Aktuelle Entwicklungen in der regionalen Behandlung von peritonealen und pleuralen Tumoren (inkl. HIPEC und HITOC)

Zusammenfassung

Die multimodale Therapie von begrenzten peritonealen Metastasen kann bei ausgewählten Tumorentitäten die Prognose der Patienten günstig beeinflussen, sollte eine komplette Resektion erfolgen (Pseudomyxoma peritonei, malignes peritoneales Mesotheliom, kolorektales Karzinom, Magenkarzinom und Ovarialkarzinom). Oft wird additiv eine hypertherme intraperitoneale Chemotherapie (HIPEC) intraoperativ durchgeführt. Wenn die Behandlung in erfahrenen (und zertifizierten) Zentren durchgeführt wird, ist diese mit einer niedrigen Letalität verbunden. Die intrakavitäre hypertherme Perfusionschemotherapie (HITOC) in der Pleura kann zur Behandlung bösartiger Pleuratumoren eingesetzt werden. Wesentliche Indikationen sind das Pleuramesotheliom oder der sekundäre Pleurabefall durch ein Thymom (Stadium IV a). Die HITOC wird in Einzelfällen auch bei Patienten mit einer Pleurakarzinose durchgeführt. Beide Verfahren (HIPEC und HITOC) sind komplex und der genaue Stellenwert der lokoregionalen hyperthermen Chemotherapie muss durch weitere prospektiv randomisierte Studien geklärt werden.

Abstract

The multimodal treatment of limited peritoneal metastases may improve prognosis in selected patients (pseudomyxoma peritonei, malignant peritoneal mesothelioma, colorectal, gastric and ovarian cancer) provided complete cytoreduction can be performed. Additive intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) is often performed. If the treatment is undertaken in experienced (and certified) centres, associated mortality is low. Intrapleural hyperthermic chemoperfusion (HITOC) can be performed in patients with pleural malignancies, mainly for malignant pleural mesothelioma or metastases from a thymoma. In single patients, pleural metastases from gastrointestinal malignancies might be an indication. Both therapies (HIPEC and HITOC) are complex and their exact role has to be defined within further prospective randomised trials.

Schlüsselwörter

Peritonealkarzinose - Peritonektomie - Chemotherapie

Key words

metastasis - chemotherapy - peritoneal carcinomatosis

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