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

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
 Pre-intervention planning scan with tumour (red), planned safety margin (yellow) and planned ablation zone (green)
 
02_Case_Antwerp_verfiy_1050x700Post-intervention CT used for quantitive margin assessment with AblaSure.
 
03_Case_Antwerp_plan_02_1050x700
Planning scan of the re-ablation to also cover the remnant shown in the above picture.
 
Video_Case_Antwerp

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

Learn more about the stereotactic navigation system CAS-One IR.

Subscribe to our newsletter