria for the glass cohort, the mean tumor dose for patients with progressive or stable disease was 294±0 Gy, while the mean dose for those with partial response was 465.4±292.4 Gy and 951.8±666.5 Gy for those with complete response. Tumor dose analysis found an area under the curve of 0.738, while the cutoff point indicated by the Youden index was >541.7 Gy (sensitivity: 55.56%; specificity: 92.86%) for the glass cohort. Patients who achieved a complete response and those who were treated with glass vs. resin had significantly longer survival. Seven of the 17 treatments in 13 patients that were performed along with chemotherapy necessitated a delay in chemotherapy; but after the delay, all patients reinitiated the treatment. "There appears to be a relationship between tumor dose and radiologic response, with this study suggesting a target of ≥541.7 Gy being warranted in patients receiving treatment with glass microspheres," the researchers concluded.
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Journal of Gastrointestinal Oncology (10/31/23) Vol. 14, No. 5 S Young; P Torkian; S Flanagan; et al.
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A retrospective cohort study found that ultrasound-guided radiofrequency ablation (RFA) effectively treats small, low-risk papillary thyroid carcinoma (PTC). The study involved 382 patients with unifocal T1N0M0 PTC who had a single ablation zone biopsy and standard neck ultrasound/contrast-enhanced ultrasound imaging follow-up at 1, 3, 6, and 12 months and every 6-12 months after RFA. All participants also underwent chest computed tomography each year. Core-needle biopsy in the target lesion ablation zone central, peripheral, and surrounding thyroid perenchyma was used to detect tumor cells, and levothyroxine was prescribed if the thyrotropin level was >2?mU/L. The overall incidence of persistent disease during a mean follow-up of 67.8 months was 3.9% (2.9% of T1a and 12.2% of T1b), while the technical efficacy rate — defined as tumor disappearance by imaging follow-up along with the confirmed absence of tumor cells in the ablation zone — was 96.1%. Risk factors associated with persistent disease included tumor size and subcapsular location. The technical success rate was 100%, and 91.6% (336/367) of the ablation zones indicated tumor disappearance on ultrasound, with no re-emergence of tumors visible on imaging during the follow-up period. Factors significantly associated with tumor disappearance include male sex, age <40 years, T1a tumor, and energy per milliliter. The researchers note, "Tumor disappearance on US after RFA may suggest an excellent prognosis and confirm complete ablation of the macroscopic tumor, but this sonographic finding is generally late and requires histological confirmation."
Thyroid (11/20/23) X Li; Y Li; L Yan; et al.
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A recent study evaluated the long-term outcomes of radiofrequency ablation (RFA) in the treatment of T1N0M0 papillary thyroid carcinoma (PTC). The cohort study, which was conducted in China, involved 1,613 adults with 1,834 T1N0M0 PTC tumors who underwent ultrasound-guided RFA. Eligible participants had biopsy-confirmed PTC with a maximum diameter of 20 mm or less; no indications of extrathyroidal extension, lymph node metastasis, or distant metastasis on ultrasonography or computed tomography; and no evidence of an aggressive PTC subtype on biopsy. The local tumor progression rate was 4.3%, including 2.6% with tumor recurrence and 1.7% with tumor persistence, during a mean follow-up of 58.5 months. The overall complication rate was low, at 2.0%, while the rate of major complications was 0.4%. At 1, 3, 5, and 8 years, cumulative disease-free survival rates were 98.0%, 96.7%, 96.0%, and 95.7%, respectively. Risk factors for local tumor progression included subcapsular tumor location 2 mm or less from the capsule or trachea and multifocal tumors, while factors linked to complete tumor disappearance included age 40 years or less, stage T1a tumors, and unifocal tumors. The findings indicate the potential for excellent long-term outcomes for patients with T1N0M0 PTC treated with RFA, especially those with subcapsular tumors more than 2 mm from the capsule or trachea and unifocal tumors.
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JAMA Surgery (10/25/23) Li,X; L Yan; J Xiao; et al.
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A 10 mm thermal ablation (TA) margin yields the best results for colorectal liver metastases (CLMs), new research shows, while 5 mm minimal ablation margin is the minimum critical endpoint required for local tumor control. For the systematic review and meta-analysis, researchers examined 21 studies with a total of 2,005 patients and 2,873 ablated CLMs. Pooled local tumor progression (LTP) rates were examined, stratified by ablation margins following TA for CLMs. The data showed an association between TA with margins less than 5 mm and a 3.6 times increased risk for LTP in all 21 studies. Confirmation of margins less than 5 mm with 3D software yielded a 5.1 times greater LTP risk (N = 4 studies). There was also a significant association between a TA margin less than 10 mm but greater than 5 mm and a 3.64 times higher LTP risk compared with a minimal margin greater than 10 mm (N = 7 studies). "A margin smaller than 5 mm is no longer to be considered acceptable for local tumor control, especially in patients with KRAS-confirmed mutation," the authors concluded. "This finding was more prominent in studies that used 3D software for ablation margin confirmation."
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Cancers (12/12/23) DD Chlorogiannis; VS Sotirchos; C Georgiades; et al.
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As much as 82% of cancer pain controlled inadequately. Such pain can impact a patient's daily activities, affect quality of life, and increase the risk of depression. This review describes the basic concepts for interventional radiology procedures for pain control. Nerve blocks, neurolysis, bone ablation, spine and peripheral musculoskeletal augmentation techniques, embolization, and cordotomy are among the alternative minimally invasive pain palliation options. Their use may be hampered by limited awareness and availability, however. To boost efficacy and safety, the researchers stress the need for a personalized approach to pain relief for patients with debilitating cancer pain.
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Clinical Radiology (04/23) Vol. 78, No. 4, P. 245 N Heptonstall; J Scott-Warren; R Berman; et al.
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The Society of Interventional Oncology presents an opportunity to share key findings from interesting patient cases within the interventional oncology community. Access to these cases and engaging in the discussion surrounding their content is a benefit of SIO membership. New cases will be released in the SIO Insider.
January Case Spotlight - Cryoablation of a Pancreatic Insulinoma
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AJ Gunn, MD
SIO Publications Chair
Elena Violari, MD
SIO Publications Vice Chair
Edward Kim, MD, FSIR
SIO Board Liaison
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Christine E. Boone, MD, PhD
Ji Buethe, MD
Juan C. Camacho, MD
Xindi Chen, BS
Cynthia De la Garza-Ramos, MD
Husameddin El Khudari, MD
Christos Georgiades, MD, PhD, FSIR, FCIRSE
Anish Ghodadra, MD
Sean Golden, MD
Andrew Kolarich, MD
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Yilun Koethe, MD, RPVI
Venkatesh P. Krishnasamy, MD
Giovanni Mauri, MD
Greg Pommier, BA
Junaid Raja, MD
Ishu Sivakumar, BS
Chi Trinh, BA
Maria Tsitskari, MD
Dakota Williams, MS
Chiara Zini, MD
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This newsletter is brought to you by the Society of Interventional Oncology (SIO). SIO's mission is to advance interventional oncology by developing evidence supporting IO therapies, educating IO practitioners, and improving patient access to IO therapies. 2001 K Street NW, 3rd Floor North Washington, DC 20006 USA +1-202-367-1164
info@sio-central.org |
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