Kristen Telischak, MD

Abstract

To assess the feasibility, safety and preliminary efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of extra-abdominal desmoid tumours.Fifteen patients with desmoid fibromatosis (six males, nine females; age range, 7-66years) were treated with MRgFUS, with seven patients requiring multiple treatments (25 total treatments). Changes in viable and total tumour volumes were measured after treatment. Efficacy was evaluated using an exact one-sided Wilcoxon test to determine if the median reduction in viable tumour measured immediately after initial treatment exceeded a threshold of 50% of the targeted volume. Median decrease after treatment of at least two points in numerical rating scale (NRS) worst and average pain scores was tested with an exact one-sided Wilcoxon test. Adverse events were recorded.After initial MRgFUS treatment, median viable targeted tumour volume decreased 63%, significantly beyond our efficacy threshold (P=0.0013). Median viable total tumour volume decreased (105mL [interquartile range {IQR}, 217mL] to 54mL [IQR, 92mL]) and pain improved (worst scores, 7.51.9 vs 2.72.6, P=0.027; average scores, 62.3 vs 1.32, P=0.021). Skin burn was the most common complication.MRgFUS significantly and durably reduced viable tumour volume and pain in this series of 15 patients with extra-abdominal desmoid fibromatosis. Retrospective four-centre study shows MRgFUS safely and effectively treats extra-abdominal desmoid tumours This non-invasive procedure can eradicate viable tumour in some cases Alternatively, MRgFUS can provide durable control of tumour growth through repeated treatments Compared to surgery or radiation, MRgFUS has relatively mild side effects.

View details for DOI 10.1007/s00330-016-4376-5

View details for Web of Science ID 000392142000034

Abstract

To assess the feasibility, safety and preliminary efficacy of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of extra-abdominal desmoid tumours.Fifteen patients with desmoid fibromatosis (six males, nine females; age range, 7-66years) were treated with MRgFUS, with seven patients requiring multiple treatments (25 total treatments). Changes in viable and total tumour volumes were measured after treatment. Efficacy was evaluated using an exact one-sided Wilcoxon test to determine if the median reduction in viable tumour measured immediately after initial treatment exceeded a threshold of 50% of the targeted volume. Median decrease after treatment of at least two points in numerical rating scale (NRS) worst and average pain scores was tested with an exact one-sided Wilcoxon test. Adverse events were recorded.After initial MRgFUS treatment, median viable targeted tumour volume decreased 63%, significantly beyond our efficacy threshold (P=0.0013). Median viable total tumour volume decreased (105mL [interquartile range {IQR}, 217mL] to 54mL [IQR, 92mL]) and pain improved (worst scores, 7.51.9 vs 2.72.6, P=0.027; average scores, 62.3 vs 1.32, P=0.021). Skin burn was the most common complication.MRgFUS significantly and durably reduced viable tumour volume and pain in this series of 15 patients with extra-abdominal desmoid fibromatosis. Retrospective four-centre study shows MRgFUS safely and effectively treats extra-abdominal desmoid tumours This non-invasive procedure can eradicate viable tumour in some cases Alternatively, MRgFUS can provide durable control of tumour growth through repeated treatments Compared to surgery or radiation, MRgFUS has relatively mild side effects.

View details for PubMedID 27147222

Abstract

To increase cost transparency and uncover potential areas for savings in patients receiving selective transarterial chemoembolization at a tertiary care academic center.The hospital cost accounting system charge master sheet for direct and total costs associated with selective transarterial chemoembolization in fiscal years 2013 and 2014 was queried for each of the four highest volume interventional radiologists at a single institution. There were 517 cases (range, 83-150 per physician) performed; direct costs incurred relating to care before, during, and after the procedure with respect to labor, supply, and equipment fees were calculated.A median of 48 activity codes were charged per selective transarterial chemoembolization from five cost centers, represented by the angiography suite, units for care before and after the procedure, pharmacy, and observation floors. The average direct cost of selective transarterial chemoembolization did not significantly differ among operators at $9,126.94, $8,768.77, $9,027.33, and $8,909.75 (P = .31). Intraprocedural costs accounted for 82.8% of total direct costs and provided the greatest degree in cost variability ($7,268.47-$7,691.27). The differences in intraprocedural expense among providers were not statistically significant (P = .09), even when separated into more specific procedure-related labor and supply costs.Cost accounting systems could effectively be interrogated as a method for calculating direct costs associated with selective transarterial chemoembolization. The greatest source of expenditure and variability in cost among providers was shown to be intraprocedural labor and supplies, although the effect did not appear to be operator dependent.

View details for DOI 10.1016/j.jvir.2015.09.004

View details for PubMedID 26521766