[Microinvasive CT-controlled tumor therapy of soft tissue and skeletal metastases]

Micro-invasive CT-guided intratumoral therapy (MIC-ITT) when used in combination with sympathectomy can be an excellent palliative treatment with little impairment of the patient. Rapid as well as complete reduction of pain without systemic side effects can be achieved under local anesthesia in patients in advanced tumor stages by the direct instillation of 50 to 96% alcohol and/or a locally efficacious low toxic cytostatic (Mitoxantron) under CT guidance. CT enables not only exact puncture without injuring endangered structures but also a controlled application of medication. The interventions can be performed with special probes with a diameter of 18 to 25 G. The study population consisted of 145 patients who received a total of 434 treatments. Repeated micro invasive intratumoral treatment was performed on 110 patients with bone and soft tissue metastases (Group I, 335 single treatments) and on 35 patients with vertebral metastases (Group II, 109 single treatments). In all patients conventional therapeutic strategies had been exhausted or were no longer applicable on the basis of a reduced Karnofsky Index. Treatment was performed in combination with sympathetic neurolysis at the upper tumor pole in all cases. The maximum follow-up time was 30 months. Pain reduction was estimated on a visual analogic scale. In Group I up to time of death a pain reduction of 75% or better was achieved in 88 patients (80%). A reduction in tumor size concomitant with a stabilization of the tumor region could be shown in 25% in this group, no change in 62% and progression in 13%. In Group II a pain reduction greater than 75% was achieved in 84% as well as a reduction in tumor size (< 50%) in 18% of the patients. Necrotic zones could be shown in 27% and calcification of tumor area in 35%. No change in tumor size was found in 66% of the patients, progression in 16%. All treatments were free of complications. On the whole the results of this therapeutic approach are encouraging. In particular one aspect should be mentioned: with respect to palliative treatment the reduction of tumor size is not crucial. The decisive factor is the improvement in quality of life of the patient using an intervention which impairs the patient only minimally. Furthermore this micro invasive approach should always involve the combination of local tumor treatment with treatment or lysis of the autonomic sympathetic nervous system in tumor vicinity.(ABSTRACT TRUNCATED AT 400 WORDS)