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Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review

SIMPLE SUMMARY: Thermal ablation is a minimally invasive, potentially curative approach for the treatment of primary and secondary liver tumors. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Both methods induce an ir...

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Autores principales: Laimer, Gregor, Schullian, Peter, Bale, Reto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301079/
https://www.ncbi.nlm.nih.gov/pubmed/34356499
http://dx.doi.org/10.3390/biology10070644
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author Laimer, Gregor
Schullian, Peter
Bale, Reto
author_facet Laimer, Gregor
Schullian, Peter
Bale, Reto
author_sort Laimer, Gregor
collection PubMed
description SIMPLE SUMMARY: Thermal ablation is a minimally invasive, potentially curative approach for the treatment of primary and secondary liver tumors. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Both methods induce an irreverible destruction of the tumor tissue by applying thermal energy. Conventionally, a single ablation probe is placed using ultrasound (US) or computed tomography (CT). Using these standard guidance techniques the creation of necrosis zones to treat large tumors (i.e., >2–3 cm) is hampered by technical limitations. These limitations can be overcome by stereotactic thermal ablation: a multiple needle approach with 3D treatment planning and precise stereotactic needle placement combined with immediate verification of treatment success by means of image fusion. The stereotactic multi-needle technique allows for local curative treatment of multiple and large tumors within a single session. Ultimately, due to the application of these sophisticated tools and advanced techniques, a local curative treatment option can be offered to a higher number of patients suffering of primary and secondary liver tumors. This article provides an overview of the current stereotactic techniques for thermal ablation and summarizes the available clinical evidence for this approach. ABSTRACT: Thermal ablation is an emerging, potentially curative approach in treating primary and metastatic liver cancer. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Regardless of the technique, destruction of the entire tumor, including an adequate safety margin, is key. In conventional single-probe US- or CT-guided thermal ablation, the creation of such large necrosis zones is often hampered by technical limitations, especially for large tumors (i.e., >2–3 cm). These limitations have been overcome by stereotactic RFA (SRFA): a multiple needle approach with 3D treatment planning and precise stereotactic needle placement combined with intraprocedural image fusion of pre- and post-interventional CT scans for verification of treatment success. With these sophisticated tools and advanced techniques, the spectrum of locally curable liver malignancies can be dramatically increased. Thus, we strongly believe that stereotactic thermal ablation can become a cornerstone in the treatment of liver malignancies, as it offers all the benefits of a minimally invasive method while providing oncological outcomes comparable to surgery. This article provides an overview of current stereotactic techniques for thermal ablation, summarizes the available clinical evidence for this approach, and discusses its advantages.
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spelling pubmed-83010792021-07-24 Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review Laimer, Gregor Schullian, Peter Bale, Reto Biology (Basel) Review SIMPLE SUMMARY: Thermal ablation is a minimally invasive, potentially curative approach for the treatment of primary and secondary liver tumors. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Both methods induce an irreverible destruction of the tumor tissue by applying thermal energy. Conventionally, a single ablation probe is placed using ultrasound (US) or computed tomography (CT). Using these standard guidance techniques the creation of necrosis zones to treat large tumors (i.e., >2–3 cm) is hampered by technical limitations. These limitations can be overcome by stereotactic thermal ablation: a multiple needle approach with 3D treatment planning and precise stereotactic needle placement combined with immediate verification of treatment success by means of image fusion. The stereotactic multi-needle technique allows for local curative treatment of multiple and large tumors within a single session. Ultimately, due to the application of these sophisticated tools and advanced techniques, a local curative treatment option can be offered to a higher number of patients suffering of primary and secondary liver tumors. This article provides an overview of the current stereotactic techniques for thermal ablation and summarizes the available clinical evidence for this approach. ABSTRACT: Thermal ablation is an emerging, potentially curative approach in treating primary and metastatic liver cancer. Different technologies are available, with radiofrequency ablation (RFA) and microwave ablation (MWA) being the most widely used. Regardless of the technique, destruction of the entire tumor, including an adequate safety margin, is key. In conventional single-probe US- or CT-guided thermal ablation, the creation of such large necrosis zones is often hampered by technical limitations, especially for large tumors (i.e., >2–3 cm). These limitations have been overcome by stereotactic RFA (SRFA): a multiple needle approach with 3D treatment planning and precise stereotactic needle placement combined with intraprocedural image fusion of pre- and post-interventional CT scans for verification of treatment success. With these sophisticated tools and advanced techniques, the spectrum of locally curable liver malignancies can be dramatically increased. Thus, we strongly believe that stereotactic thermal ablation can become a cornerstone in the treatment of liver malignancies, as it offers all the benefits of a minimally invasive method while providing oncological outcomes comparable to surgery. This article provides an overview of current stereotactic techniques for thermal ablation, summarizes the available clinical evidence for this approach, and discusses its advantages. MDPI 2021-07-10 /pmc/articles/PMC8301079/ /pubmed/34356499 http://dx.doi.org/10.3390/biology10070644 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Laimer, Gregor
Schullian, Peter
Bale, Reto
Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title_full Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title_fullStr Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title_full_unstemmed Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title_short Stereotactic Thermal Ablation of Liver Tumors: 3D Planning, Multiple Needle Approach, and Intraprocedural Image Fusion Are the Key to Success—A Narrative Review
title_sort stereotactic thermal ablation of liver tumors: 3d planning, multiple needle approach, and intraprocedural image fusion are the key to success—a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301079/
https://www.ncbi.nlm.nih.gov/pubmed/34356499
http://dx.doi.org/10.3390/biology10070644
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