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
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 the treatment of benign or malignant primary adrenal neoplasm4.
Prognostics factors:
Hasegawa et al5 have described four significant poor prognosis factors in their study:
- Male sex
- Age > 65 years
- Existence of extra-adrenal tumor
- Metastasis from non small cell lung cancer.
3 thermal technics are described in the literature:
-Cryotherapy: It causes tissue death by cell freezing which lead to protein denaturation,
cell membrane rupture and ischemia.
Treatment required 2 freezing of ten minutes with thaw of 10 minutes between the two freezing.
It’s seems to be a promising technic for this localization.
-Radiofrequency: It is the most described technic in the literature,
using alternative current to induce localized heat and tissue necrosis.
Different devices are available,
and we preferentially use expandable electrode with co-axial system in our practice.
-Micro waves: It corresponds to an electromagnetic energy which agitates water molecules,
creating frictional heat and finally death cell.
Advantages are a larger ablation area and quicker procedure time due to faster and higher heat increase.