Multisequentielle arterielle Chemoembolisation fortgeschrittener hepatozellulärer Karzinome: Computertomographische Verlaufsparameter zur Beurteilung des Ansprechens auf die Therapie

Zusammenfassung.

Evaluierung computertomographischer und klinischer Parameter zur Verlaufskontrolle der interventionellen Therapie des hepatozellulären Karzinoms (HCC) mittels transarterieller Chemoembolisation (TACE). Material und Methodik: Retro- und prospektive Verlaufsbeurteilung von 123 TACE Therapiezyklen bei 37 Patienten mit HCC mit einem Altersmittelwert von 63,3 Jahren. Ergebnisse: Die Überlebenszeit im Gesamtkollektiv betrug 785 Tage (± 88,7) im Mittel und 387 Tage median. Die 1-Jahresüberlebenswahrscheinlichkeit lag bei 62 %. Für die quantitative Evaluierung der Tumorvolumina im Verlauf errechnete sich eine statistisch signifikante Differenz der Überlebensraten von im Mittel 678 Tagen für eine Verringerung des Tumorvolumens um 0 - 50 % (Kat. 1) (n = 18), von 976 Tagen für eine Verringerung des Tumorvolumens um 51 - 100 % (Kat. 2) (n = 12) sowie von 277 Tagen für eine Zunahme des Tumorvolumens (Kat. 3) im Verlauf. Ein signifikant besseres Überleben ließ sich ermitteln für Tumoren mit geringer Lipiodolentspeicherung (0 - 50 % Entspeicherung), als prognostisch vorteilhaft erwies sich ein homogener intratumoraler Lipiodoleinlagerungstyp. Schlußfolgerung: Bei bildmorphologischen Kriterien eines primären Therapieansprechens nach TACE kann die Prognose durch Reembolisationen verbessert werden.

Purpose: An evaluation of clinical and computed tomography parameters for the transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). Material and Methods: Retro- and prospective analysis of 123 TACE procedures in 37 patients (mean age: 63.3 years). Results: Overall mean survival rate for all treated patients was 785 days with a mean value of 387 days. The 1 year survival rate was 62 %. Quantitative tumor volumetry revealed a significant difference in survival rate with a mean value of 678 days for patients with a reduction of tumor volume between 0 and 50 %, 976 days for a volume reduction of 51 - 100 % and 277 days for an increase in tumor volume during therapy. Patients with a high lipiodol retention presented improved survival data (902 days) versus patients with a low lipiodol retention (513 days). Homogeneous retention of lipiodol was a positive factor on survival as compared to an inhomogenous form of retention. Conclusion: In patients with a positive therapy response after TACE the prognosis can be improved by repeated embolization.

Schlüsselwörter:

Transarterielle Chemoembolisation (TACE) - Chemoembolisation - Computertomographie - HCC - Volumetrie

Key words:

Transarterial chemoembolization (TACE) - Hepatocellular carcinoma - Computed tomography (CT)

Literatur

• 1 Bruix J, Castells A, Motanya X, Calvet X, Bru C, Ayuso C, Jover L, Garcia R, Vilana R, Broix L. Phase II study of transarterial embolization in European patients with hepatocellular carcinoma: need for controlled trials.  Hepatology. 1994;  20 643-650
• 2 Choi I, Kim H C, Han J K, Park J H, Kim Y I, Kim Y I, Kim S T, Lee H S, Kim C Y, Han M C. Therapeutic effect of transcatheter oily chemoembolization therapy for encapsulated nodular hepatocellular carcinoma: CT and pathologic findings.  Radiology. 1992;  182 709-713
• 3 Huppert P E, Geißler F, Duda S H, Lauchart W, Dette S, Dietz K, Brambs H J, Claussen C D. Chemoembolisation des hepatozellulären Karzinoms: Computertomographische Befunde und klinische Resultate bei prospektiv repetitiver Therapie.  Fortschr Röntgenstr. 1994;  160 425-432
• 4 Ikeda K, Kumada H, Saitoh S, Arase Y, Chayama K. Effect of repeated transcatheter arterial embolization on the survival time in patients with hepatocellular carcinoma. An analysis by the Cox proportional hazard model.  Cancer. 1991;  68 2150-2154
• 5 Nakamura H, Tanaka T, Hori S, Yoshioka H, Kuroda C, Okamura J, Sakurai M. Transcatheter embolisation of hepatocellular carcinoma: Assessment of efficacy in cases of resection following embolisation.  Radiology. 1983;  147 401-405
• 6 Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakahima Y, Ohnishi K. Natural history of hepatocellular carcinoma and prognosis in relation to treatment, study of 850 patients.  Cancer. 1985;  56 918-928
• 7 Colella G, Bottelli R, De Carlis L, Sansalone C V, Rondinara G F, Alberti A, Belli L S, Gelosa F, Iamoni G M, Rampoldi A, De Gasperi A, Corti A, Mazza E, Aseni P, Meroni A, Slim A O, Finzi M, Di Benedetto F, Manochehri F, Follini M L, Ideo G, Forti D. Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization.  Radiol Med. 1998;  95 362-368
• 8 Lencioni R, Paolicchi A, Moretti M, Pinto F, Armillotta N, Di Giulio M, Cicorelli A, Donati F, Cioni D, Bartolozzi C. Combined transcatheter arterial chemoembolization and percutaneous ethanol injection for the treatment of large hepatocellular carcinoma: local therapeutic effect and long-term survival rate.  Eur Radiol. 1998;  8 439-444
• 9 Vogl T J, Muller P K, Mack M G, Straub R, Engelmann K, Neuhaus P. Liver metastases: interventional therapeutic techniques and results, state of the art.  Eur Radiol. 1999;  9 675-684
• 10 Palma L D. Diagnostic imaging and interventional therapy of hepatocellular carcinoma.  Br J Radiol. 1998;  71 808-818
• 11 Shah S R, Riordan S M, Karani J, Williams R. Tumour ablation and hepatic decompensation rates in multi-agent chemoembolization of hepatocellular carcinoma.  QJM. 1998;  91 821-828
• 12 Gattoni F, Cornalba G, Brambilla G, Dova S, Pompili G, Rampoldi A, Damiani G, Carnevali G, Uslenghi C M. Survival of 184 patients with hepatocellular carcinoma in cirrhotic liver treated with chemoembolization. A multicenter study.  Radiol Med. 1998;  95 362-368
• 13 Yamada T, Makita F, Takehara K, Saitou S, Satou S, Endou K, Shimoda R, Matsuzaki Y, Yuasa K, Takagi H, Yamada S, Mori M. Evaluation of the therapeutic effect of TAE on primary liver cancer.  Cancer Chemother Pharmacol. 1996;  33 (Suppl) 59
• 14 Di Carlo V, Ferrari G, Castoldi R, De Nardi P, Bergamo C, Taccagni G, Salvioni M, Angeli E, Venturini M, Del Maschio A. Pre-operative chemoembolization of hepatocellular carcinoma in cirrhotic patients.  Hepatogastroenterology. 1998;  45 1950-1954
• 15 Fan J, Tang Z Y, Yu Y Q, Wu Z Q, Ma Z C, Zhou X D, Zhou J, Qui S J, Lu J Z. Improved survival with resection alter transcatheter arterial chemoembolization (TACE) for unresectable hepatocellular carcinoma.  Dig Surg. 1998;  15 674-678
• 16 Sanz-Altamira P M, Spence L D, Huberman M S, Posner M R, Steele G Jr, Perry L J, Stuart K E. Selective chemoembolization in the management of hepatic metastasis in refractory colorectal carcinoma: a phase II trial.  Dis Colon Rectum. 1997;  40 770-775
• 17 Okuda K, Peters R L, Simson I W. Gross Anatomic Features of Hepatocellular Carcinoma from three disparate Geographic Areas.  Cancer. 1984;  54 2165-2173
• 18 Kanematsu T, Matsumata T, Shirabe K, Sugimachi K, Sakamoto S, Nawata H, Hasuo K, Honda H, Masuada K. A comparative study of hepatic resection and transcatheter arterial embolisation for the treatment of primary hepatocellular carcinoma.  Cancer. 1993;  68 2150-2154
• 19 Nishimine K, Uchida H, Matsuo N, Sakaguchi H, Nishimura Y, Guo Q, Ohishi H, Nagano N, Yoshioka T, Ohue S, Fukui H, Tsujii T. Segmental transarterial chemoembolization with Lipiodol mixed with anticancer drugs for nonresectable hepatocellular carcinoma: follow-up CT and therapeutic results.  Cancer Chemother Pharmacol. 1994;  33 (Suppl) 68
• 20 Matsui O, Kadoya M, Yoshikawa J, Gabata T, Arai K, Demachi H, Miyayama S, Takashima T, Unoura M, Kogayashi K. Small Hepatocellular Carcinoma: Treatment with Subsegmental Transcatheter Arterial Embolization.  Radiology. 1993;  188 79-83
• 21 Lopez R R Jr, Pan S H, Lois J F, McMonigle M E, Hoffman A L, Sher L S, Lugo D, Makowka L. Transarterial chemoembolization is a safe treatment for unresectable hepatic malignancies.  Am Surg. 1997;  63 923-926
• 22 Yamashita Y, Takahashi M, Koga Y, Saito R, Nanakawa S, Hatanaka Y, Sato N, Nakashima K, Urata J, Yoshizumi K, Ito K, Sumi S, Kann M. Prognostic Factors in the Treatment of Hepatocellular Carcinoma With Transcatheter Arterial Embolization and Arterial Infusion.  Cancer. 1991;  67 385-391
• 23 Ryder S D, Rizzi P M, Metivier E, Karani J, Wiliams R. Chemoembolisation with lipiodol and doxorubicin: applicability in British patients with hepatocellular carcinoma.  Gut. 1996;  38 125-128
• 24 Buscarini L, Fomari F, Canaletti R, Sbolli G, Cavanna L, Di Stasi M. Diagnostic Aspect and Follow-Up of 174 Cases of Hepatocellular Carcinoma.  Oncology. 1991;  48 26-30
• 25 Taniquchi K, Nakato K, Kato Y, Sato Y, Hamasaki K, Tsuruta S, Nakataki S. Treatment of hepatocellular carcinoma with transcatheter arterial embolisation. Analysis of prognostic factors.  Cancer. 1994;  73 1341-1345
• 26 Yamamoto K, Masuzawa M, Kato M, Okuyama T, Tamura K. Analysis of prognostic factors in patients with hepatocellular carcinoma treated by transcatheter arterial embolisation.  Cancer Chemother Pharmacol. 1992;  31 (Suppl) 81
• 27 Lee H S, Kim J S, Choi I J, Chung J W, Park J H, Kim C Y. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal vein obstruction. A prospective controlled study.  Cancer. 1997;  79 2087-2094
• 28 Kenji J, Hyodo I, Tnaimizo M, Nishikawa Y, Hosokawa Y, Mandai K, Moriwaki S. Total necrosis of hepatocellular carcinoma with a combination therapy of arterial Infusion of chemotherapeutic lipiodol and transcatheter arterial embolization: report of 14 cases.  Semin Oncol. 1997;  24 (2 Suppl 6) 680
• 29 Vogl T J, Trapp M, Pegios W, Mack M, Bechsteon W O, Keck W, Scholz A, Schröder H, Neuhaus P, Felix R. Volumetrische und morphologische CT-Parameter zur Prognoseabschätzung und Therapiekontrolle des hepatozellularen Karzinoms unter arterieller Chemoembolisation.  Fortschr. Röntgenstr. 1997;  167 219-226