Selektive interne Radiotherapie bei fortgeschrittenen Lebertumoren

Zusammenfassung

Die selektive interne Radiotherapie (SIRT, Radioembolisation) wird zur Behandlung von primären und sekundären Lebertumoren eingesetzt. Derzeit wird diese innovative Therapieform (außerhalb von Studien) empfohlen, wenn die Lebererkrankung unter etablierten Therapiekonzepten weiter fortschreitet oder diese Therapien aufgrund intolerabler Toxizitäten vorzeitig abgebrochen werden müssen. Bei der Radioembolisation werden Mikrosphären, die Betastrahlen emittierendes Yttrium-90 enthalten, über einen transarteriellen Zugangsweg superselektiv in die Leberarterien injiziert. Die Mikrosphären sammeln sich in präkapillären Gefäßen in und um das Tumorgewebe an. Hier entfalten die Betastrahlen aufgrund ihrer geringen Penetrationstiefe von durchschnittlich 2,5 mm ihre lokale, strahlentherapeutische Wirkung unter Schonung des umgebenden, gesunden Leberparenchyms.

Abstract

Selective Internal Radiation Therapy (SIRT, Radioembolization) is used for the treatment of primary and secondary liver tumors. Currently, the treatment is performed when under classical and well established treatment concepts a tumor progression is detected or when the treatment has to be abandoned due to toxic effects. Microspheres are labelled with the beta-emitting isotope 90Yttrium and are infused into the hepatic arteries resulting in very high doses of radiation being selectively targeted to tumours via their arterial blood supply. The beta radiation of ⁹⁰Yttrium has an average penetration in soft tissue of approximately 2,5 mm und therefore provides high doses of radiation delivered to the tumor without harming the surrounding, healthy liver parenchyma.

Keywords

Radioembolization, ⁹⁰Yttrium, liver metastases, colorectal cancer, hepatocellular carcinoma

Kernaussagen

• Die Radioembolisation ist eine Methode zur gezielten Behandlung von primären und sekundären Lebertumoren.

• Bei der Radioembolisation/SIRT (selektive interne Radiotherapie) werden mit einem Betastrahler beladene Mikrosphären über einen transarteriellen Zugangsweg selektiv in die Äste der A. hepatica eingebracht.

• Gegenwärtig wird diese palliative Therapieform eingesetzt, wenn chirurgische oder andere lokal ablative Maßnahmen nicht möglich sind bzw. unter Standardchemotherapiekonzepten eine Progression der Lebermetastasen aufgetreten ist.

• Bislang wird die SIRT bei Patienten eingesetzt, bei denen keine andere Therapieoption mehr besteht. Daher sind nun Studien nötig, um zu definieren, ob die Radioembolisation zu einem früheren Zeitpunkt der Erkrankung eingesetzt werden kann und welche Patienten besonders von der Radioembolisation als Therapieoption profitieren.

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