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Z Gastroenterol 2009; 47(1): 37-54
DOI: 10.1055/s-2008-1028002
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Selektive interne Radiotherapie (Radioembolisation) und Strahlentherapie beim HCC – Stand und Perspektiven

Selective Internal Radiotherapy (Radioembolization) and Radiation Therapy for HCC – Current Status and PerspectivesP. Hilgard1, 2 , S. Müller3 , M. Hamami3 , W. S. Sauerwein4 , U. Haberkorn5 , G. Gerken1 , G. Antoch6
  • 1Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen
  • 2Medizinische Klinik, Ev. Krankenhaus, Mülheim a. d. Ruhr
  • 3Institut für Nuklearmedizin, Universitätsklinikum Essen
  • 4Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen
  • 5Klinik für Nuklearmedizin, Universitätsklinikum Heidelberg
  • 6Institut für diagnostische und interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen
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Publication History

Manuskript eingetroffen: 5.10.2008

Manuskript akzeptiert: 30.11.2008

Publication Date:
20 January 2009 (online)

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Zusammenfassung

Die Mikrosphären- und Partikel-Technologie mit gezieltem Transport tumorizider Substanzen oder Strahlung repräsentiert eine neue Generation von Therapeutika in der interventionellen Onkologie. So erlaubt die intrahepatische Applikation von radioaktiven Mikrosphären über die Arteria hepatica eine lokal ablative Behandlung auch diffuser und multifokaler Lebertumoren, die bisher nur einer systemischen Therapie zugänglich waren. Derzeitiger Standard für eine solche selektive interne Radiotherapie (SIRT) oder Radioembolisation ist die Verwendung von Yttrium-90 angereicherten Glas- oder Kunstharz-Mikrosphären. Indikation, Technik und derzeitige Ergebnisse dieser Therapie beim hepatozellulären Karzinom (HCC) werden ausführlich diskutiert. Außer Yttrium-90-Mikrosphären sind in jüngster Vergangenheit aber auch andere Radiopharmaka wie 131-Jod- oder 188-Rhenium-Lipiodol für eine SIRT verwendet worden. Zusätzlich zur internen gewinnt aber jüngst auch die perkutane Strahlentherapie, vor allem begründet in der Verfügbarkeit neuer schonender Bestrahlungstechniken, bei der lokoregionären Therapie des HCCs zunehmend an Bedeutung.

Abstract

Microsphere and particle technologies for the selective transport of tumoricidal agents or radiation represent a new generation of therapeutics in interventional oncology. The intrahepatic application of radioactive microspheres via the hepatic artery, for instance, allows locoregional therapy of diffuse or multifocal liver tumours, for which to date systemic therapy was the only remaining option. Current standards for this selective internal radiotherapy or radioembolisation are 90-yttrium glass or resin microspheres. Indication, technique, and the current results are extensively discussed. In addition to 90-yttrium microspheres, other radiopharmaceuticals, such as 131-iodine or 188-rhenium lipiodol, have been successful used for SIRT. As a result of new, more selective radiation techniques, internal radiotherapy for the locoregional treatment of HCC has been recently complemented by an increasing use of percutaneous radiotherapy.

Schlüsselwörter

hepatozelluläres Karzinom - Radioembolisation - Radiotherapie - SIRT - lokoregionäre Therapie - Lebertumor

Key words

hepatocellular carcinoma - radioembolisation - radiotherapy - SIRT - locoregional therapy - liver tumours

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PD Dr. Philip Hilgard

Medizinische Klinik Abt. für Allg. Innere Medizin und Gastroenterologie

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45468 Mülheim a. d. R.

Phone: 02 08/3 09-26 00

Fax: 02 08/3 09-26 28

Email: philip.hilgard@evkmh.de