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.
Highlights
The analysis showed that larger vessels (>5 mm) and bile ducts remained intact after
Our results show that even larger lesions can be treated effectively, provided that the limited ablation volume of individual electrodes and probes is respected, and multiprobe technologies are used that generate ablation volumes that better cover the target lesion
It is possible to use methods that are not limited by heat-sink effects, such as ECT or iBT
Summary
Local tumour control (LTC) has established itself as an important pillar of modern oncology, complementing systemic chemotherapy (SCT) and surgery [1–3]. Patients can be provided long-term disease control and survival benefit if the critical foci of disease are removed. Surgery was and still is the gold standard for removing malignancies, flanked by newer and less invasive methods such as stereotactic ablative radiotherapy (SABR) and a multitude of LAT [5]. The core goals of LAT are the achievement of local tumour and symptom control in the gentlest possible way, and with the shortest possible hospitalization [6].The choice of LAT depends on the parameters “entity, number, size and location” of the targets and, last but not least, on the expertise and armamentarium available on site [2]. The safety and effectiveness of the individual procedures have already been sufficiently evaluated, we know today that not all procedures are equivalent in all situations [2,7]
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