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Laserinduzierte Thermotherapie von Lungenmetastasen und primären Lungentumoren

Laser-induced thermotherapy of lung metastases and primary lung tumors

  • Perkutane Ablation von Lungenmetastasen
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Zusammenfassung

Wir stellen nachfolgend die Ergebnisse der laserinduzierten Thermotherapie (LITT) primärer und sekundärer Lungentumoren vor und analysieren die Indikationsstellung und die Interventionstechnik. Dreißig Patienten mit Lungenmetastasen unterschiedlicher Primärtumoren (n=24) sowie lokalisierten Bronchialkarzinomen (n=6) wurden prospektiv in 41 Sitzungen mittels MR-gesteuerter LITT therapiert. Zum Einsatz kam ein MR-kompatibles Punktionssystem in direkter Punktionstechnik; die Punktion erfolgte jeweils unter CT-Steuerung in Care-vision-Technik. Acht Patienten wurden mittels MR-tomographischem Monitoring thermoablatiert, 22 Patienten mittels CT-Monitoring. Evaluiert wurden die lokalen Therapieeffekte, Tumorkontrollrate, und die Frage von Nebenwirkungen und Komplikationen. Bei den 24 Patienten mit Lungenmetastasen gelang eine lokal vollständige Ablation in 74% (28/38 Läsionen), bei den 6 Patienten mit Bronchialkarzinom in allen Fällen. Die Komplikationsrate (Pneumothorax) betrug 9,8%, bezogen auf die Anzahl der Prozeduren. Ein Patient mit Bronchialkarzinom musste aufgrund einer intrabronchialen Blutung thorakotomiert und reseziert werden. 93% der Patienten leben noch. Die perkutane LITT von Lungentumoren erlaubt bei einer niedrigen Komplikationsrate eine komplette Ablation von Lungenmetastasen und Bronchialkarzinomen. Die Indikationsstellung umfasst dabei Lungenmetastasen bis zu einer Größe von 3 cm im Durchmesser, bei einer Herdanzahl bis zu 5.

Abstract

We present laser-induced thermotherapy (LITT) of primary and secondary lung tumors analysing indications and technical concepts. Thirty patients with lung metastases of different primary tumors (n=24) as well as localized lung tumors (n=6) were prospectively treated in 41 sessions using laser-induced thermotherapy (LITT). An MR-compatible puncture system was used with direct puncture technique. The puncture was performed via CT guidance in care vision technique. Eight patients were thermoablated using MR tomographical monitoring, 22 patients using CT monitoring. Local therapy effects, tumor control rate, side effects, complications, and survival were evaluated. In 74% of cases (28/38 lesions) of 24 patients with lung metastases and in all cases of the 6 patients with lung carcinoma a complete local ablation could be achieved. The complication rate (pneumothorax) was 9,8%. One patient with bronchial carcinoma had to be thoracotomized and resected. 93% of the patients are still alive. Percutaneous LITT of lung tumors permits a complete ablation of lung metastases and lung carcinomas with a low complication rate. Indications for the procedure were defined for patients with no more than 5 metastases up to 3 cm in size.

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Authors and Affiliations

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

    T. J. Vogl, K. Eichler, R. Straub, T. Lehnert, S. Zangos & M. Mack

  2. Klinik für Thorax-, Herz- und thorakale Gefäßchirurgie, Klinikum der J.-W.-Goethe-Universität Frankfurt

    H. G. Fieguth

  3. Institut für Diagnostische und Interventionelle Radiologie, Klinikum der J.-W.-Goethe-Universität, Theodor-Stern-Kai 7, 60590 , Frankfurt

    T. J. Vogl

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  1. T. J. Vogl
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  2. H. G. Fieguth
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  3. K. Eichler
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  4. R. Straub
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Correspondence to T. J. Vogl.

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Vogl, T.J., Fieguth, H.G., Eichler, K. et al. Laserinduzierte Thermotherapie von Lungenmetastasen und primären Lungentumoren. Radiologe 44, 693–699 (2004). https://doi.org/10.1007/s00117-004-1073-1

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