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Daniel B Rukstalis

Publications and source records attributed to Daniel B Rukstalis.

6 recordsLinked to original sources
PubMed2006

Long-term results of cryoablation for renal cancer and complex renal masses.

The purpose of this article is to review our experience with 5-year clinical follow-up after cryosurgical ablation of renal neoplasms. A retrospective review of a de-identified database was undertaken to retrieve information on patients with > or = 36 months' follow-up. Patient demographics, tumor characteristics, radiologic follow-up, and disease-free and overall survival data were evaluated. A total of 48 patients, with a median follow-up of 64 months (range, 36-110 months) and an overall survival rate of 89.5% were identified. Median lesion size was 2.6 cm (range, 1.1-4.6 cm). A total of 12.5% patients were diagnosed with persistent disease during the follow-up period. The cancer-specific survival rate was 100%, and the cancer-free survival rate after a single cryoablation procedure was 87.5%. This improved to 97.5% after a repeat procedure. No major complications were observed. Our data suggest that cryosurgical ablation of renal neoplasms can lead to acceptable long-term disease-free survival. Careful radiologic follow-up strategies are crucial in monitoring treatment success and identifying those who may require a secondary salvage procedure.

Adult↗
PubMed2006

Percutaneous ultrasound-guided cryoablation of renal tumors using the CIVCO assist positioning system.

Cryoablation is emerging as an accepted treatment for small renal tumors. Percutaneous placement of cryoprobes using ultrasound guidance is an attractive option for patients with tumors easily seen with transabdominal ultrasonography; however, the placement of probes using hand-held devices is technically challenging. To improve the accuracy and ease of cryoprobe placement during percutaneous renal cryoablation, we describe the novel application of the CIVCO Assist positioning arm system during these complex procedures.

Cryosurgery↗
PubMed2002

Prostate cryoablation: a scientific rationale for future modifications.

This investigation was designed to identify potential directions for future modification of the percutaneous prostate cryoablation procedure. An analysis of prostate cancer location and volume in radical prostatectomy specimens was performed to evaluate the potential clinical consequences of these proposed modifications. A list of recommendations for improvements in the prostate cryoablation procedure was compiled from informal discussions held with participants in 9 training courses and conferences on prostate cryoablation over 18 months. Subsequently, a population of 112 consecutive, sagittally sectioned whole-mount radical prostatectomy samples was evaluated for prostate cancer volume, number of individual foci, and location to examine the disease-specific outcomes of these proposed modifications. The most common areas for potential alterations in the current cryoablation technique include modifications that would further simplify the procedure, continue to reduce real and perceived toxicity, and augment efficacy. Importantly, modifications designed to reduce treatment side effects could conflict with efforts designed to improve eradication of prostate cancer. Pathologic analysis revealed multifocal cancer in 79.5% of the samples, with 66% of cases exhibiting cancer within 5 mm of the urethra. The median volume of the index cancer was 1.6 cm3, whereas the median volume of the smaller ancillary lesions was 0.3 cm3. Prostate parenchymal-sparing alterations, proposed to reduce incontinence and erectile dysfunction by targeting the index cancer, would likely eradicate clinically significant cancer in 79% of men. The recent enthusiasm for prostate cryoablation as a reasonable minimally invasive treatment option for men with clinically localized cancer is likely to result in modifications of the established surgical technique. Knowledge of the anatomic location and cancer volume within the prostate gland is an important adjunct to planning such alterations. It is possible that parenchymal-sparing modifications to total gland prostate cryoablation can eradicate clinically significant cancer in most men, with a reduction in toxicity and cost.

Adenocarcinoma↗
PubMed2002

Preliminary experience with cryoablation of renal lesions smaller than 4 centimeters.

Nephron-sparing surgical techniques represent an attractive treatment approach for small renal lesions that are limited only by potential operative morbidity. This study tests the hypothesis that an alternative strategy of in situ cryoablation of these lesions may further reduce the incidence of complications with similar efficacy. Beginning August 1996,17 patients were enrolled in an institutional review board-approved protocol for open renal cryoablation for lesions smaller than 4 cm in diameter. The median age was 62 years (range, 35-75 years). The median preoperative lesion size was 2.0 cm (range, 1.1-4.2 cm) determined with either computed tomography or magnetic resonance imaging. A double freeze-thaw technique to -180 degrees C was used under direct intraoperative ultrasound monitoring. The median length of follow-up was 30 months (range, 10-60 months), with 8 patients followed up for more than 20 months. The procedure was accomplished in 3 hours (range, 2.25-4.25 hours) through a 5-cm to 7-cm subcostal incision. The median blood loss was 100 mL, and the median hospital stay was 2 days (range, 2-8 days). The median intraoperative lesion was 2.4 cm, which was not statistically different from preoperative measurements. Postoperative serum creatinine levels were unchanged except for a transient increase from 5.5 mg/dL to 7.0 mg/dL in one patient. Follow-up magnetic resonance imaging scans have demonstrated infarction and a reduction of lesion size in 15 of 16 cases. The size of one patient's mass was unchanged after 3 months. Renal cryoablation via an open approach is associated with few complications and represents a viable alternative to extirpative surgical techniques. The open exposure provides an accurate assessment of the renal unit with definitive ultrasound visualization.

Adult↗
PubMed2002

Treatment options after failure of radiation therapy-a review.

Radioresistant or recurrent prostate cancer represents a serious health risk for approximately 20%-30% of patients treated with primary radiation therapy for clinically localized prostate cancer. The majority of patients exhibit large volume and poorly differentiated disease at the time of diagnosis, which limits the ability of salvage therapy to eradicate the cancer. Early detection with serum PSA monitoring and prostate needle biopsy following primary radiation therapy may identify residual adenocarcinoma at an earlier stage and increase the likelihood of successful salvage therapy. Radical prostatectomy, prostate cryoablation, and brachytherapy comprise the options for salvage treatment available for radiorecurrent prostate cancer. The goal of disease eradication must be balanced against the potential for serious treatment-related side effects. As a result, many patients receive noncurative therapy with androgen ablation despite the real risk of disease progression and mortality.

Journal Article↗