Rofo 2011; 183(8): 704-713
DOI: 10.1055/s-0029-1246082
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Radiofrequenzablation der Leber – eine aktuelle Übersicht

Radiofrequency of the Liver – an UpdateC. Bangard1
  • 1Institut und Poliklinik für Radiologische Diagnostik, Uniklinik Köln
Further Information

Publication History

eingereicht: 4.9.2010

angenommen: 22.1.2011

Publication Date:
11 February 2011 (online)

Zusammenfassung

Die Bedeutung der Radiofrequenzablation (RFA) als lokal tumordestruierendes Verfahren nimmt zu. Die Indikation zur RFA von kleinen hepatozellulären Karzinomen (HCC) (Durchmesser eines Herdes ≤ 5 cm oder max. dreier Herde ≤ 3 cm) ist durch prospektive, randomisierte Studien gesichert. Für resektable kolorektale Lebermetastasen (CRLM) gilt die chirurgische Resektion weiterhin als Goldstandard. Zahlreiche Einzelserien rechtfertigen jedoch die Indikation der RFA bei nicht resektablen CRLM und zeigen Überlebensraten, die durch alleinige Chemotherapie nicht erreicht werden. Die lokale Tumorrezidivrate steigt bei Tumoren > 3 cm signifikant an. Aufgrund der unzureichenden Datenlage kann derzeit keine abschließende Bewertung vorgenommen werden, welcher Zugangsweg bei der Behandlung CRLM der beste ist. Die technische Weiterentwicklung der Elektroden, verbesserte Ablationsprotokolle und eine Vereinfachung der genauen Elektrodenplatzierung durch die Echtzeitfusion von präinterventionellen CT- oder MRT-Bildern mit intrainterventionellem Ultraschall haben das Potenzial, die derzeit variable und teilweise hohe lokale Tumorrezidivrate, insbesondere bei Tumoren mit einem Durchmesser größer 3 cm, zu reduzieren. Die klinische Relevanz immunologischer Aspekte nach RFA auf das Patientenüberleben und die Entwicklung von Lokalrezidiven bleibt abzuwarten.

Abstract

The impact of radiofrequency ablation (RFA) as a local ablative tumor therapy is increasing. Randomized trials justify RFA for small hepatocellular carcinoma (HCC) (single tumor ≤ 5 cm or three or less tumors ≤ 3 cm). Surgical resection still remains the gold standard for resectable colorectal liver metastases (CRLM). Several single center trials demonstrate improved patient survival by RFA and justify RFA for non-resectable CRLM. Local recurrence increases significantly with tumor diameters > 3 cm. There is insufficient evidence at this time to resolve the issue of optimal approach for treatment of CRLM. Technical development of the electrode design, improved ablation algorithms, and simplification of the exact electrode placement by new real-time fusion techniques of pre-interventional CT or MRT images with intra-interventional ultrasound have the potential to reduce the variable and sometimes high rate of local tumor recurrence. The clinical impact of immunological aspects following RFA with regard to patient survival and local tumor recurrence remains unclear.

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