Lokale Radiofrequenzablation von Leberherden - Möglichkeiten und Grenzen

Zusammenfassung

Die Radiofrequenzablation stellt die verbreitetste Methode der lokalen Thermotherapie der Leber dar. Sie ist relativ einfach in der Anwendung, beliebig wiederholbar und verbindet eine hohe Effektivität in der lokalen Zelldestruktion mit einer relativ geringen Komplikationsrate. In dieser Übersichtsarbeit werden das Prinzip der RF-Ablation (RFA) und die zur Verfügung stehenden Systeme beschrieben. Danach wird ein Überblick über die Rationale hinter der RFA von Leberherden, klinische Indikationen, Ergebnisse sowie zu erwartende Komplikationen gegeben. Die Hauptproblematik der Beurteilung des onkologischen Erfolges der RFA besteht in der immer breiteren Anwendung bei vielen Tumorentitäten, ohne dass große kontrollierte und randomisierte Studien zur Wirksamkeit vorliegen. Aus technischer Sicht ist die Hauptlimitation der RFA bei allem Fortschritt der Technik die immer noch limitierte Größe der Koagulationsnekrose. Die Indikation zur RFA muss interdisziplinär gestellt werden. Prinzipiell sollte außer bei symptomatischen neuroendokrinen Metastasen eine komplette Tumorablation (ggf. in mehreren Sitzungen) angestrebt werden. Die Rolle einer additiven Chemotherapie in Kombination mit der RFA insbesondere bei der Behandlung von Lebermetastasen ist derzeit unklar.

Abstract

Radiofrequency ablation (RFA) is currently the most established technique for the local destruction of tumors within the liver. It is technically straightforward, can be repeated and combines a high efficiency in tissue destruction with a low to moderate incidence of complications. This review explains the principle of RFA and lists currently available systems. In addition, the rationale behind RFA is discussed, and an overview of clinical indications, results and complications is presented. One of the main problems in assessing the clinical value of RFA is the fact that no large and controlled randomized studies are available, while the number of ablations and treated tumor entities are steadily increasing. From a technical point of view, the major problem is the still limited volume of necrosis that is achievable. The indication for RFA has to be discussed interdisciplinarily. A complete tumor necrosis should be the aim of all ablations, with the exception of symptomatic metastases of neuroendocrine tumors. The value of additional chemotherapy to RFA is still unclear, especially in the treatment of liver metastases.

Schlüsselwörter

Radiofrequenzablation - Leber - Lebermetastasen - hepatozelluläres Karzinom

Key words

Radiofrequency ablation - liver - liver metastases - hepatocellular carcinoma

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