The What, the Why, and the How of Liver Ablations: A Practical Guide for the Medical Oncologist

Oncology ◽  
2021 ◽  
pp. 1-10
Author(s):  
Nicolò Gennaro ◽  
Simone Schiaffino ◽  
Giovanni Mauri ◽  
Lorenzo Monfardini
Keyword(s):  
Therapeutic Option ◽  
Fusion Imaging ◽  
Colorectal Metastases ◽  
Technical Aspects ◽  
Oncological Patient ◽  
Image Guided ◽  
Liver Ablation ◽  
Contrast Enhanced ◽  
Medical Oncologists ◽  
Malignant Liver

Interventional oncology plays a major role within modern oncological patient management. Image-guided thermal ablation has been recognized as a successful local therapeutic option in patients with primary and secondary malignant liver diseases, as also recalled by the recent European Society of Medical Oncology (ESMO) guidelines on colorectal metastases. As image-guided treatments may be as effective as surgery in selected patients with liver lesions, the clinical oncologist should be familiar with the indications, risks, and technical aspects of liver ablation in order to provide their patients with the best outcomes. This article provides a broad overview of the most commonly used ablation techniques and highlights the most relevant technical aspects such as the ideal setting in the operating theatre; which image-guided methods are available, including the growing application of fusion imaging; or contrast-enhanced ultrasound for guiding/monitoring the procedure. A further aim is to expand the knowledge among medical oncologists about liver ablation procedures and to provide insights into the future perspectives of percutaneous minimally invasive procedures in the liver.

Contrast-enhanced ultrasound of malignant liver lesions

2017 ◽  
Vol 43 (4) ◽  
pp. 819-847 ◽  
Author(s):  
Isabelle Durot ◽  
Stephanie R. Wilson ◽  
Jürgen K. Willmann
Keyword(s):  
Liver Lesions ◽  
Contrast Enhanced Ultrasound ◽  
Contrast Enhanced ◽  
Malignant Liver ◽  
Malignant Liver Lesions

scholarly journals PV-0376: Contrast-enhanced respiration managed cone-beam CT for image-guided intrahepatic radiotherapy

2016 ◽  
Vol 119 ◽  
pp. S175-S176 ◽  
Author(s):  
M. Lock ◽  
N. Jensen ◽  
R. Kozak ◽  
J. Chen ◽  
T. Lee ◽  
...  
Keyword(s):  
Cone Beam Ct ◽  
Cone Beam ◽  
Image Guided ◽  
Contrast Enhanced

scholarly journals Evaluation of Contrast-Enhanced Intraoperative Ultrasound in the Detection and Management of Liver Lesions in Patients with Hepatocellular Carcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Cristina Pace ◽  
Vittorio Nardone ◽  
Silvia Roma ◽  
Fabrizio Chegai ◽  
Luca Toti ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Intraoperative Ultrasound ◽  
Preoperative Imaging ◽  
Liver Lesions ◽  
Therapy Decision ◽  
Contrast Enhanced ◽  
Regenerative Nodules ◽  
Malignant Liver

Aim. To evaluate the role of contrast-enhanced intraoperative ultrasound (CE-IOUS) during liver surgery in the detection and management of liver lesions in patients with hepatocellular carcinoma (HCC). Materials and Methods. From December 2016 to December 2017, 50 patients with HCC, who were candidates for liver resection, were evaluated with intraoperative ultrasound (IOUS). For all patients, MRI and/or CT were performed before surgery. During surgery, IOUS was performed after liver mobilization, and when nodules that had not been detected in the preoperative MRI and/or CT were observed, CE-IOUS scans were carried out with the dual purpose of better characterizing the unknown lesion and discovering new lesions. Results. In 12 patients, IOUS showed 14 nodules not detected by preoperative MRI and/or CT, before surgery. Out of the 12 lesions, five presented vascular features compatible with those of malignant HCC to the evaluation with CE-IOUS and four of these were simultaneously treated with intraoperative radiofrequency ablation (RFA). The fifth lesion was resected by the surgeon. The remaining nine lesions recognized by IOUS were evaluated as benign at CE-IOUS and considered regenerative nodules. The last diagnosis was confirmed during follow-up obtained by means of CT and/or MRI after 1, 3, 6, or 12 months. Conclusion. In our experience, CE-IOUS is a useful diagnostic tool in both benign pathologies, such as regenerative nodules, and malignant liver lesions. The advantage of this approach is the possibility of intraoperatively characterizing, based on vascularization patterns, lesions that could not be diagnosed by preoperative imaging, resulting in modification of the surgical therapy decision and expansion of the resection or intraoperative ablation.

Transarterial Fiducial Marker Placement for Image-guided Proton Therapy for Malignant Liver Tumors

2014 ◽  
Vol 38 (5) ◽  
pp. 1288-1293 ◽  
Author(s):  
Kengo Ohta ◽  
Masashi Shimohira ◽  
Shigeru Sasaki ◽  
Hiromitsu Iwata ◽  
Hiroko Nishikawa ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Liver Tumors ◽  
Fiducial Marker ◽  
Image Guided ◽  
Malignant Liver Tumors ◽  
Malignant Liver

scholarly journals Image-guided radiosurgery in the treatment of spinal metastases

2001 ◽  
Vol 11 (6) ◽  
pp. 1-7 ◽  
Author(s):  
Martin J. Murphy ◽  
Steven Chang ◽  
Iris Gibbs ◽  
Quynh-Tu Le ◽  
David Martin ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Therapeutic Option ◽  
Spinal Metastases ◽  
Target Volume ◽  
Outpatient Setting ◽  
Spinal Tumors ◽  
High Dose ◽  
Radiation Beam ◽  
Image Guided ◽  
Frameless Radiosurgery

Object The authors describe a new method for treating metastatic spinal tumors in which noninvasive, image-guided, frameless stereotactic radiosurgery is performed. Stereotactic radiosurgery delivers a high dose of radiation in a single or limited number of fractions to a lesion while maintaining delivery of a low dose to adjacent normal structures. Methods Image-guided radiosurgery was developed by coupling an orthogonal pair of real-time x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the radiation beam to treatment sites associated with radiographic landmarks. This procedure can be conducted in an outpatient setting without the use of frame-based skeletal fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Four patients with spinal metastases underwent radiosurgery with total prescription doses of 1000 to 1600 cGy in one or two fractions. Alignment of the treatment dose with the target volume was accurate to within 1.5 mm. During the course of each treatment fraction, patient movement was less than 0.5 mm on average. Dosimetry was highly conformal, with a demonstrated ability to deliver 1600 cGy to the perimeter of an irregular target volume while keeping exposure to the cord itself below 800 cGy. Conclusions These experiences indicate that frameless radiosurgery is a viable therapeutic option for metastatic spine disease.

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