Multi-trajectory MWA of the adrenal gland

An initially diagnosed RCC was treated with radical nephrectomy of the left kidney in 1991, along with a partial nephrectomy of the right kidney in 2007. Pulmonary mets were diagnosed in 2017, treated with chemo, and the right kidney was treated with multiple MWA. A metastatic lesion of the right adrenal gland was detected in 2021 and treated with radiotherapy, however, in 2023 it showed progression and it was decided that the patient was to be treated with MWA and CAS-One IR due to the challenging position of the target directly adjacent to the inferior vena cava. Two overlapping ablation zones were planned and executed transhepatically, along with track ablation to prevent tumor seeding. Post-procedure, the lesion showed a reduction and there were no periprocedural complications. The patient awaits longer term follow up but is doing well.

Planning scan of both trajectories in needle-eye view with organ and vasculature reconstruction (on left -red: segmentation of the tumorous region, orange: 5 mm safety margin, green: overlapping ablation zones) 

Planning scan of first trajectory including portal and hepatic vein segmentation

Planning scan of second trajectory with liver and kidney segmentation

Post-ablation scan showing reduced tumor size and devascularization

Name: Vinzenz Mayr, Andrea Goetz, PD Dr. Ingo Einspieler

Institution: Regensburg University Hospital, Germany

Patient age, sex:  65, Female

Initial condition:

• An initially diagnosed renal cell carcinoma was treated with radical nephrectomy of the left kidney in 1991
• Partial nephrectomy of the right kidney was performed in 2007
• Several cycles of differing chemotherapies were performed
• Multiple microwave ablations of renal lesions in the right kidney were conducted
• A metastatic lesion of the right adrenal gland was detected in 2021 and radiotherapy was performed
• In 2023 the initially stable metastasis of the right adrenal gland showed progression
• Patient referred to our center for CAS-One IR MWA of the adrenal metastasis.

Treatment: 

• The metastasis of the right adrenal gland was directly adjacent to the inferior vena cava
• Lesion size was 38 x 25 x 46mm
• Two overlapping ablation zones were planned using CAS-One IR
• Correct electrode placement was achieved using a transhepatic access
• Two ablation cycles were performed over a duration of 8 minutes using 75 W and 100 W, respectively
• Track ablation was performed to prevent tumor seeding

Result:

• Directly after ablation the adrenal metastasis showed devascularization and a decrease in size
• The patient showed a swift recovery
• Microwave ablation of two renal lesions was successfully performed afterwards