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Chapter31:Palliative procedures for ascites and eusion
repeated thoracentesis for temporary symptom relief may be
benecial. Otherwise, most patients with malignant eusions
require some type of permanent drainage.
instructed to drain up to 1,000mL of uid every other day.17
ey are asked to record the amount of drainage in each session. If the drainage drops below 25mL on three consecutive
sessions, the patient should be investigated with a chest radio-
Chest drainage catheters
Chest drainage is performed using either pigtail catheters or
tunneled (PleurX or Asept) catheters. ese are outpatient
procedures and are performed under conscious sedation using
ultrasonographic and uoroscopic guidance.
graph in two views. If no residual eusion is detected, the catheter can be removed. If there is a residual eusion despite low
drainage, it is recommended to administer tissue plasminogen
activator into the catheter.17 is will usually improve drainage
and re-establish patency. If this method is not successful the
catheter may need to be replaced or repositioned.
Pigtail catheters
e catheters are made of silicone or polyurethane. e
sizes that are used as chest tubes range from 8 to 16F. While
small-bore chest tubes are adequate for treating pneumothorax,
they easily clog with protein-rich pleural uid, so larger drains
(12–16F) should be used for uid management. Non-tunneled
catheters are benecial when the pleural eusion is multiloculated and not free-owing. ese catheters are mainly used for
admitted patients and are placed to a Pleurovac. Once the daily
drainage is less than 25mL, a chest radiograph in two views
(posteroanterior and lateral views) is obtained. If the eusion
has resolved, the catheter can be removed. If the chest radiograph demonstrates residual eusion, the catheter can be repositioned or upsized using uoroscopic guidance. Alternatively,
tissue plasminogen activator can be injected into the catheter.
Summary of recommendations and guidelines
e best management strategy depends on the characteristic
of the uid, status of the disease, life expectancy and patients’
personal preference.
1. Diuretics and sodium restriction form the rst line of therapy, and are eective in approximately 40–44% of patients
with malignant ascites.
2. Large-volume paracentesis is indicated in all patients who
do not respond to diuretics and diet restriction.
3. Once the frequency of large-volume paracentesis
becomes burdensome, catheter drainage is recommended.
Treatment options depend on the patient’s life expectancy
and preferences:
Tunneled catheters
When the eusion is free-owing, a tunneled catheter is used
(Figure31.8). e eusion is drained intermittently using vacuum bottles by the patient or care giver at home. Patients are
a. If life expectancy is less than 1month, and the ascites
is not loculated, a tunneled catheter can be used. If the
ascites is loculated, pigtail catheters can also beused.
b. If life expectancy is more than 1month, and the ascites
is not loculated and the patient has no contraindications, then Denver shunt placement is recommended.
c. If life expectancy is more than 1month, and the ascites
is not loculated and Denver shunt is contraindicated,
then a tunneled catheter can be placed.
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332
Index
ablative margin
microwave ablation,8
radiofrequency ablation,8
absolute ethanol
embolization material,36–37
accessory le gastric artery (LGA),
108–109
acetaminophen,299
adrenal arteries,118
Adriamycin, 120, 150
Anitor, 168–169
alprazolam,309
American Association for the Study
of Liver Diseases (AASLD)
guidelines,91
amikacin,292
anorexia and weight loss, 306–307
anterior superior
pancreaticoduodenal artery
(PDA),110
antidepressants, 308–309
anxiety in cancer patients
management,309
apixaban,289
as low as reasonably achievable
(ALARA) principle,69
ascites
cancers associated with,323
causes,323
denition,323
diagnostic tests,323
malignant ascites,323
management,307
Asept catheter,326
Cope-type loop catheter,325
diuretics, 323–324
furosemide, 323–324
immunotherapy,328
intraperitoneal
chemotherapy,328
large-volume paracentesis,324
peritoneal
Port-A-Catheters,326
peritoneovenous shunts,
326–328
permanent indwelling
catheters, 324–328
pigtail catheter,325
PleurX catheter,326
role of palliative therapies,323
sodium restriction, 323–324
spironolactone, 323–324
summary of recommendations
and guidelines,329
targeted therapy,328
Tenckho catheter, 325–326
transjugular intrahepatic
portosystemic shunts
(TIPS),328
pathophysiology of malignant
ascites,323
refractory ascites,323
Asian Pacic Association for the
Study of Liver (APASL),91
axitinib,211
balloon kyphoplasty,255
Barcelona Clinic Liver Cancer
(BCLC) classication,91
benzodiazepines,309
bereavement support,294
bevacizumab, 58, 59, 149, 211, 288
biliary injury
related to 90Y treatment,161
biliary plexus, 111–112
bisphosphonates,302
blood–brain barrier(BBB)
disruption using HIFU,30–31
bone augmentation, 255
See also cementoplasty
bone metastases
bone lesions and fractures,255
cementoplasty,255
bone cement properties,
259
complications,258–259
contraindications,255
ecacy,258–259
hybrid stabilization techniques,
259–262
indications,255
osteoplasty, 259–262
PMMA properties, 259
postprocedural care and
follow-up,259
pre-procedural care,256
sacroplasty, 259–262
technique, 256–258
hybrid stabilization techniques,
259–262
incidence,243
pain associated with,243
pain management approaches,243
pain management options, 255,
302
percutaneous thermal
ablation,243
contraindications,244
cryoablation pain palliation
outcomes, 250–252
cryoablation technique,
248–250
eectiveness of pain
palliation,252
emerging technologies,252
indications for ablation
treatment, 243–244
laser ablation,252
magnetic resonance focused
ultrasound (MRgFUS),252
microwave ablation,252
pre-procedural imaging,244
radiofrequency ablation
pain palliation outcomes,
245–248
radiofrequency ablation
technique, 244–246
bone tumors
high-intensity focused ultrasound
(HIFU),27–29
brachytherapy,158
BRAF status, 148, 149, 150
breaking badnews
communication with cancer
patients, 296–298
breast cancer
high-intensity focused ultrasound
(HIFU),25–28
buspirone,309
C-arm CT,40–41
cancer anorexia–cachexia syndrome,
306–307
Candida spp.,291
capecitabine, 149, 168
CAPOX,149
CapTem,169
carcinoembryonic antigen
(CEA),148
care coordination in advanced
cancer patients,310
celecoxib,299
celiac plexus neurolysis, 315–319
an at omy, 315–316
antecrural approach, 317–318
approach, 316–319
complications, 318–319
outcomes,318
positioning and approach,
316–317
retrocrural approach, 318–319
technique, 316–317
celiac trunk anatomy, 100–104
celiac occlusion, 100–103
celiac stenosis, 100–103
normal anatomy and variations,
100–102
cementoplasty
bone cement properties, 259
complications,258–259
contraindications,255
ecacy,258–259
hybrid stabilization techniques,
259–262
indications,255
osteoplasty, 259–262
PMMA properties, 259
postprocedural care and
follow-up,259
pre-procedural care,256
sacroplasty, 259–262
technique, 256–258
cetuximab, 58–59, 148, 288
chemoembolization
basic principle, 38
See also transarterial
chemoembolization(TACE)
chemotherapy
combining with radiofrequency
ablation,9–10
HAI combined with best systemic
chemotherapy,59–60
chemotherapy-induced peripheral
neuropathy (CIPN),298
Child–Pugh classication of liver
cancer,92
cisplatin, 38, 120, 121, 136, 150
clinical trials in interventional
oncology,1–2
clonazepam,309
codeine,300
colic branches
extrahepatic collateral arteries
(EHCs),118
colorectal cancer
prognosis,148
colorectal liver metastases. See liver
metastases (colorectal)
combination therapies,125
common hepatic artery (CHA),108
communication with cancer
patients,295
breaking bad news, 296–298
prognostication, 295–296
constipation in cancer patients,
304–306
333
Index
constitutional symptoms
management of, 306–307
contrast-enhanced MRI
(CE-MRI),78–79
volumetric approach,79–80
cystic artery, 111–112
dabigatran,289
DC Beads, 151, 152
depression in cancer patients
management, 307–309
dexamethasone,288
diabetic peripheral neuropathy,298
diclofenac,299
diusion-weighted MRI
(DW-MRI),78–79
volumetric approach,79–80
dorsal pancreatic artery,110
doxorubicin, 9, 38, 120, 121, 150, 151
drug-eluting bead TACE
(DEB-TACE), 39–40, 120
clinical outcome, 124–125
combination therapies,125
complications,124
concept, 120–121
contraindications, 121–122
evaluation of treatment response,
123–124
follow-up, 123–124
future developments,125
materials used, 120–121
patient selection, 121–122
polymer-based microspheres,
120–121
side eects,124
technique, 121–123
Eastern Cooperative Oncology
Group (ECOG),128
electroporation
denition,13
embolization
denition,35
embolotherapy. See tumor
embolotherapy
epidermal growth factor receptor
(EGFR),58
epidermal growth factor receptor
(EGFR) inhibitors, 148, 149
epirubicin,121
Erbitux,148
Escherichia coli,292
ethiodized oil,150
etodolac,299
European Association for the Study
of the Liver (EASL),91
everolimus, 168–169, 211
external-beam radiation therapy
(EBRT),197
extrahepatic biliary cancer
bile duct obstruction,193
endoscopic drainage and stenting,
193–195
intraluminal brachytherapy,
197–199
photodynamic therapy, 195–197
radiotherapy, 197–199
stenting, 193–195
surgical resection,193
systemic chemotherapy,193
extrahepatic collateral arteries
(EHCs), 111–118
adrenal arteries,118
an at omy, 116–118
blood supply to hepatic tumors,
111–115
colic branches,118
gastric arteries,118
how to predict, 113–116
inferior phrenic arteries
(IPA),116
intercostal arteries,117
internal mammary arteries
(IMA),117
lumbar arteries,117
omental arteries, 117–118
renal and renal capsular
arteries,118
suggestive ndings, 113–116
transcatheter management of
EHCs,118
fatigue in cancer patients, 306–307
fentanyl,300
transdermal patch,300
oxuridine,288
use for colorectal liver metastases,
53–54, 57
5-uorouracil (5-FU), 149, 150, 151,
287–288
use for colorectal liver metastases,
54–55, 57
focused ultrasound (FUS). See
high-intensity focused
ultrasound(HIFU)
FOLFIRI, 149, 150, 154, 288
FOLFOX, 149, 288
FOLFOXIRI,288
folinic acid,288
fondaparinux,289
FUDR, 287–288
use for colorectal liver metastases,
53–54, 57
functional status assessment,
295–296
furosemide, 323–324
ganglion impar neurolysis,321
an at omy,321
complications,321
outcomes,321
technique,321
gastric arteries,118
Gelfoam
embolization material,35–36
gemcitabine,136
Glasgow Prognostic Score
(GPS),295
Hepaspheres, 121, 151
hepatic arterial infusion (HAI),52
5-uorouracil (5-FU),54–55
aims and assumptions,52–53
combination chemotherapy
administration,57–58
combined with best systemic
chemotherapy,59–60
consideration of drug
properties,53
decreased systemic exposure,53
oxuridine (FUDR), 53–54, 57
5-uorouracil (5-FU),57
future research,60
increased local
concentrations,52–53
increased therapeutic
response,53
irinotecan, 55–56, 57
irinotecan-loaded drug-eluting
beads (DEBIRI),58
oxaliplatin,56–57
pharmacology,60–61
therapeutic monoclonal
antibodies,58–59
hepatic artery anatomy, 104–107
normal anatomy, 104–105
segmental location of liver
tumors, 106–107
variations in intrahepatic
branching of segmental
hepatic arteries, 105–106
variations in origin and anatomic
course, 104–105
hepatic artery infusion
chemotherapy (HAIC)
catheter/port placement success
rate,287
chemotherapy, 287–288
contraindications, 285–287
indications,283
placement of catheter/port,
284–287
rationale for, 283–284
hepatic falciform artery (HFA),
109–110
hepatic intra-arterialport
access route,284
arterial ow remodeling, 284–286
catheter positioning, 284–285
catheter/port placement success
rate,287
chemotherapy, 287–288
contraindications, 285–287
indications for HAIC,283
placement of catheter/port for
HAIC, 284–287
rationale for HAIC, 283–284
hepatic vascular anatomy,100
celiac trunk anatomy, 100–104
extrahepatic collateral arteries
(EHCs), 111–118
hepatic artery anatomy, 104–107
non-hepatic arteries arising from
hepatic arteries, 106–112
hepatocellular carcinoma(HCC)
assessment,85–87
Barcelona Clinic Liver Cancer
(BCLC) classication,91
Child–Pugh classication,92
classication systems,91
detection,85
diagnostic criteria,85–86
early diagnosis,91
early-stage HCC,92–95
HAIC chemotherapy, 287–288
high-intensity focused ultrasound
(HIFU),26–30
Hong Kong Liver Cancer (HKLC)
staging system,91
image-guided ablation methods
and techniques,95–96
incidence,85, 91
indications for HAIC,283
indications for image-guided
ablation,91
irreversible electroporation
(IRE),95–96
microwave ablation,95
placement of catheter/port for
HAIC, 284–287
rationale for HAIC, 283–284
risk factors,85
role of image-guided ablation
techniques,95–97
staging systems,86–87
therapeutic options, 85
triage,87–88
early-stage,87–88
future developments,89
image-guided ablation,87–88
intermediate-advanced
stage,88
liver transplantation,87
sorafenib,88
surgical resection,87
systemic treatment,88
TACE,88
transarterial treatment,88
yttrium 90 (90Y)
radioembolization,88
very-early-stage HCC,91–92
hepatocyte growth factor
(HGF),177
herpes zoster infection
(shingles),298
high-intensity focused ultrasound
(HIFU),20
ablation,20–22
blood–brain barrier (BBB)
disruption,30–31
bone tumors,27–29
breast cancer,25–28
cavitation,23
clinical applications,24–29
emerging applications,29–31
enhanced drug delivery to
tumors,23
future development,31
hepatocellular carcinoma,26–30
HIFU devices,24
history,20
histotripsy,23
hyperthermia,22
imaging guidance,23–24
mechanical eects,23
microstreaming,23
MRI guidance,23–24
prostate cancer,25
radiation forces,23
system technology,23–24
targeted drug delivery,29–30
thermal dose concept,22–23
thermal eects,20–22
transducer design,22
ultrasound eld generation,22
ultrasound guidance,23
histotripsy,23
holmium-166 (
166
Ho) poly
-lactic acid (PLLA)
microspheres,45
Hong Kong Liver Cancer (HKLC)
staging system,91
hospice care, 294–295
hydrocodone,300
hydromorphone,300
hypoxia inducible factor-1
(HIF-1),125
ibuprofen,299
image-guided ablation
early-stage HCC,92–95
evolving methods and
techniques,95–96
very-early-stage HCC,91–92
image-guided minimally invasive
ablation therapies
aims,3
typesof,3
image-guided nveurolysis
celiac plexus neurolysis, 315–319
denition of neurolysis,315
ganglion impar neurolysis,321
imaging modalities,315
neurolytic agents,315
334
Index
role in cancer pain
management,315
superior hypogastric neurolysis,
319–321
imaging
advances in real-time imaging,66
contrast agents,66–67
developments for interventional
oncology,65–69
for procedure planning,65
for therapy assessment,70–71
functions in interventional
oncology,65
image registration and
fusion,67–68
intraprocedural
monitoring,69–70
navigation,68
open access to the patient,69
radiation exposure,69
robotics,68–69
three-dimensionality,66
inferior phrenic arteries (IPA),116
intensity-modulated radiation
therapy (IMRT),197
intercostal arteries,117
interferon-α,211
interleukin-2,211
internal mammary arteries
(IMA),117
interventional oncology
building an IO practice,1
clinical trials,1–2
developments in imaging,65–69
embolotherapy,220
neuroendocrine tumors
(NETs),173
palliative care,310
role in multidisciplinary
oncologic care,1
role of the interventional
oncologist, 173, 220, 310
use of imaging,65
intrahepatic cholangiocarcinoma
assessment, 134–135
chemoembolization, 136–137
curative therapies, 134–136
developments in
management,134
diagnosis,134
incidence,134
liver transplantation
outcomes,128
multidisciplinary approach,137
non-curative therapies, 136–137
percutaneous ablation,136
progression,134
radioembolization (90Y),137
resection outcomes, 134–135
risk factors,134
staging, 134–135
triage, 134–135
irinotecan, 121, 149, 151, 287, 288
use for colorectal liver metastases,
55–56, 57
irinotecan-loaded drug-eluting
beads (DEBIRI),58
irreversible electroporation(IRE)
ablation probes,16
anesthesia requirements,13–15
applications,13–14
approach by physicians,18
clinical considerations,16–18
clinical experience,17–18
denition,13
electrical eld strength,13–14
equipment,16
in hepatocellular
carcinoma,95–96
largely non-thermal
mechanism,13–14
neuromuscular stimulation,13–15
number of pulses,15
numerical simulations,15–16
physiological eects,13–15
probe placement and
technique,13–15
pulse length,14–15
selection of pulse
parameters,13–15
theoretical models,15
Joule–ompson eect,224
Karnofsky Performance Status (KPS)
scale, 295–296
KRAS status, 148, 149, 150
kyphoplasty,255
lanreotide,169
laser-based ablation
pulsed-energy techniques,8
laser-induced interstitial
thermotherapy (LITT),142
LC Beads, 120–121, 151
le inferior phrenic artery (IPA),110
leucovorin, 149, 150, 288
linezolid,308
lipiodol,150
lipiodol chemoembolization,38–39
Lipiodol Ultrauoride,120
liposomal doxorubicin,9
liver cancer
drug-eluting bead TACE
(DEB-TACE),120
intra-arterial therapies,120
need for alternatives to surgical
therapies,120
transarterial chemoembolization
(TACE),120
yttrium 90 (90Y)
radioembolization, 89, 128
See also hepatocellular
carcinoma; intrahepatic
cholangiocarcinoma; liver
metastases
liver metastases (colorectal)
ablation,149
chemoembolization,149
outcomes,153
patient selection,150
regimens,150
technical aspects, 151–152
cryoablation,141
drug-eluting microspheres,
150–151
delivery endpoints,153
drug loading,152
embolization technique,
152–153
outcomes, 154–155
peri- and intraprocedural
management,153
preclinical animal testing,151
technical aspects, 152–153
oxuridine (FUDR), 53–54, 57
5-uorouracil (5-FU), 54–55, 57
HAIC chemotherapy, 287–288
image-guided percutaneous
ablation therapies,139
incidence, 139, 148
indications for HAIC,283
indications for image-guided
ablation,139
intra-arterial chemoinfusion,149
irinotecan, 55–56, 57
irreversible electroporation
(IRE),142
laser-induced interstitial
thermotherapy (LITT),142
microwave ablation, 141–142
oxaliplatin,56–57
patient assessment,148
placement of catheter/port for
HAIC, 284–287
prognosis of colorectal
cancer,148
radioembolization,158
biliary injury,161
CT/PET evaluation of tumor
response,161
dosimetry and dose
calculation, 159–160
GI ulceration, 160
lung radiation dose
calculation,160
lymphopenia,161
pancreatitis, 160
patient presentation, 158–159
patient selection, 158–159
postembolization
syndrome,160
postprocedure
considerations,160
preimplantation work-up
procedure,159
radiation cholecystitis,161
radiation gastritis, 160
radiation hepatitis,161
radiation pneumonitis,161
radioembolic products,158
review of studies, 161–163
role of 90Y therapy,163
side eects and toxicities,
160–161
treatment process,159
radiofrequency ablation, 139–141
rationale for HAIC, 283–284
resection, 148–149
role of image-guided ablation in
management, 142–144
surgical resection,139
systemic therapy,149
therapeutic monoclonal
antibodies,58–59
therapeutic options, 139, 158
triage, 148–149
liver metastases (NETs), 165–166
diagnosis, 165–167
hepatic arterial therapy, 170–173
image-guided therapy, 169–173
multidisciplinary triage,167
prognosis,167
role of the interventional
oncologist,173
surgical management, 168–169
systemic therapies, 168–169
tumor ablation, 169–170
liver regeneration
compensatory hyperplasia,
176–177
hepatocyte growth factor
(HGF),177
hypertrophy aer PVE or
resection, 176–177
mechanisms, 176–177
rate of,177
liver resection
preoperative portal vein
embolization (PVE),176
risk of complications,176
role of preoperative PVE, 187–188
liver transplantation
outcomes in intrahepatic
cholangiocarcinoma,128
lumbar arteries,117
lung cancer
treatment options, 223
See also thoracic malignancies
lymphopenia
related to 90Y treatment,161
magnetic resonance focused
ultrasound (MRgFUS),252
major depressive disorder (MDD),
307–308
malignant eusions
chest drainage catheters,329
management, 328–329
thoracentesis, 328–329
medical symptom management
constipation, 304–306
general principles,298
nausea and vomiting, 302–304
pain management, 298–302
meperidine,300
methadone,300
microspheres
embolic material,37
microstreaming,23
microwave ablation
applications,3–4
benets and trade-os,6
biology of heating,4–5
comparison with radiofrequency
ablation,6
eects of tissue factors,5–6
features of successful tumor
ablation,10
future directions,10
in hepatocellular carcinoma,95
operator and technique,8
ablative margin,8
ancillary techniques,9
choice of applicator,8
combination therapies,9
overlapping techniques,8–9
patient selection,10
principles for eective
ablation,3–4
technology,6
cooling systems,8
multiapplicator arrays,6–7
multitine applicators,7
technology pulsed-energy
techniques,8
mitomycin,136
mitomycin C, 38, 120, 136, 150
monoclonal antibodies
use for colorectal liver
metastases,58–59
morphine, 299, 300
sustained-release formulation,300
multiple endocrine neoplasia,165
nalbuphine,299
naproxyn,299
nausea and vomiting
management, 302–304
neuroendocrine tumors (NETs)
classication, 165–166
denition, 165–166
demographics,165
diagnosis, 165–167
335
Index
neuroendocrine tumors (NETs)
(cont.)
hepatic arterial therapy, 170–173
image-guided therapy, 169–173
incidevnce, 165–166
metastases, 165–166, 167
multidisciplinary triage,167
prevalence,165
prognosis,167
role of the interventional
oncologist,173
surgical management, 168–169
systemic therapies, 168–169
tumor ablation, 169–170
neurobromatosis,165
neurolysis. See image-guided
neurolysis
non-hepatic arteries arising from
hepatic arteries, 106–112
accessory le gastric artery
(LGA), 108–109
biliary plexus, 111–112
consequences of inadvertent
infusion, 106–107
cystic artery, 111–112
denition of non-hepatic
artery,106
detection of non-hepatic arteries,
106–108
hepatic falciform artery (HFA),
109–110
le inferior phrenic artery
(IPA),110
pancreaticoduodenal arcades,
110–111
prevention of infusion of
therapeutic agents, 106–107
right gastric artery (RGA),
107–109
superselective catheterization
procedure, 106–107
non-steroidal anti-inammatory
drugs (NSAIDs),299
octreotide, 168, 169
omental arteries, 117–118
Oncozene microspheres,151
opioid analgesics, 299–301
opioid-induced constipation,
304–306
osteoplasty, 255, 259–262
oxaliplatin, 149, 287, 288
use for colorectal liver
metastases,56–57
oxycodone,300
sustained-release formulation,300
pain management, 298–302
adjuvant analgesics, 301–302
categories of pain,298
comprehensive pain assessment,
298–299
neuropathic pain,298
nociceptive pain,298
non-opioid analgesics,299
opioid analgesics, 299–301
pain in cancer patients,298
refractory pain,302
somatic pain,298
treatment (drug therapy),
299–302
treatment (non-drug
therapy),299
visceral pain, 298, 302
See also bone metastases;
image-guided neurolysis
palliativecare
benets of specialist palliative
care,294
comparison with hospice care,
294–295
components of,294
denition,294
goals of,294
interdisciplinary nature,294
role of the interventional
oncologist,310
scope of,294
palliative medicine,294
pancreaticoduodenal arcades,
110–111
panitumumab, 58, 59, 148
pazopenib,211
pentazocine,299
peptide receptor radiotherapy
(PRRT), 168–169
performance status assessment,
295–296
pharmacological concepts,61–63
pharmacology
regional chemotherapy,60–61
photodynamic therapy, 195–197
photothermal ablation (PTA),
270–271
pleural eusions
chest drainage catheters,329
management, 328–329
thoracentesis, 328–329
polymer-based microspheres,
120–121
polymethylmethacrylate
(PMMA),255
properties, 259
polyvinyl alcohol foam(PVA)
embolization material,35–36
portal vein embolization(PVE)
approaches, 179–180
before liver resection,176
complications, 183–184
embolic materials,183
extent of embolization, 182–183
FLR volume measurement,
178–179
general contraindications,185
general indications, 184–185
high-dose chemotherapy, 186–187
in conjunction with transarterial
therapies, 180–184
indications related to FLR volume,
178–179
liver hypertrophy aer, 176–177
liver regeneration mechanisms,
176–177
normal underlying liver, 185–186
pathophysiology of preoperative
PVE, 177–178
prediction of postoperative
hepatic function, 178–179
rate of liver regeneration,177
role in major hepatectomy,
187–188
standard approaches, 179–180
technical considerations, 179–184
tumor growth aer
PVE, 186–187
underlying liver disease,186
posterior superior
pancreaticoduodenal artery
(PDA),110
prognostication
communication with cancer
patients, 295–296
propoxyphene,300
prostate cancer
incidence,265
prostate cancer ablation
ablation techniques, 268–274
as alternative to surgical
resection,265
cancer detection and treatment
guidance, 265–266
complications, 271–277
cryoablation, 269–270
CT guidance,268
future developments,277
high-intensity focused ultrasound
(HIFU) ablation, 25,
268–271
image guidance techniques,
267–268
irreversible electroporation
(IRE),271
MR guidance,268
outcomes, 271–277
patient selection,266
PET guidance,268
photodynamic therapy
(PDT),271
photothermal ablation (PTA),
270–271
postprocedure evaluation,271
tumor-targeting strategies,
266–267
ultrasound guidance, 267–268
prostate-specic antigen (PSA)
screening,265
Pseudomonas spp.,291
psychiatric symptoms in cancer
patients, 307–309
pulmonary metastases
treatment options, 223
See also thoracic malignancies
Quadraspheres, 121, 151
radiation cholecystitis,161
radiation hepatitis, 130, 161
radiation-induced liver disease
(RILD),130
radiation pneumonitis, 160, 161
radiation therapy
combining with RF ablation,10
radiculopathy,298
radioembolization
base and follow-up cross-sectional
imaging,46–47
case of autopsy, burial, or
cremation,49–50
contraindications,45–46
denition, 44, 128
determining treatment dosage
(activity),48
European Association of
Nuclear Medicine (EANM)
guidelines,45–46
history of development,44
holmium-166 (
166
Ho) poly
-lactic acid (PLLA)
microspheres,45
imaging considerations,46–48
indications,45–46
localization imaging,47–48
mechanism,44–45
microcatheters,48
nuclear medicine imaging,47–48
patient release,49
radiation safety
considerations,48–49
case of autopsy, burial, or
cremation,49–50
cases involving surgery,49
patient release,49
radioembolic material,45
SIR-Spheres, 45–46, 48
technical considerations,48
eraSphere, 45, 46, 48
yttrium 90 (90Y) microspheres,45
radiofrequency ablation
applications,3–4
benets and trade-os,6
biology of heating,4
comparison with microwave
ablation,6
eects of tissue factors,5
features of successful tumor
ablation,10
future directions,10
operator and technique,8
ablative margin,8
ancillary techniques,9
choice of applicator,8
combination therapies,9–10
combining RF ablation with
chemotherapy,9–10
combining RF ablation with
radiation therapy,10
combining RF ablation with
TACE,9
overlapping techniques,8–9
patient selection,10
principles for eective
ablation,3–4
technology,6
bipolar arrays,7
clusterRF,8
internally cooled
electrodes,7
multiapplicator arrays,6
multitine applicators,7
perfused electrodes,7–8
pulsed RF application,8
switching RF applicator
energy,8
regional chemotherapy
consideration of drug
properties,53
decreased systemic exposure,53
features of eective drug
delivery,52–53
future research,60
hepatic arterial infusion (HAI),52
increased local
concentrations,52–53
increased therapeutic response,53
pharmacology,60–61
rationale for,52
therapeutic monoclonal
antibodies,58–59
renal and renal capsular arteries,118
renal cell carcinoma(RCC)
chromophobe RCC,203
clear-cell RCC,203
collecting-duct RCC,203
diagnosis, 203–204
embolotherapy,214
clinical and imaging work-up,
214–215
complications, 219–220
embolization technique,215
multidisciplinary
approach,214
palliative embolization,
218–219
partial nephrectomy, 215–218
336
Index
postoperative
embolization,218
preoperative embolization,
215–218
radical nephrectomy,215
role of the interventional
oncologist,220
vascular functional renal
an at omy, 214–215
familial clear-cell RCC,203
genetic predisposition,203
histological subtypes,203
incidence,203
incidental detection, 203, 214
medical therapies,211
metastatic disease,203
papillary RCC,203
patient presentation,214
percutaneous ablation
adjacent structures, 208–209
adjunctive procedures,206
anesthesia,206
clinical ecacy,208
complications, 208–209
cryoablation, 205–206, 208
indications for,206
microwave ablation, 205,
207–208
modality for guidance,206
postprocedure follow-up,208
pre-ablation imaging,206
procedure, 206–209
radiofrequency ablation,205
RFA for metastatic disease,
209–210
techniques, 204–206
risk factors,203
staging, 203–204
surgery,204
surgery for metastatic disease,
209–210
symptoms,203
therapeutic decision making,211
therapeutic options, 203, 204–209,
214
treatment of metastatic disease,
209–211
tumor size for therapy
initiation,203
retroduodenal artery,110
right gastric artery (RGA), 107–109
rivaroxaban,289
robotics
imaging,68–69
sacroplasty, 255, 259–262
Sapareto–Dewey thermal dose
model,22–23
selective cyclooxygenase-2
inhibitors,299
SIR-Spheres, 45–46, 48, 158, 160
studies,161
sorafenib, 88, 149, 211
combination therapies,125
spironolactone, 323–324
Staphylococcus aureus,291
Staphylococcus epidermidis,292
Stenotrophomonas spp.,291
stereotactic radiation therapy,197
sunitinib, 168, 169, 211
superior hypogastric neurolysis,
319–321
an at omy,320
complications,321
outcomes,321
positioning and approach,
320–321
technique,320
supraduodenal artery, 110, 111
Sutent,168
symptom management
anorexia, 306–307
anxiety,309
ascites, 307, 323–328, 329
constipation, 304–306
constitutional symptoms, 306–307
depression, 307–309
fatigue, 306–307
general principles,298
malignant eusions, 328–329
nausea and vomiting, 302–304
pain management, 298–302
pleural eusions, 328–329
psychiatric symptoms, 307–309
weight loss, 306–307
tapendatol,299
Temodar,168
temozoliomide,168
temsirolimus,211
therapeutic monoclonal antibodies
use for colorectal liver
metastases,58–59
eraSphere, 45, 46, 48, 158,
159–160
studies, 162–163
thoracic malignancies
ablation therapy,223
applications, 229–238
comparison of thermal ablation
techniques, 228–229
cryoablation, 224, 225–227, 228
future developments,238
imaging follow-up, 227–228
irreversible electroporation,
224, 227, 228
microwave ablation, 223–224,
225, 228
outcomes, 229–238
palliative treatment, 237–238
patient selection,224
performing ablation therapy,
224–227
physics of ablation therapy,
223–224
radiofrequency ablation, 223,
225, 227
studies of primary and
metastatic tumor
treatment,237
treatment options,223
tramadol,299
transarterial catheterization
(TACE)
microcatheter systems,40
transarterial chemoembolization
(TACE),120
basic principle,38
chemotherapeutic agents used,38
clinical outcome, 124–125
combination therapies,125
combining with radiofrequency
ablation,9
complications,124
concept, 120–121
contraindications, 121–122
drug-eluting bead TACE
(DEB-TACE),39–40
evaluation of treatment response,
123–124
follow-up, 123–124
future developments,125
lipiodol
chemoembolization,38–39
Lipiodol Ultrauide,120
materials used, 120–121
patient selection, 121–122
side eects,124
subsegmental
chemoembolization,39
superselective catheterization and
C-arm CT,40–41
technique, 121–123
transjugular intrahepatic
portosystemic shunts
(TIPS),328
treatment response assessment
anatomic biomarkers,77–78
contrast-enhanced MRI
(CE-MRI),78–80
diusion-weighted MRI
(DW-MRI),78–80
functional biomarkers,78–79
future developments in
volumetric analysis,80–83
multiparametric MRI,77
volumetric approach,79–80
Tumor Boards,1
tumor embolotherapy
denition of embolization,35
embolic materials,35–37
absolute ethanol,36–37
coils,35–37
Gelfoam,35–36
microspheres,
polyvinyl alcohol foam
(PVA),35–36
general indications,35
pre-embolization CT
evaluation,37
roadmap,37
superselective
catheterization,37–38
ultrasound. See high-intensity
focused ultrasound
(HIFU)
vancomycin,292
vascular endothelial growth factor
(VEGF), 58, 125
Vectibix,148
venous catheter andports
access routes, 289–291
antibiotic-lock technique,
291–292
applications,288
blood sampling with ports,289
catheter-related infection,
291–292
catheter tip location, 290–291
description, 288–289
indications,289
preoperative assessment,289
venous thrombosis prophylaxis
and treatment,291
vertebroplasty,255
von Hippel–Lindau syndrome, 3,
165, 203
weight loss in cancer patients,
306–307
Xeloda, 149, 168
XELOX,149
yttrium 90 (90Y) microspheres,45
yttrium 90 (90Y) radioembolization
adverse events, 129–130
clinical outcomes, 130–131
denition of
radioembolization,128
dosimetry,129
for liver tumors,128
intrahepatic
cholangiocarcinoma,137
patient selection,128
radioactive microspheres,128
technique, 128–129
toxicities, 129–130
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