Dynamic contrast-enhanced computed tomography in the treatment evaluation of patients with colorectal liver metastases treated with ablation: a feasibility study

Abstract

Background A major concern following ablation treatment is the risk of insufficient heating leaving vital tumor tissue at the treatment site, leading to recurrent disease and reduced survival. Dynamic contrast-enhanced computed tomography (DCE-CT) has the potential to evaluate the treatment site in an objective and standardized manner and provide a marker of recurrent disease. Purpose To evaluate the feasibility of measuring changes in the dynamic parameters of the treatment site following ablation of colorectal liver metastases, assessed by DCE-CT using a novel evaluation method, applying a circumferential semi-automated attenuation-restricted volume of interest (VOI). Material and Methods Forty-three treatment sites following ablation in 39 patients with colorectal liver metastases were evaluated using DCE-CT. A total of 159 DCE-CT scans were analyzed using the circumferential semi-automatized VOI. Results We found no significant differences in the dynamic parameters over time between a group of patients with recurrent disease and a group without. No consistent associations between time to recurrence and the dynamic histogram parameters were identified. Conclusion In this exploratory feasibility study, we were not able to differentiate between the two groups (recurrence/no recurrence) using the dynamic parameters derived from the standardized circumferential VOI. In time, the method may have potential to evaluate the treatment site following ablation in an objective and standardized manner. Currently, the method needs further refinement before clinical implementation.

Limited Liver or Lung Colorectal Cancer Metastases. Systemic Treatment, Surgery, Ablation or SBRT

“…ESMO guidelines [ 1 ] indicate that the selection of the best tools for the treatment of oligometastatic patients should be based on the following: The size and localization of the metastases and therefore, access regarding selection of the best treatment method; The local control rates achieved (with greater local control for surgery than for the remaining options); The invasiveness of the technique; The non-tumor-related prognostic considerations and patient-relevant factors as well as patient preferences; The local expertise regarding the use of each ablative treatment method; Consideration of patient frailty and life expectancy [ 2 ]. …”

“…The local expertise regarding the use of each ablative treatment method; • Consideration of patient frailty and life expectancy [2].…”