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DOI: 10.1055/a-0820-5564
Fortgeschrittenes Pankreaskarzinom: Hoch-intensiver fokussierter Ultraschall (HIFU) und andere lokal ablative Verfahren
Article in several languages: English | deutschPublication History
28 December 2017
27 November 2018
Publication Date:
31 January 2019 (online)
![](https://www.thieme-connect.de/media/roefo/201903/lookinside/thumbnails/roefo-2983_10-1055-a-0820-5564_de-1.jpg)
Widmung
Diese Übersichtsarbeit widmen wir Herrn Univ.-Prof. Dr. med. Hans H. Schild, bei dem wir uns ganz herzlich für die langjährige und stete Unterstützung in allen klinischen und wissenschaftlichen Belangen bedanken möchten.
Zusammenfassung
Hintergrund Das lokal fortgeschrittene Pankreaskarzinom ist ein lebenslimitierender Tumor mit einer Vielzahl von Symptomen, u. a. Tumorschmerz. Lokal ablative Verfahren, die thermische oder auch nichtthermische Techniken anwenden, können als moderne Therapieoptionen zur Tumorkontrolle und symptomatischen Verbesserung eingesetzt werden. Dieser Artikel gibt einen Überblick über die derzeit verfügbaren Behandlungsverfahren und -ergebnisse, einschließlich unserer eigenen Erfahrungen mit dem hoch-intensiven fokussierten Ultraschall (HIFU).
Methode Unsere Erfahrungen mit der HIFU-Therapie beim Pankreaskarzinom basieren auf 89 Patienten (UICC III-IV). Neben den HIFU-Ergebnissen wurden Ergebnisse zur lokalen Tumorkontrolle, Sicherheit sowie Mortalität und behandlungsabhängigen Veränderung von Symptomen aus publizierten Studien zur Radiofrequenz-, Mikrowellen- und Kryoablation, irreversiblen Elektroporation und stereotaktischen Strahlentherapie einbezogen.
Ergebnisse Obwohl die unterschiedlichen Modalitäten überwiegend sicher durchführbar sind, bietet der HIFU mit seiner Nicht-Invasivität einen entscheidenden methodischen Vorteil. Mit HIFU konnte bei 85 % der Patienten eine effektive und langanhaltende Schmerzlinderung erreicht werden; bei 50 % war nach 6 Wochen keinerlei analgetische Medikation erforderlich. Leider sind Schmerzlinderung und Lebensqualität bei den anderen lokalen Behandlungsmethoden nur selten untersucht. Eine Tumormassenreduktion konnte mit allen ablativen Therapien erreicht werden, wobei diese 6 Monate nach HIFU im Mittel bei 60 % lag. Unterschiede in der behandlungsassoziierten Morbidität wurden berichtet, sind jedoch aufgrund der unausgewogenen Studienpopulationen nur eingeschränkt vergleichbar.
Schlussfolgerung Eine Vielzahl an lokal ablativen Behandlungsmodalitäten sind zur Tumormassenreduktion beim fortgeschrittenen Pankreaskarzinom verfügbar, bieten aber unterschiedlichen symptomatischen Nutzen. Eine effektive und langanhaltende Reduktion von Tumorschmerzen ohne Einführen von Nadeln oder Elektroden in den Tumorbereich bietet ausschließlich das HIFU-Verfahren. Randomisierte, kontrollierte klinische Studien zum direkten Vergleich der hier vorgestellten Modalitäten sind in der näheren Zukunft zu befürworten.
Kernaussagen:
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Zur lokalen Behandlung des nicht operablen Pankreaskarzinoms stehen unterschiedliche ablative Therapien zur Verfügung.
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Die Tumormassenreduktion und Symptomlinderung stellen Hauptziele der lokalen Tumortherapie dar.
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HIFU unterscheidet sich durch seinen nichtinvasiven Zugang und die geringe Nebenwirkungsrate.
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Mit HIFU ist eine effektive, anhaltende Schmerzlinderung in > 80 % der Patienten möglich.
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Die HIFU-assoziierte Schmerzreduktion ist unabhängig vom Tumorstadium und Metastasierungsstatus.
Zitierweise
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Marinova M, Wilhelm-Buchstab T, Strunk H. Advanced Pancreatic Cancer: High-Intensity Focused Ultrasound (HIFU) and Other Local Ablative Therapies. Fortschr Röntgenstr 2019; 191: 216 – 227
Key words
abdomen - pancreas - ablation procedures - interventional procedures - ultrasound - adenocarcinoma* contributed equally.
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