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Percutaneous Thermal Segmentectomy: Proof of Concept

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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 cm3 (± 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.

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Authors and Affiliations

  1. Vascular and Interventional Radiology Unit, Department of Radiological, Oncological, and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy

    Pierleone Lucatelli, Bianca Rocco & Carlo Catalano

  2. Diagnostic Imaging and Interventional Radiology, University Hospital of Rome Tor Vergata, Rome, Italy

    Renato Argirò & Fulvio Gasparrini

  3. Department of Radiology and Interventional Radiology, University of Pisa, Pisa, Italy

    Laura Crocetti & Elena Bozzi

  4. Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia - Area Di Diagnostica per Immagini, UOC Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario “A. Gemelli” – IRCCS, L.go A Gemelli 8, 00168, Rome, Italy

    Alessandro Tanzilli & Roberto Iezzi

  5. Università Cattolica del Sacro Cuore, L.go F Vito 1, 00168, Rome, Italy

    Roberto Iezzi

Authors
  1. Pierleone Lucatelli
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  2. Renato Argirò
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  9. Roberto Iezzi
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Correspondence to Pierleone Lucatelli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent for the procedure for anonymized publication of this series of patients was obtained from all individual participants included in the study.

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Lucatelli, P., Argirò, R., Crocetti, L. et al. Percutaneous Thermal Segmentectomy: Proof of Concept. Cardiovasc Intervent Radiol 45, 665–676 (2022). https://doi.org/10.1007/s00270-022-03117-y

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  • DOI: https://doi.org/10.1007/s00270-022-03117-y

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