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Der Nuklearmediziner 2011; 34(03): 145-148
DOI: 10.1055/s-0031-1283166
Selektive Interne Radiotherapie – SIRT
Georg Thieme Verlag KG Stuttgart · New York

Aktuelle onkologische Ansätze bei der Therapie von Lebermetastasen

Modern Oncologic Strategies in the Treatment of Liver Metastasis
H. Wilke
,
S. Pluntke
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Publication History

Publication Date:
26 September 2011 (online)

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Zusammenfassung

Durch Verbesserung und Erweiterung therapeutischer Möglichkeiten bei Lebermetastasen solider Tumoren, hat sich die Prognose vieler Patienten verbessert. Dies gilt sowohl für palliative als auch kurative Behandlungsintentionen. Da in diesen Situationen verschiedene Fachdisziplinen eng zusammenarbeiten müssen, um die unterschiedlichen Therapieoptionen möglichst rational einzusetzen, gewinnt die Interdisziplinarität auch bei Patienten mit Lebermetastasen eine immer größere Bedeutung. Von speziellem Interesse ist, dass durch die Kombination von Chemotherapie oder interventioneller Therapie bei einigen Patienten primär nicht resektable Metastasen größenreduziert, dann komplett entfernt oder zerstört werden können und bei einem Teil dieser Patienten auch eine langfristige Tumorfreiheit erreicht werden kann. Die Rolle der Chirurgie und der Chemotherapie ist hierbei relativ klar definiert. Der therapeutische Stellenwert vieler moderner interventioneller Verfahren wie TACE oder SIRT ist zukünftig durch gut geplante klinische Prüfungen (randomisierte Studien) besser zu definieren.

Abstract

The prognosis of patients with liver metastases of solid tumors has improved over the past decade. This is due to improved surgical techniques, better drug therapy and modern interventional treatment procedures, which nowadays are used with palliative and curative intent as well. Therefore a close cooperation of the various medical disciplines, involved in the treatment of liver metastases is a must. Of special interest is the increasing experience, that initially unresectable liver metastases can be downsized by “neoadjuvant” approaches such as chemotherapy or interventional therapies, thereby offering the possibility for a secondary complete resection or destruction with the chance of long-term survival. To date the role of surgery of chemotherapy is relatively well defined in the management of metastatic liver disease. This is much less clear for many of the modern interventional approaches (TACE, SIRT) being increasingly used. Here we clearly need well designed prospective and especially randomized trials to define better their future role in the treatment algorithm of liver metastases.

Schlüsselwörter

Lebermetastasen - perioperative Therapie - Multidisziplinarität

Key words

liver metastases - perioperative therapy - multidisciplinarity
 

  • Literatur

  • 1 Abdalla EK, Vauthey JN, Ellis LM et al. Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 2004; 239: 818-825; discussion 825-827
    CrossrefPubMedGoogle Scholar
  • 2 Adam R, Huguet E, Azoulay D et al. Hepatic resection after down-staging of unresectable hepatic colorectal metastases. Surg Oncol Clin N Am 2003; 12: 211-220
    CrossrefPubMedGoogle Scholar
  • 3 Arnold D, Stöltzing O, Timm S et al. Resectable colorectal liver metastases: pro neoadjuvant therapy – contra neoadjuvant therapy. Z Gastroenterol 2010; 48: 1375-1383
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Auernhammer CJ, Jauch KW, Hoffmann JN. Liver metastases from neuroendocrine tumours of the gastroenteropancreatic system – therapeutic strategies. Zentralbl Chir 2009; 134: 410-417. Epub 2009 Sep 15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Bower M, Metzger T, Robbins K et al. Surgical downstaging and neo-adjuvant therapy in metastatic colorectal carcinoma with irinotecan drug-eluting beads: a multi-institutional study. HPB (Oxford) 2010; 12: 31-36
    PubMedGoogle Scholar
  • 6 Brown RE, Bower MR, Martin RC. Hepatic resection for colorectal liver metastases. Surg Clin North Am 2010; 90: 839-852
    CrossrefPubMedGoogle Scholar
  • 7 Chang DT, Swaminath A, Kozak M et al. Stereotactic body radiotherapy for colorectal liver metastases: A pooled analysis. Cancer. 2011; Mar 22. DOI: 10.1002/cncr.25997.
    PubMedGoogle Scholar
  • 8 Coldwell D, Sangro B, Salem R et al. Radioembolization in the Treatment of Unresectable Liver Tumors: Experience Across a Range of Primary Cancers. Am J Clin Oncol 2010; Nov 30. (Epub ahead of print)
    PubMedGoogle Scholar
  • 9 de Baere T, Deschamps F. Arterial therapies of colorectal cancer metastases to the liver. Abdom Imaging 2011; Jun: 17. (Epub ahead of print)
    PubMedGoogle Scholar
  • 10 Eadens MJ, Grothey A. Curable metastatic colorectal cancer. Curr Oncol Rep 2011; 13: 168-176
    CrossrefPubMedGoogle Scholar
  • 11 Folprecht G, Grothey A, Alberts S et al. Neoadjuvant treatment of unresectable colorectal liver metastases: correlation between tumour response and resection rates. Ann Oncol 2005; 16: 1311-1319
    CrossrefPubMedGoogle Scholar
  • 12 Folprecht G, Gruenberger T, Bechstein WO et al. Tumour response and secondary resectability of colorectal liver metastases following neoadjuvant chemotherapy with cetuximab: the CELIM randomised phase 2 trial. Lancet Oncol 2010; 11: 38-47
    CrossrefPubMedGoogle Scholar
  • 13 Halfdanarson TR, Kendrick ML, Grothey A. The role of chemotherapy in managing patients with resectable liver metastases. Cancer J 2010; 16: 125-131
    CrossrefPubMedGoogle Scholar
  • 14 Hompes D, Prevoo W, Ruers T. Radiofrequency ablation as a treatment tool for liver metastases of colorectal origin. Cancer Imaging 2011; 11: 23-30
    PubMedGoogle Scholar
  • 15 Kalinowski M, Dressler M, König A et al. Selective internal radiotherapy with Yttrium-90 microspheres for hepatic metastatic neuroendocrine tumors: a prospective single center study. Digestion 2009; 79: 137-142
    CrossrefPubMedGoogle Scholar
  • 16 Kennedy A, Coldwell D, Sangro B et al. Integrating Radioembolization into the Treatment Paradigm for Metastatic Neuroendocrine Tumors in the Liver. Am J Clin Oncol 2011; 26
    PubMedGoogle Scholar
  • 17 Lee WS, Yun SH, Chun HK et al. Pulmonary resection for metastases from colorectal cancer: prognostic factors and survival. Int J Colorectal Dis 2007; 22: 699-704
    CrossrefPubMedGoogle Scholar
  • 18 Makowiec F, Möhrle S, Neeff H et al. Chemotherapy, liver injury, and postoperative complications in colorectal liver metastases. Gastrointest Surg 2011; 15: 153-164
    CrossrefPubMedGoogle Scholar
  • 19 Martin RC, Joshi J, Robbins K et al. Hepatic intra-arterial injection of drug-eluting bead, irinotecan (DEBIRI) in unresectable colorectal liver metastases refractory to systemic chemotherapy: results of multi-institutional study. Ann Surg Oncol 2011; 18: 192-198
    CrossrefPubMedGoogle Scholar
  • 20 Masi G, Cupini S, Marcucci L et al. Treatment with 5-fluorouracil/folinic acid, oxaliplatin, and irinotecan enables surgical resection of metastases in patients with initially unresectable metastatic colorectal cancer. Ann Surg Oncol 2006; 13: 58-65
    CrossrefPubMedGoogle Scholar
  • 21 Mulier S, Ruers T, Jamart J et al. Radiofrequency ablation versus resection for resectable colorectal liver metastases: time for a randomized trial? An update. Dig Surg 2008; 25: 445-460
    CrossrefPubMedGoogle Scholar
  • 22 Nazario J, Gupta S. Transarterial liver-directed therapies of neuroendocrine hepatic metastases. Semin Oncol 2010; 37: 118-126
    CrossrefPubMedGoogle Scholar
  • 23 Nordlinger B, Vauthey JN, Poston G et al. The timing of chemotherapy and surgery for the treatment of colorectal liver metastases. Clin Colorectal Cancer 2010; 9: 212-218
    CrossrefPubMedGoogle Scholar
  • 27 Sato T. Locoregional management of hepatic metastasis from primary uveal melanoma. Semin Oncol 2010; 37: 127-138
    CrossrefPubMedGoogle Scholar
  • 28 Schuster R, Lindner M, Wacker F et al. Transarterial chemoembolization of liver metastases from uveal melanoma after failure of systemic therapy: toxicity and outcome. Melanoma Res 2010; 20: 191-196
    PubMedGoogle Scholar
  • 24 Tang JT, Wang JL, Fang JY. Meta-analysis: perioperative regional liver chemotherapy for improving survival and preventing liver metastases in patients with colorectal carcinoma. J Dig Dis 2010; 11: 208-214
    PubMedGoogle Scholar
  • 25 Townsend A, Price T, Karapetis C. Selective internal radiation therapy for liver metastases from colorectal cancer. Cochrane Database Syst Rev 2009; 7 CD007045
    PubMedGoogle Scholar
  • 26 Tsoulfas G, Pramateftakis MG, Kanellos I. Surgical treatment of hepatic metastases from colorectal cancer. World J Gastrointest Oncol 2011; 15: 1-9
    PubMedGoogle Scholar
  • 29 Xu KC, Niu LZ, He WB et al. Percutaneous cryosurgery for the treatment of hepatic colorectal metastases. World J Gastroenterol 2008; 14: 1430-1436
    CrossrefPubMedGoogle Scholar