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Radiofrequenzablation des hepatozellulären Karzinoms

Radiofrequency ablation of hepatocellular carcinoma

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Zusammenfassung

Die perkutane Radiofrequenzablation (RFA) hat sich in der Therapie des hepatozellulären Karzinoms etabliert. Aufgrund ihres kurativen Potentials ist sie die Methode der Wahl beim nichtresektablen BCLC (Barcelona Liver Clinic) 0 and A. Die RFA ist eine Alternative zur Resektion beim kleinen HCC und die Methode der Wahl zum Bridging vor Transplantation und bei Rezidiv nach Resektion oder Transplantation. Die technische Machbarkeit der RFA hängt von der Größe und Lokalisation des HCCs und von der Verfügbarkeit der Ablationstechnik (Ein-Nadel Technik, Multi-Nadel Technik) ab. Die stereotaktische Multi-Nadel Technik mit 3D Trajektorien Planung und geführter Nadelplatzierung erweitert dabei substantiell das Spektrum der behandelbaren Läsionen inklusive großvolumiger Tumore. Der Behandlungserfolg ist abhängig von der Realisation von Ablationen mit großem Sicherheitssaum von tumorfreiem Gewebe (A0 Ablation in Analogie zur R0 Resektion), was mithilfe einer Bildfusion von Post- mit Präablationsbildern zu dokumentieren und im Follow-up zu bestätigen ist.

Summary

Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.

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Literatur

  1. Llovet JM DM, Lencioni R, Di Bisceglie AM, Galle PR, Dufour JF, Greten TF, Raymond E, Roskams T, De Baere T, Ducreux M, Mazzaferro V, Bernardi M, Bruix J, Colombo M, Zhu A. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012 Apr;56(4):908–43.

    Google Scholar 

  2. Widmann G, Bodner G, Bale R. Tumour ablation: technical aspects. Cancer Imaging. 2009;9(Spec No A):S63–7.

    Article  PubMed  Google Scholar 

  3. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology. 2003 Feb;226(2):441–51.

    Article  PubMed  Google Scholar 

  4. Mulier S, Mulier P, Ni Y, Miao Y, Dupas B, Marchal G, et al. Complications of radiofrequency coagulation of liver tumours. Br J Surg. 2002 Oct;89(10):1206–22.

    Article  CAS  PubMed  Google Scholar 

  5. Widmann G, Schullian P, Haidu M, Bale R. Stereotactic Radiofrequency Ablation (SRFA) of liver lesions: technique effectiveness, safety, and interoperator performance. Cardiovasc Interv Radiol. 2012 Jun;35(3):570–80.

    Article  Google Scholar 

  6. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg. 2006 Mar;243(3):321–8.

    Article  PubMed  Google Scholar 

  7. Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the „test-of-time approach“. Cancer. 2003 Jun 15;97(12):3027–35.

    Article  PubMed  Google Scholar 

  8. Poon RT, Fan ST, Lo CM, Liu CL, Ng IO, Wong J. Long-term prognosis after resection of hepatocellular carcinoma associated with hepatitis B-related cirrhosis. J Clin Oncol. 2000 Mar;18(5):1094–101.

    CAS  PubMed  Google Scholar 

  9. Figueras J, Jaurrieta E, Valls C, Ramos E, Serrano T, Rafecas A, et al. Resection or transplantation for hepatocellular carcinoma in cirrhotic patients: outcomes based on indicated treatment strategy. J Am Coll Surg. 2000 May;190(5):580–7.

    Article  CAS  PubMed  Google Scholar 

  10. Cha CH, Ruo L, Fong Y, Jarnagin WR, Shia J, Blumgart LH, et al. Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg. 2003 Sep;238(3):315–21; discussion 21–3.

    PubMed  Google Scholar 

  11. Machi J, Bueno RS, Wong LL. Long-term follow-up outcome of patients undergoing radiofrequency ablation for unresectable hepatocellular carcinoma. World J Surg. 2005 Nov;29(11):1364–73.

    Article  PubMed  Google Scholar 

  12. Xu HX, Lu MD, Xie XY, Yin XY, Kuang M, Chen JW, et al. Prognostic factors for long-term outcome after percutaneous thermal ablation for hepatocellular carcinoma: a survival analysis of 137 consecutive patients. Clin Radiol. 2005 Sep;60(9):1018–25.

    Article  PubMed  Google Scholar 

  13. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology. 1999 Mar;210(3):655–61.

    CAS  PubMed  Google Scholar 

  14. Ramsey DE, Kernagis LY, Soulen MC, Geschwind JF. Chemoembolization of hepatocellular carcinoma. J Vasc Interv Radiol. 2002 Sep;13(9 Pt 2):S211–21.

    Article  PubMed  Google Scholar 

  15. Vogl TJ, Naguib NN, Nour-Eldin NE, Rao P, Emami AH, Zangos S, et al. Review on transarterial chemoembolization in hepatocellular carcinoma: palliative, combined, neoadjuvant, bridging, and symptomatic indications. Eur J Radiol. 2009 Dec;72(3):505–16.

    Article  PubMed  Google Scholar 

  16. Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol. 2010 Sep;195(3):758–65.

    Article  PubMed  Google Scholar 

  17. Bale R, Widmann G. Navigated CT-guided interventions. Minim Invasive Ther Allied Technol. 2007;16(4):196–204.

    Article  PubMed  Google Scholar 

  18. Bale R, Widmann G, Haidu M. Stereotactic radiofrequency ablation. Cardiovasc Interv Radiol. 2010 Aug 24;34(4):852–6.

    Article  Google Scholar 

  19. Bale R, Widmann G, Stoffner DI. Stereotaxy: breaking the limits of current radiofrequency ablation techniques. Eur J Radiol. 2010 Jul;75(1):32–6.

    Article  PubMed  Google Scholar 

  20. Bale R, Widmann G, Schullian P, Haidu M, Pall G, Klaus A, et al. Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases. Eur Radiol. 2012 Apr;22(4):930–7.

    Article  PubMed  Google Scholar 

  21. Haidu M, Dobrozemsky G, Schullian P, Widmann G, Klaus A, Weiss H, et al. Stereotactic Radiofrequency Ablation of Unresectable Intrahepatic Cholangiocarcinomas: a retrospective study. Cardiovasc Interv Radiol. 2011 Oct 18;35(5):1074–82.

    Article  Google Scholar 

  22. Park MH, Rhim H, Kim YS, Choi D, Lim HK, Lee WJ. Spectrum of CT findings after radiofrequency ablation of hepatic tumors. Radiographics. 2008 Mar-Apr;28(2):379–90; discussion 90–2.

    Article  PubMed  Google Scholar 

  23. Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Interv Radiol. 2010 Feb;33(1):11–7.

    Article  Google Scholar 

  24. Ng KK, Poon RT, Lo CM, Yuen J, Tso WK, Fan ST. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma. J Gastrointest Surg. 2008 Jan;12(1):183–91.

    Article  PubMed  Google Scholar 

  25. Okuwaki Y, Nakazawa T, Shibuya A, Ono K, Hidaka H, Watanabe M, et al. Intrahepatic distant recurrence after radiofrequency ablation for a single small hepatocellular carcinoma: risk factors and patterns. J Gastroenterol. 2008;43(1):71–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Mikroinvasive Therapie, Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    Gerlig Widmann MD

  2. Section of Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Österreich

    Gerlig Widmann MD, Peter Schullian MD & Reto Bale MD

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  1. Gerlig Widmann MD
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  2. Peter Schullian MD
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  3. Reto Bale MD
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Correspondence to Gerlig Widmann MD.

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Widmann, G., Schullian, P. & Bale, R. Radiofrequenzablation des hepatozellulären Karzinoms. Wien Med Wochenschr 163, 132–136 (2013). https://doi.org/10.1007/s10354-013-0176-6

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  • DOI: https://doi.org/10.1007/s10354-013-0176-6

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