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Magnetic Resonance-guided Laser-induced Thermotherapy in Patients With Oligonodular Hepatocellular Carcinoma: Long-term Results Over a 15-year Period

Eichler, Katrin MD; Zangos, Stephan MD; Gruber-Rouh, Tatjana MD; Vogl, Thomas J. MD; Mack, Martin G. MD

Journal of Clinical Gastroenterology: October 2012 - Volume 46 - Issue 9 - p 796–801
doi: 10.1097/MCG.0b013e3182641806
LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Goals: To prospectively evaluate the therapeutic potential of magnetic resonance (MR)-guided laser-induced thermotherapy (LITT) in patients with oligonodular hepatocellular carcinoma.

Study: A total of 113 patients with 175 intrahepatic lesions were treated with MR-guided LITT. The Nd-YAG laser fiber was introduced with a percutaneously positioned irrigated laser application system. Qualitative and quantitative MR parameters and clinical data were evaluated. Survival data were calculated using the Kaplan-Meier method.

Results: All patients tolerated the procedure well under local anesthesia. The total procedure time was 90 minutes. All observed complications were minor and no further treatment was necessary. Online MR thermometry allowed exact visualization of the extension of laser-induced changes and their relationship to the neighboring anatomy. Lesions up to 2 cm in diameter could be efficiently treated with a single laser application; larger lesions were treated with a dual, triple, and quadruple simultaneous application. In 98% of the patients we achieved a complete necrosis of the tumor and up to 5 mm of safety margin. The mean survival rate for all patients, with calculation started on the date of diagnosis of the HCC nodules treated with LITT, was 4.9 years (95% confidence interval, 3.6, 5.1). The median survival rate for all patients, with calculation started on the date of diagnosis of the HCC nodules treated with LITT, was 3.5 years (95% confidence interval, 2.7, 4.2). One-year survival was 95%; 2-year survival 72%, 3-year survival 54%; and 5-year survival 30%.

Conclusions: In intrahepatic oligonodular involvement of hepatocellular carcinoma LITT appears to be an effective therapeutic procedure.

Department of Diagnostic and Interventional Radiology, J.W. Goethe University of Frankfurt, Frankfurt, Germany

K.E. got honoraria for presentation from Somatex in the past for institution. T.V. gets administrative support in the past for the institution. The other authors declare that they have nothing to disclose.

Reprints: Katrin Eichler, MD, Department of Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Theodor-Stern-Kai 7, Frankfurt 60590, Germany (e-mail: k.eichler@em.uni-frankfurt.de).

Received December 20, 2011

Accepted June 11, 2012

© 2012 Lippincott Williams & Wilkins, Inc.