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Der Nuklearmediziner 2018; 41(02): 145-156
DOI: 10.1055/a-0571-9107
Seltene nuklearmedizinische Untersuchungen
© Georg Thieme Verlag KG Stuttgart · New York

„Auf den Punkt gebracht“ − Die Radioembolisation primärer und sekundärer Lebertumoren mit unterschiedlichen Mikrosphären

“Right on Target” – Radioembolization of Primary and Secondary Liver Tumors with Different Microspheres
Harun Ilhan
Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München
,
Andrei Todica
Klinik und Poliklinik für Nuklearmedizin, Klinikum der Universität München, München
› Author Affiliations
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Publication History

Publication Date:
11 June 2018 (online)

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Zusammenfassung

Die duale Gefäßversorgung der Leber spielt eine wichtige Rolle für die Entwicklung von Lebermetastasen, die oft prognosebestimmend sind. Diese Gefäßversorgung ist jedoch auch die Grundlage intraarterieller Therapieoptionen, bei denen die Blutversorgung primärer und sekundärer Lebertumoren durch die A. hepatica ausgenutzt wird. Bei der Radioembolisation werden nach Ausschöpfung chirurgischer Therapieoptionen radioaktiv markierte Mikrosphären über die Leberarterie in und um Lebertumoren unter weitgehender Schonung des gesunden Leberparenchyms appliziert. Die Therapie findet bereits seit mehreren Jahrzehnten klinische Anwendung. In den letzten Jahren wurden mehrere prospektive Phase III-Studien mit 90Y-Mikrosphären durchgeführt, die jedoch meist keinen signifikanten Überlebensvorteil im Vergleich zur systemischen Chemotherapie oder zu Thyrosinkinase-Inhibitoren zeigen konnten. Dennoch findet die Radioembolisation insbesondere als Zweit- oder Drittlinientherapie Empfehlung in zahlreichen Leitlinien zu primären und sekundären Lebertumoren, wobei jedoch oft zwischen verschiedenen intraarteriellen Therapieverfahren keine verbindliche Empfehlung bezüglich der Methode der Wahl ausgesprochen wird. Dieser Übersichtsartikel soll einen Überblick über die derzeitig verfügbaren radioaktiv markierten Mikrosphären geben, die im Rahmen der Radioembolisation Verwendung finden. Diese unterscheiden sich teilweise deutlich in ihren physikalischen Eigenschaften. Der Stellenwert der 99 mTc-MAA-Angiografie sowie die Bestimmung des Leber-Lungen-Shunts und die szintigrafische Beurteilung eines möglichen dystopen Abstromes werden in der Literatur teilweise kontrovers diskutiert. Diese Aspekte sollen zusammen mit den unterschiedlichen Berechnungsmethoden der Therapieaktivität je nach Wahl der Mikrosphären beleuchtet werden.

Abstract

The dual blood supply to the liver plays an important role in the development of liver metastases, which often determine the prognosis. The dual blood supply to the liver, however, is also essential for intraarterial therapy options in primary and secondary liver tumors. Radioembolization is a therapy option in non-resectable liver tumors that enables targeted application of radioactive microspheres in and around tumor lesions. Radioembolization has found clinical application for several decades. Unfortunately, several prospective phase III trials could not demonstrate a survival benefit of radioembolization with 90Y-microspheres in comparison to systemic chemotherapy or novel therapy options such as thyrosine kinase inhibitors. Nevertheless, radioembolization remains a guideline recommended therapy especially as a second or third line option, although the method of choice between different intraarterial therapy methods remains unclear. This review is supposed to give an overview on currently available microspheres for radioembolization. These compounds have some relevant differences in their physical characteristics. The status of 99 mTc-MAA angiography during pretreatment work-up, the evaluation of liver-lung-shunting and the scintigraphic assessment of non-target embolization is still subject to controversy. These aspects and the differences in dose calculation methods with respect to the different microspheres are highlighted in this review.

Schlüsselwörter

SIRT - Radioembolisation - MAA - Leber-Lungen-Shunt - Aktivitätsberechnung - Dosimetrie

Keywords

SIRT - radioembolization - MAA - liver-shunt-fraction - dose calculation - dosimetry
 

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