Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer, Anja; Tinguely, Pascale; Maurer, Martin; Frehner, Lorenz; Knöpfli, Marina Janusheva; Peterhans, Matthias; Weber, Stefan; Dufour, Jean‐François; Candinas, Daniel; Banz, Vanessa

doi:10.1111/liv.14187

Cited by 59 publications

(48 citation statements)

References 45 publications

(47 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While little is known about factors influencing targeting accuracy and therapeutic efficacy when using such navigation systems for stereotactic tumor targeting, they likely facilitate accessibility and treatment of traditionally difficult to target liver tumors (28). Our group has previously reported the benefits of using stereotactic imageguided microwave ablation (SMWA) in the treatment of HCC (29). The aim of the current study was to investigate factors influencing targeting accuracy and treatment efficacy when using SMWA for malignant liver tumors in a multivariable model that includes challenging lesion locations.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors—A Multivariable Accuracy and Efficacy Analysis

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Therapeutic success of thermal ablation for liver tumors depends on precise placement of ablation probes and complete tumor destruction with a safety margin. We investigated factors influencing targeting accuracy and treatment efficacy of percutaneous stereotactic image-guided microwave ablation (SMWA) for malignant liver neoplasms. Materials and methods : All consecutive patients treated with SMWA for malignant liver tumors over a 3-year period were analyzed. A computed tomography-based navigation system was used for ablation probe trajectory planning, stereotactic probe positioning, and validation of probe positions and ablation zones. Factors potentially influencing targeting accuracy [target positioning error (TPE)] and treatment efficacy within 6 months [ablation site recurrence (ASR)] were analyzed in a multivariable regression model, including challenging lesion locations (liver segments I, VII, and VIII; subphrenic location). Results: Three hundred one lesions (174 hepatocellular carcinomas, 87 colorectal liver metastases, 17 neuroendocrine tumors, and 23 others) were targeted in 191 interventions in 153 patients. The median TPE per ablation probe was 2.9 ± 2.3 mm (n = 384). Correction of ablation probe positions by repositioning was necessary in 4 out of 301 lesions (1%). Factors significantly influencing targeting accuracy were cirrhosis (R 0.67, CI 0.22-1.12) and targeting trajectory length (R 0.21, CI 0.12-0.29). Factors significantly influencing early ASR were lesion size >30 mm (OR 5.22, CI 2.44-11.19) and TPE >5 mm (OR 2.48, CI 1.06-5.78). Challenging lesion locations had no significant influence on targeting accuracy or early ASR. Conclusions: SMWA allows precise and effective treatment of malignant liver tumors even for lesions in challenging locations, with treatment efficacy depending on targeting accuracy in our model. Allowing for many tumors to be safely reached, SMWA has the potential to broaden treatment eligibility for patients with otherwise difficult to target tumors.

show abstract

Section: Introductionmentioning

confidence: 99%

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors—A Multivariable Accuracy and Efficacy Analysis

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…All of the 34 included works were single-centre studies, of which 26 were retrospective studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)31,(49)(50)(51)(52)(53)(54)(32)(33)(34)(35)(36)(37)(38), 3 prospective case series(55-57), 3 prospective cohort studies(58-60) and 2 randomised controlled trials (61,62). Two studies reported results using a laparoscopic treatment access (44,55), the other 32 reporting on thermal ablations using a percutaneous approach.…”

Section: Resultsmentioning

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…There are also large retrospective studies showing the potential benefits and applications of stereotactic image-guided ablations. While these studies do not show better oncological outcomes when using stereotactic ablation over conventional ablation, they state that the number of patients treated with a curative intent largely increased with the introduction of stereotactic guidance [1,30,31]. Furthermore, it has been shown in case-reports that stereotaxy was especially useful in very difficult cases when the tumor would not be reachable with conventional CT guidance [32].…”

Section: Current Evidence and Future Perspectivesmentioning

confidence: 99%

Stereotactic Image-Guidance for Ablation of Malignant Liver Tumors

Paolucci¹,

Sandu²,

Tinguely³

et al. 2021

Liver Pathology

Self Cite

View full text Add to dashboard Cite

Stereotactic percutaneous ablation is a rapidly advancing modality for treatment of tumors in soft solid organs such as the liver. Each year, there are about 850,000 cases of primary liver cancer worldwide. Although surgical resection still is the gold standard for most cases, only 20-30% of patients are candidates for it, due to the advanced stage of the disease. Surgery can also be a huge burden to the patient and his/her quality of life might be temporarily severely reduced due to long hospital stays, complications, and slow recovery. To overcome these disadvantages, thermoablation of tumors of up to 3 cm has become a more viable alternative especially in the last decade, offering a potentially equally effective but minimally invasive and tissue sparing treatment alternative. In conjunction with improved CT imaging, stereotactic image-guidance techniques and image fusion technology were introduced to increase safety, efficacy, and accuracy of this treatment. Stereotactic image-guidance leads to a simple, fast, and accurate placement of the ablation probe into the liver tumor, which is a prerequisite for a complete destruction of the tumor by ablation. More and more physicians, including surgeons, consider ablation a viable alternative to resection whenever feasible. Patients undergoing such a minimally invasive treatment benefit from a shorter hospital stays, reduced complication rates, and faster recovery.

show abstract

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Cited by 59 publications

References 45 publications

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors—A Multivariable Accuracy and Efficacy Analysis

Stereotactic Image-Guided Microwave Ablation for Malignant Liver Tumors—A Multivariable Accuracy and Efficacy Analysis

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

Stereotactic Image-Guidance for Ablation of Malignant Liver Tumors

Contact Info

Product

Resources

About