Thermal ablation of unresectable liver tumors: Factors associated with partial ablation and the impact on long-term survival

Wiggermann, Philipp; Puls, Ralf; Vasilj, A.; Sieroń, Dominik; Schreyer, A.; Jung, Ernst Michael; Wawrzynek, Wojciech; Stroszczynski, Christian

doi:10.12659/msm.882463

Cited by 10 publications

(3 citation statements)

References 43 publications

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“…3 shows an example of an incomplete ablation in one of our patients, most likely due to the adjacency of the liver vein and thus the heat sink effekt. Several studies investigated risk factors associated with partial ablation and local recurrence [23][24][25][26]. To our knowledge, there is no previous study investigating the detectability of the target lesion as a potential risk factor.…”

Section: Discussionmentioning

confidence: 99%

Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome

Barzakova

Senthilvel

Bruners

et al. 2021

Rofo

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Purpose Small hepatic malignancies scheduled for CT-guided percutaneous ablation may have been identified in the hepatobiliary phase of liver MRI or in a specific phase of multi-phase CT but may be occult on unenhanced CT used to guide the ablation. We investigated whether the detectability of the target lesion would impact the efficacy of CT-guided hepatic tumor ablations. Materials and Methods We included 69 patients with 99 malignant liver lesions (25 primary, 44 metastases) who underwent IRE (n = 35), RFA (n = 41), or MWA (n = 23) between 01/2015 and 06/2018. All procedures were performed under CT guidance. Lesions not detectable on CT (NDL) were targeted through identification of anatomical landmarks on preinterventional contrast-enhanced CT or MRI. Rates of incomplete ablation, size of ablation zone, local tumor recurrence, intrahepatic progression-free survival (ihPFS), and adverse event rates were compared for detectable lesions (DL) vs. NDL. Results 40 lesions were NDL, and 59 lesions were DL on unenhanced CT. The mean follow-up was 16.2 months (14.8 for DL and 18.2 for NDL). The mean diameter of NDL and DL was similar (12.9 mm vs. 14.9 mm). The mean ablation zone size was similar (37.1 mm vs. 38.8 mm). Incomplete ablation did not differ between NDL vs. DL (5.0 % [2/40; 0.6–16.9 %] vs. 3.4 % [2/59; 0.4–11.7 %]), nor did local tumor recurrence (15.4 % [6/39; 5.7 %–30.5 %] vs. 16.9 % [10/59; 8.4–29.0 %]), or median ihPFS (15.5 months vs. 14.3 months). Conclusion Target lesion detectability on interventional CT does not have a significant impact on outcome after percutaneous liver ablation when anatomical landmarks are used to guide needle placement. Key Points: Citation Format

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Section: Discussionmentioning

confidence: 99%

Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome

Barzakova

Senthilvel

Bruners

et al. 2021

Rofo

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“…The 5-year survival after thermal ablation is 44% if the ablation is complete and 20% if it is partial. The frequency of partial ablation ranges from 38% to 52% [114][115][116]. The size of neoplastic mass is the main predictive factor for the completeness of the ablation, with better results achieved in metastases smaller than 3 cm [116,117].…”

Section: Nonsurgical Treatment Of Liver Metastases Of Colorectal Cancermentioning

confidence: 99%

Hepatic Surgery for Colorectal Cancer Metastasis — Possibilities and Prerequisites

Štrumfa¹,

Vasko²,

Vanags³

et al. 2015

Recent Advances in Liver Diseases and Surgery

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Colorectal cancer is among the most frequent malignant tumours. Liver metastases develop in % of patients affected by colorectal carcinoma. Nowadays, surgical treatment can significantly improve the -year survival ranging % of the patients undergoing liver surgery. The operation extent ranges from nonanatomic minor resection to major hepatectomy. Recently, liver transplantation has been performed for metastatic colorectal cancer. Laparoscopic approach and robotic surgery can be used by experienced specialists. The prerequisites for successful surgical treatment include exact radiologic diagnostics to determine the number and size of metastases and their association with anatomic structures individual anatomic peculiarities and remnant liver volume, ranging % in respect to functional liver status. Magnetic resonance imaging is the most sensitive method that has marked advantages in the diagnostics of lesions smaller than cm and metastases on the background of liver steatosis. Computed tomography is an acceptable alternative that benefits from high spatial resolution and optimal reconstructions to evaluate the anatomy. Additional information can be obtained from tumour markers, including traditional, e.g., carcinoembryonic antigen CEA and novel, e.g., microRNAs. To ensure that each colorectal cancer patient receives the best care, the medical society should be well informed about the possibilities in the treatment of liver metastases of colorectal cancer regarding the methods, indications and limits.Keywords: Colorectal cancer, liver metastasis, liver resection, magnetic resonance imaging © 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. . IntroductionColorectal cancer CRC represents one of the leading malignant tumours both by incidence and death rate [ , ]. Metastatic spread to liver occurs in % of patients, and % of CRC patients present with synchronous liver metastases [ , , ]. Although the presence of metastatic disease significantly adversely affects the survival, a wide scope of treatment options exists. To ensure that each colorectal cancer patient receives the best care, the medical society should be well informed about the possibilities in the treatment of liver metastases of colorectal cancer regarding the methods, indications and limits.Surgery is the preferred option for long term survival. The operation extent ranges from major hepatic resection trisegmentectomy, hepatectomy, extended hepatectomy, and hemihepatectomy to parenchyma-sparing minor resection such as segmentectomy or wedge resection [ ]. Laparoscopic approach and robotic surgery can be considered, especially in advanced centres [ , ]. In patients with questionable adequacy of the liver remnant and wide intrahepatic tumour spread, portal vein occlusion, forced liver hypertrophy and staged ...

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“…Studies have reported local tumor progression rates of up to 40% at 12 months follow-up [16]. This might be explained by persisting difficulties regarding the optimal timing and imaging method during the procedure and for follow-up [17,18].…”

Section: Introductionmentioning

confidence: 99%

Color Coded Perfusion Imaging with Contrast Enhanced Ultrasound (CEUS) for Post-Interventional Success Control Following Irreversible Electroporation (IRE) of Primary and Secondary Malignant Liver Lesions

Rennert

Wiesinger

Schicho

et al. 2019

JGLD

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Aim: Evaluation of the post-interventional success following irreversible electroporation (IRE) using a new color coded perfusion quantification software with contrast-enhanced ultrasound (CEUS) in patients with malignant lesions of the liver. Methods: Thirty-eight patients with 68 malignant liver lesions underwent IRE. All malignant lesions were investigated with CEUS before and within 24 hours following IRE to detect residual tumor tissue. The parameters analyzed by color coded perfusion quantification software were: the peak enhancement (pE), time to peak (TTP), mean transit time (mTT), rise (Ri) and wash-in area under the curve (WiAUC). Perfusion in the center, the margins of the lesions and in the surrounding liver were evaluated using these parameters. Results: Hepatocellular carcinoma (HCC) with complete ablation showed significantly different changes between the center and the margin of the lesions for WiAUC (p<0.05) and pE (p<0.01). Also significant differences were noted between the center of the lesions and the surrounded tissue for the same parameters (p<0.01). In the completely ablated metastatic lesions, significant differences were found between the center of the lesion and the margins (p < 0.01) and between the center of the lesion and the surrounding liver (p < 0.05) for WiAUC. mTT, TTP and Ri showed no significant changes between the center of the lesions, margin of the lesions or surrounding tissue. Also, no significant differences were found for these parameters in the different regions of interest for HCC or the metastatic lesions with partial ablation success. Conclusion: CEUS with perfusion imaging is a valuable supporting tool for the post-interventional evaluation of liver lesions following IRE. Focus should be placed on the peak enhancement (pE) and the wash-in area under the curve (WiAUC).

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Thermal ablation of unresectable liver tumors: Factors associated with partial ablation and the impact on long-term survival

Cited by 10 publications

References 43 publications

Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome

Detectability of Target Lesion During CT-Guided Tumor Ablations: Impact on Ablation Outcome

Hepatic Surgery for Colorectal Cancer Metastasis — Possibilities and Prerequisites

Color Coded Perfusion Imaging with Contrast Enhanced Ultrasound (CEUS) for Post-Interventional Success Control Following Irreversible Electroporation (IRE) of Primary and Secondary Malignant Liver Lesions

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