Palliative Therapie von Gallengangs- und Gallenblasenkarzinomen

Zusammenfassung

Irresektable Gallengangs- und Gallenblasenkarzinome sind mit einer schlechten Prognose verbunden. Neben den Empfehlungen des „best supportive care” ist die Schaffung einer suffizienten biliären Drainage bei maligner Stenose der Gallenwege wichtiger Bestandteil der palliativen Therapie. Mit der photodynamischen Therapie steht mittlerweile ein Verfahren zur Verfügung, das in zwei Studien bei hilärem Gallengangskarzinom zu einem verbesserten Überleben geführt hat. Die externe Strahlentherapie und intraluminale Brachytherapie werden bisher nicht als gesichert wirksam gewertet. Auch die Indikation zur Chemotherapie ist weiterhin umstritten, lediglich eine einzige Studie mit einer kombinierten Gruppe an Patienten mit Gallenwegs- und Pankreaskarzinomen hat bisher einen Überlebensvorteil für diese Therapieform gezeigt. In den letzten Jahren wurden neue Protokolle mit vereinzelt viel versprechendem medianen Überleben angewendet. Lokale Wege der Chemotherapieapplikation sind bisher zu wenig evaluiert, um für diese Tumorart breit propagiert werden zu können. Lokal ablative Verfahren sind bisher nur in Einzelfällen eingesetzt worden. Eine weitere Evaluation dieser Therapiestrategien in klinischen Studien erscheint sinnvoll.

Abstract

Non-resectable cholangiocarcinoma and gallbladder carcinoma have a poor prognosis. In addition to the general aspects of “best supportive care”, biliary drainage is an important part of the palliative treatment of patients with malignant biliary stenosis. Photodynamic therapy has led to an improved median survival in hilar cholangiocarcinoma in two controlled studies. The survival benefit of external radiation or intraluminal brachytherapy has not yet been convincingly demonstrated. Whether or not systemic chemotherapy should be applied is still under debate. A single study including advanced biliary and pancreatic cancer patients has demonstrated a survival benefit for the combined group. In recent years, new chemotherapy protocols have been applied, some with promising results. Intra-arterial chemotherapy and chemotherapeutically coated stents have not been evaluated well enough to be recommended outside clinical studies. Ablative therapies have been used in a limited number of patients only. Further studies are necessary to clarify whether these treatment modalities are effective.

Schlüsselwörter

Cholangiozelluläres Karzinom - Gallenblasenkarzinom - Klatskin-Tumor - Gallengangskarzinom

Key words

Cholangiocellular carcinoma - gallbladder carcinoma - Klatskin’s tumour - cholangiocarcinoma

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