Zusammenfassung
Die Radiofrequenzablation ist eine vielversprechende und sich schnell weiterentwickelnde Technik zur minimal invasiven Therapie von Lebermalignomen. Bis vor einigen Jahren war der limitierende Faktor dieses Verfahrens der unter Verwendung der zur Verfügung stehenden Ablationssonden maximal erzeugbare Läsionsdurchmesser von 1,6 cm. Entscheidende Fortschritte erfuhr dieses Verfahren durch die Entwicklung leistungsfähigerer Generatoren (bis 250 Watt) in Kombination mit offen oder geschlossen gekühlten Ablationssonden bzw. expandierbaren Ablationssonden. Hiermit sind nunmehr Ablationsareale mit Durchmessern bis über 5 cm in-vivo möglich. Weiterhin konnte mit angiographischen bzw. pharmakologischen Strategien eine weitere Vergrößerung der Ablationsvolumina erzielt werden. In diesem Artikel werden die grundlegenden Prinzipien der RF-Ablation sowie die aktuellsten RF-Systeme im Hinblick auf die Ablationscharakteristika dargestellt.
Abstract
Radiofrequency (RF) thermal ablation is a promising and rapidly evolving technique for the minimal invasive treatment of liver malignancies. Until a few years ago, conventional RF treatment performed with a single monopolar electrode produced thermal necrosis lesions not exceeding 1.6 cm in diameter. Substantial improvements in the RF technique included the development of high-power generators (up to 250 watts) combined with open-perfused electrodes, internally cooled-tip electrodes or expandable electrode needles, capable of ablating an area of over 5 cm in diameter. Moreover, angiographically and pharmacologically assisted strategies were introduced for expanding the volume of RF-induced coagulation necrosis. This article presents a synopsis of current RF techniques and reviews the basic principles of RF ablation with the goal of providing guidance for optimal results.
Schlüsselwörter
Leber - Leber, Neoplasma - Leber, Therapie - Ablation, Radiofrequenz
Keywords
Liver - liver, neoplasms - liver, therapy - ablation, radiofrequency
Literatur
-
1
Gazelle G S, Goldberg S N, Solbiati L, Livraghi T.
Tumor ablation with radio-frequency energy.
Radiology.
2000;
217
633-646
-
2
Wood B J, Ramkaransingh J R, Fojo T, Walther M cC, Libutti S K.
Percutaneous tumor ablation with radiofrequency.
Cancer.
2002;
94
443-451
-
3
Sweet W H, Mark V H, Hamlin H.
Radiofrequency lesions in the central nervous system of man and cat, including case reports of eight bulbar pain-tract interruptions.
J Neurosurg.
1960;
17
213-225
-
4
Solbiati L, Goldberg S N, Ierace T, Livraghi T, Meloni F, Dellanoce M, Sironi S, Gazelle G S.
Hepatic metastases: Percutaneous radio-frequency ablation with cooled-tip electrodes.
Radiology.
1997;
205
367-373
-
5
Rossi S, DiStasi M, Buscarini E, Quaretti P, Garbagnati F, Squassante L, Paties C T, Silverman P E, Buscarini L.
Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer.
Am J Roentgenol.
1996;
169
759-769
-
6
Greenelee R T, Hill-Harman M B, Murray T.
Cancer statistics 2001.
Cancer J Clin.
2001;
50
7-33
-
7
Ohlsson B, Stenram U, Tranberg K G.
Resection of liver metastases: 25-year experience.
World J Surg.
1998;
22
268-276
-
8
Dizon D S, Kemeny N E.
Intrahepatic arterial infusion of chemotherapy: Clinical results.
Sem Oncol.
2002;
29
126-135
-
9
Clouse M E, Lee R G, Duszlak E J, Lokich J J, Trey C, Alday M R, Yobum D C, Diamond J, Crosson A W, Costello P.
Peripheral hepatic artery embolization for primary and secondary hepatic neoplasms.
Radiology.
1983;
147
407-411
-
10
Vogl T, Mack M, Straub R, Zangos S, Woitaschek , Eichler K, Engelmann K.
Thermische Ablation von Lebermetastasen.
Der Radiologe.
2001;
41
49-55
-
11
Shibata T, Iimuro Y, Yamamoto Y, Maetoni Y, Ametani F, Itoh K, Konishi J.
Small hepatocellular carcinoma: Comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.
Radiology.
2002;
223
(2)
331-337
-
12
Cline H E, Hynynen K, Watkins R D, Adams W J, Schenck J F, Ettinger R H, Vetro J P, Jolesz F A.
Focussed US system for MR imaging-guided tumor ablation.
Radiology.
1995;
194
731-737
-
13
Onik G M, Atkinson D, Zemel R, Weaver M L.
Cryosurgery of liver cancer.
Sem Surg Oncol.
1993;
9
309-317
-
14
Silverman S G, Tuncali K, Adams D F, van Sonnenberg E, Zou K H, Kacher D F, Morrison P R, Jolesz F A.
MR imaging-guided percutaneous cryotherapy of liver tumors: Initial experience.
Radiology.
2000;
217
(3)
657-664
-
15
Rossi S, Buscarini E, Garbagnati F, DiStasi M, Quaretti P, Rago M, Zangrandi A, Andreola S, Silverman D, Buscarini L.
Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.
Am J Roentgenol.
1998;
170
1015-1022
-
16
Curley S A, Izzo F, Delrio P, Ellis C M, Grandi J, Vallone P, Fiore F, Pignata S, Daniele B, Cremona F.
Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: Results in 123 patients.
Ann Surg.
1999;
230
1-8
-
17
Solbiati L, Livraghi T, Goldberg S N, Ierace T, Meloni F, Dellanoce M, Cova L, Halpern E, Gazelle G S.
Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: Long-term results in117 patients.
Radiology.
2001;
221
159-166
-
18
D'Arsonval M A.
Action physiologique des courants alternatifs.
CR Soc Biol.
1891;
43
283-286
-
19
Organ L W.
Electrophysiologic principles of radiofrequency lesion making.
Appl Neurophysiol.
1976;
39
69-76
-
20
McGahan J P, Brock J M, Tesluk H, Gu W Z, Schneider P, Browning P D.
Hepatic ablation with use of radiofrequency electrocautery in the animal model.
J Vasc Interv Radiol.
1992;
3
291-297
-
21
Zervas N T, Kuwayama A.
Pathological characteristics of experimental thermal lesions: Comparison of induction heating and radiofrequency electrocoagulation.
J Neurosurg.
1972;
37
418-422
-
22
Goldberg S N, Gazelle G S, Dawson S L, Rittman W J, Mueller P R, Rosenthal D I.
Tissue ablation with radiofrequency: Effect of probe size, gauge, duration and temperature on lesion volume.
Acad Radiol.
1995;
2
399-404
-
23
Trübenbach J, Pereira P L, Schick F, Claussen C D, Huppert P E.
MRI- guided radiofrequency ablation of liver tumors: A valuable and minimally-invasive therapeutic option.
Min Invas Ther.
1998;
6
533-539
-
24
Goldberg S N, Gazelle G S, Compton C C, Mueller P R, Tanabe K K.
Treatment of intrahepatic malignancy with radiofrequency ablation: Radiologic-pathologic correlation.
Cancer.
2000;
88
2452-2463
-
25
Pennes H H.
Analysis of tissue and arterial blood temperatures in the resting human forearm.
J Appl Physiol.
1948;
1
93-122
-
26 Hill R P, Hunt J W. Hyperthermia. In: Tannock IF, Hill RP (Hrsg.) The basic science of oncology. New York; Pergamon 1987: 337-357
-
27
Seegenschmidt M H, Brady L W, Sauer R.
Interstitial thermoradiotherapy: review on technical and clinical aspects.
Am J Clin Oncol.
1990;
13
352-363
-
28
Larson T R, Bostwick D G, Corcia A.
Temperature-correlated histopathologic changes following microwave thermoablation of obstructive tissue in patients with benign prostatic hyperplasia.
Urology.
1996;
47
463-469
-
29
Thomsen S.
Pathologic analysis of photothermal and photomechanical effects of laser-tissue interactions.
Photochem Photobiol.
1991;
53
825-835
-
30
Goldberg S N, Solbiati L, Hahn P F, Cosman E, Conrad J E, Fogle R, Gazelle G S.
Large-volume tissue ablation with radiofrequency by using a clustered, internally-cooled electrode technique: Laboratory and clinical experience in liver metastases.
Radiology.
1998;
209
371-379
-
31
Trübenbach J, Huppert P E, Pereira P L, Ruck P, Claussen C D.
Radiofrequenzablation der Leber in vitro: Effektivitätserhöhung mittels perfundierter Sonden.
Fortschr Röntgenstr.
1997;
167
633-637
-
32
Goldberg S N, Gazelle G S.
Radiofrequency tissue ablation: Physical principles and techniques for increasing coagulation necrosis.
Hepatogastroenterol.
2001;
48
359-367
-
33
Goldberg S N, Gazelle G S, Dawson S L, Mueller P R, Rittman W J, Rosenthal D I.
Radiofrequency tissue ablation using multiprobe arrays: Greater tissue destruction than multiple probes operating alone.
Acad Radiol.
1995;
2
670-674
-
34
LeVeen R F.
Laser hyperthermia and radiofrequency ablation of hepatic lesions.
Semin Int Radiology.
1997;
14
313-324
-
35
Goldberg S N, Gazelle G S, Solbiati L, Rittman W J, Mueller P R.
Radiofrequency tissue ablation: Increased lesion diameter with a perfusion electrode.
Acad Radiol.
1996;
3
636-644
-
36
Lorentzen T.
A cooled needle electrode for radiofrequency tissue ablation: Thermodynamic aspects of improved performance compared with conventional needle design.
Acad Radiol.
1996;
3
556-563
-
37 Schmidt D, Trübenbach J, König C W, Putzhammer H, Duda S H, Claussen C D, Pereira P L. Automated saline-enhanced radiofrequency thermal ablation: Initial results in ex-vivo liver. Am J Roentgenol 2003: (in press)
-
38
Kettenbach J, Peer K, Grgurin M, Berger J, Hupfl M, Lammer J.
MRI- guided percutaneous radiofrequency ablation of neoplasms using a MR-compatible RF-system: first technical and clinical experiences.
Radiology (abstr.).
2001;
221
626
-
39
McGahan J P, Wei-Zhong G, Brock J M, Tesluk H, Jones C D.
Hepatic ablation using bipolar radiofrequency electrocautery.
Acad Radiol.
1996;
3
418-422
-
40
Mack M G, Straub R, Desinger K, Balzer J O, Zangos S, Vogl T.
MR-guided interstitial bipolar RF thermometry: In-vivo evaluations and first clinical results.
Radiology (abstr.).
2000;
217
539
-
41
Goldberg S N, Stein M, Gazelle G S, Sheiman R G, Kruskal J B, Clouse M E.
Percutaneous radiofrequency tissue ablation: Optimization of pulsed-RF technique to increase coagulation necrosis.
J Vasc Interv Radiol.
1999;
10
907-916
-
42
Merkle E, Goldberg S N, Boll D T, Shankaranarayanan A, Boaz T, Jacobs G H, Wendt M, Lewin J S.
Effect of superparamagnetic MR contrast agents on radiofrequency-induced temperature distribution: In-vitro measurements in polyacrylamide phantoms and in-vivo results in a rabbit liver model.
Radiology.
1999;
212
459-466
-
43
Livraghi T, Goldberg S H, Monti F, Bizzini A, Lazzaroni S, Meloni F, Pellicano S, Solbiati L, Gazelle S G.
Saline-enhanced radiofrequency tissue ablation in the treatment of liver metastases.
Radiology.
1997;
202
205-210
-
44
Goldberg S N, Solbiati L, Halpern E F, Gazelle G S.
Variables affecting proper system grounding for radiofrequency ablation in animal model.
J Vasc Interv Radiol.
2000;
11
1069-1075
-
45
deBaere T, Denys A, Wood B J, Lassau N, Kardache M, Vilgrain V, Menu Y, Roche A.
Radiofrequency liver ablation: experimental comparative study of water-cooled versus expandable systems.
Am J Roentgenol.
2001;
176
187-192
-
46
Goldberg S N, Hahn P F, Tanabe K K, Mueller P R, Schima W, Athanasoutis C A, Compton C C, Solbiati L, Gazelle G S.
Percutaneous radiofrequency tissue ablation: Does perfusion-mediated tissue cooling limit coagulation necrosis?.
J Vasc Interv Radiol.
1998;
9
101-111
-
47
Goldberg S N, Hahn P F, Halpern E, Fogle R, Gazelle G S.
Radiofrequency tissue ablation: effect of pharmacologic modulation of blood flow on coagulation diameter.
Radiology.
1998;
209
761-769
-
48
Buscarini L, Buscarini E, diStasi M, Quaretti P, Zangrandi A.
Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma.
Ultraschall in Med.
1999;
20
47-53
-
49
Pereira P L, Trübenbach J, König C W, Viebahn R, Duda S H, Claussen C D.
Phase II study: transarterial chemoembolization with single session radiofrequency ablation of liver carcinomas larger than 5 cm.
Radiology (abstr.).
2001;
221
250
-
50
Goldberg S N, Saldinger P F, Gazelle G S, Huertas J L, Stuart K E, Jacobs T, Kruskal J B.
Percutaneous tumor ablation: increased coagulation necrosis with combined radiofrequency and percutaneous doxorubicin injection.
Radiology.
2001;
220
(2)
420-427
PD Dr. med. Philippe L. Pereira
Eberhard-Karls-Universität Tübingen
Abteilung für Radiologische Diagnostik
Hoppe-Seyler-Strasse 3
72076 Tübingen
Telefon: +49 7071 2986676
Fax: +49 7071 295694
eMail: philippe.pereira@med.uni-tuebingen.de
