Invited scientific papers
101.4 - SIRFLOX study: a novel approach to define the depth of response (DpR) within a volumetric model in patients with metastatic colorectal cancer (mCRC)
V. Heinemann1, J. Ricke2, N.K. Sharma3, M.P. Findlay4, M. Peeters5, V. Gebski6, M. Van Buskirk7, P. Gibbs8, G.A. van Hazel9; 1Munich/DE, 2Magdeburg/DE, 3Reading, PA/US, 4Auckland/NZ, 5Antwerp/BE, 6Camperdown, NSW/AU, 7Chester, NJ/US, 8Melbourne, VIC/AU, 9Perth, WA/AU
presented by T.K. Helmberger, Munich/DE
presented in session
CF 101 - Colorectal cancer patients - the challenge
Sunday, April 23, 08:30-10:00, Main Auditorium (Sala A1)
Purpose: To assess DpR based on independent blinded reader RECIST data from SIRFLOX: a comparison of first-line FOLFOX (±bev) + Y-90 resin microspheres [SIRT] and FOLFOX (±bev) alone [Control] in patients with non-resectable, liver-only or liver-dominant mCRC.
Material and methods: Spherical tumor volume was estimated from the longest unidimensional length for ≤5 target hepatic lesions (RECIST 1.0) in the SIRFLOX ITT population. Modelling was used to identify potential predictors of DpR.
Results: The decrease in median liver tumor volume in SIRT vs. con¬trol was −75% vs. −68% (P=0.036). Deepest response (median time to nadir) occurred 60 days later in SIRT compared with control (266 vs. 206 days; P<0.001). A larger treatment effect and longer time to nadir were observed in patients with >12% hepatic tumor burden (median DpR −90% in SIRT vs. −77% in Control, P=0.003; median nadir 298 vs. 196 days, P<0.001), compared to those with ≤12% tumor burden (median DpR −93% vs. −94%, P=0.763; median nadir 243.5 vs. 220 days, P=0.152). PFS in the liver by competing risk analy¬sis was significantly longer in patients with >12% hepatic tumor bur¬den receiving SIRT vs. control (median 27.2 vs. 13.1 months, P=0.003), whereas complete response [CR] for SIRT vs. control was more com¬mon in patients with ≤12% liver tumor burden (12.9% vs. 3.5%; P=0.001).
Conclusion: In SIRFLOX, the addition of SIRT to standard chemo¬therapy significantly increased hepatic DpR. The impact of SIRT on PFS was greatest in patients with a baseline tumor burden >12%, whereas the impact on CR rate was greater where tumor burden was <12%.
402.4 - Antitumour magnetic hyperthermia induced by RGD functionalized Fe3O4 nanoparticles, in an experimental model of colorectal liver metastases
O.K. Arriortua1, E. Garaio1, B. Herrero de la Parte1, M. Insausti1,2, L. Lezama1,2, F. Plazaola1,
J. Angel García1,2, J.M. Aizpurua3, M. Sagartzazu3, M. Irazola1, N. Etxebarria1, I. García-Alonso1,
A. Saiz-López4, J.J. Echevarria-Uraga4; 1Bilbao/ES, 2Derio/ES, 3Donostia/ES, 4Galdakao/ES
presented in session
'TF 402 - Cutting-edge developments'
Sunday, April 23, 15:00-16:30, Auditorium 2 (Barria Room 1)
There has been an important advance in the study of magnetic nanoparticles (MNPs) due to their application in different research fields such as magnetic hyperthermia. Nanotherapy based on targeted nanoparticles could become an attractive alternative to conventional oncologic treatments as it allows a local heating in tumoral surroundings without damage to healthy tissues. RGD peptide conjugated magnetite nanoparticles have been designed to specifically target αvβ3 receptor-expressing cancer cells, being bound the RGD peptides by “click chemistry” due to its selectivity and applicability. Thermal decomposition of iron metallo-organic precursors have yield Fe3O4 homogeneous nanoparticles which have been properly functionalized with RGD peptides and the preparation of magnetic fluids has been achieved. The nanoparticles have been characterized by means of transmission electron microscopy (TEM), vibrating sample magnetometer (VSM), electron magnetic resonance spectroscopy (EMR) and magnetic hyperthermia. The nanoparticles present superparamagnetic behavior with very high magnetization values, which yield hyperthermia values above 500 W/g for magnetic fluids. These fluids have been administrated to rats, but instead of injecting the fluids of MNPs directly into liver tumours, intravascular administration of MNPs in animals with induced colorectal tumours has been performed; afterwards the animals have been exposed to an alternating magnetic field, in order to achieve hyperthermia. Thus, the evolution in an in vivo model has been described, obtaining a significant reduction in tumour viability.
published in Beilstein J Nanotechnol. 2016; 7: 1532–1542. Published online 2016 Oct 28. doi: 10.3762/bjnano.7.147
801.3 - Multi-center study of metastatic lung tumors targeted by interventional cryoablation evaluation (SOLSTICE): preliminary safety outcomes
P.W. Eiken1, T. de Baère2, F. Deschamps2, J. Palussière3, X. Buy3, M.R. Callstrom1,
D.A. Woodrum1, F. Abtin4, R.D. Suh4, B. Pua5, D.C. Madoff5, D. Papadouris6, S. Bagla6,
D.E. Dupuy7, T. Healey7, W. Moore8, S.B. Solomon5, H. Yarmohammadi5, H. Krebs9;
1Rochester, MN/US, 2Villejuif/FR, 3Bordeaux/FR, 4Los Angeles, CA/US, 5New York, NY/US, 6Alexandria, VA/US, 7Providence, RI/US, 8Stony Brook, NY/US, 9Newnan, GA/US
presented in session
'CF 801 - Lung metastases'
Monday, April 24, 08:30-10:00, Main Auditorium (Sala A1)
Purpose: To assess the safety of percutaneous cryoablation for treatment of pulmonary metastases ≤ 3.5 cm.
Material and methods: Patients with up to 6 pulmonary metastases were treated in a multicenter, prospective study with CT-guided percutaneous cryoablation. Patient follow-up was performed at 1 week and 3, 6, 12, and 24 months. Complications were assessed using the CTCAE 4.03.
Results: Two-hundred nineteen tumors in 126 patients (64 males, 62 females; mean age 64 years) were treated over 163 procedures, constituting the largest prospective multicenter lung cryoablation trial to date. Sixty-two percent (n=78) of the patients had 1 tumor, and 40% had 2 or more. Mean tumor size was 1.2 cm (0.4–4.5 cm). General anesthesia was employed in 69% (n=113) of procedures, conscious sedation in 29% (n=47), and local anesthesia in 2% (n=3). Treatment time ranged from 30 to 225 min. (mean=72.9 min). Ninety-eight procedure-related events occurred within 30 days of the treatment. Thirty-seven percent were classified CTCAE grade 1 (n=36), 57% grade 2 (n=57), 5% grade 3 (n=5), and 1% grade 4 (n=1). The most frequent event was pneumothorax, of which 8% (n=4) were grade 1, 83% (n=40) grade 2, and 8% (n=4) grade 3. Six percent (n=6) of all events were grade 3 or higher: grade 3 pneumothoraces (n=4), grade 3 pleural hemorrhage (n=1), and grade 4 gas embolism (n=1). All events resolved without further sequelae.
Conclusion: Percutaneous CT-guided cryoablation demonstrates an acceptable safety profile for treatment of lung metastases ≤ 3.5 cm.
1202.3 - Microwave ablation for lung neoplasms: a retrospective analysis of long-term results
T.T. Healey, B.T. March, G. Baird, D.E. Dupuy; Providence, RI/US
presented in session
'CF 1202 - Primary lung cancer'
Monday, April 24, 17:00-18:30, Auditorium 2 (Barria Room 1)
Purpose: To determine the long-term safety and efficacy of microwave (MW) ablation in the treatment of lung tumors at a single academic medical center.
Materials and Methods: Retrospective review was performed of 108 patients (42 female; mean age, 72.5 y ± 10.3 [standard deviation]) who underwent computed tomography (CT)-guided percutaneous MW ablation for a single lung malignancy. Eighty-two were primary non-small-cell lung cancers and 24 were metastatic tumors (9 colorectal carcinoma, 2 renal-cell carcinoma, 4 sarcoma, 2 lung, and 7 other). Mean maximum tumor diameter was 29.6 mm ± 17.2. Patient clinical and imaging data were reviewed. Statistical analysis was performed by Kaplan-Meier modeling and logistic regression.
Results: Odds of primary technical success were 11.1 times higher for tumors < 3 cm vs those > 3 cm (95% confidence interval [CI], 2.97-41.1; P = .0003). For every millimeter increase in original tumor maximal diameter (OMD), the odds of not attaining success increased by 7% (95% CI, 3%-10%; P = .0002). For every millimeter increase in OMD, the odds of complications increased by 3% (95% CI, 0.1%-5%; P = .04). Median time to tumor recurrence was 62 months (95% CI, 29, upper bound not reached; range, 0.2-96.6 mo). Recurrence rates were estimated at 22%, 36%, and 44% at 1, 2, and 3 years, respectively. Recurrence rates were estimated at 31% at 13 months for tumors > 3 cm and 17% for those < 3 cm. Complications included pneumothorax (32%), unplanned hospital admission (28%), pain (20%), infection (7%), and postablation syndrome (4%).
Conclusions: This study further supports the safe and effective use of MW ablation for the treatment of lung tumors.
published in J Vasc Interv Radiol. 2017 Feb;28(2):206-211. doi: 10.1016/j.jvir.2016.10.030. Epub 2016 Dec 18.
1501.4 - Percutaneous thermal ablation of breast cancer metastases in oligometastatic patients
M. Barral1, A. Auperin1, A. Hakimé1, V. Cartier1, V. Tacher1, Y. Otmezguine2, L. Tselikas1,
T. de Baère1, F. Deschamps1; 1Villejuif/FR, 2Boulogne-Billancourt/FR
presented in session
'CF 1501 - Breast cancer patients - the IO add-on'
Tuesday, April 25, 08:30-10:00, Auditorium 2 (Barria Room 1)
Objective: To evaluate prognostic factors associated with local control and disease-free-survival (DFS) of oligometastatic breast cancer patients treated by percutaneous thermal ablation (PTA).
Materials and Methods: Seventy-nine consecutive patients (54.5 ± 11.2 years old) with 114 breast cancer metastases (28.9 ± 16.1 mm in diameter), involving the lungs, the liver, and/or the bone, were treated using PTA with a curative intent. The goal was to achieve a complete remission in association with systemic chemotherapy and hormonal therapy. We retrospectively evaluated the prognostic factors associated with 1- and 2-year local control and the 1- and 2-year DFS rates.
Results: The 1- and 2-year local control rates were 83.0 and 76.1 %, respectively. Tumor burden was associated with a poorer outcome for local control after PTA (HR 1.027 by additional millimeter, p = 0.026; >4 cm HR 3.90). The 1- and 2-year DFS rates were 54.2 and 30.4 %, respectively. In multivariate analysis, triple-negative histological subtype and increased size of treated metastases were associated with a poorer DFS (HR 2.22; 95 % CI [1.13–4.36]; p = 0.02 and HR 2.43; 95 % CI [1.22–4.82]; p = 0.011, respectively).
Conclusion: PTA is effective for local control of breast cancer oligometastases. Tumor burden >4 cm and triple-negative histological subtype are associated with a poorer outcome.
published in CardioVascular and Interventional Radiology, June 2016, Volume 39, Issue 6, pp 885–893
1601.3 - Percutaneous internal fixation to prevent impeding pathological hip fractures: a 1-year follow-up study
F. Deschamps1, T. Carteret2, L. Tselikas1, B. Lapuyade2, T. de Baère1, F. Cornelis2; 1Villejuif/FR, 2Bordeaux/FR
presented in session
'CF 1601 - MSK tumours beyond the spine'
Tuesday, April 25, 10:30-12:00, Auditorium 2 (Barria Room 1)
Purpose: A percutaneous internal fixation device (Y-STRUT®, Hyprevention) has been developed to prevent hip fractures in case of osteolytic metastases located in the femoral neck. Tolerance of Y-STRUT® and the related operative procedure has been prospectively evaluated in this multicenter pilot study.
Material and methods: A total of 12 cancer patients have been considered for prophylactic consolidation in 2 different hospitals. These consolidations were performed percutaneously under fluoroscopic guidance by interventional radiologists. All patients presented a high risk of hip fracture (Mirels score ≥8). Patients were followed by medical consultations and radiographic exams.
Results: Two patients suffered from a fracture that occurred prior to the prophylactic consolidation and were excluded from the study analysis. Ten patients (40% females, mean 61±6 years) were treated for impending pathological fractures (mean Mirels score 9±1). All the procedures were performed with success. Average hospitalization was 2.3±1.4 days. Four of the 10 patients were discharged the day following the intervention, indicating that the implantation could be performed as an ambulatory procedure. Wound healing was achieved in all cases with no access site complication. Mean pain decreased from 3.6±2.9 at baseline to 2.4±0.9 at 2 months. During the follow-up, 6 patients deceased from severe progression of their underlying cancer after a mean follow-up of 142 days (24–324). All survival patients have reached a follow-up of 1 year.
Conclusion: Preliminary results demonstrated the feasibility and the safety of Y-STRUT® implantation as well as the tolerance of the device.
1901.3 - The Metastatic Spine Disease Multidisciplinary Working Group algorithms
A.N. Wallace1, C.G. Robinson1, J. Meyer2, N.D. Tran3, A. Gangi4, M.R. Callstrom5, S.T. Chao6,
B.A. Van Tine1, J.M. Morris5, B.M. Bruel7, J. Long1, R.D. Timmerman2, J.M. Buchowski1,
J.W. Jennings1; 1Saint Louis, MO/US, 2Dallas, TX/US, 3Tampa, FL/US, 4Strasbourg/FR,
5Rochester, MN/US, 6Cleveland, OH/US, 7Houston, TX/US
presented in session
'CF 1901 - Spinal tumours'
Tuesday, April 25, 17:00-18:30, Main Auditorium (Sala A1)
The Metastatic Spine Disease Multidisciplinary Working Group consists of medical and radiation oncologists, surgeons, and interventional radiologists from multiple comprehensive cancer centers who have developed evidence- and expert opinion-based algorithms for managing metastatic spine disease. The purpose of these algorithms is to facilitate interdisciplinary referrals by providing physicians with straightforward recommendations regarding the use of available treatment options, including emerging modalities such as stereotactic body radiation therapy and percutaneous tumor ablation. This consensus document details the evidence supporting the Working Group algorithms and includes illustrative cases to demonstrate how the algorithms may be applied.
published in Oncologist. 2015 Oct; 20(10): 1205-1215