scholarly journals Image-Guided Ablation for Colorectal Liver Metastasis: Principles, Current Evidence, and the Path Forward

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3926
Author(s):  
Yuan-Mao Lin ◽  
Iwan Paolucci ◽  
Kristy K. Brock ◽  
Bruno C. Odisio
Keyword(s):  
Systemic Chemotherapy ◽  
Controlled Trial ◽  
Tumor Biology ◽  
Local Tumor Control ◽  
Current Evidence ◽  
Tumor Control ◽  
Image Guided ◽  
Size Number ◽  
Vascular Structures ◽  
The Impact

Image-guided ablation can provide effective local tumor control in selected patients with CLM. A randomized controlled trial suggested that radiofrequency ablation combined with systemic chemotherapy resulted in a survival benefit for patients with unresectable CLM, compared to systemic chemotherapy alone. For small tumors, ablation with adequate margins can be considered as an alternative to resection. The improvement of ablation technologies can allow the treatment of tumors close to major vascular structures or bile ducts, on which the applicability of thermal ablation modalities is challenging. Several factors affect the outcomes of ablation, including but not limited to tumor size, number, location, minimal ablation margin, RAS mutation status, prior hepatectomy, and extrahepatic disease. Further understanding of the impact of tumor biology and advanced imaging guidance on overall patient outcomes might help to tailor its application, and improve outcomes of image-guided ablation.

scholarly journals Thermal Ablation of Bone Metastases

2018 ◽  
Vol 35 (04) ◽  
pp. 299-308 ◽  
Author(s):  
A. Kurup ◽  
Matthew Callstrom ◽  
Michael Moynagh
Keyword(s):  
Radiation Therapy ◽  
Bone Metastases ◽  
Thermal Ablation ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Pain Palliation ◽  
Local Tumor ◽  
Image Guided ◽  
Skeletal Related Events ◽  
Percutaneous Thermal Ablation

AbstractImage-guided, minimally invasive, percutaneous thermal ablation of bone metastases has unique advantages compared with surgery or radiation therapy. Thermal ablation of osseous metastases may result in significant pain palliation, prevention of skeletal-related events, and durable local tumor control. This article will describe current thermal ablation techniques utilized to treat bone metastases, summarize contemporary evidence supporting such thermal ablation treatments, and outline an approach to percutaneous ablative treatment.

scholarly journals How important is the relative balance of fat and carbohydrate as sources of energy in relation to health?

2015 ◽  
Vol 75 (2) ◽  
pp. 147-153 ◽  
Author(s):  
Thomas A. B. Sanders
Keyword(s):  
Controlled Trial ◽  
Dietary Guidelines ◽  
Partial Replacement ◽  
Current Evidence ◽  
Added Sugar ◽  
Increased Risk ◽  
Total Fat ◽  
Randomised Controlled ◽  
Refined Carbohydrates ◽  
The Impact

Both the intake of fat, especially saturated trans fatty acids, and refined carbohydrates, particularly sugar, have been linked to increased risk of obesity, diabetes and CVD. Dietary guidelines are generally similar throughout the world, restrict both intake of SFA and added sugar to no more than 10 and 35 % energy for total fat and recommend 50 % energy from carbohydrates being derived from unrefined cereals, tubers, fruit and vegetables. Current evidence favours partial replacement of SFA with PUFA with regard to risk of CVD. The translation of these macronutrient targets into food-based dietary guidelines is more complex because some high-fat foods play an important part in meeting nutrient requirements as well as influencing the risk of chronic disease. Some of the recent controversies surrounding the significance of sugar and the type of fat in the diet are discussed. Finally, data from a recently published randomised controlled trial are presented to show the impact of following current dietary guidelines on cardiovascular risk and nutrient intake compared with a traditional UK diet.

Percutaneous Image-Guided Cryoablation of Musculoskeletal Metastases: Pain Palliation and Local Tumor Control

2016 ◽  
Vol 27 (12) ◽  
pp. 1788-1796 ◽  
Author(s):  
Adam N. Wallace ◽  
Sebastian R. McWilliams ◽  
Sarah E. Connolly ◽  
John S. Symanski ◽  
Devin Vaswani ◽  
...  
Keyword(s):  
Local Tumor Control ◽  
Tumor Control ◽  
Pain Palliation ◽  
Local Tumor ◽  
Image Guided

Are all stage III Wilms tumors the same? Data from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10030-10030
Author(s):  
F. Spreafico ◽  
L. Piva ◽  
P. D'Angelo ◽  
M. Terenziani ◽  
P. Collini ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Wilms Tumor ◽  
Tumor Biology ◽  
Local Tumor Control ◽  
Stage Iii ◽  
Tumor Control ◽  
Abdominal Radiotherapy ◽  
Intensified Chemotherapy ◽  
Cava Vein

10030 Background: Criteria to classifying Wilms tumor (WT) as stage III are much heterogeneous, including factors referring both to tumor biology and surgical skills. Methods: We analyzed survival results in patients aged less than 18 years with stage III WT enrolled in the AIEOP CNR92 and TW2003 clinical trials (10/1991–10/2008). Main therapy differences across the trials were the timing of abdominal radiotherapy (RT) (anticipated to 2nd week from nephrectomy) and doxorubicin cumulative dose reduction from 360 mg/m2 to 240 in TW2003. Results: Of 553 in-study patients, 106 (19%) were classified as stage III according to NWTS4 criteria (59 patients in CNR92, 47 in TW2003; median age 49 months). Reasons for stage III as follows: lymph nodes (LN) 40 cases (alone 28 cases, combined with other factors 12); cava vein tumor thrombus 7, peritoneum involvement 8, post-operative gross or microscopic tumor remains 24, pre-operative rupture 9, surgical rupture 17. For 29 patients (27%) information on regional LN were missing. 36 patients received primary 4-week vincristine/dactinomycin regimen, while the others had up-front nephrectomy. Adjuvant therapy consisted of 8-months vincristine/dactinomycin/doxorubicin + flank 1440 cGy RT (whole abdominal 15 Gy in case of diffuse peritoneal contamination). 7 patients had intensified chemotherapy/RT for diffuse anaplasia. Interval between nephrectomy and RT was 75 days in CNR92 (median) and 33 in TW2003. Overall 16 tumor failure occurred (2 in anaplastic tumors): abdominal relapse 8 (combined to other extra-abdominal site 3), lung 5, tumor progression 2, metacronous tumor 1. After median follow-up of 49 months 5-year RFS and OS were 83% ±4 and 90% ±3 for the whole cohort of children, respectively. Noteworthy the doxorubicin dose reduction in TW2003 did not jeopardize survival (82% 4-year RFS for CNR92, 84% TW2003). Overall, RFS was 75% ±7 in patients with at least LN involvement compared to 89% ±4 in patients classified as stage III for the remaining criteria, including those without LN sampling (Logrank p.09). Conclusions: The sensible doxorubicin dose reduction did not jeopardize survival. 1440 cGy flank RT warranted satisfactory local tumor control. The worse outcome reported in LN-positive patients deserves further attention. No significant financial relationships to disclose.

The impact of radiosurgery fractionation and tumor radiobiology on the local control of brain metastases

2013 ◽  
Vol 119 (5) ◽  
pp. 1131-1138 ◽  
Author(s):  
Eric K. Oermann ◽  
Marie-Adele S. Kress ◽  
Jonathan V. Todd ◽  
Brian T. Collins ◽  
Riane Hoffman ◽  
...  
Keyword(s):  
Local Control ◽  
Local Tumor Control ◽  
Dose Fractionation ◽  
Tumor Control ◽  
Metastatic Tumors ◽  
Single Fraction ◽  
Frameless Radiosurgery ◽  
Whole Brain Radiation ◽  
The Impact ◽  
The Brain

Object Experience with whole-brain radiation therapy for metastatic tumors in the brain has identified a subset of tumors that exhibit decreased local control with fractionated regimens and are thus termed radioresistant. With the advent of frameless radiosurgery, fractionated radiosurgery (2–5 fractions) is being used increasingly for metastatic tumors deemed too large or too close to crucial structures to be treated in a single session. The authors retrospectively reviewed metastatic brain tumors treated at 2 centers to analyze the dependency of local control rates on tumor radiobiology and dose fractionation. Methods The medical records of 214 patients from 2 institutions with radiation-naive metastatic tumors in the brain treated with radiosurgery given either as a single dose or in 2–5 fractions were analyzed retrospectively. The authors compared the local control rates of the radiosensitive with the radioresistant tumors after either single-fraction or fractionated radiosurgery. Results There was no difference in local tumor control rates in patients receiving single-fraction radiosurgery between radioresistant and radiosensitive tumors (p = 0.69). However, after fractionated radiosurgery, treatment for radioresistant tumors failed at a higher rate than for radiosensitive tumors with an OR of 5.37 (95% CI 3.83–6.91, p = 0.032). Conclusions Single-fraction radiosurgery is equally effective in the treatment of radioresistant and radiosensitive metastatic tumors in the brain. However, fractionated stereotactic radiosurgery is less effective in radioresistant tumor subtypes. The authors recommend that radioresistant tumors be treated in a single fraction when possible and techniques for facilitating single-fraction treatment or dose escalation be considered for larger radioresistant lesions.

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