With data increasingly positioning thermal ablation as a viable alternative to surgery for select liver metastases, the demands on the interventional oncologist have never been higher. Mastering the nuances of patient selection and precise margin assessment is now essential for ensuring effective disease control locally. In this episode of the BackTable Podcast, interventional radiologist Dr. Jonas Redmond of UC San Diego Health joins host Dr. Sabeen Dhand to discuss the current state of microwave ablation (MWA) in the management of oligometastatic liver disease, focusing on tumor assessment, preprocedural planning, and the integration of local and systemic therapies.
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This podcast is supported by:
Varian IntelliBlate
https://www.varian.com/products/interventional-solutions/microwave-ablation-solutions
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SYNPOSIS
The conversation delves into the complexities of timing systemic versus local ablative therapies and explores questions surrounding adequate treatment margins. Dr. Redmond goes on to emphasize the need for operators to approach procedures with a high level of adaptability, advocating for interdisciplinary preprocedural planning and thoughtful modality selection. Exploring the complications that could arise from injury to adjacent viscera, the physicians speak to the critical importance of rigorous intraprocedural reassessment and discuss how modern software and robotics are transforming procedural precision and safety. Framing these MWA pearls within the context of recent clinical trials like COLLISION and ACCLAIM, the episode underscores the transition of interventional oncology from providing palliative services to increasingly curative solutions that may offer better prospects for patients with metastatic disease.
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TIMESTAMPS
00:00 - Introduction
04:30 - Role of Local Therapy in Systemic Disease
09:49 - Patient Selection and Treatment Modalities
13:15 - Challenging Lesion Characteristics and Locations
19:56 - Y-90 Radioembolization versus Microwave Ablation
23:04 - Intraoperative Ablation and Combining Locoregional Modalities
29:36 - Complications of Microwave Ablation in the Liver
36:43 - Future of Ablation and Liver Metastases Treatment
39:25 - Final Thoughts and Closing Remarks
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RESOURCES
UC San Diego Health. Cryoablation and Arterial Infusion of SD-101 in Combination with Durvalumab and Tremelimumab.
https://clinicaltrials.ucsd.edu/trial/NCT06710223
COLLISION trial
https://clinicaltrials.gov/study/NCT03088150
ACCLAIM trial
https://clinicaltrials.gov/study/NCT05265169
