Publications by authors named "Stephen B Solomon"

258 Publications

Current Management of Oligometastatic Lung Cancer and Future Perspectives: Results of Thermal Ablation as a Local Ablative Therapy.

Cancers (Basel) 2021 Oct 16;13(20). Epub 2021 Oct 16.

Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.

A growing body of evidence shows improved overall survival and progression-free survival after thermal ablation in non-small cell lung carcinoma (NSCLC) patients with a limited number of metastases, combined with chemotherapy or tyrosine kinase inhibitors or after local recurrence. Radiofrequency ablation and microwave ablation are the most evaluated modalities, and target tumor size <3 cm (and preferably <2 cm) is a key factor of technical success and efficacy. Although thermal ablation offers some advantages over surgery and radiotherapy in terms of repeatability, safety, and quality of life, optimal management of these patients requires a multidisciplinary approach, and further randomized controlled trials are required to help refine patient selection criteria. In this article, we present a comprehensive review of available thermal ablation modalities and recent results supporting their use in oligometastatic and oligoprogressive NSCLC disease along with their potential future implications in the emerging field of immunotherapy.
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http://dx.doi.org/10.3390/cancers13205202DOI Listing
October 2021

Internet Search Trends Relevant to Interventional Oncology: A Google Trends Study (2004-2020).

J Vasc Interv Radiol 2021 Oct 20;32(10):1445-1448.e1. Epub 2021 Jul 20.

Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland; Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address:

Interventional Radiology (IR) procedures addressing cancer have been grouped in the subspecialty of interventional oncology and represent an important component of modern multidisciplinary cancer care. This study pinpoints temporal and geographical trends of public online searches for terms related to the field, as well as IR-related cancer therapies. Google Trends data were analyzed for long-term (2004-2020) trends in the United States and worldwide. Overall, search interest for IR increased throughout the United States but decreased globally. Specific search volumes for cancer-related IR techniques such as radioembolization and chemoembolization therapies increased by 2.8- and 2.5-fold, respectively, in the United States, whereas the search volumes for ablation techniques remained steady or decreased. Future research and advocacy may focus on increasing public awareness of the field.
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http://dx.doi.org/10.1016/j.jvir.2021.07.005DOI Listing
October 2021

Consensus Guidelines for the Definition of Time-to-Event End Points in Image-guided Tumor Ablation: Results of the SIO and DATECAN Initiative.

Radiology 2021 Sep 28:203715. Epub 2021 Sep 28.

From the Department of Radiology, Center of Image-guided Tumor Ablation, Amsterdam University Medical Centers, Location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands (R.S.P., H.J.S., M.R.M.); Department of Radiology, Onze Lieve Vrouwe Gasthuis (OLVG) Hospital, Amsterdam, the Netherlands (R.S.P.); Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass (M.A., S.N.G.); Department of Radiology, King's College, St Thomas' Hospital, London, England (A.A.); Department of Radiology, National Cancer Center Hospital, Tokyo, Japan (Y.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (R.A., D.A.G.); Department of Radiology, Institut de Cancérologie Gustave Roussy, Villejuif, France (T.d.B.); Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (R.B.); Clinical and Epidemiological Research Unit, Comprehensive Cancer Centre, Institut Bergonié, Bordeaux, France (C.B.); Department of Radiology, Kantonsspital Winterthur, Winterthur, Switzerland (C.A.B.); Department of Radiology, Biomedical Engineering, and Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wis (C.L.B., F.T.L.); Department of Radiology, University Hospital Southampton, Southampton, England (D.J.B.); 2nd Department of Radiology, University General Hospital "ATTIKON" Medical School, National and Kapodistrian University of Athens, Athens, Greece (E.B., D.F., A.K.); Department of Radiology, Mayo Clinic, Rochester, Minn (M.R.C.); Department of Radiology, Dipartimento di Scienze Medico-Chirurgiche, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy (G.C.); Department of Radiology, Yale University School of Medicine, New Haven, Conn (J.C., H.S.K., D.C.M.); Department of Radiology, IRCCS Ospedale San Raffaele, Milan, Italy (F.d.C.); Department of Epidemiology and Data Science, Decision Modeling Center, Amsterdam University Medical Centers, Location VUMC, Amsterdam, the Netherlands (V.M.H.C., B.I.L.W.); Department of Radiology, University of Pisa, Pisa University Hospital, Pisa, Italy (L.C.); Department of Radiology, CHUV University of Lausanne, Lausanne, Switzerland (A.D.); and Department of Radiology, Brown Medical School, Cape Cod Hospital, Hyannis, Mass (D.E.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (J.P.E., C.T.S., S.B.S.); Department of Radiology, University Hospital of Strasbourg, Strasbourg, France (A.G.); Department of Radiology, The London Clinic, London, England (A.R.G.); Society of Interventional Oncology, Washington, DC (T.G.); Department of Radiology, University Hospital of Dijon, Dijon, France (B.G.); Department of Radiology, University Hospitals Schlewsig-Holstein, Lübeck, Germany (T.H.); Department of Radiology, Agostino Gemelli University Policlinic, Catholic University of the Sacred Heart, Rome, Italy (R.I.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (T.W.K., M.W.L., H.R.); Department of Radiology, Universitätsklinikum Augsburg, Augsburg, Germany (T.K.); Department of Radiology, University of Washington Medical Center, Seattle, Wash (S.K.); Department of Radiology, David Geffen School of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, Calif (E.W.L., D.S.L.); Department of Radiology, Chinese PLA General Hospital, Beijing, China (P.L.); Department of Radiology, IEO Istituto Europeo di Oncologia, Gruppo Ospedaliero San Donato, Milan, Italy (G.M.); Department of Radiology, Ospedale Valduce, Como, Italy (M.F.M.); Department of Radiology, St George's University Hospitals, London, England (R.M.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (G. Nadolski, M.C.S.); Department of Radiology, Baptist Health of South Florida, Miami Cardiac and Vascular Institute, Miami, Fla (G. Narayanan); Department of Radiology, University of California, San Diego Health, San Diego, Calif (I.N.); Department of Radiology, Cooley Dickinson Hospital, Northampton, Mass (B.N.); Department of Radiology, European Institute of Oncology, IRCCS, Milan, Italy (F.O.); Department of Radiology, Academic Hospital Ruprecht-Karls-University Heidelberg, SLK Clinics GmbH, Heilbronn, Germany (P.L.P.); Department of Radiology, Tan Tock Seng Hospital, Singapore (U.P.); Department of Radiology, Klinikum der Universität München, Munich, Germany (J.R.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (W.R.); Department of Radiology, Northwestern University, Chicago, Ill (R.S.); Department of Radiology, Humanitas University, Ospedale Generale, Milan, Italy (L.A.S.); Department of Radiology, Stanford University, Stanford University Medical Center, Stanford, Calif (D.S., D.S.W.); Department of Radiology, John Radcliffe Hospital, Oxford, England (R.U.); Department of Radiology, University of Frankfurt, University Hospital Frankfurt Johann Wolfgang Goethe-University, Frankfurt, Germany (T.J.V.); and Department of Radiology and Imaging Science, National Institutes of Health, Bethesda, Md (B.J.W.); Department of Radiology, Image-guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel (S.N.G.); and Department of Radiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands (M.R.M.).

There is currently no consensus regarding preferred clinical outcome measures following image-guided tumor ablation or clear definitions of oncologic end points. This consensus document proposes standardized definitions for a broad range of oncologic outcome measures with recommendations on how to uniformly document, analyze, and report outcomes. The initiative was coordinated by the Society of Interventional Oncology in collaboration with the Definition for the Assessment of Time-to-Event End Points in Cancer Trials, or DATECAN, group. According to predefined criteria, based on experience with clinical trials, an international panel of 62 experts convened. Recommendations were developed using the validated three-step modified Delphi consensus method. Consensus was reached on when to assess outcomes per patient, per session, or per tumor; on starting and ending time and survival time definitions; and on time-to-event end points. Although no consensus was reached on the preferred classification system to report complications, quality of life, and health economics issues, the panel did agree on using the most recent version of a validated patient-reported outcome questionnaire. This article provides a framework of key opinion leader recommendations with the intent to facilitate a clear interpretation of results and standardize worldwide communication. Widespread adoption will improve reproducibility, allow for accurate comparisons, and avoid misinterpretations in the field of interventional oncology research. Published under a CC BY 4.0 license. See also the editorial by Liddell in this issue.
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http://dx.doi.org/10.1148/radiol.2021203715DOI Listing
September 2021

Ablation Zone Involution of Liver Tumors Is Faster in Patients Treated with Irreversible Electroporation Than Microwave Ablation.

Medicina (Kaunas) 2021 Aug 26;57(9). Epub 2021 Aug 26.

Department of Mechanical & Industrial Engineering, University of Massachusetts, Amherst, MA 01002, USA.

: To compare ablation zone involution following microwave ablation (MWA) or irreversible electroporation (IRE) of liver tumors. : MWA or IRE performed for colorectal cancer liver metastasis (CRLM) or hepatocellular carcinoma (HCC) during January 2011 to December 2015 were analyzed. Patients with a tumoral response on 1-year follow-up computed tomography (CT) were included. Generalized estimating equations were used to evaluate the differences between the two modalities on ablation zone involution observed on CT at 6 (M6) and 12 months (M12), and on laboratory values (total bilirubin, alanine transaminase, aspartate transaminase, alkaline phosphatase, albumin, and platelets count). The likelihood ratio test was used to assess whether the association between ablation modalities and these outcomes differed over time. : Seventeen (17/44, 39%) women and 27 (27/44, 61%) men were included, with 25 HCC (25/44, 57%) and 19 CRLM (19/44, 43%) patients. IRE was used in 9 (9/19, 47%) CRLM and 5 (5/25, 20%) HCC patients, respectively. All other patients had MWA. Ablation zone size and involution between IRE and MWA differed significantly over time (interaction < 0.01), with a mean of 241.04 vs. 771.08 mm (ratio 0.313; 95% CI, 0.165-0.592; < 0.01) at M6 and 60.47 vs. 589.43 mm (ratio 0.103; 95% CI, 0.029-0.365; < 0.01) at M12. Changes in liver enzymes did not differ significantly between IRE and MWA at both timepoints. : Liver tumors treated with IRE underwent faster involution when compared to tumors treated with MWA, but liver enzymes levels were comparable.
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http://dx.doi.org/10.3390/medicina57090877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467214PMC
August 2021

Hemoptysis associated with percutaneous transthoracic needle biopsy: Development of critical events checklist and procedure outcomes.

J Radiol Nurs 2021 Sep 25;40(3):221-226. Epub 2021 May 25.

Memorial Sloan Kettering Cancer Center, Department of Radiology, Memorial Sloan Kettering Cancer Center, H118, 1275 York Avenue, New York, NY 10065.

Background: A percutaneous transthoracic needle biopsy (PTNB) is performed to obtain tissue for a pathologic diagnosis. A PTNB is necessary prior to the initiation of many cancer treatments. There is a risk of hemoptysis, the expectoration of blood, with the possibility for adverse, life-threatening outcomes. A critical event checklist is a cognitive aid used in an emergency to ensure critical steps are followed. To date, there are no known checklists published for management of PTNB-related, life-threatening hemoptysis. The purpose of this report is to describe the development and implementation of a critical event checklist and the adoption of the checklist into hemoptysis management.

Methods: In March 2017, a process improvement team convened to evaluate the hemoptysis response using the Plan-Do-Study-Act (PDSA) methodology. The checklist was evaluated and updated through September 2019. The team educated Interventional Radiology (IR) clinicians on the new checklist and conducted simulations on its use. A retrospective chart review was performed on hemoptysis events between the ten-year period of October 1, 2008 and September 30, 2018 to evaluate the adoption of the checklist into practice.

Results: There were 231 hemoptysis events occurring in 229 patients (2 with repeat biopsies). Prior to implementing the protocol and checklist, there were 166 (71.9%) hemoptysis events. After implementation there were 65 (28.1%) events. The median amount of documented blood expectorated with hemoptysis was 100 mL (IQR 20.0-300.0). Twenty-six patients were admitted after PTNB for reasons related to the hemoptysis event (11.3%). During the procedure, four (1.7%) patients with hemoptysis suffered a cardiac arrest. Prior to implementation of the protocol and critical events checklist, nurses positioned patients in the lateral decubitus (LD) position in 40 out of 162 (24.7%) cases. After implementation of the critical events checklist, nurses positioned patients in the LD position 42 out of 65 cases (64.6%) (OR=5.57(95% CI 2.99-10.367), p<0.001).

Discussion: Interventional Radiology nurses successfully adopted the checklist into management of hemoptysis events. The reported incidence of hemoptysis suggests a need for IR teams to prepare for and simulate hemoptysis events. Future research is needed to evaluate the change in patient outcomes before and after critical events checklist implementation.
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http://dx.doi.org/10.1016/j.jradnu.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409504PMC
September 2021

Bronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung Metastases: A Phase I Clinical Trial.

Radiology 2021 Aug 31:210213. Epub 2021 Aug 31.

From the Department of Radiology, City of Hope Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010 (F.E.B.); Interventional Radiology Service, Department of Radiology (F.E.B., C.T.S., E.Z., H.Y., A.B., S.B.S.), Department of Medicine (N.E.K.), Molecular Imaging and Therapy Service (R.Y.), and Department of Epidemiology and Biostatistics (M.H., C.S.M.), Memorial Sloan-Kettering Cancer Center, New York, NY; and Antitumor Assessment Core Facility, Sloan Kettering Institute, New York, NY (V.R.T.).

Background Lung chemoembolization is an emerging treatment option for lung tumors, but the optimal embolic, drug, and technique are unknown. Purpose To determine the technical success rate and safety of bronchial or pulmonary artery chemoembolization of lung metastases using ethiodized oil, mitomycin, and microspheres. Materials and Methods Patients with unresectable and unablatable lung, endobronchial, or mediastinal metastases, who failed systemic chemotherapy, were enrolled in this prospective, single-center, single-arm, phase I clinical trial (December 2019-September 2020). Pulmonary and bronchial angiography was performed to determine the blood supply to the lung metastases. Based on the angiographic findings, bronchial or pulmonary artery chemoembolization was performed using an ethiodized oil and mitomycin emulsion, followed by microspheres. The primary objectives were technical success rate and safety, according to the National Cancer Institute Common Terminology Criteria for Adverse Events. CIs of proportions were estimated with the equal-tailed Jeffreys prior interval, and correlations were evaluated with the Spearman test. Results Ten participants (median age, 60 years; interquartile range, 52-70 years; six women) were evaluated. Nine of the 10 participants (90%) had lung metastases supplied by the bronchial artery, and one of the 10 participants (10%) had lung metastases supplied by the pulmonary artery. The technical success rate of intratumoral drug delivery was 10 of 10 (100%) (95% CI: 78, 100). There were no severe adverse events (95% CI: 0, 22). The response rate of treated tumors was one of 10 (10%) according to the Response Evaluation Criteria in Solid Tumors and four of 10 (40%) according to the PET Response Criteria in Solid Tumors. Ethiodized oil retention at 4-6 weeks was correlated with reduced tumor size (ρ = -0.83, = .003) and metabolic activity (ρ = -0.71, = .03). Pharmacokinetics showed that 45% of the mitomycin dose underwent burst release in 2 minutes, and 55% of the dose was retained intratumorally with a half-life of more than 5 hours. The initial tumor-to-plasma ratio of mitomycin concentration was 380. Conclusion Lung chemoembolization was technically successful for the treatment of lung, mediastinal, and endobronchial metastases, with no severe adverse events. Clinical trial registration no. NCT04200417 © RSNA, 2021 See also the editorial by Georgiades et al in this issue.
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http://dx.doi.org/10.1148/radiol.2021210213DOI Listing
August 2021

Percutaneous liver venous deprivation: outcomes in heavily pretreated metastatic colorectal cancer patients.

HPB (Oxford) 2021 Aug 12. Epub 2021 Aug 12.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States. Electronic address:

Background: To evaluate liver venous deprivation (LVD) outcomes in patients with colorectal liver metastasis (CRLM) heavily pretreated with systemic and hepatic arterial infusion pump (HAIP) chemotherapies that had an anticipated insufficient future liver remnant (FLR) hypertrophy after portal vein embolization (PVE).

Methods: PVE was performed with liquid embolics using a transsplenic or ipsilateral transhepatic approach. Simultaneously and via a trans-jugular approach, the right hepatic vein was embolized with vascular plugs. Liver volumetry was assessed on computed tomography before and 3-6 weeks after LVD.

Results: Twelve consecutive CRLM patients that underwent LVD before right hepatectomy or trisectionectomy were included, all previously treated with systemic chemotherapy for a mean of 11.9 months. Six patients had additional HAIP. After embolization, FLR ratio increased from 28.7% ± 5.9 to 42.2% ± 9.0 (P < 0.01). Mean kinetic growth rate (KGR) was 3.56%/week ± 2.3, with a degree of hypertrophy (DH) of 13.8% ± 7.1. In the HAIP subgroup, mean KGR and DH were respectively 3.58%/week ± 2.8 and 14.3% ± 8.7. No severe complications occurred. Ten patients reached surgery after 39 days ± 7.5.

Conclusion: In heavily pretreated patients, LVD safely stimulated a rapid and effective FLR hypertrophy, with a resultant high rate of resection.
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http://dx.doi.org/10.1016/j.hpb.2021.08.816DOI Listing
August 2021

A Phase I Trial of Regional Mesothelin-Targeted CAR T-cell Therapy in Patients with Malignant Pleural Disease, in Combination with the Anti-PD-1 Agent Pembrolizumab.

Cancer Discov 2021 Jul 15. Epub 2021 Jul 15.

Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York.

Malignant pleural diseases, comprising metastatic lung and breast cancers and malignant pleural mesothelioma (MPM), are aggressive solid tumors with poor therapeutic response. We developed and conducted a first-in-human, phase I study of regionally delivered, autologous, mesothelin-targeted chimeric antigen receptor (CAR) T-cell therapy. Intrapleural administration of 0.3M to 60M CAR T cells/kg in 27 patients (25 with MPM) was safe and well tolerated. CAR T cells were detected in peripheral blood for >100 days in 39% of patients. Following our demonstration that PD-1 blockade enhances CAR T-cell function in mice, 18 patients with MPM also received pembrolizumab safely. Among those patients, median overall survival from CAR T-cell infusion was 23.9 months (1-year overall survival, 83%). Stable disease was sustained for ≥6 months in 8 patients; 2 exhibited complete metabolic response on PET scan. Combination immunotherapy with CAR T cells and PD-1 blockade agents should be further evaluated in patients with solid tumors. SIGNIFICANCE: Regional delivery of mesothelin-targeted CAR T-cell therapy followed by pembrolizumab administration is feasible, safe, and demonstrates evidence of antitumor efficacy in patients with malignant pleural diseases. Our data support the investigation of combination immunotherapy with CAR T cells and PD-1 blockade agents in solid tumors.
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http://dx.doi.org/10.1158/2159-8290.CD-21-0407DOI Listing
July 2021

Prevalence and Landscape of Actionable Genomic Alterations in Renal Cell Carcinoma.

Clin Cancer Res 2021 Oct 14;27(20):5595-5606. Epub 2021 Jul 14.

Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Purpose: We report our experience with next-generation sequencing to characterize the landscape of actionable genomic alterations in renal cell carcinoma (RCC).

Experimental Design: A query of our institutional clinical sequencing database (MSK-IMPACT) was performed that included tumor samples from 38,468 individuals across all cancer types. Somatic variations were annotated using a precision knowledge database (OncoKB) and the available clinical data stratified by level of evidence. Alterations associated with response to immune-checkpoint blockade (ICB) were analyzed separately; these included DNA mismatch repair (MMR) gene alterations, tumor mutational burden (TMB), and microsatellite instability (MSI). Data from The Cancer Genome Atlas (TCGA) consortium as well as public data from several clinical trials in metastatic RCC were used for validation purposes. Multiregional sequencing data from the TRAcking Cancer Evolution through Therapy (TRACERx) RENAL cohort were used to assess the clonality of somatic mutations.

Results: Of the 753 individuals with RCC identified in the MSK-IMPACT cohort, 115 showed evidence of targetable alterations, which represented a prevalence of 15.3% [95% confidence interval (CI), 12.7%-17.8%). When stratified by levels of evidence, the alterations identified corresponded to levels 2 (11.3%), 3A (5.2%), and 3B (83.5%). A low prevalence was recapitulated in the TCGA cohort at 9.1% (95% CI, 6.9%-11.2%). Copy-number variations predominated in papillary RCC tumors, largely due to amplifications in the gene. Notably, higher rates of actionability were found in individuals with metastatic disease (stage IV) compared with those with localized disease (OR, 2.50; 95% CI, 1.16-6.16; Fisher's = 0.01). On the other hand, the prevalence of alterations associated with response to ICB therapy was found to be approximately 5% in both the MSK-IMPACT and TCGA cohorts and no associations with disease stage were identified (OR, 1.35; 95% CI, 0.46-5.40; = 0.8). Finally, multiregional sequencing revealed that the vast majority of actionable mutations occurred later during tumor evolution and were only present subclonally in RCC tumors.

Conclusions: RCC harbors a low prevalence of clinically actionable alterations compared with other tumors and the evidence supporting their clinical use is limited. These aberrations were found to be more common in advanced disease and seem to occur later during tumor evolution. Our study provides new insights on the role of targeted therapies for RCC and highlights the need for additional research to improve treatment selection using genomic profiling.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-4058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530915PMC
October 2021

Ultrasound-Guided Percutaneous Laser Ablation of the Thyroid Gland in a Swine Model: Comparison of Ablation Parameters and Ablation Zone Dimensions.

Cardiovasc Intervent Radiol 2021 Jul 12. Epub 2021 Jul 12.

Interventional Radiology Service, Department of Radiology, Weill-Cornell Medical College, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Howard 118, New York 10065, T 212 639 2209, New York, NY, USA.

Background: To compare laser ablation (LA) zone dimensions at two predetermined energy parameters to cover a theoretical 10 mm zone + 2 mm margin in a thyroid swine model.

Methods: Approval of the Institutional Animal Care and Use Committee was obtained. After hydrodissection, an ultrasound-guided LA (Elesta Echolaser X4 with Orblaze technology, 1064 nm) was performed in the periphery of the thyroid in 10 swine. Two cohorts were established to ablate a region of 10mm diameter with 2mm margin based on manufacturer's ex vivo data (n= 5 at 3W/1400J and n= 5 at 3W/1800J). The ablation zone was measured on contrast-enhanced computed tomography (CT) and compared to the pathological specimen. Euthanasia was performed 48 hours following ablation.

Results: All ablations in the 3W/1800J group achieved a diameter of 12 mm ± 1 mm in three dimensions. In the 3W/1400J group, 1 ablation reached 12 mm ± 1 mm in 2 dimensions and 4 ablations reached this size in one dimension. Maximum diameter was higher in the 3W/1800J compared to the 3W/1400J group, both on histology (1.46 cm ± 0.05 vs. 1.1 cm ± 0.0, p< 0.01) and CT (1.52 cm ± 0.04 vs. 1.18 cm ± 0.04, p< 0.01). Similar results were obtained regarding volumes, both on histology (1.12 mL ± 0.13 vs. 0.57 mL ± 0.06, p< 0.01) and CT (1.24 mL ± 0.13 vs. 0.59 mL ± 0.07, p< 0.01). Histology showed coagulation necrosis and correlated well with CT measurements.

Conclusion: Optimal parameters to obtain a LA zone of 10 mm with 2 mm margin utilizing a single needle are 3W/1800J.
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http://dx.doi.org/10.1007/s00270-021-02915-0DOI Listing
July 2021

Effectiveness of Thermal Ablation and Stereotactic Radiotherapy Based on Stage I Lung Cancer Histology.

J Vasc Interv Radiol 2021 07 31;32(7):1022-1028.e4. Epub 2021 Mar 31.

Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut; Section of Medical Oncology, Yale School of Medicine, New Haven, Connecticut; Division of Vascular and Interventional Radiology, Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address:

Purpose: To assess whether the effectiveness of thermal ablation (TA) and stereotactic body radiotherapy (SBRT) as initial treatments for stage I lung cancer varies depending on the histological subtype.

Materials And Methods: The 2004-2016 National Cancer Database was queried for patients with American Joint Committee on Cancer stage I lung cancer treated with TA or SBRT. Patients <18 years, those treated with surgery or chemotherapy, or those with unknown survival and follow-up were excluded. TA and SBRT patients were 1:5 propensity score matched separately for each histological subtype to adjust for confounders. Overall survival (OS) was assessed using Cox models.

Results: A total of 28,425 patients were included (SBRT, n = 27,478; TA, n = 947). TA was more likely to be used in Caucasian patients, those with more comorbidities and smaller neuroendocrine tumors (NETs) of the lower lobe, and those whose treatment had taken place in the northeastern United States. After propensity score matching, a cohort with 4,085 SBRT and 817 TA patients with balanced confounders was obtained. In this cohort, OS for TA and SBRT was comparable (hazard ratio = 1.07; 95% confidence interval,0.98-1.18; P = .13), although it varied by histological subtypes: higher OS for TA was observed in patients with non-small cell NETs (vs SBRT hazard ratio = 0.48; 95% confidence interval, 0.24-0.95; P = .04). No significant OS differences between TA and SBRT were noted for adenocarcinomas, squamous cell carcinomas, small cell carcinomas, and non-neuroendocrine large cell carcinomas (each, P > .1).

Conclusions: OS following TA and SBRT for stage I lung cancer is comparable for most histological subtypes, except that OS is longer after TA in non-small cell NETs.
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http://dx.doi.org/10.1016/j.jvir.2021.02.025DOI Listing
July 2021

Decreased public pursuit of cancer-related information during the COVID-19 pandemic in the United States.

Cancer Causes Control 2021 Jun 8;32(6):577-585. Epub 2021 Mar 8.

Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Blalock 524D1, 600 N Wolfe St, Baltimore, MD, 21287, USA.

Background: In response to the prioritization of healthcare resources towards the COVID-19 pandemic, routine cancer screening and diagnostic have been disrupted, potentially explaining the apparent COVID-era decline in cancer cases and mortality. In this study, we identified temporal trends in public interest in cancer-related health information using the nowcasting tool Google Trends.

Methods: We used Google Trends to query search terms related to cancer types for short-term (September 2019-September 2020) and long-term (September 2016-September 2020) trends in the US. We compared average relative search volumes (RSV) for specified time ranges to detect recent and seasonal variation.

Results: General search interest declined for all cancer types beginning in March 2020, with changes in search interest for "Breast cancer," "Colorectal cancer," and "Melanoma" of - 30.6%, - 28.2%, and - 26.7%, respectively, and compared with the mean RSV of the two previous months. In the same time range, search interest for "Telemedicine" has increased by + 907.1% and has reached a 4-year peak with a sustained increased level of search interest. Absolute cancer mortality has declined and is presently at a 4-year low; however, search interest in cancer has been recuperating since July 2020.

Conclusion: We observed a marked decline in searches for cancer-related health information that mirrors the reduction in new cancer diagnoses and cancer mortality during the COVID-19 pandemic. Health professions need to be prepared for the coming demand for cancer-related healthcare, foreshadowed by recovering interest in cancer-related information on Google Trends.
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http://dx.doi.org/10.1007/s10552-021-01409-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938033PMC
June 2021

Transarterial Embolization of Liver Cancer in a Transgenic Pig Model.

J Vasc Interv Radiol 2021 04 23;32(4):510-517.e3. Epub 2021 Jan 23.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Electronic address:

Purpose: To develop and characterize a porcine model of liver cancer that could be used to test new locoregional therapies.

Materials And Methods: Liver tumors were induced in 18 Oncopigs (transgenic pigs with Cre-inducible TP53 and KRAS mutations) by using an adenoviral vector encoding the Cre-recombinase gene. The resulting 60 tumors were characterized on multiphase contrast-enhanced CT, angiography, perfusion, micro-CT, and necropsy. Transarterial embolization was performed using 40-120 μm (4 pigs) or 100-300 μm (4 pigs) Embosphere microspheres. Response to embolization was evaluated on imaging. Complications were determined based on daily clinical evaluation, laboratory results, imaging, and necropsy.

Results: Liver tumors developed at 60/70 (86%) inoculated sites. Mean tumor size was 2.1 cm (range, 0.3-4 cm) at 1 week. Microscopically, all animals developed poorly differentiated to undifferentiated carcinomas accompanied by a major inflammatory component, which resembled undifferentiated carcinomas of the human pancreatobiliary tract. Cytokeratin and vimentin expression confirmed epithelioid and mesenchymal differentiation, respectively. Lymph node, lung, and peritoneal metastases were seen in some cases. On multiphase CT, all tumors had a hypovascular center, and 17/60 (28%) had a hypervascular rim. After transarterial embolization, noncontrast CT showed retained contrast medium in the tumors. Follow-up contrast-enhanced scan showed reduced size of tumors after embolization using either 40-120 μm or 100-300 μm Embosphere microspheres, while untreated tumors showed continued growth.

Conclusions: Liver tumors can be induced in a transgenic pig and can be successfully treated using bland embolization.
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http://dx.doi.org/10.1016/j.jvir.2020.09.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451249PMC
April 2021

Interventional molecular imaging.

Q J Nucl Med Mol Imaging 2021 Mar 26;65(1):1-3. Epub 2021 Jan 26.

University Medical Centre Leipzig, Leipzig, Germany.

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http://dx.doi.org/10.23736/S1824-4785.21.03329-XDOI Listing
March 2021

Practice and prospects for PET/CT guided interventions.

Q J Nucl Med Mol Imaging 2021 Mar 26;65(1):20-31. Epub 2021 Jan 26.

Unit of Molecular Imaging and Therapy Physics, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA -

During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.
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http://dx.doi.org/10.23736/S1824-4785.21.03291-XDOI Listing
March 2021

Retrospective Use of Breathing Motion Compensation Technology (MCT) Enhances Vessel Detection Software Performance.

Cardiovasc Intervent Radiol 2021 Apr 20;44(4):619-624. Epub 2021 Jan 20.

Radiology Department, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue H-118, New York , NY, USA.

Purpose: Cone beam CT (CBCT) with planning software is used in intra-arterial liver-directed therapies. Software accuracy relies on high CBCT image quality, which can be impaired by breathing motion. We assessed the impact of a specific MCT on software performance for procedure planning and navigation.

Materials And Methods: Institutional Review Board (IRB)-approved retrospective evaluation of liver-directed therapies from July 2015 to April 2018 was performed. CBCTs with at least one well-defined tumor and noticeable breathing motion were included. Each CBCT was reconstructed with and without breathing MCT (Motion Freeze, GE Healthcare). Automatic tumor-supplying vessel detection was performed on up to 4 tumors in each CBCT reconstruction (Liver ASSIST V.I., GE Healthcare). Vessel detection sensitivity and positive predictive value (PPV) were measured with and without MCT using Digital Subtracted Angiography (DSA) as reference. Preprocedural contrast-enhanced CT was also utilized in some cases to rule out the possibility of extrahepatic supplying vessels.

Results: MCT was applied retrospectively to 18 CBCTs with a total of 30 tumors. At least one supplying vessel was detected for 28/30 (93%) tumors with MCT versus 20/30 (66%) without. On the subgroup of 10 CBCTs (22 tumors, 76 feeders) in which the automatic vessel detection initially worked in both reconstructions, the average sensitivity and PPV increased from 63% (48/76) and 57% (48/84) before MCT to 83% (63/76) and 79% (63/80) after (p = 0.002 and p < 0.001).

Conclusion: Breathing MCT improves planning software performance in CBCT impaired by breathing motion.
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http://dx.doi.org/10.1007/s00270-021-02767-8DOI Listing
April 2021

Utilization of integrated angiography-CT interventional radiology suites at a tertiary cancer center.

BMC Med Imaging 2020 10 15;20(1):114. Epub 2020 Oct 15.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1250 York Ave, Suite H112, New York, NY, 10021, USA.

Background: Integrated Angiography-Computed Tomography (ACT) suites were initially designed in the 1990's to perform complex procedures requiring high-resolution cross-sectional imaging and fluoroscopy. Since then, there have been technology developments and changes in patient management. The purpose of this study was to review the current usage patterns of a single center's integrated ACT suites.

Methods: All procedures performed in 2017 in 3 ACT suites (InterACT Discovery RT, GE Healthcare) at a tertiary cancer center were reviewed retrospectively. Usage was classified as: Standard, in which the patient underwent a single procedure using either fluoroscopy, CT, or ultrasound (US); Combined, in which the patient underwent a single procedure utilizing both fluoroscopy and CT; or Staged, in which the patient underwent 2 separate but successive procedures using fluoroscopy and CT individually. The most frequently performed Combined and Staged procedures were further reviewed to determine how the different modalities were used. The duration of the most common Staged procedures was compared to analogous procedures' durations in single modality rooms over the period Jan 2016 to Sep 2019.

Results: A total of 3591 procedures were performed on 2678 patients in the 3 ACT Suites. 80% of patients underwent a Standard procedure using fluoroscopy (38%), CT (32%) or US (10%) and accounted for 70% of the room occupation time. Fourteen and three percent of the patients underwent Combined or Staged procedures, occupying 19 and 5% of the room time, respectively. The remaining procedures were classified as both Combined and Staged, representing 3% of the patients and 6% of the room occupation time. The most common Combined procedures were drainages, hepatic arterial embolizations or radioembolizations, arterial, and biliary interventions. The most common Staged procedures were multiple drainages and hepatic arterial embolizations followed by biopsies or ablations. The room occupation time for liver tumor embolization and ablation was significantly shorter (p < 0.01) when performed in a Staged fashion versus the analogous procedures in single modality room.

Conclusion: An integrated ACT system provides the capability to perform complex Combined or Staged procedures as well as scheduling flexibility by allowing any type of case to be performed in the IR suite.
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http://dx.doi.org/10.1186/s12880-020-00515-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559017PMC
October 2020

Percutaneous computed tomography guided biopsy of sub-solid pulmonary nodules: differentiating solid from ground glass components at the time of biopsy.

Clin Imaging 2021 Jan 25;69:332-338. Epub 2020 Jul 25.

Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States of America.

Introduction: This study assessed (i) the ability to identify the solid components of part-solid nodules (PSN) during computed tomography (CT) guided lung biopsy (CTGLB), (ii) the ability of CTGLB to assess the invasive nature of a nodule on pathology.

Materials And Methods: Sixty-nine nodules were studied in 68 patients who underwent CTGLB between 1/1/2014 and 10/31/2015. Diagnostic CT images and CTGLB images were reviewed. On diagnostic CT images, nodules were classified as ground glass nodules (GGN) or PSNs. Nodule size, location, and percentage of solid component were recorded. At the time of biopsy, the ability to visualize the solid component of a PSN, depth of lesion from skin, and ability to identify the needle within the solid component were recorded.

Results: There were 42 (61%) part-solid nodules and 27 (39%) GGNs. During biopsy, it was possible to differentiate the solid from the ground glass components in 35 (83%) PSNs. Fifty-nine (86%) nodules were neoplastic based on biopsy pathology (all non-small cell lung carcinoma). Thirty-nine (66%) were resected. In all cases biopsy pathology and surgical pathology agreed regarding the presence of lung carcinoma. In 6 (15%) cases biopsy pathology demonstrated purely lepidic growth but had some non-lepidic growth on surgical pathology, including 2 cases with acinar growth as a dominant pattern.

Conclusion: In most patients, the solid and ground glass components of a PSN were distinguishable when performing a CTGLB. In a minority of patients, discrepancy was noted between biopsy pathology and surgical pathology regarding the invasive nature of a nodule.
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http://dx.doi.org/10.1016/j.clinimag.2020.07.011DOI Listing
January 2021

Intratumoral Injection of -NT Spores in Patients with Treatment-refractory Advanced Solid Tumors.

Clin Cancer Res 2021 01 12;27(1):96-106. Epub 2020 Oct 12.

BioMed Valley Discoveries Inc., Kansas City, Missouri.

Purpose: Intratumorally injected -NT (nontoxic; lacking the alpha toxin), an attenuated strain of , replicates within hypoxic tumor regions resulting in tumor-confined cell lysis and inflammatory response in animals, which warrants clinical investigation.

Patients And Methods: This first-in-human study (NCT01924689) enrolled patients with injectable, treatment-refractory solid tumors to receive a single intratumoral injection of -NT across 6 dose cohorts (1 × 10 to 3 × 10 spores, 3+3 dose-escalation design) to determine dose-limiting toxicities (DLT), and the maximum tolerated dose.

Results: Among 24 patients, a single intratumoral injection of -NT led to bacterial spores germination and the resultant lysis of injected tumor masses in 10 patients (42%) across all doses. The cohort 5 dose (1 × 10 spores) was defined as the maximum tolerated dose; DLTs were grade 4 sepsis ( = 2) and grade 4 gas gangrene ( = 1), all occurring in three patients with injected tumors >8 cm. Other treatment-related grade ≥3 toxicities included pathologic fracture ( = 1), limb abscess ( = 1), soft-tissue infection ( = 1), respiratory insufficiency ( = 1), and rash ( = 1), which occurred across four patients. Of 22 evaluable patients, nine (41%) had a decrease in size of the injected tumor and 19 (86%) had stable disease as the best overall response in injected and noninjected lesions combined. -NT injection elicited a transient systemic cytokine response and enhanced systemic tumor-specific T-cell responses.

Conclusions: Single intratumoral injection of NT is feasible. Toxicities can be significant but manageable. Signals of antitumor activity and the host immune response support additional studies of NT in humans.
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http://dx.doi.org/10.1158/1078-0432.CCR-20-2065DOI Listing
January 2021

Induction and characterization of pancreatic cancer in a transgenic pig model.

PLoS One 2020 21;15(9):e0239391. Epub 2020 Sep 21.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America.

Background: Preclinical testing of new locoregional therapies for pancreatic cancer has been challenging, due to the lack of a suitable large animal model.

Purpose: To develop and characterize a porcine model of pancreatic cancer. Unlike small animals, pigs have similar physiology, drug dosing, and immune response to humans. Locoregional therapy in pigs can be performed using the same size catheters and devices as in humans.

Methods: The Oncopig is a transgenic pig with Cre-inducible TP53R167H and KRASG12D mutations. In 12 Oncopigs, CT-guided core biopsy of the pancreas was performed. The core biopsy was incubated with an adenoviral vector carrying the Cre recombinase gene. The transformed core biopsy was injected back into the pancreas (head, tail, or both). The resulting tumors (n = 19) were characterized on multi-phase contrast-enhanced CT, and on pathology, including immunohistochemistry. Angiographic characterization of the tumors was performed in 3 pigs.

Results: Pancreatic tumors developed at 19 out of 22 sites (86%) that were inoculated. Average tumor size was 3.0 cm at 1 week (range: 0.5-5.1 cm). H&E and immunohistochemical stains revealed undifferentiated carcinomas, similar to those of the pancreatobiliary system in humans. Neoplastic cells were accompanied by a major inflammatory component. 1 of 12 pigs only had inflammatory nodules without evidence of neoplasia. On multiphase CT, tumors were hypovascular compared to the normal pancreas. There was no pancreatic duct dilation. In 3 pigs, angiography was performed, and in all 3 cases, the artery supplying the pancreatic tumor could be catheterized using a 2.4 F microcatheter. Selective angiography showed the pancreatic tumor, without extra-pancreatic perfusion.

Conclusion: Pancreatic cancer can be induced in a transgenic pig. Intra-arterial procedures using catheters designed for human interventions were technically feasible in this large animal model.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239391PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505440PMC
November 2020

Temporary Organ Displacement to Escalate Radiation Dose to Retroperitoneal Tumors and Decrease Toxicity to Organs at Risk.

J Vasc Interv Radiol 2020 Oct 27;31(10):1578-1586. Epub 2020 Aug 27.

Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Purpose: To demonstrate that temporary organ displacement (TOD) by drainage catheter placement and hydrodissection is feasible and reproducible for simulation (SIM) and stereotactic body radiation treatment (SBRT).

Materials And Methods: Between February 2010 and December 2018, 31 consecutive patients (20 men and 11 women; median age, 59 years; range 20-80 years) received both SIM and SBRT with TOD. The minimum required displacement was 10 mm between the gross tumor volume (GTV) and the organ at risk (OAR). Complete displacement was defined as the ability to displace the OAR from the GTV a minimum of 10 mm across the entire boundary. SIM was performed with hydrodissection on the same day. On the day of SBRT, displacement was reproduced by hydrodissection. Displacement was measured on computed tomography images of TOD, SIM, and SBRT. The drain was removed after SBRT.

Results: TOD (hydrodissection) was significantly associated with successful displacement of the OAR from a GTV greater than 10 mm (median, 20 mm vs 4.1 mm, P < .001) and maintained displacement at SIM and SBRT (SIM: 29.4 mm vs 4.1 mm, P < .001; SBRT: 32.4 mm vs 4.1 mm, P < .001). The OAR-GTV boundary showed a median reduction of 35 mm (95% confidence interval, 27.5-37.5 mm) after TOD. TOD achieved complete displacement in 22 of 31 (71%) patients, and 25 of 31 (81%) patients were able to undergo single-fraction ablative SBRT. No patients developed procedure-related complications within 30 days. SIM and SBRT were successful without OAR toxicities within a median of 33 months (range, 3-92 months).

Conclusions: TOD with placement of drain and hydrodissection is technically feasible and safe and maintains displacement for SIM and SBRT.
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http://dx.doi.org/10.1016/j.jvir.2020.01.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541436PMC
October 2020

NRF2 Dysregulation in Hepatocellular Carcinoma and Ischemia: A Cohort Study and Laboratory Investigation.

Radiology 2020 10 11;297(1):225-234. Epub 2020 Aug 11.

From the Department of Radiology (E.Z., L.K., I.N., F.E.B., J.P.E., L.C., E.N.P., L.A.B., A.M.C., G.G., C.S., S.B.S., H.Y.), Sloan Kettering Institute (Y.Z.), and Department of Medicine (J.J.H., G.K.A.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065; Department of Radiology, University of Utah Health, Salt Lake City, Utah (K.T.B.); and Weill Medical College at Cornell University, New York, NY (E.Z., I.N., F.E.B., J.P.E., A.M.C., G.G., J.J.H., C.S., G.K.A., S.G.S., H.Y.).

Background Intermediate stage hepatocellular carcinomas (HCCs) are treated by inducing ischemic cell death with transarterial embolization (TAE) or transarterial chemoembolization (TACE). A subset of HCCs harbor nuclear factor E2-related factor 2 (NRF2), a major regulator of the oxidative stress response implicated in cell survival after ischemia. NRF2-mutated HCC response to TAE and/or TACE is unknown. Purpose To test whether ischemia resistance is present in individuals with NRF2-mutated HCC and if this resistance can be overcome by means of NRF2 inhibition in HCC cell lines. Materials and Methods This was a combined retrospective review of an institutional database (from January 2011 to December 2018) and prospective study (from January 2014 to December 2018) of participants with HCC who underwent TAE and a laboratory investigation of HCC cell lines. Imaging follow-up included liver CT or MRI at 1 month after the procedure followed by 3-month interval scans. Tumor radiologic response was assessed on the basis of follow-up imaging. The time to local progression after TAE for individuals with and individuals without NRF2 pathway alterations was estimated by using competing risk analysis (Gray test). The in vitro response to ischemia in four HCC cell lines with and without NRF2 overexpression was evaluated, and the combination of ischemia with NRF2 knockdown by means of short hairpin RNA or an NRF2 inhibitor was tested. Doubling time estimates, dose response curve regression, and comparison analyses were performed. Results Sixty-five individuals (median age, 69 years [range, 19-84 years]; 53 men) were evaluated. HCCs with NRF2 pathway mutation had a shorter time to local progression after TAE compared to those without mutation (6-month cumulative incidence of local progression, 56% [range, 19%-91%] vs 22% [range, 12%-34%], respectively; < .001) and confirmed ischemia resistance in NRF2-overexpressing HCC cell lines. However, ischemia and NRF2 knock-down worked synergistically to decrease proliferation of NRF2-overexpressing HCC cell lines. Dose response curves of ML385, an NRF2 inhibitor, showed that ischemia induces addiction to NRF2 in cells with NRF2 alterations. Conclusion Hepatocellular carcinoma with nuclear factor E2-related factor 2 (NRF2) alterations showed resistance to ischemia, but ischemia simultaneously induced sensitivity to NRF2 inhibition. © RSNA, 2020 See also the editorial by Weiss and Nezami in this issue.
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http://dx.doi.org/10.1148/radiol.2020200201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526944PMC
October 2020

Predictors of Progression-Free Survival and Local Tumor Control after Percutaneous Thermal Ablation of Oligometastatic Breast Cancer: Retrospective Study.

J Vasc Interv Radiol 2020 Aug 19;31(8):1201-1209. Epub 2020 Jul 19.

Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address:

Purpose: To describe ablation of bone, liver, lung, and soft tissue tumors from oligometastatic breast cancer and to define predictors of local progression and progression-free survival (PFS).

Materials And Methods: A total of 33 women (mean age 52 ± 12 years old; range, 28-69 years), underwent 46 thermal ablations of liver (n = 35), lung (n = 7), and bone/soft tissue (n = 4) metastases. Mean tumor diameter was 18 ± 15 mm (range, 6-50 mm). Ablations were performed to eradicate all evident sites of disease (n = 24) or to control growing sites in the setting of other stable or responding sites of disease (n = 22). Patient characteristics, ablation margins, imaging responses, and cases of PFS were assessed. Follow-up imaging was performed using contrast-enhanced computed tomography (CT), magnetic resonance (MR) imaging, or positron-emission tomography/ CT.

Results: Median PFS was 10 months (95% confidence interval [CI], 6.2 -14.5 months), and time to local progression was 11 months (95% CI, 5-16 months). Eight patients (24%) maintained no evidence of disease during a median follow-up period of 39 months. Ablation margin ≥5 mm was associated with no local tumor progression. Longer PFS was noted in estrogen receptor-positive patients (12 vs 4 months; P = .037) and younger patients (12 vs 4 months; P = .039) treated to eradicate all sites of disease (13 vs 5 months; P = .05). Eighteen patients (55%) developed new metastases during study follow-up.

Conclusions: Thermal ablation of oligometastatic pulmonary, hepatic, bone, and soft tissue tumors can eliminate local tumor progression if margins are ≥5 mm. Longer PFS was observed in patients who were estrogen receptor-positive and patients who were younger and in whom all sites of disease were eradicated.
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http://dx.doi.org/10.1016/j.jvir.2020.02.016DOI Listing
August 2020

Reply by Authors.

J Urol 2020 10 22;204(4):823. Epub 2020 Jul 22.

Interventional Radiology Service, Department of Radiology, New York, New York.

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http://dx.doi.org/10.1097/JU.0000000000001121.02DOI Listing
October 2020

Follow-up after radiological intervention in oncology: ECIO-ESOI evidence and consensus-based recommendations for clinical practice.

Insights Imaging 2020 Jul 16;11(1):83. Epub 2020 Jul 16.

Dept of Radiology, University Clinic of Navarra, Calle Benjamín de Tudela, 2, 31008, Pamplona, Navarra, Spain.

Interventional radiology plays an important and increasing role in cancer treatment. Follow-up is important to be able to assess treatment success and detect locoregional and distant recurrence and recommendations for follow-up are needed. At ECIO 2018, a joint ECIO-ESOI session was organized to establish follow-up recommendations for oncologic intervention in liver, renal, and lung cancer. Treatments included thermal ablation, TACE, and TARE. In total five topics were evaluated: ablation in colorectal liver metastases (CRLM), TARE in CRLM, TACE and TARE in HCC, ablation in renal cancer, and ablation in lung cancer. Evaluated modalities were FDG-PET-CT, CT, MRI, and (contrast-enhanced) ultrasound. Prior to the session, five experts were selected and performed a systematic review and presented statements, which were voted on in a telephone conference prior to the meeting by all panelists. These statements were presented and discussed at the ECIO-ESOI session at ECIO 2018. This paper presents the recommendations that followed from these initiatives. Based on expert opinions and the available evidence, follow-up schedules were proposed for liver cancer, renal cancer, and lung cancer. FDG-PET-CT, CT, and MRI are the recommended modalities, but one should beware of false-positive signs of residual tumor or recurrence due to inflammation early after the intervention. There is a need for prospective preferably multicenter studies to validate new techniques and new response criteria. This paper presents recommendations that can be used in clinical practice to perform the follow-up of patients with liver, lung, and renal cancer who were treated with interventional locoregional therapies.
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http://dx.doi.org/10.1186/s13244-020-00884-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366866PMC
July 2020

High-intensity focused ultrasound ablation of muscle in an anticoagulated swine model.

Minim Invasive Ther Allied Technol 2020 Jun 3:1-5. Epub 2020 Jun 3.

Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Image-guided non-invasive high-intensity focused ultrasound (HIFU) has been gaining recognition in treating musculoskeletal tumors and desmoids. However, there is no consensus on the appropriate perioperative management for patients on ongoing anticoagulation who undergo HIFU ablation. Image-guided HIFU treatment was performed in swine on an ongoing oral anticoagulation protocol ( = 5) in two treatment sessions seven days apart. On day one, a total of twenty locations were ablated, and on day eight, ten more muscle ablations were performed, and the animals were euthanized. Imaging, clinical examination, and histopathology were performed to investigate treated tissue for bleeding. Imaging, clinical examination, and histopathology revealed either no bleeding or, in some samples, only small scattered cavities (0.2-2 mm in diameter) filled with blood. Noninvasive HIFU ablation of muscle may not require a coagulation profile within normal limits.
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http://dx.doi.org/10.1080/13645706.2020.1760301DOI Listing
June 2020

Treatment of Chylous Ascites with Peritoneovenous Shunt (Denver Shunt) following Retroperitoneal Lymph Node Dissection in Patients with Urological Malignancies: Update of Efficacy and Predictors of Complications.

J Urol 2020 10 5;204(4):818-823. Epub 2020 May 5.

Interventional Radiology Service, Department of Radiology, New York, New York.

Purpose: We investigated the efficacy and analyzed the complication risk factors of peritoneovenous shunt in treating refractory chylous ascites following retroperitoneal lymph node dissection in patients with urological malignancies.

Materials And Methods: From April 2001 to March 2019 all patients with refractory chylous ascites after retroperitoneal lymph node dissection treated with peritoneovenous shunt were reviewed. Demographic characteristics, technical success, efficacy, patency period and complications were studied. Univariate and multivariate logistic regression analysis was performed to identify predictors of complications.

Results: Twenty patients were included in this study. Testicular cancer was the most common malignancy (85%). The mean number of days from surgery to detection of chylous ascites was 21 days (SD 15, range 4 to 65). Ascites permanently resolved after peritoneovenous shunt in 18 patients (90%), leading to shunt removal in 17 patients (85%) between 46 and 481 days (mean 162, SD 141). The mean serum albumin level increased 24% after shunt placement (mean 3.0±0.6 gm/dl before, 3.9±0.8 gm/dl after, p <0.05). The most common complication was occlusion (30%). Relative risk of complications increased significantly when shunt placement was more than 70 days after surgery and in patients with more than 5 paracenteses before peritoneovenous shunt placement (AR 0.71% vs 0.25%, RR 2.9, p <0.048 and AR 0.6% vs 0.125%, RR 4.8, p <0.04, respectively).

Conclusions: Peritoneovenous shunt permanently treated chylous ascites in 90% of patients after retroperitoneal lymph node dissection. Peritoneovenous shunt was removed in 85% of patients. Shunt placement is an effective and safe treatment option for refractory chylous ascites. These patients might benefit from earlier intervention, after 4 to 6 weeks of conservative management as opposed to 2 to 3 months.
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http://dx.doi.org/10.1097/JU.0000000000001121DOI Listing
October 2020

Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE).

J Thorac Oncol 2020 07 7;15(7):1200-1209. Epub 2020 Mar 7.

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

Objective: To assess the safety and local recurrence-free survival in patients after cryoablation for treatment of pulmonary metastases.

Methods: This multicenter, prospective, single-arm, phase 2 study included 128 patients with 224 lung metastases treated with percutaneous cryoablation, with 12 and 24 months of follow-up. The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. Time to progression of the index tumor(s), metastatic disease, and overall survival rates were estimated using the Kaplan-Meier method. Complications were captured for 30 days after the procedure, and changes in performance status and quality of life were also evaluated.

Results: Median size of metastases was 1.0 plus or minus 0.6 cm (0.2-4.5) with a median number of tumors of 1.0 plus or minus 1.2 cm (one to six). Local recurrence-free response (local tumor efficacy) of the treated tumor was 172 of 202 (85.1%) at 12 months and 139 of 180 (77.2%) at 24 months after the initial treatment. After a second cryoablation treatment for recurrent tumor, secondary local recurrence-free response (local tumor efficacy) was 184 of 202 (91.1%) at 12 months and 152 of 180 (84.4%) at 24 months. Kaplan-Meier estimates of 12- and 24-month overall survival rates were 97.6% (95% confidence interval: 92.6-99.2) and 86.6% (95% confidence interval: 78.7-91.7), respectively. Rate of pneumothorax that required pleural catheter placement was 26% (44/169). There were eight grade 3 complication events in 169 procedures (4.7%) and one (0.6%) grade 4 event.

Conclusion: Percutaneous cryoablation is a safe and effective treatment for pulmonary metastases.
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http://dx.doi.org/10.1016/j.jtho.2020.02.022DOI Listing
July 2020

Radiotheranostics: a roadmap for future development.

Lancet Oncol 2020 03;21(3):e146-e156

Department of Radiology, and Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address:

Radiotheranostics, injectable radiopharmaceuticals with antitumour effects, have seen rapid development over the past decade. Although some formulations are already approved for human use, more radiopharmaceuticals will enter clinical practice in the next 5 years, potentially introducing new therapeutic choices for patients. Despite these advances, several challenges remain, including logistics, supply chain, regulatory issues, and education and training. By highlighting active developments in the field, this Review aims to alert practitioners to the value of radiotheranostics and to outline a roadmap for future development. Multidisciplinary approaches in clinical trial design and therapeutic administration will become essential to the continued progress of this evolving therapeutic approach.
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http://dx.doi.org/10.1016/S1470-2045(19)30821-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367151PMC
March 2020
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