Essentials in Inter ventionalOncology

José Ignacio BilbaoRiccardo LencioniJim A. Reekers

Editors

Proceedings of the European Conference onInterventional Oncology ECIO 2010

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Professor José Ignacio Bilbao Clínica Universitaria de NavarraPamplona, Spain

Professor Riccardo Lencioni University of PisaPisa, Italy

Professor Jim A. Reekers Academic Medical CentreAmsterdam, Netherlands

organised by the CIRSE Foundation

Cardiovascular and Interventional Radiological Society of Europe | www.cirse.org

Essentials in Inter ventionalOncology

Proceedings of the European Conference onInterventional Oncology ECIO 2010

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Preface

Dear Colleagues,

As you may remember, the first European Conference on Inter -ventional Oncology, ECIO 2008, organised by the CIRSE Founda -tion was a great success. The scientific content, the quality ofthe presentations, and the overall number of delegates who at -tended the meeting exceeded even the highest of expectations.

Even more importantly, the encouraging and lively atmosphereof the conference produced exclusive outcomes as interventio-nal radiologists and oncology clinicians shared knowledge andexpressed points of views in the various scientific debates andworkshops.

For this second European Conference on InterventionalOncology, ECIO 2010, the scientific programme has been

further expanded with respect to 2008 in view of the growingnumber of novel clinical applications and the many innovativetechniques that have been recently introduced.

For the ECIO Proceedings, leading experts from around theworld have prepared updates on both well-established andnew, promising therapies from this exciting and rapidly evolvingfield; and it is our aim to re vise and update the publicationevery two years to establish an ultimate reference guide forinterventional oncology.

We believe that the ECIO 2010 will be another top scientific andeducational meeting and we hope that this volume proves tobe a useful resource for all clinicians involved in the discipline.

Professor Riccardo LencioniECIO 2010 Programme Committee ChairmanUniversity of PisaPisa, Italy

José Ignacio BilbaoECIO 2010 Programme Committee MemberClínica Universitaria de NavarraPamplona, Spain

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Interventional oncology is one of the most inspirational deve-lopments within interventional radiology, and certainly onewhich has given the spectrum of cancer management anotherdimension.

The countless studies currently in progress supporting new andexisting therapies reinforce even further the situation of theminimally invasive, tumour-targeted treatment of cancer, whichhas been the fastest growing area of medicine in the last fiveyears.

Especially noteworthy is the early success in the treatment ofliver tumours, which has since been mirrored in many otherorgans affected by cancer, such as the lungs, kidneys andbones. Moreover, combinations of local drug-eluting particleswith local radiofrequency ablation have in many cases becomestandard practice. Countless new possibilities are just on thehorizon with the variety of treatment modalities expandingalmost on a daily basis.

Ever since IR’s beginnings in the early sixties, it has been themission of interventional radiologists to constantly explore newavenues of treatment and patient care. In this way, IR advancesat such a rapid pace, which lends to it fascinating and cutting-edge quality.

Any challenges in showcasing the complete range of its state-of-the-art therapy options have hereby been met by offering acurrent status of interventional oncology, intended as a livingdocument to be renewed at every ECIO meeting.

Many prominent researchers in the field have contributed tothis particular edition and will hopefully continue their partici-pation over the coming years to provide the most up-to-dateinformation.

Such is the nature of the discipline, and rather than being adrawback, this evolutionary dynamism is one of interventionaloncology’s major strengths.

Professor Jim A. ReekersChairman of the CIRSE FoundationECIO Advisory Board MemberAcademic Medical CentreAmsterdam, Netherlands

Foreword

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Professor Andreas AdamSt. Thomas’ Hospital | London, United Kingdom

Dr. Decimo AgnelloUniversity of Insubria | Varese, Italy

Dr. Marcello A. AmbrogiUniversity of Pisa | Pisa, Italy

Dr. Lorenzo AndreanaRoyal Free Hospita | London, United Kingdom

Dr. Giovanni Carlo AnselmettiInstitute for Cancer Research and Treatment | Candiolo, Italy

Professor Carmen AyusoUniversity of Barcelona | Barcelona, Spain

Professor Reto BaleMedical University Innsbruck | Innsbruck, Austria

Professor José Ignacio BilbaoClínica Universitaria de Navarra | Pamplona, Spain

Dr. Eveline BoucherComprehensive Cancer Centre E Marquis | Rennes, France

Dr. Christopher L. BraceUniversity of Wisconsin, Madison | Wisconsin, USA

Dr. Manon BuijsJohns Hopkins University School of Medicine | Baltimore,Maryland, USA

Professor Andrew K. BurroughsRoyal Free Hospital | London, United Kingdom

Dr. Alessandro CampatelliUniversity of Pisa | Pisa, Italy

Professor James G. CaridiUniversity of Florida | Gainesville, Florida, USA

Professor Gianpaolo CarrafielloUniversity of Insubria | Varese, Italy

Dr. Stephan ClasenUniversity Hospital of Tübingen | Tübingen, Germany

Professor Massimo ColomboFondazione IRCCS Maggiore Hospital | Milan, Italy

Dr. Elisa CottaUniversity of Insubria | Varese, Italy

Dr. Laura CrocettiUniversity of Pisa | Pisa, Italy

Dr. Thierry de BaèreInstitut Gustave Roussy | Villejuif, France

Dr. Irene De BernardiUniversity of Insubria | Varese, Italy

Dr. Clotilde Della PinaUniversity of Pisa | Pisa, Italy

Professor Giulio Di CandioUniversity of Pisa | Pisa, Italy

Dr. Annalisa Di MassaUniversity of Insubria | Varese, Italy

Dr. Luca Di TommasoIstituto Clinico Humanitas | Milan, Italy

Professor Alfredo FalconeUniversity of Pisa | Pisa, Italy

Dr. Federico FontanaUniversity of Insubria | Varese, Italy

Professor Carlo FugazzolaUniversity of Insubria | Varese, Italy

Dr. Shanmugasundaram Ganapathy-KanniappanJohns Hopkins University School of Medicine | Baltimore,Maryland, USA

Dr. Etienne GarinComprehensive Cancer Centre E Marquis | Rennes, France

Professor Jean-François H. GeschwindJohns Hopkins University School of Medicine | Baltimore,Maryland, USA

Dr. Alice GillamsUniversity College London Hospital | London, United Kingdom

Dr. Sofia S. GourtsoyianniUniversity Hospital of Heraklion | Heraklion, Greece

Professor Carlo GrecoUniversity of Pisa | Pisa, Italy

Professor Thomas K. HelmbergerKlinikum Bogenhausen | Munich, Germany

Dr. Ralf-Thorsten HoffmannUniversity of Munich | Munich, Germany

Dr. Graziella IsgòRoyal Free Hospital | London, United Kingdom

Contributors

The Editors would like to thank all contributors for their cooperation and efforts, which were indispensible to the creation of this book.

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Dr. Massimo IavaroneFondazione IRCCS Maggiore Hospital | Milan, Italy

Professor Claus-Henning KöhneKlinikum Oldenburg | Oldenburg, Germany

Dr. Ming KuangSun Yat-sen University | Guangzhou, China

Dr. Domenico LaganàUniversity of Insubria | Varese, Italy

Dr. Fred T. Lee Jr.University of Wisconsin | Madison, Wisconsin, USA

Professor Riccardo LencioniUniversity of Pisa | Pisa, Italy

Dr. Sebastian LindemayrUniversity of Frankfurt | Frankfurt, Germany

Dr. Fotios LoupakisUniversity of Pisa, Pisa, Italy

Professor Martin G. MackUniversity of Frankfurt | Main, Frankfurt, Germany

Dr. Antonio MancaInstitute for Cancer Research and Treatment | Candiolo, Italy

Dr. Monica ManginiUniversity of Insubria | Varese, Italy

Dr. Gianluca MasiUniversity of Pisa | Pisa, Italy

Dr. Fabrizio MatteucciUniversity of Pisa | Pisa, Italy

Dr. Luca MorelliUniversity of Pisa | Pisa, Italy

Dr. Franco MoscaUniversity of Pisa | Pisa, Italy

Dr. Marco PanichiUniversity of Pisa | Pisa, Italy

Dr. Carlo PellegrinoUniversity of Insubria | Varese, Italy

Professor Philippe L. PereiraRuprecht-Karls-University Heidelberg | Heilbronn, Germany

Dr. Stefan O.R. PfleidererCentral Institute of Radiology and Nuclear Medicine, KlinikumReinkenheide | Bremerhaven, Germany

Dr. Filippo PiacentinoUniversity of Insubria | Varese, Italy

Dr. Francesco PorcelliUniversity of Pisa | Pisa, Italy

Dr. Luigi PuglieseUniversity of Pisa | Pisa, Italy

Professor Jean-Luc RaoulComprehensive Cancer Centre E Marquis | Rennes, France

Dr. Hansjörg RemppUniversity Hospital of Tübingen | Tübingen, Germany

Dr. Yan RollandComprehensive Cancer Centre E Marquis | Rennes, France

Professor Massimo RoncalliUniversity of Milan & Istituto Clinico Humanitas | Milan, Italy

Professor Steven C. RoseUniversity of California | San Diego, California, USA

Dr. Lisa SalvatoreUniversity of Pisa | Pisa, Italy

Dr. Stephen B. Solomon Memorial Sloan-Kettering Cancer Center | New York, New York, USA

Dr. Michael C. SoulenUniversity of Pennsylvania | Philadelphia, Pennsylvania, USA

Dr. Stefano SpagnesiUniversity of Pisa | Pisa, Italy

Professor Josef TackeKlinikum Passau | Passau, Germany

Professor Kenneth R. ThomsonAlfred Hospital, Melbourne | Victoria, Australia

Dr. Mustafa ValiJohns Hopkins University School of Medicine | Baltimore,Maryland, USA

Professor Thomas J. VoglUniversity of Frankfurt | Frankfurt, Germany

Dr. Gerlig WidmannMedical University Innsbruck | Innsbruck, Austria

PrefaceRiccardo Lencioni, José Ignacio BilbaoForewordJim A. ReekersContributors

1. State-of-the-Art Techniques in Tumour Ablation1. 1 HIFU: High Intensity Focused Ultrasound

Giulio Di Candio, Luca Morelli, Luigi Pugliese, Alessandro Campatelli, Francesco Porcelli, Franco Mosca1. 2 Chemical Ablation

Ming Kuang1. 3 Cyroablation

Stephen Solomon1. 4 Irreversible Electroporation

Thomas K. Helmberger1. 5 Light-Activated Drug Therapy

Riccardo Lencioni

2. Advances in Image-Guidance2. 1 Radiofrequency Ablation under MR-Guidance

Philippe L. Pereira, Hansjörg Rempp, Stephan Clasen2. 2 Stereotaxy and Robotics

Reto Bale, Gerlig Widmann

3. Current Concepts in the Treatment of Colorectal Hepatic Metastases3. 1 Current Chemotherapy Regimens in First and Second Line

Alfredo Falcone, Lisa Salvatore, Fotios Loupakis, Gianluca Masi3. 2 The Adjuvant Treatment of Unresectable Colorectal Liver Metastases - the CELIM Experience

Claus-Henning Köhne3. 3 Radioembolisation of Liver Metastases

José Ignacio Bilbao3. 4 Chemoembolisation of Colorectal Liver Metastases

Michael C. Soulen

4. Lung Tumours4. 1 Clinical Overview and Surgical Management of Lung Tumours

Marcello A. Ambrogi4. 2 Ablation Outcomes: Primary Lung Cancer

Laura Crocetti, Riccardo Lencioni4. 3 Radiofrequency Ablation of Lung Metastases: Outcomes

Thierry de Baère4. 4 Complications of Lung Ablation

Gianpaolo Carrafiello, Federico Fontana, Elisa Cotta, Irene De Bernardi, Annalisa Di Massa, Carlo Pellegrino, Filippo Piacentino, Domenico Laganà, Monica Mangini, Carlo Fugazzola

4. 5. Cyberknife RadiosurgeryRalf-Thorsten Hoffman

4. 6. Stereotactic Body Radiation Therapy (SBRT) of Early Stage NSCLCCarlo Greco, Stefano Spagnesi, Marco Panichi, Fabrizio Matteucci

4. 7. Intra-Arterial Chemoembolisation as an Intervention al Treatment Method for Unresectable Tumours of the LungThomas J. Vogl, Sebastian Lindemayr

5. Early Stage Hepatocellular Carcinoma5. 1 Diagnosis and Staging of Early Hepatocellular Carcinoma

Massimo Colombo, Massimo Iavarone5. 2 Outcomes of Percutaneous Ablation

Laura Crocetti, Riccardo Lencioni

Contents

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6. Intermediate-Advanced Hepatocellular Carcinoma6. 1 Interventional Treatment of Hepatocellular Carcinoma in the Era of Molecular-Targeted Therapies

Riccardo Lencioni

7. Diagnosis and Treatment of Hepatocellular Carcinoma: Ongoing Challenges7. 1 When Biopsy is Needed and Imaging is Not Enough: Novel Pathology Criteria

Massimo Roncalli, Luca Di Tommaso7. 2 HCC Staging, Evaluation of Treatment Efficacy and Detection of Recurrence

Carmen Ayuso7. 3 Surgery and Interventional Radiology for the Treatment of HCC: Are they Competitors or Complementary?

Andrew K. Burroughs, Lorenzo Andreana, Graziella Isgò7. 4 Hepatocellular Carcinoma: Is Radiotherapy Back?

Jean-Luc Raoul, Eveline Boucher, Etienne Garin, Yan Rolland

8. Kidney Tumours8. 1 Radiofrequency Ablation for Renal Neoplasms

Andreas Adam8. 2 Cryoablation versus RF Ablation

Josef Tacke8. 3 Embolisation of Renal Tumours

James G. Caridi8. 4 Current Role of Interventions in Metastatic Kidney Tumours

Gianpaolo Carrafiello, Monica Mangini, Annalisa Di Massa, Elisa Cotta, Carlo Pellegrino, Filippo Piacentino, Decimo Agnello, Federico Fontana, Carlo Fugazzola

9. Emerging Technologies and Synergies in Interventional Oncology9. 1 Advanced Thermal Ablation Systems: Are Bigger Burns Possible?

Fred T. Lee Jr., Christopher L. Brace9. 2 Cryoimmunotherapy

Stephen B. Solomon 9. 3 Irreversible Electroporation: Moving from Bench Investigation to Clinical Experience

Riccardo Lencioni9. 4 Oncolytic Virotherapy

Steven C. Rose9. 5 Targeting Tumour Metabolism with Intra-Arterial Therapy

Jean-François H. Geschwind, Mustafa Vali, Manon Buijs, Shanmugasundaram Ganapathy-Kanniappan

10. Image-Guided Ablation: New Frontiers10. 1 Breast

Stefan O.R. Pfleiderer10. 2 Head and Neck

Martin G. Mack, Thomas J. Vogl10. 3 Pelvis and Retroperitoneum

Alice Gillams10. 4 Novel Areas of Investigation: Nanoknife

Kenneth R. Thomson

11. Bone Tumours11. 1 Treatment of Bone Metastases

Giovanni Carlo Anselmetti, Antonio Manca11. 2 Radiofrequency Ablation in Combination with Osteoplasty for the Treatment of Bone Malignancies

Ralf-Thorsten Hoffmann

12. Advances in Cancer Imaging Integrating Interventional Oncology12. 1 Diffusion MRI

Sofia S. Gourtsoyianni12. 2 New Response Criteria: Beyond RECIST

Clotilde Della Pina