MRI-guided microwave ablation of hepatic malignancies: 4-year institutional outcomes
Daniel Markus Düx, Marcel Gutberlet, Julian Glandorf, Simon Schröer, Kristina Imeen Ringe, Frank Wacker, Bennet Hensen, Lena BeckerPurpose
We assessed the safety and efficacy of magnetic resonance (MR)-guided microwave ablation for treating hepatic malignancies.
Methods
This retrospective single-center review evaluated patients who underwent MR-guided microwave ablation for hepatic malignancies between 02/15/2017–04/22/2020. Complications were classified following CIRSE guidelines. Local tumor progression (LTP), local tumor recurrence (LTR), non-target progression (NTP), progression-free survival (PFS) and time to progression (TTP) were assessed, with data presented as mean ± standard deviation.
Results
Sixteen patients (60.75 ± 14.4 years; 9 males, 7 females) underwent 17 MR-guided microwave ablation for 21 hepatic malignancies (17 (81.0%) hepatocellular carcinoma, 1 (4.8%) cholangiocarcinoma, 2 (9.5%) metastases, and 1 (4.8%) suspicious lesion in a patient with primary sclerosing cholangitis). Lesion size was 12.2 ± 4.8 mm and total procedure time 138 ± 53 minutes. Complications included fever (N = 2), abdominal pain (N = 2), biloma (N = 1), and reactive cholecystitis (N = 1). These resolved with pain medication for one patient and antibiotics for another. No tumor recurrence was observed at ablation sites (LTP and LTR = 0%) at 36.7 ± 28.2 months. NTP occurred in 11 patients (68.8%) with a TTP of 14.8 ± 11.4 months. PFS was 44 months (95% CI: 10–85 months). Three patients died during follow-up — one from complications after liver transplantation and two from disease progression. Post-ablation liver transplantation was performed in two patients.
Conclusion
MR-guided microwave ablation for hepatic malignancies is safe and effective, with no local tumor recurrences noted over a follow-up period of 36.7 ± 28.2 months.
Clinical significance
MR-guided microwave ablation is a promising minimally invasive treatment for hepatic malignancies, demonstrating no LTR at 36.7 ± 28.2 months. Precise, radiation-free needle placement in real-time and effective targeting of small tumors may further improve future patient care.