Laser-induced thermotherapy of malignant liver tumors: general principals, equipment(s), procedure(s)--side effects, complications and results.

摘要

PURPOSE: To prospectively evaluate the therapeutic potential of MR-guided and ultrasound-guided laser-induced thermotherapy (LITT) in patients with liver metastases and oligonodular hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Between June 1993 and June 2000 a total of 1608 LITT sessions was performed to treat 1914 lesions in 676 consecutive patients. The Nd-YAG laser fiber was introduced with a percutaneously positioned cooled application set. Qualitative and quantitative ultrasound and magnetic resonance (MR) parameters, as well as clinical data were evaluated. RESULTS: All patients tolerated the procedure well under local anesthesia; no relevant clinical complications were observed. The mean laser power was 25 W and the mean duration was 25 min. MR proved to be superior over computed tomography and ultrasound due the thermosensitivity of the MR sequences allowing a better visualization of the volume of laser-induced changes and their relation to the neighboring geographical structures. The ultrasound-guided LITT should be restricted for patients with contraindications for MR imaging monitoring and for selected patients with low diameter oligonodular HCC. In 95% of cases, we achieved a complete necrosis of the tumor and a 5-mm safety margin, resulting in a complete destruction of the tumor without local recurrences. Mean survival in this group was 35 months (calculated with the Kaplan-Meier method). CONCLUSION: MR-guided, or ultrasound-guided, LITT appears to be a safe and effective treatment protocol for liver metastases and oligonodular HCC.