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Interventional Radiology in Palliative and Support Care

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: closed (28 September 2022) | Viewed by 5882

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Special Issue Editor

Prof. Dr. Rebecca Wong

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Guest Editor

Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
Interests: clinical trial design; outcomes research; systematic reviews; clinical guidelines development; patient preferences: measurement and application; gastrointestinal malignancies; palliative radiotherapy

Special Issue Information

Dear Colleagues,

Symptom burden in cancer patients matters—70% of patients will experience significant distress during their cancer journey. Significant symptoms detract from quality of life, functional status, weaken the will to live, and increase hospital admissions and emergency room visits, while holistic attention to symptoms and supportive care needs will improve life expectancy. Significant pharmacological advances have allowed significant strides, including in the treatment of pain and depression, in recent years. Similarly, advances in image-guided interventional therapeutics provide treatment options with impressive results, favorable adverse event profiles, and in some circumstances provide treatment options where none existed before. Image guidance allows visualization of the source of the symptoms and targeting while avoiding systemic side effects. In this issue, we bring together expertise from a multidisciplinary group of experts from interventional radiology, radiation oncology, medical oncology, surgical oncology, anesthesia, and palliative care to provide the state-of-the-art in image-guided interventions for the management of cancer symptoms. We will provide a practical guide on how oncologists and frontline health care teams can integrate image-guided treatment options into their care pathway to address cancer symptoms, understand the supporting evidence, practice logistics, inform patient selection considerations, enable decision-making, and impact on patient outcomes.

Prof. Dr. Rebecca Wong
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

image guided
interventional radiology
interventional endoscopy
interventional pain management
intractable pain
image-guided radiotherapy
nerve block
endoscopic stents
vascular stents
kyphoplasty
cementoplasty
bleeding in cancer
liver directed therapies
symptom burden
will to live

Published Papers (3 papers)

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Research

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13 pages, 703 KiB

Open AccessArticle

Prognostic Nutritional Index (PNI) and Neutrophil to Lymphocyte Ratio (NLR) as Predictors of Short-Term Survival in Patients with Advanced Malignant Biliary Obstruction Treated with Percutaneous Transhepatic Biliary Drainage

by Milos Zakosek, Dusan Bulatovic, Vedrana Pavlovic, Aleksandar Filipovic, Aleksa Igic, Danijel Galun, Darko Jovanovic, Jelena Sisevic and Dragan Masulovic

J. Clin. Med. 2022, 11(23), 7055; https://doi.org/10.3390/jcm11237055 - 29 Nov 2022

Cited by 1 | Viewed by 1472

Abstract

Background: Effective biliary tree decompression plays a central role in the palliation of malignant biliary obstruction (MBO). When endoscopic drainage is unfeasible or unsuccessful, percutaneous transhepatic biliary drainage (PTBD) is the method of choice and preferred treatment approach in advanced hilar MBO. The prognostic nutritional index (PNI) reflects the patient’s immunonutritional status, while the neutrophil to lymphocyte ratio (NLR) reflects the patient’s inflammation status. The aim of the present study was to evaluate the prognostic value of preprocedural PNI and NLR on short-term survival in the advanced stage MBO population threatened with PTBD and to characterize the differences in immunonutritional and inflammatory status between 60-day survivors and non-survivors, as well as analyze other variables influencing short-term survival. Methods: This single-center retrospective study was conducted on patients undergoing palliative PTBD caused by MBO as a definitive therapeutic treatment between March 2020 and February 2022. After the procedure, patients were followed until the end of August 2022. Results: A total of 136 patients with malignant biliary obstruction were included in the study. Based on receiver operating characteristic (ROC) curve analysis, optimal cut off-values for NLR (3) and PNI (36.7) were determined. In univariate regression analysis, age, absolute neutrophil count, albumin level, NLR ≤ 3, and PNI ≥ 36.7 were significant predictors of 60-day survival. Level of obstruction and PNI ≥ 36.7 were statistically significant independent predictors of 60-day survival in a multivariate regression model. Using PNI ≥ 36.7 as a significant coefficient from the multivariate regression model with the addition of NLR ≤ 3 from univariate analysis, a 60-day survival score was developed. Conclusions: PNI and NLR are easy to calculate from routine blood analysis, which is regularly conducted for cancer patients. As such, they represent easily available, highly reproducible, and inexpensive tests capable of expressing the severity of systemic inflammatory responses in patients with cancer. Our study highlights that preprocedural PNI and NLR values provide predictors of short-term survival in patients with MBO treated with palliative PTBD. In addition, the proposed 60-day survival score can contribute to better selection of future candidates for PTBD and recognition of high-risk patients with expected poor outcomes. Full article

(This article belongs to the Special Issue Interventional Radiology in Palliative and Support Care)

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11 pages, 1341 KiB

Open AccessArticle

Bi-Centric Independent Validation of Outcome Prediction after Radioembolization of Primary and Secondary Liver Cancer

by Matthias Philipp Fabritius, Max Seidensticker, Johannes Rueckel, Constanze Heinze, Maciej Pech, Karolin Johanna Paprottka, Philipp Marius Paprottka, Johanna Topalis, Andreas Bender, Jens Ricke, Andreas Mittermeier and Michael Ingrisch

J. Clin. Med. 2021, 10(16), 3668; https://doi.org/10.3390/jcm10163668 - 19 Aug 2021

Cited by 1 | Viewed by 1650

Abstract

Background: Yttrium-90 radioembolization (RE) plays an important role in the treatment of liver malignancies. Optimal patient selection is crucial for an effective and safe treatment. In this study, we aim to validate the prognostic performance of a previously established random survival forest (RSF) with an external validation cohort from a different national center. Furthermore, we compare outcome prediction models with different established metrics. Methods: A previously established RSF model, trained on a consecutive cohort of 366 patients who had received RE due to primary or secondary liver tumor at a national center (center 1), was used to predict the outcome of an independent consecutive cohort of 202 patients from a different national center (center 2) and vice versa. Prognostic performance was evaluated using the concordance index (C-index) and the integrated Brier score (IBS). The prognostic importance of designated baseline parameters was measured with the minimal depth concept, and the influence on the predicted outcome was analyzed with accumulated local effects plots. RSF values were compared to conventional cox proportional hazards models in terms of C-index and IBS. Results: The established RSF model achieved a C-index of 0.67 for center 2, comparable to the results obtained for center 1, which it was trained on (0.66). The RSF model trained on center 2 achieved a C-index of 0.68 on center 2 data and 0.66 on center 1 data. CPH models showed comparable results on both cohorts, with C-index ranging from 0.68 to 0.72. IBS validation showed more differentiated results depending on which cohort was trained on and which cohort was predicted (range: 0.08 to 0.20). Baseline cholinesterase was the most important variable for survival prediction. Conclusion: The previously developed predictive RSF model was successfully validated with an independent external cohort. C-index and IBS are suitable metrics to compare outcome prediction models, with IBS showing more differentiated results. The findings corroborate that survival after RE is critically determined by functional hepatic reserve and thus baseline liver function should play a key role in patient selection. Full article

(This article belongs to the Special Issue Interventional Radiology in Palliative and Support Care)

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Review

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13 pages, 5445 KiB

Open AccessReview

Interventional Endoscopy for Palliation of Luminal Gastrointestinal Obstructions in Management of Cancer: Practical Guide for Oncologists

by Matthew Kim, Mandip Rai and Christopher Teshima

J. Clin. Med. 2022, 11(6), 1712; https://doi.org/10.3390/jcm11061712 - 19 Mar 2022

Cited by 2 | Viewed by 2070

Abstract

Self-expanding metal stents placed during endoscopy are increasingly the first-line treatment for luminal obstruction caused by esophageal, gastroduodenal, and colorectal malignancies in patients who are not candidates for definitive surgical resection. In this review, we provide a practical guide for clinicians to optimise patient and procedure selection for endoscopic stenting in malignant gastrointestinal obstructions. The role of endoscopic stenting in each of the major anatomical systems (esophageal, gastroduodenal, and colorectal) is presented with regard to pre-procedural patient evaluation, procedural techniques, clinical outcomes, and potential complications, as well as post-procedure aftercare. Full article

(This article belongs to the Special Issue Interventional Radiology in Palliative and Support Care)

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