title: [Interstitial photocoagulation with laser in the treatment of liver metastasis].
abstract: Interstitial laser photocoagulation (ILP) causes tumor necrosis with local hyperthermia produced by laser light energy. We treated with US-guided ILP 14 patients (7 men and 7 women; mean age: 67 years) and 20 metastases: 9 of them were < 3 cm in max. diameter and 11 were > 3 cm (mean diameter: 2.9 cm); 14 metastases were from colon carcinoma, 5 from breast cancer and 1 from lung cancer. ILP was performed with 300 and 600 microns quartz fiberoptic guides advanced in 21-18G Chiba needles and a continuous-wave Nd: YAG laser with 1064 nm wavelength. We used single expositions of 5-6 minutes with an irradiation power of 5 watts and scheduled 3 treatment sessions, performing CT scans and biopsies at the end of each session. The extent of induced necrosis was classified as follows on the basis of CT findings: grade 1 = 100% necrosis; grade 2 = necrosis > 50%; grade 3 = necrosis < 50%. The average follow-up was 6 months. After the 3 scheduled treatment sessions, CT showed grade 1 necrosis in all the lesions < 3 cm in diameter and in 4/9 (44%) lesions > 3 cm and grade 2 and 3 necrosis in the remaining cases (necrosis > 50% in 95% of the lesions and 92% of the patients). The cytologic findings were in agreement with CT results in all grade 2 and 3 cases, but in one grade 1 necrosis cytology showed residual viable tumor. To conclude, ILP is a safe and well-tolerated procedure. Maximum efficacy was observed in the lesions < 3 cm, while lesion volume was markedly reduced in the lesions > 3 cm. US is a useful tool in the real-time monitoring of this procedure and CT is the most accurate imaging technique to assess treatment efficacy.
authors.affiliation: Dipartimento di Radiologia e Diagnostica per Immagini, Albano Laziale, Roma.
authors.forename: C M
authors.initials: CM
authors.lastname: Pacella
authors.forename: G
authors.initials: G
authors.lastname: Bizzarri
authors.forename: F S
authors.initials: FS
authors.lastname: Ferrari
authors.forename: V
authors.initials: V
authors.lastname: Anelli
authors.forename: D
authors.initials: D
authors.lastname: Valle
authors.forename: A
authors.initials: A
authors.lastname: Bianchini
authors.forename: Z
authors.initials: Z
authors.lastname: Rossi
authors.forename: M
authors.initials: M
authors.lastname: Stefani
authors.forename: A
authors.initials: A
authors.lastname: Crescenzi
authors.forename: G
authors.initials: G
authors.lastname: Guazzi
authors.forename: S
authors.initials: S
authors.lastname: Minuto
authors.forename: P
authors.initials: P
authors.lastname: Stefani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
vernacular_title: La fotocoagulazione interstiziale con laser nel trattamento delle metastasi epatiche.