Zusammenfassung
Analyse der repetitiven transarteriellen Chemoembolisation (TACE) von Lebermetastasen
als palliatives oder neoadjuvantes Therapieverfahren im Vergleich zu publizierten
Daten. Für die TACE von Lebermetastasen konnte derzeit noch kein standardisiertes
Therapiekonzept etabliert werden. Bei 351 Patienten mit irresektablen Lebermetastasen
verschiedener Primärtumoren wurden 1158 repetitive TACE-Sitzungen unter Verwendung
eines Gemisches aus Lipiodol, Mitomycin C und Spherex in einem Intervall von 4 Wochen
durchgeführt. Hierbei wurden 272 Patienten in palliativer und symptomatischer Intention
und 79 Patienten primär neoadjuvant behandelt mit nachgeschalteter MR-gesteuerten
Ablation (LITT) der Metastasen bei 71 Patienten. Die TACE kann in der Regel erfolgreich
durchgeführt werden bei minimaler lokaler Komplikationsrate wie einem asymptomatischen
hepatischen Gefäßverschluss oder Leberabszess. In 81 % der behandelten Läsionen gelingt
vergleichbar mit den publizierten Daten eine primäre hohe Embolisatbelegung der zu
therapierenden Metastasen. Im Rahmen der Palliation resultiert in 36 % der Läsionen
eine Größenreduktion der embolisierten Metastasen, in 24 % ein Wachstumsstillstand
und in 40 % eine Reduktion der Wachstumsgeschwindigkeit. Bei der neoadjuvanten TACE
gelang in 70 % eine Größenreduktion der Metastasen. In unserem Kollektiv errechnete
sich eine mittlere Überlebenszeit von 8,6 Monaten, in der Literatur schwanken die
mittleren Überlebenszeiten von 8,5 bis 23 Monaten bei Patienten mit Lebermetastasen.
Die TACE stellt ein minimal invasives Therapieverfahren für Lebermetastasen dar mit
einem neoadjuvanten Einsatz für lokal ablative Verfahren an der Leber und in palliativer
Intention.
Absgtract
We have analyzed the effectiveness of repetitive transarterial chemoembolization (TACE)
of liver metastases as a neoadjuvant or palliative treatment modality in comparison
with published data. Chemoembolization of liver metastases is performed with different
cytotoxic drugs. In a 4-week interval, 357 patients were treated with repetitive 1,158
TACE courses performed with lipiodol, mitomycin C and spherex. 254 patients were treated
palliatively, 18 patients symptomatically and 79 patients via the neoadjuvant protocol,
71 patients of whom received additional MR-guided laser-induced thermoablation (LITT)
of the metastases after TACE. Our results were compared with the literature. Most
of the patients with a low rate of local complications like vascular occlusion or
liver abscess could be treated successfully using TACE. In 81 % of the treated lesions
a primary high lipiodol retention was observed. In the palliative group a reduction
of the tumor size was noted in 36 % of the lesions, a growth stop in 24 % and a reduction
of the tumor growth rate in 40 %. In 70 % of the patients treated neodadjuvantly a
reduction of the tumor size was found. The median survival rate of our collective
of patients with liver metastases averages 8.6 months. In the literature median survival
rates in patients with liver metastases were between 8.5 and 23 months after TACE.
TACE is judged as a minimal invasive and outpatient treatment protocol for liver metastases.
A combination of TACE and different local treatment modalities presents a neoadjuvant
treatment strategy to control the diseased liver.
Schlüsselwörter
Lebermetastasen - transarterielle Chemoembolisation - TACE
Key words
Liver metastases - transarterial chemoembolization - TACE
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Prof. Dr. med. Thomas J. Vogl
Institut für Diagnostische und Interventionelle Radiologie
J. W. Goethe-Universität Frankfurt
Theodor-Stern-Kai 7
60590 Frankfurt
Phone: 069/6301-7277
Fax: 069/6301-7258
Email: T.Vogl@em.uni-frankfurt.de