Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Hocquelet, Arnaud; Trillaud, Hervé; Frulio, Nora; Papadopoulos, Panteleimon; Balageas, P.; Salut, Cécile; Meyer, Marie; Blanc, Jean‐Frédéric; Montaudon, Michel; Senneville, Baudouin Denis de

doi:10.1016/j.jvir.2016.02.031

Cited by 35 publications

(41 citation statements)

References 39 publications

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“…Attempts at tumor eradication by extending surgical margins have been the subject of much speculation, but ultimately, in setting resection margins, surgeons should try to balance postoperative morbidity and mortality with survival benefits . As tumor recurrence was detected more commonly under the RFA treatment, extensive ablation margins were expected to improve patient outcome . Whereas, these margins should be based on liver function as well as tumor characteristics in HCC, the ablative depth should also be controlled by operators.…”

Section: Discussionmentioning

confidence: 99%

“…Improvements in imaging techniques allow for more precise measurement of the ablative margin. Several techniques such as the R grading system, ferucarbotran application, and automatic registration methods have been reported. Moreover, intra‐arterial infusion with iodized oil can demonstrate a clear borderline in post‐ablative HCC lesions, thus allowing the necrotic tumor, ablative margin, and normal parenchyma to be distinguished from the same image .…”

Section: Discussionmentioning

confidence: 99%

“…24,25 As tumor recurrence was detected more commonly under the RFA treatment, 26 extensive ablation margins were expected to improve patient outcome. [27][28][29] Whereas, these margins should be based on liver function as well as tumor characteristics in HCC, the ablative depth should also be controlled by operators. According to our subgroup analysis, the ablative margin was one of the major factors associated with cancer recurrence in Child-Pugh class B HCC patients.…”

Section: Subgroup Analysismentioning

confidence: 99%

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Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Liao

Zhong

Zhang

et al. 2017

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Subgroup Analysismentioning

confidence: 99%

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Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Liao

Zhong

Zhang

et al. 2017

Journal of Surgical Oncology

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“…Accumulating evidence has pointed towards the postablation safety margin (minimal ablative margin) as a critical determinant of RFA success. In several studies, a minimal ablative margin (MAM) of less than 5 mm has been associated with higher rates of LTP [24][25][26]. Therefore, we postulate that the assessment of the MAM can be used as an intraprocedural tool to evaluate the treatment success of stereotactic RFA and facilitate further ablation in the same session if needed.…”

Section: Introductionmentioning

confidence: 99%

Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation

et al. 2020

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Objectives To assess the minimal ablative margin (MAM) by image fusion of intraprocedural pre-and post-ablation contrastenhanced CT images and to evaluate if it can predict local tumor progression (LTP) independently. Furthermore, to determine a MAM with which a stereotactic radiofrequency ablation (SRFA) can be determined successful and therefore used as an intraprocedural tool to evaluate treatment success. Methods A total of 110 patients (20 women, 90 men; mean age 63.7 ± 10.2) with 176 hepatocellular carcinomas were assessed by retrospective analysis of prospectively collected data. The MAM was determined through image fusion of intraprocedural preand post-ablation images using commercially available rigid imaging registration software. LTP was assessed in contrastenhanced CTs or MR scans at 3-6-month intervals. Results The MAM was the only significant independent predictor of LTP (p = 0.036). For each millimeter increase of the MAM, a 30% reduction of the relative risk for LTP was found (OR = 0.7, 95% CI 0.5-0.98, p = 0.036). No LTP was detected in lesions with a MAM > 5 mm. The overall LTP rate was 9 of 110 (8.2%) on a patient level and 10 of 173 (5.7%) on a lesion level. The median MAM was 3.4 (1.7-6.9) mm. The mean overall follow-up period was 26.0 ± 10.3 months.Conclusions An immediate assessment of the minimal ablative margin (MAM) can be used as an intraprocedural tool to evaluate the treatment success in patients treated with stereotactic RFA. A MAM > 5 mm has to be achieved to consider an ablation as successful. Key Points • An intraoperatively measured minimal ablative margin (MAM) > 5 mm correlates with complete remission.• MAM is the only significant independent predictor of LTP (OR = 0.7, 95% CI 0.5-0.98, p = 0.036) after stereotactic RFA of hepatocellular carcinoma. • Image fusion using commercially available rigid imaging registration software is possible, even though considerably complex.Therefore, improved (semi-)automatic fusion software is highly desirable.

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“…Technical effectiveness of the procedure depends on the safety margin of the ablation zone, which is directly proportional to the tumor recurrence rate [13]. Recent studies revealed that the risk of local recurrence after thermal ablation of hepatocellular carcinoma can be substantially minimized by achieving a three-dimensional (3D) safety margin of 0.5 cm [14][15][16][17].…”

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confidence: 99%

Thermal ablation—an option in curative treatment of HCC

Putzer

Schullian

Eberle

et al. 2020

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Minimally invasive thermal ablation techniques are an integral part of international treatment guidelines in hepatocellular carcinoma (HCC). Due to highly effective local tumor control in nonresectable liver tumors with a relatively low rate of morbidity and mortality, thermal ablation even challenges the surgical approach as the first-line treatment in selected patients. Ablation outcome is largely dependent on the size and location of the HCC as well as on the applied ablation technique and image guidance. The creation of a sufficient ablation margin (A0 ablation in analogy to R0 resection) is prerequisite to assure low recurrence rates. In large tumors, tumorfree margins can be achieved only by overlapping ablation zones, which can be accomplished using stereotactic multiprobe ablation techniques (stereotactic radiofrequency ablation [SRFA], stereotactic microwave ablation [SMWA], stereotactic irreversible electroporation [SIRE]) in combination with 3D trajectory planning and image fusion for intraoperative evaluation of treatment results.

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Three-Dimensional Measurement of Hepatocellular Carcinoma Ablation Zones and Margins for Predicting Local Tumor Progression

Cited by 35 publications

References 39 publications

Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Radiofrequency ablation using a 10‐mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: A prospective randomized trial

Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation

Thermal ablation—an option in curative treatment of HCC

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