title: Microwave ablation of liver malignancies: comparison of effects and early outcomes of percutaneous and intraoperative approaches with different liver conditions : New advances in interventional oncology: state of the art.
abstract: Liver thermal ablation is an alternative treatment for hepatocellular carcinoma (HCC) and secondary liver malignancies. Microwave ablation (MWA) produces large ablation zones (AZ) in short time; however, AZ prediction is based on preclinical ex vivo models, rising concerns about reproducibility and safety in humans. We aimed to investigate the effects produced by a new-generation MWA system on human liver in vivo with different approaches (percutaneous or intraoperative) and liver conditions (cirrhosis or previous chemotherapy treatment), in comparison with manufacturer-provided predictions based on ex vivo animal models. Complete tumor ablation (CA) and early clinical outcomes were also assessed. From October 2014, 60 consecutive patients (cirrhotic = 31; non-cirrhotic = 10; chemotherapy-treated = 19) with 81 liver nodules (HCC = 31; mets = 50) underwent MWA procedures (percutaneous = 30; laparotomic = 18; laparoscopic = 12), with a 2450 MHz/100 W generator with Thermosphere™ Technology (Emprint™, Medtronic). A contrast-enhanced CT or MR was performed after one month to assess CA and measure AZ. A linear correlation between AZ volumes and ablation times was observed in vivo, without differences from manufacturer-provided ex vivo predictions in all operative approaches and liver conditions. Other independent variables (sex, age, nodule location) showed no relationship when added to the model. Median (IQR) longitudinal and transverse roundness-indexes of the AZs were, respectively, 0.77(0.13) and 0.93(0.11). CA at 1 month was 93% for percutaneous and 100% for intraoperative procedures (p = 0.175). Thirty-day morbidity and mortality were 3% and 0%. MWA with Thermosphere™ Technology produces predictable AZs on human liver in vivo, according to manufacturer-provided ex vivo predictions. In our experience, this new-generation MWA system is effective and safe to treat liver malignancies in different operative and clinical settings.
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Cobelli
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. marra.paolo@hsr.it.|Vita-Salute San Raffaele University, Milan, Italy. marra.paolo@hsr.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marra
authors.affiliation: Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ambrosi
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Colombo
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Damascelli
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Sallemi
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Gusmini
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Salvioni
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Diana
authors.affiliation: Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.affiliation: Department of Surgery, Hepato-biliary Surgery Unit, San Raffaele Scientific Institute, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
authors.affiliation: Department of Radiology and Experimental Imaging Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.|Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Maschio
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008872:Microwaves / Q000627:therapeutic use*
keywords: Ablation zone (AZ); Colorectal cancer (CRC); Complete ablation (CA); Hepatocellular carcinoma (HCC); Liver metastases; Microwave ablation (MWA)