Transarterielle Chemoembolisation (TACE) des hepatozellulären Karzinoms: Technik, Indikationsstellung und Ergebnisse

Zusammenfassung

Vorstellung der Technik, Indikationsstellung und Ergebnisse der transarteriellen Chemoembolisation (TACE) des hepatozellulären Karzinoms (HCC). Dem Prinzip der TACE folgend, werden verschiedene Zytostatika in die A. hepatica injiziert, wie z. B. die Substanzen Doxorubicin, Cisplatin oder Mitomycin C. Als Embolisat wird in der Regel Lipiodol verwendet, zur temporären Gefäßokklusion Gelfoam oder abbaubare Mikrosphären. Die häufigsten Nebenwirkungen nach TACE stellen Fieber, Bauchschmerzen und Erbrechen dar, bis zu einem akuten/chronischen Leberversagen. Bei palliativer Indikation zeigt die TACE bei irresektablem HCC eine erfolgreiche Tumorkontrolle in 15 bis 60 % der Patienten und 5-Jahres-Überlebensraten von 8 - 43 %. Bei potenziell kurativer Indikation erlaubt die TACE eine lokale Tumorkontrollrate von 18 - 63 %. Bei neoadjuvanter (downsizing) Indikation in Kombination mit perkutaner Alkoholinstillation (PEI) oder Radiofrequenzablation (RFA) liegt die lokale Tumorkontrollrate bei 80 - 96 %. Vor Lebertransplantation eingesetzt, lassen sich 5-Jahres-Überlebensraten von 59 - 93 % erreichen. Die symptomatische Indikation ist gegeben, um Schmerzen und akuten/subakuten Blutungen beim HCC entgegenzuwirken. Das lokale Therapieansprechen liegt bei 88 % und Blutungskontrollraten bei 83 bis 100 % der Fälle. Schlussfolgerung: Bei lokalisiertem und diffusem HCC erlaubt der Einsatz der TACE spezifische symptomatische, palliative, potenziell kurative und neoadjuvante Therapieoptionen.

Abstract

To present current data on technique, indications and results of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The principle of TACE is the intra-arterial injection of chemotherapeutic drug combinations like doxorubicin, cisplatin and mitomycin into the hepatic artery, followed by lipiodol injection, Gelfoam for vessel occlusion and degradable microspheres. The side effects and complications after TACE range from fever, upper abdominal pain and vomiting to acute or chronic liver cell failure. The palliative effect in unresectable HCC using TACE allows local tumor control in 15 to 60 % of cases and 5-year survival rates ranging from 8 - 43 %. The potentially curative treatment option allows local tumor control from 18 - 63 %. The neoadjuvant treatment option of TACE in combination with other treatment options like percutaneous ethanol injection (PEI) or radiofrequency ablation (RFA) reach local tumor control rates between 80 - 96 %. The bridging effect of TACE before liver transplantation reaches 5-year survival rates from 59 - 93 %. The symptomatic therapy option of TACE is used to counteract pain directly caused by HCC and acute/subacute bleeding in the HCC. The local tumor response reaches up to 88 % and the bleeding control is from 83 to 100 %. Conclusion: TACE is a potentially curative, palliative, neoadjuvant, bridging and symptomatic therapy option for local and diffuse HCC.

Key words

hepatic arteries - interventional procedures - transarterial chemoembolization

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