Perkutane interstitielle Thermotherapie maligner Lebertumoren

 

 Buy Article Permissions and Reprints

Zusammenfassung.

Zielsetzung: Vorstellung von lokal ablativen Techniken wie der laserinduzierten Thermotherapie (LITT) und der Radiofrequenzablation zur perkutan interstitiellen Thermotherapie maligner Lebertumoren. Material und Methoden: Die MR-gesteuerte LITT wird heute mittels perkutan implantierbarer Kathetersysteme durchgeführt. Zur Insertion des Katheters wird die CT als Kontrollmethode eingesetzt. Sowohl für die LITT als auch für die Radiofrequenztherapie stehen gespülte Applikationssysteme zur Verfügung. Ergebnisse: Die perkutane LITT erlaubt derzeit eine lokale Tumorkontrolle von 97,2 % bei lokalisierten Lebermetastasen ohne extrahepatisches Befallsmuster. In einem Patientenkollektiv von 381 Patienten konnten mittlere Überlebenszeiten von 45,7 Monaten für Lebermetastasen, von 42,7 Monaten für Patienten mit kolorektalen Lebermetastasen und von 32 Monaten für HCC-Tumoren dokumentiert werden. Die Daten für die Radiofrequenzablation belegen die hohe Wertigkeit für die Tumorkontrolle von hepatozellulären Karzinomen bei deutlich schlechteren Resultaten für Lebermetastasen. Schlußfolgerungen: Die perkutane MR-gesteuerte LITT erlaubt eine hohe Tumorkontrolle bei Lebermetastasen kleiner 5 cm und einer Anzahl kleiner 5 mit einer Verbesserung der Überlebensdaten. Beim HCC konkurrieren derzeit die perkutane Alkoholinjektion, die Radiofrequenzablation und die LITT.

Purpose: Description of local ablative techniques such as laser-induced thermotherapy (LITT) and radiofrequency ablation in the percutaneous interstital thermotherapy for malignant liver tumors. Patients and Methods: MR-guided LITT is currently performed by means of implantable percutaneous catheter systems. CT is used to control the insertion of the catheter. Irrigated administration systems are available both for LITT and for radiofrequency therapy. Results: At present LITT enables a local tumor control of 97.2 % for localized liver metastases without extrahepatic spreading patterns. In a group of 381 patients the average survival times were 45.7 months for patients with liver metastasis, 42.7 months for those with colorectal liver metastases, and 32 months for HCC tumors. The data for radiofrequency ablation confirm the high value for tumor control of hepatocellular carcinomas with poorer results for liver metastases. Conclusions: Percutaneous, MR-guided LITT permits good tumor control of liver metastases smaller than 5 cm and less than 5 in number. For HCC, at present percutaneous injection of alcohol, radiofrequency ablation, and LITT are equally effective.

Literatur

• 1 Weiss L, Grundmann E, Torhorst J, Hartveit F, Moberg I, Eder M, Fenoglio Preiser C M, Napier J, Horne C H, Lopez M J. Haematogenous metastatic patterns in colonic carcinoma: an analysis of 1541 necropsies.  J Pathol. 1986;  150 195-203
  CrossrefPubMedGoogle Scholar
• 2 Weiss L. Inefficiency of metastasis from colorectal carcinomas. Boston, Kluwer Academic Publishers 1994: 35-37
  Google Scholar
• 3 Vogl T J, Mack M G, Roggan A, Straub R, Eichler K C, Müller P K, Knappe R V, Felix R. Internally cooled Power laser for MR-guided interstitial laser-induced thermotherapy of liver lesions: Initial clinical results.  Radiology. 1998;  209 381-385
  PubMedGoogle Scholar
• 4 Rossi S, Di Stasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L. et al . Percutaneous RF Interstitial Thermal Ablation in the Treatment of Hepatic Cancer.  American J Roentgenol. 1996;  167 759-768
  PubMedGoogle Scholar
• 5 Solbiati L, Goldberg S N, Ierace T, Livraghi T, Meloni F, Dellanoce M. et al . Hepatic metastases: Percoutaneous Radio-Frequency Ablation with Cooled-Tip Electrodes.  Radiology. 1997;  205 367-373
  PubMedGoogle Scholar
• 6 Solbiati L, Ierace T, Goldberg S N, Sironi S, Livraghi T, Fiocca R. et al . Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients.  Radiology. 1997;  202 195-203
  CrossrefPubMedGoogle Scholar
• 7 Livraghi T, Goldberg S, Monti F, Bizzini A, Lazzaroni S, Meloni F. et al . Saline-enhanced Radio-Frequency Tissue Ablation in the Treatment of Liver Metastases.  Radiology. 1997;  202 205-210
  PubMedGoogle Scholar
• 8 Livraghi T, Goldberg N, Lazzaroni S, Meloni B, Solbiati L, Gazelle G S. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection.  Radiology. 1999;  210 655-661
  CrossrefPubMedGoogle Scholar
• 9 Wingo P A, Tong T, Boldon S. Cancer Statistics, 1995.  CA Cancer J Clin. 1995;  45 8-30
  PubMedGoogle Scholar
• 10 Bross I DJ, Blumenson L E. Metastatic sites that produce generalized cancer: identification and kinetics of generalizing sites., Fundamental Aspects of Metastasis. Edited by Weiss L. Amsterdam, North-Holland 1976: 359-375
  Google Scholar
• 11 Viadana E, Bross I DJ, Pickren J W. The metastatic spread of cancers of the digestive system in man.  Oncology. 1978;  35 114-126
  PubMedGoogle Scholar
• 12 Stangl R, Altendorf Hofmann A, Charnley R M, Scheele J. Factors influencing the natural history of colorectal liver metastases.  Lancet. 1994;  343 1405-1410
  CrossrefPubMedGoogle Scholar
• 13 Bengmark S, Hafström L. The Natural History of Primary and Secondary Malignant Tumors of the Liver.  Cancer. 1969;  23 198-202
  CrossrefPubMedGoogle Scholar
• 14 Palmer M, Petrelli N J, Herrera L. No treatment option for liver metastases from colorectal adenocarcinoma.  Dis Colon Rectum. 1989;  32 698-701
  PubMedGoogle Scholar
• 15 Lemeny N, Niedzwiecki D, Shurgot B, Oderman P. Prognostic Variables in Patients with Hepatic Metastases from Colorectal Cancer.  Cancer. 1989;  63 742-747
  PubMedGoogle Scholar
• 16 Ringe B, Bechstein W O, Raab R, Meyer H-J, Pichlmayr R. Leberresektion bei 175 Patienten mit colorektalen Metastasen.  Chirurg. 1990;  61 272-279
  PubMedGoogle Scholar
• 17 Scheele J, Altendorf-Hofmann A, Stangl R, Schmidt K. Surgical Resection of Colorectal Liver Metastases: Gold Standard for Solitary and Completely Resectable Lesions.  Swiss Surg Suppl. 1996;  4 4-17
  PubMedGoogle Scholar
• 18 Nordlinger B, Guiguet M, Vaillant J C, Balladur P, Boudjema K, Bachellier P. et al . Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Française de Chirurgie.  Cancer. 1996;  77 1254-1262
  CrossrefPubMedGoogle Scholar
• 19 Nordlinger B, Vaillant J-C. Repeat resections for recurrent colorectal liver metastases. Boston, Kluwer Academic Publishers 1994
  Google Scholar
• 20 Lange J F, Leese T, Castaining D, Bismuth H. Repeat hepatectomy for recurrent malignant tumors of the liver.  Surg Gynecol Obstet. 1989;  169 119
  PubMedGoogle Scholar
• 21 Harned R K, Chezmar J L, Nelson R C. Recurrent tumor after resection of hepatic metastases from colorectal carcinoma: location and time of discovery as determined by CT.  Am J Roentgenol. 1994;  163 93-97
  PubMedGoogle Scholar
• 22 Adson M A. Resection of liver metastases - When is it worthwhile?.  World J Surg. 1987;  11 511-520
  CrossrefPubMedGoogle Scholar
• 23 Mazzaferro V, Dindazans V J, Makova L, van Thiel D H. Approach to hepatic metastases from colorectal adenocarcinoma.  Semin Liver Dis. 1988;  8 247
  PubMedGoogle Scholar
• 24 Soyer P, Pelage J P, Dufresne A-C, Boudiaf M, Kardache M, Dahan H. et al . CT for abdominal wall metastases after abdominal percutaneous procedures.  J Comput Assist Tomogr. 1998;  22 889-893
  CrossrefPubMedGoogle Scholar
• 25 Smith E H. Complications of percutaneous abdominal fine-needle biopsy.  Radiology. 1991;  178 253-258
  CrossrefPubMedGoogle Scholar
• 26 Chapman W C, Sharp K W, Weaver F, Sawyers J F. Tumor Seeding from percutaneous biliary catheters.  Ann Surg. 1989;  6 708-715
  PubMedGoogle Scholar
• 27 Loew R, Dueber C, Schwarting A, Thelen M. Subcutaneous implantation metastasis of a cholangiocarcinoma of the bile duct after percutaneous transhepatic biliary drainage (PTBD).  Eur Radiol. 1997;  7 259-261
  CrossrefPubMedGoogle Scholar
• 28 Lau W Y, Ho S, Leung T WT, Chan M, Ho R, Johnson P J. et al . Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial Infusion of yttrium microspheres.  Int J Radiation Oncology Biol Phys. 1998;  40 583-592
  CrossrefPubMedGoogle Scholar
• 29 Hesse U J, Troisi R, Defreyne L, Praet M, Pattyn P, Elewaut A, Hemtinne de B. Die kombinierte transarterielle Chemoembolisation (TAE) und perkutane Ethanolinjektion (PEI) beim hepatozellulären Karzinom vor Transplantation.  Langenbecks Arch Chir. 1997;  I (Forumband) 121-125
  PubMedGoogle Scholar
• 30 Livraghi T, Giorgio A, Marin G, Salmi A, de Sio I, Bolondi L, Pompili M, Brunello F, Lazzaroni F, Torzolli G. Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous ethanol injection.  Radiology. 1995;  197 101-108
  CrossrefPubMedGoogle Scholar
• 31 Kanematsu T, Matsumata T, Shirabe K. A comperative study of hepatic resection and transcatheter arterial embolization for the treatment of primary hepatocellular carcinoma.  Cancer. 1993;  71 1281-1286
  PubMedGoogle Scholar
• 32 Lencioni R, Goletti O, Armillotta N, Paolicchi A, Moretti M, Cioni D, Donati F, Cicorelli A, Ricci S, Carrai M, Conte P F, Carina E, Bartolozzi C. Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle: results of a pilot clinical trial.  Eur Radiol. 1998;  8 1205-1211
  CrossrefPubMedGoogle Scholar
• 33 Ravikumar T S, Kane R, Cady B, Jenkins R, Clouse M, Steele G. A 5-year study of cryosurgery in the treatment of liver tumors.  Arch Surg. 1991;  126 1520-1524
  PubMedGoogle Scholar
• 34 Vogl T J, Mack M G, Straub R, Roggan A, Felix R. Percutaneous MRI-guided laser-induced thermotherapy for hepatic metastases for colorectal cancer.  The Lancet. 1997;  350 29
  PubMedGoogle Scholar
• 35 Lopez R L, Pan S H, Lois J F, McMonicle M E, Hoffmann A L, Sher L S, Lugo D, Makowa L. Transarterial chemoembolization is a safe treatment for unresectable hepatic malignancies.  Am Surg. 1997;  63 923-926
  PubMedGoogle Scholar
• 36 Martin M, Tarata D, Wu Y M, Ukah F, Fabrega A, Corwin C, Lange E. Mitros Intrahepatic arterial chemoembolization for hepatocellular carcinoma and metastatic neuroendocrine tumors in the era of liver transplantation.  Am Surg. 1996;  62 724-732
  PubMedGoogle Scholar
• 37 Sanz-Altamira P M, Spence L D, Hubermann L S, Posner M R, Steele G J., Perry L J, Stuart K E. Selective chemoembolization in the management of hepatic metastases in refractory colorectal carcinoma: a phase II trial.  Dis Colon Rectum. 1997;  40 770-775
  CrossrefPubMedGoogle Scholar
• 38 Amin Z, Bown S G, Lees W R. Local treatment of colorectal liver metastases: a comparison of interstitial laser photocoagulation (ILP) and percutaneous alcohol injection (PAI).  Clin Radiol. 1993;  48 166-171
  PubMedGoogle Scholar

1 Dornier, Germering, Deutschland

2 Somatex, Berlin, Deutschland

Prof. Dr. Thomas J. Vogl

Institut für Diagnostische und Interventionelle Radiologie

Klinikum der Johann Wolfgang Goethe-Universität

Theodor-Stern-Kai 7

60590 Frankfurt am Main



Email: T.Vogl@em.uni-frankfurt.de