Die Radiofrequenzablation in der Behandlung von kolorektalen Lebermetastasen: Was ist belegt?

Zusammenfassung

Die Indikationsstellung zur Radiofrequenzablation (RFA) kolorektaler Lebermetastasen wurde in der Vergangenheit sehr uneinheitlich gehandhabt. Entsprechend inhomogen waren die berichteten Ergebnisse mit einem 5-Jahres-Überleben zwischen 17 und 48 %. Potenziell können zwischen 3 und 5 % aller Patienten mit kolorektalen Lebermetastasen einer RFA zugeführt werden. Als Grenzwerte für Größe und Anzahl der Metastasen eignet sich heute die sogenannte Dreierregel (nicht mehr als 3 Metastasen, keine davon > 3 cm). Unumstrittene Indikationen bleiben irresektable Lebertumoren aufgrund Anzahl, Lokalisation, Verteilungsmuster der Metastasen oder fehlender funktioneller Reserve der Leber. Die Nähe zu großen Gefäßen ist durch die heute deutlich liberaleren Resektabilitätskriterien kein eindeutiges Irresektabilitätskriterium mehr und darüber hinaus wegen konvektiven Temperaturverlusts ein Risikofaktor für eine nicht ausreichend radikale Thermoablation, wobei dieses Argument derzeit kontrovers diskutiert wird, da eine klinisch eindeutige Evidenz dafür in der Literatur fehlt. Als kurative Alternative zur Resektion kann die RFA nur im Rahmen offen-chirurgischer (oder laparoskopischer) Eingriffe bei Patienten gelten, die ein erhöhtes Morbiditäts- oder Rezidivrisiko aufweisen. Unbedingt ist die Einbindung der RFA in ein onkologisches Gesamtbehandlungskonzept zu fordern; dabei ist eher zur rechtzeitigen RFA mit einer nachfolgenden Chemotherapie als zur alleinigen Chemotherapie oder zur ausschließlichen RFA ohne oder nach einer Chemotherapie zu raten.

Abstract

Radiofrequency ablation (RFA) of colorectal liver metastases is frequently reported, but, however, lacks clear criteria for indication and reliable, convincing results with 5-year survival ranging from 17 to 48 %. RFA may be the appropriate treatment modality in approximately 3 to 5 % of all patients suffering from colorectal liver metastases. To date, RFA seems to be limited to no more than three metastases, each smaller than 3 cm. The main indication remains irresectability due to number, site, distribution and/or marginal liver function. Tumours in the vicinity of larger vessels (predominantly branches of portal or hepatic veins) are a case for controversy, since advances in hepatobiliary surgery enable a proportion of patients to undergo resections which would have been declared irresectable until most recently, and the oncological value of a thermoablation is questioned, as a certain amount of temperature is lost due to convective heat sinks. RFA is not a curative alternative to hepatic resection unless small tumours appear during open or laparoscopic procedures in a patient with elevated risk for early recurrence or postoperative morbidity following liver resection. The inclusion of RFA into a holistic system of oncological therapy is mandatory. Early RFA followed by systemic (regional?) chemotherapy can rather be recommended than chemo only, RFA only or first-line chemo with subsequent RFA.

Schlüsselwörter

lokale Tumorablation - Lebermetastase - Leberchirurgie - Indikation - kolorektales Karzinom

Key words

local tumour ablation - liver metastasis - liver surgery - indication - colorectal carcinoma

• Literatur:

• 1 Deutsche Krebsgesellschaft (DKG). Krebshäufigkeit – die aktuellen Zahlen (Quelle: Robert Koch-Institut, Hrsg. Krebs in Deutschland – Häufigkeiten und Trends, 8. Ausg. 2012). Im Internet: http://www.krebsgesellschaft.de/krebshaeufigkeit,11267.html Stand: 14.03.2012
• 2 Kanas GP, Taylor A, Primrose JN et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012; 4: 283-301
• 3 Pereira PL. Actual role of radiofrequency ablation of liver metastases. Eur Radiol 2007; 17: 2062-2070
• 4 Neumann UP, Seehofer D, Neuhaus P. The surgical treatment of hepatic metastases in colorectal carcinoma. Dtsch Arztebl Int 2010; 107: 335-342
• 5 Adam R, Delvart V, Pascal G et al. Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 2004; 240: 644-657 discussion 657–658
• 6 Al-Asfoor A, Fedorowicz Z, Lodge M. Resection versus no intervention or other surgical interventions for colorectal cancer liver metastases. Cochrane Database Syst Rev 2008; (2) CD006039
• 7 Cirocchi R, Trastulli S, Boselli C et al. Radiofrequency ablation in the treatment of liver metastases from colorectal cancer. Cochrane Database Syst Rev 2012; (6) CD006317
• 8 rgb Onkologisches Management GmbH. Publikationen des Jahrestreffens der Projektgruppe Internistische Onkologie 2012 (31.03.2012). Im Internet: http://www.rgb-onkologie.de/images/doc/pu/2012/2012-03-31-10_00-pio-meyer.pdf Stand: 31.03.2012
• 9 Mantke R, Niepmann D, Gastinger I et al. Kurative und diagnostische Resektionen an der Leber. Chirurg 2006; 77: 1135-1143
• 10 Birth M, Hildebrand P, Dahmen G et al. Aktueller Stand der Radiofrequenzablation von Lebertumoren. Chirurg 2004; 75: 417-423
• 11 Sutherland LM, Williams JA, Padbury RT et al. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 2006; 141: 181-190
• 12 McGrane S, McSweeney SE, Maher MM. Which patients will benefit from percutaneous radiofrequency ablation of colorectal liver metastases? Critically appraised topic. Abdom Imaging 2008; 33: 48-53
• 13 Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 2005; 30: 419-426
• 14 Salkeld G, Solomon M, Short L et al. A matter of trust – patientʼs views on decision-making in colorectal cancer. Health Expect 2004; 7: 104-114
• 15 Heinrich S, Lang H. Liver metastases from colorectal cancer: Technique of liver resection. J Surg Oncol 2013; 107: 579-584
• 16 Solbiati L, Ahmed M, Cova L et al. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology 2012; 265: 958-968
• 17 Oshowo A, Gillams A, Harrison E et al. Comparison of resection and radiofrequency ablation for treatment of solitary colorectal liver metastases. Br J Surg 2003; 90: 1240-1243
• 18 Machi J, Uchida S, Sumida K et al. Ultrasound-guided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches. J Gastrointest Surg 2001; 5: 477-489
• 19 Joosten J, Jager G, Oyen W et al. Cryosurgery and radiofrequency ablation for unresectable colorectal liver metastases. Eur J Surg Oncol 2005; 31: 1152-1159
• 20 Lu DS, Raman SS, Limanond P et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14: 1267-1274
• 21 Thanos L, Mylona S, Galani P et al. Overcoming the heat-sink phenomenon: Successful radiofrequency thermal ablation of liver tumors in contact with blood vessels. Diagn Interv Radiol 2008; 14: 51-56
• 22 Wong SL, Mangu PB, Choti MA et al. American society of clinical oncology 2009 clinical evidence review on radiofrequency ablation of hepatic metastases from colorectal cancer. J Clin Oncol 2010; 28: 493-508
• 23 Siperstein AE, Berber E, Ballem N et al. Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 2007; 246: 559-565
• 24 Veltri A, Guarneri T, Gazzera C et al. Long-term outcome of radiofrequency thermal ablation (RFA) of liver metastases from colorectal cancer (CRC): size as the leading prognostic factor for survival. Radiol Med 2012; 117: 1139-1151
• 25 Hamada A, Yamakado K, Nakatsuka A et al. Radiofrequency ablation for colorectal liver metastases: prognostic factors in non-surgical candidates. Jpn J Radiol 2012; 30: 567-574
• 26 Solbiati L, Ierace T, Tonolini M et al. Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound 2001; 13: 149-158
• 27 Gillams AR, Lees WR. Radio-frequency ablation of colorectal liver metastases in 167 patients. Eur Radiol 2004; 14: 2261-2267
• 28 Mulier S, Ruers T, Jamart J et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: Time for a randomized trial?. Dig Surg 2008; 25: 445-460
• 29 Bleicher RJ, Allegra DP, Nora DT et al. Radiofrequency ablation in 447 complex unresectable liver tumors: Lessons learned. Ann Surg Oncol 2003; 10: 52-58
• 30 Amersi FF, McElrath-Garza A, Ahmad A et al. Long-term survival after radiofrequency ablation of complex unresectable liver tumors. Arch Surg 2006; 141: 581-587 discussion 587–588
• 31 Veltri A, Sacchetto P, Tosetti I et al. Radiofrequency ablation of colorectal liver metastases: Small size favourably predicts technique effectiveness and survival. Cardiovasc Intervent Radiol 2008; 31: 948-956
• 32 Solbiati L, Livraghi T, Goldberg SN et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001; 221: 159-166
• 33 Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 2009; 19: 1206-1213
• 34 Hammill CW, Billingsley KG, Cassera M et al. Outcome after laparoscopic radiofrequency ablation of technically resectable colorectal liver metastases. Ann Surg Oncol 2011; 18: 1947-1954
• 35 Kennedy TJ, Cassera MA, Khajanchee YS et al. Laparoscopic radiofrequency ablation for the management of colorectal liver metastases: 10-year experience. J Surg Oncol 2013; 107: 324-328
• 36 White TJ, Roy-Choudhury SH, Breen DJ et al. Percutaneous radiofrequency ablation of colorectal hepatic metastases – initial experience. Dig Surg 2004; 21: 314-320
• 37 Suppiah A, White TJ, Roy-Choudhury SH et al. Long-term results of percutaneous radiofrequency ablation of unresectable colorectal liver metastases: final outcomes. Dig Surg 2007; 24: 358-360
• 38 Sofocleous CT, Petre EN, Gonen M et al. CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy. J Vasc Interv Radiol 2011; 22: 755-761
• 39 Schindera ST, Nelson RC, DeLong DM et al. Intrahepatic tumor recurrence after partial hepatectomy: value of percutaneous radiofrequency ablation. J Vasc Interv Radiol 2006; 17: 1631-1637
• 40 Knudsen AR, Kannerup AS, Mortensen FV et al. Radiofrequency ablation of colorectal liver metastases downstaged by chemotherapy. Acta Radiol 2009; 7: 716-721
• 41 Abdalla EK, Vauthey JN, Ellis LM et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combines resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-827
• 42 Aloia TA, Vauthey JN, Loyer EM et al. Solitary colorectal liver metastasis – resection determines outcome. Arch Surg 2006; 141: 460-467
• 43 White RR, Avital I, Sofocleous CT et al. Rates and patterns of recurrence for percutaneous radiofrequency ablation and open wedge resection for solitary colorectal liver metastases. J Gastrointest Surg 2007; 11: 256-263
• 44 Lee WS, Yun SH, Chun HK et al. Clinical outcomes of hepatic resection and radiofrequency ablation in patients with solitary colorectal liver metastasis. J Clin Gastroenterol 2008; 42: 945-949
• 45 Park IJ, Kim HC, Yu CS et al. Radiofrequency ablation for metachronous liver metastasis from colorectal cancer after curative surgery. Ann Surg Oncol 2008; 15: 227-232
• 46 Berber E, Tsinberg M, Tellioglu G et al. Resection versus laparoscopic radiofrequency thermal ablation of solitary colorectal liver metastasis. J Gastrointest Surg 2008; 12: 1967-1972
• 47 McKay A, Fradette K, Lipschitz J. Long-term outcomes following hepatic resection and radiofrequency ablation of colorectal liver metastases. HPB Surg 2009; 2009: 346863
• 48 Reuter NP, Woodall CE, Scoggins CR et al. Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent?. J Gatrointest Surg 2009; 13: 486-491
• 49 Hur H, Ko YT, Min BS et al. Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases. Am J Surg 2009; 197: 728-736
• 50 Lee KH, Kim HO, Yoo CH et al. Comparison of radiofrequency ablation and resection for hepatic metastasis from colorectal cancer. Korean J Gastroenterol 2012; 59: 218-223
• 51 Gravante G, Overton J, Sorge R et al. Radiofrequency ablation versus resection for liver tumours: an evidence-based approach to retrospective comparative studies. J Gastrointest Surg 2011; 15: 378-387
• 52 Weng M, Zhang Y, Zhou D et al. Radiofrequency ablation versus resection for colorectal cancer liver metastases: a meta-analysis. PLoS ONE 2012; 7: e45493
• 53 Wu YZ, Li B, Wang T et al. Radiofrequency ablation vs. hepatic resection for solitary colorectal liver metastasis: A meta-analysis. World J Gastroenterol 2011; 17: 4143-4148
• 54 Khajanchee YS, Hammill CW, Cassera MA et al. Hepatic resection vs. minimally invasive radiofrequency ablation for the treatment of colorectal liver metastases – a Markov analysis. Arch Surg 2011; 146: 1416-1423
• 55 Gleisner AL, Choti MA, Assumpcao L et al. Colorectal liver metastases: recurrence and survival following hepatic resection, radiofrequency ablation, and combined resection-radiofrequency ablation. Arch Surg 2008; 143: 1204-1212
• 56 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
• 57 Otto G, Düber C, Hoppe-Lotichius M et al. Radiofrequency ablation as first-line treatment in patients with early colorectal liver metastases amenable to surgery. Ann Surg 2010; 251: 796-803
• 58 Doyle MBM, Chapman WC. Radiofrequency ablation for resectable colorectal hepatic metastases – Is it time for a randomized controlled trial?. Ann Surg 2010; 251: 804-806
• 59 Curley SA. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial?. Ann Surg Oncol 2008; 15: 11-13
• 60 Grundmann RT, Hermanek P, Merkel S et al. Arbeitsgruppe Workflow Diagnostik und Therapie von Lebermetastasen kolorektaler Karzinome. Diagnostik und Therapie von Lebermetastasen kolorektaler Karzinome – Workflow. Zentralbl Chir 2008; 133: 267-284
• 61 Eisele RM, Neumann U, Neuhaus P et al. Open surgical is superior to percutaneous access for radiofrequency ablation of hepatic metastases. World J Surg 2009; 33: 804-811
• 62 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
• 63 Mulier S, Ni Y, Jamart J et al. Local recurrences after hepatic radiofrequency (RF) coagulation – Multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242: 158-171
• 64 Ayav A, Germain A, Marchal F et al. Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence. Am J Surg 2010; 200: 435-439
• 65 Thelen A, Jonas S, Benckert C et al. Simultaneous versus staged liver resection of synchronous liver metastases from colorectal cancer. Int J Colorectal Dis 2007; 22: 1269-1276
• 66 Reddy SK, Pawlik T, Zorzi D et al. Simultaneous resections of colorectal cancer and synchronous liver metastases: a multi-institutional analysis. Ann Surg Oncol 2007; 14: 3481-3491
• 67 Assumpcao L, Choti MA, Gleisner AL et al. Patterns of recurrence following liver resection for colorectal metastases – effect of primary rectal tumor site. Arch Surg 2008; 143: 743-749
• 68 Hsu CW, King TM, Chang MC et al. Factors influencing survival in colorectal cancer with synchronous distant metastasis. J Chin Med Ass 2012; 75: 370-375
• 69 Hopt UT, Drognitz O, Neeff H. Zeitlicher Ablauf von Leber- und Darmresektion bei Patienten mit kolorektalem Karzinom und synchronen Lebermetastasen. Zentralbl Chir 2009; 134: 425-429
• 70 Merkel S, Bialecki D, Meyer T et al. Comparison of clinical risk scores predicting prognosis after resection of colorectal liver metastases. J Surg Oncol 2009; 100: 349-357
• 71 Fong Y, Fortner J, Sun RL et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer – analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-321
• 72 Chen YY, Perera DS, Yan TD et al. Applying Fongʼs CRS liver score in patients with colorectal liver metastases treated by cryotherapy. Asian J Surg 2006; 29: 238-241
• 73 Rocha FG, dʼAngelica M. Treatment of liver colorectal metastases: Role of laparoscopy, radiofrequency ablation, and microwave coagulation. J Surg Oncol 2010; 102: 968-974
• 74 Eisele RM, Zhukowa J, Chopra S et al. Results of liver resection in combination with radiofrequency ablation for hepatic malignancies. Eur J Surg Oncol 2010; 36: 269-274
• 75 Vyslouzil K, Klementa I, Starý L et al. Radiofrequenzablation von kolorektalen Lebermetastasen. Zentralbl Chir 2009; 134: 145-148
• 76 de Jong MC, van Vledder MG, Ribero D et al. Therapeutic efficacy of combined intraoperative ablation and resection for colorectal liver metastases: an international, multi-institutional analysis. J Gastrointest Surg 2011; 15: 336-344
• 77 Mima K, Beppu T, Chikamoto A et al. Hepatic resection combined with radiofrequency ablation for initially unresectable colorectal liver metastases after effective chemotherapy is a safe procedure with a low incidence of local recurrence. Int J Clin Oncol 2012; Sep 1 [Epub ahead of print] DOI: 10.1007/s10147-012–0471-z.
• 78 Trübenbach J, Schmidt D, Pereira PL. Interventionell-radiologische Therapie bei Lebermetastasen. Zentralbl Chir 2003; 128: 920-927
• 79 Seehofer D, Neuhaus P. Kolorektale Lebermetastsen: Aktueller Stand der multimodalen Therapie. Zentralbl Chir 2011; 136: 343-351
• 80 Evrard S, Rivoire M, Arnaud JP et al. Unresectable colorectal cancer liver metastases treated by intraoperative radiofrequency ablation with or without resection. Br J Surg 2012; 99: 558-565
• 81 Ruers T, Punt C. Van Coevorden F et al. für die EORTC Gastro-Intestinal Tract Cancer Group, Arbeitsgruppe Lebermetastasen und -tumoren in der Chirurgischen Arbeitsgemeinschaft Onkologie (ALM-CAO) and the National Cancer Research Institute Colorectal Clinical Study Group (NCRI CCSG). Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC40004). Ann Oncol 2012; 23: 2619-2626
• 82 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. Eur J Cancer 2009; 45: 1748-1756
• 83 Damm R, Seidensticker R, Ricke J et al. Radiologisch-interventionelle Verfahren zur Therapie von kolorektalen Lebermetastasen. Zentralbl Chir 2013; 138: 76-83
• 84 Lorentzen T, Skjoldbye BO, Nolsoe CP. Microwave ablation of liver metastases guided by contrast-enhanced ultrasound: experience with 125 metastases in 39 patients. Ultraschall Med 2011; 32: 492-496
• 85 Niessen C, Jung EM, Stroszczynski C et al. Ablation einer Lebermetastase mit irreversibler Elektroporation (IRE) im Lebersegment II angrenzend an die Area nuda. Fortschr Röntgenstr 2012; 184: 937-938