Radiologisch-interventionelle Verfahren zur Therapie von kolorektalen Lebermetastasen

Zusammenfassung

Mikrotherapeutische Verfahren in der interventionellen Radiologie stellen bei Inoperabilität (technische Inoperabilität, funktionelle Inoperabilität, Komorbiditäten, Wunsch des Patienten) neben der Chemotherapie eine Möglichkeit zur lokalen Kontrolle von Lebermetastasen dar. Einen Schwerpunkt stellen lokale Verfahren wie die Radiofrequenzablation oder die interstitielle Brachytherapie dar, bei denen unter Bildführung durch Ultraschall sowie CT- oder offene MRT-Systeme eine thermische bzw. radiogene Ablation der Malignome durchgeführt wird. Diese erweisen sich als sehr effektiv, sind dabei aber auf einen oligonodulären Befall limitiert. Zur Behandlung einer disseminierten Metastasierung haben sich lokoregionäre Techniken wie die Yttrium-90-Radioembolisation etabliert. Hier wird unter angiografischer Kontrolle der Wirkstoff in Form von radioaktiv markierten Mikrosphären über einen arteriellen Zugang appliziert. Dieser Artikel fokussiert sich auf Metastasen des kolorektalen Karzinoms als häufigste Tumorentität zur interventionell-radiologischen Therapie.

Abstract

Microtherapeutic procedures performed by interventional radiologists pose a viable alternative or additive to systemic chemotherapy for local tumour control in cases of non-operable (for technical, functional, and comorbidity reasons or at the patientʼs wish) liver metastases. A main focus includes local therapies such as radiofrequency ablation and interstitial brachytherapy which are performed under ultrasound, CT or MRI guidance to achieve a thermal or radiogenic ablation of the malignancy. Although highly effective, these procedures are limited to oligonodular manifestations. For disseminated metastases, locoregional techniques like the yttrium-90 radioembolisation have become established. Here, the active principle in the form of radioactively labelled microspheres is introduced into the liver through an arterial catheter under angiographic guidance. The present article focuses on metastases of colorectal cancer as the most frequent tumour entity encountered in interventional radiotherapy.

Schlüsselwörter

interventionelle Radiologie - Lebermetastase - Ablationstechniken - minimalinvasive Chirurgie - Radioonkologie

Key words

interventional radiology - liver metastases - ablation techniques - minimally invasive surgical procedures - radiation oncology

^* Robert Damm und Ricarda Seidensticker haben gleichen Anteil an der Erstautorenschaft.

• Literatur

• 1 Cady B, Monson DO, Swinton NW. Survival of patients after colonic resection for carcinoma with simultaneous liver metastases. Surg Gynecol Obstet 1970; 131: 697-700
• 2 Wood CB, Gillis CR, Blumgart LH. A retrospective study of the natural history of patients with liver metastases from colorectal cancer. Clin Oncol 1976; 2: 285-288
• 3 Hompes D, Prevoo W, Ruers T. Radiofrequency ablation as a treatment tool for liver metastases of colorectal origin. Cancer Imaging 2011; 11: 23-30
• 4 Ito K, Govindarajan A, Ito H et al. Surgical treatment of hepatic colorectal metastasis: evolving role in the setting of improving systemic therapies and ablative treatments in the 21st century. Cancer J 2010; 16: 103-110
• 5 Andreou A, Brouquet A, Abdalla EK et al. Repeat hepatectomy for recurrent colorectal liver metastases is associated with a high survival rate. HPB (Oxford) 2011; 13: 774-782
• 6 Khatri VP, Petrelli NJ, Belghiti J. Extending the frontiers of surgical therapy for hepatic colorectal metastases: is there a limit?. J Clin Oncol 2005; 23: 8490-8499
• 7 Goldberg RM, Sargent DJ, Morton RF et al. A randomized controlled trial of fluorouracil plus leucovorin, irinotecan, and oxaliplatin combinations in patients with previously untreated metastatic colorectal cancer. J Clin Oncol 2004; 22: 23-30
• 8 Yothers G. Toward progression-free survival as a primary end point in advanced colorectal cancer. J Clin Oncol 2007; 25: 5153-5154
• 9 Sutherland LM, Williams JA, Padbury RT et al. Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 2006; 141: 181-190
• 10 Solbiati L, Livraghi T, Goldberg SN et al. Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology 2001; 221: 159-166
• 11 Gillams AR, Lees WR. Radiofrequency ablation of colorectal liver metastases. Abdom Imaging 2005; 30: 419-426
• 12 Berber E, Pelley R, Siperstein AE. Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. J Clin Oncol 2005; 23: 1358-1364
• 13 Siperstein AE, Berber E, Ballem N et al. Survival after radiofrequency ablation of colorectal liver metastases: 10-year experience. Ann Surg 2007; 246: 559-565
• 14 Gillams AR, Lees WR. Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation. Eur Radiol 2009; 19: 1206-1213
• 15 Sofocleous CT, Petre EN, Gonen M et al. CT-guided radiofrequency ablation as a salvage treatment of colorectal cancer hepatic metastases developing after hepatectomy. J Vasc Interv Radiol 2011; 22: 755-761
• 16 Mack MG, Straub R, Eichler K et al. Percutaneous MR imaging-guided laser-induced thermotherapy of hepatic metastases. Abdom Imaging 2001; 26: 369-374
• 17 Vogl TJ, Straub R, Eichler K et al. Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy—local tumor control rate and survival data. Radiology 2004; 230: 450-458
• 18 Pech M, Wieners G, Freund T et al. MR-guided interstitial laser thermotherapy of colorectal liver metastases: efficiency, safety and patient survival. Eur J Med Res 2007; 12: 161-168
• 19 Morita T, Shibata T, Okuyama M et al. [Microwave coagulation therapy for liver metastases from colorectal cancer]. Gan To Kagaku Ryoho 2004; 31: 695-699
• 20 Ogata Y, Uchida S, Hisaka T et al. Intraoperative thermal ablation therapy for small colorectal metastases to the liver. Hepatogastroenterology 2008; 55: 550-556
• 21 Ricke J, Mohnike K, Pech M et al. Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography-guided high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 2010; 78: 479-485
• 22 Stubbs RS, OʼBrien I, Correia MM. Selective internal radiation therapy with 90Y microspheres for colorectal liver metastases: single-centre experience with 100 patients. ANZ J Surg 2006; 76: 696-703
• 23 Kennedy AS, Coldwell D, Nutting C et al. Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 2006; 65: 412-425
• 24 Jakobs TF, Hoffmann RT, Dehm K et al. Hepatic yttrium-90 radioembolization of chemotherapy-refractory colorectal cancer liver metastases. J Vasc Interv Radiol 2008; 19: 1187-1195
• 25 Cosimelli M, Golfieri R, Cagol PP et al. Multi-centre phase II clinical trial of yttrium-90 resin microspheres alone in unresectable, chemotherapy refractory colorectal liver metastases. Br J Cancer 2010; 103: 324-331
• 26 Seidensticker R, Denecke T, Kraus P et al. Matched-pair comparison of radioembolization plus best supportive care versus best supportive care alone for chemotherapy refractory liver-dominant colorectal metastases. Cardiovasc Intervent Radiol 2011; 35: 1066-1073
• 27 Kosmider S, Tan TH, Yip D et al. Radioembolization in combination with systemic chemotherapy as first-line therapy for liver metastases from colorectal cancer. J Vasc Interv Radiol 2011; 22: 780-786
• 28 Pereira PL, Trubenbach J, Schmidt D. Radiofrequency ablation: basic principles, techniques and challenges. Rofo 2003; 175: 20-27
• 29 Pereira PL. Perkutane bildgesteuerte Leber-Tumortherapie mittels Radiofrequenz-Ablation (RFA). Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie 2012. Im Internet: http://v2.degir.de/download/dokman/Leitlinie-RFA Stand 9.2.2012
• 30 Kim KH, Yoon YS, Yu CS et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81: 25-34
• 31 Jung EM, Clevert DA, Rupp N. Contrast-enhanced ultrasound with Optison in percutaneous thermoablation of liver tumors. Rofo 2003; 175: 1403-1412
• 32 Stroszczynski C, Gretschel S, Gaffke G et al. [Laser-induced thermotherapy (LITT) for malignant liver tumours: the role of sonography in catheter placement and observation of the therapeutic procedure]. Ultraschall Med 2002; 23: 163-167
• 33 Rempp H, Clasen S, Pereira PL. Image-based monitoring of magnetic resonance-guided thermoablative therapies for liver tumors. Cardiovasc Intervent Radiol 2011; Jul 22 [Epub ahead of print]
• 34 Nemcek AA. Complications of radiofrequency ablation of neoplasms. Semin Intervent Radiol 2006; 23: 177-187
• 35 Vogl TJ, Straub R, Zangos S et al. MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data. Int J Hyperthermia 2004; 20: 713-724
• 36 Simon CJ, Dupuy DE, Iannitti DA et al. Intraoperative triple antenna hepatic microwave ablation. AJR Am J Roentgenol 2006; 187: W333-W340
• 37 Boutros C, Somasundar P, Garrean S et al. Microwave coagulation therapy for hepatic tumors: review of the literature and critical analysis. Surg Oncol 2010; 19: e22-e32
• 38 Thomson KR, Cheung W, Ellis SJ et al. Investigation of the safety of irreversible electroporation in humans. J Vasc Interv Radiol 2011; 22: 611-621
• 39 Dritschilo A, Harter KW, Thomas D et al. Intraoperative radiation therapy of hepatic metastases: technical aspects and report of a pilot study. Int J Radiat Oncol Biol Phys 1988; 14: 1007-1011
• 40 Herfarth KK, Debus J, Lohr F et al. Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol 2001; 19: 164-170
• 41 Ricke J, Wust P, Stohlmann A et al. CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases. Strahlenther Onkol 2004; 180: 274-280
• 42 Seidensticker M, Seidensticker R, Mohnike K et al. Quantitative in vivo assessment of radiation injury of the liver using Gd-EOB-DTPA enhanced MRI: Tolerance dose of small liver volumes. Radiat Oncol 2011; 6: 40
• 43 Wallace S, Carrasco CH, Charnsangavej C et al. Hepatic artery infusion and chemoembolization in the management of liver metastases. Cardiovasc Intervent Radiol 1990; 13: 153-160
• 44 Liu DM, Salem R, Bui JT et al. Angiographic considerations in patients undergoing liver-directed therapy. J Vasc Interv Radiol 2005; 16: 911-935
• 45 Denecke T, Ruhl R, Hildebrandt B et al. Planning transarterial radioembolization of colorectal liver metastases with Yttrium 90 microspheres: evaluation of a sequential diagnostic approach using radiologic and nuclear medicine imaging techniques. Eur Radiol 2008; 18: 892-902
• 46 Gray B, Van Hazel G, Hope M et al. Randomised trial of SIR-Spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 2001; 12: 1711-1720
• 47 Seidensticker R, Seidensticker M, Damm R et al. Hepatic toxicity after radioembolization of the liver using (90)Y-microspheres: sequential lobar versus whole liver approach. Cardiovasc Intervent Radiol 2011; 35: 1109-1118
• 48 Scheele J, Altendorf-Hofmann A, Grube T et al. Resection of colorectal liver metastases. What prognostic factors determine patient selection?. Chirurg 2001; 72: 547-560
• 49 Welsh FK, Tekkis PP, OʼRourke T et al. Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making. Surg Oncol 2008; 17: 3-13
• 50 Berber E, Siperstein A. Local recurrence after laparoscopic radiofrequency ablation of liver tumors: an analysis of 1032 tumors. Ann Surg Oncol 2008; 15: 2757-2764
• 51 Mulier S, Ni Y, Jamart J et al. Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 2005; 242: 158-171
• 52 Van Tilborg AA, Meijerink MR, Sietses C et al. Long-term results of radiofrequency ablation for unresectable colorectal liver metastases: a potentially curative intervention. Br J Radiol 2011; 84: 556-565
• 53 Wu YZ, Li B, Wang T et al. Radiofrequency ablation vs. hepatic resection for solitary colorectal liver metastasis: A meta-analysis. World J Gastroenterol 2011; 17: 4143-4148
• 54 Lambert LA, Colacchio TA, Barth jr. RJ. Interval hepatic resection of colorectal metastases improves patient selection. Arch Surg 2000; 135: 473-479
• 55 Livraghi T, Solbiati L, Meloni F et al. Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer 2003; 97: 3027-3035
• 56 Kim KH, Yoon YS, Yu CS et al. Comparative analysis of radiofrequency ablation and surgical resection for colorectal liver metastases. J Korean Surg Soc 2011; 81: 25-34
• 57 Aliberti C, Fiorentini G, Muzzio PC et al. Trans-arterial chemoembolization of metastatic colorectal carcinoma to the liver adopting DC Bead®, drug-eluting bead loaded with irinotecan: results of a phase II clinical study. Anticancer Res 2011; 31: 4581-4587
• 58 Stang A, Fischbach R, Teichmann W et al. A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. Eur J Cancer 2009; 45: 1748-1756