Ablative Group Research Articles

Ablation and laparoscopic adrenalectomy: Balancing efficacy and safety in the treatment of benign adrenal gland tumors: A systematic review and meta-analysis

BackgroundAldosterone-producing adenomas cause hypertension in 5–10 % of cases. Laparoscopic adrenalectomy is the gold standard treatment for early-stage adrenal gland tumors, but minimally invasive procedures, such as ablative techniques can also be applied. Therefore, we aimed to compare laparoscopic adrenalectomy and ablation techniques in terms of efficacy and safety in the treatment of benign adrenal gland tumors. Materials and methodsWe conducted a systematic search in five databases and included studies comparing the efficacy and safety of ablation techniques and laparoscopic adrenalectomy. We calculated odds ratios (ORs) for eligible studies with binary outcomes, and mean differences (MD) with 95 % confidence intervals (CI) for continuous outcomes. ResultsFive studies focusing on aldosterone-producing adenomas were included in our review. A total of 119 patients at 14 centers underwent ablation, and 161 patients had laparoscopic adrenalectomy. The complication rates (OR: 0.98, CI: 0.35–2.69) were similar in both groups, but among complications, hypertensive crisis (OR: 8.13; CI: 1.14–58.11) was more frequent in the ablative group, and even the success rate of interventions - the resolution of hypertension (OR: 0.30, CI: 0.16–0.56) - was lower in this group. On the other hand, the advantage of ablation was shorter intervention time (MD: 75.64 min; CI: 6.33–144.95), shorter hospital stay (MD: 1.6 days; CI: 0.88–2.31), and less perioperative blood loss (MD: 43.55 ml; CI: 12.07–75.04) compared to laparoscopy. ConclusionLaparoscopic adrenalectomy is still the best therapeutic approach, but ablation can be an appropriate alternative option for the treatment of aldosterone-producing adrenal gland tumors.

Efficacy of Fractional Versus Fully Ablative CO2 Laser for Distolateral Onychomycosis: Experience With 20 Patients.

Oral antifungals are the treatment choice for onychomycosis, and topical therapies are favored in cases of limited nail involvement. Recently, carbon dioxide (CO2) laser treatment has emerged as an option to enhance the effectiveness of topical therapies. Our objective was to compare the efficacy of fractional ablative and fully ablative CO2 laser treatments for distolateral subungual onychomycosis affecting a single toenail and caused by dermatophytes. The records of 10 patients treated with a single fully ablative CO2 session were matched with those of 10 patients who underwent a single CO2 fractional treatment. All had previously failed topical antifungal lacquers and were discharged with the prescription of topical ciclopirox nail lacquer (8%) for 3 months. The clinical response rates were 80% for the fully ablative group and 60% for the fractional group. Additionally, the mean reduction in Onychomycosis Severity Index from baseline to 8.6±1.6 weeks after treatment completion was 6.9±5.4 in the fully ablative group and 3.6±6.6 in the fractional group. The relapse rate among responders was 12.5% in the fully ablative and 33.3% in the fractional group after a mean follow-up time of 29.4±2.3 weeks. Fractional and fully ablative CO2 laser in combination with ciclopirox lacquer could increase the response rate in onychomycosis resistant to topical antifungals when systemic therapy is contraindicated or not yet pursued. Fully ablative mode therapy is significantly more effective than fractional (P < 0.05). Further studies are needed to identify prognostic response factors and assess the long-term effectiveness of CO2 laser treatment.

Outcomes of ablative therapy and radical treatment for prostate cancer: a systematic review and meta-analysis.

To compare biochemical recurrence, sexual potency and urinary continence outcomes of ablative therapy and radical treatment (radical prostatectomy or radiotherapy with androgen deprivation therapy). A systematic review and meta-analysis followed the PRISMA guidelines were performed. We searched MEDLINE/PubMed. Biochemical recurrence at three and five years; incontinence rate (patients who used one pad or more) and erectile dysfunction rate at 12 and 36 months (patients who did not have sufficient erection to achieve sexual intercourse) were evaluated. The Mantel-Haenszel method was applied to estimate the pooled risk difference (RD) in the individual studies for categorical variables. All results were presented as 95% confidence intervals (95%CI). Random effects models were used regardless of the level of heterogeneity (I²). (PROSPERO CRD42022296998). Eight studies comprising 2,677 men with prostate cancer were included. There was no difference in biochemical recurrence between ablative and radical treatments. We observed the same biochemical recurrence between ablative therapy and radical treatment within five years (19.3% vs. 16.8%, respectively; RD 0.07; 95%CI=-0.05, 0.19; I2=68.2%; P=0.08) and continence rate at 12 months (9.2% vs. 31.8%, respectively; RD -0.13; 95%CI, -0.27, 0.01; I2=89%; P=0.32). When focal treatment was analyzed alone, two studies with 582 patients found higher erectile function at 12 months in the ablative therapy group than in the radical treatment (88.9% vs. 30.8%, respectively; RD -0.45; 95%CI -0.84, -0.05; I2=93%; P=0.03). Biochemical recurrence and urinary continence outcomes of ablative therapy and radical treatment were similar. Ablative therapy appears to have a high rate of sexual potency.

Optimal Treatment Strategy for Oligo-Recurrence Lung Cancer Patients with Driver Mutations.

The efficacy of local therapies for lung cancer patients with postoperative oligo-recurrence has been reported. However, whether local therapies should be chosen over molecular targeted therapies for oligo-recurrence patients with driver mutations remains controversial. Therefore, we aimed to investigate the optimal initial treatment strategy for oligo-recurrence in lung cancer patients with driver mutations. Among 2152 patients with lung adenocarcinoma who underwent surgical resection at our institute between 2008 and 2020, 66 patients with driver mutations who experienced cancer oligo-recurrence after surgery and were treated with local or molecularly targeted therapy as an initial therapy after recurrence were evaluated. Oligo-recurrence was characterized by the presence of 1 to 3 recurrent lesions. These patients were investigated, focusing on their post-recurrence therapies and prognoses. The median follow-up period was 71 months. Local and molecular targeted therapies were administered to 41 and 25 patients, respectively. The number of recurrence lesions tended to be lower in the initial local therapy group than in the molecular targeted therapy group. In the initial local therapy group, 23 patients (56%) subsequently received molecular targeted therapies. The time from recurrence to the initiation of molecular targeted therapy was significantly longer in the local therapy group than in the molecular targeted therapy group (p < 0.001). There was no significant difference in post-recurrence overall survival (hazard ratio, 1.429; 95% confidence interval, 0.701-2.912; log-rank, p = 0.324) and post-recurrence progression-free survival (hazard ratio, 0.799; 95% confidence interval, 0.459-1.390; log-rank, p = 0.426) in the initial local ablative therapy group compared with the initial molecular targeted therapy group. Local therapies as a first-line treatment did not show statistically significant differences in post-recurrence survival or progression-free survival compared with molecular targeted therapies. However, local therapies as an initial treatment should be considered preferably, as they can cure the recurrence and can delay the start of administration of molecular targeted therapies.

SBRT with ipilimumab and nivolumab to metastatic MSS colorectal and pancreatic cancer: A pooled analysis of four prospective phase II trials.

752 Background: The role of immunotherapy (IO) in microsatellite stable (MSS) pancreatic and colorectal cancer is limited. Stereotactic body radiation therapy (SBRT) is increasingly used in the limited metastatic setting, however its use with IO remains an area of investigation for both target response and overall systemic response. Here we evaluate the local failure rate of irradiated target lesions with and without IO. Methods: We pooled four prospective phase II single-arm studies of patients with metastatic MSS colorectal or pancreatic cancer treated with SBRT alone or with IO. Those in the first study (NCT01239381) received ablative liver SBRT to a maximum biologically effective dose (BED) of 48-100 Gy. Patients in the remaining studies received low dose SBRT to liver, lung, or nodal metastases with 24 Gy in 3 fractions to a BED of 43.2 Gy in combination with Ipilimumab and Nivolumab during the first (NCT04361162, NCT04575922) or second (NCT03104439) cycles. Local failure rates at the time of first progression were estimated by the cumulative incidence with non-target progression only and death as competing risks and compared using Gray’s test. The best response at the target was measured with the RECIST 1.1 criteria using the largest reduction in target size during follow up. Fisher’s exact test was used to compare objective response (ORR) and disease control rates (DCR), while the Wilcoxon rank sum test was performed to compare target size and percentage of tumor reduction. Results: Across all four studies there were 154 evaluable patients including 50 who received ablative SBRT and 104 patients who received low dose SBRT with IO. There were 92 patients with colorectal and 62 with pancreatic cancer. Median target size was 3.7 cm in the ablative SBRT group and 2.8 cm in the IO group (P=0.04). The 6-month, 1-year, and 2-year local failure rates were 10%, 18%, and 20% respectively following ablative SBRT and 24%, 25%, and 26% following low dose SBRT with IO (P=0.32). The ORR was 50.0% with SBRT alone and 23.1% with the addition of IO (P=0.001). There was no significant difference in the DCR (80.0% vs. 68.3%, P=0.18). The percent decrease in size was significantly higher in those with ablative SBRT (median -53.0% vs. -10.6%, p=0.02). There was no difference in the percent tumor response with respect to primary tumor type (P=0.13), KRAS (P=0.11) or TP53 (P=0.27) status. Conclusions: Despite the use of low dose SBRT with immune checkpoint inhibitors, there was no significant difference in local failure rates compared to ablative SBRT. Ablative SBRT dosing yielded a significantly higher depth of response. As clinical and preclinical studies suggest liver metastases are less responsive to IO, understanding dose and fractionation schemas for optimal local control is critical. Further studies are needed to explore the radiation dose with regards to local control when delivered with IO.

Impact of cervical intraepithelial neoplasia and treatment on IVF/ICSI outcomes.

Does treatment selection for cervical lesions affect the outcome of IVF/ICSI? There was no difference in pregnancy outcome between treated and untreated groups, or between different types of IVF/ICSI treatment. Human papillomavirus (HPV) infection and HPV-induced cervical lesions are associated with decreased fertility, and cervical intraepithelial neoplasia (CIN) treatment may increase the risk of adverse pregnancy outcomes. Between 2018 and 2020, 190 women with infertility who had abnormal HPV screening or cytology results prior to IVF/ICSI, and were diagnosed with CIN2/CIN3 by colposcopy biopsy at a tertiary hospital, were enrolled in a retrospective cohort study with follow-up until 31 December 2021. Patients with infertility who were diagnosed with CIN2/CIN3 by colposcopy biopsy were divided into the treatment and expectant management groups. The treatment group was divided into two intervention subgroups: the ablative therapy group and the surgical treatment group. The baseline data, number of oocytes retrieved, and rates of fertilization, high-quality embryos, positive serum HCG, clinical pregnancy, abortion, live birth, and cumulative pregnancy were compared among groups. Among the 190 patients included in the study, 152 were diagnosed with CIN2, and 38 patients had CIN3. There was no significant difference in the baseline data between the treatment and expectant groups. The time from confirmed lesions to the onset of gonadotrophin administration in the surgical treatment group was significantly longer than in the ablative therapy group and the expectant group (P = 0.007 and P = 0.024, respectively). For the treatment and expectant groups, respectively, the average number of oocytes retrieved (12.95 ± 8.77; 13.32 ± 9.16), fertilization rate (71.01 ± 23.86; 64.84 ± 26.24), and high-quality embryo rate (48.93 ± 30.72; 55.17 ± 34.13) did not differ, and no differences were detected between the different treatment subgroups. There were no differences among groups in rates of HCG positivity, clinical pregnancy, miscarriage, live birth, or cumulative pregnancy. The live birth rate in the surgical treatment group was slightly higher than that in the expectant groups (77.78% versus 66.67%), but the difference was not statistically significant. The 3-year cumulative pregnancy rates in the surgical treatment and expectant groups were 58.19% and 64.00%, respectively. This is a retrospective study, which by nature can include selection bias, and the number of cases in the expectant group was <30, which may result in a false-negative result owing to the small sample size. For patients with CIN2/CIN3, the treatment of cervical lesions does not affect the outcome of IVF/ICSI. Patients with CIN2 can enroll for IVF/ICSI cycles, with close follow-up to prevent the progression of cervical lesions, in order to avoid further delay in starting ART. For patients with CIN3, ovulation induction and embryo cryopreservation can be initiated as soon as possible after cervical lesions are treated, and frozen-thawed embryo transfer can be carried out 9-12 months later. This work was funded by the Key Clinical Projects of the Peking University Third Hospital (to Y.W., BYSYZD2021014). The authors declare no conflicts of interest. N/A.

Extended criteria liver resection: Can noncurative intent resection of colorectal liver metastasis improve survival?

164 Background: From initially believed to be a palliative diagnosis, CRLM management has ranged from nonoperative, resection of only solitary lesions, resection only if 1 cm margin could be obtained, to major hepatectomies with liver regenerative procedures. With a greater understanding of the disease and advances in systemic therapy, clinicians have been able to continuously push the envelope in both resection and local therapies to improve overall survival in patients with CRLM. The constant evolution of management for CRLM raises the question – would patients benefit from a non-curative intent resection by decreasing overall tumor burden? Is there a role for debulking of disease as an extended criterion to improve median survival? Methods: A retrospective study was conducted by identifying patients who consented to participate in the liver disease biobank research program. Consented patients with CRLM evaluated for a two-stage hepatectomy (TSH) between 2012-2020 were identified. Patients were divided into three groups: those that successfully completed TSH, those that underwent the first stage only of the TSH (surgical debulking + best chemotherapy +/- local ablative therapy), and those that were not resected (best chemotherapy +/- local ablative therapy). Patients that underwent successful completion of TSH were excluded from analysis. Kaplan Meier survival curves and log-rank test were performed to assess the median survival between the surgical debulking + best chemotherapy +/- local ablative therapy and best chemotherapy +/- local ablative therapy groups. Results: Of the 114 patients identified, 47 patients underwent successful completion of TSH, 35 patients underwent the first stage only of the TSH, and 32 patients were eventually deemed unresectable. Reasons for unresectability included intraoperative findings (n = 14), progression of disease on best chemotherapy (n = 8), unresectable extrahepatic disease, local recurrence of primary, or unfit for surgery. Patients who underwent first stage of the TSH and those that were not resected both received best chemotherapy with/without local ablative therapies. 32 of the 35 patients in the surgical debulking + best chemotherapy +/- local ablative therapy group and 27 of 32 patients in the best chemotherapy +/- local ablative therapy group presented with synchronous disease. Tumor volume resected ranged from 5% - 95%. Median survial of the surgical debulking + best chemotherapy +/- local ablative therapy group was 31 months vs 20 months in the best chemotherapy +/- local ablative therapy group (p = 0.029). Conclusions: Patients undergoing incomplete resection of CRLM demonstrated a survival benefit compared to patients who did not undergo any surgical resection. This suggests there may be a potential systemic benefit to reducing overall tumor burden. This preliminary study provides the framework to further explore the systemic effects of surgical debulking of CRLM to improve median survival as an extended criterion for non-curative intent liver resection.

Ablative radiation therapy for hepatocellular carcinoma is associated with reduced treatment- and tumor-related liver failure and improved survival

More than 70% of patients with hepatocellular carcinoma (HCC) are not candidates for curative therapy or recur after curative-intent therapy. There is growing evidence on the use of ablative radiation therapy (RT) for liver tumors. We aimed to analyze outcomes of HCC patients treated with conventional versus ablative RT. We retrospectively analyzed medical records of HCC patients treated with liver RT from 2001 to 2019. We defined ablative RT as biologically effective dose (BED) ≥80 Gy. RECIST 1.1 was used to define early responses at 3-6 months after RT, and local control (LC) at last follow-up (FU). Data was analyzed using Fisher exact test, Kaplan-Meier, cumulative incidence rates, Cox proportional hazards model and Fine-Gray competing risks. Forty-five patients were identified, of whom 14 (31.1%) received ablative RT using a stereotactic technique. With median FU of survivors of 10.1 months, 1-year cumulative incidence of LC was 91.7% for ablative and 75.2% for BED <80 Gy. At early FU, patients treated with ablative RT had better responses compared to BED <80 Gy, with 7% progressing versus 19%, and 21.4% with complete response versus none (P=0.038). On univariate analysis (UVA), Child-Pugh (CP) score [hazard ratio (HR): 3 for CP-B, HR: 16 for CP-C] and BED (HR: 7.69 for BED <80 Gy) correlated with deterioration of liver function, leading to liver failure. Most liver failure cases were due to disease progression. No RT-related liver failure occurred in the ablative RT group. On UVA, only BED ≥80 Gy was associated with improved overall survival (OS) (HR: 0.4; P=0.044). Median OS (mOS) and 1-year OS were 7 months and 35% respectively for BED <80 Gy compared to 28 months and 66% for BED ≥80 Gy. No grade 3+ bowel toxicity was reported in either group. Greater than 90% LC was achieved after stereotactic ablative RT, which was associated with minimized tumor- and treatment-related liver failure and improved survival for highly selected inoperable HCC patients.

Comparison of 2940 nm Er: YAG laser treatment in the microlaser peel, fractional ablative laser, or combined modes for the treatment of concave acne scars.

Objective:To compare and analyze the effects of Er:YAG laser treatment in the microlaser peeling, fractional ablative laser, or combined modes for the treatment of concave acne scars.Method:Ninety patients of concavity acne scar were randomly assigned to three different groups:microlaserpeeling mode group (MM group), fractional ablative mode group (FM group) and combined mode group (CM group). MM group received microlaserpeeling mode with depth of 60 μm and a repetition rate of 20%, FM group received fractional ablative mode with depth of 300 μm and a fractional density of 8%, and CM group received a fractional depth of 200 μm, density of 8%, and a peeling depth of 30 μm, repetition rate of 20%. All patients were evaluated for their treatment effects and side effects 30 days after treatment, including the treatment satisfaction, the ECCA grading scale, pain score and pigmentation level.Results:According to the effect satisfaction of patients’ self-assessment, the difference among the three groups was statistically significant (P < .05), the CM group was better than the other two groups, but there was no significant difference between the FM group and the MM group (P > .05). About the ECCA grading scale 30 days after treatment, the statistical result among the three groups was significant (P < .05), the CM group is much lower than the FM group which is approximately equal to the MM group. There was statistical difference in pain score among the three groups and every two groups (P < .05), the CM group had the highest pain score, while FM group had the lowest. About the pigmentation level, there was statistical difference among the three groups (P < .05), FM group had the lightest pigmentation, while the CM group had the heaviest.Conclusions:Three treatment modes are all effective in treating the concavity acne scar. Among the three modes, CM group is best effective, also accompanied with the most severe side effect; FM group achieves the best balance between treatment effect and side effect. The treatment practices indicate that when the Er:YAG laser with a wavelength of 2940 nm is used to treat concavity acne scars, the right treatment mode should be subject to the severity of the scar.

Ablative Volume of Radiofrequency Ablation Related to Intrahepatic Recurrence-Free Survival of Hepatocellular Carcinoma

Abstract Purpose The aim of this study was to evaluate intrahepatic recurrence-free survival of hepatocellular carcinoma (HCC) after Radiofrequency ablation (RFA) Methods A retrospective cohort study of single HCC treated by RFA between 2015 and 2017. Fifty patients were enrolled in the study. Tumor volume and ablative volume were measured by using Syngo.via application (Siemen Healthineers, United States). Ablative volume classified into small and large ablative volumes. Ablative margin was evaluated by visual comparison between pre- and post-RFA images and classified into two groups: closed ablative margin (&lt;0.5cm) and large ablative margin (&gt;0.5 cm). The recurrence tumor was classified as local tumor progression (LTP) and intrahepatic distant recurrence (IDR). The recurrence-free survival rate and independent risk for tumor recurrence were analyzed. Results Recurrence-free survival rate at the first, second, third, and fourth year after RFA was 83, 56, 44, and 44%, respectively. The average recurrence-free survival time in large ablative volume group was significantly longer than small ablative volume group (31.57 vs. 8.50 months, p = 0.003). A significant independent risk factor for tumor recurrence was large ablative volume (hazard ratio = 0.12, 95% confidence interval = 0.02–0.84, p = 0.033). The IDR group had ratio of actual ablative volume by ideal ablative volume (ablative ratio) higher than LTP group and nonrecurrent group. Conclusion The large ablative volume prevented tumor recurrence and increased recurrence-free survival rate. But aggressive ablation with high ablative volume ratio could increase risk of IDR.

Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars

BackgroundHypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars. MethodsForty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO2 laser and fractional ablative CO2 laser group (group 1, n = 20) or fractional ablative CO2 laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed. ResultsForty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05). ConclusionEffective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.

Role of Prophylactic Coronoidectomy in Oral Cancer Treatment: a Retrospective Cohort Study.

To evaluate the effectiveness of coronoidectomy to prevent trismus in patients undergoing primary surgery for oral cancer. Patients who underwent primary surgery for oral gingivo-buccal cancers were analysed. Group 1 (G1) consists of patients who underwent coronoidectomy during the primary ablative procedure and group 2 (G2) who underwent standard ablative surgery without coronoidectomy. Post-treatment maximum interincisor opening was compared between the two groups. Sixty-four patients were included, 31 in G1 and 33 patients in G2. Overall, 81% had reduction in mouth opening at the time of evaluation. The post-treatment mean mouth opening was 28.81 ± 8.2 and 22.30 ± 10.9 (p = .01) in G1 and G2, respectively. Amongst factors predisposing to trismus, patients with oral submucous fibrosis (p = .008) had reconstruction with microvascular free flap (p = .007), without post-operative radiotherapy (p = .01) and good patient compliance (p = .003) had significant benefit with simultaneous coronoidectomy. In the sub-group analysis in patients without OSMF and PORT, the mean reduction in mouth opening was significantly better in G1 (p = .04). Prophylactic coronoidectomy done at the time of primary surgery showed significant reduction in post-surgical trismus.

Synergistic effects of anti-PDL-1 with ablative radiation comparing to other regimens with same biological effect dose based on different immunogenic response.

Irradiation can induce multiple inhibitory and stimulatory effects on the immune system. In recent studies, it has been noted that administration of radiation with various doses and fractionation plans may influence on immune responses in microenvironment of tumor. But in radiobiology, the Biologically Effective Dose (BED) formula has been designed for calculating isoeffect doses in different regimens of daily clinical practice. In other words, BED has also been used to predict the effects of fractionation schedules on tumor cells. In our study, three different regimens with BEDs of 40 gray (Gy) were analyzed in BALB/c mice. These included conventional fractionated radiotherapy (RT) (3Gyx10), high-dose hypofractionated RT (10Gyx2), and single ablative high-dose RT (15Gyx1). As BED predicts, all three similarly decreased tumor volumes and increased survival times relative to controls, but after high dose exposure in ablative group, the expression of IFNγ was increased following high infiltration of CD8 cells into the tumor microenvironment. When anti-PDL-1 was combined with RT, single ablative high-dose radiation enhanced antitumor activity by increasing IFNγ in tumors and CD8+ tumor-infiltrating lymphocytes; as a result, this combining therapy had enhanced antitumor activity and lead to control tumor volume effectively and improve significantly survival rate and finally the recurrence of tumor was not observed. Results show distinct radiation doses and fractionation schemes with same BED have different immunogenic response and these findings can provide data helping to design regimens of radiation combined with immune checkpoint blockers (ICBs).

Comparison of the Effectiveness of Ablative and Non-Ablative Fractional Laser Treatments for Early Stage Thyroidectomy Scars.

BackgroundOpen thyroidectomy is conventionally performed at the anterior side of neck, which is a body part with a comparatively great degree of open exposure; due to this, postoperative scarring may cause distress in patients. We aimed to compare the effects of ablative and nonablative fractional laser treatments on thyroidectomy scars. We examined medical records in a retrospective manner and analyzed scars based on their digital images by using the modified Manchester Scar Scale (mMSS).MethodsBetween February 2012 and May 2013, 55 patients with thyroidectomy scars were treated with ablative (34 patients) or nonablative (21 patients) fractional laser. Each patient underwent 4 laser treatment sessions in 3–4 week intervals, 1–2 months postoperatively. Scar improvement was assessed using patient images and the mMSS scale.ResultsThe mean decrease in scar score was 3.91 and 3.47 in the ablative and nonablative groups, respectively; the reduction between 2 groups did not exhibit any significant difference (P=0.16). We used the scale once again to individually evaluate scar attributes. The nonablative group accounted for a considerably higher color score value (P=0.03); the ablative group accounted for a considerably higher contour score value (P<0.01). Patient satisfaction was high and no complications occurred.ConclusionsBoth types of fractional laser treatments can be used successfully for thyroidectomy scar treatment with minimal complications; however, results indicate that higher effectiveness may be obtained from the use of ablative and nonablative lasers for hypertrophic scars and early erythematous scars, respectively. Therefore, the appropriate laser for scar treatment should be selected according to its specific characteristics.

Topical Lidocaine Enhanced by Laser Pretreatment

Injectable forms of anesthesia for nonsurgical facial rejuvenation, although efficacious, are uncomfortable for the patient. Preclinical studies have demonstrated that laser pretreatment at low energies enhances absorption of topical lidocaine. The authors assess the safety and efficacy of laser-assisted transdermal delivery of topical anesthetic. Ten patients were split into 2 groups (A and B). All patients received 15 g of BLT (20% benzocaine, 6% lidocaine, and 4% tetracaine triple anesthetic cream) for 20 minutes with no occlusion. Then the cream was removed and the first blood draw taken. Group A patients were pretreated with the full ablative laser and group B patients with a fractional ablative laser to the full face. A further 15 g BLT was applied for another 20 minutes. Group A patients then underwent full ablative laser treatment, and group B received fractionated ablative laser treatment. Blood draws were taken at 60, 90, 120, 180, and 240 minutes after the initial topical anesthetic application, and the serum was analyzed for lidocaine and monoethylglycinexylidide (MEGX) levels. Patients were asked to rate the pain felt at intervals during the procedure. No patient required supplemental nerve blocks. Pain scores were equivalent at the end of the first pass for both groups (P = .436). Group A patients had significantly lower pain scores at the start of the second laser treatment (P = .045), but pain scores became equivalent by the end (P = .323). Combined serum lidocaine and MEGX levels were significantly higher in group A patients up to 90 minutes (peak average of 0.61 µg/mL for group A and 0.533 µg/mL for group B; P = .0253), which corresponded to greater initial analgesic effect. Data from this study demonstrate that topical anesthetic for facial rejuvenation can be enhanced with laser pretreatment while maintaining safe blood serum levels. Further studies should examine optimal application amount and time to allow safe multipass facial rejuvenation without the need for invasive nerve blocks.

Thermochemotherapy for Non-Muscle-Invasive Bladder Cancer: Is There a Chance to Avoid Early Cystectomy?

Objectives: Non-muscle-invasive bladder cancer is characterized by a high recurrence rate after primary transurethral resection. In case of bacillus Calmette-Guérin-refractory neoplasms, cystectomy is the gold standard. In this study the effects of thermochemotherapy with mitomycin C were evaluated in high-risk bladder cancer nonresponders to previous therapy. Patients and Methods: Between January 2006 and December 2009, 30 patients were enrolled with recurrent stage carcinoma in situ, Ta and T1, grade G1 to G3 non-muscle-invasive bladder cancer refractory to chemotherapy or immunotherapy and so becoming suitable for radical cystectomy. All patients underwent endovesical thermochemotherapy: 16 patients underwent a prophylactic scheme and 14 patients underwent an ablative scheme. Results: All the patients completed the study. The mean follow-up for all the patients enrolled was 14 months. Thirteen of 30 patients (43.30%) were disease free and 17 patients (56.70%) had recurrence. In the prophylactic group, 7 of 16 patients (43.75%) were disease free and 9 patients (46.25%) had tumor recurrence; no progression was observed. In the ablative group, 3 patients (17, 64%) had progression to muscle-invasive disease. Side effects were generally mild. Conclusions: Thermochemotherapy could be considered an additional tool in patients refractory to intravesical therapies before considering early cystectomy.

Functional ability and physical activity in children and young adults after limb‐salvage or ablative surgery for lower extremity bone tumors

Aim of our study was to compare functional ability and physical activity in children and young adults who underwent surgery for a malignant bone tumor that was located around the knee. This cross-sectional study included 82 patients aged 8-25 years with a follow-up of 1-5 years. The functional ability and the amount of physical activity were evaluated by means of questionnaires and objective instruments. Thirty nine patients underwent limb-salvage surgery (24 allograft and 15 endoprosthesis) and 43 underwent ablative surgery (27 amputations and 16 rotationplasty). Patients in the limb-salvage group were significantly older at the time of surgery than patients in the ablative group (mean age 15.2 years vs. 13.2 years, P = 0.03). Apart from significantly better scores for the timed up and down stairs and various walking activities in the limb-salvage group as compared to the ablative surgery group, no significant differences were seen for any of the outcome measures. One to 5 years after limb-salvage and ablative surgery due to a malignant bone tumor children and young adults do, apart from a few activities involving walking and climbing stairs, not differ with respect to overall functional ability and physical activity.

Effect of Peripheral Blood Stem Cell (PBSC) Graft Composition on Graft Versus Host Disease (GVHD) and Mortality After Allogeneic Transplantation

AbstractAbstract 676We investigated the relationship of PBSC graft composition on GVHD and survival in 2,350 allogeneic transplant recipients from a single institution. Characteristics of the cohort included: median age: 50 (0.5-79); disease risk: low 12%, intermediate 41%, high 35%; HLA-matched sibling donor 53% and reduced-intensity conditioning 36%. Graft composition cell subsets included stem/progenitors (CD34+), monocytes (CD14+), B (CD20+), NK (CD3-CD56+), NK/T (CD3+CD56+), dendritic cell subsets (DC1 and DC2), and T-cell subsets (CD3+CD4+, CD3+CD8+, Memory, Naïve, Regulatory), measured by multicolor FACS analyses and expressed as infused cell subset/kg of actual recipient weight. Cell doses were modeled as continuous linear variables, by quartiles, or by cubic splines (allowing for non-linear models). Results:In contrast with previous findings, increasing CD34+ cell dose was not statistically associated with acute GVHD (p=0.49), chronic GVHD (p=0.91) or survival (p=0.74). However, several other cell subsets showed important associations. Shown in Figure 1 is a cubic spline graph of the hazard ratio (HR) of chronic GVHD as a function of CD3+CD4+ T-cell dose relative to a relatively low dose of 0.5 × 107/kg. [Display omitted] A highly significant correlation was found between larger doses of CD14+ monocytes and less chronic GVHD (p<0.001). Figure 2 displays the HR results compared to a dose of 0.5 × 108 CD14 cells/kg, indicating a strong association in the alternative donor setting (p<0.001: by quartile analysis HR=0.59 for Q4 vs. Q1; p=.0004), and remained a suggestive trend in the matched sibling group. For the overall mortality analysis, several cell subsets showed significant associations. Patients receiving higher doses of NK cells had lower survival (p=0.007). Higher doses of memory CD4 was also found to be associated with lower survival, but the effect appeared to be restricted to the matched-sibling donor group (p=0.007). Increasing doses of DC1 were also associated with worse survival (p=0.02) for both reduced intensity and ablative conditioning groups, although the dose response was stronger in the ablative group (HR=1.17 Q4 vs. Q1). In contrast, higher doses of with NK/T cells correlated with lower mortality (p=0.01) but only in the matched-sibling group (Q4 vs. Q1, HR=0.78, p=0.05). [Display omitted] Conclusions:In this large, single center study, no associations of CD34 cell dose with GVHD or overall mortality were found. Further, our results suggest that previously reported associations between T cell dose and chronic GVHD are primarily driven by CD4 content in PBSC, and restricted to the matched-sibling donor (Figure 1). The lack of correlation with alternative donors may reflect differences in T-cell responses to the greater minor histocompatibility divergence with alternative donors, or changes in donor T-cell functionality associated with the higher dose of G-CSF (16 μg/kg/day) used for sibling donor mobilization at our center. To our knowledge, the correlation of higher CD14 dose with a reduced incidence of chronic GVHD is a novel finding, perhaps reflecting the known shift to a more immunosuppressive function of monocytes after G-CSF exposure. Similarly, reduced survival associated with higher doses of NK, memory CD4, and DC1 cells, and improved survival with greater numbers of NK/T cells represent new findings that will require additional analyses. Altogether, these correlations of GVHD and mortality with PBSC cell subsets support the concept that engineering of grafts could result in improved outcomes with allogeneic transplantation. Disclosures:No relevant conflicts of interest to declare.

A Comparison of Hepatic Resection and Ablative Therapy regarding the Survival of Hepatocellular Carcinoma Patients in Nagasaki

To identify the effect of local treatments for hepatocellular carcinoma (HCC) in our associated institutes in Nagasaki prefecture, we performed a comparative study of hepatic resection and local ablative therapies, including alcohol injection, microwave coagulation and radio-frequency ablation. We examined the patient demographics, outcomes and tumor-free and overall survival between a hepatectomy group (n=210) and a local ablative therapy group (n=52). In the ablative therapy group, there were significantly more patients with cirrhosis and poorer hepatic function than in the hepatectomy group (p<0.001). Larger tumors and vascular involvement in the hepatectomy group were significantly more frequent than in the ablative therapy group (p<0.001 and p=0.002, respectively). The multivariate Cox regression analysis indicated no significant difference either in the time to the first recurrence of tumor after surgery or in mortality between ablative therapy and hepatectomy. By making full use of various modalities in each specialty, the satisfactory HCC treatment could be achieved at this stage.

Acute and chronic graft-versus-host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantation.

In this study, we evaluated the influence of nonmyeloablative and ablative conditioning regimens on the occurrence of acute and chronic graft-versus-host disease (GVHD). One hundred thirty-seven patients undergoing matched-related sibling transplantations received the same GVHD prophylaxis. Myeloablative regimens included intravenous busulfan/cyclophosphamide (n=45) and fludarabine/melphalan (n=29). Patients in the nonmyeloablative group (n=63) received fludarabine/idarubicin/cytarabine, cisplatin/fludarabine/idarubicin, and fludarabine/cyclophosphamide. The actuarial rate of grade II to IV acute GVHD was significantly higher (hazard ratio, 3.6; 95% confidence interval, 1.5-8.8) in patients receiving ablative regimens (36%) compared with the nonmyeloablative group (12%). The cumulative incidence of chronic GVHD was higher in the ablative group (40%) compared with the nonmyeloablative group (14%). The rates were comparable within the first 200 days and were significantly higher in the ablative group beyond day 200 (hazard ratio, 5.2; 95% confidence interval, 1.2-23.2). Nonrelapse and GVHD-related mortality were relatively low in both groups. The use of the described nonmyeloablative preparative regimens was associated with a reduced incidence of grade II to IV acute GVHD and chronic GVHD compared with the busulfan/cyclophosphamide and fludarabine/melphalan transplant regimens. It is interesting to note that nonrelapse mortality with nonmyeloablative regimens in older and more debilitated patients was low (14%) and comparable to that achieved with standard high-dose regimens in younger patients.