Percutaneous Thermal Segmentectomy: Proof of Concept

• Published in: Cardiovascular and interventional radiology Vol. 45; no. 5; pp. 665 - 676
• Main Authors: Lucatelli, Pierleone, Argirò, Renato, Crocetti, Laura, Rocco, Bianca, Bozzi, Elena, Gasparrini, Fulvio, Tanzilli, Alessandro, Catalano, Carlo, Iezzi, Roberto
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2022; Springer Nature B.V
• Subjects: Ablation; Breast; Cancer; Carcinoma, Hepatocellular - therapy; Cardiology; Chemoembolization; Chemoembolization, Therapeutic - methods; Cholangiocarcinoma; Clinical Investigation; Colorectal carcinoma; Complications; Embolization; Epirubicin; Hepatocellular carcinoma; Humans; Imaging; Interventional Oncology; Irinotecan; Liver; Liver cancer; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Medicine; Medicine & Public Health; Metastases; Metastasis; Necrosis; Nuclear Medicine; Pneumonectomy; Radiology; Retrospective Studies; Sarcoma; Treatment Outcome; Tumors; Ultrasound; Balloon-occluded transcatheter arterial chemoembolization (b-TACE); Balloon-occluded microwave ablation (b-MWA); Intrahepatic cholangiocarcinoma (iCC); Liver colorectal metastasis (mCRC); Hepatocellular carcinoma (HCC)
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-022-03117-y

Aim To report the multicenter retrospective experience on combination of balloon-occluded MWA(b-MWA) followed by balloon-occluded TACE(b-TACE) in patients with liver malignancies > 3 cm, focusing on appearance and volume of necrotic area, safety profile and oncological results. Materials and Methods Twenty-three patients with liver primary malignancies (hepatocellular carcinoma,HCC = 18; intrahepatic cholangiocarcinoma,iCC = 2) and metastasis (colorectal cancer metastasis = 1;sarcoma metastasis = 1;breast metastasis = 1) were treated. Maximum mean diameter of lesions was 4.4 cm (± 1 cm). Treatments were performed using a single-step approach:b-MWA was performed after balloon-microcatheter inflation, followed by b-TACE (with epirubicin or irinotecan). Necrotic area shape and discrepancy with the expected volume of necrosis suggested by vendor’s ablation chart were assessed at post-procedural CT. Complications were categorized according to CIRSE classification. Oncological results at 1 and 3–6 months were evaluated using m-RECIST(HCC) and RECISTv1.1(metastasis/iCC). Results Mean volume of necrotic area was 75 cm 3 (± 36). Discrepancy with vendor chart consisted in a medium percentage of volumetric incrementation of necrotic area of 103.2% (± 99.8). Non-spherical shape was observed in 22/23 patients (95.7%). No complications occurred; Post-embolization syndrome occurred in 12/23patients. Complete response and partial response were, respectively, 91, 3% (21/23) and 8.7% (2/23) at 1 month, 85.7% (18/21) and 9.5% (2/21) at 3–6 months. Progression of disease was 4.7% (1/21) at 3–6 months for extra-hepatic progression. Among partial responders, average percentage of tumor volume debulking was 78.8% (± 9.8%). Conclusion b-MWA followed by b-TACE in a single-step procedure led to larger necrotic areas than the proposed by vendors ablation chart, non-spherical in shape and corresponded to the vascular segment occluded during ablation. This permitted to safely achieve promising oncological results in patients with > 3 cm tumors.