Subscribe to RSS
DOI: 10.1055/a-0851-4562
Interventionelle Onkologie – was der Radiologe im Tumorboard wissen sollte
Publication History
Publication Date:
28 August 2019 (online)
![](https://www.thieme-connect.de/media/rad-u2d/201903/lookinside/thumbnails/10-1055-a-0851-4562_ra_beyer-1.jpg)
In den letzten Jahren hat die interventionelle Onkologie enorme Fortschritte erzielt. Themen dieses Beitrags sind die technischen Möglichkeiten und die Grenzen der perkutanen Ablation und der Embolisation einerseits und der aktuelle Stand zum therapeutischen Vorgehen bei den wichtigsten Tumorentitäten andererseits.
-
Bei den hitzebasierten Ablationsverfahren hat die Mikrowellenablation gegenüber der Radiofrequenzablation Vorteile, wenn große Tumoren und Tumoren in der Nähe von Gefäßen behandelt werden müssen.
-
Die irreversible Elektroporation kann eingesetzt werden, wenn die anderen Ablationsverfahren kontraindiziert sind, z. B. bei zentralen Lebertumoren unmittelbar an den Gallengängen.
-
Die TACE basiert auf der Kombination aus einer hohen lokalen Konzentration eines Chemotherapeutikums und Ischämie. Die DEB-TACE hat ein günstigeres pharmakokinetisches Profil als die cTACE mit weniger systemischen Nebenwirkungen – ein längeres Gesamtüberleben ist jedoch nicht belegt.
-
Beim hepatozellulären Karzinom ist im sehr frühen und frühen Stadium die Ablation als alternatives Erstlinienverfahren zur Resektion etabliert. Im intermediären Stadium ist die TACE die Standardtherapie.
-
Bei Leber- oder Lungenmetastasen eines kolorektalen Karzinoms (< 5 cm), die nicht resektabel sind oder falls Gründe vorliegen, die dringend gegen eine Resektion sprechen (z. B. Patientenalter, -wunsch, -komorbiditäten), ist alternativ eine Ablation möglich.
-
Lokal-ablative Verfahren bei Nierentumoren werden in den Leitlinien bisher nur für Patienten mit kleinen Tumoren und signifikanten Komorbiditäten empfohlen. Laut aktueller Datenlage kann jedoch ein zur Resektion vergleichbares Gesamtüberleben erreicht werden.
-
Aufgrund der guten Datenlage werden bei nicht resektablen intrahepatischen cholangiozellulären Karzinomen in der Praxis häufig lokal-ablative Verfahren und/oder die TACE eingesetzt, auch wenn dies (noch) nicht durch die Leitlinien gedeckt ist.
-
Bei nicht resektablen Lebermetastasen von gastroenteropankreatischen neuroendokrinen Neoplasien kommen die Ablation oder TACE mit dem Ziel einer Tumor- und/oder Symptomreduktion in Betracht.
-
Literatur
- 1 Goldberg SN, Gazelle GS, Dawson SL. et al. Tissue ablation with radiofrequency: effect of probe size, gauge, duration, and temperature on lesion volume. Acad Radiol 1995; 2: 399-404
- 2 Brace CL. Radiofrequency and Microwave Ablation of the Liver, Lung, Kidney, and Bone: What Are the Differences?. Curr Probl Diagn Radiol 2009; 38: 135-143 doi:10.1067/j.cpradiol.2007.10.001
- 3 Harari CM, Magagna M, Bedoya M. et al. Microwave Ablation: Comparison of Simultaneous and Sequential Activation of Multiple Antennas in Liver Model Systems. Radiology 2016; 278: 95-103 doi:10.1148/radiol.2015142151
- 4 Lee EW, Chen C, Prieto VE. et al. Advanced hepatic ablation technique for creating complete cell death: irreversible electroporation. Radiology 2010; 255: 426-433 doi:10.1148/radiol.10090337
- 5 Cannon R, Ellis S, Hayes D. et al. Safety and early efficacy of irreversible electroporation for hepatic tumors in proximity to vital structures. J Surg Oncol 2013; 107: 544-549 doi:10.1002/jso.23280
- 6 Kim Y, Lim HK, Rhim H. et al. Ten-year outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: Analysis of prognostic factors. J Hepatol 2013; 58: 89-97 doi:10.1016/j.jhep.2012.09.020
- 7 Kang TW, Rhim H, Lee MW. et al. Radiofrequency Ablation for Hepatocellular Carcinoma Abutting the Diaphragm: Comparison of Effects of Thermal Protection and Therapeutic Efficacy. Am J Roentgenol 2011; 196: 907-913 doi:10.2214/AJR.10.4584
- 8 Teratani T, Yoshida H, Shiina S. et al. Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 2006; 43: 1101-1108 doi:10.1002/hep.21164
- 9 Kang TW, Lim HK, Lee MW. et al. Long-term Therapeutic Outcomes of Radiofrequency Ablation for Subcapsular versus Nonsubcapsular Hepatocellular Carcinoma: A Propensity Score Matched Study. Radiology 2016; 280: 300-312 doi:10.1148/radiol.2016151243
- 10 Nakagomi R, Tateishi R, Shiina S. et al. Drastically Reduced Neoplastic Seeding Related to Radiofrequency Ablation for Hepatocellular Carcinoma. Am J Gastroenterol 2014; 109: 774-776 doi:10.1038/ajg.2014.42
- 11 Choi D, Lim HK, Kim MJ. et al. Liver Abscess After Percutaneous Radiofrequency Ablation for Hepatocellular Carcinomas: Frequency and Risk Factors. Am J Roentgenol 2005; 184: 1860-1867 doi:10.2214/ajr.184.6.01841860
- 12 Venkatesan AM, Kundu S, Sacks D. et al. Society of Interventional Radiology Standards of Practice Committee. Practice guidelines for adult antibiotic prophylaxis during vascular and interventional radiology procedures. Written by the Standards of Practice Committee for the Society of Interventional Radiology and Endorsed by the Cardiovascular Interventional Radiological Society of Europe and Canadian Interventional Radiology Association [corrected]. J Vasc Interv Radiol 2010; 21: 1611-1630 doi:10.1016/j.jvir.2010.07.018 quiz 1631
- 13 Miyayama S, Yamashiro M, Ikuno M. et al. Ultraselective transcatheter arterial chemoembolization for small hepatocellular carcinoma guided by automated tumor-feeders detection software: technical success and short-term tumor response. Abdom Imaging 2014; 39: 645-656 doi:10.1007/s00261-014-0094-0
- 14 Lammer J, Malagari K, Vogl T. et al. Prospective Randomized Study of Doxorubicin-Eluting-Bead Embolization in the Treatment of Hepatocellular Carcinoma: Results of the PRECISION V Study. Cardiovasc Intervent Radiol 2010; 33: 41-52 doi:10.1007/s00270-009-9711-7
- 15 Håkansson L, Håkansson A, Morales O. et al. Spherex (degradable starch microspheres) chemo-occlusion-enhancement of tumor drug concentration and therapeutic efficacy: an overview. Semin Oncol 1997; 24: S6-100-S6-109
- 16 Orlacchio A, Chegai F, Francioso S. et al. Repeated Transarterial Chemoembolization with Degradable Starch Microspheres (DSMs-TACE) of Unresectable Hepatocellular Carcinoma: A Prospective Pilot Study. Curr Med Imaging Rev 2018; 14: 637-645 doi:10.2174/1573405613666170616123657
- 17 Vogel A, Cervantes A, Chau I. et al. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019; DOI: 10.1093/annonc/mdy510.
- 18 Galle PR, Forner A, Llovet JM. et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol 2018; 69: 182-236 doi:10.1016/j.jhep.2018.03.019
- 19 Rahbari NN, Mehrabi A, Mollberg NM. et al. Hepatocellular Carcinoma. Ann Surg 2011; 253: 453-469 doi:10.1097/SLA.0b013e31820d944f
- 20 Cucchetti A, Piscaglia F, Cescon M. et al. Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma. J Hepatol 2013; 59: 300-307 doi:10.1016/j.jhep.2013.04.009
- 21 Liu Y, Zheng Y, Li S. et al. Percutaneous microwave ablation of larger hepatocellular carcinoma. Clin Radiol 2013; 68: 21-26 doi:10.1016/j.crad.2012.05.007
- 22 Yang DJ, Luo KL, Liu H. et al. Meta-analysis of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization alone for hepatocellular carcinoma. Oncotarget 2017; 8: 2960-2970 doi:10.18632/oncotarget.13813
- 23 Shibata T, Isoda H, Hirokawa Y. et al. Small Hepatocellular Carcinoma: Is Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization More Effective than Radiofrequency Ablation Alone for Treatment?. Radiology 2009; 252: 905-913 doi:10.1148/radiol.2523081676
- 24 Lo C, Ngan H, Tso WK. et al. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 2002; 35: 1164-1171 doi:10.1053/jhep.2002.33156
- 25 Llovet JM, Real MI, Montaña X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet (London, England) 2002; 359: 1734-1739 doi:10.1016/S0140-6736(02)08649-X
- 26 Llovet J, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003; 37: 429-442 doi:10.1053/jhep.2003.50047
- 27 Burrel M, Reig M, Forner A. et al. Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial design. J Hepatol 2012; 56: 1330-1335 doi:10.1016/j.jhep.2012.01.008
- 28 Takayasu K, Arii S, Kudo M. et al. Superselective transarterial chemoembolization for hepatocellular carcinoma. Validation of treatment algorithm proposed by Japanese guidelines. J Hepatol 2012; 56: 886-892 doi:10.1016/j.jhep.2011.10.021
- 29 Prajapati HJ, Kim HS. Treatment algorithm based on the multivariate survival analyses in patients with advanced hepatocellular carcinoma treated with trans-arterial chemoembolization. PLoS One 2017; 12: e0170750 doi:10.1371/journal.pone.0170750
- 30 Kirstein MM, Voigtländer T, Schweitzer N. et al. Transarterial chemoembolization versus sorafenib in patients with hepatocellular carcinoma and extrahepatic disease. United Eur Gastroenterol J 2018; 6: 238-246 doi:10.1177/2050640617716597
- 31 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 2.1, 2019, AWMF Registrierungsnummer: 021/007OL.
- 32 Van Cutsem E, Cervantes A, Adam R. et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol 2016; 27: 1386-1422 doi:10.1093/annonc/mdw235
- 33 House MG, Ito H, Gönen M. et al. Survival after Hepatic Resection for Metastatic Colorectal Cancer: Trends in Outcomes for 1,600 Patients during Two Decades at a Single Institution. J Am Coll Surg 2010; 210: 744-752 doi:10.1016/j.jamcollsurg.2009.12.040
- 34 Otto G, Düber C, Hoppe-Lotichius M. et al. Radiofrequency Ablation as First-Line Treatment in Patients With Early Colorectal Liver Metastases Amenable to Surgery. Ann Surg 2010; 251: 796-803 doi:10.1097/SLA.0b013e3181bc9fae
- 35 Solbiati L, Ahmed M, Cova L. et al. Small Liver Colorectal Metastases Treated with Percutaneous Radiofrequency Ablation: Local Response Rate and Long-term Survival with Up to 10-year Follow-up. Radiology 2012; 265: 958-968 doi:10.1148/radiol.12111851
- 36 Sørensen SM, Mortensen FV, Nielsen DT. Radiofrequency ablation of colorectal liver metastases: long-term survival. Acta Radiol 2007; 48: 253-258 doi:10.1080/02841850601161539
- 37 Correa-Gallego C, Fong Y, Gonen M. et al. A Retrospective Comparison of Microwave Ablation vs. Radiofrequency Ablation for Colorectal Cancer Hepatic Metastases. Ann Surg Oncol 2014; 21: 4278-4283 doi:10.1245/s10434-014-3817-0
- 38 Niessen C, Thumann S, Beyer L. et al. Percutaneous Irreversible Electroporation: Long-term survival analysis of 71 patients with inoperable malignant hepatic tumors. Sci Rep 2017; 7: 43687 doi:10.1038/srep43687
- 39 de Baère T, Aupérin A, Deschamps F. et al. Radiofrequency ablation is a valid treatment option for lung metastases: experience in 566 patients with 1037 metastases. Ann Oncol 2015; 26: 987-991 doi:10.1093/annonc/mdv037
- 40 Hiraki T, Gobara H, Iguchi T. et al. Radiofrequency ablation as treatment for pulmonary metastasis of colorectal cancer. World J Gastroenterol 2014; 20: 988 doi:10.3748/wjg.v20.i4.988
- 41 Fiorentini G, Aliberti C, Tilli M. et al. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res 2012; 32: 1387-1395
- 42 Martin RCG, Scoggins CR, Schreeder M. et al. Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer 2015; 121: 3649-3658 doi:10.1002/cncr.29534
- 43 Bhutiani N, Akinwande O, Martin RCG. Efficacy and Toxicity of Hepatic Intra-Arterial Drug-Eluting (Irinotecan) Bead (DEBIRI) Therapy in Irinotecan-Refractory Unresectable Colorectal Liver Metastases. World J Surg 2016; 40: 1178-1190 doi:10.1007/s00268-015-3386-9
- 44 Jones RP, Malik HZ, Fenwick SW. et al. PARAGON II – A single arm multicentre phase II study of neoadjuvant therapy using irinotecan bead in patients with resectable liver metastases from colorectal cancer. Eur J Surg Oncol 2016; 42: 1866-1872 doi:10.1016/j.ejso.2016.07.142
- 45 Pantuck AJ, Zisman A, Belldegrun AS. The changing natural history of renal cell carcinoma. J Urol 2001; 166: 1611-1623
- 46 Crépel M, Jeldres C, Sun M. et al. A Population-based Comparison of Cancer-control Rates Between Radical and Partial Nephrectomy for T1A Renal Cell Carcinoma. Urology 2010; 76: 883-888 doi:10.1016/J.UROLOGY.2009.08.028
- 47 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms, Langversion 1.2, 2017, AWMF Registernummer: 043/017OL.
- 48 Ljungberg B, Albiges L, Abu-Ghanem Y. et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. Eur Urol 2019; 75: 799-810 doi:10.1016/j.eururo.2019.02.011
- 49 Gordetsky J, Eich ML, Garapati M. et al. Active Surveillance of Small Renal Masses. Urology 2019; 123: 157-166 doi:10.1016/j.urology.2018.09.017
- 50 Xing M, Kokabi N, Zhang D. et al. Comparative Effectiveness of Thermal Ablation, Surgical Resection, and Active Surveillance for T1a Renal Cell Carcinoma: A Surveillance, Epidemiology, and End Results (SEER)–Medicare-linked Population Study. Radiology 2018; 288: 81-90 doi:10.1148/radiol.2018171407
- 51 Atwell TD, Schmit GD, Boorjian SA. et al. Percutaneous Ablation of Renal Masses Measuring 3.0 cm and Smaller: Comparative Local Control and Complications After Radiofrequency Ablation and Cryoablation. Am J Roentgenol 2013; 200: 461-466 doi:10.2214/AJR.12.8618
- 52 Samarasekera D, Khalifeh A, Autorino R. et al. 1795 Percutaneous radiofrequency ablation versus percutaneous cryoablation: long-term outcomes following ablation for renal cell carcinoma. J Urol 2013; 189: e737-e738 doi:10.1016/j.juro.2013.02.2845
- 53 Zhou W, Arellano RS. Thermal Ablation of T1c Renal Cell Carcinoma: A Comparative Assessment of Technical Performance, Procedural Outcome, and Safety of Microwave Ablation, Radiofrequency Ablation, and Cryoablation. J Vasc Interv Radiol 2018; 29: 943-951 doi:10.1016/j.jvir.2017.12.020
- 54 Valle JW, Borbath I, Khan SA. et al. ESMO Guidelines Committee. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2016; 27: v28-v37 doi:10.1093/annonc/mdw324
- 55 Kim JH, Won HJ, Shin YM. et al. Radiofrequency ablation for recurrent intrahepatic cholangiocarcinoma after curative resection. Eur J Radiol 2011; 80: e221-e225 doi:10.1016/j.ejrad.2010.09.019
- 56 Butros SR, Shenoy-Bhangle A, Mueller PR. et al. Radiofrequency ablation of intrahepatic cholangiocarcinoma: feasability, local tumor control, and long-term outcome. Clin Imaging 2014; 38: 490-494 doi:10.1016/j.clinimag.2014.01.013
- 57 Kim JH, Won HJ, Shin YM. et al. Radiofrequency Ablation for the Treatment of Primary Intrahepatic Cholangiocarcinoma. Am J Roentgenol 2011; 196: W205-W209 doi:10.2214/AJR.10.4937
- 58 Park SY, Kim JH, Yoon HJ. et al. Transarterial chemoembolization versus supportive therapy in the palliative treatment of unresectable intrahepatic cholangiocarcinoma. Clin Radiol 2011; 66: 322-328 doi:10.1016/j.crad.2010.11.002
- 59 Kiefer MV, Albert M, McNally M. et al. Chemoembolization of intrahepatic cholangiocarcinoma with cisplatinum, doxorubicin, mitomycin C, ethiodol, and polyvinyl alcohol. Cancer 2011; 117: 1498-1505 doi:10.1002/cncr.25625
- 60 Hyder O, Marsh JW, Salem R. et al. Intra-arterial Therapy for Advanced Intrahepatic Cholangiocarcinoma: A Multi-institutional Analysis. Ann Surg Oncol 2013; 20: 3779-3786 doi:10.1245/s10434-013-3127-y
- 61 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S2k-Leitlinie Neuroendokrine Tumore, 2018, AWMF Registrierungsnummer: 021/27.
- 62 Bloomston M, Al-Saif O, Klemanski D. et al. Hepatic Artery Chemoembolization in 122 Patients with Metastatic Carcinoid Tumor: Lessons Learned. J Gastrointest Surg 2007; 11: 264-271 doi:10.1007/s11605-007-0089-z
- 63 Saxena A, Chua TC, Sarkar A. et al. Progression and survival results after radical hepatic metastasectomy of indolent advanced neuroendocrine neoplasms (NENs) supports an aggressive surgical approach. Surgery 2011; 149: 209-220 doi:10.1016/j.surg.2010.06.008
- 64 de Baere T, Deschamps F, Tselikas L. et al. GEP-NETS UPDATE: Interventional radiology: role in the treatment of liver metastases from GEP-NETs. Eur J Endocrinol 2015; 172: R151-R166 doi:10.1530/EJE-14-0630
- 65 Apfelbeck M, Herlemann A, Stief CG. et al. Fokale Therapie des Prostatakarzinoms in Deutschland. Urologe 2016; 55: 584-592 doi:10.1007/s00120-016-0104-7
- 66 Valerio M, Cerantola Y, Eggener SE. et al. New and Established Technology in Focal Ablation of the Prostate: A Systematic Review. Eur Urol 2017; 71: 17-34 doi:10.1016/j.eururo.2016.08.044
- 67 van der Poel HG, van den Bergh RCN, Briers E. et al. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74: 84-91 doi:10.1016/J.EURURO.2018.01.001
- 68 Senkus E, Kyriakides S, Ohno S. et al. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26: v8-v30 doi:10.1093/annonc/mdv298
- 69 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Früherkennung, Diagnose, Therapie und Nachsorge des Mammakarzinoms, Version 4.1, 2018 AWMF Registernummer: 032 – 045OL.
- 70 Chua TC, Saxena A, Liauw W. et al. Hepatic resection for metastatic breast cancer: A systematic review. Eur J Cancer 2011; 47: 2282-2290 doi:10.1016/j.ejca.2011.06.024
- 71 Wang M, Zhang J, Ji S. et al. Transarterial chemoembolisation for breast cancer with liver metastasis: A systematic review. Breast 2017; 36: 25-30 doi:10.1016/j.breast.2017.09.001
- 72 Wolf FJ, Grand DJ, Machan JT. et al. Microwave Ablation of Lung Malignancies: Effectiveness, CT Findings, and Safety in 50 Patients. Radiology 2008; 247: 871-879 doi:10.1148/radiol.2473070996