Shamar Young, Jack Hannallah, Dan Goldberg, Mohammad Khreiss, Rachna Shroff, Junaid Arshad, Aaron Scott, Gregory Woodhead
In the past several decades, major advances in both systemic and locoregional therapies have been made for many cancer patients. This has led to modern cancer treatment algorithms frequently calling for active interventions by multiple subspecialists at the same time. One of the areas where this can be clearly seen is the concomitant use of locoregional and systemic therapies in patients with primary or secondary cancers of the liver. These combined algorithms have gained favor over the last decade and are largely focused on the allure of the combined ability to control systemic disease while at the same time addressing refractory/resistant clonal populations. While the general concept has gained favor and is likely to only increase in popularity with the continued establishment of viable immunotherapy treatments, for many patients questions remain. Lingering concerns over the increase in toxicity when combining treatment methods, patient selection, and sequencing remain for multiple cancer patient populations. While further work remains, some of these questions have been addressed in the literature. This article reviews the available data on three commonly treated primary and secondary cancers of the liver, namely, hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Furthermore, strengths and weaknesses are reviewed and future directions are discussed.
{"title":"Liver-Directed Therapy Combined with Systemic Therapy: Current Status and Future Directions","authors":"Shamar Young, Jack Hannallah, Dan Goldberg, Mohammad Khreiss, Rachna Shroff, Junaid Arshad, Aaron Scott, Gregory Woodhead","doi":"10.1055/s-0043-1777711","DOIUrl":"https://doi.org/10.1055/s-0043-1777711","url":null,"abstract":"<p>In the past several decades, major advances in both systemic and locoregional therapies have been made for many cancer patients. This has led to modern cancer treatment algorithms frequently calling for active interventions by multiple subspecialists at the same time. One of the areas where this can be clearly seen is the concomitant use of locoregional and systemic therapies in patients with primary or secondary cancers of the liver. These combined algorithms have gained favor over the last decade and are largely focused on the allure of the combined ability to control systemic disease while at the same time addressing refractory/resistant clonal populations. While the general concept has gained favor and is likely to only increase in popularity with the continued establishment of viable immunotherapy treatments, for many patients questions remain. Lingering concerns over the increase in toxicity when combining treatment methods, patient selection, and sequencing remain for multiple cancer patient populations. While further work remains, some of these questions have been addressed in the literature. This article reviews the available data on three commonly treated primary and secondary cancers of the liver, namely, hepatocellular carcinoma, cholangiocarcinoma, and metastatic colorectal cancer. Furthermore, strengths and weaknesses are reviewed and future directions are discussed.</p> ","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1777748
Tanvir Agnihotri, Abheek Ghosh, Ashley Lamba, Charles E Ray
{"title":"Endometriosis: An Overview.","authors":"Tanvir Agnihotri, Abheek Ghosh, Ashley Lamba, Charles E Ray","doi":"10.1055/s-0043-1777748","DOIUrl":"10.1055/s-0043-1777748","url":null,"abstract":"","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139562627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
McKenzie J. White, Eric H. Jensen, David G. Brauer
The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.
{"title":"A Review of Resection and Surgical Ablation for Primary and Secondary Liver Cancers","authors":"McKenzie J. White, Eric H. Jensen, David G. Brauer","doi":"10.1055/s-0043-1777747","DOIUrl":"https://doi.org/10.1055/s-0043-1777747","url":null,"abstract":"<p>The surgical management of primary and secondary liver tumors is constantly evolving. Patient selection, particularly with regard to determining resectability, is vital to the success of programs directed toward invasive treatments of liver tumors. Particular attention should be paid toward determining whether patients are best served with surgical resection or ablative therapies. A multidisciplinary approach is necessary to provide optimal care to patients with liver malignancy.</p> ","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Donna L. D'Souza, Ranjan Ragulojan, Chunxiao Guo, Connie M. Dale, Christopher J. Jones, Reza Talaie
Cryoablation is commonly used in the kidney, lung, breast, and soft tissue, but is an uncommon choice in the liver where radiofrequency ablation (RFA) and microwave ablation (MWA) predominate. This is in part for historical reasons due to serious complications that occurred with open hepatic cryoablation using early technology. More current technology combined with image-guided percutaneous approaches has ameliorated these issues and allowed cryoablation to become a safe and effective thermal ablation modality for treating liver tumors. Cryoablation has several advantages over RFA and MWA including the ability to visualize the ice ball, minimal procedural pain, and strong immunomodulatory effects. This article will review the current literature on cryoablation of primary and secondary liver tumors, with a focus on efficacy, safety, and immunogenic potential. Clinical scenarios when it may be more beneficial to use cryoablation over heat-based ablation in the liver, as well as directions for future research, will also be discussed.
冷冻消融常用于肾脏、肺部、乳腺和软组织,但在肝脏却不常用,因为肝脏主要是射频消融(RFA)和微波消融(MWA)。这在一定程度上是历史原因造成的,因为使用早期技术进行开放式肝脏冷冻消融时曾发生过严重的并发症。当前的技术与图像引导的经皮方法相结合,改善了这些问题,使冷冻消融术成为治疗肝脏肿瘤的一种安全有效的热消融方式。与 RFA 和 MWA 相比,冷冻消融术具有多项优势,包括冰球可视化、手术疼痛轻微、免疫调节作用强等。本文将回顾目前有关原发性和继发性肝肿瘤冷冻消融的文献,重点关注其疗效、安全性和免疫原性。文章还将讨论在哪些临床情况下使用冷冻消融术比使用热消融术对肝脏更有利,以及未来的研究方向。
{"title":"Thermal Ablation in the Liver: Heat versus Cold—What Is the Role of Cryoablation?","authors":"Donna L. D'Souza, Ranjan Ragulojan, Chunxiao Guo, Connie M. Dale, Christopher J. Jones, Reza Talaie","doi":"10.1055/s-0043-1777845","DOIUrl":"https://doi.org/10.1055/s-0043-1777845","url":null,"abstract":"<p>Cryoablation is commonly used in the kidney, lung, breast, and soft tissue, but is an uncommon choice in the liver where radiofrequency ablation (RFA) and microwave ablation (MWA) predominate. This is in part for historical reasons due to serious complications that occurred with open hepatic cryoablation using early technology. More current technology combined with image-guided percutaneous approaches has ameliorated these issues and allowed cryoablation to become a safe and effective thermal ablation modality for treating liver tumors. Cryoablation has several advantages over RFA and MWA including the ability to visualize the ice ball, minimal procedural pain, and strong immunomodulatory effects. This article will review the current literature on cryoablation of primary and secondary liver tumors, with a focus on efficacy, safety, and immunogenic potential. Clinical scenarios when it may be more beneficial to use cryoablation over heat-based ablation in the liver, as well as directions for future research, will also be discussed.</p> ","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139559969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-24eCollection Date: 2023-12-01DOI: 10.1055/s-0043-1777713
Sara Rostami, Jacob Miller, Nikhil Grandhi, Charles E Ray, Ali Kord
{"title":"Intravascular Ultrasound-Guided Retrieval of a Radiolucent Foreign Body from the Superior Vena Cava.","authors":"Sara Rostami, Jacob Miller, Nikhil Grandhi, Charles E Ray, Ali Kord","doi":"10.1055/s-0043-1777713","DOIUrl":"10.1055/s-0043-1777713","url":null,"abstract":"","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139562902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1774407
Mohammad-Kasim Fassia, Resmi Charalel, Adam D Talenfeld
While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.
{"title":"Demonstrating the Value of Interventional Radiology.","authors":"Mohammad-Kasim Fassia, Resmi Charalel, Adam D Talenfeld","doi":"10.1055/s-0043-1774407","DOIUrl":"https://doi.org/10.1055/s-0043-1774407","url":null,"abstract":"<p><p>While national healthcare expenditures per capita in the United States exceed those in all other Organisation for Economic Co-operation and Development (OECD) countries, measures of health outcomes in the United States lag behind those in peer nations. This combination of high healthcare spending and relatively poor health has led to attempts to identify high- and low-value healthcare services and to develop mechanisms to reimburse health care providers based on the value of the care delivered. This article investigates the meaning of value in healthcare and identifies specific services delivered by interventional radiologists that have accrued evidence that they meet criteria for high-value services. Recognizing the shift in reimbursement to high-value care, it is imperative that interventional radiology (IR) develop the evidence needed to articulate to all relevant stakeholders how IR contributes value to the system.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1774408
Joseph N McLaughlin, Daniel Lamus, Siddhi Hegde, Sanjeeva P Kalva
The authors report a case of endobronchial migration of a POD packing coil following embolization of a pulmonary artery pseudoaneurysm in a patient with cavitary tuberculosis and its successful management by bronchoscopy-assisted removal of the coil. Coil migration may be secondary to continued cough and persistence of a bronchial to pulmonary artery fistula from tuberculous infection and inflammation.
{"title":"Endobronchial Migration of a POD Packing Coil Following Embolization of a Pulmonary Artery Pseudoaneurysm.","authors":"Joseph N McLaughlin, Daniel Lamus, Siddhi Hegde, Sanjeeva P Kalva","doi":"10.1055/s-0043-1774408","DOIUrl":"https://doi.org/10.1055/s-0043-1774408","url":null,"abstract":"<p><p>The authors report a case of endobronchial migration of a POD packing coil following embolization of a pulmonary artery pseudoaneurysm in a patient with cavitary tuberculosis and its successful management by bronchoscopy-assisted removal of the coil. Coil migration may be secondary to continued cough and persistence of a bronchial to pulmonary artery fistula from tuberculous infection and inflammation.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622237/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1775841
Katharine L Krol
The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article describes the process and its implications for interventional radiology.
{"title":"How Medical Services Get Valued.","authors":"Katharine L Krol","doi":"10.1055/s-0043-1775841","DOIUrl":"https://doi.org/10.1055/s-0043-1775841","url":null,"abstract":"<p><p>The mechanisms for Medicare payment to physicians are complicated and, in fee for service Medicare, the value of a procedure code explicitly determines the payment to the physician and the out-of-pocket cost to the beneficiary. These codes are created and then valued for payment through a complex but reproducible and transparent process that allows for physician and specialty society input. This article describes the process and its implications for interventional radiology.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71491194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-02eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1775719
James B Spies
Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success.
{"title":"Communicating with Your Department Chair: A Primer on How to Advocate for Your IR Section.","authors":"James B Spies","doi":"10.1055/s-0043-1775719","DOIUrl":"https://doi.org/10.1055/s-0043-1775719","url":null,"abstract":"<p><p>Many interventional radiologists express concern about communicating their practice needs to their radiology department chairs. As a result, they may have difficulty getting support for hiring of additional physicians and staff, capital investments in equipment, and marketing of IR services. Some perceive that chairs have a preference for diagnostic radiology initiatives over interventional and want to know why. More importantly, they want to know how to approach their chair and succeed in their advocacy for IR. The key to success is understanding the perspective of the chair and the pressures and demands they face. That understanding allows the IR to propose their initiatives in a form that helps address some of the chair's needs and thus eases their path to success.</p>","PeriodicalId":48689,"journal":{"name":"Seminars in Interventional Radiology","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}