Purpose: This study aimed to retrospectively evaluate the overall survival and prognostic factors of patients treated using microballoon-occluded transarterial chemoembolization (B-TACE) with miriplatin for hepatocellular carcinoma (HCC).
Materials and Methods: Thirty-seven patients (23 men and 14 women; mean age, 74.1 years; Barcelona Clinic Liver Cancer stage A:21, B:10, C:6; first TACE, 17) treated using B-TACE with miriplatin were retrospectively analyzed. Overall survival and progression-free survival were analyzed using Kaplan-Meier methods, and a multivariate analysis was performed to identify prognostic factors. Side effects were analyzed on the basis of the National Cancer Institute's Common Terminology Criteria for Adverse Events (ver. 4.0).
Results: The 1-, 2-, and 3-year survival rates were 89.2% (95% confidence interval [CI], 74.5-95.9%), 67.3% (95% CI, 50.7-80.4%), and 60.9% (95% CI, 44.1-75.4%), respectively. The median survival time was 3.6 years. The median progression-free survival time was 8 months. Balloon increase (increased tumor stain under balloon occlusion; hazard ratio, 3.17; 95% CI, 1.135-11.201; P = 0.027) was the only factor significantly associated with overall survival on the multivariate analysis. No deaths occurred, but grade 2 cholecystitis requiring conservative treatment developed in 2 patients (4.8%). No adverse events over grade 3 occurred.
Conclusion: B-TACE with miriplatin was associated with comparable tumor control and overall survival without severe adverse events in patients with HCC. Balloon increase was the only factor significantly associated with overall survival.
Purpose: To evaluate the origin of feeding arteries in recurrent tongue cancers under treatment with intra-arterial infusion chemotherapy (IAIC).
Material and Methods: Eleven patients who underwent IAIC for recurrent tongue cancer at our institute between January 2007 and August 2017 were enrolled. Two patients received a second IAIC treatment for tumor recurrence after the first round of IAIC. Thus, 13 recurrent tongue tumors were evaluated. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery.
Results: The main feeding artery was the ipsilateral lingual artery (LA) in 7 of the 13 (54%) tumors, the contralateral LA in 3 (24%) tumors, and the ipsilateral superior thyroid artery (STA) in 3 (24%) tumors. Feeding was detected from the ipsilateral LA in 12 of the 13 tumors (92%), from the contralateral LA in 8 (62%), from the ipsilateral facial artery (FA) in 3 (23%), from the contralateral FA in 1 (8%), from the ipsilateral STA in 3 (23%), from the contralateral STA in 2 (15%), and from the artery anastomosed to a flap in 2 (15%). Three tumors (23%) had only 1 feeding artery, and multiple feeders were detected in the remaining 10 (77%). Of the 10 tumors with multiple feeding arteries, 4 tumors had 2 feeding arteries, 4 tumors had 3 feeding arteries, and the other 2 tumors had 4 feeding arteries.
Conclusions: Recurrent tongue cancers are often supplied by multiple feeding arteries. A careful search for feeding arteries including the STA is required.
Background and Purpose: During a percutaneous vertebroplasty (PVP) procedure, patients typically lie in the prone position. However, some elderly patients have difficulty in maintaining the prone position. Therefore, we aimed to investigate the safety and efficacy of PVP in a lateral decubitus position in patients experiencing difficulty in maintaining the prone position.
Materials and Methods: A total of 123 PVP procedures performed consecutively on 117 patients for symptomatic vertebral fractures caused by bone tumors or osteoporosis were studied. The patients were divided into prone (n=113) and decubitus groups (n=10) according to their positions during the PVP procedures. The factors related to the patients' background, procedures, therapeutic effects, and adverse events were compared between the 2 groups. Univariate analysis was performed using Student's t-test, Mann-Whitney's U-test, chi-squared test, or Wilcoxon signed-rank test.
Results: In the decubitus group, the average age was 6.7 years older (p<0.05), the average set-up time was 1.6 times longer (p<0.01), the average fluoroscopic exposure dose was 1.37 times greater (p<0.05), the average dose-length product of interventional computed tomography was 1.78 times greater (p<0.05), and mobility restoration on the 7th day after the PVP was less (p<0.05) compared to the prone group. There were no significant differences in bone cement leakage, pulmonary embolism, recurrence of compression fractures, or pain relief.
Conclusion: Although some disadvantages were observed, decubitus PVP seemed to be completed safely and successfully. Decubitus PVP can become a treatment option for patients with vertebral fractures and difficulty in maintaining the prone position.
Purpose: The optimal side for placement of a central venous port (CVP) remains unclear. The authors aimed to compare adverse events (AEs) and imaging findings according to CVP placement via the right and left subclavian vein (SCV) in patients with malignant tumor (s).
Material and Methods: A total of 254 consecutive adult patients, who underwent CVP placement between January and August 2012, were included. Percutaneous ultrasound-guided access was attempted in the right SCV in 134 (59 men, 75 women; median age 61 years) and left SCV in 120 (58 men, 62 women; median age 61 years) patients. The primary tumor was colorectal (right, 17/ left, 71); upper gastrointestinal (33/7); bone and soft tissue (21/9); and others (63/33). A retrospective evaluation of technical success, AEs, and computed tomography findings was performed.
Results: Technical success was achieved in 99% of patients in both groups. Median procedure time was 30 min in both groups. There were no statistically significant differences in intraprocedural AEs. In postprocedural AEs during a median follow-up of 347 (right)/530 (left) days, CVP placement in the left SCV was associated with a significantly higher rate of catheter occlusion (right, 0%; left, 5.8%). Both symptomatic venous thrombosis (right, 0.7%; left, 4.2%) and image-confirmed venous thrombosis (right, 4.8%; left, 21.8%) occurred more frequently in the left-CVP group.
Conclusion: Left-CVP was associated with significantly higher rates of late AEs and venous thrombosis. Despite the inherent limitations of the retrospective study design and small sample size, re-evaluation of left-CVP may be required in patients with malignant tumor (s).
A 61-year-old Japanese man with right common iliac artery stenosis underwent magnetic resonance plaque imaging for an evaluation of the nature of the stenosis that used inversion-recovery and fat-suppressed three-dimensional steady-state free precession (IR-SSFP) and T1-weighted black blood imaging. The stenosis was depicted as diffuse high signal intensity on the IR-SSFP, and the deep layer was depicted as high signal intensity on the T1-weighted black blood image, suggesting a lipid-rich necrotic core in the shallow layer and intraplaque hemorrhage in the deep layer. After an evaluation by intravascular endoscopy and optical coherence tomography (OCT), stent placement was performed under balloon protection. Yellowish plaque was aspirated from a balloon guiding catheter, and a histopathological examination confirmed cholesterol crystals and a thrombus.
Purpose: To report our initial experience with transarterial infusion chemotherapy/embolization (TAI/TAE) in the pelvic cavity using a steerable microcatheter alone through the outer cannula of an 18-gauge needle used as a sheath (SMOC) without a conventional diagnostic catheter and introducer sheath.
Materials and Methods: From January to September 2017, the SMOC method was attempted in six consecutive patients (4 male, 2 female; median age, 79.5 years; range, 21-88 years) undergoing elective TAI/TAE in the pelvic cavity. TAI was performed with cisplatin and methotrexate for bladder cancer in four patients, while TAE was performed with gelatin sponge particles for chronic urethral bleeding after total cystectomy in one patient and for a retained placenta in one patient. The items evaluated were the performance of TAI/TAE procedure with the SMOC method, fluoroscopic time, manual compression time, post-procedural bed rest time, and complications.
Results: Five of six patients (83%) successfully underwent the procedure with the SMOC method; in one patient with a severely tortuous iliac artery, we abandoned the SMOC method. The median fluoroscopic time in the five successful cases was 16 min (range, 7-33 min). The manual compression time was approximately 5 min in each case. The postoperative bed rest time was 5 h in the first three cases and 2 h in the subsequent two cases. No procedure-related complications, including arterial injury and hematoma formation, occurred in any patients.
Conclusions: The SMOC method can be an alternative to the conventional method for TAI/TAE in the pelvic cavity.