A 64-year old was diagnosed with cirrhosis due to alcohol and hepatitis C in 2022 and was treated with anti-virals. Two suspected-HCC lesions were detected in segment IV in October 2024. After the lesions were shown to be growing quickly, the MDT decided in March 2025 on radiofrequancy ablation of the lesions as the patient would wait for a transplantation in the future.
CAS-One IR was needed to confidently place the needles with 10mm separation to cover both lesions which were irregularly shaped, and to confirm complete coverage with maximum margin. The procedure was done quickly and saferly, and AblaSure showed 100% tumor coverage with a Minimal Ablative Margin of 6mm. A 3-month follow up confirmed these results.
The planning scan showing the 3 RFA probes with 10mm separation
Verification scan of the 3 probes showing accuracy and inter-probe distance - no adjustments necessary
AblaSure showing a complete treatment of the lesion with a 6 mm safety margin
CT Follow-up at 3 months showing complete response
Name: Dr. Andreina Olavarria, Dr. Ana Palomera Rico
Institution: Hospital Universitario Ramón y Cajal, Madrid, Spain
Patient age and sex: Male, 64 years-old
Initial condition:
- Diagnosed in 2022 with cirrhosis (Child-Pugh A stage 5) related to chronic alcohol-use and Hepatitis C
- In October 2024 two adjacent lesions of 13 and 9 mm in segment IV were found on imaging, suggesting HCC
- In January 2025 the decision was made to ablate under ultrasound but the tumor appeared different than previous MRI and decision was made to do a biopsy.
- In March 2025 the lesions increased to 18 and 15 mm and patient was referred to Ramón y Cajal Hospital for treatment
- Decision was made by the MDT in June 2025 to do a thermoablation of the lesion with CAS-One IR and await transplantation
- Multiprobe RFA was chosen because of the unusual lesion shape
Treatment:
- Patient was under general anesthesia
- Treatment was done in June 2025, using the STARmed Octopus system
- CAS-One IR was used to properly plan the probes with a 10mm separation ensuring complete treatment volume, accurately place the probes including spacing, and assess the complete ablation of the lesion and margin
Result:
- The 3 probes were placed easily and accurately with the stereotactic arm of CAS-One IR in 20 minutes
- AblaSure® analysis demonstrated what appeared to be complete coverage of the lesion and a minimal ablative margin of 6 mm.
- The patient was discharged the following day without complications
- Follow-up imaging confirmed full coverage of the treated lesion at 3 months and patient was taken off the transplant list due to its good response to the treatment.
Conclusion:
- Dr. Olavarria said of the case "CAS-One IR is ideal in situations like this to not only plan to cover an unusually shaped lesion, but to place multiple probes quickly with single-insertions, and most importantly to use ablation confirmation to ensure the proper treatment has been achieved"
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