Ki 67 is an Independent Predictive Biomarker of Cancer Specific and Local Recurrence-Free Survival After Lung Tumor Ablation

Sofocleous, Constantinos T.; Garg, Sandeep; Cohen, Perry; Petre, Elena N.; Gönen, Mithat; Erinjeri, Joseph P.; Downey, Robert J.; Travis, William D.; Solomon, Stephen B.

doi:10.1245/s10434-013-3140-1

Cited by 39 publications

(45 citation statements)

References 35 publications

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“…However, there is still a significant discrepancy between complete ablation based on imaging alone and residual microscopic disease that may remain undetected at the ablation site [70]. This is supported by studies that analyzed the tissue extracted from the electrode after liver RFA [71][72][73] and correlated the identification of residual prolific [11] or viable tumor cells [74] with LTP [11,74] as well as overall patient survival, after both lung and liver tumor ablation [75]. More recently, the strong correlation between the identification of viable tumor cells and LTP was prospectively validated through biopsies performed immediately after CLM ablation with pathologic and immunohistochemical assessment of the ablation zone [30].…”

Section: Discussionmentioning

confidence: 99%

Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease

Petre

Sofocleous

2017

Visc Med

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Background: Surgical resection of limited colorectal liver disease improves long-term survival and can be curative in a subset of selected cases. Image-guided percutaneous ablation therapies have emerged as safe and effective alternative options for selected patients with unresectable colorectal liver metastases (CLM) that can be ablated with margins. Ablation causes focal destruction of tissue and has increasingly been shown to provide durable eradication of tumors. Methods: A selective review of literature was conducted in PubMed, focusing on recent studies reporting on the safety, efficacy, and long-term outcomes of percutaneous ablation modalities in the treatment of CLM. The present work gives an overview of the different ablation techniques, their current clinical indications, and reported outcomes from most recently published studies. The ‘test of time' concept for using ablation as a first local therapy is also described. Results: There are several thermal ablative tools currently available, including radiofrequency ablation (RFA), microwave ablation, and cryoablation. Most data to date originated from the application of RFA. Adjuvant thermal ablation in the treatment of oligometastatic colon cancer liver disease offers improved oncologic outcomes. The ideal CLM amenable to percutaneous ablation is a solitary tumor with the largest diameter up to 3 cm that can be completely ablated with a sufficient margin. 5-year overall survival rates up to 70% after ablation of unresectable CLM have been reported. Pathologic confirmation of complete tumor necrosis with margins over 5 mm provides best long-term local tumor control by thermal ablation. Conclusion: Current evidence suggests that percutaneous ablation as adjuvant to chemotherapy improves oncologic outcomes of patients with CLM. For small tumors that can be ablated completely with clear margins, percutaneous ablation may offer outcomes similar to those of surgery.

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Section: Discussionmentioning

confidence: 99%

Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease

Petre

Sofocleous

2017

Visc Med

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“…Other markers of tumor biology may also be useful to assess. Sofocleous et al (31) have previously reported Ki-67 as a predictive biomarker after RFA. In their cohort of 47 lung tumors, 13 were known to represent primary lung cancers.…”

Section: Vascular and Interventional Radiologymentioning

confidence: 97%

Lung Adenocarcinoma: Predictive Value ofKRASMutation Status in Assessing Local Recurrence in Patients Undergoing Image-guided Ablation

et al. 2017

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Purpose:To establish the relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Materials and Methods:This study consisted of a HIPAA-compliant institutional review board-approved retrospective review of 56 primary lung adenocarcinomas in 54 patients (24 men, 30 women; median age, 72 years; range, 54-87 years) treated with percutaneous image-guided ablation and with available genetic mutational analysis. KRAS mutation status and additional clinical and technical variables-Eastern Cooperative Oncology Group (ECOG) status, smoking history, stage at diagnosis, status (new primary or not), history of radiation, history of surgery, prior systemic treatment, modality of ablation, size of nodule, ablation margin, and presence of ground-glass appearance-were recorded and evaluated in relation to time to local recurrence, which was calculated from the time of ablation to the first radiographic evidence of recurrence. Predictors of outcome were identified by using a proportional hazards model for both univariate and multivariate analysis, with death as a competing risk. Results:Technical success was 100%. Of the 56 ablated tumors, 37 (66%) were wild type for KRAS and 19 (34%) were KRAS mutants. The 1-year and 3-year cumulative incidences of recurrence were 20% and 35% for wild-type KRAS compared with 40% and 63% for KRAS mutant tumors. KRAS mutation status was a significant predictor of local recurrence at both univariate (P = .05; subdistribution hazard ratio [sHR], 2.32) and multivariate (P = .006; sHR, 3.75) analysis. At multivariate analysis, size (P = .026; sHR, 2.54) and ECOG status (P = .012; sHR, 2.23) were also independent significant predictors, whereas minimum margin (P = .066) was not. Conclusion:The results of this study show that there is a relationship between KRAS mutation status and local recurrence after image-guided ablation of lung adenocarcinoma. Specifically, KRAS mutation status of the ablated lesion is a significant predictor of time to local recurrence, independent of size and margin.q RSNA, 2016

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“…Additional biomarkers (e.g., Ki-67, KRAS, and EGFR), inflammatory cytokines, and immune markers, and imaging findings have been the focus of studies aimed at the early prediction of local recurrence and treatment response (23,24).…”

Section: Editorialmentioning

confidence: 99%

Thermal ablation for the treatment of primary and secondary pulmonary malignancies

Kim

2017

J. Thorac. Dis.

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In the review article entitled "The Role of Percutaneous Image-Guided Thermal Ablation for the Treatment of Pulmonary Malignancies" (1) recently published in the American Journal of Roentgenology (AJR) by Mouli and colleagues, the authors reviewed thermal ablation techniques [radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation] for the treatment of pulmonary malignancies [non-small cell lung cancer (NSCLC) and metastasis] with respect to treatment mechanism, local efficacy, imaging modalities used for guidance, treatment response evaluation, and clinical outcomes. The authors also reviewed the comparative studies of thermal ablations with surgery and stereotactic beam radiotherapy (SBRT).Ablation is a good candidate for treating pulmonary malignancies because lungs have heat and electrical insulating characteristics, which enable larger volumes of tissue to be ablated using thermal energy than is possible for other body tissues (2). Because thermal energy delivery is limited by the heat-sink effect of adjacent blood vessels and airways, the presence of vessels or bronchi greater than 3 mm in diameter within the ablation zone are predictors of incomplete local treatment (3). Ablation zones must exceed tumor dimensions to obtain adequate margins, and in practice, sufficient RFA-induced ground-glass opacity (GGO) indicates complete ablation (4). MWA permit larger ablation zones than RFA because delivers energy simultaneous using multiple probes, and thus, provides larger tumor ablation volumes and faster ablation times. Cryoablation uses compressed argon gas to generate subzero temperatures, but unlike heat-based ablation, cryoablation does not create GGO; instead, it creates iceballs.CT is the preferred imaging modality for guidance during thermal ablation. It provides excellent contrast between tumors and normal lung parenchyma, and multi-planar CT images enable accurate and rapid probe placement. CT is also the modality of choice for postablation follow-up evaluations (Figure 1). Immediately after ablation therapy, targeted lesions are replaced by dense opacity surrounded by GGO (5). GGO margins of <3 mm have been associated with local treatment failure. During the early post-ablation period (<2 months), central dense opacity and surrounding GGO serves as the new "baseline", and any increase in lesion size during follow-up should be considered local progression. However, morphologic evolution occurs in ablation zones and its extent depends on the thermal ablation methods used, for example, RFAtreated lesions show a relatively slow rate of involution, with a 40% decrease in size at 15 months after treatment, whereas cryoablated lesions show more rapid involution on follow-up CT images (6). PET/CT may be helpful for differentiating morphologic evolution and local recurrence, but early PET/CT within 3 months of ablation can be confounded by inflammatory changes. Editorial

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Ki 67 is an Independent Predictive Biomarker of Cancer Specific and Local Recurrence-Free Survival After Lung Tumor Ablation

Abstract: Ki-67+ tumor cells on the electrode after pulmonary tumor RF ablation is an independent predictor of LTP, shorter LPFS, and DSS.

Cited by 39 publications

References 35 publications

Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease

Thermal Ablation in the Management of Colorectal Cancer Patients with Oligometastatic Liver Disease

Lung Adenocarcinoma: Predictive Value ofKRASMutation Status in Assessing Local Recurrence in Patients Undergoing Image-guided Ablation

Thermal ablation for the treatment of primary and secondary pulmonary malignancies

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