19. Δλδείμεηο RFA ήπαηνο
Μηθξά HCC ή κε εμαηξέζηκνη όγθνη
(HCC – Barcelona Clinic Liver Cancer
classification - patients not candidates
for liver resection or transplantation /
tumour smaller or as many as three
nodules <3 cm each / no vascular invasion
or extrahepatic spread / performance
status test of 0 / liver cirrhosis in Child-
Pugh class A or B, colon metastases)
Πνιπεζηηαθή λόζνο (≤5 εζηίεο)
Ηπαηηθή αλεπάξθεηα
Γεηηλίαζε λενπιάζκαηνο
κε κείδνλα ελδνεπαηηθά αγγεία
(leading to margin-positive resection)
Β. Δ. Σουφτάς > Ablation
20. Δλδείμεηο RFA, επίζεο…
Μεηαζηάζεηο από κε – νξζνθνιηθά θαξθηλώκαηα
(breast, adrenocortical cancer, neuroendocrine, carcinoid tumors)
Νενπιάζκαηα ζε δύζθνιεο αλαηνκηθέο εληνπίζεηο
(subcapsular, perivascular, in the hilum of the liver)
Μεγάινη όγθνη
(multiple procedures with overlapping hyperthermic zones
may produce satisfactory results)
Ρήμε HCC
(hemostatic effect)
Β. Δ. Σουφτάς > Ablation
21. Tu ζε απόζηαζε <1 cm από ηνλ θνηλό επαηηθό πόξν (θίλδπλνο
ζηέλσζεο ηνπ πόξνπ)
Γηάηαζε ελδνεπαηηθώλ ρνιεθόξσλ
Πξόζζηα εμσθπόκελε εληόπηζε
(θίλδπλνο εκθπηεύζεσλ)
Υνινπεπηηθή αλαζηόκσζε
Αζεξάπεπηε / αλέιεγθηε δηαηαξαρή πεθηηθόηεηαο
Αληελδείμεηο RFA
L. Crocetti et al.:
Guidelines for RFA
of Liver Tumours,
Cardiovasc Intervent
Radiol (2010) 33:11–17
Β. Δ. Σουφτάς > Ablation
30. US
Lesion recognition / targeting / guidance
Ablation procedure itself monitorship
(Transient Hyperechoic Zone (30–90 min) of increased echogenicity
within and surrounding a tumour , during / immediately after RFA)
Microbubble contrast-enhanced wide-band harmonic gray-scale US
reveal blood flow in residual tumors with an accuracy comparable
to that of helical CT
Β. Δ. Σουφτάς > Ablation
42. Απνηειεζκαηηθόηεηα
HCC:
complete ablation rate on imaging of approximately 90% in tumours <3 cm
complete tumour necrosis on pathology in 83% of tumours <3 cm and
88% of tumours located in a nonperivascular space
Colorectal Cancer Liver Metastases:
complete response do not exceed 60–70%
eradication of 91% - 97% of metastases
L. Crocetti et al.: Guidelines for RFA of Liver Tumours, Cardiovasc Intervent Radiol (2010) 33:11–17
Β. Δ. Σουφτάς > Ablation
43. Studies reporting long-term survival outcomes of patients
with early-stage HCC who underwent percutaneous RFA
L. Crocetti et al.: Guidelines for RFA of Liver Tumours, Cardiovasc Intervent Radiol (2010) 33:11–17
Β. Δ. Σουφτάς > Ablation
44. Studies reporting long-term survival outcomes of patients
with colorectal hepatic metastases who underwent percutaneous RFA
L. Crocetti et al.: Guidelines for RFA of Liver Tumours, Cardiovasc Intervent Radiol (2010) 33:11–17
Β. Δ. Σουφτάς > Ablation
45. Reported and acceptable rate of major complications
L. Crocetti et al.: Guidelines for RFA of Liver Tumours, Cardiovasc Intervent Radiol (2010) 33:11–17
Β. Δ. Σουφτάς > Ablation
47. Interfaces similar to video games
Image fusion-guided procedures
Medical global positioning system technology: optical tracking
Electromagnetic tracking
Rotational angiography-based tools
Mechanical laser pointers and needle stabilization devices
πζηήκαηα πινήγεζεο γηα ablation
Β. Δ. Σουφτάς > Ablation
48. 127 lesions, General anaesthesia
2.5 mm CE-helical CT scan
Tumor size 1-11 cm (median 3.1 cm)
Planed pathways
Navigation system (Medtronic, USA)
1-20 probes advanced through
aiming device
CIRSE 2007, Session:Tumour ablation
3D-navigated computer assisted RFA
of primary and secondary liver tumours
Predefined depth
RFA devices: unipolar Cooltip (Tyco)
or multipolar Celon (Olympus)
Follow-up CE-CTs every 3 months
(mean follow-up 9 months)
Recurrences in 11 of 127 (8.7%)
lesions
2 lesions successfully re-ablated
R. Bale, M. Haidu, P. Kovacs, R. Stoffner, H. Weiss, I. Graziadei, W. Jaschke; Innsbruck/AT
Β. Δ. Σουφτάς > Ablation
52. Microwave tumor ablation
Tissue heating through
ohmic dissipation (Joule effect)
and ionic agitation
The oscillations of atomic dipoles,
striving to catchup with the
continuously switching electric field,
generates frictional heat
Β. Δ. Σουφτάς > Ablation