Combined Trans-arterial Embolization and Microwave Ablation for the Treatment of >3 cm Liver Metastases

Background: Evaluate efficacy and safety of a combined therapy for liver metastases treatment >3 cm, using a two-step single session combined approach of transarterial embolization (TAE) followed by percutaneous microwave ablation (MWA) for curative intent. Method(s): Between January 2015 and December 2017, 24 technically unresectable liver metastases >3 cm were selected for the combined treatment. The percentile variation in ablated tissue volume with respect to a stand-alone thermal coagulation therapy (δv) was calculated. The final ablation volume (VE-T) was compared with the initial nodule volume (VN) and the expected ablation volume of stand-alone MWA (VT). Technical success was defined as complete target devascularization at the immediate post-procedural CT. One, 3, 6 and 12 months post-procedure follow-up was performed and major and minor complications were reported. Result(s): Tumor dimension ranged from 32 to 73 mm. Full technical success was achieved in all treated tumors. The final ablation volumes were in the range 50-450 cm3 with short-axis diameter of the ablation zone ranged between 12 and 48 mm. The mean δv increment in final ablation volume with respect to stand-alone MWA was 196% (range: 25 cm3 – 210 cm3) (p<0.05). The VE-t mean was 4 times the VN mean, while the VT mean was about twice the VN mean. No recurrence and only one major complication were observed. Conclusion(s): Our results provide preliminary evidence of efficacy, obtaining a larger necrotic area, and safety, for the low complication rate, of a combined two-step single-session TAE-MWA treatment of unresectable hepatic metastasis >3 cm.

Publication History

Article published online:
11 May 2021