Zusammenfassung
Bildgeführte, minimal–invasive lokale und lokoregionäre Ablationstechniken, wie Radiofrequenz
(RFA), interstitielle Brachytherapie, transarterielle Chemoembolisation (TACE) und
selektive interne Radiotherapie (SIRT) mit 90Yttrium (90Y) Mikrosphären ermöglichen die Zerstörung großer Tumorzellverbände in der Leber bei
akzeptabler Toxizität. Für eine sichere Durchführung der Therapien ist eine enge Zusammenarbeit
zwischen dem interventionellen Radiologen und Anästhesisten unerlässlich.
Abstract
Image guided minimally invasive local and locoregional tumor ablation techniques like
radiofrequency ablation, interstitial brachytherapy, transarterial chemoembolization
(TACE) and selective internal radiotherapy (SIRT) with 90Yttrium (90Y) microspheres have been established as valuable amendments in oncologic therapy
concepts. These techniques allow the destruction of extensive liver tumors with an
acceptable toxicity profile. Necessity for a safe performance of these procedures
is a close collaboration between interventional radiologist and anesthetist.
Schlüsselwörter:
Lebertumoren - minimal invasiv - Tumorablation
Key words:
Liver tumors - minimally invasive - tumor ablation
Kernaussagen
-
Die Effektivität bildgeführter, interstitieller und endovaskulärer Eingriffe in der
Behandlung primärer und sekundärer Lebertumoren sind für sich und in Kombination mit
chirurgischen und systemischen Ansätzen durch eine Vielzahl klinischer Studien gesichert.
-
Lokale Ablationstechniken wie RFA und interstitielle Brachytherapie werden bei umschriebenem
Tumorwachstum eingesetzt.
-
Für eine vollständige Ablation mittels Radiofrequenz ist die gleichmäßige Erwärmung
im Zielgebiet Voraussetzung. Perfusionsbedingte Kühleffekte können insbesondere bei
größeren Tumoren die Ablation erschweren und Rezidive generieren.
-
Im Gegensatz zur RFA bestehen für die interstitielle Brachytherapie keine Einschränkungen
hinsichtlich maximaler Tumorgröße und Tumorlokalisation.
-
Endovaskuläre Therapien, wie TACE oder SIRT kommen bei multifokal lokalisierten hypervaskularisierten
Tumoren zum Einsatz.
-
Die TACE ist derzeit Therapiestandard beim inoperablen HCC sowie zur Palliation des
Karzinoidsyndroms bei neuroendokrinen Lebermetastasen. Die Effektivität der Methode
ist limitiert bei hypovaskularisierten Lebermetastasen.
-
Die SIRT hat das Potenzial zum neuen Therapiestandard bei inoperablen hyper– und hypoperfundierten
Lebertumoren. Da auch Anteile der nicht tumortragenden Leber eine partielle Strahlenexposition
erfahren, ist prätherapeutisch eine adäquate Leberfunktion zu beachten.
-
Die Aufgabe des Anästhesisten bei den interstitiellen und endovaskulären Verfahren
ist die Analgosedierung des Patienten und das Monitoring der Vitalparameter. Insbesondere
bei den interstitiellen Ablationen ist die Analgosedierung so zu steuern, dass der
Patient ansprechbar bleibt und Atemkommandos folgen kann.
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Christian Wybranski
Konrad Mohnike
Prof. Dr. med. Jens Ricke
eMail: christian.wybranski@med.ovgu.de
eMail: jens.ricke@med.ovgu.de
