Image-Guided Thermal Ablation for Colorectal Liver Metastases

Kamarinos, Nikiforos Vasiniotis; Kaye, Elena; Sofocleous, Constantinos T.

doi:10.1016/j.tvir.2020.100672

Cited by 24 publications

(13 citation statements)

References 44 publications

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“…To achieve this goal for thermal ablation, it is key to cover the whole tumor with necrosis zone, including an adequate safety margin [2]. This safety margin, defined as the shortest distance between tumor border and margin of the necrosis zone, is a critical determinant for successful ablations [3]. In conventional, US-or CT-guided single-probe thermal ablation the creation of such large necrosis zones is often hampered by technical limitations, especially for large tumors (i.e., >2-3 cm).…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

Laimer

Schullian

Bale

2021

Biology

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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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Section: Introductionmentioning

confidence: 99%

Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

Laimer

Schullian

Bale

2021

Biology

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“…Notably, length of hospital stay was longer in the repeat resection group compared to the repeat thermal ablation group ( p = 0.009). Therefore, in addition to outcomes reported of thermal ablation versus partial hepatectomy for the initial local treatment of CRLM [ 10 ], this study no longer validates repeat partial hepatectomy as the only curative intent local treatment option for recurrent CRLM. The results even suggest that thermal ablation might be favored for small-size recurrent lesions suitable for both resection and ablation [ 7 ], given the lower invasiveness [ 30 ], lower costs [ 36 ] and reduced hospital stay when compared to surgery.…”

Section: Discussionmentioning

confidence: 75%

“…In the past few decades surgical resection has been considered the gold standard in upfront resectable CRLM, while thermal ablation emerged for small (≤ 3 cm) unresectable CRLM [ 3 , 7 , 8 , 9 , 10 ]. When compared to partial hepatectomy, thermal ablation is currently associated with a lower complication rate, reduced hospital stay and lower costs but also with an inferior survival according to two recent meta-analyses and propensity score analyses [ 3 , 10 , 11 , 12 , 13 , 14 ]. Given the high risk of selection bias when comparing partial hepatectomy for resectable tumors with thermal ablation for unresectable disease, survival outcomes of the two techniques are currently considered to be in equipoise and the results of the prospective COLLISION trial (NCT03088150) are eagerly awaited [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Dijkstra

Nieuwenhuizen

Puijk

et al. 2021

Cancers

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The aim of this study was to assess safety, efficacy and survival outcomes of repeat thermal ablation as compared to repeat partial hepatectomy in patients with recurrent colorectal liver metastases (CRLM). This Amsterdam Colorectal Liver Met Registry (AmCORE) based study of two cohorts, repeat thermal ablation versus repeat partial hepatectomy, analyzed 136 patients (100 thermal ablation, 36 partial hepatectomy) and 224 tumors (170 thermal ablation, 54 partial hepatectomy) with recurrent CRLM from May 2002 to December 2020. The primary and secondary endpoints were overall survival (OS), distant progression-free survival (DPFS) and local tumor progression-free survival (LTPFS), estimated using the Kaplan–Meier method, and complications, analyzed using the chi-square test. Multivariable analyses based on Cox proportional hazards model were used to account for potential confounders. In addition, subgroup analyses according to patient, initial and repeat local treatment characteristics were performed. In the crude overall comparison, OS of patients treated with repeat partial hepatectomy was not statistically different from repeat thermal ablation (p = 0.927). Further quantification of OS, after accounting for potential confounders, demonstrated concordant results for repeat local treatment (hazard ratio (HR), 0.986; 95% confidence interval (CI), 0.517–1.881; p = 0.966). The 1-, 3- and 5-year OS were 98.9%, 62.6% and 42.3% respectively for the thermal ablation group and 93.8%, 74.5% and 49.3% for the repeat resection group. No differences in DPFS (p = 0.942), LTPFS (p = 0.397) and complication rate (p = 0.063) were found. Mean length of hospital stay was 2.1 days in the repeat thermal ablation group and 4.8 days in the repeat partial hepatectomy group (p = 0.009). Subgroup analyses identified no heterogeneous treatment effects according to patient, initial and repeat local treatment characteristics. Repeat partial hepatectomy was not statistically different from repeat thermal ablation with regard to OS, DPFS, LTPFS and complications, whereas length of hospital stay favored repeat thermal ablation. Thermal ablation should be considered a valid and potentially less invasive alternative for small-size (0–3 cm) CRLM in the treatment of recurrent new CRLM. While, the eagerly awaited results of the phase III prospective randomized controlled COLLISION trial (NCT03088150) should provide definitive answers regarding surgery versus thermal ablation for CRLM.

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“…Image-guided thermal ablation using microwaves (MWA) or radiofrequency (RFA) is an established tissue-sparing, lowmorbidity treatment techniques for malignant liver tumors (1). Frequently applied imaging modalities include ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI), which allow high quality guidance in a minimally invasive treatment environment.…”

Section: Introductionmentioning

confidence: 99%

“…The latter was confirmed to be an independent predictor of ablation site recurrence (ASR) in several studies (6)(7)(8)(9)(10)(11). The recommended minimal ablation margin is currently defined as 5 mm, a 10 mm margin being preferred (1,7,9). At present, the ablation margin is most commonly assessed visually, either using side-by-side juxtaposition of pre-and postablation images or using image-fusion, and reported in 2D at the site of largest tumor diameter (3,4,6,12).…”

Section: Introductionmentioning

confidence: 99%

Volumetric Quantitative Ablation Margins for Assessment of Ablation Completeness in Thermal Ablation of Liver Tumors

et al. 2021

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BackgroundIn thermal ablation of liver tumors, complete coverage of the tumor volume by the ablation volume with a sufficient ablation margin is the most important factor for treatment success. Evaluation of ablation completeness is commonly performed by visual inspection in 2D and is prone to inter-reader variability. This work aimed to introduce a standardized approach for evaluation of ablation completeness after CT-guided thermal ablation of liver tumors, using volumetric quantitative ablation margins (QAM).MethodsA QAM computation metric based on volumetric segmentations of tumor and ablation areas and signed Euclidean surface distance maps was developed, including a novel algorithm to address QAM computation in subcapsular tumors. The code for QAM computation was verified in artificial examples of tumor and ablation spheres simulating varying scenarios of ablation margins. The applicability of the QAM metric was investigated in representative cases extracted from a prospective database of colorectal liver metastases (CRLM) treated with stereotactic microwave ablation (SMWA).ResultsApplicability of the proposed QAM metric was confirmed in artificial and clinical example cases. Numerical and visual options of data presentation displaying substrata of QAM distributions were proposed. For subcapsular tumors, the underestimation of tumor coverage by the ablation volume when applying an unadjusted QAM method was confirmed, supporting the benefits of using the proposed algorithm for QAM computation in these cases. The computational code for developed QAM was made publicly available, encouraging the use of a standard and objective metric in reporting ablation completeness and margins.ConclusionThe proposed volumetric approach for QAM computation including a novel algorithm to address subcapsular liver tumors enables precision and reproducibility in the assessment of ablation margins. The quantitative feedback on ablation completeness opens possibilities for intra-operative decision making and for refined analyses on predictability and consistency of local tumor control after thermal ablation of liver tumors.

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Image-Guided Thermal Ablation for Colorectal Liver Metastases

Cited by 24 publications

References 44 publications

Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

Thermal Ablation Compared to Partial Hepatectomy for Recurrent Colorectal Liver Metastases: An Amsterdam Colorectal Liver Met Registry (AmCORE) Based Study

Volumetric Quantitative Ablation Margins for Assessment of Ablation Completeness in Thermal Ablation of Liver Tumors

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