Single-Session Bland Embolisation Followed by Microwave Ablation for Hepatocellular Carcinoma: Chasing Anatomic Resectio
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LETTER TO THE EDITOR
INTERVENTIONAL ONCOLOGY
Single-Session Bland Embolisation Followed by Microwave Ablation for Hepatocellular Carcinoma: Chasing Anatomic Resection Nicolo` Gennaro1,2 • Dario Poretti1 • Giuseppe Ferrillo1,2 • Paolo Della Vigna3 Franco Orsi3 • Guido Bonomo3 • Guido Torzilli2,4 • Vittorio Pedicini1
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Received: 13 October 2020 / Accepted: 21 October 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
To the Editor, Although thermal ablation is usually performed as single-therapy, arterial embolisation has been combined with thermal ablation in selected cases of hepatic tumours to increase the chance of local control. We report on the rationale of performing single-session bland arterial embolisation with microspheres followed by microwave ablation (MWA) in two patients diagnosed with hepatocellular carcinoma (HCC). Patient 1 was a 58-year-old man with HCV infection and a residual HCC who had been treated with MW ablation four months earlier. The residual HCC was located in segment VIII and measured 3.2 cm (Fig. 1A). Patient 2 was a 63-year-old man with chronic hepatitis due to hemochromatosis and a single HCC in segment IVa (3.5 cm in the longest diameter). Both tumours were located within 5 mm of the Glisson capsule. Liver function (Child–Pugh-A) and performance status (ECOG-0) were preserved in both patients. Treatment indications were given after multidisciplinary discussion in the effort to improve local tumour control considering the rapid lesion
& Nicolo` Gennaro [email protected] 1
Department of Radiology, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
2
Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele (Milan), Italy
3
Interventional Radiology Unit, Istituto Europeo Di Oncologia IEO, IRCCS, Milan, Italy
4
Liver Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano (Milan), Italy
growth and the sub-diaphragmatic location hampering wide ablation margins. In both patients, sub-segmental trans-arterial bland embolisation (TAE) of the tumour feeding arteries was performed after 4F-femoral access using 1.8 Fr micro-catheter, 0.01600 -180 cm guide and 40 lm microspheres (Embozene; Merit Medical Systems, South Jordan, UT, USA) (Fig. 1B) with no chemotherapy drugs, as the aim of the embolisation was exclusively to cause an ischaemic effect in the tumour-bearing liver segment. Cone-beam CT scan was acquired to confirm the extent of the embolisation (Fig. 1C). A 15 cm-MW antenna (Emprint Ablation System, Medtronic, Minneapolis, Minnesota, USA) was then deployed under USand fluoroscopy-guidance (1d). Ablation was performed at low power (70 W) for 9 min, including 1 min of track ablation. The total duration of the procedure was 90 and 115 min, respectively. The technical success in both cases was confirmed by the absence of enhancing tumour areas at postoperative 24 h contrast-enhanced CT (F
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