Der Radiologe

, Volume 52, Issue 1, pp 29–37 | Cite as

Kryoablation – wieder da?

Leitthema
First Online:
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Zusammenfassung

Klinisches Problem

Primäre und sekundäre Lebertumoren stellen oft einen lebenslimitierenden Faktor dar. Nur bei einer Minderheit der Patienten ist eine potenziell kurative Therapie mittels Resektion möglich. Minimalinvasive Therapieverfahren wie Radiofrequenzablation (RFA), Mikrowellenablation (MWA) oder die Kryoablation bieten nichtoperablen Patienten bei begrenzter Tumorausdehnung eine gut verträgliche alternative Therapiemöglichkeit in kurativem und palliativem Therapieansatz. Die Größe der Ablationsareale und damit der zu behandelnden Raumforderungen ist bei den hyperthermen Ablationsverfahren begrenzt. Ferner kann die tatsächliche Größe des Ablationsareals während der Intervention nur ungenau mit CT, MRT und Ultraschall dargestellt werden.

Therapeutische Standardverfahren

Standardverfahren der minimalinvasiven sondenbasierten Tumortherapie ist die RFA. Die Kryoablation war bislang dagegen aufgrund technischer Nachteile (großer Sondendurchmesser; lange Ablationszeiten) weniger verbreitet.

Neue Therapieverfahren

Die argon-/heliumbasierten Kryoablationssysteme der aktuellen Generation verbinden den Vorteil von mit RFA und MWA vergleichbaren schmalkalibrigen Applikatoren mit den methodischen Vorteilen der Kryoablation.

Bewertung

Die Kryoablation ist eine Methode der minimalinvasiven Tumortherapie mit methodischen Vorteilen wie beinahe beliebiger Größe der Ablationsareale und Visualisierung des Ablationsareals mittels CT, MRT und Ultraschall in Echtzeit und intrinsischer analgetischer Wirkung. Jedoch ist die Kryoablation deutlich weniger zeitökonomisch als die MWA. Insbesondere bei Lebermetastasen ist die RFA das etabliertere Verfahren.

Empfehlung für die Praxis

Die Kryoablation ist eine faszinierende Methode, die mit guten Ergebnissen bei hepatozellulären Karzinomen innerhalb der Milan-Kriterien und bei T1a-Nierenzellkarzinomen eingesetzt werden kann. Des Weiteren kann sie als effektive Methode zur Schmerzlinderung bei Knochentumoren eingesetzt werden.

Schlüsselwörter

Ablation Ablationsareal Kryotherapie Tumor Interventionelle Onkologie 

Cryoablation – back again?

Abstract

Clinical issue

Primary and secondary liver tumors often limit patient outcome and only a minority of patients are eligible for potential curative surgery. Minimally invasive treatments, such as radiofrequency ablation (RFA), microwave ablation (MWA) and cryoablation are alternative treatment options in a curative and palliative setting. One major limitation of RFA and MWA is the limited size of tumor ablation. Furthermore during the procedure the ablation size can only be roughly estimated using RFA and MWA.

Standard treatment

RFA is the standard modality of minimally invasive tumor therapy. In comparison cryoablation is rarely used despite its advantages.

Treatment innovations

Argon-helium-based cryoablation systems of the newest generation combine the advantage of small diameter applicators comparable with those of RFA and MWA systems with intrinsic advantages.

Achievements

Cryoablation is a minimally invasive treatment option with advantages, such as virtually unlimited ablation size, real-time visualization using computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound and intrinsic analgesic effects. On the other hand it is not very time-efficient in comparison to MWA. Especially in liver metastases RFA is the preferred treatment option.

Practical recommendations

Cryoablation is a fascinating treatment option in minimally invasive tumor treatment. It demonstrates good results in hepatocellular carcinoma within the Milan criteria and T1a renal cell carcinoma. Furthermore it is a well-established treatment modality for palliative pain management in bone tumors.

Keywords

Ablation Ablation size Cryotherapy Neoplasm Interventional oncology 
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Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Klinik für Diagnostische und Interventionelle RadiologieUniversitätsklinikum RWTH AachenAachenDeutschland
  2. 2.Helmholtz-Institut für Biomedizinische Technik, AME - Interventionelle TherapietechnikRWTH AachenAachenDeutschland

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