Palliative lokoregionäre Therapie des hilären Gallengangskarzinoms: photodynamische Therapie und Brachytherapie

Zusammenfassung

Eine kurative Resektion des hilären Gallengangskarzinoms ist nur bei 20-30 % der Patienten möglich, sodass für die Mehrzahl der Patienten nur die Option einer palliativen Therapie verbleibt. Da der Krankheitsverlauf bei irresektablem Tumor durch lokoregionäre Komplikationen bestimmt wird, erscheint neben der Gallengangsdränage ein lokaler Therapieansatz erfolgversprechend. Hier hat sich in den vergangenen Jahren die endoluminale photodynamische Therapie (PDT) als ein durch zwei prospektiv-randmomisierte Studien und weitere prospektive Studien an insgesamt fast 200 Patienten validiertes Therapieverfahren etabliert. Das Verfahren erreicht mit geringer Komplikations- und Nebenwirkungsrate eine deutliche Verlängerung des medianen Überlebens und auch eine Verbesserung der Lebensqualität selbst bei Patienten in reduziertem Allgemeinzustand. Als weiteres lokoregionäres Therapiekonzept steht die Radiotherapie in verschiedenen Varianten (Brachytherapie, Teletherapie, kombinierte Therapie) zur Verfügung. Allerdings fehlen hier bisher prospektive und gegen eine Kontrollgruppe validierte Daten, sodass die palliative Strahlentherapie des hilären Gallenganskarzinoms derzeit noch als experimentelles Verfahren eingestuft werden muss.

Abstract

In hilar cholangiocarcinoma, only 20-30 % of the patients are candidates for curative surgical resection, leaving the majority with merely palliative treatment options. Since the natural history of hilar cholangiocarcinoma is dominated by local complications rather than metastatic disease, local palliative treatment seems a reasonable option. Here, endoluminal photodynamic therapy has emerged as a promising treatment with several prospective observational studies and 2 prospective randomised studies published which included nearly 200 patients. With low complication rate and morbidity, PDT achieves an increased median survival as well as an increased quality of life even in patients with reduced performance status. Radiotherapy is an alternative local treatment option applied as brachytherapy, external beam radiotherapy or combined modality treatment. To date, however, sufficient data from controlled clinical trials are lacking, thus palliative radiotherapy has to be considered an experimental treatment option.

Gallengangskarzinom - Klatskin-Tumor - photodynamische Therapie - Brachytherapie - lokoregionäre Therapie

cholangiocarcinoma - Klatskin tumor - photodynamic therapy - brachytherapy - locoregional therapy

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