Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control

2018 ◽  
Vol 69 (1) ◽  
pp. 51-62 ◽  
Author(s):  
Robbert S. Puijk ◽  
Alette H. Ruarus ◽  
Hester J. Scheffer ◽  
Laurien G.P.H. Vroomen ◽  
Aukje A.J.M. van Tilborg ◽  
...  
Keyword(s):  
Quality Control ◽  
Tumour Size ◽  
Irreversible Electroporation ◽  
Progression Free Survival ◽  
Liver Tumour ◽  
Efficacy Rate ◽  
Liver Tumours ◽  
Operator Experience ◽  
Local Progression ◽  
Tumour Ablation

Liver tumour ablation nowadays represents a routine treatment option for patients with primary and secondary liver tumours. Radiofrequency ablation and microwave ablation are the most widely adopted methods, although novel techniques, such as irreversible electroporation, are quickly working their way up. The percutaneous approach is rapidly gaining popularity because of its minimally invasive character, low complication rate, good efficacy rate, and repeatability. However, matched to partial hepatectomy and open ablations, the issue of ablation site recurrences remains unresolved and necessitates further improvement. For percutaneous liver tumour ablation, several real-time imaging modalities are available to improve tumour visibility, detect surrounding critical structures, guide applicators, monitor treatment effect, and, if necessary, adapt or repeat energy delivery. Known predictors for success are tumour size, location, lesion conspicuity, tumour-free margin, and operator experience. The implementation of reliable endpoints to assess treatment efficacy allows for completion-procedures, either within the same session or within a couple of weeks after the procedure. Although the effect on overall survival may be trivial, (local) progression-free survival will indisputably improve with the implementation of reliable endpoints. This article reviews the available needle navigation techniques, evaluates potential treatment endpoints, and proposes an algorithm for quality control after the procedure.

Imaging after percutaneous thermal and non-thermal ablation of hepatic tumour: normal appearances, progression and complications

2021 ◽  
pp. 20201327
Author(s):  
Germain Bréhier ◽  
Louis Besnier ◽  
Anaïs Delagnes ◽  
Frédéric Oberti ◽  
Jérôme Lebigot ◽  
...  
Keyword(s):  
Thermal Ablation ◽  
Irreversible Electroporation ◽  
Coagulation Necrosis ◽  
Percutaneous Ablation ◽  
Hepatic Tumour ◽  
Liver Tumours ◽  
Local Progression ◽  
Percutaneous Thermal Ablation ◽  
New Treatment ◽  
Microwave Techniques

The increasing number of liver tumours treated by percutaneous ablation leads all radiologists to be confronted with the difficult interpretation of post-ablation imaging. Radiofrequency and microwave techniques are most commonly used. Recently, irreversible electroporation treatments that do not induce coagulation necrosis but cellular apoptose and respect the collagen architecture of bile ducts and vessels have been introduced and lead to specific post-ablation features and evolution. Ablations cause ‘normal’ changes in ablation and periablation zones. It is necessary to know these post-ablation features to avoid the misinterpretation of recurrence or complication that would lead to unnecessary treatments. Another challenge for the radiologist is to detect as early as possible the residual unablated tumour or the disease progression (local progression and tumour seeding) that will require a new treatment. Finally, the complications, frequent or rarer, should be recognised to be managed adequately. The purpose of this article is therefore to describe the large spectrum of normal and pathological aspects related to the treatment of hepatic tumour by percutaneous thermal ablation and irreversible electroporation ablation.

scholarly journals MRI Texture Analysis for the Prediction of Stereotactic Radiosurgery Outcomes in Brain Metastases from Lung Cancer

2021 ◽  
Vol 10 (2) ◽  
pp. 237
Author(s):  
Jung Hyun Park ◽  
Byung Se Choi ◽  
Jung Ho Han ◽  
Chae-Yong Kim ◽  
Jungheum Cho ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Texture Analysis ◽  
Multivariable Analysis ◽  
Texture Features ◽  
Progression Free Survival ◽  
Clinical Parameter ◽  
Imaging Biomarker ◽  
Local Progression

This study aims to evaluate the utility of texture analysis in predicting the outcome of stereotactic radiosurgery (SRS) for brain metastases from lung cancer. From 83 patients with lung cancer who underwent SRS for brain metastasis, a total of 118 metastatic lesions were included. Two neuroradiologists independently performed magnetic resonance imaging (MRI)-based texture analysis using the Imaging Biomarker Explorer software. Inter-reader reliability as well as univariable and multivariable analyses were performed for texture features and clinical parameters to determine independent predictors for local progression-free survival (PFS) and overall survival (OS). Furthermore, Harrell’s concordance index (C-index) was used to assess the performance of the independent texture features. The primary tumor histology of small cell lung cancer (SCLC) was the only clinical parameter significantly associated with local PFS in multivariable analysis. Run-length non-uniformity (RLN) and short-run emphasis were the independent texture features associated with local PFS. In the non-SCLC (NSCLC) subgroup analysis, RLN and local range mean were associated with local PFS. The C-index of independent texture features was 0.79 for the all-patients group and 0.73 for the NSCLC subgroup. In conclusion, texture analysis on pre-treatment MRI of lung cancer patients with brain metastases may have a role in predicting SRS response.

scholarly journals Clinical Application of CT-Guided Percutaneous Microwave Ablation for the Treatment of Lung Metastasis from Colorectal Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Lin Li ◽  
Ketong Wu ◽  
Haiyang Lai ◽  
Bo Zhang
Keyword(s):  
Colorectal Cancer ◽  
Lung Metastasis ◽  
Microwave Ablation ◽  
Progression Free Survival ◽  
Ct Guided ◽  
Metastatic Lesions ◽  
Local Progression ◽  
Invasive Method ◽  
Percutaneous Microwave Ablation

Objective. The aim of our research is to explore the clinical efficacy and safety of CT-guided percutaneous microwave ablation (MWA) for the treatment of lung metastasis from colorectal cancer. Materials and Methods. CT-guided percutaneous MWA was performed in 22 patients (male 14, female 8, mean age: 56.05 ± 12.32 years) with a total of 36 lung metastatic lesions from colorectal cancer between February 2014 and May 2017. Clinical data were retrospectively analyzed with respect to the efficacy, safety, and outcome. Results. Of the 36 lesions, 34 lesions (94.4%) reduced obviously with small cavitations or fibrous stripes formed and had no evidence of recurrence during follow-up. The volume of the other 2 lesions demonstrated local progression after 6 months by follow-up CT. The primary complications included pneumothorax (28%), chest pain (21%), and fever (5%). These symptoms and signs were obviously relieved or disappeared after several-day conservative treatment. The mean follow-up of the patients was 25.54 ± 12.58 months (range 2–41 months). The estimated progression-free survival rate was 94.4%. Conclusion. Our results demonstrate that CT-guided percutaneous MWA appears to be an effective, reliable, and minimally invasive method for the treatment of lung metastasis from colorectal cancer. This trial is registered with ChiCTR-ORC-17012904.

scholarly journals Irreversible Electroporation Treatment With Intraoperative Biliary Stenting for Unresectable Perihilar Cholangiocarcinoma: A Pilot Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Po-Chih Yang ◽  
Yan-Jun Chen ◽  
Xiao-Yong Li ◽  
Chih-Yang Hsiao ◽  
Bing-Bing Cheng ◽  
...  
Keyword(s):  
Stent Placement ◽  
Irreversible Electroporation ◽  
Progression Free Survival ◽  
Carbohydrate Antigen ◽  
Biliary Stent ◽  
Perihilar Cholangiocarcinoma ◽  
Total Serum ◽  
Medical Centers ◽  
Serum Carbohydrate Antigen ◽  
One Year

BackgroundTreating perihilar cholangiocarcinoma (PHCC) is particularly difficult due to the fact that it is usually in an advanced stage at the time of diagnosis. Irreversible electroporation treatment (IRE) involves the local administration of a high-voltage electric current to target lesions without causing damage to surrounding structures. This study investigated the safety and efficacy of using IRE in conjunction with intraoperative biliary stent placement in cases of unresectable PHCC.MethodsThis study enrolled 17 patients with unresectable Bismuth type III/IV PHCC who underwent IRE in conjunction with intraoperative biliary stent placement (laparotomic) in two medical centers in Asia between June 2015 and July 2018. Analysis focused on the perioperative clinical course, the efficacy of biliary decompression, and outcomes (survival).ResultsMean total serum bilirubin levels (mg/dL) on postoperative day (POD) 7, POD30, and POD90 were significantly lower than before IRE (respectively 3.46 vs 4.54, p=0.007; 1.21 vs 4.54, p<0.001; 1.99 vs 4.54, p<0.001). Mean serum carbohydrate antigen 19-9 (CA19-9, U/ml) levels were significantly higher on POD3 than before the operation (518.8 vs 372.4, p=0.001) and significantly lower on POD30 and POD90 (respectively 113.7 vs 372.4, p<0.001; 63.9 vs 372.4, p<0.001). No cases of Clavien-Dindo grade III/IV adverse events or mortality occurred within 90 days post-op. The median progression-free survival was 21.5 months, and the median overall survival was 27.9 months. All individuals who survived for at least one year did so without the need to carry percutaneous biliary drainage (PTBD) tubes.ConclusionsIt appears that IRE treatment in conjunction with intraoperative biliary stent placement is a safe and effective approach to treating unresectable PHCC. The decompression of biliary obstruction without the need for PTBD tubes is also expected to improve the quality of life of patients.

scholarly journals Initial experience with irreversible electroporation of liver tumours

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S326
Author(s):  
D. Stillstrom ◽  
M. Beermann ◽  
J. Engstrand ◽  
J. Freedman ◽  
H. Nilsson
Keyword(s):  
Irreversible Electroporation ◽  
Initial Experience ◽  
Liver Tumours

scholarly journals Initial experience with irreversible electroporation of liver tumours

2019 ◽  
Vol 6 ◽  
pp. 62-67 ◽  
Author(s):  
David Stillström ◽  
Marie Beermann ◽  
Jennie Engstrand ◽  
Jacob Freedman ◽  
Henrik Nilsson
Keyword(s):  
Irreversible Electroporation ◽  
Initial Experience ◽  
Liver Tumours

Stereotactic hypofractionated high-dose irradiation (STI) for stage I non-small cell lung cancer (NSCLC): Mature results in 300 cases of a Japanese multi-institutional study

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7045-7045 ◽  
Author(s):  
H. Onishi ◽  
Y. Nagata ◽  
H. Shirato ◽  
K. Karasawa ◽  
K. Gomi ◽  
...  
Keyword(s):  
Total Dose ◽  
Local Control ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Pulmonary Complications ◽  
Stage I ◽  
High Dose ◽  
Stage Ib ◽  
Local Progression ◽  
Stage Ia

7045 Background: With the increasing accuracy of localization for tumor-bearing areas using various new techniques, hypofractionated or single high-dose stereotactic irradiation (STI) has been actively investigated for stage I NSCLC in Japan. The current study retrospectively evaluated Japanese multi-institutional results for high-dose STI for stage I NSCLC. Methods: From 1993 to 2003, stereotactic three-dimensional treatment was performed using 3–10 non-coplanar dynamic arcs or 6–20 static ports for a total of 300 stage I (median age, 75 years; T1N0M0, n = 193; T2N0M0, n = 107) patients with primary NSCLC (adenocarcinoma, n = 138; squamous cell carcinoma, n = 129; and others, n = 33) in 14 institutions. Totally 190 patients were medically inoperable, and other 110 were medically operable but selected STI. A total dose of 18–75 Gy at the isocenter was administered in 1–22 fractions. Median calculated biological effective dose (BED) was 108 Gy (range, 57–180 Gy). Results: Median follow-up period of survivors was 38 months (range; 2–128 months). Pulmonary complications of NCI-CTC criteria (version 2.0) grade ≥ 3 were noted in 9 patients (3.0%). Local progression occurred in 44 patients (14.7%), and 5-year local control rate was high (86%) for BED ≥100 Gy (n = 227) compared to 67% for <100 Gy (n = 73) (P < 0.001). Overall 5-year survival rates of operable and inoperable patients were 65% and 37%, respectively. Overall 5-year survival rates in operable cases was high (74%) for BED ≥100 Gy (n = 85) compared to 37% for <100 Gy (n = 24) (P < 0.01). In a subset of operable patients irradiated with BED ≥100, 3-year locally progression-free survival rates was high (81%) for stage IA (n = 60) compared to 67% for stage IB (n = 23) (P < 0.05) Conclusions: Local control and survival rates of STI for stage I NSCLC are better with BED ≥100 Gy compared to <100 Gy. Survival rates in selected patients (medically operable, BED ≥100 Gy) were excellent, and potentially comparable to those of surgery. Stage IB patients displayed higher rate of local progression than stage IA. We have started multi-institutional prospective study for stage IA NSCLC with a schedule of total dose of 48 Gy in 4 fractions during 4–8 days. No significant financial relationships to disclose.

Radiation Therapy Oncology Group (RTOG) 9413: Randomized trial comparing whole pelvic radiotherapy (WPRT) to prostate only (PORT) and neoadjuvant hormone therapy (NHT) to adjuvant hormone therapy (AHT).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 96-96 ◽  
Author(s):  
Mack Roach ◽  
Yan Yan ◽  
Colleen Anne Lawton ◽  
I-Chow Joe Hsu ◽  
Robert A. Lustig ◽  
...  
Keyword(s):  
Hormone Therapy ◽  
Radiation Therapy Oncology Group ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Adjuvant Hormone Therapy ◽  
Entire Cohort ◽  
Local Progression ◽  
Increased Risk ◽  
First Occurrence ◽  
Secondary Endpoints

96 Background: RTOG 9413 demonstrated that NHT+WPRT improved progression-free survival (PFS) compared to NHT+PORT, WPRT+AHT and PORT+AHT. We update primary and secondary endpoints (SE): biochemical failure (BF), time to metastasis (Mets), prostate specific survival (PSS) and overall survival (OS). Methods: RTOG 9413 opened on April 1, 1995, and closed on June 1, 1999, with 1275 eligible pts who were required to have a risk of lymph node (LN) involvement >15% but LN-positive pts were ineligible. They were stratified by T Stage, GS (<7 vs 7-10) and PSA (>30 vs < 30ng/ml) and randomized to PORT +/- WPRT to 70 Gy and NHT or AHT. Hormonal therapy (HT) consisted of flutamide, and leuprolide or goserelin, monthly x 4 mos, beginning 2 mos before RT and continued until RT is completed (NHT) or beginning at the completion of RT (AHT). For this analysis PFS was defined as the first occurrence of local/regional or LN progression, Mets, BF (PSA nadir+2ng/mL), or death from any cause. PSS is defined as a death due to prostate cancer, treatment toxicity or unknown causes with local progression, Mets or BF. Results: For the entire cohort WPRT or NHT did not appear to improve any endpoint compared with PORT or AHT, (although there was a trend for improvement in regional failure for WPRT vs PORT, (p=0.07)). However, there were complex sequence/volume dependent interactions between HT and RT and statistically significant differences between the 4 arms in PFS (p=0.03). There was a trend for NHT+WPRT to improved PFS compared to NHT+PO (p=0.07) and WPRT+AHT (p=0.04). NHT+WPRT was associated with an increased risk of late GI toxicity, 5% compared to 0.6%, 2% and 2% for NHT+PORT, WPRT+AHT and PORT+AHT (p<0.001) but not in GU late toxicity. Conclusions: The failure to improve SE or definitively impact PFS may reflect sample size, pt selection, and inadequate RT doses. RTOG 0924 will test the hypotheses that modern techniques and doses will improve OS without increasing late toxicity.

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