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Rofo 2004; 176(11): 1658-1666
DOI: 10.1055/s-2004-813465
Interventionelle Radiologie

© Georg Thieme Verlag KG Stuttgart · New York

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
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Publication History

Publication Date:
20 October 2004 (online)

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Zusammenfassung

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.

Key words

Radiofrequency - LITT - RFA - metastases - lung - interventional - laser

Literatur

  • 1 Amin Z, Bown S G, Lees W R. Local treatment of colorectal liver metastases: a comparison of interstitial laser photocoagulation (ILP) and percutaneous alcohol injection (PAI).  Clin Radiol. 1993;  48 166-171
    PubMedGoogle Scholar
  • 2 Anzai Y, Lufkin R B, Saxton R E. et al . Nd: YAG interstitial laser phototherapy guided by magnetic resonance imaging in an ex vivo model: dosimetry of laser-MR-tissue interaction.  Laryngoscope. 1991;  101 755-760
    PubMedGoogle Scholar
  • 3 Buscarini L, Rossi S, Fornari F. et al . Laparoscopic ablation of liver adenoma by radiofrequency electrocauthery.  Gastrointest Endosc. 1995;  41 68-70
    PubMedGoogle Scholar
  • 4 Castro D J, Lufkin R B, Saxton R E. et al . Metastatic head and neck malignancy treated using MRI guided interstitial laser phototherapy: an initial case report.  Laryngoscope. 1992;  102 26-32
    PubMedGoogle Scholar
  • 5 Curley S, Izzo F, Delrio P. Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients.  Ann Surg. 1999;  230 1-8
    CrossrefPubMedGoogle Scholar
  • 6 Gazelle G, Goldberg S, Solbiati L. et al . Tumor ablation with radiofrequency energy.  Radiology. 2002;  217 633-646
    PubMedGoogle Scholar
  • 7 Goldberg S N, Solbiati L, Hahn P. et al . Large-volume tissue ablation with radiofrequency by using a clustered, internally cooled electrode technique: Laboratory and clinical experience in liver metastases.  Radiology. 1998;  209 371-379
    CrossrefPubMedGoogle Scholar
  • 8 Goldberg S. Radiofrequency tumor ablation: principles and techniques.  Ultrasound. 2001;  13 129-147
    PubMedGoogle Scholar
  • 9 Izzo F, Barnett C C Jr, Curley S A. Radiofrequency ablation of primary and metastatic malignant liver tumors.  Adv Surg. 2001;  35 225-250
    PubMedGoogle Scholar
  • 10 Kahn T, Bettag M, Harth T. et al . Laser-induced interstitial induced hyperthermia of cerebral tumors with nuclear magnetic resonance tomography control.  Radiologe. 1996;  36 713-721
    CrossrefPubMedGoogle Scholar
  • 11 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
    CrossrefPubMedGoogle Scholar
  • 12 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 Safaty and Feasibility.  JMRI. 1998;  8 40-47
    PubMedGoogle Scholar
  • 13 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
  • 14 Masters A, Steger A C, Lees W R. et al . Interstitial laser hyperthermia: a new approach for treating liver metastases.  Br J Cancer. 1992;  66 518-522
    PubMedGoogle Scholar
  • 15 Pacella C M, Bizzarri G, Cecconi P. et al . Hepatocellular Carcinoma: Long-term Results of Combined Treatment with Laser Thermal Ablation and Transcatheter Arterial Chemoembolization.  Radiology. 2001;  219 669-678
    CrossrefPubMedGoogle Scholar
  • 16 Pereira P L, Trubenbach J, Schmidt D. [Radiofrequency ablation: basic principles, techniques and challenges].  Fortschr Röntgenstr. 2003;  175 20-27
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Reither K, Wacker F, Ritz J. et al . Laserinduzierte Thermotherapie (LITT) von Lebermetastasen in einem offenen 0.2T MRT.  Fortschr Röntgenstr. 2000;  172 175-178
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Solbiati L, Livraghi T, Goldberg S. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients.  Radiology. 2001;  221 159-166
    CrossrefPubMedGoogle Scholar
  • 19 Yamakado K, Nakatsuka A, Ohmori S. et al . Radiofrequency ablation combined with chemoembolization in hepatocellular carcinoma: treatment response based on tumor size and morphology.  J Vasc Interv Radiol. 2002;  13 1225-1232
    CrossrefPubMedGoogle Scholar
  • 20 Germer C, Isbert C, Albrecht D. et al . Laser-induced thermotherapy for the treatment of liver metastasis. Correlation of gadolinium-DTPA-enhanced MRI with histomorphologic findings to determine criteria for follow-up monitoring.  Surg Endosc. 1998;  12 1317-1325
    CrossrefPubMedGoogle Scholar
  • 21 Mack M, Vogl T. MR-guided ablation of head and neck tumors.  Magn Reson Imaging Clin N Am. 2002;  10 707-713
    PubMedGoogle Scholar
  • 22 Mack M G, Straub R, Eichler K. et al . MR-guided laser-induced thermotherapy in recurrent extrahepatic abdominal tumors.  Eur Radiol. 2001;  11 2041-2046
    CrossrefPubMedGoogle Scholar
  • 23 Puls R, Stroszczynski C, Gaffke G. et al . Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit.  J Magn Reson Imaging. 2003;  17 663-670
    CrossrefPubMedGoogle Scholar
  • 24 Reimer P, Bremer C, Horch C. et al . MR-Monitored LITT as a Palliative Concept in Patients with High Grade Gliomas: Preliminary Clinical Experience.  JMRI. 1998;  8 240-244
    PubMedGoogle Scholar
  • 25 Vogl T, Mack M, Straub R. et al . MR-guided laser-induced thermotherapy of the infratemporal fossa and orbit in malignant chondrosarcoma via a modified technique.  Cardiovasc Intervent Radiol. 2001;  24 432-435
    CrossrefPubMedGoogle Scholar
  • 26 Vogl T, 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
    CrossrefPubMedGoogle Scholar
  • 27 Wiedemann G, Feyerabend T. Ist die laserinduzierte Thermotherapie (LITT) bei Tumorerkrankungen angezeigt?.  Dtsch Med Wochenschr. 2002;  127 286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Lee J, Jin G, Goldberg S. et al . Percutaneous radiofrequency ablation for inoperable non-small cell lung cancer and metastases: preliminary report.  Radiology. 2004;  230 125-134
    CrossrefPubMedGoogle Scholar
  • 29 Dupuy D, Mayo-Smith W, Abbott G. et al . Clinical applications of radio-frequency tumor ablation in the thorax.  Radiographics. 2002;  22 (Spec. No) S259-S269
    CrossrefPubMedGoogle Scholar
  • 30 Dupuy D, Zagoria R, Akerley W. et al . Percutaneous radiofrequency ablation of malignancies in the lung.  AJR. 2000;  174 (1) 57-59
    PubMedGoogle Scholar
  • 31 Herrera L, Fernando H, Perry Y. et al . Radiofrequency ablation of pulmonary malignant tumors in nonsurgical candidates.  J Thorac Cardiovasc Surg. 2003;  125 929-937
    CrossrefPubMedGoogle Scholar
  • 32 Hosten N, Stier A, Weigel C. et al . Laser-induzierte Thermotherapie (LITT) von Lungenmetastasen: Beschreibung eines miniaturisierten Applikators, Optimierung und erste Patientenbehandlungen.  Fortschr Röntgenstr. 2003;  175 393-400
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Nishida T, Inoue K, Kawata Y. et al . Percutaneous radiofrequency ablation of lung neoplasms: a minimally invasiv strategy for inoperable patients.  J Am Coll Surg. 2002;  195 (3) 426-430
    CrossrefPubMedGoogle Scholar
  • 34 Schaefer O, Lohrmann C, Ghanem N. et al . CT-guided radiofrequency heat ablation of malignant lung tumors.  Med Sci Monit. 2003;  9 127-131
    PubMedGoogle Scholar
  • 35 Steinke K, Glenn D, King J. et al . Percutaneous pulmonary radiofrequency ablation: difficulty achieving complete ablations in big lung lesions.  Br J Radiol. 2003;  76 742-745
    CrossrefPubMedGoogle Scholar
  • 36 Steinke K, Habicht J, Thomsen S. et al . CT-guided radiofrequency ablation of a pulmonary metastasis followed by surgical resection.  Cardiovasc Intervent Radiol. 2002;  25 543-546
    PubMedGoogle Scholar
  • 37 Thanos L, Mylona S, Pomoni M. et al . Primary lung cancer: treatment with radio-frequency thermal ablation.  Eur Radiol. 2003;  14 897-901
    PubMedGoogle Scholar
  • 38 Roberts H RS, Paley M, Sams V R. et al . Magnetic Resonance Imaging control of laser destruction of hepatic metastases: correlation with post-operative helical CT.  Min Invas Ther & Allied Technol. 1997;  6 53-64
    PubMedGoogle Scholar
  • 39 Pushek T, Farahani K, Saxton R E. et al . Dynamic MRI-guided interstitial laser therapy: a new technique for minimally invasive surgery.  Laryngoscope. 1995;  105 1245-1252
    PubMedGoogle Scholar
  • 40 Pacella C, Bizzarri G, Magnolfi F. et al . Laser Thermal Ablation in the Treatment of Small Hepatocellular Carcinoma: Results in 74 Patients.  Radiology. 2001;  221 712-720
    CrossrefPubMedGoogle Scholar
  • 41 Müller-Lisse G U, Heuck A, Stehling M K. et al . MRT-Monitoring vor, während und nach der interstitiellen laserinduzierten Thermotherapie der benignen Prostatahyperplasie. Erste klinische Erfahrungen.  Radiologe. 1996;  36 722-731
    CrossrefPubMedGoogle Scholar
  • 42 Jolesz F A, Bleier A R, Jakab P. et al . MR imaging of laser-tissue interactions.  Radiology. 1988;  168 249-253
    PubMedGoogle Scholar
  • 43 Fried M P, Morrison P R, Hushek S G. et al . Dynamic T1-weighted magnetic resonance imaging of interstitial laser photocoagulation in the liver: observations on in vivo temperature sensitivity.  Lasers Surg Med. 1996;  18 410-419
    CrossrefPubMedGoogle Scholar
  • 44 Castro D J, Saxton R E, Layfield L J. et al . Interstitial laser phototherapy assisted by magnetic resonance imaging: a new technique for monitoring laser-tissue interaction.  Laryngoscope. 1990;  100 541-547
    PubMedGoogle Scholar
  • 45 Anzai Y, Lufkin R B, Hirschowitz S. et al . MR imaging-histopathologic correlation of thermal injuries induced with interstitial Nd:YAG laser irradiation in the chronic model.  J Magn Reson Imaging. 1992;  2 671-678
    PubMedGoogle Scholar
  • 46 Baron O, Amini M, Duveau D. et al . Surgical resection of pulmonary metastases from colorectal carcinoma.  Eur J Cardiothorc Surg. 1996;  10 347-351
    CrossrefPubMedGoogle Scholar
  • 47 Davidson R, Nwogu C, Brentjens M. et al . The surgical management of pulmonary metastasis: current concepts.  Surg Oncol. 2001;  10 35-42
    CrossrefPubMedGoogle Scholar
  • 48 Friedel G, Pastorino U, McCormack P. et al . Resektion von Lungenmetastasen, Langzeitresultate prognostischer Faktoren auf der Basis von 5206 Fällen - The international Registry of Lung Metastases.  Zentralbl Chir. 1999;  124 96-103
    PubMedGoogle Scholar
  • 49 McCormack P, Burt M, Bains M. et al . Lung resection for colorectal metastases: 10-year results.  Arch Surg. 1992;  127 1403-1406
    PubMedGoogle Scholar
  • 50 McCormack P, Attizeh F. Resected pulmonary metastases from colorectal cancer.  Dis Colon Rectum. 1979;  22 553-556
    PubMedGoogle Scholar
  • 51 Pfannschmidt J, Muley T, Hoffmann H. et al . Prognostic factors and survival after complete resection of pulmonary metastases from colorectal carcinoma: experiences in 167 patients.  J Thorac Cardiovasc Surg. 2003;  126 (3) 732-739
    CrossrefPubMedGoogle Scholar
  • 52 Saito Y, Omiya H, Kohno K. et al . Pulmonary metastasectomy for 165 patients with colorectal carcinoma: A prognostic assessment.  J Thorac Cardiovasc Surg. 2002;  124 (5) 1007-1013
    CrossrefPubMedGoogle Scholar
  • 53 Yano T, Fukuyama Y, Yokoyama H. Failure in resection of multiple pulmonary metastases from colorectal cancer.  J Am Coll Surg. 1997;  185 120-122
    CrossrefPubMedGoogle Scholar
  • 54 Zanella A, Marchet A, Mainente P. et al . Resection of pulmonary metastases from colorectal carcinoma.  Eur J Surg Oncol. 1997;  23 424-427
    CrossrefPubMedGoogle Scholar
  • 55 Shaham D. Semi-invasive and invasive procedures for the diagnosis amd staging of lung cancer I: Percutaneous transthoracic needle biopsy.  Radiol Clin N America. 2000;  38 525-534
    PubMedGoogle Scholar
  • 56 Landreneau R, DeGiacomo T, Mack M. et al . Therapeutic video-assisted thorascopic surgical resection of coloretal pulmonary metastases.  Eur J Cardiothorc Surg. 2000;  18 (6) 671-677
    CrossrefPubMedGoogle Scholar
  • 57 Inoue M, Kotake Y, Nakagawa K. Surgery for pulmonary metastases from colorectal carcinoma.  Ann Thorax Surg. 2000;  70 380-383
    CrossrefPubMedGoogle Scholar
  • 58 Selzner M, Morse M, Vredenburgh J. et al . Liver metastases from breast cancer: long-term survival after curative resection.  Surgery. 2000;  127 383-389
    CrossrefPubMedGoogle Scholar
  • 59 Suh R, Wallace A, Sheehan R. et al . Unresectable Pulmonary Malignancies: CT-guided Percutaneous Radiofrequency Ablation - Preliminary Results.  Radiology. 2003;  229 821-829
    CrossrefPubMedGoogle Scholar
  • 60 Zagoria R, Chen M, Kavanagh P. et al . Radiofrequency ablation of lung metastases from renal cell carcinoma.  J Urol. 2001;  166 (5) 1827-1828
    PubMedGoogle Scholar
  • 61 Brookes J, Lees W, Bown S. Interstitial laser photocoagulation for the treatment of lung cancer.  AJR. 1997;  168 (2) 357-358
    PubMedGoogle Scholar
  • 62 Dupuy D, Goldberg S. Image-guided radiofrequency tumor ablation: challenges and opportunities - part II.  J Vasc Interv Radiol. 2001;  1135-1148
    PubMedGoogle Scholar
  • 63 Schaefer O, Lohrmann C, Langer M. CT-guided radiofrequency ablation of a bronchogenic carcinoma.  Br J Radiol. 2003;  76 268-270
    PubMedGoogle Scholar
  • 64 Steinke K, King J, Glenn D. et al . Radiologic appearance and complications of percutaneous computed tomography-guided radiofrequency-ablated pulmonary metastases from colorectal carcinoma.  J Comput Assist Tomogr. 2003;  27 750-757
    CrossrefPubMedGoogle Scholar
  • 65 Goldberg S, Charboneau J, Dodd G. et al . Image-guided tumor ablation: proposal for standardization of terms and reporting criteria.  Radiology. 2003;  228 335-345
    PubMedGoogle Scholar
  • 66 Lee J, Jin G, Li C. et al . Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility, safety, and effectiveness.  Invest Radiol. 2003;  38 129-139
    CrossrefPubMedGoogle Scholar
  • 67 Lee J M, Kim S W, Chung G H. et al . Open radio-frequency thermal ablation of renal VX2 tumors in a rabbit model using a cooled-tip electrode: feasibility, safety, and effectiveness.  Eur Radiol. 2003;  13 1324-1332
    PubMedGoogle Scholar
  • 68 Goldberg S, Gazelle G, Sompton C. Radiofrequency ablation of VX2 tumor nodules in the rabbit lung.  Acad Radiol. 1996;  3 929-935
    CrossrefPubMedGoogle Scholar
  • 69 Goldberg S, Gazelle G, Sompton C. et al . Radiofrequency tissue ablation in the rabbit lung: Efficacy and complications.  Acad Radiol. 1995;  2 776-784
    PubMedGoogle Scholar
  • 70 Sewell P, Jackson M, Vance R. et al . Assessing radiofrequency ablation of non-small cell lung cancer with positron emission tomography (PET).  Radiology. 2000;  217 (Suppl.) 551
    CrossrefPubMedGoogle Scholar
  • 71 Vaughn C, Mychaskiw G, Sewell P. Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm.  Anesth Analg. 2002;  94 1149-1151
    CrossrefPubMedGoogle Scholar
  • 72 Rose S, Fotoohi M, Levin D. et al . Cerebral microembolization during radiofrequency ablation of lung malignancies.  J Vasc Interv Radiol. 2002;  13 1051-1054
    CrossrefPubMedGoogle Scholar

Prof. Dr. med. Thomas J. Vogl

Institut für Diagnostische und Interventionelle Radiologie, J. W. Goethe-Universität Frankfurt

Theodor-Stern-Kai 7

60590 Frankfurt

Phone: 0 69/63 01-72 77

Fax: 0 69/63 01-72 58

Email: T.Vogl@em.uni-frankfurt.de

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