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  • Radiologie Interventionnelle Oncologique

    Pr Frank Boudghene

    Radiologie Hôpital Tenon

    APHP.6 - Sorbonne Université

    PARIS

  • Radiologie Interventionnelle

    • Guidage par imagerie => Mini invasif • Induit moins de complications, et réduit la durée d’hospitalisation

    Movable gantry puts clinicians in control The Discovery IGS provides full flexibility in your clinical

    space. Controls available at tableside and at the back

    of the gantry let you maneuver the system easily and

    conveniently. When in position for imaging, the gantry

    swivels around the table on a defined path, with

    precise laser guidance. Combined gantry and GE OR

    table movement enables you to stop and image at any

    point for coverage from head to toe.

    6 Discovery IGS Discovery IGS 7

    One-touch back-in and back-out means fully

    flexible procedures

    With the Discovery IGS, you can t ruly have it both

    ways: Move the gantry to the table for imaging,

    move it aside when not needed – and all at the

    touch of a button. From seven posit ions at the

    table, you can back the gantry out to predefined

    locat ions. Back-out distances are customizable to

    suit different room sizes.

    Customized parking provides the maximum

    freedom

    When it ’s not needed for imaging, you can move

    the gantry aside completely, allowing complete

    pat ient access at the table and enabling easy

    room cleaning. You can pre-configure two parking

    spaces to suit your room size and shape.

    Teams work better with nothing in their way

    The Discovery IGS gives physicians, nurses,

    anesthesiologists and technologists ample space

    to work together effect ively. Clinicians can

    posit ion on either side of the pat ient according

    to preference. With the offset C-arm, the

    anesthesiologist can work comfortably at the

    patient’s head. Addit ionally y ou can work with the

    system posit ioned slight ly to the left to facilitate

    access to the patient when using TEE.

    La RI n’est pas de la Chirurgie : elles sont complémentaires

    1

  • Radiologie Interventionnelle dédiée à la prise en charge des cancers Comprend toutes les techniques percutanées et/ou endovasculaires/endoluminales guidées par l’image:

    – Diagnostic – Traitement – Management des incidents

    • Sous guidage par l’image (US, TDM, IRM, PET)

    • Très liée à la recherche comme à l’ innovation

    • «Optimisation de la prise en charge»

    - ambulatoire - sans anesthésie générale - récupération rapide

    «activité préservée »

    2

    Oncologie Interventionnelle

  • Quelles procédures ?

     Biopsies guidées

     Drainages

     Stents, filtres caves

     Embolisations

     Ablations tumorales

     patient à jeun, perfusé

     crase sanguine, groupe sanguin …..

     consultation RI (48h)

     antalgiques + anti inflammatoires

    3

    Oncologie Interventionnelle

  • BIOPSIES et médecine de précision

    Biopsie du FOIE sous TDM

    Biopsie OSSEUSE sous PET-CT

    Biopsie liquide (CTC)

    Biopsie solide

    4

    Biopsie du SEIN sous ECHO

    Biopsie du SEIN sous IRM

  • Quels équipements? => CBCT

    5

  • Procédures ENDOLUMINALES

    Drainages

  • Procédures ENDOVASCULAIRES

    PIC et PAC Filtres Caves

  • Stents Emboles

    Procédures ENDOVASCULAIRES

  • Quels traitements? EMBOLISATIONS

    CHIMIO Embolisation

    RADIO Embolisation

    TACE - LIPIODOL

    HCC

    11

  • Quels traitements? ABLATIONS

    Radio Frequence Micro Ondes

    Cryotherapie Electroporation

    TOUS ORGANES

    (initialement pour tumeurs du foie)

  • Ablations = Médecine personnalisée

  • Ablations thermiques

    Techniques « chaudes » Techniques « froides »

    Apoptose Nécrose

  • Résultats

    3 mois de suivi

    CBCT de planification

    Même dans des zones difficiles d’accès

  • Radio Fréquence ou Cryothérapie?

    Radio Fréquence Cryothérapie

    Accessibilité X 0

    Volume d’ablation 0 X

    Proximité des structures « sensibles » (nerfs, peau, vaisseaux)

    0 X

    Anesthesie locale 0 X

    Injection de ciment X 0

    Durée de la procedure X 0

    Cout = =

    En pratique courante nous avons souvent à choisir

  • Effet abscopal

    Complémentaire de l’ablation 17

    10/2015 01/2016 04/2016 09/2017

  • Avant embolisation portale

    Foie gauche/ Foie total = 29 %

    Après embolisation portale

    Foie gauche/ Foie total = 48 %

    Embolisation portale pré-opératoire

    Techniques non concurrentes mais complémentaires

    18

    Traitements combinés = embolisation + chirurgie

  • Complémentaire de la chirurgie ce qui permet de traiter plus de patients 19

    Traitements combinés = radiofréquence + chirurgie

  • 20

    Pluri étagée

    Traitements combinés = cimentoplastie + chirurgie

  • Nouveaux matériels développés pour RIO = Kiva, Vexim, VBS, LPBS

    RANDOMIZED TRIAL KAST Study: The Kiva System • Tutton et al

    870 www.spinejournal.com June 2015

    In the 285 AT subjects, VAS scores improved signifi cantly

    over baseline in both groups after 12 months (Kiva: 70.8 ±

    26.3; and BK: 71.8 ± 23.5). ODI scores also improved sig-

    nifi cantly at 12 months over baseline in both groups (Kiva:

    38.1 ± 19.8; and BK: 42.2 ± 21.7). A comparison of VAS

    ( Figure 5A ) and ODI ( Figure 5B ) scores over time across

    groups is presented.

    In the AT subjects at 12 months, 20.9% (28/134) of the

    Kiva group and 22.3% (29/130) of the BK group had expe-

    rienced a new adjacent level compression fracture (symptom-

    atic and asymptomatic combined rate), meeting the endpoint

    of noninferiority in the Kiva group. An analysis of the per

    protocol population showed that 13.8% (16/116) of the Kiva

    group and 20.2% (23/114) of the BK group had experienced

    a new adjacent level fracture.

    Extravasation of bone cement observed at the procedure

    was assessed independently by the CL and IPA. Statisti-

    cal noninferiority was met for the extravasation rate by CL

    and IPA. The extravasation rate as reported by the site was

    signifi cantly lower in the Kiva group when compared with

    BK (Kiva: 16.9%; and BK: 25.8%). Secondary endpoints are

    summarized in Table 5 .

    DISCUSSION The KAST study was a prospective, multicenter, randomized

    controlled trial designed to evaluate the safety and effective-

    ness of the Kiva system, a novel implant-based vertebral aug-

    mentation device. Given its randomized controlled design,

    large cohort, and 12-month follow-up, it provides level 1

    evidence in the study of 2 treatment arms for osteoporotic

    compression fractures. Focal tenderness and marrow edema

    on magnetic resonance imaging were required inclusion cri-

    teria. These refi ned inclusion criteria identifi ed patients with

    acute or subacute osteoporotic VCF-related pain, unlike ear-

    lier reported randomized controlled trials without correlative

    examination or strict imaging criteria. 1 , 7 The KAST study

    incorporated the use of an independent CL for radiographical

    evaluations and used an IPA for adjudication of safety data

    in an effort to remove bias in its assessment of effi cacy and

    safety.

    The KAST study was able to prove that Kiva is noninferior

    to BK in its ability to safely relieve pain and improve func-

    tion in the treatment of osteoporotic VCFs. Pain and func-

    tion were signifi cantly improved from baseline at 30 days,

    6 months, and 12 months in both groups, demonstrating the

    clinical success of these techniques in treating painful VCFs.

    No cement-related clinical complications were reported in

    the 300 subjects enrolled. The observed rate of extravasation

    Copyright © 2015 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

    Figure 1. Image of the Kiva system used for vertebral augmentation.

    Figure 2. Image under fl uoroscopy of ( A ) the Kiva implant being de-

    ployed during treatment of VCF and ( B ) post-VCF treatment with the

    Kiva system. The Kiva implant provides a predictable reservoir for bone

    cement and the vertebra is restored. VCF indicates vertebral compres-

    sion fracture.

    Figure 3. Image of ( A ) polymethylmethacrylate being injected and con-

    tained within the Kiva implant. ( B ) The Kiva implant.

    SPINE141054_LR 870 21/05/15 10:31 AM

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  • Y-strut®

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