European Conference on Interventional Oncology
ECIO countries

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

April 28 - May 1 | Palma de Mallorca, ES

ProgrammeSneak peeks overviewAblation: a place in small ICCs?

Ablation: a place in small ICCs?

Three reasons why you cannot miss my lecture

  1. You will learn about pertinent data related to percutaneous thermal ablation (PTA) for intrahepatic cholangiocarcinoma (ICC) management
  2. You will be able to achieve evidence-based expansion of your practice for treating ICCs patients with PTA
  3. You will understand the technical aspects associated with ICC treatment outcomes, with a focus on the importance of procedure standardization

Prof. Bruno Odisio
Speaker bio

Add this session to your calendar!

Current evidence for intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumour, characterized by high mortality due to invasiveness, advanced stage at diagnosis, and resistance to systemic treatments [1,2]. Surgical resection, the primary curative treatment, is feasible for fewer than 20% of patients and is associated with high post-resection recurrence rates [1,2,4]. Liver failure, primarily caused by parenchymal loss, vascular or biliary obstruction, is the primary cause of death in patients with ICC [3]. To address such challenges, interdisciplinary management along with the use of systemic and locoregional therapies are routinely applied in clinical practice aiming to achieve effective local tumour control while preserving enough liver function.

Ablation for small ICC – What do we know?

Liver-direct locoregional therapies are increasingly investigated for intrahepatic cholangiocarcinoma, particularly in cases of liver-only disease, which may have a better prognosis compared to extrahepatic disease [5]. In this context, image-guided ablative therapies are emerging as an alternative therapy for small ICCs with contraindications to surgery and recurrent/residual tumours, showing promising results with similar median overall survival to repeated resection [6].

Percutaneous thermal ablation (PTA) provides several advantages due to its minimally invasive nature, enabling multiple retreatments, and favourable outcomes regarding complication rates, health-related costs, and recovery time. Additionally, PTA shows promise across various treatment scenarios for intrahepatic cholangiocarcinoma, including as a potential primary treatment, adjuvant therapy alongside surgery, for disease recurrence post-resection, and as a palliative option for unresectable disease [7] (Figure 1). A maximum diameter of 3 cm has been proposed as a threshold for both primary and recurrent intrahepatic cholangiocarcinoma due to its impact on complete ablation and local tumor progression rates, consistent with existing liver ablation literature for other tumor types [8,9]. This size cut-off also aids in distinguishing anatomo-pathological findings, such as a lower incidence of well-differentiated cholangiocarcinoma without microvascular invasion from poorly differentiated tumors with microvascular invasion [8].

The prognosis of patients with ICC is influenced by factors such as tumor size, lymph node status, vascular invasion, pathology, and margin width [2]. Currently, the minimal ablative margin (MAM) associated with acceptable local tumor progression (LTP) rates for ICC is extrapolated from studies on hepatocellular carcinoma and colorectal cancer liver metastases (CLMs), typically falling within the range of 5-10 mm [10-14]. However, ICC may require larger ablative margins due to its infiltrative nature and high LTP rates [6]. In a retrospective analysis utilizing biomechanical deformable image registration (DIR) for intra-procedural ablative margin quantification (Figure 2), percutaneous thermal ablation (PTA) has demonstrated effectiveness as a local therapy for small ICCs, providing comparable survival outcomes to surgery. Despite these promising findings, further investigations with a larger patient sample and extended follow-up are required to confirm these results.

Future directions and conclusion

The increasing availability and recent technical refinements of percutaneous thermal ablation (PTA), along with standardization opportunities provided by stereotactic and robotic ablation methods, are poised to broaden indications and enhance the effectiveness of ablation as an alternative for patients with intrahepatic cholangiocarcinoma. Additionally, advancements in tumour molecular profiling, coupled with the development of systemic treatments targeting specific genetic alterations, along with AI-based prediction models, are expected to optimize patient selection and enable the precise use of ablation in ICC management.

Figure 1: CT-guided percutaneous microwave ablation on a 65-year-old male patient presenting with post-resection ICC (2.6 cm). (A) Preablation contrast-enhanced CT image shows ICC in segment II. (B) Native CT image shows MWA antennas during PTA. (C) Intraprocedural postablation contrast-enhanced CT image shows immediate ablation zone. (D) Contrast-enhanced follow-up CT image 2 months post-PTA shows complete response.
Figure 2: Flow diagram shows the steps in biomechanical DIR method and MAM quantification in a 65-year-old man with recurrent ICC (1.6 cm). (A) Pre- and postablation contrast-enhanced CT images showing the tumor and ablation zone. (B) Pre- and postablation contrast-enhanced CT images with artificial intelligence–based autosegmentation show the liver, tumor, and ablation zone (blue, green and orange, respectively). (C) Biomechanical DIR is performed to correlate the pre- and postablation CT images. Then, the MAM (red) is computed and visualized in images with two-dimensional (C) and three-dimensional volume rendering (D). (E) Axial contrast-enhanced CT images obtained 2 months after the ablation procedure shows complete response.

Thank you to Iwan Paolucci, PhD and Jessica Albuquerque, MD for their support in providing the above images.


Bruno Odisio, University of Texas MD Anderson Cancer Center, Houston/US

Dr. Odisio serves as Professor and Co-Director of Research at the Department of Interventional Radiology, Division of Diagnostic Imaging at the University of Texas MD Anderson Cancer Center in Houston, Texas. Dr. Odisio also serves as one of the medical directors of the Image Guided Cancer Therapy (IGCT) Research Program. Dr. Odisio’s main area of clinical practice and research encompass the use of several minimally invasive local therapies for the treatment and palliation of primary and secondary liver malignancies, with an emphasis on the use of percutaneous ablative therapies as a curative-intent treatment option for patients with diverse types of liver cancers. Additionally, Dr. Odisio lab investigates the use of novel advanced imaging method s for improving and predicting outcomes of minimally invasive procedures such as chemoembolization and liver ablation, as well its potential use in combination with hepato-biliary surgical procedures.



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  2. Dai YS, Hu HJ, Lv TR, Hu YF, Zou RQ, Li FY. The influence of resection margin width in patients with intrahepatic cholangiocarcinoma: a meta-analysis. World J Surg Oncol. 2023;21(1):16.
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