Combined IRE and MWA for two local HCC recurrences in Seg. IVa + VIII

Multimodal Quality Ablation treatment of two HCC recurrences in liver segments IVa & VIII with Irreversible Electroporation and Microwave Ablation in one continuous session.  

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Case Regensburg
 

Name: Dr. Lukas Lürken 


Institution: University Hospital Regensburg (Germany)


Patient age and sex: 59 years, male


Initial condition:

  • 10/2017: Diagnosis HCC
  • 11/2017: R0-resection in Seg. VI
  • Pathology: HCC G1/BCLC A
  • 2018: Followed by Antiviral Hep-C-therapy that showed the patient maintained good liver function and no transplantation was necessary
  • 02/2020: HCC recurrence, atypical resection Seg. III & II
  • 02/2021: MRI shows HCC suspect recurrence in Seg. IVa (1,6 x 1,1 cm) and Seg. VIII (0,7 x 0,5 cm)
  • Tumour board decision: Radiologic Interventional Oncology-Treatment

Treatment: 

  • Due to the proximity to the bile duct and portal venous vessel inclusion in Seg. IVa, a decision for stereotactic navigated IRE procedure with 4 planned needle trajectories was taken
  • A 5th trajectory to take a biopsy prior to treatment was planned
  • CAS-One IR guided Microwave Ablation in Seg. VIII during the same session

Case_Regensbrug_2021_Overview

Top row: IRE planning scan and post-ablation scan
Bottom row: MWA planning scan and post-ablation scan


Result:

In this case, the use of stereotactic navigation was mandatory:
  • IRE requires precise needle placement taking anatomical structures in account. With the help of CAS-One IR, planning and placement of the probes was possible in one step
  • Implementing multimodal treatment (IRE/MWA/Biopsy) options in one session is a great advantage and prevents further sessions
  • Initial post-ablation scan shows technical success in both lesions
  • A total of 6 needles were planned, navigated and validated
  • Total procedure time: 2:30h

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

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