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Percutaneous Thermal Segmentectomy: Proof of Concept.

Pierleone Lucatelli1, Renato Argirò2, Laura Crocetti3

  • 1Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy. pierleone.lucatelli@gmail.com.

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|March 31, 2022
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Summary

Balloon-occluded microwave ablation (b-MWA) followed by balloon-occluded transarterial chemoembolization (b-TACE) safely treats large liver tumors. This combined approach achieved high response rates and larger necrotic areas than expected.

Keywords:
Balloon-occluded microwave ablation (b-MWA)Balloon-occluded transcatheter arterial chemoembolization (b-TACE)Hepatocellular carcinoma (HCC)Intrahepatic cholangiocarcinoma (iCC)Liver colorectal metastasis (mCRC)

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Area of Science:

  • Interventional Radiology
  • Oncology
  • Hepatobiliary Malignancies

Background:

  • Liver malignancies larger than 3 cm pose treatment challenges.
  • Combination therapies are explored to improve outcomes for unresectable liver tumors.
  • Minimally invasive techniques are crucial for managing complex liver lesions.

Purpose of the Study:

  • To evaluate the safety and efficacy of a combined balloon-occluded microwave ablation (b-MWA) and balloon-occluded transarterial chemoembolization (b-TACE) approach.
  • To assess the characteristics (size, shape) of the necrotic area post-treatment.
  • To report oncological outcomes in patients with liver tumors > 3 cm.

Main Methods:

  • Multicenter retrospective study of 23 patients with liver tumors > 3 cm.
  • Single-step procedure: b-MWA followed by b-TACE using epirubicin or irinotecan.
  • Assessment of necrotic area volume and shape via CT.
  • Evaluation of complications using CIRSE classification.
  • Oncological outcomes assessed by m-RECIST and RECIST v1.1.

Main Results:

  • Mean necrotic volume was 75 cm³; 95.7% of necrotic areas were non-spherical.
  • Necrotic volume exceeded vendor chart predictions by 103.2%.
  • Complete response (CR) was 91.3% at 1 month and 85.7% at 3-6 months.
  • Partial response (PR) was 8.7% at 1 month and 9.5% at 3-6 months.
  • Post-embolization syndrome occurred in 12/23 patients; no major complications were reported.

Conclusions:

  • The combination of b-MWA and b-TACE in a single session creates larger, non-spherical necrotic areas.
  • This approach is safe and achieves promising oncological results for liver tumors > 3 cm.
  • Treatment outcomes correlate with the vascular territory occluded during ablation.