Radiofrequenzablation der Leber – eine aktuelle Übersicht

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.

Key words

radiofrequency - colorectal liver metastases - hepatocellular carcinoma - outcome - approach

Literatur

• 1 Goldberg S N, Gazelle G S, Compton C C et al. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation.  Cancer. 2000;  88 2452-2463
• 2 Goldberg S N, Gazelle G S, Mueller P R. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance.  Am J Roentgenol. 2000;  174 323-331
• 3 Goldberg S N, Gazelle G S, Dawson S L et al. Tissue ablation with radiofrequency using multiprobe arrays.  Acad Radiol. 1995;  2 670-674
• 4 Mulier S, Miao Y, Mulier P et al. Electrodes and multiple electrode systems for radiofrequency ablation: a proposal for updated terminology.  Eur Radiol. 2005;  15 798-808
• 5 Chen M S, Li J Q, Zheng Y et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma.  Ann Surg. 2006;  243 321-328
• 6 Lu M D, Kuang M, Liang L J et al. Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial.  Zhonghua Yi Xue Za Zhi. 2006;  86 801-805 (Chinese)
• 7 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
• 8 Lin S M, Lin C J, Lin C C et al. Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less.  Gut. 2005;  54 1151-1156
• 9 Shiina S, Teratani T, Obi S et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma.  Gastroenterology. 2005;  129 122-130
• 10 Lencioni R, Cioni D, Crocetti L et al. Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation.  Radiology. 2005;  234 961-967
• 11 Buscarini L, Buscarini E, Di Stasi M et al. Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results.  Eur Radiol. 2001;  11 914-921
• 12 Choi D, Lim H K, Kim M J et al. Recurrent hepatocellular carcinoma: percutaneous radiofrequency ablation after hepatectomy.  Radiology. 2004;  230 135-141
• 13 Tateishi R, Shiina S, Teratani T et al. Percutaneous radiofrequency ablation for hepatocellular carcinoma. An analysis of 1000 cases.  Cancer. 2005;  103 1201-1209
• 14 Porrett P M, Peterman H, Rosen M et al. Lack of benefit of pre-transplant locoregional hepatic therapy for hepatocellular cancer in the current MELD era.  Liver Transpl. 2006;  12 665-673
• 15 Abdalla E K, Vauthey J N, Ellis L M et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases.  Ann Surg. 2004;  239 818-825
• 16 Aldrighetti L, Castoldi R, Di Palo S et al. Prognostic factors for long-term outcome of hepatic resection for colorectal liver metastases.  Chir Ital. 2005;  57 555-570 (Italian)
• 17 Aloia T A, Vauthey J N, Loyer E M et al. Solitary colorectal liver metastasis: resection determines outcome.  Arch Surg. 2006;  141 460-466
• 18 Simmonds P C, Primrose J N, Colquitt J L et al. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies.  Br J Cancer. 2006;  94 982-999
• 19 Mulier S, Ni Y, Jamart J et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial?.  Ann Surg Oncol. 2008;  15 144-157
• 20 Stang A, Fischbach R, Teichmann W et al. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases.  J Cancer. 2009;  45 1748-1756
• 21 Reuter N P, Woodall C E, Scoggins C R et al. Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent?.  J Gastrointest Surg. 2009;  13 486-491
• 22 Curley S A. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial?.  Ann Surg Oncol. 2008;  15 11-13
• 23 Meijer V E, Ijzermans J N, Verhoef de C. A place for radiofrequency ablation in the treatment of resectable colorectal liver metastases?.  Ann Surg Oncol. 2008;  15 2063
• 24 Gillams A R, Lees W R. Five-year survival following radiofrequency ablation of small, solitary, hepatic colorectal metastases.  J Vasc Interv Radiol. 2008;  19 712-717
• 25 Gillams A R, Lees W R. Radiofrequency ablation of colorectal liver metastases in 167 patients.  Eur Radiol. 2004;  14 2261-2267
• 26 Pereira P L, Clasen S, Hoffmann R T et al. Long-term survival after CT- and MR-guided percutaneous radiofrequency ablation of colorectal metastases: clinical results of the German Study Group. Paper presented at: Radiological Society of North America, 92nd Scientific Assembly and Annual Meeting; November 26 – December 1, 2006 Chicago, IL;
• 27 Lawes D, Chopada A, Gillams A et al. Radiofrequency ablation (RFA) as a cytoreductive strategy for hepatic metastasis from breast cancer.  Ann R Coll Surg Engl. 2006;  88 639-642
• 28 Berber E, Flesher N, Sieperstein A E. Laparoscopic radiofrequency ablation of neuroendocrine liver metastasis.  World J Surg. 2002;  26 985-990
• 29 Bathe O, Kaklamanos I G, Moffat F L et al. Metastasectomy as a cytoreductive strategy for treatment of isolated pulmonary and hepatic metastases from breast cancer.  Surg Oncol. 1999;  8 35-42
• 30 Vogl T J, 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
• 31 Puls R, Langner S, Rosenberg C et al. Laser ablation of liver metastases from colorectal cancer with MR thermometry: 5-year survival.  J Vasc Interv Radiol. 2009;  20 225-234
• 32 Mack M G, Straub R, Eichler K et al. Breast cancer metastases in liver: laser-induced interstitial thermotherapy – local tumor control rate and survival data.  Radiology. 2004;  233 400-409
• 33 Wright A S, Sampson L A, Warner T F et al. Radiofrequency versus microwave ablation in a hepatic porcine model.  Radiology. 2005;  236 132-139
• 34 Morita T, Shibata T, Okuyama M et al. Microwave coagulation therapy for liver metastases from colorectal cancer.  Gan To Kagaku Ryoho. 2004;  31 695-699
• 35 Dong B, Liang P, Yu X et al. Percutaneous sonographically guided microwave coagulation therapy for hepatocellular carcinoma: results in 234 patients.  Am J Roentgenol. 2003;  180 1547-1555
• 36 Liang P, Dong B, Yu X et al. Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation.  Radiology. 2005;  235 299-307
• 37 Xu K C, Niu L Z, Zhou Q et al. Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma.  World J Gastroenterol. 2009;  15 3664-3669
• 38 Livraghi T, Solbiati L, Meloni M F et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study.  Radiology. 2003;  226 441-451
• 39 Elias D, Sideris L, Pocard M et al. Incidence of unsuspected and treatable metastatic disease associated with operable colorectal liver metastases discovered only at laparotomy (and not treated when performing percutaneous radiofrequency ablation).  Ann Surg Oncol. 2005;  12 298-302
• 40 Mulier S, Ni Y, Jamart J et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors.  Ann Surg. 2005;  242 158-171
• 41 Hubert C, Gras J, Goffette P et al. Percutaneous and surgical radiofrequency ablation of liver malignancies: a single institutional experience.  Acta Gastroenterol Belg. 2007;  70 188-194
• 42 Wong S L, Manug P B, MA C hoti et al. American Society of Clinical Oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases of colorectal cancer.  J Clin Oncol. 2009;  28 493-508
• 43 Bartolotta T V, Taibbi A, Midiri M et al. Focal liver lesions: contrast-enhanced ultrasound.  Abdom Imaging. 2009;  34 193-209
• 44 Meloni M F, Livraghi T, Filice C et al. Radiofrequency ablation of liver tumors: the role of microbubble ultrasound contrast agents.  Ultrasound Q. 2006;  22 41-47
• 45 Becker H C, Meissner O, Waggershauser T. C-Bogen CT-unterstützte 3D Navigation perkutaner Interventionen.  Radiologe. 2009;  49 852-855
• 46 Morimoto M, Numata K, Kondo M et al. C-arm cone beam CT for hepatic tumor ablation under real-time 3D imaging.  Am J Roentgenol. 2010;  194 W452-W454
• 47 Lee S S, Park S H, Kim J K et al. Percutaneous radiofrequency ablation of small hepatocellular carcinoma invisible on both ultrasonography and unenhanced CT: a preliminary study of combined treatment with transarterial chemoembolisation.  Eur Radiol. 2009;  19 1951-1959
• 48 Jung E M, Schreyer A G, Schacherer D et al. New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results.  Clin Hemorheol Microcirc. 2009;  43 57-69
• 49 Clasen S, Pereira P L. Magnetic resonance guidance for radiofrequency ablation of liver tumors.  J Magn Reson Imaging. 2008;  27 421-433
• 50 Senneville B D, Mougenot de C, Quesson B et al. MR thermometry for monitoring tumor ablation.  Eur Radiol. 2007;  17 2401-2410
• 51 Möller P H, Ivarsson K, Stenram U et al. Comparison between interstitial laser thermotherapy and excision of an adenocarcinoma transplanted into rat liver.  Br J Cancer. 1998;  77 1884-1892
• 52 Harun N, Nikfarjam M, Muralidharan V J et al. Liver regeneration stimulates tumor metastases.  Surg Res. 2007;  138 284-290
• 53 Breitenbuch von P, Köhl G, Guba M et al. Thermoablation of colorectal liver metastases promotes proliferation of residual intrahepatic neoplastic cells.  Surgery. 2005;  138 882-887
• 54 Meredith K, Haemmerich D, Qi C et al. Hepatic resection but not radiofrequency ablation results in tumor growth and increased growth factor expression.  Ann Surg. 2007;  245 771-276
• 55 Wagenaar-Miller R A, Gorden L, Matrisian L M. Matrix metalloproteinases in colorectal cancer: is it worth talking about?.  Cancer Metastasis Rev. 2004;  23 119-135
• 56 Schueller G, Kettenbach J, Sedivy R et al. Heat shock protein expression induced by percutaneous radiofrequency ablation of hepatocellular carcinoma in vivo.  Int J Oncol. 2004;  24 609-611
• 57 Ciocca D R, Clark G M, Tandon A K et al. Heat shock protein hsp70 in patients with axillary lymph node-negative breast cancer: prognostic implications.  J Natl Cancer Inst. 1993;  85 570-574
• 58 Wissniowski T T, Hänsler J, Neureiter D et al. Activation of tumor-specific T lymphocytes by radio-frequency ablation of the VX 2 hepatoma in rabbits.  Cancer Res. 2003;  63 6496-6500
• 59 Zerbini A, Pilli M, Penna A et al. Radiofrequency thermal ablation of hepatocellular carcinoma liver nodules can activate and enhance tumor-specific T-cell responses.  Cancer Res. 2006;  66 1139-1146
• 60 Mazzaferro V, Battiston C, Perrone S et al. Radiofrequency ablation of small hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation: a prospective study.  Ann Surg. 2004;  240 900-909
• 61 Stippel D L, Brochhagen H G, Arenja M et al. Variability of size and shape of necrosis induced by radiofrequency ablation in human livers: a volumetric evaluation.  Ann Surg Oncol. 2004;  11 420-425
• 62 Blussé van Oud-Alblas M, Fioole B, Jansen M C et al. Radiofrequency ablation of colorectal metastases to the liver: results since the first application in the Netherlands.  Ned Tijdschr Geneeskd. 2008;  152 880-886
• 63 Mulier S, Ni Y, Miao Y et al. Size and geometry of hepatic radiofrequency lesions.  Eur J Surg Oncol. 2003;  29 867-878
• 64 Bangard C, Rösgen S, Wahba R et al. Large-volume multi-tined expandable RF ablation in pig livers: comparison of 2D and volumetric measurements of the ablation zone.  Eur Radiol. 2010;  20 1073-1078
• 65 Hirakawa M, Ikeda K, Kawamura Y et al. New ablation procedure for a radiofrequency liver tissue coagulation system using an expandable needle.  Liver Int. 2008;  28 214-219
• 66 Appelbaum L, Sosna J, Pearson R et al. Algorithm optimization for multitined radiofrequency ablation: comparative study in ex vivo and in vivo bovine liver.  Radiology. 2010;  254 430-440
• 67 Pereira P L, Trübenbach J, Schmidt D. Radiofrequenzablation: Grundlagen, Techniken und Herausforderungen.  Fortschr Röntgenstr. 2003;  175 20-27
• 68 Cha J, Choi D, Lee M W et al. Radiofrequency ablation zones in ex vivo bovine and in vivo porcine livers: comparison of the use of internally cooled electrodes and internally cooled wet electrodes.  Cardiovasc Intervent Radiol. 2009;  32 1235-1240
• 69 Schmidt D, Clasen S, Boss A et al. Comparison of a single perfusion device and an internally cooled cluster device: laboratory experience in ex vivo liver tissue with longer duration of energy application.  J Vasc Interv Radiol. 2009;  20 524-531
• 70 Seror O, N’Kontchou G, Tin-Tin-Htar M et al. Radiofrequency ablation with internally cooled versus perfused electrodes for the treatment of small hepatocellular carcinoma in patients with cirrhosis.  J Vasc Interv Radiol. 2008;  19 718-724
• 71 Tacke J, Mahnken A, Roggan A et al. Multipolar radiofrequency ablation: first clinical results.  Fortschr Röntgenstr. 2004;  176 324-329
• 72 Frericks B B, Ritz J P, Roggan A et al. Multipolar radiofrequency ablation of hepatic tumors: initial experience.  Radiology. 2005;  237 1056-1062
• 73 Bruners P, Schmitz-Rode T, Günther R W et al. Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results.  Fortschr Röntgenstr. 2008;  180 216-222
• 74 Stippel D L, Bangard C, Prenzel K et al. Which parameters are needed for targeting a multitined radiofrequency device--an approach to a simple algorithm.  Langenbecks Arch Surg. 2009;  394 671-679
• 75 Goldberg S N, Hahn P F, Tanabe K K et al. Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?.  J Vasc Interv Radiol. 1998;  9 101-111
• 76 Bangard C, Gossmann A, Kasper H U et al. Experimental radiofrequency ablation near the portal and the hepatic veins in pigs: differences in efficacy of a monopolar ablation system.  J Surg Res. 2006;  135 113-119
• 77 Frericks B B, Ritz J P, Albrecht T et al. Influence of intrahepatic vessels on volume and shape of percutaneous thermal ablation zones: in vivo evaluation in a porcine model.  Invest Radiol. 2008;  43 211-218
• 78 Rossi S, Garbagnati F, Lencioni R et al. Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply.  Radiology. 2000;  217 119-126
• 79 Baere de T, Deschamps F, Briggs P et al. Hepatic malignancies: percutaneous radiofrequency ablation during percutaneous portal or hepatic vein occlusion.  Radiology. 2008;  248 1056-1066
• 80 Veltri A, Moretto P, Doriguzzi A et al. Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC).  Eur Radiol. 2006;  16 661-669
• 81 Jaskolka J D, Asch M R, Kachura J R et al. Needle tract seeding after radiofrequency ablation of hepatic tumors.  J Vasc Interv Radiol. 2005;  16 485-491
• 82 Kim S H, Lim H K, Choi D et al. Changes in bile ducts after radiofrequency ablation of hepatocellular carcinoma: frequency and clinical significance.  Am J Roentgenol. 2004;  183 1611-1617
• 83 Stippel D L, Bangard C, Kasper H U et al. Experimental bile duct protection by intraductal cooling during radiofrequency ablation.  Br J Surg. 2005;  92 849-855
• 84 Elias D, Sideris L, Pocard M et al. Intraductal cooling of the main bile ducts during radiofrequency ablation prevents biliary stenosis.  J Am Coll Surg. 2004;  198 717-721
• 85 Ogawa T, Kawamoto H, Kobayashi Y et al. Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube.  Eur J Radiol. 2010;  73 385-390
• 86 Yamakado K, Nakatsuka A, Akeboshi M et al. Percutaneous radiofrequency ablation of liver neoplasms adjacent to the gastrointestinal tract after balloon catheter interposition.  J Vasc Interv Radiol. 2003;  14 1183-1186
• 87 Hinshaw J L, Laeseke P F, Winter 3 rd T C et al. Radiofrequency ablation of peripheral liver tumors: intraperitoneal 5 % dextrose in water decreases postprocedural pain.  Am J Roentgenol. 2006;  186 S306-S310