---
title: Metastatic SCLC lesion in the liver dome, treated safely with Cryoablation
description: This 69 year old female patient presented with a metastatic SCLC lesion in Segment 8 of the Liver. Cryoablation was the chosen method of treatment of this lesion due 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. The patient experienced no complications during the procedure.
image: https://www.cascination.com/hubfs/Needle3d3.jpg
---

 Wednesday, 26 April 2023

# Metastatic SCLC lesion in the liver dome, treated safely with Cryoablation

Metastatic SCLC lesion in the liver dome, treated safely with Cryoablation

3:02

 

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.

 ![PlanMPR-1](https://www.cascination.com/hs-fs/hubfs/PlanMPR-1.jpg?width=1116&height=698&name=PlanMPR-1.jpg)

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)

Needle verification shown in needle plan and 3D view (rendered in version 4.1)

 

 

![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)

One month follow-up CE-CT showed a complete ablation of the lesion 

 

---

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](https://www.cascination.com/products/cas_one_ir?hsLang=en).

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