Quality Ablation of 5 rectal cancer liver metastases

A 57 year old patient diagnosed with rectal cancer in 2022 had surgery and chemotherapy that was fairly successful. In January 2024 the patient met the criteria for the microwave ablation of the remaining 5 liver metastasis, requiring 6 trajectories with CAS-One IR. The procedure was performed with excellent accuracy, and AblaSure showed good coverage of the lesions and the chosen margin.

Planning video of the 6 trajectories required to treat the 5 lesions.

Verification scans of the 6 needles. 2 needles were positioned manually due to a shift in the liver post ablations. 

AblaSure showing 100% coverage with 1 cm safety margins of the large lesion in segment VI.

AblaSure showing a 3D reconstruction showing sufficient coverage of all 5 lesions. 

Name: Dr. Ádám Zoltán Farkas

Institution: Semmelweis University, Budapest, Hungary

Patient age and sex:  Male, 52 years old

Initial condition:

• Patient initially diagnosed in 2022 with rectal carcinoma with multiple metastases in the liver.
• A DIXON surgery was performed in July 2022 with resection of multiple positive lymph nodes.
• Following surgery the patient was put in panitumumab therapy and Folfox chemotherapy until 2023
• In early 2023, the patient still had 10 liver metastases that showed size and metabolic regressions with negative tumor markers.
• In July 2023 the mets showed progression and the patient restarted Folfirinox chemotherapy and Cetuximab.
• In January 2024 the patient had 5 liver mets that could be ablated with Microwave.
• Decision to perform the MWA with the ECO system assisted by CAS-One IR

Treatment: 

• Patient under general anaesthesia. Multiple comorbidities.
• The 5 lesions were visible on the CT scan and required 6 trajectories with an overlapping treatment for the largest lesion in segment VI.
• MWA was performed using the ECO system with 60W and 10 minutes applied to all the probes.

Result:

• All 5 lesions were satisfyingly ablated according to AblaSure.
• The patient was discharged the next day with no complications. 
• Patient developed a minor fever in the next days following the ablation that resolved spontaneously.
• At 3 months, an MRI was performed and showed complete ablation of all 5 lesions.
• Unfortunately the patient had a new lesion in segment VIII and an asymptomatic biloma at the site of the biggest lesion in segment VI.
• Last follow-up in July 2024 showed the latest lesion in segment VIII completely ablated, and the other 5 lesions were still recurrence free. 
• New lesion appeared at the border of segment V/VIII and by the time of ablation the lesion had grown making it non eligible to thermoablation. Patient was put back under chemotherapy and referred for an ECT of that lesion.

Learn more about the stereotactic navigation system CAS-One IR.