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Image-Guided Percutaneous Thermal Ablation of Metastatic Pelvic Tumor From Gynecologic Malignancies

Butros, Selim R. MD; DelCarmen, Marcela G. MD; Uppot, Raul N. MD; Arellano, Ronald S. MD

doi: 10.1097/AOG.0000000000000133
Contents: Procedures and Instruments
Journal Club
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BACKGROUND: Image-guided percutaneous thermal ablation is a commonly performed therapeutic procedure for various tumors. Thermal ablation is not frequently used in the pelvis as a result of anatomic concerns and the potential risk of nontarget tissue injury.

TECHNIQUE: Percutaneous thermal ablation is a minimally invasive procedure involving special probes inserted through the skin to the target lesion under imaging guidance. Various delivery methods of thermal ablation exist, including radiofrequency ablation, which burns tissue, and cryoablation, which freezes tissue with an ultimate goal to destroy the target tumor while minimizing damage to adjacent structures. Protective measures can be used to provide access and safe treatment delivery such as pyeloperfusion to protect the ureter with the infusion of water using a ureteral stent or hydrodissection to protect adjacent structures by displacing them away with the infusion of water using percutaneously placed needles.

EXPERIENCE: The authors' experience with the technique involves thermal ablation of recurrent pelvic tumor in three patients with various gynecologic malignancies who each had a single focus of pelvic recurrence after surgical resection and radiation treatment. No residual or recurrent disease was seen at the treatment site on follow-up imaging consistent with local tumor control.

CONCLUSION: Thermal ablation of metastatic or recurrent pelvic tumor is technically feasible and should be considered in selected patients with no treatment alternative.

Thermal ablation of metastatic pelvic tumor is technically feasible and should be considered in patients with no treatment alternative.

Department of Radiology, Division of Abdominal Imaging and Intervention, and the Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Corresponding author: Selim R. Butros, MD, Department of Radiology, Division of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 92114; e-mail: sbutros@partners.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.