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.
Pre-intervention planning scan with tumour (red), planned safety margin (yellow) and planned ablation zone (green)
Post-intervention CT used for quantitive margin assessment with AblaSure.
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, 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
