Stereotactic Percutaneous Thermal Ablation of Primary and Metastatic Liver Tumors: A Prospective Registry-Based Study

To prospectively evaluate safety, accuracy, and effectiveness of stereotactic thermal ablation of malignant liver tumors at a large academic center in the United States.

From June 2023 to November 2024, 100 thermal liver ablation procedures were performed using CAS-One IR (CAScination, Bern, Switzerland), a stereotactic image-guidance device, by 8 board-certified interventional radiologists. Ninety-six patients (median age, 58 years; male, 69%) undergoing 100 procedures for 164 liver tumors were included. General anesthesia with complete neuromuscular blockade was delivered with breath holds or high-frequency jet ventilation (HFJV) for respiratory control. Lateral targeting errors and their correlation with body mass index (BMI) and respiratory control, procedure times, short-term local outcomes, and adverse events (AEs) per Common Terminology Criteria for Adverse Events (CTCAE) v5 are reported. The Wilcoxon rank-sum test was used to compare lateral errors, and Kaplan-Meier survival analysis was used to estimate the cumulative incidence of local tumor progression (LTP).

The median tumor diameter was 1.6 cm (interquartile range, 1.1-2.4 cm). The median lateral targeting errors were 5.6 mm and 3.6 mm for breath holds and HFJV, respectively. BMI was positively correlated with lateral targeting error for breath holds (R = 0.26, P = .005). The LTP rates were 5.6% at 6 months and 7.4% at 12 months. Four CTCAE Grade 3 AEs (4%) occurred: 3 bleeding events (2 device-related) and 1 brachial plexus injury.

Stereotactic thermal ablation of liver tumors demonstrated similar safety, targeting accuracy, and oncologic outcomes to reported European data. These findings support its utility in thermal ablation of liver tumors in U.S.-based clinical practice.