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INDUSTRY NEWS
Cancers (07/03/21) S Nieuwenhuizen; RS Puijk; B van den Bemd; et al.
Members of the COLLISION and COLDFIRE expert panel developed a new consensus guideline for management of liver-only colorectal liver metastasis (CRLM). The resulting consensus statement is based on the highest available evidence levels and classified according to patient, disease, and tumor characteristics. Curative-intent local therapy should be considered for patients with ECOG≤2, ASA≤3, and Charlson comorbidity index ≤8. Notably, age alone does not withhold patients from local therapy. Disease is separated into 4 stages based on resectability. In stage IVa, when the liver can be easily resected or ablated, peri-procedural systemic therapy is not indicated. In stage IVb, when major hepatectomy is required, neo-adjuvant systemic therapy is appropriate for early metachronous disease with aggressive features and for cases that may decrease procedural risks with tumor downsizing. For stage IVc, defined as potentially downstageable CRLM, induction systemic therapy and/or future remnant augmentation is recommended. Patients ineligible for systemic therapy and who cannot be downstaged for resection should be considered for orthotopic liver transplant, and if not a candidate, for palliative therapy. Liver resection continues to be the gold standard, while thermal ablation should be used for unresectable CRLM and considered when patients are in poor health. For unresectable perihilar and perivascular CRLM 0-5 cm, irreversible electroporation and stereotactic body radiotherapy may be considered. "We encourage all of our colleagues to adopt the recommendations outlined in order to aid tumor board discussions, to improve consistency in the design of future prospective trials, and to advance intersociety communications," the researchers conclude.
Cancers (07/03/21) S Nieuwenhuizen; RS Puijk; B van den Bemd; et al.
Journal of Vascular and Interventional Radiology (07/21) Vol. 32, No. 7, P. 1075 M Mizandari; T Azrumelashvili; P Keshavarz; et al.
Image-guided percutaneous pancreatic duct drainage (PPDD) appears to be safe and highly feasible for patients with pancreatic duct (PD) obstruction, new research shows. The prospective observational cohort study involved 73 patients with PD obstruction. The patients, who had a mean age of 58.5 years, underwent PPDD under ultrasound and fluoroscopy guidance, computed tomography (CT) and fluoroscopy guidance, or CT guidance only. Patients were categorized as nonmalignant (26 patients with PD obstruction due to acute and chronic pancreatitis or postoperative stricture) or malignant (47 patients with pancreatic head and ampullary tumors). Image-guided PPDD was highly successful, with an overall technical success rate of 98.6% (72/73). Overall, 4.1% of the patients (3/73) experienced severe weakness, lack of appetite, and tachycardia. These complications, the result of bicarbonate and potassium loss, were managed with intravenous supplementation. There were no serious complications. The median survival time was 16.3 months; however, 15.1% of the patients (11/73) were alive 4 years later. Furthermore, the mean overall length of survival was 35.1 months for nonmalignant patients and 21.4 months for malignant patients.
Journal of Vascular and Interventional Radiology (07/21) Vol. 32, No. 7, P. 1075 M Mizandari; T Azrumelashvili; P Keshavarz; et al.
Journal of Vascular and Interventional Radiology (07/21) Vol. 32, No. 7, P. 1089 AN Kurup; JW Jennings; Sean Tutton; et al.
The Society of Interventional Radiology Foundation and the Society of Interventional Oncology convened a research consensus panel to address gaps in current evidence for interventional oncology within the musculoskeletal system. While more musculoskeletal interventions are being used for the treatment of patients with bone and soft-tissue tumors, the authors noted "there is an unmet need for high-quality evidence to guide broader application and adoption of minimally invasive interventional technologies to treat these patients." Questions that emerged in the panel's proceedings and recommendations include the effectiveness of ablation within particular patient populations and the effect of the combination of ablation with radiotherapy and/or immunotherapy. In addition, researchers discussed the possible standardization of techniques, aiming to increase both the consistency and predictability of treatment outcomes.
Journal of Vascular and Interventional Radiology (07/21) Vol. 32, No. 7, P. 1089 AN Kurup; JW Jennings; Sean Tutton; et al.
Radiology (07/01/21) Vol. 300, No. 1, P. 209 Xiao-Jing Cao; Shu-Rong Wang; Ying Che; et al.
Thermal ablation is a safe and effective treatment option for certain patients with solitary T1N0M0 papillary thyroid carcinoma (PTC), according to new research. The retrospective multicenter study sought to evaluate thermal ablation of solitary T1N0M0 PTC in patients who were ineligible for or who refused surgery. A total of 847 patients, 660 of whom were women, underwent thermal ablation for PTC (673 T1a, 174 T1b): 645 had microwave ablation (MWA) and 202 had radiofrequency ablation (RFA). The patients had a mean age of 46 years, and the mean follow-up time was 22 months. The technical success rate was 100%, the researchers report. Compared with preablation measurements, the maximum diameter and volume of the ablation zone increased in the first month after ablation; there was no difference by the third month. The tumors were smaller at 6, 9, and 12 months post-ablation. Overall, 68% of patients (577/847) had complete disappearance of their tumors, including 69% (466/673) in the T1a group and 64% (111/174) in the T1b group. Disease progression post-ablation was 1.1% (9/847), including 0.9% (6/673) in the T1a group and 1.7% (3/174) in the T1b group. Overall complications were low, at 3.4% (29/847), with 2.7% (18/673) in the T1a group and 6.3% (11/174) in the T1b group.
Radiology (07/01/21) Vol. 300, No. 1, P. 209 Xiao-Jing Cao; Shu-Rong Wang; Ying Che; et al.
Journal of Vascular and Interventional Radiology (06/21) Vol. 32, No. 6, P. 845 S Frantz; L Matsuoka; K Vaheesan; et al.
A recent study evaluated overall survival (OS), progression-free survival (PFS), and toxicity in frequently pretreated patients with hepatocellular carcinoma (HCC) who underwent transarterial radioembolization (TARE) with resin microspheres. The study included 448 patients with HCC who were treated at 36 centers between 2015 and 2019. According to the RESiN Registry, 26% of patients (107) had prior chemoembolization and 16% (68) had prior systemic therapy. Based on the Barcelona Clinic Liver Cancer (BCLC) classification system, 66 patients were BCLC A, 202 were BCLC B, 51 were BCLC C, and 26 were BCLC D. At 30 months, the median OS for patients with BCLC A disease was not reached. However, the median OS for patients with BCLC B, C, and D disease were 19.5, 13.6, and 11.5 months, respectively. The median PFS for patients in the four categories were 19.8, 10.0, 6.3, and 5.9 months, respectively. Overall, 20 patients received transplants, including 14 of 43 patients who underwent bridging and 6 of 28 who received downstaging therapy. Grade 3 toxicities reported included encephalopathy, hyperbilirubinemia, and ascites. Having a Child-Pugh Class A score or being BCLC A were among the factors predicting increased survival. The findings indicate that for this patient population, TARE with resin microspheres resulted in OS similar to those seen in other studies.
Journal of Vascular and Interventional Radiology (06/21) Vol. 32, No. 6, P. 845 S Frantz; L Matsuoka; K Vaheesan; et al.
CardioVascular and Interventional Radiology (04/22/21) B Cheng; A Villalobos; I Sethi; et al.
Researchers compared the efficacies of glass and resin-based Yttrium-90 microspheres in patients with chemorefractory intrahepatic cholangiocarcinoma (ICC). The retrospective analysis included post-Y90 treatment bremsstrahlung SPECT/CT of 38 consecutive patients receiving 45 treatments: 21 resin microspheres and 24 glass microspheres. Using MIM software to calculate the targeted tumors' dose volume histogram, the researchers found significant differences in the tumor dose (TD) thresholds predictive of tumor response (TR) for glass and resin microspheres. The thresholds for TD to predict tumor response (TR) with =80% specificity were: mean TD (Resin: 78.9 Gy; Glass: 254.7 Gy), maximum TD (Resin: 162.9 Gy; Glass: 591 Gy), minimum TD (Resin: 53.7 Gy; Glass: 149.1 Gy). However, there was no impact on survival from first Y90 based on microsphere type, with 11.2 months for resin microspheres and 10.9 months for glass microspheres. For patients receiving resin microspheres, the mean TD=75 Gy or maximum TD=150 Gy was associated with a median overall survival (OS) of 20.2 months compared with 6.5 months for those receiving less. In patients treated with glass microspheres, those who received a mean TD=150 Gy had a median OS of 14.6 months compared with 2.6 months for those receiving less.
CardioVascular and Interventional Radiology (04/22/21) B Cheng; A Villalobos; I Sethi; et al.
CROSSWORD PUZZLE
Crossword Puzzle
Introducing a fun, new feature in the newsletter — an IR-related crossword puzzle. This month's puzzle, written by Christos Georgiades MD, PhD, FSIR, FCIRSE, is titled "An Introduction to IR." Click here for a printable version of the crossword puzzle. If you're stuck, the solution can be found below as well.

Solution
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.

July Case Spotlight - PET/CT Guided Ablation of Liver CRC metastases
This newsletter is supported by an educational grant from Varian, A Siemens Healthineers Company
Publications Committee
Christos Georgiades, MD, PhD, FSIR, FCIRSE
SIO Publications Chair

Kenneth J. Kolbeck, MD, PhD, FSIR
SIO Publications Vice Chair

Edward Kim, MD, FSIR
SIO Board Liaison
Yilun Koethe, MD, RPVI
Christine E. Boone, MD, PhD
Ji Buethe, MD
Andrew Kolarich, MD
Juan C. Camacho, MD
Anish Ghodadra, MD
This newsletter is brought to you by the Society of Interventional Oncology (SIO) and supported by an educational grant from Varian, A Siemens Healthineers Company. SIO's mission is to advance interventional oncology by developing evidence supporting IO therapies, educating IO practitioners, and improving patient access to IO therapies.

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