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Laimer G, Verdonschot KHM, Kopf L, van der Lei S, Scharll Y, Hannink G, Jenniskens SFM, Meijerink MR, Bale R, Overduin CG. Multicenter and inter-software evaluation of ablative margins after thermal ablation of colorectal liver metastases. Eur Radiol 2024:10.1007/s00330-024-10956-5. [PMID: 39093415 DOI: 10.1007/s00330-024-10956-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/09/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE To assess the association between minimal ablative margin (MAM) and local tumor progression (LTP) following CT-guided thermal ablation of colorectal liver metastases (CRLM) in a multicenter cohort and across two confirmation software. MATERIALS AND METHODS This multicenter retrospective study included patients who underwent CT-guided radiofrequency or microwave ablation for CRLM between 2009 and 2021 in three institutions. Three-dimensional (3D) MAM was retrospectively assessed using dedicated ablation confirmation software by automatic non-rigid (Ablation-fit) or semi-automatic rigid co-registration (SAFIR) of intraprocedural pre- and post-ablation contrast-enhanced CT scans by two independent reader teams blinded to patient outcomes. LTP was assessed on a per-tumor basis. Factors associated with LTP-free survival were assessed using multivariable Cox regression analysis. RESULTS Overall, 113 patients (mean age: 67 ± 10 years; 78 men) who underwent thermal ablation for 189 CRLM (mean diameter: 1.9 ± 1.1 cm) met the inclusion criteria. 173/189 (92%) CRLM could be successfully analyzed using both software. Over a median follow-up of 31 months (IQR: 22-47), 21 of 173 CRLM (12.1%) developed LTP. On multivariable analysis, 3D MAM was independently associated with LTP in both software (Ablation-fit: HR 0.47, 95% CI: 0.36-0.61, p < 0.001; SAFIR: HR 0.42, 95% CI: 0.32-0.55, p < 0.001). No LTP was observed in CRLM ablated with MAM ≥ 4 mm (Ablation-fit) and ≥ 5 mm (SAFIR). The per-tumor median absolute difference in MAM quantification between both software was 2 mm (IQR: 1-3). CONCLUSION MAM was independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software. Ablations achieving a MAM ≥ 5 mm were associated with local control in both software. CLINICAL RELEVANCE STATEMENT MAMs from intraprocedural contrast-enhanced CT were independently associated with LTP after thermal ablation of CRLM across multicenter data and two confirmation software, with a margin ≥ 5 mm associated with local control in both software. KEY POINTS Sufficient ablative margins are critical for local control following thermal ablation of CRLM. Intraprocedural CT-derived MAM was the only independent factor associated with LTP across two confirmation software. No LTP was observed in CRLM ablated with a MAM ≥ 5 mm.
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Affiliation(s)
- Gregor Laimer
- Department of Radiology, Interventional Oncology, Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Koen H M Verdonschot
- Department of Medical Imaging, Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lina Kopf
- Department of Radiology, Interventional Oncology, Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Susan van der Lei
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Yannick Scharll
- Department of Radiology, Interventional Oncology, Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Gerjon Hannink
- Department of Medical Imaging, Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sjoerd F M Jenniskens
- Department of Medical Imaging, Radiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Reto Bale
- Department of Radiology, Interventional Oncology, Stereotaxy and Robotics, Medical University Innsbruck, Innsbruck, Austria
| | - Christiaan G Overduin
- Department of Medical Imaging, Radiology, Radboud University Medical Center, Nijmegen, Netherlands.
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Bale R, Laimer G, Schullian P, Alzaga A. Stereotactic ablation: A game changer? J Med Imaging Radiat Oncol 2023; 67:886-894. [PMID: 37401185 DOI: 10.1111/1754-9485.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
For both primary and metastatic liver cancer, thermal ablation represents an interesting alternative to surgery. However, except for a small fraction of patients, conventional ultrasound- and CT-guided single-probe approaches have not achieved oncologic outcomes comparable with surgery. In this overview, we describe our stereotactic ablation workflow and discuss the short- and long-term results of stereotactic radiofrequency ablation (SRFA) and stereotactic microwave ablation (SMWA) for the treatment of primary and secondary liver tumours. The advantages of this method are discussed together with a summary of the existing stereotactic techniques for thermal ablation and the clinical data that support them. Stereotactic ablation is based on an optical navigation system and a specialized aiming tool. The workflow includes advanced three-dimensional planning, precise needle/probe placements according to the plan and intraoperative image fusion to check the needle positions and the ablation margins. Stereotactic ablation offers all the advantages of a minimally invasive procedure while producing oncological results comparable with surgery. The number of locally treatable liver cancers may be significantly expanded with these cutting-edge instruments and methods. We firmly believe that it can become a cornerstone in the treatment of liver cancers.
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Affiliation(s)
- Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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3
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Solbiati LA. High-Level Standardization of Ablative Procedures: The Way to Go. Cardiovasc Intervent Radiol 2023; 46:1755-1757. [PMID: 37950088 DOI: 10.1007/s00270-023-03596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Luigi A Solbiati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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Paolucci I, Albuquerque Marques Silva J, Lin YM, Fellman BM, Jones KA, Tatsui CE, Weinberg JS, Ruiz J, Tan J, Brock KK, Bale R, Odisio BC. Study Protocol STEREOLAB: Stereotactic Liver Ablation Assisted with Intra-Arterial CT Hepatic Arteriography and Ablation Confirmation Software Assessment. Cardiovasc Intervent Radiol 2023; 46:1748-1754. [PMID: 37563313 DOI: 10.1007/s00270-023-03524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/22/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE This study aims to evaluate the technical efficacy and local tumor progression-free survival (LTPFS) of a standardized workflow for thermal ablation of colorectal liver metastases (CRLM) consisting of CT during hepatic arteriography (CTHA)-based imaging analysis, stereotactic thermal ablation, and computer-based software assessment of ablation margins. MATERIALS AND METHODS This investigator initiated, single-center, single-arm prospective trial will enroll up to 50 patients (≤ 5 CRLM, Measuring ≤ 5 cm). Procedures will be performed in an angio-CT suite under general anesthesia. The primary objective is to estimate LTPFS with a follow-up of up to 2 years and secondary objectives are analysis of the impact of minimal ablative margins on LTPFS, adverse events, contrast media utilization and radiation exposure, overall oncological outcomes, and anesthesia/procedural time. Adverse events (AE) will be recorded by CTCAE (Common Toxicity Criteria for Adverse Events), and Bayesian optimal phase-2 design will be applied for major intraprocedural AE stop boundaries. The institutional CRLM ablation registry will be used as benchmark for comparative analysis with the historical cohort. DISCUSSION The STEREOLAB trial will introduce a high-precision and standardized thermal ablation workflow for CRLM consisting of CT during hepatic arteriography imaging, stereotactic guidance, and ablation confirmation. Trial Registration ClinicalTrials.gov identifier: (NCT05361551).
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Affiliation(s)
- Iwan Paolucci
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Jessica Albuquerque Marques Silva
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Yuan-Mao Lin
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA
| | - Bryan M Fellman
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle A Jones
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudio E Tatsui
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph Ruiz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jens Tan
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Interventionelle Onkologie-Mikroinvasive Therapie (SIP), Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Bruno C Odisio
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1471, Houston, TX, USA.
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Iezzi R, Posa A, Contegiacomo A, Lee IJ, Bale R, Tanzilli A, Tenore L, Giuliante F, Gasbarrini A, Goldberg SN, Jakobs T, Pompili M, Bargellini I, Sala E, Kim HC. Early-Stage HCC Percutaneous Locoregional Management: East versus West Perspectives. Cancers (Basel) 2023; 15:3988. [PMID: 37568804 PMCID: PMC10416919 DOI: 10.3390/cancers15153988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Hepatocellular carcinoma represents an important cause of death worldwide. Early-stage hepatocellular carcinoma patients not suitable for surgery can be treated with a variety of minimally invasive locoregional interventional oncology techniques. Various guidelines in different countries address the treatment of hepatocellular carcinoma, but the actual treatment is usually discussed by a multidisciplinary tumor board in a personalized manner, leading to potential treatment differences based on Western and Eastern perspectives. The aim of this paper is to integrate literature evidence with the eminent experiences collected during a focused session at the Mediterranean Interventional Oncology (MIO) Live Congress 2023.
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Affiliation(s)
- Roberto Iezzi
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Alessandro Posa
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Andrea Contegiacomo
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - In Joon Lee
- Department of Radiology, National Cancer Center, Goyang 10408, Republic of Korea;
| | - Reto Bale
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | | | - Lorenzo Tenore
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
| | - Felice Giuliante
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Hepatobiliary Surgery Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Shraga Nahum Goldberg
- Division of Image-Guided Therapy, Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Tobias Jakobs
- Clinic of Interventional Radiology, Hospital Barmherzige Brueder, 93049 Munich, Germany;
| | - Maurizio Pompili
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
- Internal Medicine and Gastroenterology Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | | | - Evis Sala
- Department of Diagnostic Imaging, Oncologic Radiotherapy and Hematology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (A.P.); (A.C.); (L.T.); (E.S.)
- School of Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy; (F.G.); (A.G.); (M.P.)
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
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6
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Fogarollo S, Bale R, Harders M. Towards liver segmentation in the wild via contrastive distillation. Int J Comput Assist Radiol Surg 2023; 18:1143-1149. [PMID: 37145251 PMCID: PMC10329587 DOI: 10.1007/s11548-023-02912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE Automatic liver segmentation is a key component for performing computer-assisted hepatic procedures. The task is challenging due to the high variability in organ appearance, numerous imaging modalities, and limited availability of labels. Moreover, strong generalization performance is required in real-world scenarios. However, existing supervised methods cannot be applied to data not seen during training (i.e. in the wild) because they generalize poorly. METHODS We propose to distill knowledge from a powerful model with our novel contrastive distillation scheme. We use a pre-trained large neural network to train our smaller model. A key novelty is to map neighboring slices close together in the latent representation, while mapping distant slices far away. Then, we use ground-truth labels to learn a U-Net style upsampling path and recover the segmentation map. RESULTS The pipeline is proven to be robust enough to perform state-of-the-art inference on target unseen domains. We carried out an extensive experimental validation using six common abdominal datasets, covering multiple modalities, as well as 18 patient datasets from the Innsbruck University Hospital. A sub-second inference time and a data-efficient training pipeline make it possible to scale our method to real-world conditions. CONCLUSION We propose a novel contrastive distillation scheme for automatic liver segmentation. A limited set of assumptions and superior performance to state-of-the-art techniques make our method a candidate for application to real-world scenarios.
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Affiliation(s)
- Stefano Fogarollo
- Department of Computer Science Interactive Graphics and Simulation Group (IGS), University of Innsbruck, Innsbruck, Austria.
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Matthias Harders
- Department of Computer Science Interactive Graphics and Simulation Group (IGS), University of Innsbruck, Innsbruck, Austria
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7
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Glossop N, Bale R, Xu S, Pritchard WF, Karanian JW, Wood BJ. Patient-specific needle guidance templates drilled intraprocedurally for image guided intervention: feasibility study in swine. Int J Comput Assist Radiol Surg 2023; 18:537-544. [PMID: 36173542 PMCID: PMC9974549 DOI: 10.1007/s11548-022-02747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Thermal ablation of large tumors may benefit from simultaneous placement of multiple needles, but accurate placement becomes challenging as the number of needles increases. The aim of this work was to evaluate use of personalized needle guidance grid templates based on intraprocedural CT and fabricated at the point of care to implement ablation treatment plans with multiple needles in vivo. METHODS A plastic frame was designed to hold two parallel plastic guide plates in a rigid relationship, fixed over the abdomen by a mounting arm. Steel ball targets (1.5 mm) were implanted under ultrasound in the livers of two domestic swine under general anesthesia. Following breath-hold CT of the subject and frame, the targets and frame were identified using customized 3D Slicer-based planning software. Multiple needle trajectories targeting the balls were planned, including complex off-plane trajectories. A machining program for drilling the hole pattern corresponding to the planned needle trajectories was generated. The pattern was drilled in the two plates with a numerical-controlled milling machine in the suite. The plates were attached to the frame and needles passed through the paired holes to the calculated depth. Placement accuracy was defined as needle tip-to-target distance on post-placement CT. RESULTS The planning process and manufacturing required approximately 6 and 15 min, respectively. Needles were rapidly inserted (n = 11) to the target points without complications or traversing nontarget anatomy. The mean needle tip-to-target distance error was 3.4 ± 2.2, range 0-7 mm. CONCLUSION Rapid and accurate needle placement was feasible using a subject-specific, custom-drilled, needle guidance grid template fabricated intraprocedurally. Targeting accuracy and performance were similar to more complex and expensive tracking systems which may enable accurate intraprocedural implementation of treatment plans in the liver or other organs. This may be of value in complex ablation cases or in areas where more advanced guidance systems are not available.
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Affiliation(s)
- Neil Glossop
- Queen's University, Kingston, ON, Canada.
- ArciTrax Inc., Toronto, ON, Canada.
| | - Reto Bale
- Medical University of Innsbruck, Innsbruck, Austria
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
- National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, 20892, USA
- National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, MD, 20892, USA
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8
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Schullian P, Laimer G, Johnston E, Putzer D, Eberle G, Widmann G, Scharll Y, Bale R. Reliability of Stereotactic Radiofrequency Ablation (SRFA) for Malignant Liver Tumors: Novice versus Experienced Operators. BIOLOGY 2023; 12:biology12020175. [PMID: 36829454 PMCID: PMC9952769 DOI: 10.3390/biology12020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/24/2023]
Abstract
PURPOSE To compare the results of a novice with those of experienced interventional radiologists (IRs) for stereotactic radiofrequency ablation (SRFA) of malignant liver tumors in terms of safety, technical success, and local tumor control. METHODS A database, including all SRFA procedures performed in a single center between January 2011 and December 2018 was retrospectively analyzed. A total of 39 ablation sessions performed by a novice IR were compared to the results of three more experienced IRs. Comparative SRFA sessions were selected using propensity score matching considering tumor type, age, sex, tumor size, and tumor number as matching variables. Overall, 549 target tumors were treated in 273 sessions. Median tumor size was 2.2 cm (1.0-8.5 cm) for 178 hepatocellular carcinomas (HCCs) and 3.0 cm (0.5-13.0 cm) for 371 metastases. A median of 2 (1-11) tumors were treated per session. RESULTS No significant differences were observed when comparing the results of more experienced IRs with those of a novice IR regarding the rates of major complications (6.8% [16/234] vs. 5.1% [2/39]; p = 0.477), mortality (1.3% [2/234] vs. 0% [0/39]; p = 0.690), primary technical efficacy (98.5% [525/533] vs. 98.9% [94/95]; p = 0.735), and local recurrence (5.6% [30/533] vs. 5.3% [5/95]; p = 0.886). However, the median planning/placement time was significantly shorter for the experienced IRs (92 min vs. 119 min; p = 0.002). CONCLUSIONS SRFA is a safe, effective, and reliable treatment option for malignant liver tumors and favorable outcomes can be achieved even by inexperienced operators with minimal supervision.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Edward Johnston
- The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London SW3 6JJ, UK
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology—Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
- Correspondence:
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Identification and characterization of patients being exposed to computed-tomography associated radiation-doses above 100 mSv in a real-life setting. Eur J Radiol Open 2022; 10:100470. [PMID: 36590327 PMCID: PMC9800257 DOI: 10.1016/j.ejro.2022.100470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale and objectives Patients receiving high cumulative effective doses (CED) from recurrent computed tomography (CT) in a real-life setting are not well identified. Evaluation of causes and patient characteristics may help to define individuals potentially at risk of radiation-induced secondary malignancies. Materials and methods Patients who received a CED > 100 mSv from CT scans during October 2012 and April 2020 at a tertiary university center were identified with the help of a radiological radiation dose monitoring system. The primary disease and referral diagnosis, number of CT exams, time period, age, BMI and gender distribution of the 1000 patients with the highest CED were analysed. Results 3431 patients had a CED of more than 100 mSv, which corresponded to 2.75% of all patients who received a CT exam. From the 1000 patients with the highest CED, mean number of CT exams per patient was 14.6, mean CED was 257 mSv (SD 98, range 177-1339). Mean age of patients was 63.9 years (SD 10.6), male to female ratio 3:2, and mean BMI 28.7 kg/m2 (SD 5.5). 728 (72.9%) patients had cancer. The leading primary diagnosis was liver cirrhosis in 197 patients and 103 patients had a liver transplantation. In patients with liver cirrhosis, 750 exams were indicated for the follow-up of the disease, 662 for the clarification of an acute clinical condition, and 202 for CT-guided stereotactic radiofrequency ablation. Conclusion Recurrent CT scans of patients with cancer, liver cirrhosis and liver transplantation may lead to critically high CED.
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Li S, Zhou Z, Wu S, Wu W. A Review of Quantitative Ultrasound-Based Approaches to Thermometry and Ablation Zone Identification Over the Past Decade. ULTRASONIC IMAGING 2022; 44:213-228. [PMID: 35993226 DOI: 10.1177/01617346221120069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Percutaneous thermal therapy is an important clinical treatment method for some solid tumors. It is critical to use effective image visualization techniques to monitor the therapy process in real time because precise control of the therapeutic zone directly affects the prognosis of tumor treatment. Ultrasound is used in thermal therapy monitoring because of its real-time, non-invasive, non-ionizing radiation, and low-cost characteristics. This paper presents a review of nine quantitative ultrasound-based methods for thermal therapy monitoring and their advances over the last decade since 2011. These methods were analyzed and compared with respect to two applications: ultrasonic thermometry and ablation zone identification. The advantages and limitations of these methods were compared and discussed, and future developments were suggested.
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Affiliation(s)
- Sinan Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Zhuhuang Zhou
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Shuicai Wu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Weiwei Wu
- College of Biomedical Engineering, Capital Medical University, Beijing, China
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11
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Schullian P, Johnston E, Laimer G, Scharll Y, Putzer D, Eberle G, Kolbitsch C, Amann A, Stättner S, Bale R. Stereotactic radiofrequency ablation of tumors at the hepatic venous confluence. HPB (Oxford) 2022; 24:1044-1054. [PMID: 34887174 DOI: 10.1016/j.hpb.2021.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 11/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) is subject to "heat-sink" effects, particularly for treatment of tumors adjacent to major vessels. METHODS In this retrospective study, 104 patients with 137 tumors (40 HCC, 10 ICC and 54 metastatic liver tumors) close to (≤1 cm from) the hepatic venous confluence underwent stereotactic RFA (SRFA) between June 2003 and June 2018. Median tumor size was 3.7 cm (1.4-8.5) for HCC, 6.4 cm (0.5-11) for ICC and 3.8 cm (0.5-13) for metastases. Endpoints comprised safety, local tumor control, overall and disease-free survival. RESULTS The overall major complication rate was 16.0% (20/125 ablations), where 8 (40%) were successfully treated by the interventional radiologist in the same anesthetic session and did not prolong hospital stay. 134/137 (97.8%) tumors were successfully ablated at initial SRFA. Local recurrence (LR) developed in 19/137 tumors (13.9%). The median and overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 51.5 months, 73.5%, 67.0%, and 49.7% for HCC, 14.6 months, 60.0%, 32.0% and 32.0% for ICC and 38.1 months, 91.4%, 56.5% and 27.9% for metastatic disease, respectively. CONCLUSION SRFA represents a viable alternative to hepatic resection for challenging tumors at the hepatic venous confluence.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward Johnston
- Department of Radiology, The Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine V, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, D.Wilhelm Bock Strasse 1, 4840, Vöcklabruck Austria; Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Comparison of a Robotic and Patient-Mounted Device for CT-Guided Needle Placement: A Phantom Study. J Clin Med 2022; 11:jcm11133746. [PMID: 35807029 PMCID: PMC9267795 DOI: 10.3390/jcm11133746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Robotic-based guidance systems are becoming increasingly capable of assisting in needle placement during interventional procedures. Despite these technical advances, less sophisticated low-cost guidance devices promise to enhance puncture accuracy compared with the traditional freehand technique. Purpose: To compare the in vitro accuracy and feasibility of two different aiming devices for computed-tomography (CT)-guided punctures. Methods: A total of 560 CT-guided punctures were performed by using either a robotic (Perfint Healthcare: Maxio) or a novel low-cost patient-mounted system (Medical Templates AG: Puncture Cube System [PCS]) for the placement of Kirschner wires in a plexiglass phantom with different slice thicknesses. Needle placement accuracy as well as procedural time were assessed. The Euclidean (ED) and normal distances (ND) were calculated at the entry and target point. Results: Using the robotic device, the ND at the target for 1.25 mm, 2.5 mm, 3.75 mm and 5 mm slice thickness were 1.28 mm (SD ± 0.79), 1.25 mm (SD ± 0.81), 1.35 mm (SD ± 1.00) and 1.35 mm (SD ± 1.03). Using the PCS, the ND at the target for 1 mm, 3 mm and 5 mm slices were 3.84 mm (SD ± 1.75), 4.41 mm (SD ± 2.31) and 4.41 mm (SD ± 2.11), respectively. With all comparable slice thicknesses, the robotic device was significantly more accurate compared to the low-cost device (p < 0.001). Needle placement with the PCS resulted in lower intervention time (mean, 158.83 s [SD ± 23.38] vs. 225.67 s [SD ± 17.2]). Conclusion: Although the robotic device provided more accurate results, both guidance systems showed acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories.
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Scharll Y, Letrari S, Laimer G, Schullian P, Bale R. Puncture accuracy of an optical tracked robotic aiming device-a phantom study. Eur Radiol 2022; 32:6769-6776. [PMID: 35678863 PMCID: PMC9474375 DOI: 10.1007/s00330-022-08915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the targeting accuracy of stereotactic punctures based on a hybrid robotic device in combination with optical tracking-a phantom study. METHODS CT data sets of a gelatin-filled plexiglass phantom with 1-, 3-, and 5-mm slice thickness were acquired. An optical navigation device served for planning of a total of 150 needle trajectories. All punctures were carried out semi-automatically with help of the trackable iSYS-1 robotic device. Conically shaped targets inside the phantom were punctured using Kirschner wires. Up to 8 K-wires were positioned sequentially based on the same planning CT and placement accuracy was assessed by taking control CTs and measuring the Euclidean (ED) and normal distances (NDs) between the wire and the entry and target point. RESULTS Using the StealthStation S7, the accomplished mean ND at the target for the 1-mm, 3-mm, and 5-mm slice thickness was 0.89 mm (SD ± 0.42), 0.93 mm (SD ± 0.45), and 0.73 mm (SD ± 0.50), respectively. The corresponding mean ED was 1.61 mm (SD ± 0.36), 2.04 mm (SD ± 0.59), and 1.76 mm (SD ± 0.45). The mean duration of the total procedure was 27.9 min, including image acquisition, trajectory planning, registration, placement of 8 wires, and the control-CT. CONCLUSIONS The optically tracked iSYS-1 robot allows for precise punctures in a phantom. The StealthStation S7 provided acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories. In combination with our optical navigation tool, the trackable robot unit allows to cover a large treatment field and the compact design facilitates placement of needle-like instruments. KEY POINTS • The use of a robotic targeting device in combination with optical tracking (hybrid system) allows for accurate placement of needle-like instruments without repeated control imaging. • The compact robotic positioning unit in combination with a camera for optical tracking facilitates sequential placement of multiple K-wires in a large treatment volume.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sofia Letrari
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Laimer G, Schullian P, Scharll Y, Putzer D, Eberle G, Oberhuber G, Bale R. Stereotactic radiofrequency ablation as a valid first-line treatment option for hepatocellular adenomas. Int J Hyperthermia 2022; 39:780-787. [PMID: 35654476 DOI: 10.1080/02656736.2022.2082562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to assess the safety and efficacy of stereotactic radiofrequency ablation (SRFA) in patients with hepatocellular adenomas (HCA). METHODS Retrospective analyses of all patients referred for SRFA treatment at our institution between January 2010 and October 2020 revealed 14 patients (10 women; mean age 34.4 [range, 17-73 years]) with 38 HCAs treated through 18 ablation sessions. Ablations were considered successful if a safety margin >5 mm was achieved. Demographic, interventional, and outcome data were collected and analyzed. Primary and secondary technical efficacy rates were assessed based on follow-up images consisting of contrast-enhanced CT or MR scans. RESULTS The mean tumor size was 22 mm (range, 7-75 mm). Overall, 37/38 (97.4%) tumors were successfully ablated at the initial SRFA (primary efficacy rate of 97.4%). The median follow-up duration was 49.6 months. No deaths or adenoma-related complications (hemorrhage or malignant transformation) were observed. Disease-free survival rates at 1, 3, and 5 years from the date of the first SRFA were 100%, 85.8%, and 85.8%, respectively. Two patients developed new distant tumors retreated with consecutive re-ablation. No major complications occurred during any of the 18 ablation sessions. CONCLUSIONS Percutaneous thermal ablation is efficient in the treatment of HCAs and may thus be considered a valid first-line treatment option. In addition, SRFA allows for an effective, minimally invasive treatment of large and multiple hepatic tumors within one session.
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Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Oberhuber
- INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Schullian P, Laimer G, Johnston E, Putzer D, Eberle G, Scharll Y, Widmann G, Kolbitsch C, Bale R. Technical efficacy and local recurrence after stereotactic radiofrequency ablation of 2653 liver tumors: a 15-year single-center experience with evaluation of prognostic factors. Int J Hyperthermia 2022; 39:421-430. [PMID: 35227136 DOI: 10.1080/02656736.2022.2044522] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the technical outcome and local tumor control of multi-probe stereotactic radiofrequency ablation (SRFA) in a large series of patients. Furthermore, to determine factors accounting for adverse outcomes. MATERIAL AND METHODS Between 2003 and 2018, 865 patients were treated by SRFA for 2653 primary and metastatic liver tumors with a median tumor size of 2.0 cm (0.5 - 19 cm). Primary technical efficacy (PTE) and local recurrence (LR) were evaluated, and possible predictors for adverse events analyzed using uni- and multi-variable binary logistic regression. RESULTS Overall, 2553 of 2653 tumors were successfully ablated at initial SRFA resulting in a PTE rate of 96.2%. Predictors of lower PTE rates were age > 70 years, tumor size > 5 cm, number of probes, location close to liver capsule/organs and segment II. LR occurred in 220 of 2653 tumors (8.3%) with the following predictors: age, tumor type/size, conglomerates, segments I/IVa/IVb, number of probes and location close to major vessels/bile duct. Multivariable analysis revealed tumor size > 5 cm (odds ratio [OR] 3.153), age > 70 years (OR 1.559), and location in segment II (OR 1.772) as independent prognostic factors for PTE, whereas tumor location close to major vessels (OR 1.653) and in segment IVb (OR 2.656) were identified as independent prognostic factors of LR. CONCLUSIONS Stereotactic RFA is an attractive option in the management of primary or metastatic liver tumors with good local tumor control, even in large tumors. The presented prognostic factors for adverse local oncological outcome might help to stratify unfavorable tumors for ablation.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
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16
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Braunwarth E, Schullian P, Kummann M, Reider S, Putzer D, Primavesi F, Stättner S, Öfner D, Bale R. Aggressive local treatment for recurrent intrahepatic cholangiocarcinoma—Stereotactic radiofrequency ablation as a valuable addition to hepatic resection. PLoS One 2022; 17:e0261136. [PMID: 34982804 PMCID: PMC8726471 DOI: 10.1371/journal.pone.0261136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background
To evaluate the efficacy, safety and overall clinical outcome of local treatment for recurrent intrahepatic cholangiocellular carcinoma after hepatic resection.
Methods
Between 2007 and 2019 72 consecutive patients underwent hepatic resection for primary intrahepatic cholangiocellular carcinoma. If amenable, recurrent tumors were aggressively treated by HR or stereotactic radiofrequency ablation with local curative intent. Endpoints consisted of morbidity and mortality, locoregional and de novo recurrence, disease free survival, and overall survival.
Results
After a median follow-up of 28 months, recurrence of intrahepatic cholangiocellular carcinoma was observed in 43 of 72 patients undergoing hepatic resection (60.3%). 16 patients were subsequently treated by hepatic resection (n = 5) and stereotactic radiofrequency ablation (n = 11) with local curative intention. The remaining 27 patients underwent palliative treatment for first recurrence. Overall survival of patients who underwent repeated aggressive liver-directed therapy was comparable to patients without recurrence (p = 0.938) and was better as compared to patients receiving palliative treatment (p = 0.018). The 5-year overall survival rates for patients without recurrence, the repeated liver-directed treatment group and the palliative treatment group were 54.3%, 47.7% and 12.3%, respectively. By adding stereotactic radiofrequency ablation as an alternative treatment option, the rate of curative re-treatment increased from 11.9% to 37.2%.
Conclusion
Repeated hepatic resection is often precluded due to patient morbidity or anatomical and functional limitations. Due to the application of stereotactic radiofrequency ablation in case of recurrent intrahepatic cholangiocellular carcinoma, the number of patients treated with curative intent can be increased. This leads to favorable clinical outcome as compared to palliative treatment of intrahepatic cholangiocellular carcinoma recurrence.
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Affiliation(s)
- Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Interventional Oncology—Microinvasive Therapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Moritz Kummann
- Department of Radiology, Interventional Oncology—Microinvasive Therapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Reider
- Department of Internal Medicine I, Gastroenterology, Hepatology & Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Interventional Oncology—Microinvasive Therapy, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Primavesi
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Interventional Oncology—Microinvasive Therapy, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
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Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Scharll Y, Ianetti-Hackl C, Bale R. Stereotactic Radiofrequency Ablation of Breast Cancer Liver Metastases: Short- and Long-Term Results with Predicting Factors for Survival. Cardiovasc Intervent Radiol 2021; 44:1184-1193. [PMID: 33825059 PMCID: PMC8249280 DOI: 10.1007/s00270-021-02820-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate safety, local oncological control, long-term outcome and potential prognostic factors of stereotactic RFA (SRFA) for the treatment of BCLMs. METHODS Between July 2003 and December 2019, 42 consecutive female patients with median age 54.0 years were treated with SRFA at our institution for 110 BCLMs in 48 ablation sessions. Median tumor size was 3.0 cm (0.8-9.0). Eighteen (42.9%) patients had extrahepatic metastasis at initial SRFA. RESULTS Technical success rate was 100%, i.e., all coaxial needles were inserted with appropriate accuracy within 10 mm off plan and 107/110 (92.3%) BCLMs were successfully ablated at initial SRFA. Four Grade 1 (8.3%, 4/48) and one Grade 2 (2.1%, 1/48) complications occurred. No perioperative deaths occurred. Local recurrence developed in 8 of 110 tumors (7.3%). Overall survival (OS) rates of all patients at 1, 3, and 5 years from the date of the first SRFA were 84.1%, 49.3%, and 20.8% with a median OS of 32.3 months. Univariable cox regression analyses revealed age > 60 years and extrahepatic disease (without bone only metastases) as significant predictors of worse OS (p = 0.013 and 0.025, respectively). Size and number of metastases, hormone receptor status and time onset did not significantly affect OS after initial SRFA. CONCLUSIONS SRFA is a safe, minimally invasive treatment option in the management of BCLMs, especially in younger patients without advanced extrahepatic metastasis, including those with large liver tumors.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Edward Johnston
- Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Claudia Ianetti-Hackl
- Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, Innsbruck, 6020, Austria.
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Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success-A Narrative Review. BIOLOGY 2021; 10:biology10070644. [PMID: 34356499 PMCID: PMC8301079 DOI: 10.3390/biology10070644] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 01/04/2023]
Abstract
Thermal ablation is an emerging, potentially curative approach in treating primary and metastatic liver cancer. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Regardless of the technique, destruction of the entire tumor, including an adequate safety margin, is key. In conventional single-probe US- or CT-guided thermal ablation, the creation of such large necrosis zones is often hampered by technical limitations, especially for large tumors (i.e., >2-3 cm). These limitations have been overcome by stereotactic RFA (SRFA): a multiple needle approach with 3D treatment planning and precise stereotactic needle placement combined with intraprocedural image fusion of pre- and post-interventional CT scans for verification of treatment success. With these sophisticated tools and advanced techniques, the spectrum of locally curable liver malignancies can be dramatically increased. Thus, we strongly believe that stereotactic thermal ablation can become a cornerstone in the treatment of liver malignancies, as it offers all the benefits of a minimally invasive method while providing oncological outcomes comparable to surgery. This article provides an overview of current stereotactic techniques for thermal ablation, summarizes the available clinical evidence for this approach, and discusses its advantages.
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Hetzer B, Vogel GF, Entenmann A, Heil M, Schullian P, Putzer D, Meister B, Crazzolara R, Kropshofer G, Salvador C, Straub S, Karall D, Niederwanger C, Cortina G, Janecke A, Freund-Unsinn K, Maurer K, Schweigmann G, Oberhuber G, Renz O, Schneeberger S, Müller T, Bale R. Stereotactic radiofrequency ablation of a variety of liver masses in children. Int J Hyperthermia 2021; 37:1074-1081. [PMID: 32954876 DOI: 10.1080/02656736.2020.1822549] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIMS Surgical resection is currently the cornerstone of liver tumor treatment in children. In adults radiofrequency ablation (RFA) is an established minimally invasive treatment option for small focal liver tumors. Multiprobe stereotactic RFA (SRFA) with intraoperative image fusion to confirm ablation margins allows treatment for large lesions. We describe our experience with SRFA in children with liver masses. METHODS SRFA was performed in 10 patients with a median age of 14 years (range 0.5-17.0 years) suffering from liver adenoma (n = 3), hepatocellular carcinoma (n = 1), hepatoblastoma (n = 2), myofibroblastic tumor (n = 1), hepatic metastases of extrahepatic tumors (n = 2) and infiltrative hepatic cysts associated with alveolar echinococcosis (n = 1). Overall, 15 lesions with a mean lesion size of 2.6 cm (range 0.7-9.5 cm) were treated in 11 sessions. RESULTS The technical success rate was 100%, as was the survival rate. No transient adverse effects higher than grade II (Clavien and Dindo) were encountered after interventions. The median hospital stay was 5 d (range 2-33 d). In two patients who subsequently underwent transplant hepatectomy complete ablation was histologically confirmed. Follow-up imaging studies (median 55 months, range 18-129 months) revealed no local or distant recurrence of disease in any patient. CONCLUSIONS SRFA is an effective minimal-invasive treatment option in pediatric patients with liver tumors of different etiologies.
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Affiliation(s)
- Benjamin Hetzer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Andreas Entenmann
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Michel Heil
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Meister
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriele Kropshofer
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Christina Salvador
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Simon Straub
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Karall
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Gérard Cortina
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Andreas Janecke
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Karin Freund-Unsinn
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Maurer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gisela Schweigmann
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Oberhuber
- INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
| | - Oliver Renz
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Müller
- Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
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Laimer G, Schullian P, Putzer D, Eberle G, Goldberg SN, Bale R. Can accurate evaluation of the treatment success after radiofrequency ablation of liver tumors be achieved by visual inspection alone? Results of a blinded assessment with 38 interventional oncologists. Int J Hyperthermia 2021; 37:1362-1367. [PMID: 33302747 DOI: 10.1080/02656736.2020.1857445] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To assess the difficulties in the immediate judgment of treatment success after radiofrequency ablation (RFA) of liver tumors by visual inspection alone and to evaluate whether radiologist's expertise affects the resultant judgment. METHODS Peri-interventional CT-scans of nine patients with nine hepatocellular carcinomas with known outcomes after RFA were presented to 38 participants from 14 different countries. In a total of 342 reads, all interventional oncologists assessed the pre- and immediate post-interventional CT-scans through conventional side-by-side juxtapositioning of images and judged whether complete ablation (i.e., technical success and technique efficacy) was achieved. Results were compared regarding expertise in percutaneous tumor ablation (>50 interventions performed). An 'overcall' was defined as insufficient ablation that was misjudged as sufficient, and an 'undercall' as an erroneous assessment of complete ablation. RESULTS Overall 3.97 ± 1.27 out of 9 (44.1%) cases per radiologist were misjudged. The mean number of overcalls and undercalls per radiologist were 0.74 ± 0.50 out of 2 (37.0%), and 3.24 ± 1.28 out of 7 (46.3%), respectively. 18/38 (47.4%) participants had considerable experience in percutaneous tumor ablation, with such expertise having no significant influence on the results (overall: p = 0.70; overcalls: p = 0.87; undercalls: p = 0.75). CONCLUSIONS Conventional side-by-side evaluation of treatment success after RFA of liver tumors by the juxtaposition of pre- and post-interventional CT-scans is very difficult for experienced radiologists. The implementation of advanced processing techniques such as rigid/non-rigid image fusion with the assessment of the periablational margin is thus likely needed in order to decrease errors and objectively evaluate technical success and predict technique efficacy of liver RFA.
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Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Laimer G, Jaschke N, Schullian P, Putzer D, Eberle G, Solbiati M, Solbiati L, Goldberg SN, Bale R. Volumetric assessment of the periablational safety margin after thermal ablation of colorectal liver metastases. Eur Radiol 2021; 31:6489-6499. [PMID: 33447860 PMCID: PMC8379110 DOI: 10.1007/s00330-020-07579-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/21/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To retrospectively assess the periablational 3D safety margin in patients with colorectal liver metastases (CRLM) referred for stereotactic radiofrequency ablation (RFA) and to evaluate its influence on local treatment success. METHODS Forty-five patients (31 males; mean age 64.5 [range 31-87 years]) with 76 CRLM were treated with stereotactic RFA and retrospectively analyzed. Image fusion of pre- and post-interventional contrast-enhanced CT scans using a non-rigid registration software enabled a retrospective assessment of the percentage of predetermined periablational 3D safety margin and CRLM successfully ablated. Periablational safety zones (1-10 mm) and percentage of periablational zone ablated were calculated, analyzed, and compared with subsequent tumor growth to determine an optimal safety margin predictive of local treatment success. RESULTS Mean overall follow-up was 36.1 ± 18.5 months. Nine of 76 CRLMs (11.8%) developed local tumor progression (LTP) with mean time to LTP of 18.3 ± 11.9 months. Overall 1-, 2-, and 3-year cumulative LTP-free survival rates were 98.7%, 90.6%, and 88.6%, respectively. The periablational safety margin assessment proved to be the only independent predictor (p < 0.001) of LTP for all calculated safety margins. The smallest safety margin 100% ablated displaying no LTP was 3 mm, and at least 90% of a 6-mm circumscribed 3D safety margin was required to achieve complete ablation. CONCLUSIONS Volumetric assessment of the periablational safety margin can be used as an intraprocedural tool to evaluate local treatment success in patients with CRLM referred to stereotactic RFA. Ablations achieving 100% 3D safety margin of 3 mm and at least 90% 3D safety margin of 6 mm can predict treatment success. KEY POINTS • Volumetric assessment of the periablational safety margin can be used as an intraprocedural tool to evaluate local treatment success following thermal ablation of colorectal liver metastases. • Ablations with 100% 3D periablational safety margin of 3 mm and ablations with at least 90% 3D safety margin of 6 mm can be considered indications of treatment success. • Image fusion of pre- and post-interventional CT scans with the software used in this study is feasible and could represent a useful tool in daily clinical practice.
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Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nikolai Jaschke
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.,Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Technical University of Dresden, Fetscherstr. 74, 01037, Dresden, Germany
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | | | - Luigi Solbiati
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Schullian P, Johnston E, Laimer G, Putzer D, Eberle G, Westerlund P, Henninger B, Bale R. Thermal ablation of CT 'invisible' liver tumors using MRI fusion: a case control study. Int J Hyperthermia 2020; 37:564-572. [PMID: 32484004 DOI: 10.1080/02656736.2020.1766705] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: To evaluate whether 'invisible' liver tumors on CT can be treated by stereotactic radiofrequency ablation (SRFA) using fusion of pre-ablation MRI.Methods: In this retrospective case-control study, 60 patients (14 with Hepatocellular carcinoma (HCC) and 46 with metastatic liver tumors) with CT 'invisible' lesions underwent SRFA using MRI-fusion between June 2005 and June 2018 ('fusion group'). For comparison, 60 patients who underwent SRFA without image fusion were selected using nearest neighbor propensity score matching ('control group'). Endpoints consisted of local tumor control, safety, overall and disease-free survival.Results: Major complications occurred in 6/69 ablations (8.7%) in the fusion group and in 6/89 ablations (6.7%) in the control group (p = 0.434). Primary technical efficacy rate (i.e., successful initial ablation) was 96.6% (28/29) for HCC and 97.9% (166/170) for metastatic disease in the fusion group and 100% (33/33) and 93.3% (184/194) in the control group, respectively (p = 0.468 and 0.064). Local recurrence (LR) was observed in 1/29 (3.5%) HCCs and in 6/170 metastases (4.0%) in the fusion group and 1/33 (3.0%) and 21/196 (10.7%) in the control group, respectively. The LR rate of metastasis in the control group was significantly higher (p = 0.007), although differences in OS and DFS did not reach statistical significance.Conclusions: Image fusion using pre-procedural MRI allows for ablation of CT-'invisible' liver tumors that are otherwise untreatable. Moreover, local oncological control was higher in metastatic liver tumors versus matched controls which suggests it could be useful tool for all stereotactic radiofrequency ablation procedures.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Westerlund
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
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Schullian P, Johnston EW, Putzer D, Laimer G, Waroschitz G, Braunwarth E, Amann A, Maglione M, Bale R. Stereotactic radiofrequency ablation (SRFA) for recurrent colorectal liver metastases after hepatic resection. Eur J Surg Oncol 2020; 47:866-873. [PMID: 33032865 DOI: 10.1016/j.ejso.2020.09.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/07/2020] [Accepted: 09/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To evaluate the efficacy, safety and overall clinical outcome of multiprobe SRFA as a treatment for recurrent colorectal liver metastases after hepatic resection (HR). METHODS A retrospective, single center study carried out between 2006 and 2018. 64 consecutive patients with recurrent or new CRLM after previous HR were treated by SRFA for 217 lesions (median size 2.7 cm, 1-7.5) in 103 ablation sessions. Endpoints consisted of i) technical efficacy ii) complication and mortality rates iii) local and distant recurrence, iv) disease free survival (DFS), and v) overall survival (OS). RESULTS 213/217 tumors were successfully ablated at initial SRFA (97.7% primary technical efficacy rate). Four tumors required repeat ablation, resulting in a secondary technical efficacy rate of 99.5% (216/217). Local recurrence developed in 25/217 lesions (11.5%). Major complication rate was 5.8% (6/103 sessions) and mortality rate was 1.0% (1/103 ablation sessions), respectively.1-, 3-, and 5- year OS rates from date of first SRFA were 90.1%, 46.2%, and 34.8% (median 33.1 months). DFS rates were 54.2%, 17.2%, and 17.2%, at 1-, 3- and 5- years, respectively (median 13.3 months). CONCLUSION SRFA is a safe, feasible and effective option for CRLM after HR with low morbidity levels and favorable clinical outcome.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward W Johnston
- Royal Marsden Hospital, 203 Fulham Road, Chelsea, London, SW3 6JJ, UK
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Waroschitz
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Eva Braunwarth
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Arno Amann
- Department of Internal Medicine I, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Manuel Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Quality of life analysis after stereotactic radiofrequency ablation of liver tumors. Sci Rep 2020; 10:12809. [PMID: 32732877 PMCID: PMC7393379 DOI: 10.1038/s41598-020-69331-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/19/2020] [Indexed: 01/17/2023] Open
Abstract
The purpose of this study was to evaluate the health-related quality of life (HRQoL) after stereotactic radiofrequency ablation (SRFA) of liver tumors and identify variables associated with decreased HRQoL and to compare it to other treatments in case of concurrency. From 2011 to 2017 577 patients underwent SRFA for liver tumors in 892 ablation sessions. 303 (52.5%) patients completed a HRQoL questionnaire once after the ablation. HRQoL was assessed by the Short Form (SF)-12 health survey with mental and physical component scales and by a general questionnaire to assess disease and treatment-specific items as well as to compare tolerability of SRFA to transarterial chemoembolization (TACE), hepatic resection (HR) and chemotherapy (CTX). The median SF-12 PCS was 46.6 and MCS was 53.2. Patients experiencing pain or complications and patients refusing repeat SRFA showed significantly lower PCS (43.2 vs 48.6, p = 0.0003; 32.8 vs 46.9, p = 0.005 and 40.6 vs 46.9, p = 0.009). 355 (97.8%) patients indicated willingness to undergo repeat SRFA with little to no fear in 292 (80.7%) patients. Among patients with multiple therapies, SRFA was rated by 40 (90.9%) as preferred re-treatment, HR by 1 (2.3%) and CTX by 3 (6.8%). In conclusion, we have shown that SRFA has good HRQoL-outcomes and reported low morbidity rates. Consequently the vast majority of study patients would accept a repeated SRFA if necessary (97.8%), without fear (80.7%). SRFA was preferred among patients who experienced concurrent treatments, such as HR or CTX.
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Schullian P, Putzer D, Eberle G, Laimer G, Bale R. Simultaneous Stereotactic Radiofrequency Ablation of Multiple (≥ 4) Liver Tumors: Feasibility, Safety, and Efficacy. J Vasc Interv Radiol 2020; 31:943-952. [PMID: 32414570 DOI: 10.1016/j.jvir.2019.12.794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To assess feasibility, safety, and clinical outcome of simultaneous stereotactic radiofrequency (RF) ablation of multiple (≥ 4) primary and metastatic liver tumors. MATERIALS AND METHODS This retrospective observational study included 92 patients (29 women, 62 men), 35 with ≥ 4 hepatocellular carcinomas (HCCs) and 57 with ≥ 4 metastatic liver tumors at initial stereotactic RF ablation between 2005 and 2018. The median size of 178 HCCs and 371 metastases was 2.2 cm (range, 1.0-8.5 cm) and 3.0 cm (range, 0.5-13 cm), respectively. At initial stereotactic RF ablation, 17 (48.6%) patients with HCC and 19 (33.3%) with metastases had 4 liver tumors, 11 (31.4%) and 19 (33.3%) had 5 tumors, and 7 (20%) and 19 (33.3%) had ≥ 6 tumors. RESULTS Major complications occurred in 2 of 35 ablations (5.4%) in patients with HCCs and in 7 of 63 (10%) with metastases. The primary technical efficacy rate (ie, successful initial ablation) was 100% (178/178) in HCCs and 98.8% (363/371) in metastases. Local recurrence was observed in 4 of 178 (2.2%) HCCs and in 17 of 371 (4.6%) metastases. Overall survival (OS) rates at 1, 3, and 5 years from the date of the first stereotactic RF ablation were 88.0%, 54.0%, and 30.4% for patients with HCCs with a median OS of 38.2 months and 86.1%, 53.1%, and 37.3% for patients with metastases with a median OS of 37.4 months. CONCLUSIONS Stereotactic RF ablation is a feasible, safe, and efficacious option in simultaneous management of multiple primary and metastatic liver tumors.
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Affiliation(s)
- Peter Schullian
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Daniel Putzer
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gernot Eberle
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Gregor Laimer
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria
| | - Reto Bale
- Section of Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, Innsbruck 6020, Austria.
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Schullian P, Laimer G, Putzer D, Levy E, Braunwarth E, Stättner S, Bale R. Stereotactic radiofrequency ablation as first-line treatment of recurrent HCC following hepatic resection. Eur J Surg Oncol 2020; 46:1503-1509. [PMID: 32222261 DOI: 10.1016/j.ejso.2020.03.207] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/04/2020] [Accepted: 03/16/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate the therapeutic efficacy, safety and overall clinical outcome of multiprobe stereotactic RF ablation (SRFA) as first-line treatment of HCC recurrence after hepatic resection (HR). STUDY DESIGN In this retrospective single-center study, 34 consecutive patients with previous HR were treated by SRFA between 2006 and 2018 for 140 HCCs in 60 ablation sessions. RESULTS The median treated tumor size was 3.0 cm (range 0.5-10 cm). SRFA was primarily successful for 133/140 (95%) tumors. Four tumors were successfully retreated, resulting in a secondary technical efficacy rate of 97.9%. Local tumor recurrence developed in 4 of 140 tumors (2.9%). The major complication rate was 4.8% (3 of 60 ablations). No periprocedural deaths occurred. The overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 94.0%, 70.2%, and 53.3%, respectively, with a median OS of 69.1 months (95% CI 18.8-119.3). The disease-free survival (DFS) was 52.6%, 19.7% and 15.8%, at 1-, 3- and 5- years, respectively, with a median DFS of 12.8 months (95% CI 9.0-28.9). CONCLUSION Stereotactic RFA is a safe, feasible and useful option in the management of recurrent HCC following HR with low morbidity paired with good clinical outcome.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Microinvasive Therapy instead of Section of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Microinvasive Therapy instead of Section of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Microinvasive Therapy instead of Section of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Elliot Levy
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Eva Braunwarth
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Stefan Stättner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Microinvasive Therapy instead of Section of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Laimer G, Jaschke N, Gottardis M, Schullian P, Putzer D, Sturm W, Bale R. Stereotactic Radiofrequency Ablation of an Unresectable Intrahepatic Cholangiocarcinoma (ICC): Transforming an Aggressive Disease into a Chronic Condition. Cardiovasc Intervent Radiol 2020; 43:791-796. [PMID: 32162024 PMCID: PMC7196948 DOI: 10.1007/s00270-020-02443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/22/2020] [Indexed: 11/28/2022]
Abstract
In 2010, we reported on a 72-year-old patient with a large, unresectable cholangiocarcinoma with intrahepatic metastases, which was treated by stereotactic radiofrequency ablation (SRFA) in three consecutive sessions. Within the last nine years, the same patient has received seven additional ablation sessions for a total of ten recurrent intrahepatic lesions. One year after the last SRFA, the patient's liver function is still within the physiological range, suggesting that this approach is not only sufficient for locally controlling tumor disease, but also for sparing healthy tissue. Moreover, periods of hospitalization were relatively short, while procedure-related pain was generally mild. In summary, SRFA has turned an aggressive disease with a devastating prognosis into a chronic condition while improving the patient's quality of life.
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Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nikolai Jaschke
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Maximilian Gottardis
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Wolfgang Sturm
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Schullian P, Laimer G, Putzer D, Effenberger M, Bale R. Stereotactic radiofrequency ablation of primary liver tumors in the caudate lobe. HPB (Oxford) 2020; 22:470-478. [PMID: 31591012 DOI: 10.1016/j.hpb.2019.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/04/2019] [Accepted: 09/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The encasement of the caudate lobe by a vascular ring of large vessels may apart from the technical difficulties in needle placement increase the probability of local recurrence after thermal ablation due to cooling effects. This single-center retrospective study evaluates the results after multiprobe stereotactic radiofrequency ablation (SRFA) of hepatocellular carcinoma (HCC) in the caudate lobe. METHODS Twenty patients underwent 24 multiple-probe SRFA sessions for the treatment of 24 HCCs in the caudate lobe. Eight of twenty patients had initially solitary tumors, the remaining 12 patients suffered from multifocal disease. RESULTS The median tumor size was 1.5 cm (range: 1-8 cm). After a mean follow-up of 21 months one local recurrence in the caudate lobe was observed resulting in a local recurrence rate of 4.2% (1/24). The overall survival rates at 1, 3, and 5 years from the date of the first SRFA were 95%, 59%, and 44%, respectively, with a median overall survival of 51.3 months. The disease-free survival after SRFA was 48%, 24% and 24%, at 1, 3 and 5 years, respectively. One patient suffering from Child C liver cirrhosis died due to septic shock 26 days after SRFA and one postinterventional complication required minimal invasive interventional treatment. CONCLUSION Multiprobe SRFA for HCC in the caudate lobe appears to be safe and feasible. The overall outcome is at least comparable to that of surgical resection, with low perioperative mortality and only minimal morbidity.
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Affiliation(s)
- Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria
| | - Maria Effenberger
- University Hospital for Internal Medicine I, Department of Internal Medicine, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck Austria.
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Schullian P, Johnston EW, Putzer D, Eberle G, Laimer G, Bale R. Stereotactic radiofrequency ablation of subcardiac hepatocellular carcinoma: a case-control study. Int J Hyperthermia 2020; 36:876-885. [PMID: 31462110 DOI: 10.1080/02656736.2019.1648886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the safety and efficacy of stereotactic radiofrequency ablation (SRFA) for the treatment of subcardiac hepatocellular carcinoma (HCC). Material and methods: From 2003 to 2018, 79 consecutive patients underwent 104 multi-probe SRFA sessions for the treatment of 114 subcardiac HCC with a median size of 2.5 cm (0.5-9.5 cm). The results were compared with a randomly selected control group of 79 patients with 242 HCC with a median size of 2.0 cm (0.5-12 cm) following SRFA in other (non-subcardiac) locations with propensity score matching. Results: The 95.6% of the tumors were successfully treated by the first ablation session (primary technical efficacy rate) and 99.1% after the second session (secondary technical efficacy rate). Local tumor recurrence developed in 8 nodules (7.0%). Major complication and perioperative mortality rates were 7.7% (8/104) and 1% (1/104), respectively. The overall survival (OS) rates from the date of the first SRFA with single subcardiac HCCs were 92%, 77% and 65% at 1, 3 and 5 years, respectively, with a median OS of 90.6 months. The disease-free survival (DFS) after SRFA was 75, 34 and 34%, at 1, 3 and 5 years, respectively, with a median DFS of 19.1 months. There was no statistically significant difference with the control group in terms of local tumor control, safety, OS and DFS. Conclusion: SRFA of subcardiac tumors is as safe and efficacious as when treating tumors remote from the heart.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck , Innsbruck , Austria
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Schullian P, Johnston EW, Putzer D, Eberle G, Laimer G, Bale R. Safety and efficacy of stereotactic radiofrequency ablation for very large (≥8 cm) primary and metastatic liver tumors. Sci Rep 2020; 10:1618. [PMID: 32005871 PMCID: PMC6994461 DOI: 10.1038/s41598-020-58383-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/13/2020] [Indexed: 12/15/2022] Open
Abstract
To assess the safety and clinical outcomes of multi-probe stereotactic radiofrequency ablation (SRFA) for very large (≥8 cm) primary and metastatic liver tumors with curative treatment intent. A retrospective, single center study carried out between 01.2005 and 06.2018. 34 consecutive patients had a total of 41 primary and metastatic liver tumors with a median size of 9.0 cm (8.0–18.0 cm) at initial SRFA. Patients were treated under CT guidance using a 3D navigation system. Endpoints consisted of (i) technical efficacy; primary - requiring one treatment, and secondary – requiring two treatments (ii) complication and mortality rates (iii) local and distant recurrence (LR), (iv) disease free survival (DFS), (v) overall survival (OS). 33/41 tumors were successfully ablated at initial SRFA (80.5% primary technical efficacy rate (PTE)). Four tumors required repeat ablation, resulting in a secondary technical efficacy (STE) rate of 90.2%. Local tumor recurrence (LR) developed in 4 of 41 tumors (9.8%). The 30-day perioperative mortality was 2.3% (1/ 44 ablations). The total major complication rate was 20.5% (9 of 44 ablations). Three of nine (33.3%) major complications, such as pleural effusion, pneumothoraces or perihepatic hemorrhages were relatively easy to treat. The overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 87.1%, 71.8%, and 62.8% for patients with hepatocellular carcinoma (HCC) and 87.5%, 70.0% and 70.0% for patients with intrahepatic cholangiocarcinoma (ICC) respectively. Patients with metastatic disease had OS rates of 77.8% and 22.2% at 1- and 3- years. The clinical results of SRFA in this study are encouraging and warrant a prospective multicenter study. SRFA may become one of the best therapeutic choices for a growing number of patients with primary and metastatic liver cancer.
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Affiliation(s)
- Peter Schullian
- From the Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Edward W Johnston
- From the Department of Radiology, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Daniel Putzer
- From the Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- From the Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- From the Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- From the Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy (SIP), Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Laimer G, Schullian P, Jaschke N, Putzer D, Eberle G, Alzaga A, Odisio B, Bale R. Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation. Eur Radiol 2020; 30:2463-2472. [PMID: 32002642 PMCID: PMC7160081 DOI: 10.1007/s00330-019-06609-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives To assess the minimal ablative margin (MAM) by image fusion of intraprocedural pre- and post-ablation contrast-enhanced 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 pre- and post-ablation images using commercially available rigid imaging registration software. LTP was assessed in contrast-enhanced 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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Affiliation(s)
- Gregor Laimer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nikolai Jaschke
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Amilcar Alzaga
- Siemens Healthineers, Siemensstraße 3, 91301, Forchheim, Germany
| | - Bruno Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Putzer D, Schullian P, Bale R. Locoregional ablative treatment of melanoma metastases. Int J Hyperthermia 2019; 36:59-63. [DOI: 10.1080/02656736.2019.1647353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Daniel Putzer
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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Schullian P, Putzer D, Silva MA, Laimer G, Kolbitsch C, Bale R. Stereotactic Radiofrequency Ablation of Liver Tumors in Octogenarians. Front Oncol 2019; 9:929. [PMID: 31608232 PMCID: PMC6761359 DOI: 10.3389/fonc.2019.00929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/05/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose: This study aimed to evaluate the efficacy and overall clinical outcome of patients over the age of 80 undergoing stereotactic radiofrequency ablation (SRFA) and to compare the results to a younger population with propensity score matching. Materials and Methods: Between 2006 and 2018 36 patients aged between 80 and 90 years underwent 46 SRFA sessions of 70 primary and secondary liver tumors. For comparison of treatment safety and efficacy 36 younger patients were selected with propensity score matching by the R package “MatchIt” in this retrospective, single-center study. Results: 68/70 tumors were successfully ablated at first ablation session (97% primary technical efficacy rate). Local tumor recurrence developed in 5 of 70 nodules (7.1%). The complication rate above Clavien-Dindo Grade III was 6.5% (3 of 46). The overall survival (OS) rates at 1-, 3-, and 5- years from the date of the first SRFA were 84.6, 50.5, and 37.9% for HCC patients and 87.5%, 52.5% at 1-, and 3-years for CRC patients. The disease-free survival (DFS) for HCC patients after SRFA was 79.1, 35.6, and 23.7%, at 1-, 3-, and 5- years, and 75%, 22.5% at 1-, and 3-years for CRC patients. There were no significant differences in terms of technical efficacy, local recurrences, major complications, OS and DFS compared to the control group. Conclusion: SRFA in octogenarians is a safe, feasible and useful option in the management of primary or metastatic liver tumors with no significant difference in outcomes compared to a younger control group.
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Affiliation(s)
- Peter Schullian
- Section of Interventional Oncology - Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Section of Interventional Oncology - Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael A Silva
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Gregor Laimer
- Section of Interventional Oncology - Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Section of Interventional Oncology - Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Schullian P, Putzer D, Laimer G, Levy E, Bale R. Feasibility, safety, and long-term efficacy of stereotactic radiofrequency ablation for tumors adjacent to the diaphragm in the hepatic dome: a case-control study. Eur Radiol 2019; 30:950-960. [PMID: 31489472 PMCID: PMC6957558 DOI: 10.1007/s00330-019-06399-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/13/2022]
Abstract
Objectives Achievement of adequate treatment margins may be challenging when the target is either difficult to visualize, awkward to access, or situated adjacent to vulnerable structures. Treatment of tumors located close to the diaphragm in the hepatic dome is challenging for percutaneous radiofrequency (RF) ablation for these reasons. The purpose was to assess the feasibility, safety, and clinical outcome of multi-probe stereotactic RF ablation (SRFA) of liver tumors in the subdiaphragmatic area. Methods Between 2006 and 2018, 177 patients (82 HCCs, 6 ICCs, and 89 metastatic tumors) underwent SRFA of 238 tumors abutting the diaphragm in the hepatic dome. For comparison, 177 patients were randomly selected from our database by the R package “MatchIt” for propensity score matching to compare treatment safety and efficacy in this retrospective, single-center study. Results Median treated tumor size was 2.2 cm (range 0.5 to 10 cm). SRFA was primarily successful for 232/238 (97.5%) tumors. Five tumors were successfully retreated, resulting in a secondary technical efficacy rate of 99.6%. Local tumor recurrence developed in 21 of 238 tumors (8.8%). The major ablation complication rate was 10.7% (22 of 204). Twelve (55%) of 22 major complications could be successfully treated by the interventional radiologist in the same anesthesia session. There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls. Conclusions SRFA is a safe and feasible option in the management of difficult-to-treat tumors abutting the diaphragm in the hepatic dome, with similar safety profile compared with matched controls. Key Points • RFA was primarily successful for 232/238 (97.5%) subdiaphragmatic dome tumors. Local tumor recurrence developed in 21 of 238 tumors (8.8%). • The major complication rate directly related to ablation of the hepatic dome tumors was 10.7% (22 of 204). 12/22 (55%) of major complications could be successfully treated in the same anesthesia session. • There was no significant difference in adverse events or disease control rates between the subdiaphragmatic tumors and matched controls.
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Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Elliot Levy
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology - Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Venturi D, Glossop N, Bale R. Patient-specific templates for image-guided intervention - a phantom study. MINIM INVASIV THER 2019; 29:251-260. [PMID: 31204536 DOI: 10.1080/13645706.2019.1626251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the in vitro accuracy of a new device and method for simultaneous stereotactic CT-guided punctures.Material and methods: 240 needle paths were planned in 1 mm, 1.5 mm and 3 mm slice thickness with a custom-designed software. The data were transferred to a three-axis tabletop CNC machine that then drilled the hole pattern for the needles into square plastic plates. Kirschner wires were slid through the holes of the two parallel fixed plates to aim at the chosen targets inside the phantom. The accuracy was calculated by taking control CTs and measuring the Euclidean distance and the normal distance between the wire and the entry and target point.Results: The mean Euclidean distance of the wire tip to the target for the 1 mm, 1.5mm and 3 mm slice thickness were 2.5 mm (SD ± 0.64), 2.71mm (SD ± 0.78) and 2.8 mm (SD ± 1.0). The mean normal distance was 1.42 mm (SD ± 0.65), 1.43mm (SD ± 0.75) and 1.9 mm (SD ± 1.1), respectively.Conclusion: The system yields satisfactory accuracy comparable to other image-guided intervention systems. Involuntary movements of the patient need to be taken into account in a clinical setting.
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Affiliation(s)
- David Venturi
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Neil Glossop
- Queen's University School of Computing, Kingston, Canada.,ArciTrax Inc, Toronto, Canada
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Fusion Imaging and Virtual Navigation to Guide Percutaneous Thermal Ablation of Hepatocellular Carcinoma: A Review of the Literature. Cardiovasc Intervent Radiol 2019; 42:639-647. [PMID: 30809699 DOI: 10.1007/s00270-019-02167-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/14/2019] [Indexed: 12/12/2022]
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Widmann G, Bale R, Ulmer H, Putzer D, Schullian P, Wiedermann FJ, Lederer W. Systemic Hypotension Following Intravenous Administration of Nonionic Contrast Medium During Computed Tomography: Iopromide Versus Iodixanol. Anesth Analg 2018; 126:769-775. [PMID: 28806208 DOI: 10.1213/ane.0000000000002346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality. METHODS In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly. RESULTS Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 ± 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 ± 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P < .001), significant increase in heart rate (P = .042), and significant diuresis with a 2-fold higher per-hour urine output (P = .010). Administration of iodixanol and NSS had no significant influence on blood pressure (P > .640). CONCLUSIONS Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk.
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Affiliation(s)
| | | | - Hanno Ulmer
- Medical Statistics, Informatics and Health Economy
| | | | | | - Franz-Josef Wiedermann
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Lederer
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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Putzer D, Schullian P, Braunwarth E, Fodor M, Primavesi F, Cardini B, Resch T, Oberhuber R, Maglione M, Margreiter C, Schneeberger S, Stättner S, Öfner-Velano D, Jaschke W, Bale RJ. Integrating interventional oncology in the treatment of liver tumors. Eur Surg 2018; 50:117-124. [PMID: 29875800 PMCID: PMC5968075 DOI: 10.1007/s10353-018-0521-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
Background Percutaneous ablation techniques offer a vast armamentarium for local, minimally invasive treatment of liver tumors, nowadays representing an established therapeutic option, which is integrated in treatment algorithms, especially for non-resectable liver tumors. The results of ablative treatment compare very well to surgical treatment in liver lesions, and confirm that these techniques are a valuable option for bridging for transplantation. Different techniques have been established to perform tumor ablation, and the feasibility varies according to the procedure and technical skills of the operator, depending on the size and location of the liver lesion. In recent years, stereotactic multi-needle techniques using 3D trajectory planning, general anesthesia, and tube disconnection during needle placement have had a strong impact on the application range of ablation for liver tumors. Conclusion It is well known that creating a sufficient ablation margin and overlapping ablation zones is one key issue to enable ablation of large liver lesions with tumor-free margins (A0 ablation in analogy to R0 resection). Image fusion during treatment and follow-up assure highly accurate staging procedures and interventional planning. Novel aspects Review on the standards in ablation techniques for the treatment of liver tumors. Update on different ablation techniques, indications, and contraindications for percutaneous liver tumor treatment. Summary of recently published reports on liver tumor ablation.
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Affiliation(s)
- D Putzer
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - P Schullian
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - E Braunwarth
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Fodor
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - F Primavesi
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - B Cardini
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - T Resch
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Maglione
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - C Margreiter
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - S Stättner
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - D Öfner-Velano
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - W Jaschke
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - R J Bale
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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Stereotactic Radiofrequency Ablation for Metastatic Melanoma to the Liver. Cardiovasc Intervent Radiol 2016; 39:1128-35. [PMID: 27055850 DOI: 10.1007/s00270-016-1336-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/25/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the outcome of patients with melanoma liver metastasis treated with stereotactic radiofrequency ablation (SRFA). MATERIAL AND METHOD Following IRB approval, a retrospective evaluation of the treatment of 20 patients with 75 melanoma liver metastases was performed. RESULTS A median number of 2 lesions (range 1-14) per patient with a median size of 1.7 cm (range 0.5-14.5 cm) were treated. 67 lesions were <3 cm (89.3 %) and 8 lesions were >3 cm (10.7 %). Per patient a median of 1 ablation session was performed (range: 1-4) totaling 34 sessions. There were no procedure-related deaths and all major complications (n = 3) could be easily treated by pleural drainages. The primary and secondary success rates were 89.3 and 93.3 %, respectively. The overall local recurrence rate was 13.3 %. Four of ten local recurrences were re-treated successfully by SRFA. During follow-up, 9/20 patients developed extrahepatic metastatic disease and 10/20 had liver recurrence at any location. The median OS from the date of SRFA was 19.3 months, with an OS of 64, 41, and 17 % at 1, 3, and 5 years, with no significant difference for patients with cutaneous and ocular melanoma. The median DFS after SRFA for all 20 patients was 9.5 months, with 37, 9, and 0 % at 1, 3, and 5 years. CONCLUSIONS Due to the high local curative potential and the promising long-term survival rates associated with minimal morbidity and mortality, radiofrequency ablation seems to be an attractive alternative to resection in patients with melanoma liver metastases.
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Angiographic C-Arm CT– Versus MDCT-Guided Stereotactic Punctures of Liver Lesions: Nonrigid Phantom Study. AJR Am J Roentgenol 2013; 201:1136-40. [DOI: 10.2214/ajr.12.10405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Karall D, Scholl-Bürgi S, Widmann G, Albrecht U, Niedermayr K, Maurer K, Ausserer B, Huemer M, Bale R. Stereotactic Radiofrequency Ablation for Liver Tumors in Inherited Metabolic Disorders. Cardiovasc Intervent Radiol 2013; 37:1027-33. [DOI: 10.1007/s00270-013-0756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/21/2013] [Indexed: 02/04/2023]
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[Radiofrequency ablation of hepatocellular carcinoma]. Wien Med Wochenschr 2013; 163:132-6. [PMID: 23515886 DOI: 10.1007/s10354-013-0176-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/08/2013] [Indexed: 01/21/2023]
Abstract
Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.
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Bareck E, Ba-Ssalamah A, Brodowicz T, Eisterer W, Häfner M, Högenauer C, Kastner U, Kühr T, Längle F, Liegl-Atzwanger B, Schoppmann SF, Widmann G, Wrba F, Zacherl J, Ploner F. Gastrointestinal stromal tumors: diagnosis, therapy and follow-up care in Austria. Wien Med Wochenschr 2013; 163:137-52. [PMID: 23508516 DOI: 10.1007/s10354-013-0187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 01/31/2013] [Indexed: 12/16/2022]
Abstract
Optimal treatment for patients suffering from gastrointestinal stromal tumors (GIST) is based on an interdisciplinary treatment approach. Austrian representatives of Medical and Surgical Oncology, Pathology, Radiology, Nuclear Medicine, Gastroenterology, and Laboratory Medicine issued this manuscript on a consensual base within the context of currently available and published literature. This paper contains guidelines and recommendations for diagnosis, therapy, and follow-up of GIST patients in Austria.
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Affiliation(s)
- Evelyne Bareck
- Department of Surgery, General Hospital, Wiener Neustadt, Vienna, Austria.
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Bale R, Schullian P, Haidu M, Widmann G. [Stereotactic Radiofrequency Ablation (SRFA) of intrahepatic cholangiocellular carcinomas: a minimal invasive alternative to liver resection]. Wien Med Wochenschr 2013; 163:128-31. [PMID: 23392811 DOI: 10.1007/s10354-013-0182-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 01/15/2013] [Indexed: 01/04/2023]
Abstract
Up to now resection and liver transplantation are concerned as the only curative treatment options for intrahepatic cholangiocellular carcinomas (ICCs). For patients with inoperable ICCs systemic chemotherapy and various locoregional therapies including transarterial (chemo)embolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA) and microwave ablation (MWA) are applied. Stereotactic RFA (SRFA) allows for precise 3D planning and positioning of multiple RF electrodes. Due to overlapping necroses tumors > 5 cm can be completely ablated in one session. 17 inoperable consecutive patients with 52 ICCs were treated with stereotactic RFA (SRFA). A median overall survival of 60 months was achieved. The two largest tumors with diameters > 10 cm were completely ablated. These SRFA data of irresectable ICCs are superior to the published data on resection. SRFA is a minimal invasive alternative treatment to resection and may be considered as the first-line local treatment of patients with ICCs in selected patients.
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Affiliation(s)
- Reto Bale
- Abteilung für Mikroinvasive Therapie - SIP Univ.-Klinik für Radiodiagnostik, Universitätsklinik Innsbruck, Medizinische Universität Innsbruck, Anichstraße 35, Innsbruck, Österreich.
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Bale R, Widmann G, Jaschke W. Stereotaxie und Robotik zur Ablation – Spielzeug oder Werkzeug? Radiologe 2012; 52:56-62. [DOI: 10.1007/s00117-011-2212-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bale R, Widmann G, Schullian P, Haidu M, Pall G, Klaus A, Weiss H, Biebl M, Margreiter R. Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol 2011; 22:930-7. [PMID: 22071776 DOI: 10.1007/s00330-011-2314-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/16/2011] [Accepted: 10/06/2011] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To evaluate the outcome of patients with colorectal liver metastasis (CRLM) treated with stereotactic radiofrequency ablation (SRFA). METHODS Following IRB approval, a retrospective evaluation of 98 SRFA treatment sessions of 189 CRLMs in 63 consecutive patients was performed. Local recurrence rate (LR), overall survival (OS) and disease-free survival (DFS) were analysed. RESULTS LR was identified in 16% of the tumours (31/189), with no significant differences (P = 0.635) when comparing tumour sizes <3 cm (17.7%), 3-5 cm (11.1%) and >5 cm (17.4%). The median OS from SRFA treatment was 33.2 months after a mean follow-up of 25 months (range 2-66); the corresponding 1-, 3- and 5- year survival rates were 87%, 44% and 27%. The median OS was significantly different when comparing unresectable and resectable patients (27 vs. 58 months, P = 0.002) with OS rates of 92%, 66% and 48% at 1, 3 and 5 years in resectable patients. Tumour size did not affect OS and DFS. CONCLUSION Due to the favourable outcome, SRFA challenges resection as first-line local treatment of patients with CRLM. As long as randomised studies are pending, we recommend entering an individual decision-making process with every patient. KEY POINTS Large colorectal liver metastases can be effectively treated by stereotactic radiofrequency ablation (SRFA). Using SRFA the overall survival is not affected by tumour size. SRFA achieves similar overall and disease-free survival rates as surgical resection. SRFA challenges surgical resection as the first-line treatment for colorectal liver metastases.
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Affiliation(s)
- Reto Bale
- Department of Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
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Haidu M, Dobrozemsky G, Schullian P, Widmann G, Klaus A, Weiss H, Margreiter R, Bale R. Stereotactic radiofrequency ablation of unresectable intrahepatic cholangiocarcinomas: a retrospective study. Cardiovasc Intervent Radiol 2011; 35:1074-82. [PMID: 22006031 DOI: 10.1007/s00270-011-0288-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 09/25/2011] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate treatment effects, complications, and outcome of percutaneous stereotactic radiofrequency ablation (SRFA) of intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS Eleven consecutive patients (nine men and two women) with a total of 36 inoperable ICCs (18 initial lesions, 16 lesions newly detected during follow-up, and two local recurrences) underwent SRFA between December 2004 and June 2010. Two different radiofrequency ablation (RFA) devices with internally cooled electrodes were used. Tumor diameters ranged from 0.5 to 10 cm (median 3.0 cm). A total of 23 SRFA sessions were performed. The efficacy of SRFA was evaluated by contrast-enhanced computed tomography or magnetic resonance imaging 1 month after treatment and then every 3 months. RESULTS Primary technical effectiveness rate was 92%. Further follow-up every 3 months revealed three local recurrences (8%), two of which were successfully retreated, resulting in a secondary technical effectiveness rate of 98%. After a total of 23 RFA sessions, three major complications occurred (13%) that could be managed interventionally. Mean follow-up time was 35 months (range 12-81 months). One- and 3-year overall survival rates were 91 and 71%, respectively. The median overall survival was 60 months (according to the life table method). Eight (73%) of 11 patients were still alive at the end of follow-up. CONCLUSION SRFA is effective in the treatment of unresectable ICC even if the tumor is large and located close to major vessels. SRFA shows a survival benefit compared to other palliative treatment options and may also be considered as the first-line local treatment of ICCs in selected patients.
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Affiliation(s)
- Marion Haidu
- Department of Microinvasive Therapy, Medical University Innsbruck, Innsbruck, Austria.
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Use of a novel coaxial guide needle-wire (GNW) combination system for computed tomography guided radiofrequency tumor ablation. World J Surg Oncol 2011; 9:127. [PMID: 21995771 PMCID: PMC3204259 DOI: 10.1186/1477-7819-9-127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 10/13/2011] [Indexed: 11/10/2022] Open
Abstract
We developed a novel coaxial system using a fine guide needle wire (GNW) to safely and easily place the radiofrequency needle under CT-guidance. The GNW consists of a fine needle (diameter, 21-gauge; length, 150 mm) and a wire (0.018 inch, 250 mm). An exclusive radiofrequency cannula (14-gauge; 160 mm) was also used. This system was used for the treatment of six hepatocellular carcinomas in six patients. All lesions were located deeper than 10 cm from the needle entry site. This system was useful in performing CT-guided RF ablation for deeply or precariously located liver lesions particularly in patients who are unable to hold their breath.
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Widmann G, Schullian P, Haidu M, Bale R. Stereotactic radiofrequency ablation (SRFA) of liver lesions: technique effectiveness, safety, and interoperator performance. Cardiovasc Intervent Radiol 2011; 35:570-80. [PMID: 21671150 DOI: 10.1007/s00270-011-0200-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/22/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate technique effectiveness, safety, and interoperator performance of stereotactic radiofrequency ablation (SRFA) of liver lesions. METHODS Retrospective review including 90 consecutive patients from January 2008 to January 2010 with 106 computed tomography-guided SRFA sessions using both single and multiple electrodes for the treatment of 177 lesions: 72 hepatocellular carcinoma (HCC) and 105 metastases with a mean size of 2.9 cm (range 0.5-11 cm). Technique effectiveness and 1-year local recurrence were evaluated by computed tomographic scans. Complications, mortality, and hospital days were recorded. The performance between an experienced and inexperienced interventional radiologist was compared. RESULTS The overall technique effectiveness after a single SRFA was 95.5% (93.1% for HCC and 97.1% for metastases). Four of the eight unsuccessfully treated lesions could be retreated (secondary technique effectiveness of 97.7%). Local recurrence at 1 year was 2.9%. Technique effectiveness was significantly different for lesions<5 cm (96.7%) and >5 cm (87.5%) (P=0.044) but not for lesions<3 cm (95.9%) and 3-5 cm (100%). Compared to clear parenchymal property (97.3%), vessel vicinity (93.3%) (P=0.349) and subcapsular (95.2%) (P=0.532) had no, but hollow viscera vicinity (83.3%) had a significantly lower technique effectiveness (P=0.020). Mortality rate was 0.9%. Major complications and hospital days were higher for cirrhosis Child-Pugh B (20%, 7.2 days) than Child-Pugh A (3.1%, 4.7 days) patients and for metastases (5.1%, 4.3 days). There was no significant difference in interoperator performance. CONCLUSION SRFA allowed for efficient, reliable, and safe ablation of large-volume liver disease.
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Affiliation(s)
- Gerlig Widmann
- Department of Radiology, SIP-Department of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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