MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data

Abstract

MR-guided laser-induced interstitial thermotherapy (LITT) is a percutaneous, minimally invasive treatment modality for treating liver lesions/metastases, soft tissue tumours and musculoskeletal lesions. In this group, MR-guided LITT is currently performed under local anaesthesia on an out-patient basis with a specially designed saline-cooled laser application system. Nd:YAG laser (1064 nm wave length) was used for tumour ablation. Magnetic resonance imaging (MRI) using both open and closed MR units has proven clinically effective in validating the exact positioning of optical fibres. It also allows for real time-monitoring of thermal effects and the evaluation of treatment-induced coagulation necrosis. In liver tumours, percutaneous MR-guided LITT achieves a local tumour control rate of 98.7% at 3 months post-therapy and 97.3% at 6 months with metastases smaller than 5 cm in diameter. The mean survival rate for 1259 patients with 3440 metastases treated with 14 694 laser applications at the institute (calculated with the Kaplan-Meier method) was 4.4 years (95% confidence interval: 4.1-4.8 years) and median survival was 3.00 years. No statistically significant difference in survival rates was observed in patients with liver metastases from colorectal cancer vs metastases from other primary tumours. The rate of clinically relevant side effects and complications requiring secondary treatment was 2.2%. The clinical use of MR guided LITT (size < 5 cm, number < 5) is justified in patients with liver metastases of colorectal and/or breast cancers if the inclusion criteria are carefully observed. Further indications for MR guided LITT include recurrent cancer lesions in the head and neck, lung metastases and bone and soft tissue lesions.

Phase II study on stereotactic body radiotherapy of colorectal metastases

“…Cryotherapy was the first method introduced in the treatment of liver metastases as an alternative to surgery [11]. Since then LITT [12,13] and RFA [14 Á16] were introduced and these are now the dominating methods for nonsurgical treatment of liver metastases. Local control rates in individual tumor based retrospective analysis of patients with a variety of tumor types treated by LITT or RFA are in the range 54 Á98%.…”

Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems

“…Although both methods have been used in clinical studies of radiofrequency (RF) and microwave ablation, an optimal delivery method has not yet been determined (6)(7)(8)(9) (10). Four temperature probes were placed in a line bisecting an axis of symmetry beginning at the array center, with 1 cm spacing between probes (Fig 2).…”

Controllable Cobalt Oxide/Au Hierarchically Nanostructured Electrode for Nonenzymatic Glucose Sensing

“…Typically penetration in the range of 1-20 mm is sufficient for the ablation of cancer cells that are near the surface of the skin [160,191,193,204]. However, it has been reported that depths of 50-80 mm have been achieved [186,205]. Fig.…”