Long-Term Comparative Study on the Local Tumour Control of Different Ablation Technologies in Primary and Secondary Liver Malignancies

Abstract

Purpose: To evaluate local tumour control (LTC) by local ablation techniques (LAT) in liver malignancies. Materials and methods: In patients treated with LAT between January 2013 and October 2020 target lesions were characterised by histology, dimensions in three spatial axes, volume, vascularisation and challenging (CL) location. LAT used were: Radiofrequency Ablation (RFA), Microwave Ablation (MWA), Cryoablation (CRYO), Electrochemotherapy (ECT), and Interstitial Brachytherapy (IBT). Results: 211 LAT were performed in 155 patients. Mean follow-up including MRI for all patients was 11 months. Lesions treated with ECT and IBT were significantly larger and significantly more often located in CL in comparison to RFA, MWA and CRYO. Best LTC (all data for 12 months are given below) resulted after RFA (93%), followed by ECT (81%), CRYO (70%), IBT (68%) and MWA (61%), and further, entity-related for HCC (93%), followed by CRC (83%) and BrC (72%), without statistically significant differences. LTC in hypovascular lesions was worse (64%), followed by intermediate (82% p = 0.01) and hypervascular lesions (92% p = 0.07). Neither diameter (<3 cm: 81%/3–6 cm: 74%/>6 cm: 70%), nor volume (<10 cm3: 80%/10–20 cm3: 86%/>20 cm3: 67%), nor CL (75% in CL vs. 80% in non CL) had a significant impact on LTC. In CL, best LTC resulted after ECT (76%) and IBT (76%). Conclusion: With suitable LAT, similarly good local tumour control can be achieved regardless of lesion size and location of the target.

Percutanous Electrochemotherapy (ECT) in Primary and Secondary Liver Malignancies: A Systematic Review

“…In challenging location, the best LTC resulted after RFA (82%) ECT (76%) and IBT (76%). [52] Spalleck et al [53] performed a retrospective analysis of patients with liver tumors or metastases treated with percutaneous ECT. Eighteen consecutive patients with measurable liver tumors of different histopathologic origins, mainly colorectal cancer, breast cancer, and hepatocellular cancer were recruited.…”

“…Local tumor control seems to be higher in hypervascular lesions in comparison to hypovascular ones and not dependent on diameter or volume nor on challenging locations of the target lesion [52], thanks to the careful pre-selection of the most suitable therapy based on current evidence.…”

“…Papers not indexed in the electronic databases were evaluated through the references of included studies. Eight [44,[47][48][49][50][51][52][53] out of 16 studies were selected. Preclinical studies, review articles and case reports with a single enrolled patient were excluded.…”

Safety and Feasibility of Analgosedation for Electrochemotherapy of Liver Lesions

“…In multimodal treatment of liver neoplasms, locoregional minimally invasive image-guided procedures are becoming more and more significant. In detail, local ablative therapies (LAT) expanded the therapeutic spectrum in multimodal liver cancer therapy, opening up new options in terms of therapy tolerability and compliance [ 23 ].…”

Clinical application status and prospect of the combined anti-tumor strategy of ablation and immunotherapy

“…Both MWA and RFA are widely used in the treatment of liver tumors, while MWA is more appropriate for larger diameter liver malignancy than RFA. RFA treatment causes local tissue dehydration and carbonization to prevent heat conduction to the adjacent tumor tissues, while WMA oscillates water molecules to cause tissue heating, which expands the coagulation zone in tumor tissues ( 49 ). Medhat et al evaluated 26 HCC patients with large lesions (5-7cm in diameter) with MWA treatment and found that 19/26 patients (73.1%) achieved complete ablation, while no ablation-related major complications or death ( 50 ).…”