Zusammenfassung
Lebermetastasen sind mit großem Abstand die häufigsten malignen Lebertumoren. Die
chirurgische Resektion ist heute noch der Goldstandard zur Behandlung solitärer Lebermetastasen
kolorektaler Karzinome (CRC), wobei die Fünf-Jahres-Überlebensrate etwa 30 % beträgt.
Neben den Fortschritten auf dem Gebiet der Leberchirurgie haben sich in den letzten
Jahren auch neue Techniken zur interventionellen Destruktion (Lokalablation) von Tumoren
entwickelt, etwa thermische Verfahren wie die Radiofrequenz-Thermoablation (RFTA)
und die laserinduzierte Thermotherapie (LITT) oder die perkutane Alkoholinjektion
(PEI). Obwohl kontrollierte Studien fehlen, weisen die publizierten Fallserien auf
einen positiven Effekt der Lokalablation durch RFTA oder LITT hin. Die transarterielle
Chemoembolisation (TACE) zielt auf eine temporäre Embolisation tumorversorgender Gefäße,
verursacht eine Hypoxie im Tumorgewebe und verhindert das rasche Ausschwemmen des
Chemotherapeutikums. Das Verfahren eignet sich vor allem für die Behandlung hypervaskularisierter
Tumoren wie zum Beispiel des multilokulären hepatozellulären Karzinoms (HCC), während
die Mehrzahl der Lebermetastasen eher hypovaskularisiert sind. Zu den lokaltherapeutischen
Ansätzen zählen auch die strahlentherapeutischen Verfahren, bei denen 131Jod-Lipiodol oder 90Yttrium-Mikrosphären eingesetzt werden, die sich nach transarterieller Applikation
bevorzugt im Tumorkapillargebiet festsetzen und dort zu einer hohen lokalen Strahlendosis
führen können. Ferner werden lokale perkutane Strahlentherapieverfahren evaluiert.
Summary
The liver is the most common site for tumour metastastases that are generally associated
with a poor prognosis. However, in patients with isolated liver metastases of colorectal
cancer (CRC) surgical resection results in a five-year survival of approximately 30
%. In addition to the improvement of liver surgery novel techniques for the local
destruction (ablation) of liver tumors were developed such as radiofrequency thermal
ablation (RFTA), laser induced thermal therapy (LITT) or percutaneous ethanol injection
(PEI). PEI and RFTA are well established treatment options for small hepatocellular
carcinomas (HCC), but for the treatment of liver metastases no controlled clinical
trials have been performed up to now. However, the published clinical observations
suggest, that patients may benefit from local tumor control induced by RFTA or LITT.
For transarterial chemoembolization (TACE) a mixture of lipiodol and a chemotherapeutic
agent is injected into the hepatic artery or into a tumor-feeding artery followed
by temporary embolization. This results in prolonged exposure to the chemotherapeutic
drug and in direct tumor damage by hypoxia. TACE is a successful treatment option
in HCC, but for metastatic disease only hypervascularized tumors such as renal cell
carcinomas or neuroendocrine tumors seem to respond favourably. The transarterial
route can also be used for the injection of lipiodol-131iodine or 90yttrium microspheres. These microspheres accumulate predominantly in the
tumor vasculature resulting in a high local dose of irradiation. Further, percutaneous
radiation therapy is being clinically evaluated.
Key Words
locoregional therapy - liver metastasis - radiofrequency thermal ablation - chemoembolization
- microspheres
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Anschrift für die Verfasser
PD Dr. Leonhard Mohr
Abteilung Innere Medizin II, Universitätsklinik Freiburg
Hugstetterstr. 55
79106 Freiburg
