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Interventionelle Radiologie Scan 2013; 01(01): 39-57
DOI: 10.1055/s-0032-1326541
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© Georg Thieme Verlag KG Stuttgart · New York

Behandlungsstrategien bei Intermediate-Stage-HCC

Maciej Pech
,
Konrad Mohnike
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Publication History

Publication Date:
16 May 2013 (online)

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Einleitung

Das HCC (Leberzellkarzinom) ist die 6.-häufigste Krebsart und die 3.-häufigste Ursache der durch eine Krebserkrankung bedingten Sterblichkeit in der Welt [1]. Trotz der weit verbreiteten Screening-Programme wird mehr als die Hälfte der HCC erst in späten Stadien diagnostiziert, wenn eine potenziell kurative Therapie (Resektion oder Lebertransplantation) nicht mehr angeboten werden kann [2]. Für Patienten mit einem inoperablen, nicht durch Transplantation therapierbaren HCC und einer relativ gut erhaltenen Leberfunktion (intermediäres HCC) stellen die lokoregionären, transarteriellen Behandlungsmethoden die wichtigsten therapeutischen Optionen dar. Die beiden bedeutendsten europäischen Leitlinien zum HCC, die EASL-EORTC- (European Association for the Study of the Liver und European Organisation for Research and Treatment of Cancer) und die ESMO-ESDO-Leitlinie (European Society for medical Oncology und European Society of digestive Oncology), empfehlen für intermediäre HCC gemäß der Klassifikation der BCLC (Barcelona Clinic of Liver Cancer) die TACE (transarterielle Chemoembolisation; Abb. [1]). Auch die AASLD (American Association for the Study of Liver Diseases) empfiehlt bei BCLC-B-Patienten mit einem Performance-Status 0 und einer multinodulären Erkrankung ein transarterielles Vorgehen.

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Abb. 1 Therapieempfehlungen bei HCC in Abhängigkeit vom Tumorstadium. Schematische Darstellung. a EASL-EORTC-Leitlinie [3]. b ESMO-Leitlinie [4]. BSC = Best supportive Care; OS = Overall Survival; PEI = Percutaneous Ethanol Injection; PS = Performance Status; RFA = Radiofrequency Ablation; TACE = Transarterial Chemoembolization.
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Die besondere Gefäßversorgung der Leber (A. hepatica und V. porta) und die in den meisten Fällen ausgeprägte Neoangiogenese des HCC während seiner Progression ergeben die Rationale aller katheterbasierten, transarteriellen Therapien. Am häufigsten verwendete Embolisationstechniken bei der HCC-Behandlung:

  • TACE: Es werden 2 Formen unterschieden: ohne (TACE) oder mit chemotherapeutikabindenden bzw. -freisetzenden Sphären (DEB-TACE). Bei der TACE wird eine selektive Medikamentengabe mit einer blutflussreduzierenden Embolisation der tumorversorgenden Gefäße kombiniert.

  • 90Y-RE (90Yttrium-Radioembolisation): Diese Technik stellt dagegen eine Form der Brachytherapie dar. Die mit 90Y beladenen Mikrosphären ermöglichen nach arterieller Applikation eine interne Bestrahlung des Tumors.

Die folgende Übersicht versucht, den aktuellen Stand der transarteriellen Verfahren und ihre Rolle bei der Behandlung von Patienten mit einem intermediären HCC darzustellen.

 

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