01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Yttrium-90 Radioembolization for Intrahepatic Cholangiocarcinoma: Safety, Response, and Survival Analysis

Samdeep Mouli, MD , Khairuddin Memon, MD , Talia Baker, MD , Al B. Benson III, MD , Mary F. Mulcahy, MD , Ramona Gupta, MD , Robert K. Ryu, MD , Riad Salem, MD , Robert J. Lewandowski, MD

Purpose: To present data on safety, antitumoral response, and survival following yttrium-90 (90Y) radioembolization for patients with unresectable intrahepatic cholangiocarcinoma (ICC).

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Metaanalysis of Survival, Complications, and Imaging Response following Chemotherapy-based Transarterial Therapy in Patients with Unresectable Intrahepatic Cholangiocarcinoma

Charles E. Ray Jr, MD, PhD , Anthony Edwards, MD , Mitchell T. Smith, MD, MS , Stephen Leong, MD , Kimi Kondo, DO , Matthew Gipson, MD , Paul J. Rochon, MD , Rajan Gupta, MD , Wells Messersmith, MD , Tom Purcell, MD, MBA , Janette Durham, MD, MBA

Purpose: Unresectable intrahepatic cholangiocarcinoma represents a devastating illness with poor outcomes when treated with standard systemic therapies. Several smaller nonrandomized outcomes studies have been reported for such patients undergoing transarterial therapies. A metaanalysis was performed to assess primary clinical and imaging outcomes, as well as complication rates, following transarterial interventions in this patient population.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Transarterial Chemoembolization with Irinotecan Beads in the Treatment of Colorectal Liver Metastases: Systematic Review

Arthur J. Richardson, MBBS, FRACS , Jerome M. Laurence, MBChB, PhD, FRACS , Vincent W.T. Lam, MBBS, MS, FRACS

Purpose: For patients with unresectable colorectal liver metastasis (CRLM), transarterial embolization with the use of drug-eluting beads with irinotecan (DEBIRI) represents a novel alternative to systemic chemotherapy or local treatments alone. The present systematic review evaluates available data on the efficacy and safety of DEBIRI embolization.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Prospective Evaluation of Patients with Early-/Intermediate-stage Hepatocellular Carcinoma with Disease Progression Following Arterial Locoregional Therapy: Candidacy for Systemic Treatment or Clinical Trials

Khairuddin Memon, MD , Laura Kulik, MD , Robert J. Lewandowski, MD , Ramona Gupta, MD , Robert K. Ryu, MD , Frank H. Miller, MD , Michael Vouche, MD , Rohi Atassi, DDS , Daniel Ganger, MD , Mary F. Mulcahy, MD , Riad Salem, MD, MBA

Purpose: During the course of cancer treatment, patients whose disease progresses despite therapy are offered alternative options. Similarly, patients with hepatocellular carcinoma (HCC) whose disease progresses following arterial locoregional therapies (LRTs) cross over to undergo systemic therapies or participate in clinical trials. Per current guidelines, patients must meet inclusion criteria (most importantly Child–Pugh class A status) to qualify for systemic options. The present study analyzed the candidacy for systemic agents or clinical trials of patients whose disease progresses despite LRTs.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Cancer Concepts and Principles: Primer for the Interventional Oncologist—Part I

Ryan Hickey, MD , Michael Vouche, MD , Daniel Y. Sze, MD , Elias Hohlastos, MD , Jeremy Collins, MD , Todd Schirmang, MD , Khairuddin Memon, MD , Robert K. Ryu, MD , Kent Sato, MD , Richard Chen, DO , Ramona Gupta, MD , Scott Resnick, MD , James Carr, MD , Howard B. Chrisman, MD , Albert A. Nemcek Jr, MD , Robert L. Vogelzang, MD , Robert J. Lewandowski, MD , Riad Salem, MD, MBA

Abstract: A sophisticated understanding of the rapidly changing field of oncology, including a broad knowledge of oncologic disease and the therapies available to treat them, is fundamental to the interventional radiologist providing oncologic therapies, and is necessary to affirm interventional oncology as one of the four pillars of cancer care alongside medical, surgical, and radiation oncology. The first part of this review intends to provide a concise overview of the fundamentals of oncologic clinical trials, including trial design, methods to assess therapeutic response, common statistical analyses, and the levels of evidence provided by clinical trials.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Cancer Concepts and Principles: Primer for the Interventional Oncologist—Part II

Ryan Hickey, MD , Michael Vouche, MD , Daniel Y. Sze, MD , Elias Hohlastos, MD , Jeremy Collins, MD , Todd Schirmang, MD , Khairuddin Memon, MD , Robert K. Ryu, MD , Kent Sato, MD , Richard Chen, DO , Ramona Gupta, MD , Scott Resnick, MD , James Carr, MD , Howard B. Chrisman, MD , Albert A. Nemcek Jr, MD , Robert L. Vogelzang, MD , Robert J. Lewandowski, MD , Riad Salem, MD, MBA

Abstract: This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Treatment of Medically Inoperable Non–small-cell Lung Cancer with Stereotactic Body Radiation Therapy versus Image-guided Tumor Ablation: Can Interventional Radiology Compete?

Damian E. Dupuy, MD

Abstract: Patients with medically inoperable stage IA non–small-cell lung cancer have treatment options that include image-guided tumor ablation or stereotactic body radiation therapy. Literature to date with both techniques suggests similar overall survival; however, local control rates appear to be higher with SBRT. It is important for interventional radiologists to understand the differences and similarities between these two techniques. Future research is important to determine which patients would benefit from these therapies. This review summarizes the two techniques and available clinical literature, provides relevant commentary, and suggests future directions for research in this area.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Oncolytic Virotherapy

Daniel Y. Sze, MD, PhD , Tony R. Reid, MD, PhD , Steven C. Rose, MD

Abstract: Oncolytic virotherapy is an emerging technology that uses engineered viruses to treat malignancies. Viruses can be designed with biological specificity to infect cancerous cells preferentially, and to replicate in these cells exclusively. Malignant cells may be killed directly by overwhelming viral infection and lysis, which releases additional viral particles to infect neighboring cells and distant metastases. Viral infections may also activate the immune system, unmask stealthy tumor antigens, and aid the immune system to recognize and attack neoplasms. Delivery of live virus particles is potentially complex, and may require the expertise of the interventional community.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. The Changing Face of Percutaneous Image-guided Biopsy: Molecular Profiling and Genomic Analysis in Current Practice

Dustyn Marshall, MD , Jeanne M. LaBerge, MD , Brandie Firetag, MD , Theodore Miller, MD , Robert K. Kerlan, MD

Abstract: Oncology is undergoing a revolutionary change. Image-guided biopsy is expected to play an increasingly important role in this radical transformation. Current concepts of disease and treatment are based on an established set of physical signs and symptoms and laboratory tests broken down by organ system. However, soon diseases will be categorized and treated based on much more specific and detailed molecular and genetic information. This transformation in how disease is categorized and treated will depend on the ability to harvest tissue from tumors and analyze it appropriately.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Image-guided Thermal Ablation of Tumors Increases the Plasma Level of Interleukin-6 and Interleukin-10

Joseph P. Erinjeri, MD, PhD , Contessa T. Thomas, BS , Alaiksandra Samoilia, MA , Martin Fleisher, PhD , Mithat Gonen, PhD , Constantinos T. Sofocleous, MD, PhD , Raymond H. Thornton, MD , Robert H. Siegelbaum, MD , Anne M. Covey, MD , Lynn A. Brody, MD , William Alago Jr, MD , Majid Maybody, MD , Karen T. Brown, MD , George I. Getrajdman, MD , Stephen B. Solomon, MD

Purpose: To identify changes in plasma cytokine levels after image-guided thermal ablation of human tumors and to identify the factors that independently predict changes in plasma cytokine levels.

01 agosto 2013

JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY. Personalized Oncology in Interventional Radiology

Nadine Abi-Jaoudeh, MD , Austin G. Duffy, MD , Tim F. Greten, MD , Elise C. Kohn, MD , Timothy W.I. Clark, MD , Bradford J. Wood, MD

Abstract: As personalized medicine becomes more applicable to oncologic practice, image-guided biopsies will be integral for enabling predictive and pharmacodynamic molecular pathology. Interventional radiology has a key role in defining patient-specific management. Advances in diagnostic techniques, genomics, and proteomics enable a window into subcellular mechanisms driving hyperproliferation, metastatic capabilities, and tumor angiogenesis. A new era of personalized medicine has evolved whereby clinical decisions are adjusted according to a patient’s molecular profile. Several mutations and key markers already have been introduced into standard oncologic practice. A broader understanding of personalized oncology will help interventionalists play a greater role in therapy selection and discovery.

01 septiembre 2012

RADIOLOGY. Primary Postpartum Hemorrhage: Outcome of Pelvic Arterial Embolization in 251 Patients at a Single Institution

Ha Young Lee, MD, Ji Hoon Shin, MD, Jinoo Kim, MD, Hyun-Ki Yoon, MD, Gi-Young Ko, MD, Hye-Sung Won, MD, Dong IL Gwon, MD, Jin Hyoung Kim, MD, Kyung Sik Cho, MD and Kyu-Bo Sung, MD

Purpose: To evaluate the safety and efficacy of pelvic arterial embolization (PAE) for the treatment of primary postpartum hemorrhage (PPH) and to determine the factors associated with clinical outcomes.

01 agosto 2013

RADIOLOGY. Unresectable Hepatocellular Carcinoma: MR Imaging after Intraarterial Therapy. Part I. Identification and Validation of Volumetric Functional Response Criteria

Susanne Bonekamp, DVM, PhD, , Zhen Li, MD1, , Jean-François H. Geschwind, MD, , Vivek Gowdra Halappa, MD, , Celia Pamela Corona-Villalobos, MD, , Diane Reyes, BS, , Timothy M. Pawlik, MD, , David Bonekamp, MD, , John Eng, MD, and , Ihab R. Kamel, MD, PhD

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and is associated with a very low 5-year survival rate (1). Only a few patients with HCC qualify for surgical resection or liver transplantation, as more than 50% of all HCCs are diagnosed at an advanced stage of disease (2). Intraarterial therapy (IAT), specifically transarterial chemoembolization (TACE), is considered the standard of care in patients with unresectable HCC (3,4).

14 junio 2013

WORLD JOURNAL OF GASTROENTEROLOGY. Combination treatment with comprehensive cryoablation and immunotherapy in metastatic hepatocellular cancer

Li-Zhi Niu, Jia-Liang Li, Jian-Ying Zeng, Feng Mu, Meng-Tian Liao, Fei Yao, Li Li, Chun-Yan Liu, Ji-Bing Chen, Jian-Sheng Zuo and Ke-Cheng Xu.

AIM: To retrospectively assess the effect of comprehensive cryosurgery (ablation of intra- and extra-hepatic tumors) plus dendritic cell-cytokine-induced killer cell immunotherapy in metastatic hepatocellular cancer.

01 julio 2012

JOURNAL OF HEPATOLOGY. Portal vein thrombosis, cirrhosis, and liver transplantation

Claire Francoz , Dominique Valla , François Durand

Portal vein thrombosis is not uncommon in candidates for transplantation. Partial thrombosis is more common than complete thrombosis. Despite careful screening at evaluation, a number of patients are still found with previously unrecognized thrombosis per-operatively. The objective is to recanalize the portal vein or, if recanalization is not achievable, to prevent the extension of the thrombus so that a splanchnic vein can be used as the inflow vessel to restore physiological blood flow to the allograft. Anticoagulation during waiting time and transjugular intrahepatic portosystemic shunt (TIPS) are two options to achieve these goals. TIPS may achieve recanalization in patients with complete portal vein thrombosis. However, a marked impairment in liver function, which is a characteristic feature of most candidates for transplantation, may be a contraindication for TIPS. Importantly, the MELD score is artificially increased by the administration of vitamin K antagonists due to prolonged INR. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (renoportal anastomosis or cavoportal hemitransposition) can be performed. These techniques, which do not fully reverse portal hypertension, are associated with higher morbidity and mortality risks. Multivisceral transplantation including the liver and small bowel needs to be evaluated. In the absence of prothrombotic states that may persist after transplantation, there is no evidence that pre-transplant portal vein thrombosis justifies long term anticoagulation post-transplantation, provided portal flow has been restored through conventional end-to-end portal anastomosis.