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Stereotaktische Radiofrequenzablation von intrahepatischen cholangiozellulären Karzinomen – eine minimal invasive Alternative zur Leberresektion

Stereotactic Radiofrequency Ablation (SRFA) of intrahepatic cholangiocellular carcinomas: a minimal invasive alternative to liver resection

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Zusammenfassung

Als kurative Maßnahmen bei intrahepatischem cholangiozellulärem Karzinom (ICC) galten bisher nur chirurgische Verfahren. Bei inoperablen ICCs werden die systemische Chemotherapie und lokoregionäre Therapieverfahren, wie z. B. die transarterielle (Chemo)embolisation, Radioembolisation, Radiofrequenzablation (RFA) und Mikrowellenablation (MWA) angewendet. Durch die stereotaktische RFA (SRFA) können durch präzise 3D-geplante Positionierung von mehreren Sonden und dadurch überlappenden Nekrosearealen auch Tumore > 5 cm in einer Sitzung radikal behandelt werden. Mittels stereotaktischer RFA (SRFA) wurde bei 17 konsekutiven nicht operablen Patienten mit 52 ICCs ein medianes Überleben von 60 Monaten erzielt. Dabei konnten auch die beiden größten Tumore mit Durchmessern > 10 cm in sano behandelt werden. Diese Daten bei nicht resektablen ICCs übertreffen die besten bisher publizierten chirurgischen Daten. Somit stellt die in Innsbruck entwickelte minimal invasive stereotaktische Radiofrequenzablation (SRFA) eine vielversprechende Alternative zur Chirurgie dar und sollte auch als Erstlinientherapie bei Patienten mit ICC in Erwägung gezogen werden.

Summary

Up to now resection and liver transplantation are concerned as the only curative treatment options for intrahepatic cholangiocellular carcinomas (ICCs). For patients with inoperable ICCs systemic chemotherapy and various locoregional therapies including transarterial (chemo)embolization (TACE), selective internal radiation therapy (SIRT), radiofrequency ablation (RFA) and microwave ablation (MWA) are applied. Stereotactic RFA (SRFA) allows for precise 3D planning and positioning of multiple RF electrodes. Due to overlapping necroses tumors > 5 cm can be completely ablated in one session. 17 inoperable consecutive patients with 52 ICCs were treated with stereotactic RFA (SRFA). A median overall survival of 60 months was achieved. The two largest tumors with diameters > 10 cm were completely ablated. These SRFA data of irresectable ICCs are superior to the published data on resection. SRFA is a minimal invasive alternative treatment to resection and may be considered as the first-line local treatment of patients with ICCs in selected patients.

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Interessenkonflikt

Reto Bale ist Miterfinder der Atlas Zielvorrichtung und an den Erlösen beteiligt.

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Authors and Affiliations

  1. Abteilung für Mikroinvasive Therapie – SIP Univ.-Klinik für Radiodiagnostik, Universitätsklinik Innsbruck, Medizinische Universität Innsbruck, Anichstraße 35, Innsbruck, Österreich

    Reto Bale MD,  Peter Schullian MD,  Marion Haidu MD &  Gerlig Widmann MD

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  1. Reto Bale MD
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  2. Peter Schullian MD
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  3. Marion Haidu MD
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  4. Gerlig Widmann MD
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Correspondence to Reto Bale MD.

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Bale, R., Schullian, P., Haidu, M. et al. Stereotaktische Radiofrequenzablation von intrahepatischen cholangiozellulären Karzinomen – eine minimal invasive Alternative zur Leberresektion. Wien Med Wochenschr 163, 128–131 (2013). https://doi.org/10.1007/s10354-013-0182-8

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  • DOI: https://doi.org/10.1007/s10354-013-0182-8

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