"The cost of an ablation is a fourth of the cost of a resection. So with five patients converted from surgery to ablation, the system has paid for itself"

Prof. Dr. Jacob Freedman, Senior Consultant Surgery, Danderyds University Hospital, Karolinska Institutet, Stockholm, Sweden

CAS-One IR users from the very start - The team of Prof. Dr. Freedman and Dr. Marie Beermann in Stockholm treated its 1000th patient with Quality Ablation in March 2021.

In this interview they elaborate on the clinical and economic benefits of CT-guided percutaneous ablations with CAS-One IR and shares some valuable learnings and insights of the interventional team at Danderyds Sjukhus in Stockholm, Sweden.


Dr. Marie Beermann (Senior Consultant Radiology) and Prof. Dr. Jacob Freedman (Senior Consultant Surgery)

Congratulations on doing 1000 cases with CAS-One IR – what have been the most common use case scenarios. And can you share any memorable moments with us?
The most common case is an HCC (60%) with portal hypertension and with a tumour not larger than 30mm in diameter. The rarest would be some more uncommon indications for patients with an unusual disease progression: Metastases from stomach, pancreas, wilms, lymfoma, PEComa, thymus that are not usually treated surgically and also ablation of other organs such as the spleen and adrenal gland. Most memorable is a young patient that was multimodally treated for many years for an aggressive adrenocortical tumour with metastases to the lungs and liver, we did 15 treatments on him over five years until loss of control.

What made you interested in Quality Ablation to start with?

We had an ablation site recurrence rate of around 30% with ultrasound guided perioperative ablations, mostly open. We were not happy with that. Precision in needle guidance and also the performance of our ablation device (RFA) needed upgrading to optimize the treatment, otherwise we saw no chance for the development of ablation as a curative treatment of cancer.

Did the usage of the system change over time? What are your most valuable learnings?
We were very early users and as such have had a perfect collaboration with CASCINATION, who have always listened to our ideas on how to improve the system. Many of the functions of the system have an origin here in Stockholm.

What are the biggest clinical advantages of CAS-One IR?
The system makes virtually all lesions visible and treatable. Probably half of them would be very hard to treat with traditional ultrasound guidance. Moreover the frequent use of angulated trajectories is very difficult with a traditional CT-guided technique. So we can treat many more patients, with higher precision, with a greater choice of trajectories, getting almost perfect patterns when using multiple needles for IRE, and with a very steep learning curve for new colleagues.

What indication / type of case do you think benefits the most from the use of CAS-One IR?
All ablation cases that are not really visible with ultrasound. It is still cheaper and a little bit (but not by much) quicker to use ultrasound, in our case always fused with MRI or CT images. Finally, unlike many ultrasound guided ablations, you do not need to be a radiologist to use CAS-One, this has been important for our success as many physicians in our hospital are capable of using the system to perform ablations and we can keep up production consistently. Surgery and Radiology working together is critical.

What are the biggest economic advantages of CAS-One IR?
The cost of an ablation is a fourth of the cost of a resection. So with five patients converted from surgery to ablation, the system has paid for itself!

Stockholm Interventional TeamThe Interventional Team at Danderyds Sjukhus treating the 1000th patient with CAS-One IR.

Quality Ablation Blog

Visit the Quality Ablation Blog and see an IRE of a lesion close to the portal vein followed by three microwave ablations all in one Session performed by Dr. Jacob Freedman and his team in Stockholm. The complete procedure took 98 minutes only.


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