scholarly journals Volumetric assessment of the periablational safety margin after thermal ablation of colorectal liver metastases

2021 ◽  
Author(s):  
Gregor Laimer ◽  
Nikolai Jaschke ◽  
Peter Schullian ◽  
Daniel Putzer ◽  
Gernot Eberle ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Image Fusion ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Treatment Success ◽  
Local Treatment ◽  
Safety Margin ◽  
Ct Scans ◽  
Volumetric Assessment ◽  
Safety Margins

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.

scholarly journals Correction to: Volumetric assessment of the periablational safety margin after thermal ablation of colorectal liver metastases

2021 ◽  
Author(s):  
Gregor Laimer ◽  
Nikolai Jaschke ◽  
Peter Schullian ◽  
Daniel Putzer ◽  
Gernot Eberle ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Safety Margin ◽  
Link Type ◽  
Volumetric Assessment

A Correction to this paper has been published: 10.1007/s00330-020-07579-x

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

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2769
Author(s):  
Madelon Dijkstra ◽  
Sanne Nieuwenhuizen ◽  
Robbert S. Puijk ◽  
Florentine E.F. Timmer ◽  
Bart Geboers ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Hospital Stay ◽  
Partial Hepatectomy ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Local Treatment ◽  
Length Of Hospital Stay ◽  
Progression Free Survival ◽  
Free Survival ◽  
Subgroup Analyses

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.

scholarly journals 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 ◽  
Vol 10 (7) ◽  
pp. 644
Author(s):  
Gregor Laimer ◽  
Peter Schullian ◽  
Reto Bale
Keyword(s):  
Image Fusion ◽  
Thermal Ablation ◽  
Clinical Evidence ◽  
Liver Tumors ◽  
Treatment Success ◽  
Safety Margin ◽  
Liver Malignancies ◽  
Stereotactic Techniques ◽  
Ct Guided ◽  
Invasive Method

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.

scholarly journals Primary tumor location and the prognosis of patients after local treatment of colorectal liver metastases: a systematic review and meta-analysis

HPB ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. 351-357 ◽  
Author(s):  
Florian E. Buisman ◽  
Boris Galjart ◽  
Stefan Buettner ◽  
Bas Groot Koerkamp ◽  
Dirk J. Grünhagen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Metastases ◽  
Primary Tumor ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Local Treatment ◽  
Tumor Location ◽  
Primary Tumor Location

Altered growth patterns of colorectal liver metastases after thermal ablation

Surgery ◽  
2006 ◽  
Vol 139 (1) ◽  
pp. 73-81 ◽  
Author(s):  
Mehrdad Nikfarjam ◽  
Vigayaragavan Muralidharan ◽  
Christopher Christophi
Keyword(s):  
Liver Metastases ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Growth Patterns

scholarly journals FDG-PET Improves Management of Patients with Colorectal Liver Metastases Allocated for Local Treatment: A Consecutive Prospective Study

2007 ◽  
Vol 96 (3) ◽  
pp. 209-213 ◽  
Author(s):  
M. Sørensen ◽  
F. V. Mortensen ◽  
M. Høyer ◽  
H. Vilstrup ◽  
S. Keiding ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Fdg Pet ◽  
Colorectal Liver Metastases ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Local Treatment ◽  
Liver Lesions ◽  
Term Survival ◽  
Pre Treatment

Background and Aim: Colorectal cancer is a common cancer in the Nordic countries and 50% of the patients develop liver metastases. Liver resection may result in long term survival. Proper staging is therefore essential and CT is the standard imaging modality. We examined whether additional FDG-PET improves therapeutic management of patients with colorectal liver metastases. Patients and Methods: Fifty-four consecutive patients were enrolled. Each patient had a treatment plan made based on our standard evaluation. The patients then had a PET scan and the treatment plan was re-evaluated, taking these results into account. Results: In 76% of the cases, PET did not change the treatment plan due to complete concordance with CT. In another 19% of the cases, the plan was altered due to finding of more liver lesions by PET than by CT (four patients), fewer or no liver lesions (three patients), and extrahepatic lesions not visible on CT (three patients). In 5% of the cases, non-concordance between PET and CT did not change the therapeutic plan. Conclusion: Pre-treatment FDG-PET, used supplementary to CT, improved the treatment plan in one fifth of the patients with colorectal liver metastases.

Immediate post-thermal ablation biopsy of colorectal liver metastases to predict oncologic outcomes.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 4602-4602
Author(s):  
Nikiforos Vasiniotis Kamarinos ◽  
Efsevia Vakiani ◽  
Mithat Gonen ◽  
Nancy E. Kemeny ◽  
Anne M. Covey ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Tumor Cells ◽  
Tumor Size ◽  
Thermal Ablation ◽  
Colorectal Liver Metastases ◽  
Univariate Analysis ◽  
Contrast Material ◽  
Maximum Diameter ◽  
Minimal Risk ◽  
Viable Tumor

4602 Background: Thermal ablation (TA) is used as a local cure for selected colorectal liver metastases (CLM) with minimal risk. A critical limitation of TA has been early local tumor progression (LTP). The goal of this study is to establish the role of ablation zone (AZ) biopsy in predicting LTP. Methods: This institutional review board-approved prospective study included patients with CLM of 5cm or less in maximum diameter, with confined liver disease or stable, limited extrahepatic disease. Both radiofrequency(RF) and microwave(MW) ablation modalities were used. A biopsy of the center and margin of the AZ was performed immediately after ablation. The applicators were also examined for the presence of viable tumor cells. All samples containing morphologically identified tumor cells were further interrogated with immunohistochemistry to determine the proliferative and viability potential of the detected tumor cells. Ablation margin size was evaluated on the first CT scan performed 4–8 weeks after ablation and was confirmed by 3D assessment with Ablation Confirmation Software (Neuwave™). Variables were evaluated as predictors of time to LTP with the competing-risks model (uni- and multivariate analyses). Results: Between November 2009 and February 2019, 102 patients with 182 CLMs were enrolled. Mean tumor size was 2.0 cm (range, 0.6–4.8 cm). MW was used in 95/182 (52%) tumors and RF in 87/182 (48%). Median follow-up was 19 months. Technical effectiveness was evident in 178/182 (97%) ablated tumors on the first contrast material–enhanced CT at 4–8-weeks post-ablation. The cumulative incidence of LTP at 12 months was 19% (95% confidence interval [CI]: 14, 27). Samples from 64 (35%) of the 178 technically successful cases contained viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. In a multivariate model, margin size of less than 5 mm (P < .001; hazard ratio [HR], 4.3), and positive biopsy results (P = .02; HR, 1.8) remained significant. LTP within 12 months after TA was noted in 3% (95% CI: 1, 6) of tumor-negative biopsy CLMs with margins of at least 5 mm. Conclusions: Biopsy and pathologic examination of the AZ predicts LTP regardless of TA modality used. This can optimize ablation as a potential local cure for patients with limited CLM.

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