Radiologie up2date 2017; 17(02): 139-156
DOI: 10.1055/s-0043-105752
Abdominelle und gastrointestinale Radiologie
Georg Thieme Verlag KG Stuttgart · New York

Lokal ablative Therapie bei Lebertumoren

Local ablations in liver tumors
Frank Fischbach
Jens Ricke
Katharina Fischbach

Subject Editor: Prof. Jörg Barkhausen, Lübeck
Further Information

Publication History

Publication Date:
03 August 2017 (online)


In den letzten Jahren stehen bei Patienten mit Lebertumoren interdisziplinäre Therapieansätze mit Betonung minimalinvasiver Verfahren zur Reduktion der Tumorlast zunehmend im Fokus. Lokal ablative Verfahren zur Behandlung des HCC und von Lebermetastasen kolorektaler Tumoren sind bereits in Behandlungsempfehlungen und Leitlinien integriert. Der folgende Beitrag stellt die häufigsten Verfahren vor und beschreibt ihre Relevanz für den klinischen Alltag.


The past years have seen a paradigm shift in the treatment strategies of liver tumors. Due to increasing data interdisciplinary therapy regimens focusing on minimally invasive image guided interventions in combination with surgical procedures and chemotherapy are more and more employed. At present image guided local ablations are part of the international guidelines for the treatment of hepatocellular carcinoma and liver metastases of colon carcinoma with more indications to come in the near future.

Image guide local ablations of liver tumors offer various advantages such as a low peri- and post-interventional morbidity and mortality as well as a short hospital stay when compared to classic liver surgery. Owing to the fact that local ablations are confined to the malignant lesion itself and thus spare the residual liver parenchyma they can be repetitively used and easily combined with surgical resections and systemic chemotherapy. Nowadays a multitude of local ablation approaches exists but by far the most common utilized is radiofrequency ablation. When malignant liver lesions are extensive a high-dose brachytherapy is promising. The ablation procedure to be used is chosen by the interdisciplinary oncology team in charge taking into consideration both the individual patient situation as well as the local expertise.

  • Interdisziplinäre Therapieansätze unter Einbeziehung bildgeführter lokal ablativer Therapien stehen bei der Therapie von Lebertumoren zunehmend im Fokus und sind inzwischen auch in den Leitlinien vertreten.

  • Zu den Vorteilen minimalinvasiver bildgeführter Lebereingriffe zählen unter anderem eine relativ geringe Morbidität und Mortalität, wie auch die kurze Krankenhausverweildauer infolge der geringen Invasivität.

  • Aufgrund des parenchymsparenden Vorgehens können lokale Ablationen wiederholt im Krankheitsverlauf eingesetzt und in Kombination mit einer operativen Resektion und Systemtherapie angewandt werden.

  • Die Radiofrequenzablation ist das am häufigsten eingesetzte lokale Ablationsverfahren. Bei großen Leberraumforderungen ist die Hochdosis-Brachytherapie vielversprechend.

  • Die Wahl des eingesetzten lokalen Ablationsverfahrens ist eine interdisziplinäre Entscheidung des onkologischen Teams vor Ort.

  • Literatur

  • 1 Van Cutsem E, Cervantes A, Adam R. et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27: 1386-1422
  • 2 Rhim H, Goldberg SN, Dodd 3rd GD. et al. Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. Radiographics 2001; 21(Spec No): S17-35 discussion S36–S39
  • 3 Pereira PL, Trubenbach J, Schmidt D. Radiofrequency ablation: basic principles, techniques and challenges. Rofo 2003; 175: 20-27
  • 4 Elias D, Baton O, Sideris L. et al. Local recurrences after intraoperative radiofrequency ablation of liver metastases: a comparative study with anatomic and wedge resections. Ann Surg Oncol 2004; 11: 500-505
  • 5 Bruners P, Schmitz-Rode T, Gunther RW. et al. Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results. Rofo 2008; 180: 216-222
  • 6 Simon CJ, Dupuy DE, Mayo-Smith WW. Microwave ablation: principles and applications. Radiographics 2005; 25 (Suppl. 01) S69-S83
  • 7 Hoffmann R, Rempp H, Erhard L. et al. Comparison of four microwave ablation devices: an experimental study in ex vivo bovine liver. Radiology 2013; 268: 89-97
  • 8 Carrafiello G, Lagana D, Mangini M. et al. Microwave tumors ablation: principles, clinical applications and review of preliminary experiences. Int J Surg 2008; 6 (Suppl. 01) S65-S69
  • 9 Brace CL. Microwave ablation technology: what every user should know. Curr Probl Diagn Radiol 2009; 38: 61-67
  • 10 Pech M, Werk M, Beck A. et al. System continuity and energy distribution in laser-induced thermo therapy (LITT). Rofo 2002; 174: 754-760
  • 11 Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology 1998; 37: 171-186
  • 12 Niu LZ, Li JL, Xu KC. Percutaneous Cryoablation for Liver Cancer. J Clin Transl Hepatol 2014; 2: 182-188
  • 13 Allen BC, Remer EM. Percutaneous cryoablation of renal tumors: patient selection, technique, and postprocedural imaging. Radiographics 2010; 30: 887-900
  • 14 Junginger T, Seifert JK, Weigel TF. et al. Cryotherapy of liver metastases. Initial results. Med Klin (Munich) 1998; 93: 517-523
  • 15 Hinshaw JL, Lubner MG, Ziemlewicz TJ. et al. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation – what should you use and why?. Radiographics 2014; 34: 1344-1362
  • 16 Bretschneider T, Peters N, Hass P. et al. Update on interstitial brachytherapy. Radiologe 2012; 52: 70-73
  • 17 Ricke J, Wust P, Stohlmann A. et al. CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases. Strahlenther Onkol 2004; 180: 274-280
  • 18 Narayanan G. Irreversible Electroporation. Semin Intervent Radiol 2015; 32: 349-355
  • 19 Dollinger M, Zeman F, Niessen C. et al. Bile duct injury after irreversible electroporation of hepatic malignancies: evaluation of MR imaging findings and laboratory values. J Vasc Interv Radiol 2016; 27: 96-103
  • 20 Kasper HU, Drebber U, Dries V. et al. Liver metastases: incidence and histogenesis. Z Gastroenterol 2005; 43: 1149-1157
  • 21 Kanas GP, Taylor A, Primrose JN. et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012; 4: 283-301
  • 22 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA: a cancer journal for clinicians 2015; 65: 5-29
  • 23 Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 2009; 19: 1206-1213
  • 24 Grundmann RT, Hermanek P, Merkel S. et al. Diagnosis and treatment of colorectal liver metastases – workflow. Zentralbl Chir 2008; 133: 267-284
  • 25 Berber E, Pelley R, Siperstein AE. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol 2005; 23: 1358-1364
  • 26 Stang A, Fischbach R, Teichmann W. et al. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer 2009; 45: 1748-1756
  • 27 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF): S3-Leitlinie Kolorektales Karzinom, Version 2014. Im Internet: http://Leitlinienprogramm-Onkologie.De/Leitlinien.7.0.html Stand: 15.05.2017
  • 28 Fong Y, Fortner J, Sun RL. et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 1999; 230: 309-318 discussion 318–321
  • 29 Mahnken AH, Bruners P, Tacke JA. et al. CT-guided radiofrequency ablation of liver metastases from colorectal cancer. Dtsch Med Wochenschr 2009; 134: 976-980
  • 30 Lordick F, Knodler M, Hacker U. et al. Neoadjuvant chemotherapy or primary surgery for colorectal liver metastases. Pro adjuvant chemotherapy. Chirurg 2014; 85: 11-16
  • 31 Settmacher U, Scheuerlein H, Rauchfuss F. Assessment of resectability of colorectal liver metastases and extended resection. Chirurg 2014; 85: 24-30
  • 32 Mantke R, Niepmann D, Gastinger I. et al. Hepatic resections. Analysis of data from the Tumor Documentation Center in the state of Brandenburg, Germany, focusing on liver metastases of colorectal carcinoma. Chirurg 2006; 77: 1135-1143
  • 33 Mulier S, Ni Y, Jamart J. et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial?. Ann Surg Oncol 2008; 15: 144-157
  • 34 Tanis E, Nordlinger B, Mauer M. et al. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983. Eur J Cancer 2014; 50: 912-919
  • 35 Vigano L, Capussotti L, Lapointe R. et al. Early recurrence after liver resection for colorectal metastases: risk factors, prognosis, and treatment. A LiverMetSurvey-based study of 6,025 patients. Ann Surg Oncol 2014; 21: 1276-1286
  • 36 Welsh FK, Tekkis PP, Oʼrourke T. et al. Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making. Surg Oncol 2008; 17: 3-13
  • 37 Smith MD, Mccall JL. Systematic review of tumour number and outcome after radical treatment of colorectal liver metastases. Br J Surg 2009; 96: 1101-1113
  • 38 Livraghi T, Solbiati L, Meloni MF. et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003; 226: 441-451
  • 39 Mahnken AH, Pereira PL, De Baere T. Interventional oncologic approaches to liver metastases. Radiology 2013; 266: 407-430
  • 40 Ruers T, Punt C, Van Coevorden F. et al. Radiofrequency ablation combined with systemic treatment versus systemic treatment alone in patients with non-resectable colorectal liver metastases: a randomized EORTC Intergroup phase II study (EORTC40004). Ann Oncol 2012; 23: 2619-2626
  • 41 Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995; 13: 8-10
  • 42 Milano MT, Katz AW, Zhang H. et al. Oligometastases treated with stereotactic body radiotherapy: long-term follow-up of prospective study. Int J Radiat Oncol Biol Phys 2012; 83: 878-886
  • 43 Evrard S, Poston G, Kissmeyer-Nielsen P. et al. Combined ablation and resection (CARe) as an effective parenchymal sparing treatment for extensive colorectal liver metastases. PLoS One 2014; 9: e114404
  • 44 Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology 2010; 51: 1820-1832
  • 45 European Association for the Study of The L, European Organisation For R. Treatment Of C. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012; 56: 908-943
  • 46 Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Seminars in liver disease 2005; 25: 181-200
  • 47 Liu PH, Hsu CY, Hsia CY. et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤ 2 cm in a propensity score model. Ann Surg 2016; 263: 538-545
  • 48 Jaskolka JD, Asch MR, Kachura JR. et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol 2005; 16: 485-491
  • 49 Yamakado K, Nakatsuka A, Takaki H. et al. Early-stage hepatocellular carcinoma: radiofrequency ablation combined with chemoembolization versus hepatectomy. Radiology 2008; 247: 260-266
  • 50 Park EK, Kim HJ, Kim CY. et al. A comparison between surgical resection and radiofrequency ablation in the treatment of hepatocellular carcinoma. Ann Surg Treat Res 2014; 87: 72-80
  • 51 Verslype C, Rosmorduc O, Rougier P. et al. Hepatocellular carcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23 (Suppl. 07) vii41-48
  • 52 Lee DH, Lee JM, Lee JY. et al. Radiofrequency ablation of hepatocellular carcinoma as first-line treatment: long-term results and prognostic factors in 162 patients with cirrhosis. Radiology 2014; 270: 900-909
  • 53 Wang Y, Luo Q, Li Y. et al. Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: a meta-analysis of randomized and nonrandomized controlled trials. PLoS One 2014; 9: e84484
  • 54 Lencioni RA, Allgaier HP, Cioni D. et al. Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003; 228: 235-240
  • 55 Streitparth F, Pech M, Bohmig M. et al. In vivo assessment of the gastric mucosal tolerance dose after single fraction, small volume irradiation of liver malignancies by computed tomography-guided, high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2006; 65: 1479-1486
  • 56 Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, and diagnostic imaging guidance. AJR Am J Roentgenol 2000; 174: 323-331
  • 57 Park MH, Rhim H, Kim YS. et al. Spectrum of CT findings after radiofrequency ablation of hepatic tumors. Radiographics 2008; 28: 379-390 discussion 390–392
  • 58 Mitsuzaki K, Yamashita Y, Nishiharu T. et al. CT appearance of hepatic tumors after microwave coagulation therapy. AJR Am J Roentgenol 1998; 171: 1397-1403
  • 59 Kim SK, Lim HK, Kim YH. et al. Hepatocellular carcinoma treated with radio-frequency ablation: spectrum of imaging findings. Radiographics 2003; 23: 107-121
  • 60 Onishi H, Matsushita M, Murakami T. et al. MR appearances of radiofrequency thermal ablation region: histopathologic correlation with dog liver models and an autopsy case. Acad Radiol 2004; 11: 1180-1189
  • 61 Fischbach F, Bunke J, Thormann M. et al. MR-guided freehand biopsy of liver lesions with fast continuous imaging using a 1.0-T open MRI scanner: experience in 50 patients. Cardiovasc Intervent Radiol 2011; 34: 188-192
  • 62 Clasen S, Pereira PL. Magnetic resonance guidance for radiofrequency ablation of liver tumors. J Magn Reson Imaging 2008; 27: 421-433
  • 63 Mueller-Lisse UG, Thoma M, Faber S. et al. Coagulative interstitial laser-induced thermotherapy of benign prostatic hyperplasia: online imaging with a T2-weighted fast spin-echo MR sequence-experience in six patients. Radiology 1999; 210: 373-379
  • 64 Rempp H, Clasen S, Pereira PL. Image-based monitoring of magnetic resonance-guided thermoablative therapies for liver tumors. Cardiovasc Intervent Radiol 2012; 35: 1281-1294
  • 65 Stoffner R, Schullian P, Widmann G. et al. Magnetic resonance imaging of radiofrequency current-induced coagulation zones in the ex vivo bovine liver. Rofo 2010; 182: 690-697
  • 66 Fischbach F, Lohfink K, Gaffke G. et al. Magnetic resonance-guided freehand radiofrequency ablation of malignant liver lesions: a new simplified and time-efficient approach using an interactive open magnetic resonance scan platform and hepatocyte-specific contrast agent. Invest Radiol 2013; 48: 422-428
  • 67 Kuszyk BS, Choti MA, Urban BA. et al. Hepatic tumors treated by cryosurgery: normal CT appearance. AJR Am J Roentgenol 1996; 166: 363-368
  • 68 Shyn PB, Oliva MR, Shah SH. et al. MRI contrast enhancement of malignant liver tumours following successful cryoablation. Eur Radiol 2012; 22: 398-403
  • 69 Dodd GD, 3rd Frank MS, Aribandi M. et al. Radiofrequency thermal ablation: computer analysis of the size of the thermal injury created by overlapping ablations. AJR Am J Roentgenol 2001; 177: 777-782
  • 70 Antoch G, Kuehl H, Vogt FM. et al. Value of CT volume imaging for optimal placement of radiofrequency ablation probes in liver lesions. J Vasc Interv Radiol 2002; 13: 1155-1161
  • 71 Poon RT, Ng KK, Lam CM. et al. Learning curve for radiofrequency ablation of liver tumors: prospective analysis of initial 100 patients in a tertiary institution. Ann Surg 2004; 239: 441-449
  • 72 Lu DS, Raman SS, Limanond P. et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003; 14: 1267-1274
  • 73 Livraghi T, Lazzaroni S, Meloni F. et al. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2005; 92: 856-858
  • 74 Collettini F, Lutter A, Schnapauff D. et al. Unresectable colorectal liver metastases: percutaneous ablation using CT-guided high-dose-rate brachytherapy (CT-HDBRT). Rofo 2014; 186: 606-612
  • 75 Ricke J, Thormann M, Ludewig M. et al. MR-guided liver tumor ablation employing open high-field 1.0 T MRI for image-guided brachytherapy. Eur Radiol 2010; 20: 1985-1993
  • 76 Mohnike K, Sauerland H, Seidensticker M. et al. Haemorrhagic complications and symptomatic venous thromboembolism in interventional tumour ablations: the impact of peri-interventional thrombosis prophylaxis. Cardiovasc Intervent Radiol 2016; 39: 1716-1721
  • 77 Ohmoto K, Tsuduki M, Kunieda T. et al. CT appearance of hepatic parenchymal changes after percutaneous microwave coagulation therapy for hepatocellular carcinoma. J Comput Assist Tomogr 2000; 24: 866-871
  • 78 Carrafiello G, Lagana D, Ianniello A. et al. Post-radiofrequency ablation syndrome after percutaneous radiofrequency of abdominal tumours: one centre experience and review of published works. Australas Radiol 2007; 51: 550-554