Aktuelle Technik und Anwendung der perkutanen Kryotherapie

Zusammenfassung

Hintergrund Lokal-ablative Therapien haben sich als wichtiger interventionell-onkologischer Therapieansatz etabliert. Radiofrequenzablation (RFA) und Mikrowellenablation (MWA) sind heute ein therapeutischer Standard zur Therapie des hepatozellulären Karzinoms (HCC). Die Kryotherapie, als eine der ältesten lokal-ablativen Methoden, erfährt aktuell eine Renaissance. Dabei verfügt die Kryotherapie über charakteristische Eigenschaften in Bezug auf Technik und Wirkmechanismus.

Material und Methode Nach einer systematischen Literaturrecherche mit den Suchbegriffen Kryotherapie, Kryochirurgie und Kryoablation erfolgte eine selektive Auswahl der Studien und Darstellung von Wirkmechanismus, Kryobiologie und Anwendungen der perkutanen, bildgesteuerten Kryoablation für vornehmlich onkologische Anwendungen. Aktuelle Entwicklungen werden betrachtet.

Ergebnisse Die Kryotherapie erfährt wieder zunehmende klinische Beachtung und hat für einige Entitäten wie die Behandlung des Nierenzellkarzinoms Eingang in die Leitlinien gefunden. Kryo-Immuntherapie und Kombinationstherapien sind künftige Entwicklungsfelder.

Schlussfolgerung Die Kryoablation hat ein weites Anwendungsfeld. Die größten Vorteile sind die gute Visualisierung in der Bildgebung und der anästhesiologische Effekt von Kälte. Obwohl nur sehr wenige prospektive randomisierte Studien zur Effektivität der Kryoablation vorliegen, sind die bisherigen Daten vielversprechend und rechtfertigen den Einsatz der Kryoablation bei ausgewählten Primärtumoren, Metastasen beim oligometastatischen Patienten sowie in palliativer Indikation.

Kernaussagen 

• Die Kryobiologie hat spezifische Eigenschaften, mit denen der Interventionalist vertraut sein muss.

• Für optimale Ergebnisse sind eine strikte Patientenselektion und eine optimale Bildsteuerung bedeutsam.

• Vorteile der Kryoablation sind anästhesiologische Effekte, Visualisierung und Erhalt von Kollagenfasern und Fibroblasten.

• Nachteil ist der Mangel an prospektiv randomisierten Studien.

Zitierweise

• Mahnken AH, König AM, Figiel JH. Current Technique and Application of Percutaneous Cryotherapy. Fortschr Röntgenstr 2018; 190: 836 – 846

Key words

cryoablation - oncology - ablation - neoplasm - cancer - image-guided

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