Spinal Ablative Therapies: Myelotomy

Neuroendocrine neoplasias (NENs) are a heterogeneous group of rare tumors scattered throughout the body. Surgery, locoregional or ablative therapies as well as maintenance treatments are applied in well-differentiated, low-grade NENs, whereas cytotoxic chemotherapy is usually applied in high-grade neuroendocrine carcinomas. However, treatment options for patients with advanced or metastatic NENs are limited. Immunotherapy has provided new treatment approaches for many cancer types, including neuroendocrine tumors, but predictive biomarkers of immune checkpoint inhibitors (ICIs) in the treatment of NENs have not been fully reported. By reviewing the literature and international congress abstracts, we summarize the current knowledge of ICIs, potential predicative biomarkers in the treatment of NENs, implications and efficacy of ICIs as well as biomarkers for NENs of gastroenteropancreatic system, lung NENs and Merkel cell carcinoma in clinical practice.

Download Full-text

Ablative Therapies for Early Stage Kidney Cancer and the Evolving Role of the Urologist

Urology Practice ◽

10.1016/j.urpr.2016.04.004 ◽

2017 ◽

Vol 4 (2) ◽

pp. 162-168

Author(s):

Andrew T. Lenis ◽

Hung-Jui Tan ◽

Joshua A. Halpern ◽

Aaron A. Laviana ◽

Brian Shuch ◽

...

Keyword(s):

Kidney Cancer ◽

Early Stage ◽

Ablative Therapies

Download Full-text

Abstract 15570: Direct Evidence of Endo-Epicardial Dissociation of the Atrial Wall in Patients With Longstanding Persistent Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.15570 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Natasja de Groot ◽

Lisette vd Does ◽

Ameeta Yaksh ◽

Paul Knops ◽

Pieter Woestijne ◽

...

Keyword(s):

Atrial Fibrillation ◽

Direct Evidence ◽

Persistent Atrial Fibrillation ◽

Right Atrial ◽

Electrode Arrays ◽

Atrial Wall ◽

Ablative Therapies ◽

Epicardial Layer ◽

Right Atrial Appendage ◽

The Right

Introduction: Transition of paroxysmal to longstanding persistent atrial fibrillation (LsPAF) is associated with progressive longitudinal dissociation in conduction and a higher incidence of focal fibrillation waves. The aim of this study was to provide direct evidence that the substrate of LsPAF consists of an electrical double-layer of dissociated waves, and that focal fibrillation waves are caused by endo-epicardial breakthrough. Hypothesis: LsPAF in humans is caused by electrical dissociation of the endo- and epicardial layer. Methods: Intra-operative mapping of the endo- and epicardial right atrial wall was performed in 9 patients with induced (N=4), paroxysmal (N=1), persistent (N=2) or longstanding-persistent AF (N=2). A clamp of two rectangular electrode-arrays (128 electrodes; inter-electrode distance 2mm) was introduced through an incision in the right atrial appendage. Series of 10 seconds of AF were analyzed and the incidence of endo-epicardial dissociation (≥15ms) was determined for all 128 endo-epicardial recording sites. Results: In patients with LsPAF the averaged degree of endo-epicardial dissociation was highest (24.9% vs. 5.9%). Using strict criteria for breakthrough (presence of an opposite wave within 4mm and <15ms before the origin of the focal wave), the far majority (77%) of all focal fibrillation waves could be attributed to endo-epicardial excitation. Conclusions: During LsPAF considerable differences in activation of the right endo- and epicardial wall exist. Endo-epicardial fibrillation waves that are out of phase, may conduct transmurally and create breakthrough waves in the opposite layer. This may explain the high persistence of AF and the low succes rate of ablative therapies in patients with LsPAF.

Download Full-text

Desmoid-type Fibromatosis

10.2310/cgso.16111 ◽

2019 ◽

Author(s):

Aimee M. Crago ◽

Timothy M. Loftus

Keyword(s):

Surgical Intervention ◽

Metastatic Potential ◽

Soft Tissue Tumors ◽

Nonoperative Treatment ◽

Treatment Modalities ◽

Adenomatous Polyposis ◽

Significant Morbidity ◽

Ablative Therapies ◽

Systemic Treatments ◽

Active Observation

Desmoid-type fibromatosis is a rare disease that does not have metastatic potential. It can be locally aggressive or regress spontaneously. For this reason, and because many of these tumors are inoperable or surgery is associated with significant morbidity, nonoperative treatment modalities are now more commonly employed to manage these lesions. Active observation, ablative therapies, and systemic treatments such as doxorubicin-based chemotherapy or sorafenib can be prescribed to minimize morbidities associated with the disease and surgical intervention. A thorough understanding regarding desmoid biology and the relative indications for multimodality therapies is essential to triage patients for appropriate interventions. This review contains 5 figures, and 29 references. Key Words: active observation, β-catenin, desmoid, familial adenomatous polyposis, fibromatosis, soft tissue tumors

Download Full-text

POD-6.01: A Retrospective Review of Renal Ablative Therapies for Renal Masses: Clinical Outcomes

Urology ◽

10.1016/j.urology.2008.08.117 ◽

2008 ◽

Vol 72 (5) ◽

pp. S50

Author(s):

M. Dhar ◽

R. Kozak ◽

J. Amann ◽

L. Nott ◽

S. Pautler

Keyword(s):

Clinical Outcomes ◽

Retrospective Review ◽

Renal Masses ◽

Ablative Therapies

Download Full-text

Ablative therapies for liver metastases of digestive endocrine tumours.

Endocrine Related Cancer ◽

10.1677/erc.0.0100463 ◽

2003 ◽

pp. 463-468 ◽

Cited By ~ 49

Author(s):

D O'Toole ◽

F Maire ◽

P Ruszniewski

Keyword(s):

Liver Metastases ◽

Somatostatin Analogs ◽

Hepatic Metastases ◽

Vascular Occlusion ◽

Treatment Method ◽

Vascular Tumors ◽

Endocrine Tumors ◽

Hepatic Ischemia ◽

Ablative Therapies

Hepatic metastases are frequently encountered in patients with digestive endocrine tumors and their presence plays an important role in quality of life and overall prognosis. Surgery is the treatment method of choice for hepatic metastases but this is frequently impossible due to the extent of disease. Systemic chemotherapy is offered to patients with diffuse and/or progressive liver metastases but results are disappointing especially in patients with metastases of midgut origin. In the latter patients with carcinoid syndrome, somatostatin analogs are frequently initially effective but their efficacy wanes due to disease progression and development of tachyphylaxis. Other therapeutic options in the treatment of hepatic metastases are locoregional strategies where vascular occlusion induces ischemia in these highly vascular tumors using either surgical or radiological techniques. Available methods include surgical ligation of the hepatic artery, transient hepatic ischemia or sequential hepatic arterialization. Trans-catheter arterial chemoembolization has proven effective in terms of long palliation and objective tumor responses. Other treatments aimed at regional destruction either alone or in combination with surgery include radiofrequency ablation and cryotherapy. The latter are usually important adjuncts to surgery and are usually reserved for limited disease.

Download Full-text

Short-duration dynamic [18F]DCFPyL PET and CT perfusion imaging to localize dominant intraprostatic lesions in prostate cancer: validation against digital histopathology and comparison to [18F]DCFPyL PET/MR at 120 minutes

EJNMMI Research ◽

10.1186/s13550-021-00844-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Dae-Myoung Yang ◽

Ryan Alfano ◽

Glenn Bauman ◽

Jonathan D. Thiessen ◽

Joseph Chin ◽

...

Keyword(s):

Prostate Cancer ◽

Short Duration ◽

Ct Perfusion ◽

Dice Similarity Coefficient ◽

Anatomical Landmarks ◽

Fiducial Markers ◽

Clinical Trial Registration ◽

Ablative Therapies ◽

Histopathological Images ◽

Parametric Maps

Abstract Purpose Localized prostate cancer (PCa) in patients is characterized by a dominant focus in the gland (dominant intraprostatic lesion, DIL). Accurate DIL identification may enable more accurate diagnosis and therapy through more precise targeting of biopsy, radiotherapy and focal ablative therapies. The goal of this study is to validate the performance of [18F]DCFPyL PET and CT perfusion (CTP) for detecting and localizing DIL against digital histopathological images. Methods Multi-modality image sets: in vivo T2-weighted (T2w)-MRI, 22-min dynamic [18F]DCFPyL PET/CT, CTP, and 2-h post-injection PET/MR were acquired in patients prior to radical prostatectomy. The explanted gland with implanted fiducial markers was imaged with T2w-MRI. All images were co-registered to the pathologist-annotated digital images of whole-mount mid-gland histology sections using fiducial markers and anatomical landmarks. Regions of interest encompassing DIL and non-DIL tissue were drawn on the digital histopathological images and superimposed on PET and CTP parametric maps. Logistic regression with backward elimination of parameters was used to select the most sensitive parameter set to distinguish DIL from non-DIL voxels. Leave-one-patient-out cross-validation was performed to determine diagnostic performance. Results [18F]DCFPyL PET and CTP parametric maps of 15 patients were analyzed. SUVLate and a model combining Ki and k4 of [18F]DCFPyL achieved the most accurate performance distinguishing DIL from non-DIL voxels. Both detection models achieved an AUC of 0.90 and an error rate of < 10%. Compared to digital histopathology, the detected DILs had a mean dice similarity coefficient of 0.8 for the Ki and k4 model and 0.7 for SUVLate. Conclusions We have validated using co-registered digital histopathological images that parameters from kinetic analysis of 22-min dynamic [18F]DCFPyL PET can accurately localize DILs in PCa for targeting of biopsy, radiotherapy, and focal ablative therapies. Short-duration dynamic [18F]DCFPyL PET was not inferior to SUVLate in this diagnostic task. Clinical trial registration number: NCT04009174 (ClinicalTrials.gov).

Download Full-text