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UPDATE on I n t er v ent ional Radio logy
J GARNON,
RL CAZZATO,
J CAUDRELIER,
E BOATTA,
P RAO,
M NOURI-NEUVILLE,
G KOCH,
P AULOGE,
A GANGI
Department of Interventional Radiology
University Hospital of Strasbourg, France
Disclosure
I have the following the conflict(s) of interest to declare:
BTG-Galil
Canon
Medtronic
the « interventional » radiologist
Interventional radiology in 2018
Interventional radiology in 2018
MRI ANGIO-CT CBCTUS
Patient
TEP-CT
• Ablation: - RFA- MWA- Cryo- IRE- HIFU
• Cement
• Screws
• Ethanol
• Embolization:- Bland- + chemo- + radiation
• Catheter
• Feeding tubes
diagnostic• percutaneous biopsy = 1st option in the majority of cases
• size limit = 5 mm (lung, liver, kidney, bone) to 10 mm (lymph node, adrenal…)
• nb of samples depend on location and tumor size
• almost all locations are accessible
• quality of biopsy depends on the visibility of the lesion with imaging
diagnostic
curative treatment
84 y.o
Hypertension
Diabetes
Brain stroke X3
Cardiac failure
Lung insufficiency
Renal insufficiency
Parkinson
Prostate cancer
Colon cancer
Dementia
The beginning of ablation…
curative treatment
• Percutaneous ablation can provide complete local destruction of a tumour
• different modalities:
Modality Mechanism of action approach evidences Principal applications
RFA Heat-based percutaneous +++ Liver, lung, kidney
Microwave ablation Heat-based percutaneous +++ Liver, lung
Cryoablation Cold-based percutaneous +++ Kidney, bone
HIFU Heat-based non-invasive +/- bone
Irreversibleelectroporation
Non-thermal percutaneous +/- Pancréas, liver
curative treatment
curative treatment• Kidney:
- Stage T1a RCC
- in non-surgical candidates (but more and more as an alternative to surgery)
- Cryo +++
- Technical success > 98% in recent studies
- 5y cancer-free survival > 95% in most studies
- safe in the elderly population
curative treatment• Kidney:
10,218 patients
Treatment:
4522 RN (44.2%)
2820 PN (27.6%)
899 TA (8.8%)
1978 AS (19.4%)
curative treatment• Kidney:
« Patients who underwent a local treatment had a
statistically significant CSS benefit compared to
those with deferred therapy »
1-year FU
curative treatment
Tanis E, Nordlinger B, Mauer M, Sorbye H, van Coevorden F, Gruenberger T, Schlag PM, Punt CJ, Ledermann J, Ruers TJ. Local recurrence rates after radiofrequency ablation orresection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer. 2014 Mar;50(5):912-9. doi:10.1016/j.ejca.2013.12.008.
Park MJ, Kim TH, Lee KM, Cheong JY, Kim JK. Radiofrequency ablation of metastatic liver masses: recurrence patterns and prognostic factors based on radiologic features.Hepatogastroenterology. 2013 May;60(123):563-7.
• Liver:
- early stage HCC (BLCC algorythm)
- colorectal metastasis (ESMO guidelines)
- heat-based: RFA/MWA
- optimal size: <3cm (LR < 3% for lesion < 3cm)
- ideal safety margins: 5 to 10mm
curative treatment• Lung:
- Inoperable NSCLC +
- metastasis +++
- heat-based: RFA
- optimal size: <2cm
Radiofrequency ablation is a valid treatment option for lung metastases:
Experience in 566 patients with 1037 metastases.De Baere et al. Annals of Oncology 2015
1037 metastases (566 patients) – mean size =15 mm – mean number = 1,8
OS: 1 y - 92,4%, 2 y - 79,4%, 3 y - 67,7%, 4 y - 58,9%, 5 y - 51,5%
LR : 8%
palliative treatment
symptoms interventions
denutrition Gastrostomy, jejunostomy, central lines
fractures (iliac, spine) Cementoplasty, screw fixation
pain Cementoplasty, ablation, neurolysis
Bleeding embolisation
Tumour control TACE, radioembolization
palliative treatment
palliative treatment
- significant decrease of the pain
- faster than with RT
- response duration is variable but 6 months duration can be achieved
- As a 1st line ttt or after RT
- very low rate of complication
- Not depending on the histological type of tumour
- cryoablation ++
• Ablation for pain palliation:
MRI ANGIO-CT CBCTUS
Patient
TEP-CT
ReceptionWaiting
room
Consultations
Preparation
Recovery room
Meeting
room
Department of Interventional Oncology
Patient selection and information = it is the role of the interventional radiologist !!
• IR has a role in many situations: diagnostic, palliation, curative treatment
• There are more and more evidences supporting the use of thermal ablation for local control (liver, kidney, lung but many potential other locations)
• The IR should know about the oncological pathologies
• He/she should be part of the multidisciplinary discussion
CONCLUSION
CT-scan
IR surgeon