Long-term Survival Following Radiofrequency Ablation of Lung Metastases in an Elderly Patient With Calcaneal Osteosarcoma: a Case Report and Review of the Literature

Abstract Background: Lung metastases are the primary cause of death from osteosarcomas. Complete resection of lung metastases can prolong the survival. However, complete surgical resection in elderly patients is often difficult due to high risk of peri-operative complications. Radiofrequency ablation (RFA) is a minimally invasive technique to destroy tumor nodules using heat. Here, we present an elderly patient with osteosarcoma in calcaneus a scapular osteochondroma, who metachoronusly developed multiple lung metastases. Subsequently, he has been surviving a relatively long period by the use of percutaneous computed tomography (CT)-guided lung RFA against his lung metastases.Case presentation: A 74-year-old male presented with 1-year history of heel pain. Imaging analysis demonstrated a mixture of osteolytic and osteosclerotic lesions in the calcaneus with extraskeletal lesions. The histology of the biopsy specimen showed osteoid matrix with malignant spindle cells, which was diagnosed as a conventional high-grade osteosarcoma. Below-knee amputation was performed. However, 6 lung metastases were found in both lungs 1 year after surgery. During 4.5 years from the initial percutaneous CT-guided lung RFA, 18 lung metastases were treated in 8 procedures. Lung RFA was performed under moderate sedation and local anesthesia. The most frequent complication was pneumothoraxes in 3 procedures followed by pleuritis with pneumothorax in 1 procedure. Chest tube drainage was required in 2 of 8 (25%) lung RF procedures. Mean duration of hospital stay for lung RFA was 5.3 ± 2.1 days (range, 3-10 days). The patient has been alive with disease for 5.5 years after initial surgery. Conclusion: Our experience indicates that lung RFA is effective for elderly patients with lung metastases of osteosarcoma without serious complications.

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Long-term survival following radiofrequency ablation of lung metastases in an elderly patient with calcaneal osteosarcoma

Medicine ◽

10.1097/md.0000000000026681 ◽

2021 ◽

Vol 100 (34) ◽

pp. e26681

Author(s):

Hiroyuki Futani ◽

Haruyuki Takaki ◽

Tatsuo Sawai ◽

Junichi Taniguchi ◽

Yasukazu Kako ◽

...

Keyword(s):

Elderly Patient ◽

Radiofrequency Ablation ◽

Lung Metastases ◽

Term Survival ◽

Long Term Survival

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Dedifferentiated Osteosarcoma of the Distal Ulna: A Case Report

Case Reports in Oncology ◽

10.1159/000518266 ◽

2021 ◽

pp. 1228-1236

Author(s):

Ryosuke Tsujisaka ◽

Robert Nakayama ◽

Tetsuya Sekita ◽

Naofumi Asano ◽

Kazutaka Kikuta ◽

...

Keyword(s):

Neoadjuvant Chemotherapy ◽

Bone Tumor ◽

Lung Metastases ◽

Low Grade ◽

Parosteal Osteosarcoma ◽

High Grade ◽

Distal Ulna ◽

Initial Surgery ◽

High Grade Osteosarcoma ◽

Over 40 Years

Osteosarcoma is the most common malignant primary bone tumor that occurs most frequently in the second decade of life but rarely in patients over 40 years of age. The most common primary sites of osteosarcoma are the distal femur followed by proximal tibia and proximal humerus, and involvement of the wrist is extremely rare. Moreover, dedifferentiated osteosarcoma is also a rare condition that progresses to high-grade osteosarcoma from low-grade osteosarcoma, usually central low-grade osteosarcoma or parosteal osteosarcoma that bears MDM2 and/or CDK4 gene amplifications. We herein report an extremely rare case of dedifferentiated osteosarcoma arising in the distal ulna of an adult over 40 years of age. The patient was a 46-year-old man with a 2-month history of pain in his left swollen wrist. The initial radiological findings suggested a benign bone tumor in the distal ulna, and the lesion was marginally excised at the nearby hospital. Although the pathological diagnosis at the nearby hospital suggested a benign cartilaginous tumor, the tumor recurred in an aggressive manner 8 months after the initial surgery. The patient was referred to our hospital, and an incisional biopsy showed a high-grade osteosarcoma. The primary tumor was retrospectively re-evaluated at our hospital and diagnosed as low-grade osteosarcoma. Since neoadjuvant chemotherapy failed to shrink the tumor, the patient had to undergo below the elbow amputation to cure the disease. Although the tumor was negative for MDM2 nor CDK4, the definitive diagnosis of dedifferentiated osteosarcoma was made according to the clinical course and the histological findings. Lung metastases were found 10 months after the amputation, which were successfully treated by neoadjuvant chemotherapy and surgery. The patient has been doing well with no evidence of disease for 1 year and 6 months. Surprisingly, the literature review revealed that many low-grade osteosarcomas of the distal ulna progressed to high-grade dedifferentiated osteosarcomas. One should bear in mind that the diagnosis and treatment for bone-forming tumors of the distal ulna should be made very carefully because, although rare, it is possible that the tumor may initially appear as a benign or low-grade malignant tumor and may progress to high-grade osteosarcoma.

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Radiofrequency ablation for pulmonary metastases from esophageal squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.138 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 138-138

Author(s):

Hironobu Shigaki ◽

Keisuke Kosumi ◽

Ryuma Tokunaga ◽

Kazuto Harada ◽

Junji Kurashige ◽

...

Keyword(s):

Computed Tomography ◽

Squamous Cell Carcinoma ◽

Radiofrequency Ablation ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Pulmonary Metastasis ◽

Pulmonary Metastases ◽

Lung Metastases ◽

Ct Guided ◽

Pulmonary Tumors

138 Background: Radiofrequency ablation (RFA) is increasingly being used for the treatment of intrathoracic malignancies. Although RFA has been found to be promising in the treatment of lung metastases from some types of neoplasms, little is known concerning its clinical significance in the treatment of pulmonary metastasis from esophageal squamous cell carcinoma (ESCC). This retrospective study evaluated the feasibility, safety, and effectiveness of computed tomography-guided RFA for pulmonary metastasis from ESCC. Methods: Of 322 patients with ESCC underwent esophagectomy at Kumamoto University Hospital between January 2007 and May 2015, 23 cases had pulmonary recurrence. Selection criteria for CT-guided RFA for pulmonary metastasis were as follows: (i) there were no distant metastases except for pulmonary lesions, when there were extrapulmonary recurrences that had to be controlled by additional therapies; (ii) there were up to three pulmonary tumors; (iii) the number of pulmonary tumors did not increase over a certain period while receiving pre-RFA chemotherapy; (iv) the metastatic lesions were not adjacent to major pulmonary vessels, major bronchi, or the heart. 17 patients who underwent CT-guided RFA for metachronous pulmonary metastasis from ESCC were included in this study. Results: Correct placement of the ablation device into the target tumor proved to be feasible in all tumors (100%). The mean visual analog scale score, with values that ranged from 0 (no pain) to 10 (worst pain possible), was 1. This suggested that this procedure was well tolerated. No procedure-related deaths occurred. A pneumothorax needing drainage was a major complication in two patients. 6 patients died of recurrent disease. The predicted 1- and 2-year overall survival rates after lung RFA were 78.8% and 46.7%, respectively. Conclusions: Percutaneous computed tomography-guided RFA yielded relatively high levels of local control in patients with pulmonary metastases from ESCC and was associated with an acceptable level of complications. It was concluded that a prospective study will be necessary to evaluate the effectiveness of a combination of systemic therapy and RFA for ESCC lung metastases.

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Long-Term Survival following Percutaneous Radiofrequency Ablation of Colorectal Lung Metastases

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2014.11.013 ◽

2015 ◽

Vol 26 (3) ◽

pp. 303-310 ◽

Cited By ~ 21

Author(s):

Yusuke Matsui ◽

Takao Hiraki ◽

Hideo Gobara ◽

Toshihiro Iguchi ◽

Hiroyasu Fujiwara ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Lung Metastases ◽

Percutaneous Radiofrequency Ablation ◽

Term Survival ◽

Long Term Survival ◽

Colorectal Lung Metastases

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Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01322-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zhi-qin Lin ◽

Zeng-rong Luo ◽

Qian-zhen Li ◽

Liang-wan Chen ◽

Feng Lin

Keyword(s):

Radiofrequency Ablation ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Valve Replacement ◽

Single Centre ◽

Term Survival ◽

Long Term Survival ◽

Bipolar Radiofrequency

Abstracts Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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CT-guided percutaneous radiofrequency ablation for lung metastases from colorectal cancer

International Journal of Clinical Oncology ◽

10.1007/s10147-018-1357-5 ◽

2018 ◽

Vol 24 (3) ◽

pp. 288-295 ◽

Cited By ~ 2

Author(s):

Yukiharu Hiyoshi ◽

Yuji Miyamoto ◽

Yuki Kiyozumi ◽

Hiroshi Sawayama ◽

Kojiro Eto ◽

...

Keyword(s):

Colorectal Cancer ◽

Radiofrequency Ablation ◽

Lung Metastases ◽

Percutaneous Radiofrequency Ablation ◽

Ct Guided

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Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

10.21203/rs.3.rs-35598/v2 ◽

2020 ◽

Author(s):

Zhi-qin Lin ◽

Zeng-rong Luo ◽

Qian-zhen Li ◽

Liang-wan Chen ◽

feng lin

Keyword(s):

Radiofrequency Ablation ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Valve Replacement ◽

Single Centre ◽

Term Survival ◽

Long Term Survival ◽

Bipolar Radiofrequency

Abstract Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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Efficacy, Safety, and Long-term Survival of Concomitant Valve Replacement and Bipolar Radiofrequency Ablation in Patients Aged 70 Years and Older: A Comparative Study With Propensity Score Matching From a Single-Center

10.21203/rs.3.rs-35598/v1 ◽

2020 ◽

Author(s):

Zhi-qin Lin ◽

Zeng-rong Luo ◽

Qian-zhen Li ◽

Liang-wan Chen ◽

feng lin

Keyword(s):

Radiofrequency Ablation ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Valve Replacement ◽

Untreated Group ◽

Single Center ◽

Term Survival ◽

Bipolar Radiofrequency

Abstract Background: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. We aim to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF).Methods: This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-center between January 2006 and March 2015. Early postoperative results and long-term clinical outcomes were compared after propensity score matching.Results: 34 pairs of patients (73.94±2,64 years old, 34 in the AF ablated group and 34 in the AF untreated group) were enrolled in the propensity score matching analysis. No significant differences between the two matched groups were found about surgical mortality (5.88% vs. 2.94%, P=0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival (P=0.009) in the AF ablated group. Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF ablated group (P=0.025, Gray’s test). Patients in the AF ablated group had a reduced incidence of stroke events compared with patients in the AF untreated group (P=0.009, Gray’s test). Freedom from AF after 5 years was 58.0% in the AF ablated group, compared with 3.0% in the AF untreated group.Conclusions: The addition of bipolar radiofrequency ablation is a feasible and safe procedure even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke events compared with valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF presenting for cardiac surgery.

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Radiofrequency ablation of spinal osteoid osteoma: a prospective study

Journal of Neurosurgery Spine ◽

10.3171/2016.8.spine16462 ◽

2017 ◽

Vol 26 (3) ◽

pp. 313-318 ◽

Cited By ~ 8

Author(s):

Joe Faddoul ◽

Yara Faddoul ◽

Sandra Kobaiter-Maarrawi ◽

Ronald Moussa ◽

Tony Rizk ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Osteoid Osteoma ◽

Neurological Examination ◽

Ct Scanning ◽

Neurological Status ◽

Response Threshold ◽

Invasive Technique ◽

Ct Guided ◽

Vas Score

OBJECTIVE Surgery has been considered the standard treatment for spinal osteoid osteomas that are refractory to analgesic agents. Radiofrequency ablation (RFA) is a less invasive technique with established efficiency for the treatment of peripheral osteoid osteomas. The main objectives of this study are to evaluate the safety of RFA based on the results of a previous experimental study in rats conducted in the authors' laboratory and to identify its short- and long-term efficiency in the treatment of spinal osteoid osteomas. METHODS Between March 2009 and July 2016, 8 consecutive patients with spinal osteoid osteomas were enrolled in the study and underwent 9 CT-guided RFA procedures. All patients presented with spinal pain (median preoperative visual analog scale [VAS] score 7.55, range 6–8.8) predominantly during the night, and they all had normal neurological examination results before the procedure. Pain (according to the VAS score) and neurological status were reassessed immediately before discharge, with further follow-up at 1, 6, and 12 months after the procedure. At the final follow-up, VAS score, neurological examination, patient satisfaction, and a radiological control (CT scan) were documented (median 48 months, range 12–84 months). VAS scores before and after the procedure were compared during the 3 days before surgery (D0), on the day of the surgery, Day 1 (D1), and at the final follow-up. RESULTS No neurological deficit was documented following the procedure or at the final follow-up. A statistically significant reduction in the VAS score was observed on Day 1 (mean 2.56 ± 0.68, p = 0.005) compared with D0. At the final follow-up, all patients reported a VAS score of 0 and a satisfaction rate of 100%. Only 1 patient had recurrent symptoms (pain, VAS score 8.1) 6 months after the initial RFA. A second procedure was performed, and the patient was subsequently symptom free at the final follow-up. CT scanning performed in all patients (12–84 months post-RFA) showed residual sclerosis in 4 patients and complete resolution of the radiological lesion in the remaining 4 patients. CONCLUSIONS CT-guided RFA appears to be a safe and effective method for the management of spinal osteoid osteoma and can be safely performed for lesions close to the dura or exiting nerve root based on the motor response threshold testing performed during the procedure. It should be considered the treatment of choice for spinal osteoid osteomas refractory to conservative treatment, thus avoiding more aggressive spinal approaches with subsequent potential morbidity.

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