Abstract
Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P<.05). Median overall follow-up was 17.5months after intervention and 24months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P<.05). Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
Highlights
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death and the main cause of death in patients with cirrhosis 1
We hypothesize that stereotactic image-guided microwave ablation (SMWA) is a safe and precise ablative treatment for all HCCs including those lesions that are conventionally ineligible to ablation or inoperable due to the underlying liver disease or patient comorbidities. In this first retrospective analysis, we report safety and therapeutic efficacy in terms of local tumor control and short-term survival, as well as procedural efficiency in terms of targeting accuracy and required time when using SMWA for the treatment of HCC
Analysis of 40 ablation zones in the 22 explanted livers showed complete necrosis in 26/40 (65%) treated lesions with a mean rate of necrosis of 87% [15-100] (Figure 4). In this large retrospective analysis, we report our experience with stereotactic-image-guided microwave ablation of HCC and show that SMWA is a safe and efficient minimally invasive treatment option achieving good oncological outcome and local tumor control
Summary
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death and the main cause of death in patients with cirrhosis 1. Curative treatment options for patients with early stage HCC include surgical resection, orthotopic liver transplantation (OLT) and local ablation 2. Only a minority of patients qualify for a curative treatments due to advanced liver disease, intrahepatic tumor distribution or comorbidities 3. To optimize guidance of the ablation probe and precision in tumor targeting and ablation, advanced stereotactic navigation technology has been introduced, and several navigation systems are available for image-guided interventions 17-19. First reports on stereotactic percutaneous computed tomography (CT) - guided ablation of liver tumors have been published, suggesting a safe and accurate treatment 20-22. Conclusion: Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable due to difficult anatomic locations
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