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Radiofrequenzablation von Lebermetastasen

Radiofrequency ablation of liver metastases

  • Thermotherapie
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Zusammenfassung

Die Leber ist unabhängig vom Primärtumor nach den Lymphknoten die zweithäufigste Lokalisation von Metastasen. Bis zu 50% aller Patienten mit malignen Erkrankungen werden im Verlauf ihrer Erkrankung Lebermetastasen entwickeln, die mit einer signifikanten Morbidität und Mortalität verbunden sind. Obwohl die chirurgische Resektion zu einer verlängerten Überlebenszeit führt, sind nur ca. 20% der Patienten für einen chirurgischen Eingriff geeignet.

Die Radiofrequenz-(RF-)Ablation stellt derzeit eine der effektivsten Alternativen und komplementären Methoden bei der Therapie von Lebermetastasen dar. In einem selektierten Patientengut führt die RF-Ablation über den palliativen Einsatz hinaus zu einer kurativen Therapie mit Verlängerung des Überlebens. Die RF-Ablation zeigt sich im Vergleich zu anderen interventionellen Verfahren sicherer (vs. Kryotherapie), effektiver (vs. Ethanolinstillation [PEI], transarterielle Chemoembolisation [TACE]) oder einfacher (vs. Laser).

Die RF-Ablation kann perkutan, laparoskopisch oder intraoperativ durchgeführt sowie mit Chemotherapie bzw. chirurgischer Resektion kombiniert werden. Ständige technische Weiterentwicklung der RF-Systeme, ein besseres Verständnis der elektrophysiologischen Prinzipien und ein multidisziplinäres Vorgehen mit Kombinationstherapien werden zu einer Prognoseverbesserung bei Patienten mit Lebermetastasen führen.

Abstract

The liver is the second only to lymph nodes as the most common site of metastatic disease irrespective of the primary tumor. Up to 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improvement of the survival time, only approximately 20% of the patients are eligible for surgical intervention.

Radiofrequency (RF) ablation represents one of the most important alternatives as well as complementary methods for the therapy of liver metastases. RF ablation can lead in a selected patient group to a palliation or to an increased life expectancy. RF ablation appears either safer (vs. cryotherapy) or easier (vs. laser) or more effective (percutaneous ethanol instillation [PEI], transarterial chemoembolisation [TACE]) in comparison with other minimal invasive procedures.

RF ablation can be performed percutaneously, laparoscopically or intraoperatively and may be combined with chemotherapy as well as with surgical resection. Permanent technical improvements of RF systems, a better understanding of the underlying electrophysiological principles and an interdisciplinary approach will lead to a prognosis improvement in patients with liver metastases.

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Anmerkung:

Die Expertengruppe IGRA (Interessentengemeinschaft für Radiofrequenzablation) ist Teil der Arbeitsgemeinschaft Interventionelle Radiologie (AGIR) innerhalb der Deutschen Röntgengesellschaft (DRG).

Ansprechpartner sind:

  • PD Dr. med. Markus Düx, Chefarzt, Radiologisches Zentralinstitut, Krankenhaus Nordwest, Steinbacher Hohl 2–26, 60488 Frankfurt am Main.

  • PD Dr. med. Thomas Helmberger, Geschäftsführender Oberarzt des Instituts für Klinische Radiologie, Klinikum Großhadern, Universität München, Marchioninistraße 15, 81377 München, e-mail: thomas.helmberger@ikra.med.uni-muenchen.de.

  • Dr. med. Andreas Lubienski, Oberarzt, Radiologische Abteilung Heidelberg, Im Neuheimer Feld 1, 69120 Heidelberg, e-mail: andreas.lubienski@med.uni-heidelberg.de.

  • PD Dr. med. Philippe L. Pereira, Stv. Ärztlicher Direktor, Abteilung für Radiologische Diagnostik, Radiologische Universitätsklinik der Eberhard-Karls-Universität, Hoppe-Seyler-Straße 3, 72076 Tübingen, e-mail: philippe.pereira@med.uni-tuebingen.de.

  • PD Dr. med. Josef Tacke, Oberarzt der Klinik für Radiologische Diagnostik, Rheinisch-Westfälische Technische Hochschule Aachen, Pauwelsstraße 30, 52047 Aachen, e-mail: Tacke@rad.rwth-aachen.de.

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Authors and Affiliations

  1. Abteilung für Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen

    P. L. Pereira, S. Clasen, A. Boss, D. Schmidt, J. Wiskirchen, G. Tepe & C. D. Claussen

  2. Sektion für Experimentelle Radiologie der Abteilung für Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen

    A. Boss

  3. Abteilung Immunologie des Instituts für Zellbiologie, Eberhard-Karls-Universität Tübingen

    C. Gouttefangeas

  4. Zentrum für gastroenterologische Onkologie der Medizinischen Klinik, Eberhard-Karls-Universität Tübingen

    C. Burkart

  5. Abteilung für Radiologische Diagnostik, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076 , Tübingen

    P. L. Pereira

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  1. P. L. Pereira
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  2. S. Clasen
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  3. A. Boss
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  4. D. Schmidt
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  5. C. Gouttefangeas
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  6. C. Burkart
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  7. J. Wiskirchen
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  8. G. Tepe
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  9. C. D. Claussen
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Correspondence to P. L. Pereira.

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Pereira, P.L., Clasen, S., Boss, A. et al. Radiofrequenzablation von Lebermetastasen. Radiologe 44, 347–357 (2004). https://doi.org/10.1007/s00117-004-1033-9

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  • DOI: https://doi.org/10.1007/s00117-004-1033-9

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