3D margin assessment predicts local tumor progression after ablation of colorectal cancer liver metastases

Kamarinos, Nikiforos Vasiniotis; Gönen, Mithat; Sotirchos, Vlasios S.; Kaye, Elena; Petre, Elena N.; Solomon, Stephen B.; Erinjeri, Joseph P.; Ziv, Etay; Kirov, A.; Sofocleous, Constantinos T.

doi:10.1080/02656736.2022.2055795

Cited by 26 publications

(21 citation statements)

References 28 publications

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“…Ablation outcomes, particularly patient survival (including patients that were not surgical candidates), are comparable to resection [ 139 ]. The results of percutaneous ablation have been enhanced by recent software applications that assist in intra-procedural response assessment and planning [ 140 , 141 , 142 , 143 , 144 ].…”

Section: Biomarkers and Interventional Oncology For Crlmmentioning

confidence: 99%

Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies

Kitsel

Cooke

Sotirchos

et al. 2023

Cancers

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Molecular cancer biomarkers help personalize treatment, predict oncologic outcomes, and identify patients who can benefit from specific targeted therapies. Colorectal cancer (CRC) is the third-most common cancer, with the liver being the most frequent visceral metastatic site. KRAS, NRAS, BRAF V600E Mutations, DNA Mismatch Repair Deficiency/Microsatellite Instability Status, HER2 Amplification, and NTRK Fusions are NCCN approved and actionable molecular biomarkers for colorectal cancer. Additional biomarkers are also described and can be helpful in different image-guided hepatic directed therapies specifically for CRLM. For example, tumors maintaining the Ki-67 proliferation marker after thermal ablation was shown to be particularly resilient to ablation. Ablation margin was also shown to be an important factor in predicting local recurrence, with a ≥10 mm minimal ablation margin being required to attain local tumor control, especially for patients with mutant KRAS CRLM.

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Section: Biomarkers and Interventional Oncology For Crlmmentioning

confidence: 99%

Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies

Kitsel

Cooke

Sotirchos

et al. 2023

Cancers

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“…16,18,55,[61][62][63] These assessments have higher discrimination power to detect areas of insufficient tumour coverage by the ablation zone than 2D imaging alone and can provide intraoperative feedback regarding areas with suboptimal coverage that can be re-ablated in the same setting. 16,55,[61][62][63] Although recent evidence indicates that the intraprocedural 3D assessment is more sensitive than the first post-ablation imaging for the detection of insufficient margins that can predict local tumour progression, 64 historically the technical efficacy of ablation relied on a 4-8 weeks postablation contrast-enhanced CT or MRI with contrast. 60 This latter assessment has been required to declare success after assessment of the ablation zone at a time when the post-ablation hematoma, oedema and reactive hyperaemia have resolved.…”

Section: Ablation Marginsmentioning

confidence: 99%

“…If residual, unablated tumour is present, repeat treatment in the same session is indicated. Current practices include 3D software assessments of the ablation zone and margins 16,18,55,61–63 . These assessments have higher discrimination power to detect areas of insufficient tumour coverage by the ablation zone than 2D imaging alone and can provide intraoperative feedback regarding areas with suboptimal coverage that can be re‐ablated in the same setting 16,55,61–63 .…”

Section: Ablation Marginsmentioning

confidence: 99%

“…10 With careful patient selection and appropriate technique allowing for the creation of ablation zones with adequate minimum ablation margins (≥5 mm, ideally ≥10 mm), local tumour control is similar to that observed after limited resection. 5,6,[11][12][13][14][15][16][17][18][19] The available evidence and outcomes following ablation of the most frequently encountered types of hepatic metastases in clinical practice are reviewed. Patient selection, ablative techniques, complications and follow-up considerations are discussed.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous image‐guided ablation for hepatic metastases

Sotirchos,

Petre,

Sofocleous

2023

J Med Imag Rad Onc

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SummaryThe presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative‐intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non‐surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow‐up protocols and oncologic outcomes are presented and discussed.

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“…4,5,10 In contrast, 3-dimensional software-assisted confirmation methods are based on intraprocedural contrast-enhanced CT images. 4,6,11,12 In 2021, a consensus guideline for image-guided tumor ablation recommended reporting the ablative margin immediately, or at least within 24 hours after ablation. 13 However, it is debatable that postablation immediate and late changes, such as periablation zone hyperemia and ablation zone involution, might reduce the accuracy of ablative margin assessment.…”

mentioning

confidence: 99%

Intraprocedural Versus Initial Follow-up Minimal Ablative Margin Assessment After Colorectal Liver Metastasis Thermal Ablation

Lin,

Paolucci,

Albuquerque Marques Silva

et al. 2023

Invest Radiol

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Objectives The aim of this study was to investigate the prognostic value of 3-dimensional minimal ablative margin (MAM) quantified by intraprocedural versus initial follow-up computed tomography (CT) in predicting local tumor progression (LTP) after colorectal liver metastasis (CLM) thermal ablation. Materials and Methods This single-institution, patient-clustered, tumor-based retrospective study included patients undergoing microwave and radiofrequency ablation between 2016 and 2021. Patients without intraprocedural and initial follow-up contrast-enhanced CT, residual tumors, or with follow-up less than 1 year without LTP were excluded. Minimal ablative margin was quantified by a biomechanical deformable image registration method with segmentations of CLMs on intraprocedural preablation CT and ablation zones on intraprocedural postablation and initial follow-up CT. Prognostic value of MAM to predict LTP was tested using area under the curve and competing-risk regression model. Results A total of 68 patients (mean age ± standard deviation, 57 ± 12 years; 43 men) with 133 CLMs were included. During a median follow-up of 30.3 months, LTP rate was 17% (22/133). The median volume of ablation zone was 27 mL and 16 mL segmented on intraprocedural and initial follow-up CT, respectively (P < 0.001), with corresponding median MAM of 4.7 mm and 0 mm, respectively (P < 0.001). The area under the curve was higher for MAM quantified on intraprocedural CT (0.89; 95% confidence interval [CI], 0.83–0.94) compared with initial follow-up CT (0.66; 95% CI, 0.54–0.76) in predicting 1-year LTP (P < 0.001). An MAM of 0 mm on intraprocedural CT was an independent predictor of LTP with a subdistribution hazards ratio of 11.9 (95% CI, 4.9–28.9; P < 0.001), compared with 2.4 (95% CI, 0.9–6.0; P = 0.07) on initial follow-up CT. Conclusions Ablative margin quantified on intraprocedural CT significantly outperformed initial follow-up CT in predicting LTP and should be used for ablation endpoint assessment.

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3D margin assessment predicts local tumor progression after ablation of colorectal cancer liver metastases

Cited by 26 publications

References 28 publications

Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies

Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies

Percutaneous image‐guided ablation for hepatic metastases

Intraprocedural Versus Initial Follow-up Minimal Ablative Margin Assessment After Colorectal Liver Metastasis Thermal Ablation

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