Selektive interne Radiotherapie (SIRT) inoperabler Lebertumoren mit radioaktiv markierten Mikrosphären

Zusammenfassung

Die selektive interne Radiotherapie (SIRT) ist eine Methode zur lokalen Behandlung von primären Lebertumoren sowie von Lebermetastasen verschiedener Primärtumoren. Bei der SIRT werden radioaktiv markierte Mikrosphären über einen transarteriellen Zugangsweg selektiv in Äste der A. hepatica eingebracht. Gegenwärtig wird diese Therapieform primär dann eingesetzt, wenn chirurgische oder andere lokal ablative Maßnahmen nicht Erfolg versprechend sind bzw. unter gängigen Chemotherapiekonzepten eine Progression der Lebererkrankung aufgetreten ist. In diesem Artikel werden das Prinzip der SIRT dargelegt, Kriterien für die Patientenselektion erörtert, die Durchführung der Therapie und ihrer Begleitmaßnahmen beschrieben sowie Nebenwirkungen und mögliche Komplikationen angesprochen. Abschließend werden die mit dieser Therapie erzielten Ergebnisse bei wichtigen Tumorentitäten zusammengefasst und weiterführende Perspektiven diskutiert.

Abstract

Selective internal radiotherapy (SIRT) is a method for local treatment of primary liver tumors and metastatic liver disease. SIRT is based on the delivery of radioactive labeled microspheres into the vascular bed of the liver via angiographically placed catheters in branches of the hepatic artery. Currently this therapeutic approach is predominantly applied, if surgical resection or other local forms of ablative therapies are not indicated and commonly applied chemotherapy regimen have failed to prevent progression of liver involvement. This article briefly summarizes the pathophysiologic principle of SIRT, addresses the criteria for patient selection, describes how to perform the therapeutic procedure in combination with adjuvant actions and reports on side effects and possible complications. Finally, the results obtained with this therapy are summarized for the most relevant tumor entities and some future perspectives are discussed.

Schlüsselwörter

selektive interne Radiotherapie - Mikrosphären - Lebermetastasen - primäre Lebertumoren - Salvage-Therapie

Key words

selective internal radiotherapy - microspheres - liver metastasis - primary liver tumors - salvage therapy

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