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In the realm of interventional radiology (IR), technological advancements and innovation are continuously reshaping the landscape of patient care. This has become more evident in recent years in the field of ablation, which has long been a staple for a range of oncologic and interventional treatments. As technology continues to evolve, however, so too does the need to refresh the ablation space to keep pace with innovation and patient-specific needs.
Microwave ablation (MWA) has emerged as an effective treatment modality for hepatocellular carcinoma (HCC) and metastatic liver cancer (mCRC), and as a promising alternative to surgery for in selected patients. However, as MWA assumes a more prominent role in treating primary and metastatic liver cancers, there is a concurrent need for an update in technologies that reflect the advancements that have been made in improving procedural predictability and outcomes.
Imaging and therapeutic advancement
One of the key areas driving the need for advancements is the significant progress in therapeutic and imaging technologies. These advancements have enabled medical professionals to target and treat abnormal tissue with improved accuracy, minimising damage to surrounding healthy tissue and improving patient outcomes.
With the current technologies, physicians can face challenges ablating large tumours that require the use of more than one probe. This can result in overlapping ablation zones, creating procedural complexity, as well as necessitating extensive planning to ensure the best positioning of probes to treat the patient with confidence. The ability to consistently predict and plan what is needed for individual patients is essential. When planning, parameters that need to be considered can include temperature, power, or number of probes, which are all necessary factors to gain a real-time, accurate understanding of the ablation zone.
To meet expectations of interventionalists today, ablative technologies should incorporate continuous registration capabilities throughout the procedure to ensure precise localisation of the patient’s anatomy. As physicians ablate, the initial target may become obscured, making accurate targeting difficult. With current tools that cannot always guarantee repeatability, interventionalists must have extensive experience to achieve consistent accuracy.
The ongoing Ablation with Confirmation of Colorectal Liver Metastases (ACCLAIM) prospective trial for MWA as definitive local tumour control (local cure), seeks to confirm the importance of ablative technologies, and the potential of MWA to treat metastases that can be ablated with sufficient margins. Led by Constantinos T Sofocleous (Memorial Sloan Kettering Cancer Center, New York, USA) et al, the researchers hypothesise that MWA of colorectal liver metastases (CLMs) of ≤2.5cm with confirmation of an ablation margin over 5mm, will achieve definitive local tumour control (local cure) with minimal morbidity. Currently, this international study is enrolling subjects with one to three CLMs using any United States Food and Drug Administration (FDA)-cleared or CE-marked MWA device. The procedure will be performed with the intent to create a minimum margin of ablation of 5mm, ideally ≥10mm from the edge of the target tumour to the ablation periphery. Minimum margin size will then be assessed immediately after MWA using an FDA cleared image-processing software to provide a three-dimensional (3D) assessment of the ablation zone and margin.
“If someone is doing liver tumour ablation, they should be doing margin confirmation in some way, shape or form, 100% of the time, to ensure good clinical outcomes. Newer technologies will make it better for physicians not doing it every day to achieve this,” said William Rilling (Medical College of Wisconsin, Milwaukee, USA) and ACCLAIM investigator during a recent interview featured on VISion—Varian’s blog about breakthroughs, resources, and expert insights for IR professionals.
The ACCLAIM trial seeks to affirm the importance of margin confirmation and pre and postprocedural imaging, driving a much-needed update in technologies that are utilised for MWA. Co-sponsored by Varian, the trial reflects Varian’s commitment to advancing procedural efficiency to support interventional radiologists in the future.
New groundbreaking technology
At the recent Society of Interventional Radiology (SIR) annual meeting (23–28 March, Salt Lake City, USA), Varian announced its newest ablation technology. The IntelliBlate MWA system* by Varian, a Siemens Healthineers company, combines microwave technology with advanced imaging capabilities.
Aiming to meet elevated levels of performance required to achieve optimal patient outcomes, IntelliBlate MWA system allows clinicians to tailor treatment plans to each patient’s unique anatomy and pathology. With its real-time monitoring and feedback capabilities, the system provides visual and audible cues to streamline setup and interaction for the clinician.
“This is a tangible result of our synergy and collaboration with Siemens Healthineers— IntelliBlate [is] the cornerstone of a future-focused integrated imaging and treatment ecosystem from a single provider,” said Frank Facchini, president of Varian Interventional Solutions during the unveiling of the system.
The system also includes the Ximitry* probe, which is comprised of a laser alignment disc, LED status indicator, fixed burn centre with symmetrical ablation zone growth pattern, and intuitive temperature sensors. Varian believes that a single Ximitry probe can be used for large ablation zones, sparing healthy tissue and providing consistent control across diverse tissue types, leading to optimal treatment outcomes while minimising the risk of complications.
The IntelliBlate system also integrates with the myAblation Guide* software and is further complemented by the myNeedle Companion workflow, which is available on select Siemens Healthineers imaging systems. This enables healthcare providers who use a range of systems to seamlessly transition their ablation practice to align with the most recent innovations.
Next-generation microwave ablation
The need to advance the ablation space is apparent. Due to the rapid advancements in both therapy and imaging technologies, interventionalists and innovators alike strive to provide patients with the best possible care. The IntelliBlate MWA system has the potential to reshape the landscape of ablation therapy and to provide better procedural control for physicians.
“Our dedication to understanding the performance of our new microwave ablation system goes beyond conventional preclinical research. We have invested significantly in gathering comprehensive data across various tissue types, including perfused tissues. This extensive preclinical testing has provided robust insights that we believe truly distinguish our next-generation microwave system,” says Theresa Caridi, director of medical affairs at Varian Interventional Solutions.
In summary, with the latest addition to Varian’s arsenal of tools soon to be available, innovative solutions aimed at improving predictability and planning when providing ablative therapies are on the horizon. Among the evolving technologies, the IntelliBlate MWA system is noteworthy for its potential to influence the direction of ablation therapy, with the goal of pursuing improved outcomes in this patient population.
References:
- Han Y, Zhao W, Wu M, Qian Y. Efficacy and safety of single- and multiple-antenna microwave ablation for the treatment of hepatocellular carcinoma and liver metastases: A systematic review and network meta-analysis. Medicine (Baltimore). 2022 Dec 23;101(51):e32304. doi: 10.1097/ MD.0000000000032304. PMID: 36595779; PMCID: PMC9794220.
- Dou Z, Lu F, Ren L, Song X, Li B, Li X. Efficacy and safety of microwave ablation and radiofrequency ablation in the treatment of hepatocellular carcinoma: A systematic review and meta-analysis. Medicine (Baltimore). 2022 Jul 29;101(30):e29321. doi: 10.1097/MD.0000000000029321. PMID: 35905207; PMCID: PMC9333547.
- Tang Y, Zhong H, Wang Y, Wu J, Zheng J. Efficacy of microwave ablation versus radiofrequency ablation in the treatment of colorectal liver metastases: A systematic review and meta-analysis. Clin Res Hepatol Gastroenterol. 2023 Aug;47(7):102182. doi: 10.1016/j.clinre.2023.102182. Epub 2023 Jul 20. PMID: 37479137.
- Benson AB, D’Angelica MI, Abbott DE, et al. Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(5):541-565. Published 2021 May 1. doi:10.6004/ jnccn.2021.0022
*The IntelliBlate microwave ablation system and the myAblation Guide software are pending 510(k) clearance and are not yet commercially available in the USA or any other markets. ©2024 Varian Medical Systems, Inc. VARIAN, XIMITRY and INTELLIBLATE are trademarks of Varian Medical Systems, Inc., pending or registered U.S. Pat. & Tm. Off. The following trademarks of Siemens Healthineers are registered or pending with U.S. Patent and Trademark Office: SIEMENS HEALTHINEERS, MYNEEDLE COMPANION, and MYABLATION GUIDE.
