Interventionelle Onkologie – was der Radiologe im Tumorboard wissen sollte

In den letzten Jahren hat die interventionelle Onkologie enorme Fortschritte erzielt. Themen dieses Beitrags sind die technischen Möglichkeiten und die Grenzen der perkutanen Ablation und der Embolisation einerseits und der aktuelle Stand zum therapeutischen Vorgehen bei den wichtigsten Tumorentitäten andererseits.

Kernaussagen

• Bei den hitzebasierten Ablationsverfahren hat die Mikrowellenablation gegenüber der Radiofrequenzablation Vorteile, wenn große Tumoren und Tumoren in der Nähe von Gefäßen behandelt werden müssen.

• Die irreversible Elektroporation kann eingesetzt werden, wenn die anderen Ablationsverfahren kontraindiziert sind, z. B. bei zentralen Lebertumoren unmittelbar an den Gallengängen.

• Die TACE basiert auf der Kombination aus einer hohen lokalen Konzentration eines Chemotherapeutikums und Ischämie. Die DEB-TACE hat ein günstigeres pharmakokinetisches Profil als die cTACE mit weniger systemischen Nebenwirkungen – ein längeres Gesamtüberleben ist jedoch nicht belegt.

• Beim hepatozellulären Karzinom ist im sehr frühen und frühen Stadium die Ablation als alternatives Erstlinienverfahren zur Resektion etabliert. Im intermediären Stadium ist die TACE die Standardtherapie.

• Bei Leber- oder Lungenmetastasen eines kolorektalen Karzinoms (< 5 cm), die nicht resektabel sind oder falls Gründe vorliegen, die dringend gegen eine Resektion sprechen (z. B. Patientenalter, -wunsch, -komorbiditäten), ist alternativ eine Ablation möglich.

• Lokal-ablative Verfahren bei Nierentumoren werden in den Leitlinien bisher nur für Patienten mit kleinen Tumoren und signifikanten Komorbiditäten empfohlen. Laut aktueller Datenlage kann jedoch ein zur Resektion vergleichbares Gesamtüberleben erreicht werden.

• Aufgrund der guten Datenlage werden bei nicht resektablen intrahepatischen cholangiozellulären Karzinomen in der Praxis häufig lokal-ablative Verfahren und/oder die TACE eingesetzt, auch wenn dies (noch) nicht durch die Leitlinien gedeckt ist.

• Bei nicht resektablen Lebermetastasen von gastroenteropankreatischen neuroendokrinen Neoplasien kommen die Ablation oder TACE mit dem Ziel einer Tumor- und/oder Symptomreduktion in Betracht.

Schlüsselwörter

Tumorablation - Chemoembolisation - hepatozelluläres Karzinom - kolorektales Karzinom - Lebermetastasen

Key words

tumor ablation - chemoembolization - hepatocellular carcinoma - colorectal cancer - liver metastases

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