[Laser-induced thermotherapy (LITT) of tumors of the liver in central location: results and complications]. / Laserinduzierte Thermotherapie (LITT) von Lebertumoren in zentraler Lokalisation: Ergebnisse und Komplikationen.

PURPOSE: To investigate whether laser-induced thermotherapy (LITT) for tumors of the liver in central location is a sufficient and safe therapeutic option. MATERIAL AND METHODS: According to predefined criteria, 23 of 136 patients were chosen to be treated with LITT because of malignant liver tumors. At the time of the first LITT, the patients had 28 central tumors (27 metastases, one HCC), which were treated in 34 sessions with 64 laser applications and had a clinical and imaging follow-up every 3 months. RESULTS: The primary effectiveness rate was 74.1% and the secondary effectiveness rate 82.1%. The mortality rate was 0%. Major complications occurred in one patient (hemorrhagic pleural effusion), while minor complications occurred in 10 patients. During the median follow-up of 20 months (range 3-57 months), local tumor progression developed in 22% of the tumors. The effectiveness rate was 78.6%, 71.4% and 64.3% after 3, 6 and 9 months. The median survival was 46.0 months (95% confidence interval: 28.6-47.1 months). CONCLUSION: In our patients, complications and ablation rate of laser-induced thermotherapy for central liver tumors do not differ from those in peripheral location as described in the literature.

[Percutaneous laser-induced thermotherapy of lung metastases: experience gained during 4 years]. / Perkutane laserinduzierte Thermotherapie von Lungenmetastasen: Erfahrungen nach 4-jähriger Anwendung.

We perform laser ablation of lung metastases for four years. In the following we report on technical success, ablation results and follow-up. 30 patients with a total of 42 lung metastases were treated. Patients were aged between 42 and 74 years. Primary tumors were mostly colorectal carcinomas, head and neck and uro-genital tumors. Technical success was achieved in 40, complete ablation in 14 metastases (33%); however, in 8 metastases follow-up was too short for a valid evaluation (4-8 weeks). Further analysis may improve the overall results: metastases located in the central parts of the lungs were more easily treated than those located peripherally, best results were achieved in metastases not larger than 3 cm, percutaneous ablation of lung metastases has potential as an additional therapeutic option if surgery is not possible.

[Percutaneous thermoablation of lung metastases. Indication, performance, initial results, and imaging findings]. / Perkutane Laserablation von Lungenmetastasen. Indikation, technische Durchführung, erste Ergebnisse und Bildbefunde.

Not unlike thermoablation of liver metastases, thermoablation of metastases to the lungs is gaining clinical interest. Radiofrequency ablation and laser-induced interstitial thermotherapy are both used clinically. Initially it was suspected that percutaneous treatment of lung metastases would result in a rate of pneumothoraces and tissue reactions which would not be clinically acceptable. However, this did not prove true. Fear of pneumothoraces however did lead to the desire for an applicator with a maximally reduced diameter. While clinical results are not yet available, technical success rates of laser-induced interstitial thermotherapy of lung metastases are promising. The percentage of pneumothoraces does not differ significantly from that seen in diagnostic procedures. Large metastases may be treated by simultaneous use of multiple applicators or by repositioning of an applicator (pullback technique). Surgical experience is still guiding us in deciding which primaries' metastases may be successfully treated percutaneously. The literature indicates that lung metastases from colorectal primaries are especially suited. Radiotherapy is only an alternative method in cases of lung metastases if they cause symptoms (such as pain because of thorax infiltration or difficulty in breathing because of bronchial lesion). Due to the risk of radiation-induced pneumonia general radiotherapy is not to be recommended. The possibility of stereotactic ray treatment is being considered, but because breathing shifts the metastases it is not yet feasible. Therefore, percutaneous thermoablation could be used as a minimally invasive, rather riskless therapeutic option for a relatively high percentage of inoperable lung metastases.