---
title: Ablation and Re-Ablation of Esophageal Carcinoma after intraoperative Margin Assessment
description: Combined treatment of esophageal carcinoma with chemo and radiation therapy followed by microwave ablation with intraoperative margin assessment.
image: https://www.cascination.com/hubfs/01_Case_Antwerp_plan_01_1050x700.png
---

 Wednesday, 29 September 2021

# Ablation and Re-Ablation of Esophageal Carcinoma after intraoperative Margin Assessment

Ablation and Re-Ablation of Esophageal Carcinoma after intraoperative Margin Assessment

2:36

 

Combined treatment of esophageal carcinoma with chemo and radiation therapy according to the CROSS regimen accompanied by local treatment of a delicate lesion with image-guided microwave ablation. After use of newly available intraoperative margin assessment feature in the Quality Ablation workflow, decision for immediate re-ablation to also cover the the remnants was taken.

![01_Case_Antwerp_plan_01_1050x700](https://www.cascination.com/hs-fs/hubfs/01_Case_Antwerp_plan_01_1050x700.png?width=1240&name=01_Case_Antwerp_plan_01_1050x700.png)

 Pre-intervention planning scan with tumour (red), planned safety margin (yellow) and planned ablation zone (green)

 

![02_Case_Antwerp_verfiy_1050x700](https://www.cascination.com/hs-fs/hubfs/02_Case_Antwerp_verfiy_1050x700.png?width=1240&name=02_Case_Antwerp_verfiy_1050x700.png)Post-intervention CT used for quantitive margin assessment with AblaSure.

 

![03_Case_Antwerp_plan_02_1050x700](https://www.cascination.com/hs-fs/hubfs/03_Case_Antwerp_plan_02_1050x700.png?width=1240&name=03_Case_Antwerp_plan_02_1050x700.png)

Planning scan of the re-ablation to also cover the remnant shown in the above picture.

 

Comparison of the planning- and post ablation scan using AblaSure for margin assessment.

---

**Name: **Prof. Dr. Thiery Chapelle & Dr. Bart Op de Beeck 

---

**Institution:** [Antwerp University Hospital](https://www.uza.be/english), Antwerp, Belgium

---

**Patient age and sex:** 55 years, male

---

**Initial condition:**

- 09/2020 - Poorly differentiated esophageal carcinoma – preferred/preference squamous cell carcinoma – cT3N2M0
- 10/2020 - Start of chemo and radiation therapy according to the CROSS regimen
- 12/2020 - Thoracoscopic-robotic and laparoscopic esophageal resection (cT2N3Mx - G3 L1V0 Pn0 R0 7/33 lymph nodes)
- 06/2021 - Solitary liver metastasis segment IVa (PET positive), most likely possibly from the esophageal carcinoma

---

**Treatment:** 

- 22 mm lesion close to the portal vein and the common bile duct bifurcation, as well as the hepatic veins
- Treating locally and minimal invasive is key for the poor prognosis after a metastasized esophageal carcinnoma
- Therefore, Quality Ablation for precise positioning with CAS-One IR
- MWA with a low energy was applied to create a nice spherical ablation zone and to reduce the chance on damaging the bifurcation
- Intra-operative margin assessment with AblaSure showed possible tumour remnants and not achieved safety margin. Immediate re-ablation was performed with a volume, covering the underablated area

---

**Result:**

- Intra-operative margin assessment fostered decision for immediate re-ablation
- Follow up MRI-imaging will be conducted two months after the procedure in 09/2021
- The patient will remain under close surveillance to be able to treat locally when needed. Given the difficult prognosis for esophageal cancer, treatment has no curative intent

---

Learn more about the stereotactic navigation system [CAS-One IR](https://www.cascination.com/en/quality-ablation?hsLang=en).

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