Interventionelle radiologische Verfahren in der Onkologie – Update 2021

Zusammenfassung

Transarterielle Tumorembolisationen wie die transarterielle Chemoembolisation (TACE) und die selektive interne Radiotherapie (SIRT) haben sich als Therapieoption bei primären und sekundären Lebertumoren etabliert und werden in onkologischen Zentren i.d.R. routinemäßig durchgeführt.

Transkutane Thermoablationen wie Radiofrequenzablation (RFA) und Mikrowellenablation (MWA) haben sich als i.d.R. kurative Therapieoptionen bei primären und sekundären Lebertumoren etabliert. Darüber hinaus werden die Verfahren zunehmend auch bei Nieren- und Lungentumoren eingesetzt.

Neue Verfahren Mit hochintensivem fokussiertem Ultraschall (HIFU) ist eine nicht invasive Thermoablation möglich, bisher zugelassene Indikationen sind die Behandlung von Uterusmyomen, Prostatakarzinomen und Knochentumoren. Die irreversible Elektroporation (IRE) ist ein nicht thermisches Ablationsverfahren, das sich insbesondere in der Therapie von fortgeschrittenen, inoperablen Pankreaskarzinomen etabliert hat.

Abstract

Interventional radiology plays a crucial role in oncology. The most common interventional treatments are transarterial embolisation as well as percutaneous thermal ablations. Transarterial embolisation, such as transarterial chemoembolization (TACE) or selective internal radiation therapy (SIRT) are well established, usually palliatively intended treatment options for primary and secondary hepatic malignancies. Embolisation is usually well tolerated under conscious sedation and can be repeated several times. Percutaneous thermoablation is a local ablative, usually curatively intended treatment for hepatic, renal and pulmonary tumors. As a minimally invasive technique, it competes against surgery and radiation therapy. There are different types of thermoablation, most commonly used are radiofrequency ablation (RFA), microwave ablation (MWA) and cryo-ablation. Ablation is usually performed in general anesthesia, less common in conscious sedation. New interventional treatments are high intensity focused ultrasound (HIFU) and irreversible electroporation (IRE). HIFU allows a non-invasive, imaging-guided thermoablation that is currently certified for uterine myoma, prostate cancer and bone tumors. IRE is a minimal invasive non-thermal ablation that is especially established for locally advanced tumors that show a close relationship to large vessels, for example pancreatic cancer.

Schlüsselwörter

TACE - SIRT - Thermoablation

Key words

TACE - SIRT - thermoablation

Publication History

Article published online:
23 March 2022

• Literatur

• 1 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). . S3-Leitlinie Hepatozelluläres Karzinom und biliäre Karzinome. Langversion 2.0 – Juni 2021. AWMF-Registernummer: 032 - 053OL https://www.awmf.org/uploads/tx_szleitlinien/032-053OLl_S3_HCC_bili%C3%A4re_Karzinome_2021-06.pdf
• 2 Levy J, Zuckerman J, Garfinkle R. et al. Intra-arterial therapies for unresectable and chemorefractory colorectal cancer liver metastases: a systematic review and meta-analysis. HPB 2018; 20: 905-915 DOI: 10.1016/j.hpb.2018.04.001.
• 3 Mocellin S, Pasquali S, Nitti D. Fluoropyrimidine-HAI (hepatic arterial infusion) versus systemic chemotherapy (SCT) for unresectable liver metastases from colorectal cancer. Cochrane Database Syst Rev 2009; 3: CD007823 DOI: 10.1002/14651858.CD007823.pub2.
• 4 Ricke J, Klümpen HJ, Amthauer H. et al. Impact of combined selective internal radiation therapy and sorafenib on survival in advanced hepatocellular carcinoma. J Hepatol 2019; 71: 1164-1174 DOI: 10.1016/j.jhep.2019.08.006.
• 5 Tchelebi L, Sharma NK. Selective internal radiation therapy in the multidisciplinary management of liver metastases from colorectal carcinoma. Semin Nucl Med 2019; 49: 182-188 DOI: 10.1053/j.semnuclmed.2019.01.002.
• 6 Uhlig J, Sellers CM, Stein SM. et al. Radiofrequency ablation versus surgical resection of hepatocellular carcinoma: contemporary treatment trends and outcomes from the United States National Cancer Database. Eur Radiol 2019; 29: 2679-2689 DOI: 10.1007/s00330-018-5902-4.
• 7 Xia Y, Li J, Liu G. et al. Long-term effects of repeat hepatectomy vs percutaneous radiofrequency ablation among patients with recurrent hepatocellular carcinoma: a randomized clinical trial. JAMA Oncol 2020; 6: 255-263 DOI: 10.1001/jamaoncol.2019.4477.
• 8 Yin Z, Jin H, Ma T. et al. A meta-analysis of long-term survival outcomes between surgical resection and radiofrequency ablation in patients with single hepatocellular carcinoma≤2 cm (BCLC very early stage). Int J Surg 2018; 56: 61-67 DOI: 10.1016/j.ijsu.2018.04.048.
• 9 Lee BC, Lee HG, Park IJ. et al. The role of radiofrequency ablation for treatment of metachronous isolated hepatic metastasis from colorectal cancer. Medicine (Baltimore) 2016; 95: e4999 DOI: 10.1097/MD.0000000000004999.
• 10 Johnson BA, Sorokin I, Cadeddu JA. Ten-year outcomes of renal tumor radio frequency ablation. J Urol 2019; 201: 251-258 DOI: 10.1016/j.juro.2018.08.045.
• 11 Uhlig J, Strauss A, Rücker G. et al. Partial nephrectomy versus ablative techniques for small renal masses: a systematic review and network meta-analysis. Eur Radiol 2019; 29: 1293-1307 DOI: 10.1007/s00330-018-5660-3.
• 12 Prud’homme C, Deschamps F, Moulin B. et al. Image-guided lung metastasis ablation: a literature review. Int J Hyperth 2019; 36: 37-45 DOI: 10.1080/02656736.2019.1647358.
• 13 Li G, Xue M, Chen W. et al. Efficacy and safety of radiofrequency ablation for lung cancers: A systematic review and meta-analysis. Eur J Radiol 2018; 100: 92-98 DOI: 10.1016/j.ejrad.2018.01.009.
• 14 Siedek F, Yeo SY, Heijman E. et al. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU): technical background and overview of current clinical applications (Part 1). RoFo 2019; 191: 522-530 DOI: 10.1055/a-0817-5645.
• 15 Narayanan G, Hosein PJ, Beulaygue IC. et al. Percutaneous image-guided irreversible electroporation for the treatment of unresectable, locally advanced pancreatic adenocarcinoma. J Vasc Interv Radiol 2017; 28: 342-348 DOI: 10.1016/j.jvir.2016.10.023.