Lokoregionäre Therapie des HCC

Zusammenfassung

Das Leberzellkarzinom ist der häufigste Tumor der Leber und gilt als häufigstes Malignom weltweit, mit stetig steigender Inzidenz. Die Behandlungsoptionen werden im Wesentlichen vom Tumorausmaß (Größe, Multifokalität, Leberfunktion, Grunderkrankung der Leber) bestimmt, wobei lokale und systemisch-hepatische Therapien unterschieden werden. Die Tumorresektion und Lebertransplantation gelten als prinzipiell kurative Therapieverfahren, für die sich im klinischen Alltag jedoch lediglich nur ca. 20% der Patienten qualifizieren. Bei der Mehrzahl der Patienten liegt eine fortgeschrittene Tumorerkrankung ohne oder mit zusätzlicher Lebererkrankung vor. Ist die Tumorlast dabei bez. Tumorgröße und Anzahl noch lokal begrenzt, können perkutane chemoablative, thermoablative und bei mehr multifokaler oder diffuser Tumormanifestation transarterielle chemo- und radioablative Therapieverfahren zum Einsatz kommen. Die Radioablation konkurriert bez. Indikationsstellung mit den transarteriellen, chemoablativen Verfahren (TACE) insbesondere bei Patienten mit fortgeschrittenen Tumoren, wobei sich in ersten Studien Vorteile der Radioembolisation gegenüber TACE hinsichtlich progressionsfreien Überlebens und Gesamtüberlebens zeigen. Diese initialen Ergebnisse müssen jedoch in weiteren Studien untermauert werden.

Abstract

Hepatocellular carcinomas are the most common heaptic tumors and the most common maligancies worldwide with constantly rising incidence. The potential treatment is ruled mainly by the tumor extent (e. g. tumour size, multifocaltity, hepatic function, underlying concommittend hepatic disease) whereas local from more systemic-hepatic therapies can be differntiated. Resection and transplantation are considered by definition as curative treatments, however, in clinical reality only about 20% of the patietns are eligible for one of this therapies. The majority oft patients will present with an advanced tumor disease with or without an additional hepatic disease. In locally limited tumor burden with respect to tumour size and number percutaneous chemo-ablative, thermo-ablative, and in multifocally or diffuse tumour manifestations transarterial chemo- and radioablative therapies may be administered.

Considering indications, radioablation will compete with transarterial, chemoablative trestments (TACE) especially in patients with advanced tumours, whereas in initial studies radioablation presents some advances over TACE regarding progressions-free and overall survival. This promising results have to be confirmed in further studies.

Schlüsselwörter

hepatozelluläres Karzinom - Radioembolisation - selektive interne Radiotherapie (SIRT) - Yttrium-90 - minimal-invasive Therapie

Key words

hepatocellullar carcinoma - radioembolization - selective internal radiotherapy (SIRT) - Yttrium-90 - minimal-invasive therapy

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