This single center study assessed the efficacy and outcomes of radioembolization (RE) for unresectable, chemorefractory colorectal cancer liver metastases in 53 heavily pre-treated patients. Median overall survival (OS) was 12.7 months and median liver progression-free survival 4.7 months. Patients with CEA levels ≥90ng/mL at the time of RE and with lymphovascular invasion on pathology of the primary had decreased OS. Background/Introduction This study assessed the efficacy and factors affecting outcomes of radioembolization (RE) using yttrium-90 (90Y) resin microspheres in patients with unresectable and chemorefractory colorectal cancer liver metastases (CLM). Patients and Methods Following an IRB waiver of approval, review of a HIPAA-registered, prospectively created and maintained database was performed. Patient demographics, disease characteristics, RE treatment parameters and additional treatments were evaluated for significance in predicting overall survival (OS) and liver progression-free survival (LPFS). Complications were evaluated according to the NCI Common Terminology Criteria for adverse events. Results From September 2009 to September 2013, 53 patients underwent RE at a median 35 months after CLM diagnosis. Median OS was 12.7 months. Multivariate analysis demonstrated that CEA levels at RE ≥90 ng/mL (p=0.004) and microscopic lymphovascular invasion of the primary (p=0.002) were independent predictors of decreased OS. Median LPFS was 4.7 months. At 4-8 and 12-16 weeks after RE, the majority of patients (80% and 61% respectively) according to RECIST had stable disease; additional evaluation by PERCIST led to reclassification in 77% of these cases (response or progression). No deaths were noted within the first 30 days. Within the first 90 post-RE days, four patients (8%) developed liver failure and five patients (9%) died, all with evidence of disease progression. Conclusion RE in the salvage setting was well-tolerated, permitting the administration of additional therapies and leading to a median OS of 12.7 months. Evaluation by PERCIST was more likely than RECIST to document response or progression when compared to baseline pre-RE assessment.

The rationale of this study was to examine whether 18F-FDG PET/CT and contrast-enhanced CT performed immediately after percutaneous ablation of liver metastases are predictors of local treatment failure at 1 y. Methods This Health Insurance Portability and Accountability Act–compliant, Institutional Review Board–approved retrospective study reviewed 25 PET/CT-guided thermal ablations performed from September 2011 to March 2013 on 21 patients (11 women and 10 men; mean age, 56.8 y; range, 35–79 y) for the treatment of liver metastases (colorectal, n = 23; breast, n = 1; and sarcoma, n = 1). One to 3 tumors (mean size, 2.3 cm; range, 0.7–4.6 cm; mean SUVmax, 22.7; range, 9.5–77.1) were ablated using radiofrequency (n = 16) or microwave (n = 9) energy in a single session. Immediate-postablation enhanced CT and PET/CT scans were qualitatively evaluated by 2 reviewers independently, and the results were compared with clinical and imaging outcome at 1 y. The PET/CT scans were also analyzed to determine tissue radioactivity concentration (TRC) from 3-dimensional regions of interest in the ablation zone, the margin, and the surrounding normal liver to calculate a TRC ratio, which was then compared with outcome at 1 y. Receiver operating characteristics (ROC) were used, and the maximal-accuracy threshold in predicting recurrence was calculated. Results Eleven (44%) of the 25 tumors recurred within 1 y. Enhanced CT did not significantly correlate with recurrence (P = 0.288). Accuracy was 64% (16/25), and the area under the ROC curve was 0.601 (95% confidence interval [95% CI], 0.387–0.789). The accuracy of the qualitative analysis of 18F-FDG PET was 92% (23/25) (P < 0.001), and the area under the ROC curve was 0.929 (95% CI, 0.740–0.990). The mean TRC ratio was 40.6 in the recurrence group (SD, 9.2; range, 29.3–53.9) and 15.9 in the group without recurrence (SD, 7.3; range, 3–27.3). A TRC ratio of 28.3 predicted recurrence at 1 y with 100% accuracy (25/25) (P < 0.001), and the area under the ROC curve was 1 (95% CI, 0.863–1). Conclusion Immediate PET/CT accurately predicts the success of liver metastasis ablation at 1 y and is superior to immediate enhanced CT.

Summary Context and Objective Bilateral adrenal vein sampling (AVS), the diagnostic standard for identifying surgically remediable aldosteronism (SRA), is commonly performed after cosyntropin stimulation (post‐ACTHstim). The role of AVS without cosyntropin stimulation (pre‐ACTHstim) has not been established. The selectivity index (SI), the adrenal vein (av) serum cortisol concentration divided by that in a peripheral vein, confirms av sampling. The minimally acceptable SI is controversial. The objectives of this study were to determine the role of pre‐ACTHstim AVS and a predetermined SI. Design Using biochemical cure as the endpoint, we performed a retrospective head‐to‐head comparison of pre‐ACTHstim AVS to post‐ACTHstim AVS. The specificity of a predetermined minimum SI of 1.5 in pre‐ACTHstim AVS was determined. Patients At a regional AVS referral centre, we analysed 32 patients who had undergone simultaneous bilateral AVS both pre‐ and post‐ACTHstim and had returned for postadrenalectomy evaluation. Measurements Simultaneous bilateral AVS was performed with measurements of venous concentrations of aldosterone and cortisol. End points were postadrenalectomy plasma renin activity, serum aldosterone concentration, and number of antihypertensive medications. Results All 32 patients achieved a biochemical cure following adrenalectomy. The two AVS protocols were complementary. Notably, seven patients (22%; CI = 11‐38) were found to have SRA by a lateralization index (LI) > 4 on the pre‐ACTHstim AVS, but not on the post‐ACTHstim AVS. SI pre‐ACTHstim was divided into tertiles. Specificity was 100% in all. Conclusions Simultaneous bilateral AVS performed both pre‐ACTHstim and post‐ACTHstim maximizes SRA identification. A SI of 1.5 pre‐ACTHstim does not reduce specificity.

No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

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Purpose: To determine the lethal cryoablation size of a single 15minute freeze protocol and compare it with that of the conventional 10-minute freeze, 8-minute active thaw, 10-minute freeze cycle (10-8-10) in swine liver and kidney. Materials: Percutaneous CT-guided cryoablation was performed in 5 swine livers and kidneys. In each organ, one ablation (2 probes) was performed utilizing the 10-8-10 minute cycle and a second utilizing the single 15-minute cycle. When the "ice-ball" was maximal, 10 cc of India Ink was arterially infused into the organ. The two ablations were timed to end simultaneously so that the unfrozen tissue surrounding both ablation zones was stained at maximal ablation volume. Histologic analysis was performed by a pathologist. The ablation length (long axis of the cryoprobe tract) and maximum width (perpendicular to the cryoprobe track) were measured and the tissues were fixed in formalin. Results: Histopathologically determined ablation length in the 10-8-10 samples was 5.00 ± 0.75 cm and 6.55 ± 0.55 cm for kidney and liver tissue, respectively. For the 15-minute single cycle the respective sizes were 4.96 ± 0.32 cm and 6.85 ± 0.49 cm. Similarly, ablation width in the 10-8-10 samples was 3.95 ± 0.17 cm and 4.5 ± 0.3 cm for kidney and liver, respectively, in the 10-8-10 samples and 4.00 ± 0.44 cm and 4.3 ± 0.28 cm, for kidney and liver, respectively, in the 15-minute samples. Neither ablation length nor width (and consequently volume) were significantly different between the cryoablation protocols. In addition, this was true in both kidney and liver tissue. However, ablation length and width were significantly smaller in the kidney when compared to the liver, for each cryoablation protocol. This observation can be explained by the higher tissue perfusion in the kidney compared to the liver (fourfold), and the role this perfusion plays in heat exchange within the tissue (the heat pump effect). Conclusions: An abbreviated, single 15-minute cryoablation results in an identical ablation size to that of the conventional 10-8-10 minute protocol, regardless of tissue. A larger cryoablation zone observed in hepatic tissue can potentially be explained by differences in tissue perfusion.