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