Are you up-to-date on microwave ablation for hepatocellular carcinoma (HCC) treatment? Dr. Zachary Berman and host Dr. Michael Barraza discuss this treatment modality. They cover the spectrum of pre-procedure imaging and planning, procedure steps, and tips for navigating difficult cases. Dr. Berman is a hepatobiliary interventional oncologist and Associate Clinical Professor of Radiology at UC San Diego School of Medicine.

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This podcast is supported by an educational grant from:

Variant

https://www.varian.com/

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SYNPOSIS

Dr. Berman highlights the importance of a multidisciplinary approach, referral pathways, and the role of tumor boards in decision-making. The doctors also cover various ablation technologies, pre-procedure embolization, hydrodissection, biopsy considerations, and the incorporation of immunotherapy in ongoing research. Finally, Dr. Berman emphasizes the importance of ultrasound skills and presents some cases.

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TIMESTAMPS

00:00 - Introduction

10:09 - Techniques and Technologies

17:26 - Planning and Performing Ablations

21:35 - Tumor Size and Margins

25:09 - Navigational Software and Skills

30:47 - Hydrodissection Techniques

33:20 - Post-Ablation Imaging and Follow-Up

35:52 - Future of Ablation in IR and Cases

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RESOURCES

Liver Imaging Reporting & Data System (LI-RADS®):

https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS

Liver Cancer Stages (BCLC):

https://www.cancer.gov/types/liver/what-is-liver-cancer/stages

Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6795153/

Microwave ablation compared with radiofrequency ablation for treatment of hepatocellular carcinoma and liver metastases: a systematic review and meta-analysis:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698169/

Prospective double-blinded randomized controlled trial of Microwave versus RadioFrequency Ablation for hepatocellular carcinoma (McRFA trial):

https://www.hpbonline.org/article/S1365-182X(20)30023-X/fulltext#:~:text=A%20total%20of%2093%20patients,RFA%20in%20treating%20small%20HCC.

Percutaneous radiofrequency versus microwave ablation for management of hepatocellular carcinoma: a randomized controlled trial:

https://jgo.amegroups.org/article/view/26929/html#:~:text=to%2080%20years.-,There%20were%20no%20statistically%20significant%20differences%20between%20both%20groups%20regarding,HCC%20ablation%20(Table%202).

Surgical microwave ablation for the treatment of hepatocellular carcinoma in 791 operations:

https://www.sciencedirect.com/science/article/abs/pii/S1365182X23020002

Surgery versus thermal ablation for small-size colorectal liver metastases (COLLISION): An international, multicenter, phase III randomized controlled trial:

https://meetings.asco.org/abstracts-presentations/234189

One-millimeter cancer-free margin is curative for colorectal liver metastases: a propensity score case-match approach:

https://pubmed.ncbi.nlm.nih.gov/23732261/