Minimally Invasive Treatment of Metastatic Pheochromocytoma and Paraganglioma: Efficacy and Safety of Radiofrequency Ablation and Cryoablation Therapy

McBride, Joseph J.; Atwell, Thomas D.; Charboneau, William J.; Young, William F.; Wass, Thomas C.; Callstrom, Matthew R.

doi:10.1016/j.jvir.2011.06.016

Cited by 51 publications

(34 citation statements)

References 17 publications

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“…Furthermore, only one patient in the study cohort had laboratory elevations below two times the upper limit of normal during follow up. Finally, aggressive debulking of tumor may be clinically warranted as low morbidity, minimally invasive procedures such as radiofrequency ablation are further evaluated, especially in patients with liver metastasis (31). …”

Section: Discussionmentioning

confidence: 99%

Response after Surgical Resection of Metastatic Pheochromocytoma and Paraganglioma: Can Postoperative Biochemical Remission Be Predicted?

Ellis

Patel

Prodanov

et al. 2013

Journal of the American College of Surgeons

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Background Aggressive surgical resection with intent to cure and surgical debulking procedures are commonly recommended in patients with metastatic pheochromocytoma and paraganglioma. To date there are no data on operative outcomes of patients after surgical resection of metastatic pheochromocytoma and paraganglioma to determine if such an approach is appropriate and what factors may be associated with a favorable outcome. Study Design Retrospective analysis of 30 patients with metastatic pheochromocytoma/paraganglioma who underwent surgical treatment. Clinical characteristics and genetic factors were analyzed as predictors of biochemical response to surgery. Results Thirty patients underwent a total of 42 operations with a median follow-up time of 24 months (range, 1 to 114). Complete disease resection (R0/R1) was achieved in 18 (42.9%) cases, while 24 cases (57.1%) were debulking (R2) procedures without intent to cure. Complete biochemical remission was achieved in 10 (23.8%) cases and partial biochemical response was achieved in 23 (54.8%) cases. Patients with disease confined to the abdomen were more likely to achieve and maintain a biochemical response postoperatively than those with extra-abdominal disease (P = 0.0003). Debulking operations were significantly less likely to achieve or maintain biochemical palliation, with only 1 patient maintaining a biochemical response 12 months postoperatively (P < 0.0001). Patients were less likely to obtain pharmacologic independence following debulking (P = 0.0003), with only 2 (8.3%) not requiring pharmacotherapy six months after the intervention. Factors not associated with biochemical response to surgery include gender, family history, SDHB mutation status, systemic therapy, and preoperative biochemical profile. Conclusions Depending on the extent of disease, patients with metastatic pheochromocytoma/paraganglioma can benefit from aggressive operative intervention and resection with intent to cure. Debulking procedures are unlikely to achieve clinically significant biochemical response, with any biochemical response achieved being very short-lived.

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Section: Discussionmentioning

confidence: 99%

Response after Surgical Resection of Metastatic Pheochromocytoma and Paraganglioma: Can Postoperative Biochemical Remission Be Predicted?

Ellis

Patel

Prodanov

et al. 2013

Journal of the American College of Surgeons

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“…196–199 One study of 10 patients who received RFA found that 56% had successful ablations without recurrence; in 2 of the patients, all identified metastatic lesions were ablated. 197 Another study of 6 patients with 7 metastatic lesions demonstrated complete ablation in 6 out of 7 lesions, with no serious adverse events reported. 199 Due to catecholamine release by the tumor during the procedure, experienced radiologists, in conjunction with experienced anesthesiologists, should perform the technique while monitoring blood pressure to reduce risks of intra-procedural catecholamine-induced hypertensive crises.…”

Section: Management Of Pheo/pglmentioning

confidence: 96%

Pheochromocytoma and paraganglioma: Diagnosis, genetics, management, and treatment

Martucci¹,

Pacák²

2014

Current Problems in Cancer

171

163

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“…The use of percutaneous techniques (radiofrequency, cryotherapy, alcohol injection) is a possible means to obtain local control in more than 50 % of cases, or at least temporarily reduce symptoms. The choice of the appropriate technique depends on the child’s age, clinical presentation, location and number of metastasis [17, 18]. …”

Section: Discussionmentioning

confidence: 99%

Malignant paraganglioma in children treated with embolization prior to surgical excision

et al. 2015

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BackgroundParagangliomas (PGL) are rare tumors derived from neural crest cells, whose origins may vary along the chain of the sympathetic nervous system. Such tumors are often characterized by secretion of catecholamines, but sometimes they are biochemically inactive, which makes diagnosis often challenging. Malignant paraganglioma is defined by the presence of this tumor at sites where chromaffin cells are usually not found or by local invasion of the primary tumor. Recurrence, either regional or metastatic, usually occurs within 5 years of the initial complete resection but long-term recurrence is also described. Malignancy is often linked to a SDHB mutation. Preoperative embolization has been applied in the surgical management of PGLs with the objective to decrease intra-operative blood loss and surgery length without complications.Case PresentationWe report two cases of patients with abdominal or pelvic malignant PGLs who have been treated surgically at our center after preoperative embolization. Surgery was a very challenging procedure with multiple surgical teams involved and embolization did not prevent major blood loss and intraoperative complications. Patients required adjuvant treatment with either chemotherapy or radiotherapy.ConclusionsMany studies in the adult population have established recommendations for the diagnosis and therapeutic management of PGL, but few studies concern the pediatric population. Because malignant PGL is more important in the pediatric population, screening and early diagnosis of PGL is advisable in children with genetic predisposing. Surgical resection is the mainstay of treatment, but a multimodal approach is often required due to the complexity of cases. The role of preoperative embolization is not established and in our experience it has provided little benefit and major complications.

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Minimally Invasive Treatment of Metastatic Pheochromocytoma and Paraganglioma: Efficacy and Safety of Radiofrequency Ablation and Cryoablation Therapy

Cited by 51 publications

References 17 publications

Response after Surgical Resection of Metastatic Pheochromocytoma and Paraganglioma: Can Postoperative Biochemical Remission Be Predicted?

Response after Surgical Resection of Metastatic Pheochromocytoma and Paraganglioma: Can Postoperative Biochemical Remission Be Predicted?

Pheochromocytoma and paraganglioma: Diagnosis, genetics, management, and treatment

Malignant paraganglioma in children treated with embolization prior to surgical excision

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