Combined Transarterial and Transvenous Onyx Embolization of Jugular Foramen Paragangliomas.
- 作者列表："Brahimaj BC","Beer-Furlan A","Joshi KC","Wiet RM","Lopes DK
OBJECTIVE:Jugular foramen paragangliomas are highly vascular tumors known to have significant venous hemorrhage during resection even after conventional transarterial embolization. The authors report a novel technique to the endovascular embolization of jugular foramen paragangliomas using a combined transarterial and transvenous access for better intraoperative control of blood loss and visualization. METHODS:This is a retrospective data collection of 2 patients diagnosed with jugular foramen paragangliomas with novel embolization technique and surgical resection. RESULTS:Two patients underwent embolization of jugular foramen paragangliomas through combined transarterial and transvenous routes using 2 double-lumen balloon microcatheters. In both cases, single arterial vessel embolization was performed through the occipital artery in Case 1 and the tympanic branch of the ascending pharyngeal artery in Case 2. Simultaneously, balloon microcatheter occlusion in the sigmoid sinus and single venous outflow vessel embolization was performed. Near-complete occlusion was established, with angiographic disappearance of tumor blush. Surgical resection was performed in both cases. Estimated blood loss BL was 600 mL in Case 1 and 200 mL in Case 2. No blood transfusions were required, intraoperatively or postoperatively. There were no cranial nerve deficits post embolization. One patient had a persistent House Brackman 2 facial nerve palsy after resection. CONCLUSIONS:The initial experience with simultaneous transvenous and transarterial paraganglioma embolization demonstrated the safety of the technique and superior embolic agent penetration. This was supported by our observations during embolization and intraoperatively during tumor resection. Additional patients need to be treated with this technique for better assessment of long-term efficacy and incidence of embolization-related cranial neuropathies.
目的: 颈静脉孔旁神经节瘤是一种高度血管性肿瘤，即使在传统的经动脉栓塞治疗后，也有明显的静脉出血。作者报道了一种使用经动脉和经静脉联合通路血管内栓塞颈静脉孔旁神经节瘤的新技术，以更好地控制术中失血和可视化。 方法: 收集 2 例颈静脉孔旁神经节瘤患者的回顾性资料，采用新型栓塞技术和手术切除。 结果: 2 例患者采用 2 个双腔球囊微导管经动脉和经静脉联合途径栓塞颈静脉孔旁神经节瘤。2 例均经枕动脉和咽升动脉鼓室支行单支动脉血管栓塞术。同时行乙状窦内球囊微导管封堵术和单支静脉流出血管栓塞术。建立了接近完全闭塞，肿瘤腮红血管造影消失。两例均行手术切除。病例 1 估计失血量为 600 mL，病例 2 估计失血量为 200 mL。术中或术后无需输血。栓塞后无脑神经缺损。1 例患者在切除后出现持续性House Brackman 2 面神经麻痹。 结论: 同时经静脉和经动脉栓塞副神经节瘤的初步经验证明了该技术的安全性和优越的栓塞剂渗透。我们在栓塞期间和肿瘤切除期间的术中观察结果支持了这一点。为了更好地评估栓塞相关颅神经病变的长期疗效和发生率，需要对其他患者进行该技术的治疗。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.