Lokal ablative Therapie bei Lebertumoren

Zusammenfassung

In den letzten Jahren stehen bei Patienten mit Lebertumoren interdisziplinäre Therapieansätze mit Betonung minimalinvasiver Verfahren zur Reduktion der Tumorlast zunehmend im Fokus. Lokal ablative Verfahren zur Behandlung des HCC und von Lebermetastasen kolorektaler Tumoren sind bereits in Behandlungsempfehlungen und Leitlinien integriert. Der folgende Beitrag stellt die häufigsten Verfahren vor und beschreibt ihre Relevanz für den klinischen Alltag.

Abstract

The past years have seen a paradigm shift in the treatment strategies of liver tumors. Due to increasing data interdisciplinary therapy regimens focusing on minimally invasive image guided interventions in combination with surgical procedures and chemotherapy are more and more employed. At present image guided local ablations are part of the international guidelines for the treatment of hepatocellular carcinoma and liver metastases of colon carcinoma with more indications to come in the near future.

Image guide local ablations of liver tumors offer various advantages such as a low peri- and post-interventional morbidity and mortality as well as a short hospital stay when compared to classic liver surgery. Owing to the fact that local ablations are confined to the malignant lesion itself and thus spare the residual liver parenchyma they can be repetitively used and easily combined with surgical resections and systemic chemotherapy. Nowadays a multitude of local ablation approaches exists but by far the most common utilized is radiofrequency ablation. When malignant liver lesions are extensive a high-dose brachytherapy is promising. The ablation procedure to be used is chosen by the interdisciplinary oncology team in charge taking into consideration both the individual patient situation as well as the local expertise.

Kernaussagen

• Interdisziplinäre Therapieansätze unter Einbeziehung bildgeführter lokal ablativer Therapien stehen bei der Therapie von Lebertumoren zunehmend im Fokus und sind inzwischen auch in den Leitlinien vertreten.

• Zu den Vorteilen minimalinvasiver bildgeführter Lebereingriffe zählen unter anderem eine relativ geringe Morbidität und Mortalität, wie auch die kurze Krankenhausverweildauer infolge der geringen Invasivität.

• Aufgrund des parenchymsparenden Vorgehens können lokale Ablationen wiederholt im Krankheitsverlauf eingesetzt und in Kombination mit einer operativen Resektion und Systemtherapie angewandt werden.

• Die Radiofrequenzablation ist das am häufigsten eingesetzte lokale Ablationsverfahren. Bei großen Leberraumforderungen ist die Hochdosis-Brachytherapie vielversprechend.

• Die Wahl des eingesetzten lokalen Ablationsverfahrens ist eine interdisziplinäre Entscheidung des onkologischen Teams vor Ort.

Schlüsselwörter

Lebertumor - lokale Ablation - hepatozelluläres Karzinom - Kolonkarzinom - Radiofrequenzablation - Hochdosis-Brachytherapie

Key words

Image guided interventions - local ablation - liver tumor - hepatocellular carcinoma - colon carcinoma - radiofrequency ablation - high-dose brachytherapy

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