Aktuelle onkologische Ansätze bei der Therapie von Lebermetastasen

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

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