[Modern alternatives to resection of metastases--MR-guided laser-induced thermotherapy (LITT) and other local ablative techniques].

In patients with liver metastases of different primaries modern local ablative techniques such as laser-induced thermotherapy (LITT) and radiofrequency ablation (RF) are minimal invasive therapy options, if the patients were no candidates for liver surgery. A maximum of 5 cm lesion diameter and not more than 5 metastases without extrahepatic are treatable. MR-guided LITT is currently performed by means of implantable percutaneous catheter systems in local anesthesia and with outpatient management. RF is performed sometimes in general anesthesia and a hospital admission for some days. Liquid irrigated application systems are available both for LITT and for radiofrequency therapy and realized necrosis diameter up to 6 cm. At present LITT enables a local tumor control better than 98% for localized liver metastases without extrahepatic spreading patterns. In a group of 846 patients the average survival times were 4.0 years for patients with liver metastasis from different primary tumors. The data for RF ablation confirm the high value for tumor control for hepatocellular carcinomas with poorer results for liver metastases. Percutaneous MR-guided LITT permits good tumor control of liver metastases smaller than 5 cm and less than 5 in number with an improvement of survival times.