Patient presents with HCC (4.8 cm centrally located in the right Liver) 6 month after mesorectal excision of a colorectal adenocarcinoma (CRC). He underwent neoadjuvant radiochemotherapy and was assessed free of tumour for the CRC. He had no liver metastases in prior examinations. Multidisciplinary tumour board (MTB) decision opted for tissue sparing local treatment due to suspected subclinical multifocal HCC.
The initial tumour bulk was covered by simultaneous microwave ablation with three antennas placed under CAS-One guidance. The overlapping ablation zones succeeded to cover the complete tumour in a confirmation CT-scan 72h post ablation. But the 6 month follow-up showed recurrent disease at the dorsal circumference of the ablation zone. This was treated with two overlapping microwave ablations in no-touch technique, again guided by CAS-One navigation. Patient was assessed disease free for the subsequent 1.5 years. He now returns with multifocal right sided hypervascular liver lesions (showcased on spectral CE-CT), confirmed as multifocal HCC disease. He is now treated with a combination of TACE and CAS-One guided ablations in a palliative setting, his quality of life is so far uncompromised (ECOG status 0-1). Treatment performed by Prof. Dr. Martin Hoffmann from St. Claraspital, Basel (Switzerland).
CRC after neoadj. Radio-Chemo and TME on CT, MRI showcasing a 4,8 cm Focal Lesion in Segment VIII, CAS-One Treatment Planning
Two days post first Ablation in 2018, 3 months after first Ablation, Local Recurrence (arrow) art. phase in 2019
Name: Prof. Dr. Martin Hoffmann
Institution: St. Claraspital, Basel, Switzerland
Patient age and sex: 79 years, male
Initial condition:
- HCC, T2 N0 M0, Stage 2
- MRI taken in 2018 shows a 48mm focal lesion in Segment VIII
- Biopsy confirmed differentiated trabecular and pseudo–glandular growing HCC Edmonson G2. Right lobe biopsy confirms tumour free histology
- Type two Diabetes, Kidney failure in 2018, hypertensive cardiopathy, COPD, prostate adenoma, sigma diverticulosis, adiposities, HTP both sides
From CAS-One Planning to A0 in two Ablation sessions:
Treatment:
- MWA performed in July 2018 with 3 overlapping ablation zones due to large tumour size. A three-day post ablation contrast scan confirmed successful ablation
- Follow up CT scan in December 2018 showed a small hyperdense reoccurring lesion at the dorsal border of the ablation zone
- CT scan in June 2019 shows tumour reoccurrence. Treated with MWA, two needles using the “no touch” technique. Two-day post ablation scan confirmed successful ablation
- Follow up scan in November 2020 shows multiple hyper vascularized lesions in the right liver lobe, suspected HCC. Treated with a TACE with partial success in two lesions and complete success in the other lesions. Post TACE follow up scan scheduled in three months
Result:
- Two cases of Quality Ablation supporting a tissue sparing treatment strategy to preserve the quality of life of a patient with various comorbidities.
