Technical aspects and effectiveness of percutaneous fetal therapies for large sacrococcygeal teratomas - a cohort study and a literature review.
Fiche publication
Date publication
juillet 2015
Auteurs
Membres identifiés du Cancéropôle Est :
Pr MEYER Nicolas
Tous les auteurs :
Sananes N, Javadian P, Britto IS, Meyer N, Koch A, Gaudineau A, Favre R, Ruano R
Lien Pubmed
Résumé
OBJECTIVE: The objectives of this study were to evaluate the efficacy of minimally invasive ablation of high-risk large sacrococcygeal teratomas (SCT) and to compare the efficacy of vascular and interstitial tumor ablation. METHODS: This was a retrospective multicenter study including a cohort of fetuses with high-risk large SCTs between 2004 and 2010. In addition, we performed a systematic literature review of all cases that underwent tumor ablation in order to compare the survival rates after 'vascular' and 'interstitial' ablation. Statistical analysis was conducted using Bayesian methods. RESULTS: In our cohort, a total of 13 fetuses had high-risk large SCT and five of them underwent tumor ablation. The estimated difference of hydrops resolution rate between the fetal intervention and the no fetal intervention groups was 44.6% [1.5,81.0], Pr (diff > 0) = 97.9%. The estimated difference in survival rate between the fetal intervention and the no fetal intervention groups was 31.0% [13.9,48.1], Pr (diff > 0) = 99.9%. We analyzed our 5 cases together with 28 cases from the literature and estimated the difference in survival rate between the 'vascular' and 'interstitial' ablation groups at 19.8% [-13.1,50.1], Pr (diff > 0) = 88.3%. The estimated difference of hydrops resolution rate between the 'vascular' and the 'interstitial' ablation groups was 36.7% [-5.7,72.7], Pr (diff > 0) = 95.5%. CONCLUSION: Minimally invasive surgery seems to improve perinatal outcome in cases of high-risk large fetal SCT. Our findings suggest that 'vascular' ablation may improve outcome and may be more effective than 'interstitial' tumor ablation, but this hypothesis needs further investigation in a larger multicenter prospective study.
Référence
Ultrasound Obstet Gynecol. 2015 Jul 3