Stereotactic image guided microwave ablation of HCC: A step forward and still a long way to go

Jong, Koert P. de; Ruiter, Simeon J. S.; Pennings, Jan-Pieter

doi:10.1111/liv.14238

Cited by 6 publications

(8 citation statements)

References 16 publications

(18 reference statements)

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“…For successful percutaneous RFA of the liver, accurate localization of the needle and depiction of the extent of the ablation zone is required [ 8 ]. Current imaging modalities lack accurate real-time monitoring of the ablation zone during RFA [ 17 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

“…This heat diffuses through the tissue, creating an ablation zone in which high temperatures between 50 and 100 °C cause coagulation necrosis, destroying the tumor cells [ 7 ]. Despite its success, RFA has a higher probability of tumor recurrence compared to liver resection due to incomplete ablations [ 8 , 9 ]. Percutaneous RFA is subject to varying recurrence and local tumor progression rates, being 21–43% [ 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Percutaneous RFA is subject to varying recurrence and local tumor progression rates, being 21–43% [ 10 , 11 , 12 ]. Factors contributing to successful treatment are (1) locating the tumor and blood vessels, (2) accurate placement of the RFA device, and (3) delineating the extent of the ablation zone [ 8 ]. Thus, accurate image guidance is essential for proper device targeting and assessment of ablation success.…”

Section: Introductionmentioning

confidence: 99%

“…Incomplete ablation frequently occurs with tumors near large blood vessels since they dissipate heat from the ablation region (heat sink effect) [ 13 ]. Locating the tumor and its proximity to blood vessels is an important step in achieving complete ablation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Annular Fiber Probe for Interstitial Illumination in Photoacoustic Guidance of Radiofrequency Ablation

Kruit

Francis

Rascevska

et al. 2021

Sensors

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Unresectable liver tumors are commonly treated with percutaneous radiofrequency ablation (RFA). However, this technique is associated with high recurrence rates due to incomplete tumor ablation. Accurate image guidance of the RFA procedure contributes to successful ablation, but currently used imaging modalities have shortcomings in device guidance and treatment monitoring. We explore the potential of using photoacoustic (PA) imaging combined with conventional ultrasound (US) imaging for real-time RFA guidance. To overcome the low penetration depth of light in tissue, we have developed an annular fiber probe (AFP), which can be inserted into tissue enabling interstitial illumination of tissue. The AFP is a cannula with 72 optical fibers that allows an RFA device to slide through its lumen, thereby enabling PA imaging for RFA device guidance and ablation monitoring. We show that the PA signal from interstitial illumination is not affected by absorber-to-surface depth compared to extracorporeal illumination. We also demonstrate successful imaging of the RFA electrodes, a blood vessel mimic, a tumor-mimicking phantom, and ablated liver tissue boundaries in ex vivo chicken and bovine liver samples. PA-assisted needle guidance revealed clear needle tip visualization, a notable improvement to current US needle guidance. Our probe shows potential for RFA device guidance and ablation detection, which potentially aids in real-time monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Annular Fiber Probe for Interstitial Illumination in Photoacoustic Guidance of Radiofrequency Ablation

Kruit

Francis

Rascevska

et al. 2021

Sensors

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“…Accurate tumour targeting represents the essential initial step for successful ablation of liver tumours, and an independent correlation with early ablation site recurrence has been described (29). However, many other important tumour-speci c determinants affect ablation site recurrences, such as satellite nodules detectable on pathology but not imaging, recurrence risk determined by underlying liver disease, mutational status and location of primary tumour, and different types and time points of chemotherapy regimens (70,71). This underlines the di culty of comparing treatment e cacy after a certain, currently unde ned period of time after thermal ablation of liver tumours between individual studies, which should be avoided.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

Tinguely

Paolucci

Ruiter

et al. 2020

Preprint

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Background: Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumours. We qualitatively reviewed and quantitatively summarised the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumours.Methods: A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency and treatment efficacy outcomes. Meta-analysis including subgroup analyses were performed.Results: Thirty-four studies (2 randomised controlled trials, 3 prospective cohort studies, 29 case series) were qualitatively analysed and 22 studies included for meta-analysis. Weighted average lateral targeting error was 3.7mm (CI 3.2,4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1) and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1 – 6 weeks and 90% (87, 93) if assessed at 6 – 12 weeks post ablation, with significant remaining between-study heterogeneity. Pooled odds ratio of primary technique efficacy for stereotactic versus free-hand targeting was 1.9 (1.2, 3.2)(n = 6 studies).Conclusions: Advances in stereotactic navigation technologies allow highly precise and safe tumour targeting, potentially leading to enhanced early treatment efficacy. The use of varying definitions and terminology limit comparability of safety and efficacy among studies, highlighting the crucial need for further standardization of follow-up definitions.

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Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

et al. 2022

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Objectives Thermal ablation (TA) is an established treatment for early HCC. There is a lack of data on the efficacy of repeated TA for recurrent HCC, resulting in uncertainty whether good oncologic outcomes can be obtained without performing orthotopic liver transplantation (OLTx). This study analyses outcomes after TA, with a special focus on repeat TA for recurrent HCC, either as a stand-alone therapy, or in relationship with OLTx. Methods Data from a prospectively registered database on interventions for HCC in a tertiary hepatobiliary centre was completed with follow-up until December 2020. Outcomes studied were rate of recurrence after primary TA and after its repeat interventions, the occurrence of untreatable recurrence, OS and DSS after primary and repeat TA, and complications after TA. In cohorts matched for confounders, OSS and DSS were compared after TA with and without the intention to perform OLTx. Results After TA, 100 patients (56·8%) developed recurrent HCC, of whom 76 (76·0%) underwent up to four repeat interventions. During follow-up, 76·7% of patients never developed a recurrence unamenable to repeat TA or OLTx. OS was comparable after primary TA and repeat TA. In matched cohorts, OS and DSS were comparable after TA with and without the intention to perform OLTx. Conclusions We found TA to be an effective and repeatable therapy for primary and recurrent HCC. Most recurrences can be treated with curative intent. There are patients who do well with TA alone without ever undergoing OLTx. Key Points • Recurrent HCC after primary TA can often be treated effectively with repeat TA. Survival after repeat TA is comparable to primary TA. • In matched cohorts, outcomes after TA with and without subsequent waitlisting for OLTx are comparable. • There are patients who do well for many years with primary and repeat TA alone; some despite multiple recurrences.

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Stereotactic image guided microwave ablation of HCC: A step forward and still a long way to go

Abstract: See Article on Page 1983

Cited by 6 publications

References 16 publications

Annular Fiber Probe for Interstitial Illumination in Photoacoustic Guidance of Radiofrequency Ablation

Annular Fiber Probe for Interstitial Illumination in Photoacoustic Guidance of Radiofrequency Ablation

Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumours - A Systematic Review and Meta-Analysis

Outcomes after primary and repeat thermal ablation of hepatocellular carcinoma with or without liver transplantation

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