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Percutaneous microwave ablation for colorectal cancer liver metastasis: initial results
SUNDAY: Scientific Sessions
S32
’
Sunday
Scientific Session
cryoablation at a single institution. The size and location of the renal mass and intraprocedural ice ball were recorded. The short axis ice ball diameter was compared to the renal mass diameter to determine the ice ball margin. Contrast enhanced MRI or CT scan performed 1 month after ablation classified the patient as a successful ablation (no enhancing tumor) or as having residual tumor (enhancing tumor). Results: A total of 50 patients (79%) had a successful ablation and 13 patients (21%) had residual tumor on follow-up imaging. The successfully treated patients had a mean lesion diameter of 2.5 cm (range: 0.9-4.3 cm), mean ice ball diameter of 3.6 cm (range: 1.7-5.2 cm), and mean ice ball margin of 0.4 cm (range: 0.2-1.2 cm). Masses with residual tumor had a mean diameter of 3.8 cm (range: 1.8-4.5 cm), mean ice ball diameter of 3.5 cm (range: 1.5-3.9 cm), and mean ice ball margin of -0.4 cm (range: -0.9-0.4 cm). Compared to the successful cases, residual tumors had larger lesion sizes (p o 0.01) and smaller ice ball margins (p o 0.01). There were no residual tumors when an ice ball margin of 0.5 cm or greater was achieved (100% sensitivity, 100% specificity). Outcome was independent of tumor location, hilar abutment, or number of cryoprobes. Conclusion: Ice ball margin can be helpful in predicting renal cryoablation outcome. Margins greater than 0.5 cm strongly correlated to successful treatment. Ice ball margins less than 0.5 cm and large lesion size correlated to residual tumor on followup imaging. Tumor location, hilar abutment, and number of cryoprobes did not affect outcome.
3:48 PM
Abstract No. 57
Effectiveness and safety of image-guided ablation in the management of primary and metastatic adrenal tumors F. Fintelmann1, K. Tuncali2, S.G. Silverman2, D.A. Gervais1, R. Uppot1; 1Radiology, Massachusetts General Hospital, Boston, MA; 2Radiology, Brigham and Women0 s Hospital, Boston, MA Purpose: To evaluate the effectiveness and safety of imageguided percutaneous ablation in the management of primary and metastatic adrenal tumors. Materials and Methods: An IRB approved, retrospective analysis identified 57 patients (42 men, 15 women; mean age 64 years; range 41-81) at two institutions who underwent a total of 74 adrenal tumor ablation procedures between January 2001 and June 2012 using CT-guided radiofrequency ablation (n¼ 30; 6 with supplemental ETOH injection), and MRI (n¼34) or CT (n¼10) guided cryoablation. Tumors included primary adrenal cell cancer and metastases from NSCLC, RCC, TCC, colonCa, breastCa, melanoma, endometrial Ca, ovarian teratoCa and medullary thyroidCa and ranged from 1 to 11 cm in size. Medical records and imaging studies were reviewed for procedural details, complications, results and outcome. Clinical and imaging follow-up was available for an average of 13 months (range 1-57 mos). Results: Local tumor progression was observed in 8 patients, all of which were retreated. Immediate complications included hypertensive crisis (n¼ 8), which resulted in demand ischemia in two patients, and correlated with tumor size o4 cm
’
JVIR
and pre-procedural visibility of normal adrenal tissue. One patient went into atrial fibrillation which was treated medically. Two patients experienced adrenal insufficiency. Performing adrenal ablations under general anesthesia and identifying tumors most likely to cause a hypertensive crisis based on imaging criteria aided in peri-procedural preparation. Conclusion: Image-guided ablation of adrenal tumors can be used for both palliation and tumor eradication. Careful preprocedural evaluation should include assessment of tumor size and visibility of normal adrenal tissue. Our presentation details how to prepare for and manage intra-procedural adrenaline surge and to maximize patient benefit.
3:57 PM
Abstract No. 58
Percutaneous microwave ablation for colorectal cancer liver metastasis: initial results W. Shady1, E.N. Petre1, J.P. Erinjeri1, M. Gonen2, S.B. Solomon1, C.T. Sofocleous1, K.T. Brown1, L. A. Brody1, A.M. Covey1, W. Alago, Jr.1, M. Maybody1, M. D0 Angelica3, N.E. Kemeny4; MSKCC, New York, NY; 1 Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 2 Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 3Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 4Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Purpose: To evaluate the safety and early outcomes of percutaneous microwave ablation in the management of colorectal liver metastases (CLM). Materials and Methods: Following an IRB waiver, we conducted a retrospective review of our prospectively created and maintained HIPPA registered clinical ablation database to identify all patients treated with microwave ablation for colorectal liver metastasis r 5 cm with no more than 3 liver tumors at the time of ablation. Technique effectiveness, defined as successful ablation with no residual tumor was assessed on triphasic CT 4-8 weeks post-ablation. Scans were repeated every 2-4 months to assess for tumor progression. Kaplan Meier methodology was employed to calculate progression free survival. Complications were recorded. Results: 26 patients, 14 males (54%) and 12 females (47%) underwent microwave ablation of 27 CLM from July 2008 to March 2013 with a median follow up of 8.5 months; (range 561) months. The median lesion size was 1.8 cm; range (0.7-3.6) cm. Technique effectiveness was 96%, (26/27). The one year local tumor progression free probability was 84%. Local progression occurred in 2 lesions after a period of 10 and 21 months respectively. Both were retreated successfully with no progression to date. Complications included pneumothorax (n¼2) treated by thoracostomy, asymptomatic left portal vein thrombosis with segmental liver infarction, and transient deterioration of pulmonary function in an asthmatic patient who had simultaneous lung ablation. Conclusion: Microwave ablation appears to have a good safety profile and promising early outcomes in the management of small colorectal liver metastases.
S32
’
Sunday
Scientific Session
cryoablation at a single institution. The size and location of the renal mass and intraprocedural ice ball were recorded. The short axis ice ball diameter was compared to the renal mass diameter to determine the ice ball margin. Contrast enhanced MRI or CT scan performed 1 month after ablation classified the patient as a successful ablation (no enhancing tumor) or as having residual tumor (enhancing tumor). Results: A total of 50 patients (79%) had a successful ablation and 13 patients (21%) had residual tumor on follow-up imaging. The successfully treated patients had a mean lesion diameter of 2.5 cm (range: 0.9-4.3 cm), mean ice ball diameter of 3.6 cm (range: 1.7-5.2 cm), and mean ice ball margin of 0.4 cm (range: 0.2-1.2 cm). Masses with residual tumor had a mean diameter of 3.8 cm (range: 1.8-4.5 cm), mean ice ball diameter of 3.5 cm (range: 1.5-3.9 cm), and mean ice ball margin of -0.4 cm (range: -0.9-0.4 cm). Compared to the successful cases, residual tumors had larger lesion sizes (p o 0.01) and smaller ice ball margins (p o 0.01). There were no residual tumors when an ice ball margin of 0.5 cm or greater was achieved (100% sensitivity, 100% specificity). Outcome was independent of tumor location, hilar abutment, or number of cryoprobes. Conclusion: Ice ball margin can be helpful in predicting renal cryoablation outcome. Margins greater than 0.5 cm strongly correlated to successful treatment. Ice ball margins less than 0.5 cm and large lesion size correlated to residual tumor on followup imaging. Tumor location, hilar abutment, and number of cryoprobes did not affect outcome.
3:48 PM
Abstract No. 57
Effectiveness and safety of image-guided ablation in the management of primary and metastatic adrenal tumors F. Fintelmann1, K. Tuncali2, S.G. Silverman2, D.A. Gervais1, R. Uppot1; 1Radiology, Massachusetts General Hospital, Boston, MA; 2Radiology, Brigham and Women0 s Hospital, Boston, MA Purpose: To evaluate the effectiveness and safety of imageguided percutaneous ablation in the management of primary and metastatic adrenal tumors. Materials and Methods: An IRB approved, retrospective analysis identified 57 patients (42 men, 15 women; mean age 64 years; range 41-81) at two institutions who underwent a total of 74 adrenal tumor ablation procedures between January 2001 and June 2012 using CT-guided radiofrequency ablation (n¼ 30; 6 with supplemental ETOH injection), and MRI (n¼34) or CT (n¼10) guided cryoablation. Tumors included primary adrenal cell cancer and metastases from NSCLC, RCC, TCC, colonCa, breastCa, melanoma, endometrial Ca, ovarian teratoCa and medullary thyroidCa and ranged from 1 to 11 cm in size. Medical records and imaging studies were reviewed for procedural details, complications, results and outcome. Clinical and imaging follow-up was available for an average of 13 months (range 1-57 mos). Results: Local tumor progression was observed in 8 patients, all of which were retreated. Immediate complications included hypertensive crisis (n¼ 8), which resulted in demand ischemia in two patients, and correlated with tumor size o4 cm
’
JVIR
and pre-procedural visibility of normal adrenal tissue. One patient went into atrial fibrillation which was treated medically. Two patients experienced adrenal insufficiency. Performing adrenal ablations under general anesthesia and identifying tumors most likely to cause a hypertensive crisis based on imaging criteria aided in peri-procedural preparation. Conclusion: Image-guided ablation of adrenal tumors can be used for both palliation and tumor eradication. Careful preprocedural evaluation should include assessment of tumor size and visibility of normal adrenal tissue. Our presentation details how to prepare for and manage intra-procedural adrenaline surge and to maximize patient benefit.
3:57 PM
Abstract No. 58
Percutaneous microwave ablation for colorectal cancer liver metastasis: initial results W. Shady1, E.N. Petre1, J.P. Erinjeri1, M. Gonen2, S.B. Solomon1, C.T. Sofocleous1, K.T. Brown1, L. A. Brody1, A.M. Covey1, W. Alago, Jr.1, M. Maybody1, M. D0 Angelica3, N.E. Kemeny4; MSKCC, New York, NY; 1 Interventional Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 2 Epidemiology-Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 3Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; 4Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Purpose: To evaluate the safety and early outcomes of percutaneous microwave ablation in the management of colorectal liver metastases (CLM). Materials and Methods: Following an IRB waiver, we conducted a retrospective review of our prospectively created and maintained HIPPA registered clinical ablation database to identify all patients treated with microwave ablation for colorectal liver metastasis r 5 cm with no more than 3 liver tumors at the time of ablation. Technique effectiveness, defined as successful ablation with no residual tumor was assessed on triphasic CT 4-8 weeks post-ablation. Scans were repeated every 2-4 months to assess for tumor progression. Kaplan Meier methodology was employed to calculate progression free survival. Complications were recorded. Results: 26 patients, 14 males (54%) and 12 females (47%) underwent microwave ablation of 27 CLM from July 2008 to March 2013 with a median follow up of 8.5 months; (range 561) months. The median lesion size was 1.8 cm; range (0.7-3.6) cm. Technique effectiveness was 96%, (26/27). The one year local tumor progression free probability was 84%. Local progression occurred in 2 lesions after a period of 10 and 21 months respectively. Both were retreated successfully with no progression to date. Complications included pneumothorax (n¼2) treated by thoracostomy, asymptomatic left portal vein thrombosis with segmental liver infarction, and transient deterioration of pulmonary function in an asthmatic patient who had simultaneous lung ablation. Conclusion: Microwave ablation appears to have a good safety profile and promising early outcomes in the management of small colorectal liver metastases.