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.

 

 

 

Ablation image showing ablation zone at maximum size, prior to thawing

 Planning scan showing tumor vs. post-ablation scan showing ablation zone

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.