Quality Ablation: Treating challenging lesions with increased accuracy and speed using a planning, navigation, and margin confirmation system

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This advertorial is sponsored by CASCINATION AG.

Ablation is used to destroy or shrink tumours in the liver, lung, kidney, bone, and other organs. In recent decades, image-guided ablation has become integral to modern cancer therapy with curative or palliative intent. Although a promising treatment option, the main challenge is the accurate and safe positioning of the ablation probes to achieve complete tumour coverage, especially in difficult-to-access localisations. The CAS-One® IR system (CASCINATION AG) and its AblaSure® margin assessment software aim to improve the reproducibility, reliability and accuracy of ablation procedures for liver, lung, pancreas, kidney and bone. It enables more patients, and those whose cases are more challenging, to be treated, and to reduce rates of recurrence and procedural complications.

Quality Ablation with the CAS-One IR System

Martin Hoffmann (St Claraspital, Basel, Switzerland) and Shaheen Noorani (Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK) have experience using CAS-One IR with AblaSure to ablate advanced tumours where single or multiple electrodes are required to treat the tumour adequately. They believe that lesions can be targeted more accurately using the navigation system compared to the traditional manual ablation. Hoffmann and Noorani spoke to Interventional News about their experiences using CAS-One IR with AblaSure and contextualise these in the broader landscape of ablation, as well as detailing how, and for which patients, the CASCINATION offering yields advantageous ablation results.

Hoffmann begins by stipulating that he has around five years’ experience with CAS-One IR, which contrasts with Noorani’s more recent incorporation of it into her practice. Hoffmann recalls being asked, when he started in his current hospital, whether he could find some way of treating large kidney- and liver-dominant tumour masses? This stemmed from the fact that, as Hoffmann elaborates, “we would see patients [who could not be treated systemically] declined from our surgical services.” So, CAS-One IR provides a solution for treating these “more challenging lesions in challenging locations” as Noorani puts it, illustrating that the pair share motivations for using the technology. Both Hoffmann and Noorani spoke of the advantage of achieving standardised ablation that is consistent from one patient to the next, and also from one interventional radiologist (IR) to the next.

Martin Hoffmann

Asked about the challenges involved in using conventional ultrasound or computed tomography (CT) freehand ablation, Hoffmann reframes his response from the outset: “it is not so much a limitation of CT or ultrasound,” but the ablation modalities. He then explains that “one of the prerequisites of [using NanoKnife electrodes] is that they must be arranged parallel around the tumour,” which is very challenging manually. The CASCINATION system also has the advantage of allowing the use of “an un-bordered array of microwave antennae” that work in tandem “to cover a large tumour volume, [ablating] section by section” in many different positions during the same procedure. Similarly, Noorani points to the issue of having “[to eyeball] the targeted ablation zone and needle position” when carrying the procedure out manually, which means that the “technical ability” of the IR is a “huge factor” in dictating how successful the outcome is. Furthermore, IRs encounter the issue of not being able to see the “invisible lesions” on CT that do show up on magnetic resonance imaging (MRI) scans—ablation of those lesions freehand is, consequently, impossible. Yet, Noorani clarifies that CAS-One IR resolves this problem, “[fusing] the MRI scans to the CT images.”

Shaheen Noorani

While CAS-One IR is versatile and usable with all ablation modalities and suitable for liver, kidney, lung, bone and other organs, it is AblaSure that adds value for patients, Noorani then shared, as being able to do margin assessment alongside the ablation means “we can re-treat on the same day, rather than bringing the patient back.”

Continuing in a similar vein, Noorani outlines where CAS-One IR holds potential economic value for healthcare providers. “Patients with deep-seated lesions would, in the past, have had a hepatectomy,” she begins, but as there is now the option for ablation with CAS-One IR, “[there will be fewer large operations, which] will ultimately mean reduced length of stay, [less] need for intensive care beds, and reduced wait for open theatre procedures.” Workflow can also be managed better in a hospital with the length of procedure time being shorter and less variable, as “more challenging lesions can be done in a timelier manner,” and the increased accuracy of ablation with CAS-One IR means that, in time, Noorani “[hopes] to see a reduction in patients having repeat ablations.” Moreover, “a larger cohort of patients can be treated with curative intent,” to the same end.

A case from Noorani: Trajectory plan, needle verification, AblaSure confirmation

On the hot topic of attaining sufficient margin, Hoffmann emphasises that there is, indeed, “huge demand for safety margin verification and that can only be achieved with a navigation system, such as CAS-One IR.” Image overlay, which is the means of verifying margins without such a system, is flawed, Hoffmann continues: “it can torque the kidney and liver,” and only works where there are “very advanced algorithms” at play. Noorani concurs, adding that post-ablation assessment is also “becoming more and more important […] economically to reduce re-ablation rates.”

A summarising remark from Noorani is that CAS-One IR allows for targeting lesions “at angles not previously achievable,” and this advantage is supplemented those conferred by the fusion software capabilities. Hoffmann’s own parting message is that, where in the past, ablation may have been prized by its practitioners as an art form, what IRs want now is to have “reproducible and accurate results.” Backing up his assertion with anecdote, Hoffmann stated that he finds it “embarrassing to go to a multidisciplinary tumour board meeting and be presented with evidence that there is a new tumour growing at the back of the ablation scar.” CAS-One IR is a means to avoiding such unsavoury scenarios, he concludes.

You can read more about Quality Ablation and CAS-One IR at www.cascination.com


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