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DOI: 10.1055/s-2004-813465
© Georg Thieme Verlag KG Stuttgart · New York
Perkutane Thermoablation von Lungenmetastasen - Erfahrungen mit dem Einsatz der LITT, der Radiofrequenzablation (RFA) und Literaturübersicht
Percutaneous Thermoablation of Pulmonary Metastases. Experience with the Application of Laser-induced Thermotherapy (LITT) and Radiofrequency Ablation (RFA), and a Literature ReviewPublication History
Publication Date:
20 October 2004 (online)
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Zusammenfassung
Zielsetzung: Beurteilung der Technik, der lokalen Effizienz und der Komplikationen der perkutanen RFA und LITT von Lungenmetastasen. Material und Methoden: Die prinzipiellen Techniken der bildgesteuerten thermischen Ablation von Lungenmetastasen mittels Radiofrequenzablation (RFA) und laserinduzierter Thermotherapie (LITT) werden vorgestellt. Zur primären Positionierung, zum Monitoring und zur Therapiekontrolle eignet sich hervorragend die Computertomographie (CT), in Einzelfällen auch die Magnetresonanztomographie (MRT). Für die RFA stehen derzeit verschiedene monopolare und ein bipolares System zur Verfügung, für die LITT zwei differente Techniken. Eigene Kollektive für die perkutane CT-gesteuerte RFA (20 Patienten, 32 Metastasen) und die LITT (24 Patienten, 34 Metastasen) bei inoperablen Patienten mit Metastasen ≤ 5 cm Durchmesser und einer Anzahl bis 3 Metastasen pro Lunge werden vorgestellt. Alle Patienten wurden ambulant in Analgosedierung behandelt. Ergebnisse: Sowohl RFA als auch LITT wurden in allen Fällen von den Patienten in Lokalanästhesie gut toleriert. Die Pneumothoraxrate betrug 15 % (5/32 Prozeduren) und 12 % (4/34 Prozeduren) bei der LITT, ohne Drainageindikation. Bei allen RFA-Ablationen konnte ein kompletter „roll off” (Anstieg der Impedanz) erzielt werden. Ergebnisse der lokalen Tumorkontrolle von RFA und LITT: Die lokale Tumorkontrollrate für die RFA-Prozeduren in der 6-Monatsverlaufskontrolle betrug 85 %, und vergleichbar die für die LITT 91 %.19 der 20 RFA-Patienten sind noch am Leben, ein Patient starb an seiner progredienten Metastasierung. Schlussfolgerung: Die perkutane pulmonale RFA und die LITT ermöglichen eine lokale Tumordestruktion von Lungenmetastasen bei geringer Komplikationsrate und zufrieden stellender Tumorkontrollrate.
Abstract
Purpose: Evaluation of technical aspects, local efficiency and complications of thermoablative procedures, such as radiofrequency ablation (RFA) and laser-induced thermotherapy (LITT), in percutaneous lung metastases. Materials and Methods: Techniques of thermal ablative procedures of RFA and LITT are presented. For primary positioning, monitoring and therapy control, computed tomography (CT) or magnetic resonance imaging (MRI) was performed. Different monopolar systems and one bipolar system were available for RFA and two different cooling systems for LITT. Percutaneous CT-guided RFA was performed on 32 metastases in 20 patients and percutaneous LITT on 34 metastases in 24 patients. Inclusion criteria were metastases ≤ 5 cm in diameter in unresectable patients with up to 3 metastases per lung. All treatments were performed on outpatient basis using analgosedation. Results: In our patient group, all patients tolerated both the RFA and LITT procedures well with mild sedation. The pneumothorax rate was 15 % (5/32 procedures) for the RFA group and 12 % (4/34 procedures) for the LITT group, without insertion of a chest tube. In all RF ablations, a complete “roll off” (increase in impedance) was achieved. Local tumor control rate in the 6-month follow-up was 85 % for RFA and 91 % for LITT. Nineteen of the 20 patients treated are still alive, one patient died from tumor progression. Conclusion: Both pulmonary RFA and LITT allow safe thermal ablation of pulmon arg metastases with a low complication rate and an acceptable tumor control rate.
Key words
Radiofrequency - LITT - RFA - metastases - lung - interventional - laser
Literatur
- 1 Amin Z, Bown S G, Lees W R. Local treatment of colorectal liver metastases: a comparison of interstitial laser photocoagulation (ILP) and percutaneous alcohol injection (PAI). Clin Radiol. 1993; 48 166-171
- 2 Anzai Y, Lufkin R B, Saxton R E. et al . Nd: YAG interstitial laser phototherapy guided by magnetic resonance imaging in an ex vivo model: dosimetry of laser-MR-tissue interaction. Laryngoscope. 1991; 101 755-760
- 3 Buscarini L, Rossi S, Fornari F. et al . Laparoscopic ablation of liver adenoma by radiofrequency electrocauthery. Gastrointest Endosc. 1995; 41 68-70
- 4 Castro D J, Lufkin R B, Saxton R E. et al . Metastatic head and neck malignancy treated using MRI guided interstitial laser phototherapy: an initial case report. Laryngoscope. 1992; 102 26-32
- 5 Curley S, Izzo F, Delrio P. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients. Ann Surg. 1999; 230 1-8
- 6 Gazelle G, Goldberg S, Solbiati L. et al . Tumor ablation with radiofrequency energy. Radiology. 2002; 217 633-646
- 7 Goldberg S N, Solbiati L, Hahn P. et al . 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
- 8 Goldberg S. Radiofrequency tumor ablation: principles and techniques. Ultrasound. 2001; 13 129-147
- 9 Izzo F, Barnett C C Jr, Curley S A. Radiofrequency ablation of primary and metastatic malignant liver tumors. Adv Surg. 2001; 35 225-250
- 10 Kahn T, Bettag M, Harth T. et al . Laser-induced interstitial induced hyperthermia of cerebral tumors with nuclear magnetic resonance tomography control. Radiologe. 1996; 36 713-721
- 11 Lencioni R A, Allgaier H P, Cioni D. et al . Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology. 2003; 228 235-240
- 12 Lewin J S, Connell C F, Duerk J L. et al . Interactive MRI-Guided Radiofrequency Interstitial Thermal Ablation of Abdominal Tumors: Clinical Trial for Evaluation of Safaty and Feasibility. JMRI. 1998; 8 40-47
- 13 Livraghi T, Solbiati L, Meloni F. et al . Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the „test-of-time approach”. Cancer. 2003; 97 3027-3035
- 14 Masters A, Steger A C, Lees W R. et al . Interstitial laser hyperthermia: a new approach for treating liver metastases. Br J Cancer. 1992; 66 518-522
- 15 Pacella C M, Bizzarri G, Cecconi P. et al . Hepatocellular Carcinoma: Long-term Results of Combined Treatment with Laser Thermal Ablation and Transcatheter Arterial Chemoembolization. Radiology. 2001; 219 669-678
- 16 Pereira P L, Trubenbach J, Schmidt D. [Radiofrequency ablation: basic principles, techniques and challenges]. Fortschr Röntgenstr. 2003; 175 20-27
- 17 Reither K, Wacker F, Ritz J. et al . Laserinduzierte Thermotherapie (LITT) von Lebermetastasen in einem offenen 0.2T MRT. Fortschr Röntgenstr. 2000; 172 175-178
- 18 Solbiati L, Livraghi T, Goldberg S. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology. 2001; 221 159-166
- 19 Yamakado K, Nakatsuka A, Ohmori S. et al . Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology. J Vasc Interv Radiol. 2002; 13 1225-1232
- 20 Germer C, Isbert C, Albrecht D. et al . Laser-induced thermotherapy for the treatment of liver metastasis. Correlation of gadolinium-DTPA-enhanced MRI with histomorphologic findings to determine criteria for follow-up monitoring. Surg Endosc. 1998; 12 1317-1325
- 21 Mack M, Vogl T. MR-guided ablation of head and neck tumors. Magn Reson Imaging Clin N Am. 2002; 10 707-713
- 22 Mack M G, Straub R, Eichler K. et al . MR-guided laser-induced thermotherapy in recurrent extrahepatic abdominal tumors. Eur Radiol. 2001; 11 2041-2046
- 23 Puls R, Stroszczynski C, Gaffke G. et al . Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit. J Magn Reson Imaging. 2003; 17 663-670
- 24 Reimer P, Bremer C, Horch C. et al . MR-Monitored LITT as a Palliative Concept in Patients with High Grade Gliomas: Preliminary Clinical Experience. JMRI. 1998; 8 240-244
- 25 Vogl T, Mack M, Straub R. et al . MR-guided laser-induced thermotherapy of the infratemporal fossa and orbit in malignant chondrosarcoma via a modified technique. Cardiovasc Intervent Radiol. 2001; 24 432-435
- 26 Vogl T, Straub R, Eichler K. et al . Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy - local tumor control rate and survival data. Radiology. 2004; 230 450-458
- 27 Wiedemann G, Feyerabend T. Ist die laserinduzierte Thermotherapie (LITT) bei Tumorerkrankungen angezeigt?. Dtsch Med Wochenschr. 2002; 127 286
- 28 Lee J, Jin G, Goldberg S. et al . Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report. Radiology. 2004; 230 125-134
- 29 Dupuy D, Mayo-Smith W, Abbott G. et al . Clinical applications of radio-frequency tumor ablation in the thorax. Radiographics. 2002; 22 (Spec. No) S259-S269
- 30 Dupuy D, Zagoria R, Akerley W. et al . Percutaneous radiofrequency ablation of malignancies in the lung. AJR. 2000; 174 (1) 57-59
- 31 Herrera L, Fernando H, Perry Y. et al . Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates. J Thorac Cardiovasc Surg. 2003; 125 929-937
- 32 Hosten N, Stier A, Weigel C. et al . Laser-induzierte Thermotherapie (LITT) von Lungenmetastasen: Beschreibung eines miniaturisierten Applikators, Optimierung und erste Patientenbehandlungen. Fortschr Röntgenstr. 2003; 175 393-400
- 33 Nishida T, Inoue K, Kawata Y. et al . Percutaneous radiofrequency ablation of lung neoplasms: a minimally invasiv strategy for inoperable patients. J Am Coll Surg. 2002; 195 (3) 426-430
- 34 Schaefer O, Lohrmann C, Ghanem N. et al . CT-guided radiofrequency heat ablation of malignant lung tumors. Med Sci Monit. 2003; 9 127-131
- 35 Steinke K, Glenn D, King J. et al . Percutaneous pulmonary radiofrequency ablation: difficulty achieving complete ablations in big lung lesions. Br J Radiol. 2003; 76 742-745
- 36 Steinke K, Habicht J, Thomsen S. et al . CT-guided radiofrequency ablation of a pulmonary metastasis followed by surgical resection. Cardiovasc Intervent Radiol. 2002; 25 543-546
- 37 Thanos L, Mylona S, Pomoni M. et al . Primary lung cancer: treatment with radio-frequency thermal ablation. Eur Radiol. 2003; 14 897-901
- 38 Roberts H RS, Paley M, Sams V R. et al . Magnetic Resonance Imaging control of laser destruction of hepatic metastases: correlation with post-operative helical CT. Min Invas Ther & Allied Technol. 1997; 6 53-64
- 39 Pushek T, Farahani K, Saxton R E. et al . Dynamic MRI-guided interstitial laser therapy: a new technique for minimally invasive surgery. Laryngoscope. 1995; 105 1245-1252
- 40 Pacella C, Bizzarri G, Magnolfi F. et al . Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients. Radiology. 2001; 221 712-720
- 41 Müller-Lisse G U, Heuck A, Stehling M K. et al . MRT-Monitoring vor, während und nach der interstitiellen laserinduzierten Thermotherapie der benignen Prostatahyperplasie. Erste klinische Erfahrungen. Radiologe. 1996; 36 722-731
- 42 Jolesz F A, Bleier A R, Jakab P. et al . MR imaging of laser-tissue interactions. Radiology. 1988; 168 249-253
- 43 Fried M P, Morrison P R, Hushek S G. et al . Dynamic T1-weighted magnetic resonance imaging of interstitial laser photocoagulation in the liver: observations on in vivo temperature sensitivity. Lasers Surg Med. 1996; 18 410-419
- 44 Castro D J, Saxton R E, Layfield L J. et al . Interstitial laser phototherapy assisted by magnetic resonance imaging: a new technique for monitoring laser-tissue interaction. Laryngoscope. 1990; 100 541-547
- 45 Anzai Y, Lufkin R B, Hirschowitz S. et al . MR imaging-histopathologic correlation of thermal injuries induced with interstitial Nd:YAG laser irradiation in the chronic model. J Magn Reson Imaging. 1992; 2 671-678
- 46 Baron O, Amini M, Duveau D. et al . Surgical resection of pulmonary metastases from colorectal carcinoma. Eur J Cardiothorc Surg. 1996; 10 347-351
- 47 Davidson R, Nwogu C, Brentjens M. et al . The surgical management of pulmonary metastasis: current concepts. Surg Oncol. 2001; 10 35-42
- 48 Friedel G, Pastorino U, McCormack P. et al . Resektion von Lungenmetastasen, Langzeitresultate prognostischer Faktoren auf der Basis von 5206 Fällen - The international Registry of Lung Metastases. Zentralbl Chir. 1999; 124 96-103
- 49 McCormack P, Burt M, Bains M. et al . Lung resection for colorectal metastases: 10-year results. Arch Surg. 1992; 127 1403-1406
- 50 McCormack P, Attizeh F. Resected pulmonary metastases from colorectal cancer. Dis Colon Rectum. 1979; 22 553-556
- 51 Pfannschmidt J, Muley T, Hoffmann H. et al . Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients. J Thorac Cardiovasc Surg. 2003; 126 (3) 732-739
- 52 Saito Y, Omiya H, Kohno K. et al . Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment. J Thorac Cardiovasc Surg. 2002; 124 (5) 1007-1013
- 53 Yano T, Fukuyama Y, Yokoyama H. Failure in resection of multiple pulmonary metastases from colorectal cancer. J Am Coll Surg. 1997; 185 120-122
- 54 Zanella A, Marchet A, Mainente P. et al . Resection of pulmonary metastases from colorectal carcinoma. Eur J Surg Oncol. 1997; 23 424-427
- 55 Shaham D. Semi-invasive and invasive procedures for the diagnosis amd staging of lung cancer I: Percutaneous transthoracic needle biopsy. Radiol Clin N America. 2000; 38 525-534
- 56 Landreneau R, DeGiacomo T, Mack M. et al . Therapeutic video-assisted thorascopic surgical resection of coloretal pulmonary metastases. Eur J Cardiothorc Surg. 2000; 18 (6) 671-677
- 57 Inoue M, Kotake Y, Nakagawa K. Surgery for pulmonary metastases from colorectal carcinoma. Ann Thorax Surg. 2000; 70 380-383
- 58 Selzner M, Morse M, Vredenburgh J. et al . Liver metastases from breast cancer: long-term survival after curative resection. Surgery. 2000; 127 383-389
- 59 Suh R, Wallace A, Sheehan R. et al . Unresectable Pulmonary Malignancies: CT-guided Percutaneous Radiofrequency Ablation - Preliminary Results. Radiology. 2003; 229 821-829
- 60 Zagoria R, Chen M, Kavanagh P. et al . Radiofrequency ablation of lung metastases from renal cell carcinoma. J Urol. 2001; 166 (5) 1827-1828
- 61 Brookes J, Lees W, Bown S. Interstitial laser photocoagulation for the treatment of lung cancer. AJR. 1997; 168 (2) 357-358
- 62 Dupuy D, Goldberg S. Image-guided radiofrequency tumor ablation: challenges and opportunities - part II. J Vasc Interv Radiol. 2001; 1135-1148
- 63 Schaefer O, Lohrmann C, Langer M. CT-guided radiofrequency ablation of a bronchogenic carcinoma. Br J Radiol. 2003; 76 268-270
- 64 Steinke K, King J, Glenn D. et al . Radiologic appearance and complications of percutaneous computed tomography-guided radiofrequency-ablated pulmonary metastases from colorectal carcinoma. J Comput Assist Tomogr. 2003; 27 750-757
- 65 Goldberg S, Charboneau J, Dodd G. et al . Image-guided tumor ablation: proposal for standardization of terms and reporting criteria. Radiology. 2003; 228 335-345
- 66 Lee J, Jin G, Li C. et al . Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility, safety, and effectiveness. Invest Radiol. 2003; 38 129-139
- 67 Lee J M, Kim S W, Chung G H. et al . Open radio-frequency thermal ablation of renal VX2 tumors in a rabbit model using a cooled-tip electrode: feasibility, safety, and effectiveness. Eur Radiol. 2003; 13 1324-1332
- 68 Goldberg S, Gazelle G, Sompton C. Radiofrequency ablation of VX2 tumor nodules in the rabbit lung. Acad Radiol. 1996; 3 929-935
- 69 Goldberg S, Gazelle G, Sompton C. et al . Radiofrequency tissue ablation in the rabbit lung: Efficacy and complications. Acad Radiol. 1995; 2 776-784
- 70 Sewell P, Jackson M, Vance R. et al . Assessing radiofrequency ablation of non-small cell lung cancer with positron emission tomography (PET). Radiology. 2000; 217 (Suppl.) 551
- 71 Vaughn C, Mychaskiw G, Sewell P. Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm. Anesth Analg. 2002; 94 1149-1151
- 72 Rose S, Fotoohi M, Levin D. et al . Cerebral microembolization during radiofrequency ablation of lung malignancies. J Vasc Interv Radiol. 2002; 13 1051-1054
Prof. Dr. med. Thomas J. Vogl
Institut für Diagnostische und Interventionelle Radiologie, J. W. Goethe-Universität Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt
Phone: 0 69/63 01-72 77
Fax: 0 69/63 01-72 58
Email: T.Vogl@em.uni-frankfurt.de