Hochfrequenz-Thermoablation bei Lebertumoren

Radiofrequency ablation of liver tumours

Summary

Background: A variety of local treatment modalities exists for the palliative therapy of inoperable primary or secondary liver tumours. In this connection the promising use especially of thermal ablation methods has been reported recently. Numerous procedures and technical terms have been mentioned in this context giving us the opportunity of a review on this subject.
Methods: From the literature of the last five years (Medline/PubMed) including the lists of references physical principles and application techniques, indications and contraindications, possibilities of evaluation and results of high frequency thermotherapy (HFTT) respectively radiofrequency ablation (RFA) were investigated and compared to our own first experiences. Survival and recurrence rates were estimated from the study results.
Results: Most authors describe the HF-thermoablative treatment as a technically uncomplicated and relatively low-risk procedure. After a mean follow-up of about 10 months the mean survival rate was about 90 % and tumor recurrence was seen in approximately 30 % of the patients. The main problems occurred in view of the complete registration of all tumors with imaging techniques before RFA and the complete ablation, especially of larger tumours.
Conclusions: In most of the clinical studies RFA promises an advantage of survival and improvement of quality of life compared to the known courses of untreated liver tumours. Therefore this method should be practiced on a larger scale in suitable patients. At the same time its efficacy must be proven by comparative studies.

Zusammenfassung

Hintergrund: Für inoperable primäre und sekundäre Lebertumore existieren verschiedene lokale Behandlungsmöglichkeiten zur Palliation. In diesem Zusammenhang wird seit einiger Zeit über den vielversprechenden Einsatz von thermoablativen Methoden berichtet. Zahlreiche Vorgehensweisen und technische Begriffe werden diesbezüglich genannt, welche Anlaß zu einer zusammenfassenden Darstellung geben.
Methode: Aus der Literatur der letzten fünf Jahre (Medline/PubMed) inklusive Referenzliteraturlisten wurden physikalische Grundlagen, Technologien und Anwendungstechniken, Indikationen und Kontraindikationen, Evaluationsmöglichkeiten und Ergebnisse der Hochfrequenz-Thermotherapie (HFTT) bzw. Radiofrequenzablation (RFA) recherchiert und mit ersten eigenen Erfahrungen verglichen. Aus den Studienergebnissen wurden durchschnittliche Überlebens- und Rezidivraten geschätzt.
Ergebnisse: Die meisten Autoren beschreiben die HF-thermoablative Behandlung als technisch unkompliziert und relativ risikoarm. Bei einer mittleren Nachbeobachtungszeit von 10 Monaten ergaben sich mittlere Überlebensraten von etwa 90 %. Der Anteil von Patienten mit Rezidiven betrug ungefähr 30 %. Probleme zeigten sich hauptsächlich hinsichtlich der vollständigen Erfassung aller Tumore mit bildgebenden Verfahren vor der HFTT und bezüglich der kompletten Ablation, vor allem von größeren Tumoren.
Schlußfolgerungen: In den meisten klinischen Untersuchungen verspricht die HFTT eine Verlängerung der Überlebenszeiten und Verbesserung der Lebensqualität im Vergleich zu den bekannten Verläufen der unbehandelten Lebertumore. Die Methode sollte daher in noch größerem Umfang Anwendung bei geeigneten Patienten finden. Gleichzeitig muß ihre Effektivität im Rahmen von vergleichenden Studien überprüft werden.

Key words

High frequency thermotherapy (HFTT) - radiofrequency ablation (RFA) - liver tumours - metastases - palliation

Schlüsselwörter

Hochfrequenz-Thermotherapie (HFTT) - Radiofrequenzablation (RFA) - Lebertumore - Metastasen - Palliation

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