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J Radiol 2009;90:1300-1359 © Éditions Françaises de Radiologie, Paris, 2009 édité parElsevier Masson SAS. Tous droits réservés bm.r-------d-im-a-n-c-h-e-1-s-0-c-t-o-b-r-e- Séances thématiques Séance organisée par la Deutsche Rontgen Gesellschaft DRG Responsables: Bruno Kastler, Philippe Pereira Durée: 20 minutes Durée: 20 minutes 16 h 50 Objectifs: To know advantages and drawbacks of MR and CT gui- dance for liver RFA. Know how to proceed for MR-guided RFA. Know the limitations of CT for monitoring. Messages à retenir: MR guided RFA allows safe needle placement, near on line monitoring and control of the RFA. CT evaluation irnmediately after RFA is not reliable specially for hypovascular liver tumors. Résumé: MR-guided RFA allow a safe, fast and exact placement of RF applicators by using MR-Fluoroscopy. Monitoring is possible with therrnosensiotive sequences as weil as Tl w-Images. Controlling is possible with DWI and standard sequences. CT imaging is limited for monitoring of RFA specially for liver metastases. Mots clés: Foie, tumeur - Radiofréquence, radiologie interven- tionnelle - IRM interventionnelle 17 h 10 IMAGE GUIDED RFA OF THE L1VER: CT MRI? PPereira (1), C Claussen (2) (1) Heilbronn - Allemagne, (2) Tübingen - Allemagne Correspondance: philippe.pereira@slk-kliniken,de Objectifs: To know the limit of tumor staging for RFA attempted as "curative" treatment. To know the limit oftumor staging for RFA attempted as "palliative" or "down staging" treatment. Messages à retenir: Up to 2 cm diameter RFA allows complete ablation of almost ail malignant liver tumors. Up to 5 cm diameter, on condition to use proper technology (ei: mul- tipolar), RFA is able to achieve local tumor control similar to partial liver resection. For intermediate tumor stages (T2-T3 in TNM) RFA has the right profile of an effective palliative or down staging treatment. Résumé: Up to 5 cm of tumor diameter, RFA has far from partial liver resection the higher feasibility and lower complication rates. Up to 2 cm almost ail tumors can be completely destroy by RFA even using routine monopolar technology. Therefore, for such very small tumor RFA should be regarded as first line therapeutic option. On condition to improve tissue destruction capacity of RFA (ei: multipo- lar mode), same results can be obtained in patient with medium size tumor. In patients with few tumors (= 3) even including large one (= 5 cm), RFA stills provide obvious antitumorous effect without significant increase of complications. RFA should be regarded con- sequently as an effective palliative option in patients with interme- diate stage of disease. Mots clés: Foie, tumeur - Radiofréquence, radiologie interven- tionnelle L1VER RFA: WHAT ARE THE L1MITS OF THE TREATMENT? o Seror Bondy - France Correspondance: olivier.seror@jvr,aphp,fr Durée: 20 minutes Modérateurs: Bruno Kastler, Philippe Pereira Objectifs pédagogiques Indications et limites de la radiofréquence hépatique. Intérêt du guidage IRM. Potentialités du cyberknife. L1VER RFA: WHAT ARE THE INDICATIONS AT PRESENT? C Aubé (1), J Lebigot (1), J Boursier (1), ELermite (1), P Pereira (2) (1) Angers - France, (2) Heilbronn - Allemagne Correspondance: chaube@chu-angers,fr Objectifs: To know the present indications of RF ablation in liver tumour. To know the possible evolutions of these indications. To understand the therapeutic schemes using RF ablation in liver. Messages à retenir: In hepatocellular carcinoma (HCC) RF Abla- tion is a curative treatment. In HCC RF ablation is an alternative to surgery. In metastasis RF ablation is a complement to surgery. RF ablation is an oncological treatment that must be decided in mul- tidisciplinary committees. Résumé: Radiofrequency ablation (RFA) is now a weil established treatment for liver tumours. In multidisciplinary cornmittees it must be choosed among the different oncological tools and used in a stan- dardised way. Two main indications can be individualised (hepato- cellular carcinoma and metastasis) corresponding to 2 different ways of using the RF tool.-Firstly in case of HCC: RFA is clearly conside- red as a curative treatment and takes place in substitution to surgical resection. This is currently a fact for small tumours, but following the technical evolution of the RF devices (especially multipolar techni- que) this could become true for larger tumours too. The different treat- ments (Chemoembolisation, chemotherapy, surgical treatment, transplantation) will be used in association or alternatively with the therapeutic scheme following the HCC evolution.-Secondly in case of metastasis: In this situation RFA could be an isolated treatment, but it is an exception. For the metastatic lesions surgery remains in most cases the reference and RFA should be used in association with surgery. The goal of this association is to make a carcinologic resec- tion (i. e. to be able to resect ail liver metastasis), when complete resection could not be possible using surgery alone. This leads to combined procedures; for the best in one time during the surgical intervention or in 2 times if we choose to proceed to per cutaneous RF treatment. In other hepatic tumours, like benign tumour or cho- langiocarcinoma, there is no standardised attitude and RFA is used in particular case always after a collegial decision during a multidisci- plinary committee. Mots clés: Foie, tumeur - Radiofréquence, radiologie interven- tionnelle RF ablation of the Liver: "state of the art" 16 h 30 1346

RF ablation of the Liver: “state of the art”

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Page 1: RF ablation of the Liver: “state of the art”

J Radiol 2009;90:1300-1359© Éditions Françaises de Radiologie, Paris, 2009

édité parElsevier Masson SAS. Tous droits réservés

bm.r-------d-im-a-n-c-h-e-1-s-0-c-t-o-b-r-e-

Séances thématiques

Séance organisée par la Deutsche Rontgen Gesellschaft DRG

Responsables: Bruno Kastler, Philippe Pereira

Durée: 20 minutes

Durée: 20 minutes

16 h 50

Objectifs: To know advantages and drawbacks of MR and CT gui­dance for liver RFA.Know how to proceed for MR-guided RFA.Know the limitations of CT for monitoring.Messages à retenir: MR guided RFA allows safe needle placement,near on line monitoring and control of the RFA.CT evaluation irnmediately after RFA is not reliable specially forhypovascular liver tumors.Résumé: MR-guided RFA allow a safe, fast and exact placement ofRF applicators by using MR-Fluoroscopy. Monitoring is possiblewith therrnosensiotive sequences as weil as Tlw-Images. Controllingis possible with DWI and standard sequences. CT imaging is limitedfor monitoring of RFA specially for liver metastases.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle - IRM interventionnelle

17 h 10

IMAGE GUIDED RFA OF THE L1VER: CT MRI?P Pereira (1), C Claussen (2)(1) Heilbronn - Allemagne, (2) Tübingen - AllemagneCorrespondance: philippe.pereira@slk-kliniken,de

Objectifs: To know the limit of tumor staging for RFA attempted as"curative" treatment.To know the limit oftumor staging for RFA attempted as "palliative"or "down staging" treatment.Messages à retenir: Up to 2 cm diameter RFA allows completeablation of almost ail malignant liver tumors.Up to 5 cm diameter, on condition to use proper technology (ei: mul­tipolar), RFA is able to achieve local tumor control similar to partialliver resection.For intermediate tumor stages (T2-T3 in TNM) RFA has the rightprofile of an effective palliative or down staging treatment.Résumé: Up to 5 cm of tumor diameter, RFA has far from partialliver resection the higher feasibility and lower complication rates. Upto 2 cm almost ail tumors can be completely destroy by RFA evenusing routine monopolar technology. Therefore, for such very smalltumor RFA should be regarded as first line therapeutic option. Oncondition to improve tissue destruction capacity of RFA (ei: multipo­lar mode), same results can be obtained in patient with medium sizetumor. In patients with few tumors (= 3) even including large one(= 5 cm), RFA stills provide obvious antitumorous effect withoutsignificant increase of complications. RFA should be regarded con­sequently as an effective palliative option in patients with interme­diate stage of disease.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle

L1VER RFA: WHAT ARE THE L1MITS OF THE TREATMENT?o SerorBondy - FranceCorrespondance: olivier.seror@jvr,aphp,fr

Durée: 20 minutes

Modérateurs: Bruno Kastler, Philippe Pereira

Objectifs pédagogiquesIndications et limites de la radiofréquence hépatique. Intérêt duguidage IRM. Potentialités du cyberknife.

L1VER RFA: WHAT ARE THE INDICATIONS AT PRESENT?C Aubé (1), J Lebigot (1), J Boursier (1), ELermite (1),P Pereira (2)(1) Angers - France, (2) Heilbronn - AllemagneCorrespondance: chaube@chu-angers,fr

Objectifs: To know the present indications of RF ablation in livertumour.To know the possible evolutions of these indications.To understand the therapeutic schemes using RF ablation in liver.Messages à retenir: In hepatocellular carcinoma (HCC) RF Abla­tion is a curative treatment.In HCC RF ablation is an alternative to surgery.In metastasis RF ablation is a complement to surgery.RF ablation is an oncological treatment that must be decided in mul­tidisciplinary committees.Résumé: Radiofrequency ablation (RFA) is now a weil establishedtreatment for liver tumours. In multidisciplinary cornmittees it mustbe choosed among the different oncological tools and used in a stan­dardised way. Two main indications can be individualised (hepato­cellular carcinoma and metastasis) corresponding to 2 different waysof using the RF tool.-Firstly in case of HCC: RFA is clearly conside­red as a curative treatment and takes place in substitution to surgicalresection. This is currently a fact for small tumours, but following thetechnical evolution of the RF devices (especially multipolar techni­que) this could become true for larger tumours too. The different treat­ments (Chemoembolisation, chemotherapy, surgical treatment,transplantation) will be used in association or alternatively with thetherapeutic scheme following the HCC evolution.-Secondly in caseof metastasis: In this situation RFA could be an isolated treatment,but it is an exception. For the metastatic lesions surgery remains inmost cases the reference and RFA should be used in association withsurgery. The goal of this association is to make a carcinologic resec­tion (i. e. to be able to resect ail liver metastasis), when completeresection could not be possible using surgery alone. This leads tocombined procedures; for the best in one time during the surgicalintervention or in 2 times if we choose to proceed to per cutaneousRF treatment. In other hepatic tumours, like benign tumour or cho­langiocarcinoma, there is no standardised attitude and RFA is used inparticular case always after a collegial decision during a multidisci­plinary committee.

Mots clés: Foie, tumeur - Radiofréquence, radiologie interven­tionnelle

RF ablation of the Liver: "state of the art"

16 h 30

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