Diagnose und multimodale Therapie des hepatozellulären Karzinoms

Zusammenfassung

Das hepatozelluläre Karzinom (HCC) ist weltweit eine der führenden krebsbedingten Todesursachen. Die Mehrzahl aller HCC entsteht auf dem Boden einer Leberzirrhose. Dies verkompliziert die Diagnostik und Therapie. Zur nicht invasiven Diagnostik sind klare Kriterien entwickelt worden, die auf kontrastverstärkten dynamischen bildgebenden Verfahren und dem Serum-Tumormarkerspiegel des AFP (Alpha-Fetoprotein) beruhen. Bei der Planung der Therapie müssen neben der Tumorausdehnung und -ausbreitung auch der Allgemeinzustand des Patienten und insbesondere die Leberfunktion mitberücksichtigt werden. Zur Einschätzung der Prognose und Planung der geeigneten Therapie hat sich hier insbesondere das BCLC-System der Barcelona Clinic for Liver Cancer bewährt. Nur etwa ein Drittel aller Patienten kann mittels Resektion, Transplantation oder lokaler Tumorablation kurativ behandelt werden. In den lokal fortgeschrittenen Fällen kommen v. a. transarterielle Verfahren wie die transarterielle Chemoembolisation und neuerdings die selektive interne Radiotherapie zum Einsatz. Da das HCC ein relativ chemotherapieresistenter Tumor ist, spielt die Chemotherapie kaum eine Rolle in der Therapie des HCC. Mit der Einführung des Sorafenib steht jetzt erstmals eine wirkungsvolle systemische Therapie für das fortgeschrittene und metastasierte HCC zur Verfügung. Einen besonderen Stellenwert hat die interdisziplinäre Betreuung von Patienten mit HCC, um alle für den einzelnen Patienten relevanten Therapieoptionen ausnutzen zu können.

Abstract

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death in the world. The majority of HCCs develops on the basis of a chronic liver disease. This often complicates diagnosis and therapy. Non-invasive diagnostic criteria are based on dynamic imaging techniques and the serum level of AFP (alpha-fetoprotein). When evaluating HCC patients for therapy, besides tumor burden and localisation, the therapeutic evaluation must also consider the general condition of the patient and his/her liver function. For this purpose, the BCLC algorithm of the Barcelona Clinic for Liver Disease has proven helpful. Only one-third of the patients can be cured by resection, transplantation or local tumour ablation. In locally advanced cases transarterial procedures including transarterial chemoembolisation and radioembolisation are applied. HCC is a chemo-resistant tumour and chemotherapy is not accepted as standard of care in HCC. Sorafenib is the first systemic treatment with proven efficacy approved for the treatment of advanced and metastatic HCC. Interdisciplinary management of HCC patients is essential in order to provide every patient with the optimal therapy at his specific stage of disease.

Schlüsselwörter

hepatozelluläres Karzinom - Lebertransplantation - transarterielle Chemoembolisation - Radiofrequenzablation - Sorafenib

Key words

hepatocellular carcinoma - liver transplantation - transarterial chemoembolisation - radiofrequency ablation - sorafenib

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