Zusammenfassung
Irresektable Gallengangs- und Gallenblasenkarzinome sind mit einer schlechten Prognose
verbunden. Neben den Empfehlungen des „best supportive care” ist die Schaffung einer
suffizienten biliären Drainage bei maligner Stenose der Gallenwege wichtiger Bestandteil
der palliativen Therapie. Mit der photodynamischen Therapie steht mittlerweile ein
Verfahren zur Verfügung, das in zwei Studien bei hilärem Gallengangskarzinom zu einem
verbesserten Überleben geführt hat. Die externe Strahlentherapie und intraluminale
Brachytherapie werden bisher nicht als gesichert wirksam gewertet. Auch die Indikation
zur Chemotherapie ist weiterhin umstritten, lediglich eine einzige Studie mit einer
kombinierten Gruppe an Patienten mit Gallenwegs- und Pankreaskarzinomen hat bisher
einen Überlebensvorteil für diese Therapieform gezeigt. In den letzten Jahren wurden
neue Protokolle mit vereinzelt viel versprechendem medianen Überleben angewendet.
Lokale Wege der Chemotherapieapplikation sind bisher zu wenig evaluiert, um für diese
Tumorart breit propagiert werden zu können. Lokal ablative Verfahren sind bisher nur
in Einzelfällen eingesetzt worden. Eine weitere Evaluation dieser Therapiestrategien
in klinischen Studien erscheint sinnvoll.
Abstract
Non-resectable cholangiocarcinoma and gallbladder carcinoma have a poor prognosis.
In addition to the general aspects of “best supportive care”, biliary drainage is
an important part of the palliative treatment of patients with malignant biliary stenosis.
Photodynamic therapy has led to an improved median survival in hilar cholangiocarcinoma
in two controlled studies. The survival benefit of external radiation or intraluminal
brachytherapy has not yet been convincingly demonstrated. Whether or not systemic
chemotherapy should be applied is still under debate. A single study including advanced
biliary and pancreatic cancer patients has demonstrated a survival benefit for the
combined group. In recent years, new chemotherapy protocols have been applied, some
with promising results. Intra-arterial chemotherapy and chemotherapeutically coated
stents have not been evaluated well enough to be recommended outside clinical studies.
Ablative therapies have been used in a limited number of patients only. Further studies
are necessary to clarify whether these treatment modalities are effective.
Schlüsselwörter
Cholangiozelluläres Karzinom - Gallenblasenkarzinom - Klatskin-Tumor - Gallengangskarzinom
Key words
Cholangiocellular carcinoma - gallbladder carcinoma - Klatskin’s tumour - cholangiocarcinoma
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PD Dr. Frank Klebl
Klinik und Poliklinik für Innere Medizin I, Klinikum der Universität Regensburg
Franz-Josef-Strauss-Allee 11
93042 Regensburg
Phone: ++49/9 41/9 44 70 03
Fax: ++49/9 41/9 44 70 04
Email: frank.klebl@klinik.uni-regensburg.de