Metastatic SCLC lesion in the liver dome, treated safely with Cryoablation
This 69-year-old female patient presented with a metastatic SCLC lesion in Segment VII of the Liver. Cryoablation was the chosen method of treatment for this lesion due to its tissue-sparing nature and the need to persevere diaphragmatic tissue. CAS-One IR assisted in the safe planning of this steep inferior-to-superior trajectory, resulting in accurate and precise needle placement with a 1.5 mm lateral error. The patient experienced no complications during the procedure.
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Planning scan in MPR
![NeedleMPR](https://www.cascination.com/hs-fs/hubfs/NeedleMPR.jpg?width=1116&height=698&name=NeedleMPR.jpg)
Needle verification image in MPR showing actual ablation zone in respect to needle position
![Needle3d3](https://www.cascination.com/hs-fs/hubfs/Needle3d3.jpg?width=1116&height=698&name=Needle3d3.jpg)
![Iceball_MPR](https://www.cascination.com/hs-fs/hubfs/Iceball_MPR.jpg?width=1116&height=698&name=Iceball_MPR.jpg)
Ablation image showing ablation zone at maximum size, prior to thawing
Planning scan showing tumor vs. post-ablation scan showing ablation zone
![top-case-april](https://www.cascination.com/hs-fs/hubfs/top-case-april.jpg?width=1116&height=375&name=top-case-april.jpg)
Name: Dr. Lisa Klompenhouwer
Institution: The Netherlands Cancer Institute (NKI)
Patient sex and age: Female, 69 years old
Initial condition:
- The patient was initially diagnosed with T1bN2M0, stage 3A, SLCC in the right lower lobe of the lung
- The patient underwent Chemotherapy and Radiotherapy for the treatment of the lung lesion, where she developed several pulmonary embolisms
- The patient developed liver metastasis which disappeared after Immunotherapy
- Over the years the patient developed histology-proven oligoprogression of prior liver metastasis which was treated with local therapy (thermal ablation and radiotherapy) by the decision of the MDT
- During follow-up, CT and MRI showed again a new abnormality in the liver, suspected of oligoprogression
- Cryoablation was planned for this subcapsular metastasis in segment VII of the liver
Treatment:
- Cryoablation was the chosen method of treatment in order to preserve the diaphragm Hydrodissection was not possible due to multiple prior local treatments
- A single needle was planned with an inferior to the superior oblique trajectory, to prevent advancement through the lung
- The needle was inserted successfully, with very minimal displacement
- The post-ablation CT was taken before the end of the freezing cycle to verify the ablation zone at its largest size, before thawing
- Complete ablation of the tumour and clinical margin was observed
- The patient experienced no complications during the procedure
Result:
- This difficult trajectory was safely planned and placed using CAS-One IR navigation capabilities, avoiding needle advancement through the lung
- One month follow-up showed a complete ablation. Three month post-procedural follow-up showed no sign of recurrence, however the patient did develop a new lesion in Liver Segment V
- The patient has a history of reactive pleural oedema possibly due to Vena Cava superior syndrome (as seen on post-op images)
Learn more about the stereotactic navigation system CAS-One IR.