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Z Gastroenterol 2004; 42(1): 31-38
DOI: 10.1055/s-2004-812687
Übersicht
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Lokale Ablationsverfahren als Ergänzung der Therapie maligner Leberläsionen

Local Ablation of Malignent Lesions of the Liver - Potential Applications and Limitations of the Different MethodsI. Zuber-Jerger1 , M. Geissler1 , H. C. Spangenberg1 , L. Mohr1 , F. Weizsäcker1 , H. E. Blum1
  • 1Medizinische Universitätsklinik Freiburg
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Publication History

Publication Date:
02 February 2004 (online)

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Zusammenfassung

Bösartige Neubildungen in der Leber stellen in der gastroenterologisch-onkologischen Praxis eines der häufigsten und schwierigsten Probleme dar. Klinisch unterscheidet man zwischen primären, d. h. von Hepatozyten und Gallenwegen selbst ausgehenden Tumoren (hepatozelluläres Karzinom HCC, Cholangiokarzinom CC) und sekundären Läsionen der Leber, die Absiedlungen leberfremder Tumoren (Metastasen) darstellen und aufgrund ihrer unterschiedlichen Biologie verschiedene therapeutische Strategien erfordern. Das Prinzip, Tumore der Leber zu entfernen, hat sich jedoch sowohl bei primären als auch bei sekundären Läsionen durchgesetzt. Für viele Patienten mit primären oder sekundären Lebertumoren ist technisch oder aufgrund der Begleitmorbidität eine chirurgische Resektion nicht möglich. Das hat zur Entwicklung minimalinvasiver Ablationsverfahren geführt. Perkutane Alkohol- und Essigsäureinjektionen, Radiofrequenz-, Mikrowellen- oder Laserablationen ergänzen das Spektrum der therapeutischen Möglichkeiten und eröffnen die Möglichkeit der Tumorentfernung auch für Patienten, die technisch oder aufgrund ihrer Begleiterkrankungen nicht operiert werden können.

Abstract

Malignant lesions of the liver are among the most frequent and difficult problems in clinical practice. Liver tumors can be classified as primary (hepatocellular carcinoma HCC, cholangiocarcinoma CC) and secondary liver lesions (metastasis). The therapeutic principle of resecting liver tumours, applies to both types of liver lesions. Unfortunately many patients with primary and secondary liver lesions are inoperable because of technical difficulties or comorbidity. This stimulated the development of percutaneous ablation methods. These procedures allow to destroy tumors percutaneously with alcohol, acetic acid, radiofrequency, microwaves or laser. Potential applications and limitations of the methods are discussed.

Schlüsselwörter

Lokale Ablation - PEI - RFTA - PAI - LITT - Mikrowellenkoagulation

Key words

Local ablation - PEI - PAI - RFTA - microwave coagulation - LITT

Literatur

  • 1 Alberts S R, Donohue J H, Mahoney M R. Liver resection after 5-FU, leucovorin and oxaliplatin for patients with metastatic colorectal cancer limited to the liver: A North Central Cancer Treatment (NCCTG) phase II study.  Proc Am Soc Clin Oncol. 2003;  22 263a, A1053
    PubMedGoogle Scholar
  • 2 Allgaier H P, Galandi D, Olschewski M. et al . Dtsch Ärzteblatt. 2003;  100 A2666-A2687
    PubMed
  • 3 Arii S, Yamaoka Y, Futagawa S. et al . Results of surgical and nonsurgical treatment for small sized hepatocellular carcinoma: a retrospective and nationwide survey in Japan.  Hepatology. 2000;  32 1224
    CrossrefPubMedGoogle Scholar
  • 4 Bismuth H, Adam R, Levi F. et al . Resection of nonresectable liver metastases from colorectal cancer after neoadjuvant chemotherapy.  Ann Surg. 1996;  224 509-20 , discussion 520-522
    CrossrefPubMedGoogle Scholar
  • 5 Bonatti H, Bodner G, Obrist P. et al . Skin implant metastasis after percutaneous radiofrequency therapy of liver metastasis of a colorectal carcinoma.  Am Surg. 2003;  69 763-765
    PubMedGoogle Scholar
  • 6 Castells A, Bruix J, Bru C. et al . Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection.  Hepatology. 1993;  18 1121-1126
    CrossrefPubMedGoogle Scholar
  • 7 Dizon D S, Kemeny N E. Intrahepatic arterial infusion of chemotherapy: clinical results.  Seminar Oncol. 2002;  20 126-135
    PubMedGoogle Scholar
  • 8 Elias D, De Baere T, Smayra T. et al . Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumour recurrence after hepatectomy.  Br J Surg. 2002;  89 752-756
    CrossrefPubMedGoogle Scholar
  • 9 Falcone A, Masi G, Allegrini G. et al . Biweekly chemotherapy with oxaliplatin, irinotecan, infusional fluorouracil and leucovorin: a pilot study in patients with metastatic colorectal cancer.  J Clin Oncol. 2002;  20 4006-4014
    CrossrefPubMedGoogle Scholar
  • 10 Giacchetti S, Itzhaki M, Gruia G. et al . Long-term survival of patients with unresectable colorectal cancer liver metastases following infusional chemotherapy with 5-fluorouracil, leucovorin, oxaliplatin and surgery.  Ann Oncol. 1999;  10 663-669
    CrossrefPubMedGoogle Scholar
  • 11 Huo T, Huang Y H, Wu J C. et al . Comparison of percutaneous acetic acid injection and percutaneous ethanol injection for hepatocellular carcinoma in cirrhotic patients: a prospective study.  Scand J Gastroenterol. 2003;  38 770-778
    CrossrefPubMedGoogle Scholar
  • 12 , http://www.eortc.be
  • 13 Kemeny N, Niedzwiecki D, Shurgot B. et al . Prognostic variables in patients with hepatic metastases form colorectal cancer. Importance of medical assessment of liver involvement.  Cancer. 1989;  63 742-747
    PubMedGoogle Scholar
  • 14 Kotoh K, Sakai H, Sakamoto S. et al . The effect of percutaneous ethanol injection therapy on small solitary hepatocellular carcinoma is comparable to that of hepatectomy.  Am J Gastroenterol. 1994;  89 194-198
    PubMedGoogle Scholar
  • 15 Lencioni R A, Allgaier H P, Cloni D. et al . Small hepatocellular carcinoma in cirrhosis: Randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection.  Radiology. 2003;  228 235-240
    CrossrefPubMedGoogle Scholar
  • 16 Liang H L, Yang C F, Pan H B. et al . Small hepatocellular carcinoma: safety and efficacy of single high-dose percutaneous acetic acid injection for treatment.  Radiology. 2000;  214 769-774
    PubMedGoogle Scholar
  • 17 Livraghi T, Solbiati L, Meloni M F. et al . Treatment of focal liver tumors with percutaneous radiofrequency ablation: complications encountered in a multicenter study.  Radiology. 2003;  226 441-451
    CrossrefPubMedGoogle Scholar
  • 18 Livraghi T, Goldberg S N, Lazzaroni S. et al . Small hepatocellular carcinoma: Treatment with Radiofrequency Ablation versus ethanol injection.  Radiology. 1999;  210 656-661
    PubMedGoogle Scholar
  • 19 Livraghi T, Goldberg S, Solbiati T. et al . Percutaneous radiofrequency ablation of liver metastasis from breast cancer. Initial experience with 24 patients.  Radiology. 2001;  220 145-149
    PubMedGoogle Scholar
  • 20 Livraghi T, Solbiati L, Meloni F. et al . Percutaneous Radiofrequency Ablation of liver metastases in potential candidates for resection.  Radiology. 2003;  97 3027-3035
    CrossrefPubMedGoogle Scholar
  • 21 Livraghi T, Lazzaroni S, Pellicano S. et al . Percutaneous ethanol injection of hepatic tumors: single session therapy with general anethesia.  Am J Roentgenol. 1993;  161 1065-1069
    PubMedGoogle Scholar
  • 22 Llovet. et al . Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma.  Hepatology. 2001;  33 1124-1129
    CrossrefPubMedGoogle Scholar
  • 23 Llovet. et al . Chemoembolisation improved survival of stringently selected patients with unresectable heaptocellular cracinoma.  Lancet. 2002;  359 1734-1739
    CrossrefPubMedGoogle Scholar
  • 24 Llovet J M, Beaugrand M. Hepatocellular carcinoma: present status and future prospects.  Journal of Hepatology. 2003;  38 S136-S149
    PubMedGoogle Scholar
  • 25 Lo C M, Ngan H, Tso W K. et al . Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma.  Hepatology. 2002;  35 1164-1171
    CrossrefPubMedGoogle Scholar
  • 26 Malafosse R, Penna C, Sa C unha A. et al . Surgical management of hepatic metastases from colorectal maignancies.  Ann Oncol. 2001;  12 887-894
    CrossrefPubMedGoogle Scholar
  • 27 Nagasue N, Kohno H, Tachibana M. et al . Prognostic factors after hepatic resection for hepatocellular carcinoma associated with Child-Turcotte Class B and C cirrhosis.  Ann Surg. 1999;  229 84-90
    CrossrefPubMedGoogle Scholar
  • 28 Nordlinger B, Guigeuet M, Vaillant J C. 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
  • 29 Oshowo A, Gillams A, Harrison E. et al . Resection of radiofrequency ablation for solitary colorectal liver metastases.  Br J Surg. 2002;  89 12-14
    PubMedGoogle Scholar
  • 30 Parikh A A, Curley S A, Fornage B D. et al . Radiofrequency ablation of hepatic metastases.  Seminar Oncol. 2002;  29 168-182
    PubMedGoogle Scholar
  • 31 Ruers T J, Joosten J, Jagher G J. et al . Long-term results of treating hepatic colorectal metastases with cryosurgery.  Br J Surg. 2001;  88 844-849
    CrossrefPubMedGoogle Scholar
  • 32 Rossi S, Garbagnati F, Lencioni R. et al . Percutaneous radiofrequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumour blood supply.  Radiology. 2000;  217 119-126
    CrossrefPubMedGoogle Scholar
  • 33 Shibata T, Jimuro Y, Yamamoto Y. et al . Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous microwave coagulation therapy.  Radiology. 2002;  223 331-337
    CrossrefPubMedGoogle Scholar
  • 34 Solbiati L, Goldberg S N, Ierace T. et al . Percutaneous radiofrequency ablation of hepatic metastases from colorectal cancer: Long-term results in 117 patients.  Radiology. 2001;  221 159-166
    CrossrefPubMedGoogle Scholar
  • 35 Souglakos J, Mavroudis D, Kakolyris S. et al . Triplet combination with irinotecan plus oxaliplatin plux continuous-infusion fluorouracil and leucvorin as first-line treatment in metastatic colorectal cancer: a multicenter phase II trial.  J Clin Oncol. 2002;  20 2651-2657
    CrossrefPubMedGoogle Scholar
  • 36 Vogl T J, Mack M G, Straub R. et al . Interventionelle MR-gesteuerte laserinduzierte Thermotherapie bei onkologischen Fragestellungen.  Radiologe. 1999;  39 764-771
    CrossrefPubMedGoogle Scholar
  • 37 Wietzke-Braun P, Ritzel D, Nolte W. et al . Ultrasound-guided laser intestitial thermotherapy for treatment of non-resectable primary and secondary liver tumours - a feasibility study.  Ultraschall in Med.. 2003;  24 107-112
    PubMedGoogle Scholar
  • 38 Yamamoto J, Okada S, Shimada K. et al . Treatment strategy for small hepatocellular carcinoma: Comparison of long-term results after percutaneous ethanol injection therapy and surgical resection.  Hepatology. 2001;  34 707-713
    CrossrefPubMedGoogle Scholar
  • 39 Yan D B, Clingan P, Morris D L. Hepatic cryotherapy and regional chemotherapy with or without resection for liver metastases from colorectal carcinoma: how many are too many?.  Cancer. 2003;  98 320-330
    CrossrefPubMedGoogle Scholar
  • 40 The C ancer of the Liver Italian Program investigators. Prospective Validation of the CLIP score: A new prognostic System for patients with cirrhosis and hepatocellular carcinoma.  Hepatology. 2000;  31 840-845
    CrossrefPubMedGoogle Scholar

Ina Zuber-Jerger

Medizinische Universitätsklinik Freiburg

Hugstetterstraße 55

79106 Freiburg

Email: zuber@med1.ukl.uni-freiburg.de