Interventionell-radiologische Therapie von Lebermetastasen kolorektaler Karzinome

In den letzten 2 Jahrzehnten haben Fortschritte in der interventionellen Radiologie das Behandlungsspektrum für Lebermetastasen kolorektaler Karzinome stetig erweitert. Die minimalinvasiven Verfahren verbessern Lebensqualität und Überleben, sie sind eine Alternative zur Chirurgie und haben eine vielversprechende Zukunft in der personalisierten Medizin. Dieser Artikel stellt die wichtigsten Techniken und deren Anwendungsmöglichkeiten vor.

Kernaussagen

• Lebermetastasen kolorektaler Karzinome belasten Patienten und das Gesundheitssystem erheblich und erfordern eine gezielte, multidisziplinäre Behandlungsstrategie.

• Bei der Wahl des geeigneten interventionell-radiologischen Verfahrens spielen Kriterien wie die Anzahl, Größe und Lage der Tumoren eine entscheidende Rolle.

• Die Mikrowellenablation (MWA), Radiofrequenzablation (RFA) und interstitielle Brachytherapie (HDR-BT) bieten vielversprechende Behandlungsoptionen für Lebermetastasen, besonders im Stadium der Oligometastasierung.

• Neuste Daten legen nahe, dass bei geeigneten Patienten (bis zu 3 Herde, ≤ 3 cm, gut zugänglich), aufgrund der geringeren Nebenwirkungen und kürzeren Krankenhausaufenthalte, die thermische Ablation als primäre Behandlungsstrategie in Betracht gezogen werden sollte.

• Die Therapieentscheidung hinsichtlich Ablation oder Resektion sollte immer interdisziplinär und unter Berücksichtigung der individuellen Patientensituation getroffen werden. Eine umfassende Beratung und Aufklärung der Patienten durch Radiologen und Chirurgen ist dabei unerlässlich.

• Angesichts der kaum bestehenden Limitationen könnte die HDR-BT bei zunehmender Evidenz und unter Berücksichtigung einer sorgfältigen Patientenselektion zukünftig zu einer der wichtigsten minimalinvasiven Behandlungsoptionen avancieren.

• Die Kombination von lokal ablativen Verfahren mit Immuntherapie könnte vielversprechende Synergien bieten, erfordert jedoch weitere Studien zur Bestätigung und Implementierung in der klinischen Praxis.

• Ansätze zur Hypertrophieinduktion zur Erlangung einer sekundären Resektabilität wie die Pfortaderembolisation oder die lobäre SIRT sind vielversprechend, insbesondere in Bezug auf das Streben nach kurativen Therapieansätzen.

Schlüsselwörter

interventionelle Radiologie - minimalinvasiv - Ablationen - lokoregionäre Therapien

Publication History

Article published online:
19 March 2025

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