A fast-growing NSCLC metastasis in segment VI

Written by Margrethe Rasmussen | April 20, 2026 9:54:26 AM Z

An 79-year-old male with a complex oncologic history of non-small cell lung carcinoma, treated with chemotherapy and SBRT, was referred for evaluation of a progressively enlarging liver lesion consistent with metastatic disease. Given the isolated hepatic involvement and limited treatment options, a minimally invasive, image-guided ablation approach was considered to treat this 3.8cm lesion in segment VI requiring multiple needles.

Planning scan of the 4-needle ablation of the large lesion

3D of the planned trajectories, vascular structures, and other relevant anatomy

Video of the multiple trajectories planned

Needle placement of one out of four trajectories, showcasing minimal lateral deviation

Automatic segmentation of the lesion was challenging due to the large ablation zone as well as excessive fatty tissue that was ablated, and therefore the spherical boundary was used

Name: Dr. Laurynas Kazlas

Institution: Aarhus Univeristy Hospital

Patient age and sex: Male, 79

Initial condition and Imaging:

In December 2021, the patient was diagnosed with non-small cell lung cancer (NSCLC), stage T0 N3 M0, harboring a BRAF mutation and was treated with curative intended chemotherapy followed by SBRT
In January 2022, a 15mm gastrointestinal stromal tumor (GIST) of the esophagus was incidentally identified, for which no treatment was initiated
In November 2023, recurrence of NSCLC was detected with cervical lymph node metastasis, and palliative immunotherapy was started
During follow-up in July 2025, a CT scan revealed a 14mm lesion in liver segment VII. By October 2025, the lesion had progressed to 24mm, and a CT-guided biopsy confirmed metastatic disease. PET-CT and MRI demonstrated no additional extrahepatic lesions
At MDT discussion, the patient had a performance status of 2, and progression of the liver lesion had occurred during a temporary pause in palliative immunotherapy. The consensus decision was to proceed with MWA if technically feasible. Given the lesion size and challenging subdiaphragmatic location, stereotactic MWA using the CAS-One system with MRI fusion made it feasible, and therefore was planned

Treatment:

Pre-procedural contrast-enhanced CT confirmed progression of the segment VII metastasis, measuring just under 4cm in axial diameter and slightly over 4cm in the craniocaudal direction. The previously identified small satellite lesion at the S6/S7 junction remained non-visible on CT
Using stereotactic navigation with MRI fusion, an Medtronic Emprint MWA antenna was first placed in the small metastasis, measuring only a few millimeters, and ablation was performed at 45 W for 2.5 minutes
Subsequently, the larger metastasis was targeted using two MWA antennas. The caudal portion of the lesion was ablated simultaneously at 150 W and 100 W for 10 minutes using two Emprint generators
The antennas were then repositioned cranially, followed by an additional ablation at 150 W and 100 W for 10 minutes to achieve complete coverage of the lesion

Result and Conclusion

Follow-up imaging 4 months after ablation showed complete ablation of both lesions
No complications occurred, and the patient was discharged from the hospital the day after ablation

Dr. Laurynas Kazlas said of the case: "There were many challenges with this case - size, visibility, proximity to critical structures, but the innovative features of CAS-One IR helped enable this treatment. Before we had the device - treating this patient with ablation would not have been possible"

Learn more about CAS-One IR.

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