RCC pull-back microwave ablation with two trajectories and four ablation zones

Complex microwave ablation in a renal cell carcinoma patient previously treated with a surgery.  Patient treated with left nephrectomy for renal cell carcinoma in 2004. In 2021 a biopsy confirmed a progressively growing local recurrence. Patient was referred to the interventional radiology department. First, an radiofrequency to reduce the size of the lesion was performed, followed four months later by a pull-back microwave ablation with two trajectories and four ablation zones to cover the entire tumour volume. An immediate re-ablation to ensure all residual mass has been destroyed completed the treatment.

First needle verification scan

Side by side comparison of pre ablation image on the left and post-ablation image on the right

Planning of re-ablation

Name: Dr. Levent Kara 

Institution: Stadtspital Zürich Triemli, Zürich (Switzerland)

Patient age and sex: 77 years, male

Initial condition:

• Patient was first diagnosed with a clear cell renal cell carcinoma pT1a cN0 cM0 on the left side in 2004
• Open surgery with complete left nephrectomy shortly afterwards
• Biopsy confirmed a progressively growing local recurrence in 2021
• In September 2021 the patient was referred to interventional radiology and treated with CAS-One IR guided RFA with the goal of the treatment to reduce the size of the lesion
• In January 2022 the entire lesion was treated with CAS-One IR guided MWA with a total of 5 (overlapping) ablation zones

Treatment: 

• Patient in prone position, intercostal, oblique access was chosen
• 2 trajectories, with a pulled back ablation for a total of 4 ablation zones was planned
• After the post-ablation scan, an additional ablation zone was planned to be absolutely sure to have no residual mass

Conclusion:

• CAS-One IR allowed planning of overlapping ablation zones to achieve an ablation volume big enough to cover the entire tumour volume with its atypical shape
• A suspicious looking potential underablated area was re-ablated immediately in the same session and full coverage of the tumour volume was achieved
• 3 month follow-up CT-scan showed slight decrease in volume of the lesion that is now in a liquid state 
• Patient remains under frequent surveillance 
• For this case microwave ablation showed to be significant more effective than RFA