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 ReviewT. J. Vogl1
, R. Straub1
, T. Lehnert1
, K. Eichler1
, T. Lüder-Lühr1
, J. Peters1
, S. Zangos1
, O. Söllner1
, M. Mack1
1Institut für Diagnostische und Interventionelle Radiologie, Klinikum der J. W. Goethe-Universität Frankfurt
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.
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