Ablation in Primary Liver Tumors

Minimal invasive thermal ablation techniques have a key role in the treatment regimen of primary liver tumors. These relatively low-risk procedures are established in nonresectable liver tumors and even challenge the surgical approach, which is regarded as first-line treatment in eligible patients.The location and size of the liver tumor, the applied ablation, and guidance technique are crucial for treatment outcome. The confirmation of an adequate ablation zone including sufficient tumor overlap and a safety margin (A0 ablation analogous to R0 resection) is crucial to minimize local recurrence rates and improve survival. A variety of different ablation devices is available. The outcome of conventional computed tomography- or ultrasound-guided thermal ablation in small lesions is well comparable to surgery. However, in liver lesions with large diameter overlapping ablation zones are required to ensure an adequate ablation margin. Therefore, stereotactic techniques in combination with a multiple needle approach, three-dimensional trajectory planning, and image fusion for intraoperative treatment evaluation have been successfully introduced.

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

Biology ◽

10.3390/biology10070644 ◽

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.

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4:03 PM Abstract No. 297 True three-dimensional holographic visualization for performance of percutaneous thermal ablation of solid liver tumors: an update on in-human evaluation

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.12.348 ◽

2020 ◽

Vol 31 (3) ◽

pp. S135-S136

Author(s):

G. Gadodia ◽

J. Yanof ◽

K. West ◽

S. Al-Nimer ◽

A. Hanlon ◽

...

Keyword(s):

Thermal Ablation ◽

Liver Tumors ◽

Three Dimensional ◽

Human Evaluation ◽

Percutaneous Thermal Ablation

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Predicting the Risk of Postoperative Complications in Patients Undergoing Minimally Invasive Resection of Primary Liver Tumors

Journal of Clinical Medicine ◽

10.3390/jcm10040685 ◽

2021 ◽

Vol 10 (4) ◽

pp. 685

Author(s):

Philipp K. Haber ◽

Christoph Maier ◽

Anika Kästner ◽

Linda Feldbrügge ◽

Santiago Andres Ortiz Galindo ◽

...

Keyword(s):

Liver Tumors ◽

Characteristic Curve ◽

Minimal Invasive ◽

Internal Validation ◽

Primary Liver Tumors ◽

Relative Contribution ◽

Major Complications ◽

Patient Health ◽

Performance Area ◽

Minimal Invasive Techniques

Minimal-invasive techniques are increasingly applied in clinical practice and have contributed towards improving postoperative outcomes. While comparing favorably with open surgery in terms of safety, the occurrence of severe complications remains a grave concern. To date, no objective predictive system has been established to guide clinicians in estimating complication risks as the relative contribution of general patient health, liver function and surgical parameters remain unclear. Here, we perform a single-center analysis of all consecutive patients undergoing laparoscopic liver resection for primary hepatic malignancies since 2010. Among the 210 patients identified, 32 developed major complications. Several independent predictors were identified through a multivariate analysis, defining a preoperative model: diabetes, history of previous hepatectomy, surgical approach, alanine aminotransferase levels and lesion entity. The addition of operative time and whether conversion was required significantly improved predictions and were thus incorporated into the postoperative model. Both models were able to identify patients with major complications with acceptable performance (area under the receiver-operating characteristic curve (AUC) for a preoperative model = 0.77 vs. postoperative model = 0.80). Internal validation was performed and confirmed the discriminatory ability of the models. An easily accessible online tool was deployed in order to estimate probabilities of severe complication without the need for manual calculation.

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▪ Cryosurgery and Thermal Ablation of Primary Liver Tumors and Hepatic Metastases

Surgical Ultrasound ◽

10.1055/b-0034-76198 ◽

2007 ◽

Keyword(s):

Thermal Ablation ◽

Liver Tumors ◽

Hepatic Metastases ◽

Primary Liver Tumors

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Radiofrequency Thermal Ablation of Metastatic Liver Tumors: Usefulness of Combined Chemotherapy

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2001.45.2.147 ◽

2001 ◽

Vol 45 (2) ◽

pp. 147

Author(s):

Jeong Nam Heo ◽

Hyun Chul Rhim ◽

Yong Soo Kim ◽

Byung Hee Koh ◽

On Koo Cho ◽

...

Keyword(s):

Thermal Ablation ◽

Liver Tumors ◽

Combined Chemotherapy ◽

Radiofrequency Thermal Ablation ◽

Metastatic Liver Tumors ◽

Metastatic Liver

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Eight years after introducing liver resection at the Oncology Institute of Vojvodina

Archive of oncology ◽

10.2298/aoo1304101m ◽

2013 ◽

Vol 21 (3-4) ◽

pp. 101-104

Author(s):

Ivan Majdevac ◽

Nikola Budisin ◽

Milan Ranisavljevic ◽

Dejan Lukic ◽

Imre Lovas ◽

...

Keyword(s):

Colorectal Cancer ◽

Liver Resection ◽

Liver Tumors ◽

Liver Parenchyma ◽

Malignant Neoplasms ◽

Chemotherapy Treatment ◽

Primary Liver Tumors ◽

Cancer Metastases ◽

Colorectal Cancer Metastases ◽

Medical Histories

Background: Hepatectomies are mostly performed for the treatment of hepatic benign or malignant neoplasms, intrahepatic gallstones, or parasitic cysts of the liver. The most common malignant neoplasms of the liver are metastases from colorectal cancer. Anatomic liver resection involves two or more hepatic segments, while non-anatomic liver resection involves resection of the metastases with a margin of uninvolved tissue. The aim of this manuscript was to show results of hepatectomies performed at the Oncology Institute of Vojvodina. Methods: We performed 133 liver resections from January 1997 to December 2013. Clinical and histopathological data were obtained from operative protocols, histopathological reports, and patients? medical histories. Results: We did 80 metastasectomies, 51 segmentectomies, and 18 radiofrequent ablations (RFA). Average number of colorectal cancer metastases was 1.67 per patient. We also made 10 left hepatectomies. In all cases, we made non-anatomic resections. Conclusion: Decision about anatomic versus non-anatomic resections for colorectal metastasis and primary liver tumors should be made before surgical exploration. Preservation of liver parenchyma is important with respect to liver failure and postoperative chemotherapy treatment.

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Rearrangement of a common cellular DNA domain on chromosome 4 in human primary liver tumors.

Journal of Virology ◽

10.1128/jvi.62.2.629-632.1988 ◽

1988 ◽

Vol 62 (2) ◽

pp. 629-632 ◽

Cited By ~ 37

Author(s):

C Pasquinelli ◽

F Garreau ◽

L Bougueleret ◽

E Cariani ◽

K H Grzeschik ◽

...

Keyword(s):

Liver Tumors ◽

Chromosome 4 ◽

Primary Liver Tumors ◽

Cellular Dna

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Estimating intrafraction tumor motion during fiducial-based liver stereotactic radiotherapy via an iterative closest point (ICP) algorithm

Radiation Oncology ◽

10.1186/s13014-019-1401-2 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Wu-zhou Li ◽

Zhi-wen Liang ◽

Yi Cao ◽

Ting-ting Cao ◽

Hong Quan ◽

...

Keyword(s):

Stereotactic Radiotherapy ◽

Imaging System ◽

Liver Tumors ◽

Three Dimensional ◽

Rigid Motion ◽

Iterative Closest Point ◽

Tumor Motion ◽

Tracking Accuracy ◽

Icp Algorithm ◽

Anterior Posterior

Abstract Background Tumor motion may compromise the accuracy of liver stereotactic radiotherapy. In order to carry out a precise planning, estimating liver tumor motion during radiotherapy has received a lot of attention. Previous approach may have difficult to deal with image data corrupted by noise. The iterative closest point (ICP) algorithm is widely used for estimating the rigid registration of three-dimensional point sets when these data were dense or corrupted. In the light of this, our study estimated the three-dimensional (3D) rigid motion of liver tumors during stereotactic liver radiotherapy using reconstructed 3D coordinates of fiducials based on the ICP algorithm. Methods Four hundred ninety-five pairs of orthogonal kilovoltage (KV) images from the CyberKnife stereo imaging system for 12 patients were used in this study. For each pair of images, the 3D coordinates of fiducial markers inside the liver were calculated via geometric derivations. The 3D coordinates were used to calculate the real-time translational and rotational motion of liver tumors around three axes via an ICP algorithm. The residual error was also investigated both with and without rotational correction. Results The translational shifts of liver tumors in left-right (LR), anterior-posterior (AP),and superior-inferior (SI) directions were 2.92 ± 1.98 mm, 5.54 ± 3.12 mm, and 16.22 ± 5.86 mm, respectively; the rotational angles in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were 3.95° ± 3.08°, 4.93° ± 2.90°, and 4.09° ± 1.99°, respectively. Rotational correction decreased 3D fiducial displacement from 1.19 ± 0.35 mm to 0.65 ± 0.24 mm (P<0.001). Conclusions The maximum translational movement occurred in the SI direction. Rotational correction decreased fiducial displacements and increased tumor tracking accuracy.

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