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Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

Duan XH, Wang YL, Han XW, Ren JZ, Li TF, Zhang JH, Zhang K, Chen PF - PLoS ONE (2015)

Bottom Line: The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.

ABSTRACT

Objectives: To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.

Methods: Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.

Results: Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days). With a median follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.

Conclusion: Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

No MeSH data available.


Related in: MedlinePlus

A 69-year-old man with a poorly differentiated adenocarcinoma of the middle third of the bile duct suffered stent blockage five months after stent implantation.(a) One month after intraductal RFA, CT showed the tumor was enlarged with obvious enhancement, plus liver metastases. (b) Hepatic artery angiography revealed multiple metastases nodules in the liver (arrows). (c) After the second TACE, lipiodol depositions were found in the tumor (arrows) and liver metastases. (d) CT images obtained at 3-month follow-up showed the tumor had reduced in size.
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pone.0134857.g002: A 69-year-old man with a poorly differentiated adenocarcinoma of the middle third of the bile duct suffered stent blockage five months after stent implantation.(a) One month after intraductal RFA, CT showed the tumor was enlarged with obvious enhancement, plus liver metastases. (b) Hepatic artery angiography revealed multiple metastases nodules in the liver (arrows). (c) After the second TACE, lipiodol depositions were found in the tumor (arrows) and liver metastases. (d) CT images obtained at 3-month follow-up showed the tumor had reduced in size.

Mentions: Contraindications to locoregional tumor treatments included Child-Pugh class C, a serum total bilirubin >53.5 μmol/L, serum creatinine >2 × baseline, and ECOG performance status >1. Locoregional tumor treatments were included TACE and intra-arterial chemotherapy with embolization of tumor-feeding arteries (Fig 2). Briefly, a 5.0 F RH catheter (Terumo, Tokyo, Japan) was used to perform a selective arteriogram of the celiac and superior mesenteric arteries to locate all tumor-feeding arteries. On the basis of the result of PTCB, we performed TACE with 30–50 mg pirarubicin mixed in 10–20 mL of lipiodol (Guerbet, Roissy, France) in patients with hepatocellular carcinoma (HCC); and intra-arterial chemotherapy with 0.8–1.2 g gemcitabine and 100–120 mg oxaliplatin and embolization of the tumor-feeding arteries with gelatin sponge particles (350–560 μm; Alicon, Shanghai, PR China) in patients with cholangiocarcinoma (CCA) as Gusani et al. [13] described. We implemented TACE with 10–15 mg mitomycin mixed in 5–10 mL of lipiodol in patients with gallbladder adenocarcinoma with liver metastases as described by Bode et al. [14]. In patients with liver metastases, we embolized the hepatic tumor-feeding arteries with 5–10 mL of lipiodol. Chemotherapeutic drug choice and medication dosage were made based on the patient’s previous treatment history, laboratory profile, tumor size and functional status.


Intraductal Radiofrequency Ablation Followed by Locoregional Tumor Treatments for Treating Occluded Biliary Stents in Non-Resectable Malignant Biliary Obstruction: A Single-Institution Experience.

Duan XH, Wang YL, Han XW, Ren JZ, Li TF, Zhang JH, Zhang K, Chen PF - PLoS ONE (2015)

A 69-year-old man with a poorly differentiated adenocarcinoma of the middle third of the bile duct suffered stent blockage five months after stent implantation.(a) One month after intraductal RFA, CT showed the tumor was enlarged with obvious enhancement, plus liver metastases. (b) Hepatic artery angiography revealed multiple metastases nodules in the liver (arrows). (c) After the second TACE, lipiodol depositions were found in the tumor (arrows) and liver metastases. (d) CT images obtained at 3-month follow-up showed the tumor had reduced in size.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4526692&req=5

pone.0134857.g002: A 69-year-old man with a poorly differentiated adenocarcinoma of the middle third of the bile duct suffered stent blockage five months after stent implantation.(a) One month after intraductal RFA, CT showed the tumor was enlarged with obvious enhancement, plus liver metastases. (b) Hepatic artery angiography revealed multiple metastases nodules in the liver (arrows). (c) After the second TACE, lipiodol depositions were found in the tumor (arrows) and liver metastases. (d) CT images obtained at 3-month follow-up showed the tumor had reduced in size.
Mentions: Contraindications to locoregional tumor treatments included Child-Pugh class C, a serum total bilirubin >53.5 μmol/L, serum creatinine >2 × baseline, and ECOG performance status >1. Locoregional tumor treatments were included TACE and intra-arterial chemotherapy with embolization of tumor-feeding arteries (Fig 2). Briefly, a 5.0 F RH catheter (Terumo, Tokyo, Japan) was used to perform a selective arteriogram of the celiac and superior mesenteric arteries to locate all tumor-feeding arteries. On the basis of the result of PTCB, we performed TACE with 30–50 mg pirarubicin mixed in 10–20 mL of lipiodol (Guerbet, Roissy, France) in patients with hepatocellular carcinoma (HCC); and intra-arterial chemotherapy with 0.8–1.2 g gemcitabine and 100–120 mg oxaliplatin and embolization of the tumor-feeding arteries with gelatin sponge particles (350–560 μm; Alicon, Shanghai, PR China) in patients with cholangiocarcinoma (CCA) as Gusani et al. [13] described. We implemented TACE with 10–15 mg mitomycin mixed in 5–10 mL of lipiodol in patients with gallbladder adenocarcinoma with liver metastases as described by Bode et al. [14]. In patients with liver metastases, we embolized the hepatic tumor-feeding arteries with 5–10 mL of lipiodol. Chemotherapeutic drug choice and medication dosage were made based on the patient’s previous treatment history, laboratory profile, tumor size and functional status.

Bottom Line: The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.Combination treatment was successful for all patients.Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, No. 1, East Jian She Road, Zhengzhou, 450052, Henan Province, People's Republic of China.

ABSTRACT

Objectives: To determine the safety and feasibility of intraductal radiofrequency ablation (RFA) followed by locoregional tumor treatments in patients with non-resectable malignant biliary obstruction and stent re-occlusion.

Methods: Fourteen patients with malignant biliary obstruction and blocked metal stents were studied retrospectively. All had intraductal RFA followed by locoregional tumor treatments and were monitored clinically and radiologically. The practicality, safety, postoperative complications, jaundice remission, stent patency and survival time were analyzed.

Results: Combination treatment was successful for all patients. There were no severe complications during RFA or local treatments. All patients had stent patency restored, with a decline in serum bilirubin. Three patients had recurrent jaundice by 195, 237 and 357 days; two patients underwent repeat intraductal RFA; and one required an internal-external biliary drain. The average stent patency time was 234 days (range 187-544 days). With a median follow-up of 384 days (range 187-544 days), six patients were alive, while eight had died. There was no mortality at 30 days. The 3, 6, 12 and 18 month survival rates were 100%, 100%, 64.3% and 42.9%, respectively.

Conclusion: Intraductal RFA followed by locoregional tumor treatments for occluded metal stents is safe and practically feasible and potential increase stent patency and survival times.

No MeSH data available.


Related in: MedlinePlus