Aktuelle Therapie des hepatozellulären Karzinoms unter besonderer Berücksichtigung neuer und multimodaler Therapiekonzepte

Zusammenfassung

Die Inzidenz des hepatozellulären Karzinoms (HCC) nimmt weltweit zu, was insbesondere auf einen Anstieg der Hepatitis-C-assoziierten HCC zurückzuführen ist. Bei mehr als 80 % der Patienten entsteht das HCC aus einer Leberzirrhose. Ferner haben mehr als die Hälfte der Patienten zum Zeitpunkt der Erstdiagnose ein weit fortgeschrittenes Child-Pugh- oder Tumorstadium. Nationale und internationale Therapieempfehlungen beruhen auf dem BCLC („Barcelona Clinic for Liver Cancer“) Algorithmus. Abhängig von dem Stadium der Leberfunktion und der Tumorerkrankung empfiehlt dieser die Resektion, Lebertransplantation, Radiofrequenzthermoablation (RFA), transarterielle Chemoembolisation (TACE), systemische Therapie mit Sorafenib oder eine bestmögliche unterstützende Behandlungsmaßnahme (best supportive care), berücksichtigt hingegen weder Kombinationstherapien noch neuere Therapieverfahren. Es gibt jedoch zunehmend Hinweise, dass Kombinationen, z. B. aus Sorafenib mit TACE oder Kombinationen aus verschiedenen lokoregionären Therapien miteinander, eine höhere Effektivität und damit bessere Tumorkontrolle herbeiführen können als monotherapeutische Ansätze. TACE mit Drug Eluting Beads, die selektive interne Radiotherapie (SIRT) oder Mikrowellenablation (MWA) stellen ferner viel versprechende Therapieansätze dar. Patienten mit einem HCC sollten in einem lokalen Tumorboard besprochen werden, um ein optimales und möglichst individuelles Therapieverfahren anzubieten.

Abstract

The incidence of hepatocellular carcinoma (HCC) is increasing worldwide due to the growing number of hepatitis C related HCCs. In more than 80 % of the patients, HCC arises in a cirrhotic liver. Furthermore, more than half of the patients have an advanced Child-Pugh score or an inoperable tumor stage at the initial diagnosis. Recommendations for the treatment of HCC by national and international guidelines rely on the BCLC (“Barcelona Clinic for Liver Cancer“) algorithm. Depending on the stage of liver function and tumor disease it recommends resection, liver transplantation, radiofrequency thermal ablation (RFA), transarterial chemoembolisation (TACE), systemic therapy with sorafenib or best supportive care, but does neither take into consideration combination of therapies nor new therapy modalities. However, there is increasing evidence that combinations i. e. sorafenib with TACE or combination of locoregional techniques enhance effectivity and tumor control compared to monotherapies. TACE with drug-eluting beads, selective internal radiotherapy (SIRT) and new locoregional therapy procedures like microwave ablation (MWA) are further promising therapeutic approaches. Patients with HCC should be discussed in a local tumor board in order to provide the optimal and most individual way of treatment.

Schlüsselwörter

hepatozelluläres Karzinom (HCC) - multimodal - BCLC-Algorithmus - Therapie

Keywords

hepatocellular carcinoma (HCC) - multimodal - BCLC algorithm - therapy

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