Perkutane interstitielle Thermotherapie maligner Lebertumoren

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.

Schlüsselwörter:

Lebermetastasen - Laserablation - Thermotherapie - LITT - Radiofrequenzablation

Key words:

Liver metastasis - Laser ablation - Thermotherapy - LITT - Radiofrequency ablation

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1 Dornier, Germering, Deutschland

2 Somatex, Berlin, Deutschland