Publications by authors named "Charles Mastier"

20 Publications

  • Page 1 of 1

Practical clinical and radiological models to diagnose COVID-19 based on a multicentric teleradiological emergency chest CT cohort.

Sci Rep 2021 04 26;11(1):8994. Epub 2021 Apr 26.

Imadis Teleradiology, 48 Rue Quivogne, 69002, Lyon, France.

Our aim was to develop practical models built with simple clinical and radiological features to help diagnosing Coronavirus disease 2019 [COVID-19] in a real-life emergency cohort. To do so, 513 consecutive adult patients suspected of having COVID-19 from 15 emergency departments from 2020-03-13 to 2020-04-14 were included as long as chest CT-scans and real-time polymerase chain reaction (RT-PCR) results were available (244 [47.6%] with a positive RT-PCR). Immediately after their acquisition, the chest CTs were prospectively interpreted by on-call teleradiologists (OCTRs) and systematically reviewed within one week by another senior teleradiologist. Each OCTR reading was concluded using a 5-point scale: normal, non-infectious, infectious non-COVID-19, indeterminate and highly suspicious of COVID-19. The senior reading reported the lesions' semiology, distribution, extent and differential diagnoses. After pre-filtering clinical and radiological features through univariate Chi-2, Fisher or Student t-tests (as appropriate), multivariate stepwise logistic regression (Step-LR) and classification tree (CART) models to predict a positive RT-PCR were trained on 412 patients, validated on an independent cohort of 101 patients and compared with the OCTR performances (295 and 71 with available clinical data, respectively) through area under the receiver operating characteristics curves (AUC). Regarding models elaborated on radiological variables alone, best performances were reached with the CART model (i.e., AUC = 0.92 [versus 0.88 for OCTR], sensitivity = 0.77, specificity = 0.94) while step-LR provided the highest AUC with clinical-radiological variables (AUC = 0.93 [versus 0.86 for OCTR], sensitivity = 0.82, specificity = 0.91). Hence, these two simple models, depending on the availability of clinical data, provided high performances to diagnose positive RT-PCR and could be used by any radiologist to support, modulate and communicate their conclusion in case of COVID-19 suspicion. Practically, using clinical and radiological variables (GGO, fever, presence of fibrotic bands, presence of diffuse lesions, predominant peripheral distribution) can accurately predict RT-PCR status.
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http://dx.doi.org/10.1038/s41598-021-88053-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076229PMC
April 2021

Cryoablation for Palliation of Painful Bone Metastases: The MOTION Multicenter Study.

Radiol Imaging Cancer 2021 03 12;3(2):e200101. Epub 2021 Feb 12.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Box 8131, St Louis, MO 63110 (J.W.J.); Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Ga (J.D.P.); Department of Interventional Radiology, University Hospital of Strasbourg, Strasbourg, France (J.G., A.G.); Department of Radiology, Institut Bergonié, Bordeaux, France (X.B., J.P.); Department of Radiology, Mayo Clinic, Rochester, Minn (A.N.K., M.C.); Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, Calif (S.G., F.A.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (A.J.H.); Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI (J.I.); Departments of Radiology (F.P) and Interventional Radiology (C.M.), Centre Léon Bérard, Lyon, France; Department of Radiology, Ascension Providence Rochester Hospital, Rochester, Mich (P.J.L.); and Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France (T.d.B., F.D.).

Purpose: To assess the clinical effectiveness of cryoablation for palliation of painful bone metastases.

Materials And Methods: MOTION (Multicenter Study of Cryoablation for Palliation of Painful Bone Metastases) (ClinicalTrials.gov NCT02511678) was a multicenter, prospective, single-arm study of adults with metastatic bone disease who were not candidates for or had not benefited from standard therapy, that took place from February 2016 to March 2018. At baseline, participants rated their pain using the Brief Pain Inventory-Short Form (reference range from 0 to 10 points); those with moderate to severe pain, who had at least one metastatic candidate tumor for ablation, were included. The primary effectiveness endpoint was change in pain score from baseline to week 8. Participants were followed for 24 weeks after treatment. Statistical analyses included descriptive statistics and logistic regression to evaluate changes in pain score over the postprocedure follow-up period.

Results: A total of 66 participants (mean age, 60.8 years ± 14.3 [standard deviation]; 35 [53.0%] men) were enrolled and received cryoablation; 65 completed follow-up. Mean change in pain score from baseline to week 8 was -2.61 points (95% CI: -3.45, -1.78). Mean pain scores improved by 2 points at week 1 and reached clinically meaningful levels (more than a 2-point decrease) after week 8; scores continued to improve throughout follow-up. Quality of life improved, opioid doses were stabilized, and functional status was maintained over 6 months. Serious adverse events occurred in three participants.

Conclusion: Cryoablation of metastatic bone tumors provided rapid and durable pain palliation, improved quality of life, and offered an alternative to opioids for pain control. Ablation Techniques, Metastases, Pain Management, Radiation Therapy/Oncology© RSNA, 2021.
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http://dx.doi.org/10.1148/rycan.2021200101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011449PMC
March 2021

Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience.

Quant Imaging Med Surg 2021 Feb;11(2):797-809

Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France.

Background: To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer.

Methods: Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR).

Results: Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE.

Conclusions: Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.
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http://dx.doi.org/10.21037/qims-20-808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779926PMC
February 2021

The accuracy of teleradiologists in diagnosing COVID-19 based on a French multicentric emergency cohort.

Eur Radiol 2021 May 29;31(5):2833-2844. Epub 2020 Oct 29.

Imadis Teleradiology, 48 Rue Quivogne, 69002, Lyon, France.

Objectives: To evaluate the accuracy of diagnoses of COVID-19 based on chest CT as well as inter-observer agreement between teleradiologists during on-call duty and senior radiologists in suspected COVID-19 patients.

Materials And Methods: From March 13, 2020, to April 14, 2020, consecutive suspected COVID-19 adult patients who underwent both an RT-PCR test and chest CT from 15 hospitals were included in this prospective study. Chest CTs were immediately interpreted by the on-call teleradiologist and were systematically blind reviewed by a senior radiologist. Readings were categorised using a five-point scale: (1) normal; (2) non-infectious findings; (3) infectious findings but not consistent with COVID-19 infection; (4) consistent with COVID-19 infection; and (5) typical appearance of COVID-19 infection. The diagnostic accuracy of chest CT and inter-observer agreement using the kappa coefficient were evaluated over the study period.

Results: In total, 513 patients were enrolled, of whom 244/513 (47.6%) tested positive for RT-PCR. First readings were scored 4 or 5 in 225/244 (92%) RT-PCR+ patients, and between 1 and 3 in 201/269 (74.7%) RT-PCR- patients. The data were highly consistent (weighted kappa = 0.87) and correlated with RT-PCR (p < 0.001, AUC = 0.89, AUC = 0.93). The negative predictive value for scores of 4 or 5 was 0.91-0.92, and the PPV for a score of 5 was 0.89-0.96 at the first and second readings, respectively. Diagnostic accuracy was consistent over the study period, irrespective of a variable prevalence rate.

Conclusion: Chest CT demonstrated high diagnostic accuracy with strong inter-observer agreement between on-call teleradiologists with varying degrees of experience and senior radiologists over the study period.

Key Points: • The accuracy of readings by on-call teleradiologists, relative to second readings by senior radiologists, demonstrated a sensitivity of 0.75-0.79, specificity of 0.92-0.97, NPV of 0.80-0.83, and PPV of 0.89-0.96, based on "typical appearance," as predictive of RT-PCR+. • Inter-observer agreement between the first reading in the emergency setting and the second reading by the senior emergency teleradiologist was excellent (weighted kappa = 0.87).
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http://dx.doi.org/10.1007/s00330-020-07345-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7594948PMC
May 2021

Short-term Safety and Quality of Life Outcomes Following Radioembolization in Primary and Secondary Liver Tumours: a Multi-centre Analysis of 200 Patients in France.

Cardiovasc Intervent Radiol 2021 Jan 25;44(1):36-49. Epub 2020 Sep 25.

Department of Radiology, Université de Paris, Hôpital Beaujon APHP, and CRI, INSERM 1149, Paris, France.

Purpose: Radioembolization has emerged as a treatment modality for patients with primary and secondary liver tumours. This observational study CIRT-FR (CIRSE Registry for SIR-Spheres Therapy in France) aims to evaluate real-life clinical practice on all patients treated with transarterial radioembolization (TARE) using SIR-Spheres yttrium-90 resin microspheres in France. In this interim analysis, safety and quality of life data are presented. Final results of the study, including secondary effectiveness outcomes, will be published later. Overall, CIRT-FR is aiming to support French authorities in the decision making on reimbursement considerations for this treatment.

Methods: Data on patients enrolled in CIRT-FR from August 2017 to October 2019 were analysed. The interim analysis describes clinical practice, baseline characteristics, safety (adverse events according to CTCTAE 4.03) and quality of life (according to EORTC QLQ C30 and HCC module) aspects after TARE.

Results: This cohort included 200 patients with hepatocellular carcinoma (114), metastatic colorectal cancer (mCRC; 38) and intrahepatic cholangiocarcinoma (33) amongst others (15). TARE was predominantly assigned as a palliative treatment (79%). 12% of patients experienced at least one adverse event in the 30 days following treatment; 30-day mortality was 1%. Overall, global health score remained stable between baseline (66.7%), treatment (62.5%) and the first follow-up (66.7%).

Conclusion: This interim analysis demonstrates that data regarding safety and quality of life generated by randomised-controlled trials is reflected when assessing the real-world application of TARE.

Trial Registration: Clinical Trials.gov NCT03256994.
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http://dx.doi.org/10.1007/s00270-020-02643-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728633PMC
January 2021

Hyperprogression and impact of tumor growth kinetics after PD1/PDL1 inhibition in head and neck squamous cell carcinoma.

Oncotarget 2020 May 5;11(18):1618-1628. Epub 2020 May 5.

Department of Medical Oncology, Centre Léon Bérard, Lyon, France.

Hyperprogressive disease (HPD) rate in head and neck squamous cell carcinoma (HNSCC) patients treated with immune checkpoint inhibitors (ICI) was determined using tumor growth kinetics (TGK) and compared with rapidly progressive screen-failure (SF) patients. The impact of TGK on outcomes with salvage chemotherapy (SCT) was also evaluated. HPD was found in 22/120 (18%) patients. Median TGK before the onset of immunotherapy (TGK) was 2.7 for SF patients and 4.8 for HPD patients, with no significant difference ( = 0.17). Disease control rate after initial progressive disease on ICI was 86% with SCT in case of tumor growth deceleration vs 39% in case of tumor growth acceleration. HPD was frequent, but TGK of HPD patients treated with ICI did not differ from SF patients, suggesting that there is no relevant causal relationship between HPD and ICI. After initial PD with ICI, tumor growth deceleration was associated with better outcomes, indicating that TGK might be useful to detect late responders, meriting prospective investigations. TGK ratio (TGK) was defined as the ratio of TGK on ICI (TGK) to TGK. HPD was defined as TGK ≥ 2. TGK >1 indicated tumor growth acceleration, while 0 < TGK < 1 indicated tumor deceleration.
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http://dx.doi.org/10.18632/oncotarget.27563DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210015PMC
May 2020

Cryoneurolysis in Patients with Dorsal Neuropathic Pain Secondary to Tumor Invasion.

J Vasc Interv Radiol 2020 Jun 4;31(6):917-924. Epub 2020 May 4.

Interventional Radiology, Centre Léon Bérard, 28 promenade Bullukian, 69008 Lyon, France.

Purpose: To evaluate the safety and efficacy of cryoneurolysis (CNL) in patients with refractory thoracic neuropathic pain related to tumor invasion.

Materials And Methods: Between January 2013 and May 2017, this single-center and retrospective study reviewed 27 computed tomography-guided CNLs performed on 26 patients for refractory thoracic neuropathic pain related to tumor invasion. Patients with cognitive impairment were excluded. Pain levels were recorded on a visual analog scale (VAS) before the procedure, on days 1, 7, 14, 28 and at each subsequent follow-up appointment. CNL was clinically successful if the postprocedural VAS decreased by 3 points or more. To determine the duration of clinical success, the end of pain relief was defined as either an increased VAS of 2 or more points, the introduction of a new analgesic treatment, a death with controlled pain, or for lost to follow-up patients, the latest follow-up appointment date with controlled pain.

Results: Technical success rate was 96.7% and clinical success rate was 100%. Mean preprocedural pain score was 6.4 ± 1.7 and decreased to 2.4 ± 2.4 at day 1; 1.8 ± 1.7 at day 7 (P < .001); 3.3 ± 2.5 at day 14; 3.4 ± 2.6 at day 28 (P < .05). The median duration of pain relief was 45 days (range 14-70). Two minor complications occurred.

Conclusions: Cryoneurolysis is a safe procedure that significantly decreased pain scores in patients with thoracic neuropathic pain related to tumor invasion, with a median duration of clinical success of 45 days.
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http://dx.doi.org/10.1016/j.jvir.2020.01.018DOI Listing
June 2020

Detailed overview on rare malignant ovarian tumors.

Bull Cancer 2020 Mar 27;107(3):385-390. Epub 2020 Feb 27.

Department of Medical Oncology, centre Léon-Bérard, University Claude Bernard (UCBL Lyon1), Lyon, France. Electronic address:

The group of rare malignant ovarian tumors includes the group of germ cell tumors, sex cords stromal ovarian tumors, small cell carcinoma, malignant Brenner tumors, rare epithelial tumors such as mucinous carcinoma, clear cell carcinoma, or low-grade serous carcinoma, as well as ovarian carcinosarcoma. Together they comprise about 10% of all ovarian tumors. Due to their low prevalence and their heterogeneity, data and treatment recommendations are limited. Even though all ovarian tumors are staged according to the FIGO staging of epithelial ovarian tumors, treatment differs especially in germ cell tumors and sex cords stromal ovarian tumors. Non-epithelial ovarian tumors can arise from a variety of ovarian precursor cells such as germ cells, granulosa cells, theca cells, or stromal fibroblasts. As can be expected already due to their divergent precursor lesions, these malignancies are substantially different but united by their rarity. This overview article gives a comprehensive summary on the pathology and clinical presentation, as well as therapy recommendations of a selection of those rare ovarian tumors, based on the latest national guidelines and related important publications.
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http://dx.doi.org/10.1016/j.bulcan.2020.01.011DOI Listing
March 2020

Percutaneous Cryoablation of Symptomatic Intramuscular Venous Malformation.

J Vasc Interv Radiol 2020 Apr 26;31(4):558-563.e3. Epub 2020 Feb 26.

Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008 Lyon, France.

Purpose: To evaluate the efficacy and safety of cryoablation for venous malformations.

Materials And Methods: A total of 12 patients with symptomatic intramuscular venous malformations who underwent percutaneous cryoablation between February 2015 and December 2018 were retrospectively studied. The mean age was 42 y (range, 19-58 y). Pain was reported by 11 patients (92%) and swelling by 1 (8%). Pain was assessed with a visual analog scale (VAS) before and after cryoablation. Lesion size was followed with magnetic resonance (MR) imaging at baseline and at 3-mo follow-up. Median initial VAS score was 7 (range, 0-8), and median initial lesion size was 32.5 mm (range, 11-150 mm).

Results: The median VAS score at 3 mo was 0 (range, 0-4), and the median lesion size at 3 mo was 0 mm (range, 0-142 mm). Eleven of 12 patients reported an improvement in their pain. MR imaging control showed a treatment scar with no residual lesion in 5 patients and decreased lesion size in 4. No major complications were reported. One minor hematoma and 1 small myositis were noted as defined by Society of Interventional Radiology criteria.

Conclusions: Percutaneous cryoablation is effective and safe for treatment of symptomatic intramuscular venous malformations, with improvement of symptoms.
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http://dx.doi.org/10.1016/j.jvir.2019.10.024DOI Listing
April 2020

Local Control and Analgesic Efficacy of Percutaneous Cryoablation for Desmoid Tumors.

Cardiovasc Intervent Radiol 2020 Jan 30;43(1):110-119. Epub 2019 Aug 30.

Department of Interventional Radiology, Centre Léon Bérard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France.

Objective: Cryoablation is being more and more often used to treat desmoid tumors. We report our experience of cryoablation as a local and analgesic treatment for inoperable or recurring desmoid tumors.

Methods: This study includes 34 patients who underwent percutaneous cryoablation of 41 desmoid tumors between July 2012 and September 2016. All patients underwent pain assessment using a visual analog scale (VAS) and preoperative imaging. All cryoablation procedures were performed using the same cryoablation system. Patients received clinical and radiological follow-up at 6 months post-procedure, with pain-rating and adverse events being recorded. A long-term follow-up was achieved until 31 December 2018. Disease-free survival at 3 years was also recorded. Radiological tumor response was determined by tumor measurements using RECIST 1.1.

Results: Twelve patients benefitted from curative treatment on 100% of the tumor volume, but 22 patients received debulking treatment because of the risk of neighboring structures. Two patients had a postoperative hematoma grade 2 of the CIRSE classification system for complications, and two patients had grade 4 complications involving palsy of the common fibular nerve. Disease-free survival at 3 years was 42.2%. The mean VAS pain scores were 5.7 and 2.4 at pretreatment and 6 months, respectively, showing a mean reduction of 3.3 (p < 0.001). At 6 months, all measured tumor dimensions were significantly lower than pretreatment.

Conclusion: Cryoablation is an effective therapeutic option for the local treatment and for the analgesic management of desmoid tumors.
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http://dx.doi.org/10.1007/s00270-019-02323-5DOI Listing
January 2020

Descending thoracic aortic aneurysm revealing metastasis of a soft tissue fibrosarcoma: a case report and review of the literature.

Clin Sarcoma Res 2018 26;8:22. Epub 2018 Oct 26.

1Department of Interventional Radiology, Centre Léon Bérard, 28 rue Laennec, 69008 Lyon, France.

Background: Review of the first documented case of aortic wall metastasis from a limb sarcoma.

Case Presentation: In a 56-year-old woman with a diagnosis of a high-grade limb fibrosarcoma, an aortic metastasis was revealed by a fast growing aneurysm of the descending thoracic aorta. This was managed with an endoprosthesis.

Conclusion: The presence of an aneurysm in a patient with a sarcoma with a high potential for metastasis and poor cardiovascular risk factors should alert physicians.
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http://dx.doi.org/10.1186/s13569-018-0109-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6236957PMC
October 2018

Musculoskeletal Metastases Management: The Interventional Radiologist's Toolbox.

Semin Intervent Radiol 2018 Oct 5;35(4):281-289. Epub 2018 Nov 5.

Department of Interventional Radiology, Gustave Roussy - Cancer Campus, Villejuif, France.

The prevalence of patients with painful bone metastases is constantly increasing. This is related to the rising incidence of cancer and increasing life expectancy of patients with metastatic stage. Advances in imaging and development of percutaneous techniques have gradually allowed offering minimally invasive acts on these metastases: cementing, vertebral augmentation, osteosynthesis, percutaneous thermal ablation, neurolysis, embolization. The purpose of this article is to present the main tools available to date for the interventional radiologist so that each participant can understand their functioning, indications, and limits.
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http://dx.doi.org/10.1055/s-0038-1673420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218260PMC
October 2018

Percutaneous Cryotherapy for Treatment of Chondroblastoma: Early Experience.

Cardiovasc Intervent Radiol 2019 Feb 16;42(2):304-307. Epub 2018 Oct 16.

Department of Interventional Radiology, Centre Léon Berard, 28 Prom. Léa Et Napoléon Bullukian, 69008, Lyon, France.

Surgical curettage is currently the standard of care for the chondroblastoma, but in peri-articular tumors it is limited by its morbidity. In this preliminary report, we evaluate the feasibility of percutaneous cryotherapy as an alternative ablative treatment for chondroblastoma. Three patients with a chondroblastoma treated by CT scan-guided cryotherapy are presented in this article. Pain permanently disappeared 2 days after the procedure. No local tumor recurrence or cartilage damage was observed by MRI performed 1 year after the intervention. This preliminary case report suggests that percutaneous cryotherapy may be a possible alternative to the current standard of care in chondroblastoma. Further studies are needed to evaluate if this technique offers similar anti-tumoral efficacy while providing better pain relief and less morbidity than curettage.
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http://dx.doi.org/10.1007/s00270-018-2085-yDOI Listing
February 2019

Primary malignant melanoma of the esophagus, treated with immunotherapy: a case report.

Immunotherapy 2018 08;10(10):831-835

Department of Medical Oncology, Centre Leon Berard, Claude Bernard University, Lyon, France.

Primary malignant melanoma of the esophagus is rare, accounting for less than 0.1-0.2% of all esophageal malignancies. It is associated with a poor outcome due to late detection and high metastatic potential. Here, we report a case of esophageal cancer, which was initially diagnosed as an adenocarcinoma and finally was confirmed as a primary malignant melanoma. This 75-year-old Caucasian male had a history of dysphagia and recent lingering abdominal pain. First biopsy showed a poorly-differentiated adenocarcinoma. He was then treated with neoadjuvant radiochemotherapy. Biopsies were repeated because of an incomplete tumor response, evaluated by endoscopic and imaging studies. The final diagnosis was a malignant melanoma. The patient has been treated with immune-checkpoint inhibitor, nivolumab, an anti-PD1 antibody.
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http://dx.doi.org/10.2217/imt-2018-0011DOI Listing
August 2018

Complex Biliary Leaks: Effectiveness of Percutaneous Radiological Treatment Compared to Simple Leaks in 101 Patients.

Cardiovasc Intervent Radiol 2018 Oct 5;41(10):1566-1572. Epub 2018 Jun 5.

Department of Radiology, Lyon Faculty of Medecine-UCLB1, Centre Hospitalier de la Croix-Rousse, Hospices Civils de Lyon, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France.

Purpose: To assess the effectiveness of percutaneous radiological treatment for complex biliary leaks compared to simple biliary leaks.

Materials And Methods: We retrospectively analyzed 101 percutaneous treatments for bile leak performed from January 1994 to January 2012. Sixty (59%) bile leaks were classified as simple and 41 (41%) as complex based on a morphological classification that considered eight types of biliary wound on cholangiography images. The main treatment was percutaneous transhepatic biliary drainage (PTBD), and additional procedures were performed when required. The technical success of PTBD, leak healing, and recurrence, as well as complication rates were compared between the simple and complex leak groups.

Results: Technical success of PTBP was achieved in 94/101 (93%) patients: 59/60 (98%) for simple leaks and 35/41 (85%) for complex leaks (p = 0.017). When PTBD internalization was achieved, leak healing was obtained in 80/94 (85%) patients: 52/59 (88%) for simple leaks and 28/35 (80%) for complex leaks (p = 0.37), with additional percutaneous procedures required in five patients with simple leaks and 13 patients with complex leaks (p = 0.001). There was no recurrence in 75/80 (94%) patients: 50/52 (96%) for simple leaks and 25/28 (89%) for complex leaks (p = 0.34). Major complications occurred in 28/101 (28%) patients: 16/59 (27%) for simple leaks and 12/41 (29%) for complex leaks (p = 0.82).

Conclusion: Once PTBD internalization is achieved, complex leaks heal as well as simple leaks.
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http://dx.doi.org/10.1007/s00270-018-2005-1DOI Listing
October 2018

Percutaneous cryoablation of breast tumours in patients with stable metastatic breast cancer: safety, feasibility and efficacy.

Br J Radiol 2018 Feb 12;91(1083):20170500. Epub 2018 Jan 12.

1 Department of Radiologie, Centre Léon Bérard , Lyon , France.

Purpose: To evaluate safety, feasibility and efficacy of percutaneous cryoablation of breast tumours in patients with clinically stable metastatic breast cancer, and to compare the findings with reports on alternative procedures, namely surgery and local radiotherapy.

Methods: 17 female patients (average age of 54.8 years ± 10.8; range 37-72) with primary breast tumour not surgically treated because of metastatic disease were included. Patients were treated for their primary lesion by percutaneous cryotherapy in period of stable disease. This minimally intervention was performed using ultrasound or CT scan guidance. All patients had clinical and breast-MRI evaluation before and at 1, 3, 6 and 12 months after the procedure.

Results: All procedures were performed under local anaesthesia and technically successful. The mean largest diameter of the primary lesions was 16 ± 12 mm (size range 5-45 mm). In 15 patients, we obtained a complete regression of the primary breast lesion without recurrence during the follow-up period. Two patients with lesions measured at 40 and 45 mm had recurrence in follow up period. A second session of cryotherapy was performed for these 2 patients, not included in this study. Five patients had painful masses before cryotherapy. All were immediately relieved after the intervention and durably during all follow-up.

Conclusion: These results show that the cryoablation of primary breast lesions seems to be well suited to the palliative care of metastatic patients, particularly because of its good tolerance, low complication rate and ability to provide local or analgesic control. Advances in knowledge: Therapies are limited for these symptomatic patients at metastatic state of primary breast tumour. This study shows that cryoablation in palliative care is achievable in common practice, is effective in local control of the tumour and can provide immediate and long-term analgesic control.
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http://dx.doi.org/10.1259/bjr.20170500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965483PMC
February 2018

Delayed Bronchocutaneous Fistula Without Pneumothorax Following a Microwave Ablation of a Recurrent Pulmonary Metastasis.

Cardiovasc Intervent Radiol 2018 Feb 14;41(2):340-343. Epub 2017 Sep 14.

Department of Interventional Radiology, Centre Léon Bérard, 28 rue Laennec, 69008, Lyon, France.

Percutaneous tumor ablations are rather safe and effective treatments in selected patients for non-operable non-small cell lung carcinomas or lung metastases. However, there are major complications such as bronchopleural or bronchocutaneous fistula, which it is important to know in order to manage them safely. We describe in this report a case of bronchocutaneous fistula without pneumothorax following a microwave ablation of a recurrent pulmonary metastasis and its management.
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http://dx.doi.org/10.1007/s00270-017-1797-8DOI Listing
February 2018

A Rare Complication of Percutaneous Transoral Vertebroplasty at C2: Cement Leakage within the Vertebral Artery.

J Vasc Interv Radiol 2017 09;28(9):1302-1304

Radiology Department, Centre Léon Berard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France.

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http://dx.doi.org/10.1016/j.jvir.2017.03.035DOI Listing
September 2017

Tumoral Dissemination Along the Screw Trajectory in Percutaneous Osteosynthesis and Cementoplasty: A Non-described Complication.

Cardiovasc Intervent Radiol 2018 Feb 6;41(2):336-339. Epub 2017 Jul 6.

Interventional Radiology Department, CREATIS, UMR CNRS 5220 - INSERM 1206, Centre LCC - Léon Bérard, 28 rue Laennec, Lyon, France.

Percutaneous osteosynthesis and cementoplasty (POC), a minimally invasive technique, is used for pain palliation and prevention of pathological fractures in cancer patients that are noncandidates for surgical stabilization. POC is a relatively new technique, and very few complications have been described thus far. In this case study, we report on a tumorous dissemination along the screw trajectory after POC was used for the prevention of an impending pathological fracture on a trochanteric metastasis.
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http://dx.doi.org/10.1007/s00270-017-1738-6DOI Listing
February 2018

Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors.

Spine (Phila Pa 1976) 2014 Mar;39(5):E332-8

Departments of *Interventional Radiology and †Biostatistics, Institut Gustave Roussy, Villejuif, France.

Study Design: Retrospective assessment of risk factors using univariate and multivariate analyses.

Objective: To evaluate risk factors retrospectively for cement leakage (CL), including vascular cement leakage (vCL) and cortical cement leakage (cCL), in percutaneous vertebroplasty of spinal metastasis.

Summary Of Background Data: Complications of vertebroplasty for spine metastasis are rare but related to extravertebral cement leakage that is pulmonary embolism and medullary compression. Better understanding of the risk factors for vascular and cortical types of cement leakage is necessary to prevent these complications.

Methods: Fifty-six cancer patients (30 females, 26 males; age, 56 ± 12 yr) (81 vertebrae) were treated in 58 sessions under fluoroscopy or computed tomography-fluoroscopy guidance. Leakage rates were reported. The following items were assessed for occurrence of CL, vCL, and cCL: primary tumor site, prior radiotherapy or local tumor ablation or embolization, appearance on computed tomography, cortical osteolytic destruction, vertebral collapse, operator's experience, guidance modality, and cement filling.

Results: CL, vCL, and cCL rates were 53%, 25%, and 32%. History of prior treatment correlated with a decrease in CL (P = 0.018). vCL decreased when lung was the primary tumor site (P = 0.036), in osteolytic vertebrae (P = 0.033) or when there was a vertebral collapse (P = 0.037). cCL correlated with operator's experience (P = 0.021) and vertebral collapse (P < 0.001). Superior discal cCL correlated with superior endplate cortical destruction (P = 0.012). Although history of prior treatment seemed to be an independent protective factor (odds ratio = 0.24; 95% confidence interval, 0.087-0.7; P = 0.001), vertebral collapse was isolated as a risk factor for cCL (odds ratio = 32; 95% confidence interval, 6.7-161; P = 0.001).

Conclusion: Risk factors for cCL and vCL are distinct. Vertebral collapse and cortical destruction are risk factors for cCL. History of prior treatment is a protective factor for CL.

Level Of Evidence: 4.
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http://dx.doi.org/10.1097/BRS.0000000000000134DOI Listing
March 2014