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Perkutane Radiofrequenzablation von Leberzellkarzinomen: eine aktuelle Übersicht

Percutaneous radiofrequence-ablation of liver cell carcinoma: a current overview

  • Thermotherapie
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Zusammenfassung

Bei Patienten mit hepatozellulärem Karzinom (HCC) ist die chirurgische Resektion die einzige lebensverlängernde Therapie und damit Methode der Wahl. Aus operationstechnischen Gründen und wegen der oft ausgeprägten Leberzirrhose sind weniger als 30% der Patienten resektabel. Als vielversprechende Alternative zur Resektion wird die Radiofrequenzablation (RFA) zunehmend zur Behandlung nichtresektabler Lebertumoren eingesetzt.

Entscheidende Fortschritte bei der Entwicklung leistungsfähiger Generatoren (bis 250 W) in Kombination mit expandierbaren oder gekühlten Nadelelektroden ermöglichen In-vivo-Ablationsareale bis über 5 cm.

Neuesten Daten zu Folge liegt die primäre technische Erfolgsrate der RFA von HCCs zwischen 85 und 100%. Nach RFA von HCCs (Durchmesser bis 2,8 cm) beträgt die Überlebenswahrscheinlichkeit nach 1, 2, 3, und 5 Jahren 97, 89, 71 und 48%. Komplikationsraten von 0–12% und eine Mortalität von 0–1% belegen den minimal-invasiven Charakter dieser Methode. Die grundlegenden Prinzipien der RFA, Indikationen, Kontraindikationen und Limitationen werden anhand eigener Fälle und der aktuellen Literatur dargestellt.

Abstract

In patients with hepatocellular carcinoma (HCC) surgical resection so far offers potential cure. Due to the frequent association with liver cirrhosis less then 30% of patients with HCC can be resected. In unresectable cases, radiofrequency ablation (RFA) offers an effective treatment alternative. Substantial improvements in the development of powerful generators (up to 250 W) combined with expandable, closed or open-perfused needle electrodes, provide coagulation necroses up to 5 cm in diameter. Most recently primary technical success rates of 85 to 100% were reported. Following RFA of HCC’s (diameter up to 2,8 cm) 1-, 2-, 3 and 5-year survival was reported to be 97, 89, 71 and 48%. Low complication rates of 0–12% and a mortality of 0–1% indicate the minimal-invasive character of RFA.

Basic principles, technique, indications, contraindications and limitations of percutaneous RFA will be discussed together with a presentation of own cases and a review of literature.

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  1. Klinische Abteilung für Angiographie und Interventionelle Radiologie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien

    J. Kettenbach, M. Blum, E. Kilanowicz & J. Lammer

  2. Chirurgische Klinik, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien

    S. M. Schwaighofer

  3. Klinische Abteilung für Angiographie und Interventionelle Radiologie, Allgemeines Krankenhaus der Stadt Wien, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    J. Kettenbach

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  1. J. Kettenbach
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  2. M. Blum
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  3. E. Kilanowicz
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  5. J. Lammer
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Correspondence to J. Kettenbach.

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Kettenbach, J., Blum, M., Kilanowicz, E. et al. Perkutane Radiofrequenzablation von Leberzellkarzinomen: eine aktuelle Übersicht. Radiologe 44, 330–338 (2004). https://doi.org/10.1007/s00117-004-1031-y

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