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Z Gastroenterol 2005; 43(1): 47-56
DOI: 10.1055/s-2004-813913
Übersicht

© Karl Demeter Verlag im Georg Thieme Verlag KG Stuttgart · New York

Lokale Radiofrequenzablation von Leberherden - Möglichkeiten und Grenzen

Local Radiofrequency Ablation of Liver Lesions - Scope and LimitationsA. J. Aschoff1 , H.-J Brambs1
  • 1Abt. für Röntgendiagnostik (Ärztl. Direktor: Prof. H.-J. Brambs), Universitätsklinikum Ulm
Further Information

Publication History

Manuskript eingetroffen: 22.9.2004

Manuskript akzeptiert: 7.12.2004

Publication Date:
13 January 2005 (online)

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Zusammenfassung

Die Radiofrequenzablation stellt die verbreitetste Methode der lokalen Thermotherapie der Leber dar. Sie ist relativ einfach in der Anwendung, beliebig wiederholbar und verbindet eine hohe Effektivität in der lokalen Zelldestruktion mit einer relativ geringen Komplikationsrate. In dieser Übersichtsarbeit werden das Prinzip der RF-Ablation (RFA) und die zur Verfügung stehenden Systeme beschrieben. Danach wird ein Überblick über die Rationale hinter der RFA von Leberherden, klinische Indikationen, Ergebnisse sowie zu erwartende Komplikationen gegeben. Die Hauptproblematik der Beurteilung des onkologischen Erfolges der RFA besteht in der immer breiteren Anwendung bei vielen Tumorentitäten, ohne dass große kontrollierte und randomisierte Studien zur Wirksamkeit vorliegen. Aus technischer Sicht ist die Hauptlimitation der RFA bei allem Fortschritt der Technik die immer noch limitierte Größe der Koagulationsnekrose. Die Indikation zur RFA muss interdisziplinär gestellt werden. Prinzipiell sollte außer bei symptomatischen neuroendokrinen Metastasen eine komplette Tumorablation (ggf. in mehreren Sitzungen) angestrebt werden. Die Rolle einer additiven Chemotherapie in Kombination mit der RFA insbesondere bei der Behandlung von Lebermetastasen ist derzeit unklar.

Abstract

Radiofrequency ablation (RFA) is currently the most established technique for the local destruction of tumors within the liver. It is technically straightforward, can be repeated and combines a high efficiency in tissue destruction with a low to moderate incidence of complications. This review explains the principle of RFA and lists currently available systems. In addition, the rationale behind RFA is discussed, and an overview of clinical indications, results and complications is presented. One of the main problems in assessing the clinical value of RFA is the fact that no large and controlled randomized studies are available, while the number of ablations and treated tumor entities are steadily increasing. From a technical point of view, the major problem is the still limited volume of necrosis that is achievable. The indication for RFA has to be discussed interdisciplinarily. A complete tumor necrosis should be the aim of all ablations, with the exception of symptomatic metastases of neuroendocrine tumors. The value of additional chemotherapy to RFA is still unclear, especially in the treatment of liver metastases.

Schlüsselwörter

Radiofrequenzablation - Leber - Lebermetastasen - hepatozelluläres Karzinom

Key words

Radiofrequency ablation - liver - liver metastases - hepatocellular carcinoma

Literatur

  • 1 Brodkey J S, Miyazaki Y, Ervin F R. et al . Reversible heat lesions with radio frequency current: A method of stereotactic localization.  J Neurosurg. 1964;  21 49-53
    PubMedGoogle Scholar
  • 2 Anzai Y, Lufkin R, DeSalles A. et al . Preliminary experience with MR-guided thermal ablation of brain tumors.  AJNR Am J Neuroradiol. 1995;  16 39-48
    PubMedGoogle Scholar
  • 3 Livraghi T, Goldberg S N, Monti F. et al . Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases.  Radiology. 1997;  202 205-210
    PubMedGoogle Scholar
  • 4 Solbiati L, Goldberg S N, Ierace T. et al . Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes.  Radiology. 1997;  205 367-373
    PubMedGoogle Scholar
  • 5 Zlotta A R, Wildschutz T, Raviv G. et al . Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment of renal cancer: ex vivo and in vivo experience.  J Endourol. 1997;  11 251-258
    CrossrefPubMedGoogle Scholar
  • 6 Gadaleta C, Mattioli V, Colucci G. et al . Radiofrequency ablation of 40 lung neoplasms: preliminary results.  AJR Am J Roentgenol. 2004;  183 361-368
    CrossrefPubMedGoogle Scholar
  • 7 Rosenthal D I, Springfield D S, Gebhardt M C. et al . Osteoid osteoma: percutaneous radio-frequency ablation.  Radiology. 1995;  197 451-454
    CrossrefPubMedGoogle Scholar
  • 8 Zuber-Jerger I, Geissler M, Spangenberg H C. et al . Lokale Ablationsverfahren als Ergänzung der Therapie maligner Leberläsionen [Local ablation of malignant lesions of the liver - potential applications and limitations of the different methods].  Z Gastroenterol. 2004;  42 31-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Pennes H H. Analysis of tissue and arterial blood temperatures in the resting human forearm.  J Appl Physiol. 1948;  1 93-122
    PubMedGoogle Scholar
  • 11 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.  AJR Am J Roentgenol. 2000;  174 323-331
    CrossrefPubMedGoogle Scholar
  • 12 Aschoff A J, Merkle E M, Wong V. et al . How does alteration of hepatic blood flow affect liver perfusion and radiofrequency-induced thermal lesion size in rabbit liver?.  J Magn Reson Imaging. 2001;  13 57-63
    CrossrefPubMedGoogle Scholar
  • 13 Aschoff A J, Sulman A, Martinez M. et al . Perfusion-modulated MR imaging-guided radiofrequency ablation of the kidney in a porcine model.  AJR Am J Roentgenol. 2001;  177 151-158
    PubMedGoogle Scholar
  • 14 Goldberg S N, Hahn P F, Tanabe K K. et al . Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis?.  JVascIntervRadiol. 1998;  9 101-111
    CrossrefPubMedGoogle Scholar
  • 15 de Baere T, Bessoud B, Dromain C. et al . Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.  AJR Am J Roentgenol. 2002;  178 53-59
    CrossrefPubMedGoogle Scholar
  • 16 McGahan J P, Browning P D, Brock J M. et al . Hepatic ablation using radiofrequency electrocautery.  InvestRadiol. 1990;  25 267-270
    CrossrefPubMedGoogle Scholar
  • 17 Denys A L, de Baere T, Kuoch V. et al . Radio-frequency tissue ablation of the liver: in vivo and ex vivo experiments with four different systems.  Eur Radiol. 2003;  13 2346-2352
    CrossrefPubMedGoogle Scholar
  • 18 Pereira P L, Trubenbach J, Schenk M. et al . Radiofrequency ablation: in vivo comparison of four commercially available devices in pig livers.  Radiology. 2004;  232 482-490
    CrossrefPubMedGoogle Scholar
  • 19 Tacke J, Mahnken A, Roggan A. et al . Multipolar radiofrequency ablation: first clinical results.  Rofo. 2004;  176 324-329
    PubMedGoogle Scholar
  • 20 Leyendecker J R, Dodd G D 3rd, Halff G A. et al . Sonographically observed echogenic response during intraoperative radiofrequency ablation of cirrhotic livers: pathologic correlation.  AJR Am J Roentgenol. 2002;  178 1147-1151
    CrossrefPubMedGoogle Scholar
  • 21 Solbiati L, Arsizio B, Goldberg S N. et al . Microbubble ultrasound contrast agents: a useful adjunct for radiofrequency tumor ablation.  Radiology. 1997;  367
    PubMedGoogle Scholar
  • 22 Solbiati L, Ierace T, Goldberg S N. et al . Percutaneous US-guided radio-frequency tissue ablation of liver metastases: treatment and follow-up in 16 patients.  Radiology. 1997;  202 195-203
    CrossrefPubMedGoogle Scholar
  • 23 Livraghi T, Goldberg S N, Lazzaroni S. et al . Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions.  Radiology. 2000;  214 761-768
    CrossrefPubMedGoogle Scholar
  • 24 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
    CrossrefPubMedGoogle Scholar
  • 25 Rossi S, Buscarini E, Garbagnati F. et al . Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.  AJR Am J Roentgenol. 1998;  170 1015-1022
    PubMedGoogle Scholar
  • 26 Rossi S, Fornari F, Buscarini E. Percutaneous Ultrasound-guided Radiofrequency Electrocautery for the Treatment of Small Hepatocellular Carcinoma.  Journal of Interventional Radiology. 1993;  8 97-103
    PubMedGoogle Scholar
  • 27 Rossi S, SM, Buscarini E. et al . Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer.  AJR Am J Roentgenol. 1996;  167 759-768
    PubMedGoogle Scholar
  • 28 Rossi S, SM, Buscarini E. et al . Percutaneous Radiofrequency Interstitial Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma.  Cancer J Sci Am. 1995;  1 73
    PubMedGoogle Scholar
  • 29 Pereira P L, Düx M, Helmberger T. et al . Perkutane bildgesteuerte Leber-Tumortherapie mittels Radiofrequenz-Ablation (RFA). Leitlinien der „Experten-Gruppe Radiofrequenz-Ablation” in der Arbeitsgemeinschaft Interventionelle Radiologie der Deutschen Röntgengesellschaft 2003. http://www.drg-agir.de/BrennpunktRoefo300304.pdf. 
    PubMedGoogle Scholar
  • 30 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 safety and feasibility.  JMagnResonImaging. 1998;  8 40-47
    PubMedGoogle Scholar
  • 31 Aschoff A J, Rafie N, Jesburger J A. et al . A Thermal lesion conspicuity following interstitial radiofrequency thermal tumor ablation in humans: a comparison of STIR, turbo spin echo T2-weighted, and contrast-enhanced T1-weighted MR images at 0.2 T.  J Magn Reson Imaging. 2000;  12 584-589
    CrossrefPubMedGoogle Scholar
  • 32 Mahnken A H, Buecker A, Spuentrup E. et al . MR-guided radiofrequency ablation of hepatic malignancies at 1.5 T: initial results.  J Magn Reson Imaging. 2004;  19 342-348
    CrossrefPubMedGoogle Scholar
  • 33 Huppert P E, Trübenbach J, Schick F. et al . MRT-gestützte perkutane Radiofrequenzablation hepatischer Neoplasien - Erste technische und klinische Erfahrungen. [MRI-guided percutaneous radiofrequency ablation of hepatic neoplasms - first technical and clinical experiences].  Rofo. 2000;  172 692-700
    PubMedGoogle Scholar
  • 34 Limanond P, Zimmerman P, Raman S S. et al . Interpretation of CT and MRI after radiofrequency ablation of hepatic malignancies.  AJR Am J Roentgenol. 2003;  181 1635-1640
    PubMedGoogle Scholar
  • 35 Pereira P L, Clasen S, Boss A. et al . Radiofrequenzablation von Lebermetastasen [Radiofrequency ablation of liver metastases].  Radiologe. 2004;  44 347-357
    CrossrefPubMedGoogle Scholar
  • 36 Elias D, Debaere T, Muttillo I. et al . Intraoperative use of radiofrequency treatment allows an increase in the rate of curative liver resection.  J Surg Oncol. 1998;  67 190-191
    Google Scholar
  • 37 Henn A R, Levine E A, McNulty W. et al . Percutaneous radiofrequency ablation of hepatic metastases for symptomatic relief of neuroendocrine syndromes.  AJR Am J Roentgenol. 2003;  181 1005-1010
    PubMedGoogle Scholar
  • 38 Siperstein A E, Rogers S J, Hansen P D. et al . Laparoscopic thermal ablation of hepatic neuroendocrine tumor metastases.  Surgery. 1997;  122 1147-1154
    CrossrefPubMedGoogle Scholar
  • 39 Decadt B, Siriwardena A K. Radiofrequency ablation of liver tumours: systematic review.  Lancet Oncol. 2004;  5 550-560
    CrossrefPubMedGoogle Scholar
  • 40 Mulier S, Mulier P, Ni Y. et al . Complications of radiofrequency coagulation of liver tumours.  Br J Surg. 2002;  89 1206-1222
    CrossrefPubMedGoogle Scholar
  • 41 Bowles B J, Machi J, Limm W M. et al . Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors.  Arch Surg. 2001;  136 864-869
    PubMedGoogle Scholar
  • 42 Kettenbach J, Blum M, Kilanowicz E. et al . Perkutane Radiofrequenzablation von Leberzellkarzinomen: eine aktuelle Übersicht [Percutaneous radiofrequency ablation of liver cell carcinoma: a current overview].  Radiologe. 2004;  44 330-338
    CrossrefPubMedGoogle Scholar
  • 43 Lencioni R, Cioni D, Crocetti L. et al . Percutaneous ablation of hepatocellular carcinoma: state-of-the-art.  Liver Transpl. 2004;  10 S91-97
    CrossrefPubMedGoogle Scholar
  • 44 Elias D, de Baere T, Smayra T. et al . Percutaneous radiofrequency thermoablation as an alternative to surgery for treatment of liver tumour recurrence after hepatectomy.  Br J Surg. 2002;  89 752-756
    CrossrefPubMedGoogle Scholar
  • 45 Livraghi T, Goldberg S N, Lazzaroni S. et al . Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection.  Radiology. 1999;  210 655-661
    CrossrefPubMedGoogle Scholar
  • 46 Kettenbach J, Kostler W, Rucklinger E. et al . Percutaneous saline-enhanced radiofrequency ablation of unresectable hepatic tumors: initial experience in 26 patients.  AJR Am J Roentgenol. 2003;  180 1537-1545
    PubMedGoogle Scholar
  • 47 Hansler J, Frieser M, Schaber S. et al . Radiofrequency ablation of hepatocellular carcinoma with a saline solution perfusion device: a pilot study.  J Vasc Interv Radiol. 2003;  14 575-580
    PubMedGoogle Scholar
  • 48 Dodd G D 3rd, Frank M S, Aribandi M. et al . Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations.  AJR Am J Roentgenol. 2001;  177 777-782
    PubMedGoogle Scholar
  • 49 Ahmad S A. Limitations of radiofrequency ablation in treating liver metastases: a lesson in geometry.  Ann Surg Oncol. 2004;  11 358-359
    CrossrefPubMedGoogle Scholar
  • 50 Gillams A R, Lees W R. Survival after percutaneous, image-guided, thermal ablation of hepatic metastases from colorectal cancer.  Dis Colon Rectum. 2000;  43 656-661
    CrossrefPubMedGoogle Scholar
  • 51 Hori T, Nagata K, Hasuike S. et al . Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation.  J Gastroenterol. 2003;  38 977-981
    CrossrefPubMedGoogle Scholar
  • 52 Llovet J M, Vilana R, Bru C. et al . Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma.  Hepatology. 2001;  33 1124-1129
    CrossrefPubMedGoogle Scholar
  • 53 Bleicher R J, Allegra D P, Nora D T. et al . Radiofrequency ablation in 447 complex unresectable liver tumors: lessons learned.  Ann Surg Oncol. 2003;  10 52-58
    CrossrefPubMedGoogle Scholar
  • 54 Pereira P L, Trubenbach J, Schmidt D. Radiofrequenzablation: Grundlagen, Techniken und Herausforderungen [Radiofrequency ablation: basic principles, techniques and challenges].  Rofo. 2003;  175 20-27
    Article in Thieme ConnectPubMedGoogle Scholar

PD Dr. med. Andrik J. Aschoff

Abt. Röntgendiagnostik, Universitätsklinikum Ulm

Steinhövelstraße 9

89075 Ulm

Phone: 07 31/50 02 74 30

Fax: 07 31/50 02 66 92

Email: andrik.aschoff@medizin.uni-ulm.de