Zusammenfassung
Die perkutane interstitielle Tumortherapie stellt innerhalb der interventionellen
Radiologie ein noch junges, sich aber stetig weiterentwickelndes Verfahren dar. Unter
den Thermoablationsverfahren hat die Radiofrequenzablation (RFA) die weiteste Verbreitung
gefunden, nicht zuletzt aufgrund des günstigen Verhältnisses von Sondendurchmesser
und Wirkungsrad. Die Grundlagen, technischen Hintergründe und Applikationstechniken
wurden im ersten Teil der Übersichtsarbeit zur perkutanen Radiofrequenzablation beschrieben.
In diesem zweiten Teil werden die Indikationen, Techniken und Ergebnisse der klinischen
RFA primärer und sekundärer Lebertumoren sowie Erfahrungen der extrahepatischen RFA
im Bereich der Niere, des Knochens und der Lunge vorgestellt und anhand der Literatur
diskutiert.
Abstract
Percutaneous interstitial tumor ablation therapy is a relatively new and steadily
growing field within interventional radiology. Radiofrequency ablation (RFA) became
one of the most accepted techniques among hyperthermal ablation procedures, presumably
due to its superior relation between probe diameter and efficacy. The first part of
this review provided an overview of the underlying principles, technical background
and application techniques. This second part describes the indications, techniques
and results of clinical RFA applied to primary and secondary liver tumors as well
as experiences with extrahepatic RFA applied to kidney, bone and lung, together
with a discussion of the current literature.
Schlüsselwörter
Interventionelle Radiologie - Radiofrequenzablation - hepatozelluläres Karzinom -
Lebermetastasen - interventionelle Computertomographie - interventionelle Magnetresonanztomographie
Key words
Interventional radiology - radiofrequency ablation - hepatocellular carcinoma - liver
metastases - interventional computed tomography - interventional magnetic resonance
tomography
Literatur
- 1
Taylor-Robinson S D, Foster G R, Arora S. et al .
Increase in primary liver cancer in the UK, 1979 - 94.
Lancet.
1997;
350
1142-1143
- 2
Poon R TP, Fan S T, Lo C M. et al .
Improving survival results after resection of hepatocellular carcinoma. A prospective
study of 377 patients over 10 years.
Ann Surg.
2001;
234
63-70
- 3
Fong Y, Sun R L, Jarnagin W. et al .
An analysis of 412 cases of hepatocellular carcinoma at a western center.
Ann Surg.
1999;
229
790-800
- 4
Livraghi T, Giorgio A, Marin G. et al .
Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneous
ethanol injection.
Radiology.
1995;
197
101-108
- 5
Castellano L, Calandra M, del Vecchio Blanco C. et al .
Practice factors of survival and intrahepatic recurrence of hepatocellular carcinoma
in cirrhosis after percutaneous ethanol injection: analysis of 71 patients.
J Hepatol.
1997;
27
862-870
- 6
Lin S M, Lin D Y, Lin C J.
Percutaneous ethanol injection treatment in 47 cirrhotic patients with hepatocellular
carcinoma 5 cm or less: a long-term result.
Int J Clin Pract.
1999;
53
257-262
- 7
Giorgio A, Tarantino L, Manniello N. et al .
Percutaneous ethanol injection under general anesthesia for hepatocellular
carcinoma: 3-year-survival in 112 patients.
Eur J Ultrasound.
1998;
8
201-206
- 8
Hargreaves G M, Adam R, Bismuth H.
Results after nonsurgical local treatment of primary liver malignancies.
Langenbecks Arch Surg.
2000;
385
185-193
- 9
Ikeda K, Kumada H, Saitoh S. et al .
Effect of repeated transcatheter arterial emoblization on the survival time in patients
with hepatocellular carcinoma. An analysis by the Cox proportional hazard model.
Cancer.
1991;
68
2150-2154
- 10
Mondazzi L, Bottelli R, Brambilla G. et al .
Transarterial oily chemoembolization for the treatment of hepatocellular carcinoma:
a multivariate analysis of prognostic factors.
Hepatology.
1994;
19
1115-1123
- 11
Groupe d'Etude et de Traitment du Carcinome Hepatocellulaire .
A comparison of Lipiodol chemoembolization and conservative treatment for unresectable
hepatocellular carcinoma.
N Engl J Med.
1995;
332
1256-1261
- 12
Pelletier G, Ducreux M, Gay F. et al .
Treatment of unresectable hepatocellular carcinoma with Lipiodol chemoembolization:
a multicenter randomized trial. Groupe CHC.
J Hepatol.
1998;
29
129-134
- 13
Llovet J M, Real M I, Montana X. et al .
Arterial embolisation or chemoembolisation versus symptomatic treatment in patients
with unresectable hepatocellular carcinoma: a randomised trial.
Lancet.
2002;
359
1734-1739
- 14
Landis S H, Murray T, Bolden S, Wingo P A.
Cancer statistics, 1999.
CA Cancer J Clin.
1999;
49
8-31
- 15
Lehnert T, Golling M.
Indikation und Ergebnisse der Lebermetastasenresektion.
Radiologe.
2001;
42
40-48
- 16
Baker M E, Pelley R.
Hepatic metastases: basic principles and implications for radiologists.
Radiology.
1995;
197
329-337
- 17
Ott R, Wein A, Hohenberger W.
Lebermetastasen - primäre oder multimodale Therapie?.
Chirurg.
2001;
71
887-897
- 18
Nakamura S, Suzuki S, Baba S.
Resection of liver metastases of colorectal carcinoma.
World J Surg.
1997;
21
741-747
- 19
Vogl T J, Zangos S, Balzer J O. et al .
Transarterielle Chemoembolisation von Lebermetastasen: Indikationsstellung, Technik,
Ergebnisse.
Fortschr Röntgenstr.
2002;
174
675-683
- 20
Nakajima Y, Ko S, Kanamura T. et al .
Repeat liver resection for hepatocellular carcinoma.
J Am Coll Surg.
2001;
192
339-344
- 21
Cady B, Jenkins B L, Steele G D. et al .
Surgical margin in hepatic resection for colorectal metastasis: a critical and improvable
determinant of outcome.
Ann Surg.
1998;
227
566-571
- 22
Dodd G D, Soulen M C, Kane R A, Livraghi T, Lees W R, Yamashita Y, Gilliams A R, Karahan O I,
Rhim H.
Minimally invasive treatment of malignant hepatic tumors: at the threshold of a major
breakthrough.
Radiographics.
2000;
20
9-27
- 23
Dodd G D, Frank M A, Aribandi M. et al .
Radiofrequency thermal ablation: computer analysis of the size of the thermal injury
created by overlapping ablations.
Am J Roentgenol.
2001;
177
777-782
- 24
Curley S A, Izzo F.
Radiofrequency ablation of primary and metastatic hepatic malignancies.
Int J Clin Oncol.
2002;
7
72-81
- 25
Livraghi T, Goldberg S N, Lazzaroni S. et al .
Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol
injection.
Radiology.
1999;
210
655-661
- 26
de Baere T, Elias D, Dromain C. et al .
Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than
1 year.
Am J Roentgenol.
2000;
175
1619-1625
- 27
Jiao L R, Hansen P D, Havlik R, Mirty R R, Pignatelli M, Habib N.
Clinical short-term results of radiofrequency ablation in primary and secondary liver
tumors.
Am J Surg.
1999;
177
303-306
- 28
Goldberg A N, Hahn P F, Tanabe K K. et al .
Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling
limit coagulation necrosis?.
JVIR.
1998;
9
101-111
- 29
de Baere T, Bessoud B, Dromain C. et al .
Percutaneous radiofrequency ablation of hepatic tumors during temporary venous occlusion.
Am J Roentgenol.
2002;
178
53-59
- 30
Rossi S, Garbagnati F, Lencioni R. et al .
Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma
after occlusion of tumor blood supply.
Radiology.
2000;
217
119-126
- 31
Buscarini L.
Percutaneous RF interstitial thermal ablation after transarterial embolization for
treatment or large hepatic tumors.
Radiology.
1998;
209
(Suppl)
266
- 32
Helmberger T, Holzknecht N, Schöpf U. et al .
Radiofrequenzablation von Lebermetastasen - Technik und erste Ergebnisse.
Radiologe.
2001;
41
69-76
- 33
Raman S, Lu D SK, Vodopich D J. et al .
Minimizing diaphragmatic injury during radio-frequency ablation: efficacy of subphrenic
peritoneal saline injection in a porcine model.
Radiology.
2002;
222
819-823
- 34
Lees W R, Gillams A R.
Complications of radiofrequency and laser ablation of liver metastases: incidence
and management (Abstr.).
Radiology.
1999;
231
122
- 35
Mahnken A H, Tacke J, Bücker A, Günther R W.
Perkutane Radiofrequenzablation maligner Leberläsionen: Erste Erfahrungen mit einem
200-Watt-Generator.
Fortschr Röntgenstr.
2002;
174
216-223
- 36
Francica G.
Complication of radio-frequency thermal ablation (Brief).
Radiology.
2001;
220
554
- 37
Livraghi T, Goldberg S N, Monti F.
Saline-enhanced radio-frequency tissue ablation in the treatment of liver metastases.
Radiology.
1997;
202
205-210
- 38
Dupuy D E, Goldberg S N.
Image-guided radiofrequency tumor ablation: challenges and opportunities - part II.
J Vasc Interv Radiol.
2001;
12
1135-1148
- 39
Elias D, de Baere T, Muttillo I, Cavalcanti A, Coyle C, Roche A.
Intraoperative use of radiofrequency treatment allows an increase in the rate of curative
liver resection.
J Surg Oncol.
1998;
67
190-191
- 40
Curley S A, Izzo F, Delria P. et al .
Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies:
results in 123 patients.
Ann Surg.
1999;
230
1-8
- 41
Bilchik A J, Rose D M, Allegra D P, Bostick P J, Hsuseh E, Morton D L.
Radiofrequency ablation: a minimally invasive technique with multiple applications.
Cancer J Sci Am.
1999;
5
356-361
- 42
Wood T F, Rose D M, Chung M. et al .
Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations,
and implications.
Ann Surg Oncol.
2000;
7
593-600
- 43
Bowles B J, Machi J, Limm W M. et al .
Safety and efficacy of radiofrequency thermal ablation in advanced liver tumors.
Arch Surg.
2001;
136
864-869
- 44
Siperstein A, Garland A, Angle K. et al .
Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors.
Ann Surg Oncol.
2000;
7
10-13
- 45
Cuschieri A, Bracken J, Boni L.
Initial experience with laparoscopic ultrasound-guided radiofrequency thermal ablation
of hepatic tumors.
Endoscopy.
1999;
31
318-321
- 46
Solbiati L, Livraghi T, Goldberg S N, Ierace T. et al .
Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer:
long-term results in 117 patients.
Radiology.
2001;
221
159-166
- 47
Lencioni R, Goletti O, Armilotta N. et al .
Radio-frequency thermal ablation of liver metastases with a cooled-tip electrode needle:
results of a pilot clinical trial.
Eur Radiol.
1998;
8
1205-1211
- 48
Rossi S, Buscarini E, Garbagnati F. et al .
Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode.
Am J Roentgenol.
1998;
170
1015-1022
- 49
Trübenbach J, König C W, Duda S H, Schick F, Huppert P E, Claussen C D, Pereira P L.
Perkutane Radiofrequenzablation hepatischer Neoplasien unter Verwendung von „Cluster”-Ablationssonden
- Erste klinische Erfahrungen.
Fortschr Röntgenstr.
2000;
172
905-910
- 50
Huppert P E, Trübenbach J, Schick F, Pereira P, König C, Claussen C D.
MRT-gestützte perkutane Radiofrequenzablation hepatischer Neoplasien - Erste technische
und klinische Erfahrungen.
Fortschr Röntgenstr.
2000;
172
692-700
- 51
Kettenbach J.
Percutaneous MR-guided interventions.
Eur Radiol.
2002;
12
(suppl)
13
- 52
Raman S S, Lu D SK, Vodopich D J. et al .
Creation of radiofrequency lesions in a porcine model: correlation with sonography,
CT, and histopathology.
Am J Roentgenol.
2000;
175
1253-1258
- 53
Cha C H, Lee F T, Gurney J M. et al .
CT versus sonography for monitoring radiofrequency ablation in a porcine liver.
Am J Roentgenol.
2000;
175
705-711
- 54
Solbiati L, Goldberg S N, Lerace T. et al .
Radio-frequency ablation of hepatic metastases: postoprocedural assessment with a
US microbubble contrast agent - early experience.
Radiology.
1999;
211
643-649
- 55
Meloni M F, Goldberg S N, Livraghi T. et al .
Hepatocellular carcinoma treated with radiofrequency ablation: comparison of pulse
inversion contrast-enhanced harmonic sonography, contrast-enhanced power doppler sonography,
and helical CT.
Am J Roentgenol.
2001;
177
375-380
- 56
Dromain C, de Baere T, Elias D. et al .
Hepatic tumors treated with percutaneous radio-frequency ablation: CT and MR imaging
follow-up.
Radiology.
2002;
223
255-262
- 57
Rossi S, Fornari F, Pathies C, Buscarini L.
Thermal lesions induced by 480 KHz localized current field in guinea pig and pig liver.
Tumori.
1990;
76
54-57
- 58
Rossi S, DiStasi M, Buscarini E. et al .
Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer.
Am J Roentgenol.
1996;
167
759-768
- 59
Choi D, Lim H K, Kim S H. et al .
Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: usefulness
of power doppler US with a microbubble contrast agent in evaluating therapeutic response
- preliminary results.
Radiology.
2000;
217
558-563
- 60
Buscarini L, Buscarini E, DiStasi M. et al .
Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term
results.
Eur Radiol.
2001;
11
914-921
- 61
Livraghi T, Goldberg S N, Lazzaroni S. et al .
Hepatocellular carcinoma: radio-frequency ablation of medium and large lesions.
Radiology.
2000;
214
761-768
- 62
Lencioni R, Cioni D, Donati F. et al .
Percutaneous treatment of small hepatocellular carcinoma in cirrhosis: radiofrequency
thermal ablation versus ethanol injection - a prospective, randomized trial.
Radiology.
1999;
213 (P)
123
- 63
Iekda M, Okada S, Ueno H. et al .
Radiofrequency ablation and percutaneous ethanol injection in patients with small
hepatocellular carcinoma: a comparative study.
Jpn J Clin Oncol.
2001;
31
(7)
322-326
- 64
Shibata T, Iimuro Y, Yamamoto Y. et al .
Small hepatocellular carcinoma: comparison of radio-frequency ablation and percutaneous
microwave coagulation therapy.
Radiology.
2002;
223
331-337
- 65
Nicoli N, Casaril A, Marchiori L. et al .
Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation.
J Hepatobiliary Pancreat Surg.
2001;
8
417-421
- 66
Llovet J M, Vilana R, Bru C. et al .
Increased risk of tumor seeding after percutaneous radiofrequency ablation for single
hepatocellular carcinoma.
Hepatology.
2001;
33
1124-1129
- 67
Solbiati G, Goldberg S N, Ierace T. et al .
Hepatic metastases: percutaneous radiofrequency ablation with cooled-tip electrodes.
Radiology.
1997;
205
367-373
- 68
Gillams A, Lees W R.
Survival after percutaneous, image guided thermal ablation of hepatic metastases from
colorectal cancer.
Dis Colon Rectum.
2000;
43
656-661
- 69 Siperstein A E, Rogers S J, Machi J, Goldstein R, Sielaff T, Rosato E.
Long-term follow-up of patients undergoing radiofrequency thermal ablation of primary
metastatic liver tumors: a multi-center study. Vorgestellt auf dem 88. Annual Clinical
Congress. San Francisco; Annual Clinical Congress. 9. Oktober 2002. 2002
- 70
Livraghi T, Goldberg S N, Solbiati L, Meloni F, Ierace T, Gazelle G S.
Percutaneous radio-frequency ablation of liver metastases from breast cancer: initial
experience in 24 patients.
Radiology.
2001;
220
145-149
- 71
Gazelle G S, Goldberg S N.
State of the art: tumor ablation with radiofrequency.
Radiology.
2000;
217
633-646
- 72
Francica G, Marone G.
Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency
hyperthermia with a cooled-tip needle: a preliminary clinical experience.
Eur J Ultrasound.
1999;
9
145-153
- 73
Ikeda M, Okada S, Ueno H, Okusaka T, Kuriyama H.
Radiofrequency ablation and percutaneous ethanol injection in patients with small
hepatocellular carcinoma: a comparative study.
Jpn J Clin Oncol.
2001;
31
322-326
- 74
Lim H K, Choi D, Lee W J. et al .
Hepatocellular carcinoma treated with percutaneous radio-frequency ablation: evaluation
with follow-up multiphase helical CT.
Radiology.
2001;
221
447-454
- 75
Morimoto M, Sugimori K, Shirato K. et al .
Treatment of hepatocellular carcinoma with radiofrequency ablation. Radiologic-histologic
correlation during follow-up periods.
Hepatology.
2002;
35
1467-1475
- 76
Lee C T, Katz J, Shi W, Thaler H T, Reuter V E, Russo P.
Surgical management of renal tumors 4 cm or less in a contemporary cohort.
J Urol.
2000;
163
730-736
- 77
Ono Y, Kinukawa T, Hattori R, Gotoh M, Kamihira O, Ohshima S.
The long-term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma.
J Urol.
2001;
165
1867-1870
- 78
Shingleton W B, Sewell P E.
Percutaneous renal tumor cryoablation with magnetic resonance imaging guidance.
J Urol.
2001;
165
773-776
- 79
Murphy D P, Gill I S.
Energy-based renal tumor ablation: a review.
Semin Urol Oncol.
2001;
19
33-40
- 80
Reddan D N, Raj G V, Polascik T J.
Management of small renal tumors: an overview.
Am J Med.
2001;
110
558-562
- 81
Zlotta A R, Wildschutz T, Raviv G, Peny M O, van Gansbeke D, Noel J C, Schulman C C.
Radiofrequency interstitial tumor ablation (RITA) is a possible new modality for treatment
of renal cancer: ex vivo and in vivo experience.
J Endourol.
1997;
11
251-258
- 82
McGovern F J, Wood B J, Goldberg S N, Mueller P R.
Radiofrequency ablation of renal cell carcinoma via image guided needle electrodes.
J Urol.
1999;
161
599-600
- 83
Gervais D A, McGovern F J, Wood B J, Goldberg S N, McDougal W S, Mueller P R.
Radio-frequency ablation of renal cell carcinoma: early clinical experience.
Radilogy.
2000;
217
665-672
- 84
Hall W H, Mcgahan J P, Links D P, deVere White R W.
Combined embolization and percutaneous radiofrequency ablation of a solid renal tumor.
Am J Roentgenol.
2000;
174
1592-1594
- 85
Tacke J, Mahnken A, Bücker A, Rohde D, Gunther R W.
Nephron-sparing percutaneous ablation of a 5 cm renal cell carcinoma by superselective
embolization and percutaneous RF-ablation.
Fortschr Röntgenstr.
2001;
173
980-983
- 86
Rosenthal D I, Alexander A, Rosenberg A E, Springfield D S.
Ablation of osteoid osteomas with a percutaneously placed electrode: a new procedure.
Radiology.
1992;
183
29-33
- 87
Rosenthal D I, Springfield D S, Gebhardt M C. et al .
Osteoid osteoma: percutaneous radio-frequency ablation.
Radiology.
1995;
197
451-454
- 88
Wörtler K, Vestring T, Boettner F. et al .
Osteoid osteoma: CT-guided percutaneous radiofrequency ablation and follow-up in 47
patients.
J Vasc Interv Radiol.
2001;
12
717-722
- 89
Yamane T, Tateishi A, Cho S. et al .
The effects of hyperthermia on the spinal cord.
Spine.
1992;
17
1386-1391
- 90
Dupuy D E, Hong R, Oliver B, Goldberg S N.
Radiofrequency ablation of spinal tumors: temperature distribution in the spinal canal.
Am J Roentgenol.
2000;
175
1263-1266
- 91
Janjan N A.
Radiation for bone metastases: conventional techniques and the role of systemic pharmaceuticals.
Cancer.
1997;
80
1628-1645
- 92
Dupuy D E, Safran H, Mayo-Smith W W, Goldberg S N.
Radiofrequency ablation of painful osseous metastases (Abstr).
Radiology.
1998;
209
(Suppl)
389
- 93
Grönemeyer D H, Schirp S, Gevargez A.
Image-guided percutaneous thermal ablation of bone tumors.
Acad Radiol.
2002;
9
467-477
- 94
Callstrom M R, Charboneau J W, Goetz M P. et al .
Painful metastases involving bone: feasibility of percutaneous CT- and US-guided radio-frequency
ablation.
Radiology.
2002;
224
87-97
- 95
Goldberg S N, Gazelle G S, Sompton C C, McLoud T C.
Radiofrequency tissue ablation in the rabbit lung: efficacy and complications.
Acad Radiol.
1995;
2
776-784
- 96
Goldberg S N, Gazelle G S, Compton C C. et al .
Radio-frequency ablation of VX2 tumor nodules in the rabbit lung.
Acad Radiol.
1996;
3
929-935
- 97
Dupuy D E, Zagoria R J, Akerley W. et al .
Percutaneous radiofrequency ablation of malignancies in the lung.
Am J Roentgenol.
1999;
174
57-59
- 98
Dupuy D E, Mayo-Smith W W, Abbott G F, DiPetrillo T.
Clinical applications of radio-frequency tumor ablation in the thorax.
Radiographics.
2000;
22
S259-S269
- 99 Sewell P.
Department of Radiology, University of Mississippi School of Medicine, Jackson, Mississippi,
USA. Persönliche Mitteilung. Jackson, Mississippi, USA; School of Medicine 2001
- 100
Vaughn C, Mychaskiw G, Sewell P.
Massive hemorrhage during radiofrequency ablation of a pulmonary neoplasm.
Anesth Analg.
2002;
94
1149-1151
- 101
Vogl T J, Mack M, Straub R. et al .
Perkutane interstitielle Thermotherapie maligner Lebertumoren.
Fortschr Röntgenstr.
2000;
172
12-22
- 102
Shetty A K, Rosen M P, Raptopoulos V, Goldberg S N.
Cost-effectiveness of percutaneous radiofrequency ablation for malignant hepatic neoplasms.
J Vasc Intervent Radiol.
2001;
12
823-833
PD Dr. med. Josef Tacke
Klinik für Radiologische Diagnostik, Universitätsklinikum Aachen
Pauwelsstraße 30
52047 Aachen
Telefon: + 49-241-8088332
Fax: + 49-241-8082480
eMail: tacke@rad.rwth-aachen.de
