Thermoablation maligner Lungentumoren

Zusammenfassung

Das Lungenkarzinom ist in Deutschland (50 000 Fälle/Jahr) der am häufigsten zum Tode führende Tumor. Die Lunge ist darüber hinaus die zweithäufigste Lokalisation von Fernmetastasen extrathorakaler Tumoren. Thermoablative Verfahren werden inzwischen zunehmend häufiger bei Patienten, die einem operativen Eingriff nicht zugeführt werden können, angewandt. Die größte klinische Erfahrung besteht für die Radiofrequenzablation (RFA). Kryoablation und Mikrowellenablation sowie laserinduzierte Thermotherapie sind neue, auch für den Einsatz an der Lunge vielversprechende Verfahren. In die Leitlinien zur Behandlung von Lungentumoren sind transthorakale ablative Therapieverfahren bisher noch nicht einbezogen. Prospektiv-randomisierte Studien, die stereotaktische Radiotherapie vs. Thermoablation vs. limitierte chirurgische Resektion vergleichen, liegen derzeit nicht vor. Bei nicht kleinzelligem Lungenkarzinom (NSCLC) nach RFA aufgrund von funktioneller Inoperabilität wird eine lokale Tumorkontrolle in ca. 90 % berichtet. Langzeitergebnisse nach lokaler Ablation sind aufgrund heterogener Kollektive und hoher Komorbidität vorsichtig zu interpretieren. Der peri-/postinterventionelle Pneumothorax ist die relevanteste Komplikation – die Einlage einer Thoraxdränage ist bei 10–20 % der Patienten erforderlich. Lebensqualitätsdaten nach Thermoablation maligner Lungentumoren liegen derzeit nicht vor. Die transkutane Thermoablation ergänzt das Spektrum therapeutischer Möglichkeiten für Patienten, die einem operativen Verfahren nicht zugeführt werden können. Die Indikation zur Tumorablation sollte stets im interdisziplinären Konsens nach Einschätzung der Operabilität durch einen Thoraxchirurgen festgelegt werden.

Abstract

In Germany in about 50,000 patients lung cancer is diagnosed per year – actually it is the tumour most likely to result in death. Furthermore, the lung is the second most common site of distant metastases of extrathoracic tumours. In recent years image-guided thermo-ablative techniques are increasingly being used in patients unable to undergo surgery. Radiofrequency ablation (RFA) is the most frequently used technique, cryoablation, microwave-ablation and laser-induced thermoablation are new and promising techniques. Actually there is only a small evidence base, only retrospective and prospective case series have been published as yet. Randomised controlled trials have not been conducted up to now. RFA results in a local control of tumour growth in about 90 %. Long-term results indicate 5-year survival rates of 20–61 % in patients with lung cancer or lung metastases. Pneumothorax is the most common morbidity – requiring drainage in about 10 % after the intervention. In the long term no loss of pulmonary function results after the ablation of peripheral lesions. Peripherally localised tumours < 3 cm in diameter are the most promising targets, the treatment of centrally localised tumours is subtle due to the “heat-loss” effect. The current evidence is insufficient to develop a procedure for differential indication of ablative techniques versus stereotactic radiotherapy. Tumour ablation always should be indicated on the basis of interdisciplinary consensus (including pulmonologists, oncologists, thoracic surgeons, radiotherapists). Inoperability should be assigned by the thoracic surgeon himself. Actually it cannot be considered an alternative to surgery for the treatment of malignant lung tumours with curative intent, however thermal ablation broadens the range of treatment options for patients being no candidates for surgery.

Schlüsselwörter

lokale Tumorablation - Radiofrequenzablation - Radiologie - Intervention

Key words

local tumour ablation - radiofrequency ablation - radiology - intervention

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