Therapie von Lebermetastasen des kolorektalen Karzinoms: Übersicht der hyperthermen Ablationsverfahren

Zusammenfassung

Zielsetzung und Methode: In dieser Arbeit werden die technischen Grundlagen und klinischen Ergebnisse gebräuchlicher hyperthermer Ablationsverfahren zur Therapie von Lebermetastasen des kolorektalen Karzinoms dargestellt. Mit einer selektiven Literaturrecherche in gängigen Datenbanken und anhand eigener klinischer Erfahrung an einem interdisziplinären Leberzentrum eines Universitätsklinikums wurden bereits publizierte Daten zusammengestellt und vergleichend bewertet.

Ergebnis: Für Radiofrequenzablation (RFA), Mikrowellenablation (MWA) und Laserablation (LITT) ergaben sich vergleichbare Überlebensdaten. Lokalrezidive waren nach LITT (Mittel: 7,1–10 %) etwas seltener zu beobachten als nach RFA (Mittel: 32–44 %) und MWA (Mittel: 7–15 %). Die Überlebensdaten hängen von vielen Faktoren ab. Die 3-Jahres-Überlebensraten liegen für die RFA zwischen 20,2–71,3 %, für die MWA bei 51,1 % und für die LITT zwischen 56–77 %. Die Komplikationen liegen im Mittel bei 1,8–10 %. Aktuelle Studien, welche die Thermoablationsverfahren mit lokal applizierter Chemo- oder Radiotherapie kombinieren, zeigen vielversprechende Ergebnisse.

Schlussfolgerung: RFA, MWA und LITT bieten eine gute lokale Tumorkontrolle bei ambulanter Durchführbarkeit und geringer Komplikationsrate. Indiziert sind diese Verfahren bei auf die Leber beschränkter Metastasierung mit < 5 Metastasen und einem maximalen Durchmesser ≤ 4 cm, wenn Leberresektion kontraindiziert oder bereits erfolgt ist. Die Indikation wird durch ein interdisziplinäres Tumorboard getroffen.

Abstract

Aim and method: This paper presents the basic techniques and clinical results of the most common hyperthermal ablation methods for patients with malignant liver metastases of colorectal carcinoma. An overview of recently published data is provided using selected articles from the literature and our own clinical experience in an interdisciplinary liver centre.

Results: Radiofrequency ablation (RFA), microwave ablation (MWA) and laser ablation (LITT) show comparable results concerning survival data. Local recurrence is less frequent after LITT (7,1–10 %) than after RFA (32–44 %) and MWA (7–15 %). Survival depends on many factors. The 3-year survival rate for RFA ranges from 20,2–71,3 %, for MWA it is 51,1 % and for LITT from 56–77 %. Mean complication rates range from 1,8–10 %. Recent studies showed promising results after combined therapy of regional chemotherapy or regional radiotherapy with thermal ablation.

Conclusion: Ablation methods such as RFA, MWA and LITT show good local tumor control with low complication rates and are usually performed on an outpatient basis. Indications are < 5 metastases limited to the liver with a maximum diameter of ≤ 4 cm when surgical resection is contraindicated or has been previously performed. The decision should be made by an interdisciplinary tumor board.

Schlüsselwörter

Lebermetastasen - kolorektales Karzinom - minimal invasive Therapie - interventionelle Radiologie - Thermoablation

Keywords

liver metastases - colorectal carcinoma - minimally invasive therapy - interventional radiology - thermal ablation

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