Abstracts
2002 Digestive Disease Week

# 105835 Abstract ID: 105835 Increasing the Effectivity of Laser-Induced Thermotherapy (LITT) by Combining It with Interrupted Hepatic Perfusion in Patients with Irresectable Liver Tumors
Christoph T Germer, Joerg Ritz, Christoph Isbert, Thomas Albrecht, Verena Knappe, Heinz J Buhr, Berlin, Germany

Introduction: Thermal in situ ablation techniques like laser-induced thermotherapy (LITT) have become an established therapy for liver tumors. Our experimental data showed that the combination of LITT and interrupted hepatic perfusion by application of degradable starch microspheres (DSM) or by temporary occlusion of the hepatoduodenal ligament (Pringle maneuver=PM) increases tumor response and reduces the number of intralesional recurrences. The aim of this prospective phase II study was to clinically apply these combination therapies in patients with liver tumors and to evaluate their feasibility, complication rates and effectivity. Materials/Methods: Patients with nonresectable colorectal liver metastases were included in the study. Exclusion criteria were: extrahepatic tumor, >5 metastases and Ømetastases >5 cm. LITT was performed percutaneously or per laparotomy without [Gr. I] and with interrupted perfusion by i.a. application of DSM (Spherex() [Gr. II] or PM [Gr. III]. Either MRI (open MRI, 0.5 Telsa) or intraoperative ultrasound (IOUS) [7.5 MHz] was used for on-line monitoring. Volumes were determined (MRI/IOUS) preinterventionally for metastases (MVol) and postinterventionally for lesions (LVol), and the energy per metastasis (J/MVol) and the lesions to applied energy ratios (LVol/10kJ) were calculated. Follow-ups were performed using Gd:DTPA-MRI. Results: In 56 patients (34 m, 22 f; 45-84 years), 104 metastases were treated with 124 applications. In 33 cases, LITT was performed percutaneously and in 23 by laparotomy. Complications included pleural effusion (n=5), a subcapsular hematoma (n=1), and cholecystostomy (n=1). There were no major complications or treatment-related death. Local recurrence occurred in 2 cases in Gr. I. There were no local recurrences in Gr. II or III. Conclusions: 1) The combination of LITT and interrupted hepatic perfusion can be performed percutaneously or by laparotomy without increasing morbidity. 2) This increases the lesion volumes and improves local tumor control as compared to monotherapy. 3) This combination therapy performed for the first time should be applied in a prospective randomized study for treating colorectal liver metastases with curative intention.