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Gastroenterologie up2date 2014; 10(04): 263-278
DOI: 10.1055/s-0034-1391094
Leber/Galle/Pankreas
© Georg Thieme Verlag KG Stuttgart · New York

Interventionelle Therapie und stereotaktische Strahlentherapie von Lebermetastasen

Christian Wybranski
,
Sebastian A. Lettmaier
,
Jens Ricke
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Publication History

Publication Date:
11 December 2014 (online)

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Kernaussagen

Interventionell radiologische Verfahren

  • Vorteile der lokalen perkutan-interstitiellen und lokoregionären endovaskulären Ablationsverfahren sind die minimale Invasivität, die weitgehende Vermeidung systemischer Nebenwirkungen, die gute Patiententoleranz und das hohe Sicherheitsprofil.

  • Die Radiofrequenzablation (RFA) ist das am weitesten verbreitete thermische Ablationsverfahren. Sie ist für die Therapie unifokaler Metastasen ≤ 5 cm oder oligofokaler Metastasen ≤ 3,5 cm geeignet.

  • Mittels interstitieller High-Dose-Rate-Brachytherapie können unter weitgehender Schonung des angrenzenden Lebergewebes ausgedehnte unifokale und oligofokale Metastasen behandelt werden.

  • Die selektive interne Radiotherapie (SIRT) vereint die Vorteile der selektiven Tumorembolisation und einer lokalen Radiotherapie und kann auch bei multifokaler bzw. diffuser Metastasierung zum Einsatz kommen.

Stereotaktische Strahlentherapie

  • Die stereotaktische Strahlentherapie von Lebermetastasen ist das einzige nicht invasive Therapieverfahren mit kurativem Potenzial.

  • Bei allen Patienten in ausreichendem Allgemeinzustand mit Oligometastasierung der Leber, die nicht für eine chirurgische Resektion infrage kommen, sollte eine stereotaktische Strahlentherapie erwogen werden.

  • Die hohe Strahlenempfindlichkeit des gesunden Leberparenchyms sowie die starke Atembeweglichkeit der Leber stellen große Herausforderungen für die Strahlentherapie dar.

  • Die stereotaktische Strahlentherapie erreicht mithilfe moderner bildgestützter Verfahren die räumlich präzise Applikation sehr hoher Strahlendosen unter maximaler Normalgewebsschonung.

  • Klinische Daten belegen eine sehr hohe Therapiewirksamkeit der stereotaktischen Bestrahlung bei minimaler Toxizität.

 

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