Interventionelle Verfahren zur Therapie von Lebertumoren

Zusammenfassung

Metastasen gastrointestinaler Tumoren repräsentieren in der westlichen Welt die häufigste Ursache für sekundäre, das Leberzellkarzinom (HCC) für primäre Lebertumoren. Aus der Gesamtheit dieser Patienten mit primären oder sekundären Lebermalignomen sind lediglich 20-30% einer operativen Therapie mit kurativem Ansatz zuführbar. In nicht-resektablen Situationen sind interventionelle Therapieverfahren wie die transarterielle Chemoembolisation (TACE), die perkutane Alkoholinstillationstherapie (PAIT), die perkutane Radiofrequenzablation (RFA) und die selektive interne Radiotherapie (SIRT) alternative Therapieoptionen, welche im Therapiekonzept aufgrund niedriger Nebenwirkungs- und guter Tumorkontrollraten zunehmend an Bedeutung gewinnen. Aktuelle Studienergebnisse an großen Patientenkollektiven demonstrieren den guten und langfristigen Erfolg der TACE bei nicht-operablen HCCs. Eine mehrzeitige interventionelle Kombinationstherapie ist möglich und sinnvoll. Eine Kombinationstherapie von TACE und PAIT verbessert nachweislich selbst bei großen HCCs (bis 7 cm) die Überlebensrate. Gemäß international anerkannter Empfehlungen der EASL (European Association for the Study of the Liver) wird die PAIT nach der Resektion als Verfahren zweiter Wahl bei der Therapie bis zu drei HCCs kleiner 3 cm gesehen. Die RFA findet sowohl bei primären als auch sekundären hepatischen Malignomen Einsatz. Neuere Studien belegen die Überlegenheit der RFA gegenüber der PAIT hinsichtlich Invasivität, lokaler Ansprechrate und Überleben. Die SIRT findet Einsatz bei multifokalem, ansonsten nicht mehr behandelbarem Leberbefall. Die SIRT verhindert in den meisten Fällen den Tumorprogress insbesondere auch nach vorangegangener erfolgloser Chemotherapie mit modernen Kombinationen (Oxalaplatin, Irinotecan). Aufgrund eines niedrigen Evidenzlevels der meisten Studien ist eine abschließende Bewertung lokal-ablativer Verfahren verfrüht, eine deutliche Lebenszeitverlängerung bei Patienten mit ursprünglich schlechter Prognose zeichnet sich jedoch ab.

minimalinvasive Therapie - Lebermetastasen - hepatozelluläres Karzinom - Radiofrequenzablation - Alkoholablation - transarterielle Chemoembolisation - selektive interne Radiotherapie

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