Transarterial chemoembolisation (TACE) with gemcitabine: Phase II study in patients with liver metastases of breast cancer

Objective

Evaluation of the efficacy and tolerability of transarterial chemoembolization with gemcitabine in patients with inoperable liver metastases of breast cancer.

Materials and methods

Open-label, prospective non-randomized single-center study design; patients had previous chemotherapy including anthracyclines and/or taxanes in the metastatic setting, adequate bone marrow reserve, sufficient liver/renal function, no centralnervous system metastases, Karnovsky-performance-status >70%, and life expectancy >12 weeks. Forty-three patients were enrolled (median 58 years, range 48–71). A suspension of gemcitabine 1.200 mg/m², 2–10 ml/m² of Lipiodol, and 5 ml of a degradable starch microsphere (Embocept) suspension, were administered intra-arterially up to 3 times with a 4-weaks-interval. Dose-limiting toxicit is defined as grade 4 thrombocytopenia, neutropenia, or nonhematologic toxicity > grade 3. Tumor response was evaluated by magnetic resonance (MRI) and computed tomography (CT) imaging.

Results

All patients tolerated the treatment well; with no dose limiting toxicities. Imaging follow-up according to the RECIST-criteria (Response Evaluation Criteria in Solid Tumors) revealed a partial response in 3 patients, stable disease in 16 patients and progression in 22 patients. The progression free survival was 3.3 months.A significant correlation exists only with the factor vascularization: strongly vascularized tumors show a significantly lowered response. Patients with complete or partial response and the main fraction of the stable disease group showed in the MRI and angiography only a moderate vascularization.The resulting estimate of the total survival rate amounts to a median of 10.2 months.

Conclusion

Transarterial chemoembolization with gemcitabine is well tolerated and provides an alternative treatment method for patients with liver metastases of breast cancer.     

基于肿瘤负荷评分评估TACE联合MWA治疗转移性肝癌的预后

目的评估肝动脉化疗栓塞术（TACE）联合微波消融术（MWA）治疗胃肠道转移性肝癌的有效性和安全性。探究肿瘤负荷评分（TBS）预测转移性肝癌患者术后生存预后的效能。 方法回顾性分析2015年1月至2020年4月于我院接受TACE联合MWA治疗的54例转移性肝癌患者临床资料,所有患者原发病灶均为胃肠道恶性肿瘤,分析局部肿瘤控制、生存结果、不良反应。采用TBS评估患者的肿瘤负荷,将患者分组并行组间比较：低负荷组（TBS≤3,n = 24）和高负荷组（3 < TBS < 6,n = 30）。使用时间依赖的ROC曲线及曲线下面积（AUC）分析评估TBS预测无进展生存期（PFS）和总生存期（OS）的能力。 结果54例转移性肝癌患者术后客观缓解率（ORR）为88.9%,疾病控制率（DCR）为96.3%。中位随访期为21.5个月,中位PFS和OS分别为8.2个月、23.8个月。术后半年、1年、2年、3年OS率分别为96.2%、79.2%、41.8%、24.3%。低负荷组和高负荷组中位PFS分别为9.8个月和6.6个月;两组中位OS分别为27.2个月和17.3个月。ROC曲线分析显示,TBS预测患者术后PFS和OS的AUC分别为0.720和0.606,高于肿瘤最大直径的AUC（0.695和0.575）和肿瘤数目的AUC（0.586和0.483）。不同肿瘤负荷组围手术期均无明显严重并发症。 结论TACE联合MWA是治疗胃肠道癌肝转移患者的一种安全、有效的治疗方式,能够显著改善局部肿瘤控制和延长患者总生存期。TBS可较好地预测胃肠道癌肝转移患者TACE联合MWA术后的生存预后情况。     

贲门癌肝转移的血供特点及其与经动脉化疗栓塞疗效的相关性

目的探讨贲门癌肝转移的血供特点及其与经动脉化疗栓塞治疗效果的关系。方法对42例经临床和病理组织学证实的贲门癌肝转移患者同时行贲门及肝脏肿瘤靶动脉栓塞化疗术。随后,在所有患者中观察了病灶血供特点,并评价了经动脉化疗栓塞治疗的效果及生存率。结果贲门癌病灶主要由胃左动脉供血,左膈下动脉、胃右动脉及肝左动脉可能参与供血。肝转移瘤由肝动脉供血,其中富血供、染色征明显者6例(14.3%),治疗有效率为83.3%;血供中等、染色较淡28例(66.7%),治疗有效率为53.5%;血供稀少、染色呈淡絮状或无明显染色8例(19.0%),治疗有效率为37.5%。经动脉化疗栓塞术后,0.5、1、2、3、5a生存率分别为90.4%,76.1%,33.3%,7.1%和2.4%。本组患者于诊断后中位生存期为19.6个月。结论经动脉化疗栓塞治疗是贲门癌肝转移的有效治疗方法,富血供肿瘤疗效优于乏血供肿瘤。     

Repetitive transarterial chemoembolization (TACE) of liver metastases from gastric cancer: Local control and survival results

Objective

To evaluate the local tumor control and survival data after transarterial chemoembolization with different drug combinations in the palliative treatment of patients with liver metastases of gastric cancer.

Materials and methods

The study was retrospectively performed. 56 patients (mean age, 52.4) with unresectable liver metastases of gastric cancer who did not respond to systemic chemotherapy were repeatedly treated with TACE in 4-week intervals. In total, 310 chemoembolization procedures were performed (mean, 5.5 sessions per patient). The local chemotherapy protocol consisted of mitomycin alone (30.4%), mitomycin and gemcitabine (33.9%), or mitomycin, gemcitabine and cisplatin (35.7%). Embolization was performed with lipiodol and starch microspheres. Local tumor response was evaluated by MRI according to RECIST. Survival data from first chemoembolization were calculated according to the Kaplan–Meier method.

Results

The local tumor control was: complete response in 1.8% (n = 1), partial response in 1.8% (n = 1), stable disease in 51.8% (n = 29) and progressive disease in 44.6% (n = 25) of patients. The 1-, 2-, and 3-year survival rate from the start of chemoembolization were 58%, 38%, and 23% respectively. The median and mean survival times were 13 and 27.1 months. A Statistically significant difference between patients treated with different chemotherapy protocols was noted (ρ = 0.045) with the best survival time in the mitomycin, gemcitabine and cisplatin group.

Conclusion

Transarterial chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with gastric cancer.     

Transarterial chemoembolization for liver metastases from solid pseudopapillary epithelial neoplasm of pancreas: A case report

Solid pseudo-papillary epithelial neoplasm(SPEN) is a rare epithelial tumor of pancreas with a low malignant potential occurs most commonly in young females. We report a case of 40 years old woman presented withextensive liver metastasis from SPEN of pancreatic body for which she was operated four years ago. Due to the extensive nature of metastatic disease she was offered Transarterial chemoembolisation(TACE) using gemcitabine as chemotherapeutic agent. Short term follow up after a month of TACE with multiphase computed tomography showed > 90% resolution in the viable tumor with significant clinical improvement. TACE ensures targeted delivery of chemotherapeutic drugs in higher doses with least systemic toxicity and is more effective and safe than systemic chemotherapy. TACE with gemcitabine was found to be very effective in our patient with numerous liver metastasis.     

Large-sized hepotocellular carcinoma (HCC): a neoadjuvant treatment protocol with repetitive transarterial chemoembolization (TACE) before percutaneous MR-guided laser-induced thermotherapy (LITT)

This study aims to evaluate the efficacy and safety of a neoadjuvant treatment protocol with repeated transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for large-sized hepatocellular carcinomas (HCC). Repeated TACE (mean, 3.5 treatments per patient) was performed in 48 patients with neoadjuvant intention (the largest lesion was between 50 and 80 mm in diameter, and there were no more than five lesions). For the TACE treatment, we used 10 mg/m² mitomycin, 10 ml/m² Lipiodol and microspheres. The tumor volume was measured by MRI. Lipiodol retention of the tumors was evaluated with CT. After the diameter of the tumors had decreased to less than 50 mm, the patients were treated with MR-guided LITT 4 to 6 weeks after embolization. Repeated TACE reduced the tumor size in 32 patients (66.7%), forming the basis for performing MR-guided LITT procedures. These patients received one to four laser treatments (mean, 1.9 per patient) for tumor ablation, resulting in a median survival of 36.0 months after the first treatment. For the remaining patients, no reduction in tumor size was achieved in 12 patients and disease progression in 4 patients. Neoadjuvant TACE appears to be an effective treatment of large-sized HCC, which extends the indication for MR-guided LITT.     

Colorectal liver metastases: regional chemotherapy via transarterial chemoembolization (TACE) and hepatic chemoperfusion: an update

Liver metastasis is one of the main problems encountered in colorectal cancer management as the liver is the most common metastatic site. Several treatment options are available, among which transarterial chemotherapy has proved effective in achieving some local tumour control, improving the quality of life through symptomatic control as well as survival time. The present paper is intended to provide an overview of the techniques, indications and results of regional chemotherapy, which comprises transarterial chemoembolization (TACE) and chemoperfusion. This treatment approach has symptomatic, palliative, adjuvant and potentially curative objectives. We reviewed the studies involving TACE and chemoperfusion of colorectal liver metastases during the last few years to update the previous reviews published on this subject. The results achieved were so variable, due to the variations in patient selection criteria and regimens used between the different studies. The median survival ranged from 9 to 62 months and the morphological response ranged from 14 to 76%. Technical aspects, results, and complications of this modality will be demonstrated with a detailed analysis and comments.     

聚丙交酯复合乙交酯微球经肝动脉化疗栓塞术治疗肝癌的动物实验

目的：在肝细胞癌动物模型上观察聚丙交酯复合乙交酯（PLcG)微球经肝动脉化疗栓塞术（TACE）治疗肝癌的疗效。方法：在雄性ACI大鼠（15例）肝包膜下植入Morris Hepatoma 3924A肝癌小瘤块（1mm3),移植术中13天时行磁共振检查,再经正中腹切开术和经胃十二指肠动脉逆行插管进行以下介入治疗：治疗组A（40mg PLcG 0.05mg丝裂霉素,4例）,对照组B（0．05mg丝裂霉素＋0．04mg碘化油＋肝动脉结扎,4例）和对照组C（1．5ml生理盐水,7例）,插管术后13天再次行磁共振术观察肝肿瘤体积变化。结果：在C组,肿瘤体积在实验期间增长27．12倍,在B组,肿瘤体积增长3．76倍,而在A组,肿瘤体积仅增长2．87倍。A组与C组肿瘤体积增长率在t检验时均有显著性差异（P＜0．05）,结论：在动物实验中将PLcG微球运用于TACE可明显抑制肝肿瘤生长。     

Repetitive transarterial chemoembolization (TACE) of liver metastases from renal cell carcinoma: Local control and survival results

The purpose was to evaluate the effectiveness of transarterial chemoembolization (TACE) in local tumor control and survival in patients with hepatic metastases from renal cell carcinoma (RCC). Prospective evaluation of TACE treatment outcome in 22 patients recruited from 1999 and 2005 was performed. The chemotherapeutic agent used was mitomycin only in 45% of the patients and mitomycin together with gemcitabine in the other 55%. The embolizing materials used in all of the patients were iodized oil (lipiodol) and degradable starch microspheres. Local response was evaluated by MRI and judged according to Response Evaluation Criteria in Solid Tumors (RECIST). Mean and median survival and survival probability after diagnosis and treatment were both calculated by Kaplan-Meier method. Partial response was achieved in 13.7%, stable disease in 59% and progressive disease in 27.3% of patients. Survival time from the diagnosis of metastases ranged from 18 to 307 months and from 2.2 to 35 months from the start of TACE treatment. The median and mean survival times from the date of diagnosis were 68.6 and 102.9 months, respectively. The median and mean survival times from the start of TACE were 8.2 and 11.7 months, respectively. Survival probability from the start of treatment was 31% after 1 year and 6% after 2 years. TACE can result in a favorable local tumor response in patients with hepatic metastases from RCC, but survival results are still limited.     

影像组学在结直肠癌肝转移诊疗中的应用进展

结直肠癌发病率呈逐年上升趋势,肝脏是其远处转移最常见的靶器官。目前传统影像学在发现结直肠癌隐匿性肝转移灶、预测异时性肝转移及评估治疗反应方面仍有不足。影像组学可从医学图像数据中挖掘并提取肉眼难以分辨的信息,反映肿瘤内部异质性特征,从而为结直肠癌肝转移的预测、诊断、疗效评估及预后判断提供更多的辅助信息。就影像组学在结直肠癌肝转移诊疗中的应用进展进行综述。     

动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的临床研究

目的：研究动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的效果。 方法：选取2014年1月—2016年7月我科诊治的39例结直肠癌肝转移患者,分为2组,研究组（22例）在肠系膜上动脉、肝固有动脉以51℃灌注化疗1 h,然后超选择至肝脏病灶的供血动脉,进行化疗栓塞。对照组（17例）接受传统的肝动脉化疗栓塞（TACE）治疗。比较2组的客观有效率、临床获益率及1年生存率。同时记录并比较两组的不良反应。 结果：两组的客观有效率无统计学差异（27.3% vs. 23.5%,P>0.05）,临床获益率也无统计学差异（81.8% vs. 76.5%,P>0.05）。但研究组的1年生存率显著高于对照组（63.2% vs. 46.7%,P<0.05）。两组都未出现血管痉挛、闭塞等特殊并发症。 结论：动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的远期效果优于传统TACE。     

药物缓释微球TACE对比传统碘油TACE治疗不可切除肝癌：倾向性评分匹配

目的比较药物缓释微球TACE（DEB-TACE）与传统碘油TACE（c-TACE）治疗不可切除肝癌的临床疗效。 方法回顾性分析2015年9与至2020年7月我院治疗120例原发性肝癌的临床资料,其中DEB-TACE组30例、c-TACE组90例。按1∶1进行配对后分析两种治疗方式的临床效果。首要观察指标为患者的肿瘤无进展生存期,次要观察指标是1、3、6、12个月疾病控制、客观缓解率和术后并发症。 结果实际完成配对患者23对,配对后两组间基线特征具有可比性,结果示DEB-TACE相比c-TACE治疗原发性肝癌的中位无疾病进展期分别为3、10个月（P = 0.002）。DEB-TACE组1、3、6、12个月的客观缓解率（69%、78%、60%、52%）明显高于c-TACE组客观缓解率（39%、39%、26%、8%） （P < 0.05）。DEB-TACE组术后3个月的疾病控制率95%明显高于c-TACE组73%（P < 0.05）。术后肝脓肿患者1例（DEB-TACE组1例）,引流后患者恢复良好,余均无严重并发症发生。 结论DEB-TACE治疗不可切除性肝癌在肿瘤控制方面优于c-TACE,具有更好的临床获益。     

Improved survival of mice bearing liver metastases of colon cancer cells treated with a combination of radioimmunotherapy and antiangiogenic therapy

We attempted to determine whether the combined regimen of radioimmunotherapy (RIT) and antiangiogenic therapy would favorably affect the survival of animals bearing liver metastases of colon cancer cells. Daily antiangiogenic therapy with 2-methoxyestradiol (2-ME), 75 mg/kg, was initiated at 3 days following intrasplenic cell inoculation of LS180 colon cancer cells. RIT with 7 MBq of ¹³¹I-A7, an IgG1 anti-colorectal monoclonal antibody, or ¹³¹I-HPMS-1, an irrelevant IgG1, was conducted at 7 days. Production of vascular endothelial growth factor (VEGF) by LS180 cells was assessed in vitro. All nontreated mice died by 31 days following cell inoculation (n=5). Monotherapy comprising 2-ME treatment resulted in slightly better survival of mice (n=8) (P<0.05). ¹³¹I-A7 RIT displayed a marked therapeutic effect (n=8) (P<0.001); however, all animals eventually died due to metastases by 99 days. The combined regimen of ¹³¹I-A7 RIT and antiangiogenic therapy demonstrated a superior therapeutic effect in comparison to monotherapy consisting of either RIT or antiangiogenic therapy (n=10) (P<0.05); three mice survived the entire 160-day observation period. The combination of antiangiogenic therapy and ¹³¹I-HPMS-1 RIT failed to provide an appreciable benefit (n=5). Treatment with 2-ME decreased VEGF production by LS180 cells in a dose-dependent fashion. In conclusion, a combination regimen comprising RIT and antiangiogenic therapy initiated at the early stage of metastasis would be of great benefit in terms of improvement of the therapeutic efficacy with respect to liver metastases.     

Laser-induced thermotherapy (LITT) of liver metastases: MR-guided percutaneous insertion of an MRI-compatible irrigated microcatheter system using a closed high-field unit

PURPOSE: To evaluate the efficacy and safety of a new MRI-compatible irrigated laser microcatheter system for thermal ablation of liver metastases. MATERIAL AND METHODS: The new microcatheter system consists of a titanium needle with a diameter of 1.5 mm and a surrounding Teflon catheter with an outer diameter of 1.8 mm (5.5 F). In vitro laser-induced coagulation of bovine liver tissue was performed to determine the optimal perfusion rate of cooling saline flow, maximum laser energy, and ablation time. Laser-induced thermotherapy using the new microcatheter system, an Nd:YAG laser (Dornier), and a flexible laser light guide (Somatex GmbH, Berlin, Germany) was performed in 28 patients with liver metastases. Percutaneous insertion and positioning of multiple microcatheters in the lesion and monitoring of therapy was performed with a closed high-field MRI scanner using T1-weighted gradient-echo sequences during breath-hold. RESULTS: A perfusion rate of 0.75 mL/minute, a laser energy of 15 W, and an ablation time of 20 minutes were found suitable to achieve safe and sufficient ablation of metastatic tissue. The mean volume of induced coagulation in vitro was 23.9 mL. Ablation of liver metastases in patients was technically and clinically successful. CONCLUSION: The new microcatheter system allows for both catheter placement and monitoring of therapy using a single imaging modality. This shortens the procedure and enables more precise puncture and therapy of liver metastases. Due to the miniaturized design of the catheter and the real-time monitoring, the procedure is minimally invasive and very well tolerated by patients. This new technique seems to be a safe and feasible alternative in treating liver metastases.     

肝癌肝动脉栓塞化疗术后糖尿病的发生与治疗

糖尿病是肝癌患者接受肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）治疗后并不罕见的并发症,但目前临床对此尚不够重视,对其发病的原理、临床表现、治疗及预后缺乏深入的研究。本研究收集我院放射科介入病房自2001年2月至2005年5月期间肝癌在以TACE为主的综合治疗过程中发生的糖尿病病例27例,就肝癌TACE后糖尿病发生的发病率、临床表现、诊断和治疗以及发病原因进行了探讨和研究。     

肝癌介入术后碘化油沉积CT表现及临床意义

目的:经导管动脉化疗栓塞(TACE)疗法治疗肝癌已成为中晚期肝癌的有效治疗方式。术后碘化油在CT检查中的信号表现受人关注。本文探讨肝癌介入术后CT碘化油沉积表现与治疗效果间关系。方法:对我院肝胆外科回顾分析了260例TACE术后的影像资料,以CT表现为金标准,对碘化油分布的形态进行统计。结果:根据碘化油沉积情况分4型①稀疏及无沉积型:累计病灶内碘油沉积面积少于30%者或无碘化油沉积列为稀少及无沉积型型;②密实型:整个病灶均匀浓稠摄取碘油;③缺损型:包括环型和某一区域沉积等情况;④簇集型:碘油呈小簇状分散型分布但肿瘤内碘油潴留累计不少于30%。结论:肝癌TACE后碘油沉积形态的CT表现对下一步治疗具有指导意义。     

Diagnostic performance of contrast-enhanced CT-scan in sinusoidal obstruction syndrome induced by chemotherapy of colorectal liver metastases: Radio-pathological correlation

PurposeSinusoidal obstruction syndrome (SOS) is a likely side effect of colorectal liver metastases (CRLM) chemotherapy. This study aimed to assess computed tomography scan (CT-scan) performance for SOS diagnosis for patients receiving neoadjuvant chemotherapy (NC) prior to CRLM surgery, comparing obtained results with pathological gold standard.MethodsPreoperative CT-scans of 67 patients who had received a NC prior to liver resection for CRLM from 2011 to 2016 were retrospectively analysed. Positive diagnosis and severity of SOS were established after consensual review of the slides by three pathologists. Preoperative CT-scans were separately interpreted by two radiologists and evocative signs of SOS were sought, defined according to a literature review and operators experience. In order to identify SOS predictors, univariate analysis and multivariate logistic regression were used to study CT-scan signs and pathological results correlation.ResultsTwenty-nine patient (43%) had an SOS, 22 (33%) were low-grade and 7 (10%) were high-grade. All patient had received a median of 6 cures (3–27) containing Oxaliplatin for 53 (79%) of them. In univariate analysis, hepatic heterogeneity (p < 0.001), puddle-like or micronodular appearance (p < 0.001), peripheral distribution of heterogeneity (p = 0.085), clover-like sign (p = 0.02), splenomegaly (p = 0.0026), spleen volume increase ≥30% (p = 0.04) or splenic length increase ≥15% (p = 0.04), as well as the subjective impression of the observer (P < 0.001) were significantly associated with SOS diagnosis. In multivariate analysis, clover-like sign (OR 1.87, 95% CI 1.18–2.95, p = 0.0081), increase in spleen volume ≥30% (OR 1.29, 95% CI 1.01–1.64, p = 0.04), and the peripheral distribution of heterogeneity (OR 1.53, 95% CI 1.21–1.94, p < 0.001) were independent SOS predictors. The area under the ROC curve was 0.804. The inter-observer agreement for SOS diagnosis was moderate (Kappa = 0.546).ConclusionCT-scan can detect suggestive signs of SOS in patients receiving chemotherapy for CRLM. By integrating clinical and biological information into CT-scan data, it may be fruitful to create a positive diagnostic and severity score for chemotherapy-induced SOS.     

TACE术中灌注氟尿嘧啶、奥沙利铂及吡柔比星治疗原发性肝癌的临床效果分析

目的观察评价肝动脉化疗栓塞（TACE）联合灌注奥沙利铂（OXA）、氟尿嘧啶（5-Fu）及吡柔比星（THP）方案治疗原发性肝癌的疗效和安全性。方法回顾分析采用TACE术中动脉灌注OXA/5-Fu/THP化疗药物治疗的原发性肝癌患者65例,及同期行单纯肝动脉栓塞（TAE）治疗的原发性肝癌患者21例,分为TACE组和TAE组。对TACE灌注OXA/5-Fu/THP的疗效、不良反应发生率、无进展生存时间（PFS）及总生存期（OS）进行综合评价,并与单纯肝动脉栓塞进行对比分析研究。结果 TACE联合OXA/5-Fu/THP治疗的65例患者中,客观缓解率（ORR）55.4%,疾病控制率（DCR）81.5%;患者的中位PFS时间为11.5个月,中位OS时间为18.5个月;单因素分析中,Child-Pugh A级、无门脉癌栓、无肿瘤转移、肿瘤直径小及TACE治疗次数多的患者预后较好,差异有统计学意义（P＜0.05）;巴塞罗那分期（BCLC）B期的患者预后优于C期的患者,差异有统计学意义（P=0.000）;Cox多因素分析中门脉癌栓及肿瘤远处转移是患者预后的独立危险因素。与单纯TAE 相比,TACE 联合OXA/5-Fu/THP 可提高患者的mPFS。结论TACE术中动脉灌注OXA/5-Fu/THP治疗原发性肝癌的疗效较好,不良反应少。     

Laser-induced interstitial thermotherapy of liver metastases in an interventional 0.5 Tesla MRI system: technique and first clinical experiences

Laser-induced interstitial thermotherapy (LITT) surveyed by magnetic resonance imaging (MRI) has been shown to be effective in various applications. The laser treatment of colorectal liver metastases usually requires a separate device (e.g., ultrasound or CT) to position the laser applicator. In this study, we used an interventional 0.5 T MRI system, allowing both the navigation to the target tissue and on-line thermometry. Laser irradiation was performed using a near-infrared laser source combined with a cooled laser light guide. We treated 20 patients exhibiting a total of 58 colorectal liver metastases. Clinically relevant complications did not occur. No residual tumor was observed after laser irradiation in all metastases with a diameter below 2 cm. Metastases with a mean diameter between 2 and 3 cm demonstrated total necrosis in 71%, while in larger tumors this proportion decreased to 46% (diameter, 3-4 cm) and 30% (diameter, >4 cm), respectively. We conclude that LITT, guided by the employed interventional MRI system, is feasible and safe. The results suggest a more aggressive treatment, especially for larger metastases. J. Magn. Reson. Imaging 2001;13:729-737.