Adrenal metastasis thermal ablation

Congress:

ECR 2018

Poster Number:

C-2411

Type:

Educational Exhibit

Keywords:

Abdomen, Interventional non-vascular, Oncology, Percutaneous, CT, Ablation procedures, Metastases, Neoplasia

Authors:

A. Rudel, J. HAVET, X. Carle, J. BAQUE, P. Chevallier; Nice/FR

DOI:

10.1594/ecr2018/C-2411

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2411

Fig. 1: 63-year old patient with a large right lobe HCC (blue arrow), treated first by...

Fig. 2: CT scanner showing a posterior approach, the patient being in prone position.

Fig. 3: CT scanner illustrating a posterior approach, the patient being in ipsilateral...

Fig. 4: Example of gut insulation prior to an adrenal RFA A/ Axial CT scanner showing...

Learning objectives

To know indications and clinical results of adrenal thermal ablation. To know the physiopathology and treatment of catecholamine release. To know protection modalities of surrounding organs.

Background

Adrenal glands are a frequent metastasis location of lung and kidney cancers. Historically patients were treated with a combination of radiotherapy and chemotherapy. Surgical resection and stereotactic ablative radiotherapy (SABR) had good long term outcomes but many patients are ineligible due to many comorbidities and/or oncological prognosis1-3. Recent studies evaluating percutaneous thermal ablation show similar local control and less adverse events compared to historical studies using surgery despite the lack of long-term follow up and randomized clinical trials. Thermal ablation has also been reported for...

Findings and procedure details

-Patient selection: All indications must be decided in dedicated multidisciplinary meeting. A thermal adrenal ablation is recommended for patient with solitary adrenal metastasis or oligo metastatic disease usually defined as the existence of one to five isolated macro metastases6. The diameter of the metastasis must not exceed 5 cm (Fig 1). -Cathecholamine release: The risk of catecholamine release is important during the procedure7and needs special care in order to avoid hypertensive injury. Two risk factors of hypertensive crisis have been described by Fintelman et al8...

Conclusion

Percutaneous thermal ablation is safe and accurate to treat adrenal metastasis especially if protection of surroundings organs and management of potential hypertensive crisis are known.

Personal information

References

1.Kim, S. H., Brennan, M. F., Russo, P., Burt, M. E. & Coit, D. G. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer 82, 389–394 (1998). 2.Tomasini, P. et al. Adrenal surgery for oligometastatic tumors improves survival in selected cases. J. Visc. Surg. 154, 87–91 (2017). 3.Gunjur, A., Duong, C., Ball, D. & Siva, S. Surgical and ablative therapies for the management of adrenal ‘oligometastases’ – A systematic review. Cancer Treat. Rev. 40, 838–846 (2014). 4.Abbas, A. et al. Image-guided...