Subscribe to RSS
DOI: 10.1055/a-2339-8448
Transarterielle Therapien bei HCC – ein Überblick anhand der aktuellen S3-Leitlinie
Transarterial therapies for HCC – an overview based on the current S3 guidelineIn den Leitlinien zum hepatozellulären Karzinom nehmen die transarteriellen Verfahren eine wichtige Rolle ein und sind im intermediären Stadium oft Mittel der Wahl. Die einzelnen Verfahren wie Radioembolisation und verschiedene Formen der Chemoembolisation werden in diesem Beitrag erläutert. Bei weltweit zunehmender Tumorlast ist trotz Fortschritten in der Systemtherapie von einer steigenden Bedeutung der Verfahren auszugehen.
Abstract
The current guidelines for diagnosis and therapy of hepatocellular carcinoma give an important role to transarterial therapies and are often the treatment of choice in the intermediate stage. Different modalities like radioembolization and different forms of chemoembolization with their specific indications and methods will be explained. With an increasing global tumor burden, it is likely that their importance increases in spite of advances in systemic therapy.
-
Beim intermediären HCC ist die transarterielle Therapie nach wie vor ein leitliniengerechter Standard.
-
Die Kenntnis der unterschiedlichen Therapieverfahren samt Vorteilen und Limitationen stärkt die Rolle des Radiologen in einem multidisziplinären Tumorboard.
-
Auch für sonst schwierig behandelbare Patienten bestehen z. B. mit biodegradierbaren Partikeln noch transarterielle Behandlungsoptionen.
-
Leitliniengerecht soll das Therapieansprechen nach transarterieller Behandlung nach mRECIST beurteilt werden.
-
Die technisch sorgfältige Ausführung und das klinische Verständnis sichern den Behandlungserfolg.
Schlüsselwörter
HCC - hepatozelluläres Karzinom - Chemoembolisation - Radioembolisation - SIRT - TARE - TACEKeywords
HCC - hepatocellular carcinoma - chemoembolization - radioembolization - SIRT - TARE - TACEPublication History
Article published online:
06 December 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
Literatur
- 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021; 71: 209-249
- 2 Bitzer M, Groß S, Albert J. et al. S3-Leitlinie „Diagnostik und Therapie des Hepatozellulären Karzinoms“ – Langversion 4.0. Z Gastroenterol 2024; 62: e67-e161
- 3 Llovet JM, Brú C, Bruix J. Prognosis of Hepatocellular Carcinoma: The BCLC Staging Classification. Semin Liver Dis 1999; 19: 329-338
- 4 Trevisani F, Vitale A, Kudo M. et al. Merits and boundaries of the BCLC staging and treatment algorithm: Learning from the past to improve the future with a novel proposal. J Hepatol 2024; 80: 661-669
- 5 Reig M, Forner A, Rimola J. et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2022; 76: 681-693
- 6 Yamada R, Sato M, Kawabata M. et al. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983; 148: 397-401
- 7 Lammer J, Malagari K, Vogl T. et al. Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 2010; 33: 41-52
- 8 Golfieri R, Giampalma E, Renzulli M. et al. Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 2014; 111: 255-264
- 9 Choi TW, Chung JW, Kim H-C. et al. Anatomic Variations of the Hepatic Artery in 5625 Patients. Radiol Cardiothorac Imaging 2021; 3: e210007
- 10 Llovet JM, Real MI, Montaña X. et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 2002; 359: 1734-1739
- 11 Minici R, Ammendola M, Manti F. et al. Safety and Efficacy of Degradable Starch Microspheres Transcatheter Arterial Chemoembolization (DSM-TACE) in the Downstaging of Intermediate-Stage Hepatocellular Carcinoma (HCC) in Patients With a Child-Pugh Score of 8–9. Front Pharmacol 2021; 12: 634087
- 12 Salem R, Johnson GE, Kim E. et al. Yttrium-90 Radioembolization for the Treatment of Solitary, Unresectable HCC: The LEGACY Study. Hepatology 2021; 74: 2342-2352
- 13 Villalobos A, Pisanie JLd, Gandhi RT. et al. Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips. Semin Intervent Radiol 2024; 41: 63-78
- 14 Oken MM, Creech RH, Tormey DC. et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-655
- 15 Lee MJ, Fanelli F, Haage P. et al. Patient safety in interventional radiology: a CIRSE IR checklist. Cardiovasc Intervent Radiol 2012; 35: 244-246
- 16 Gonella S, Clari M, Conti A. et al. Interventions to reduce arterial puncture-related pain: A systematic review and meta-analysis. Int J Nurs Stud 2022; 126: 104131
- 17 de Baere T, Ronot M, Chung JW. et al. Initiative on Superselective Conventional Transarterial Chemoembolization Results (INSPIRE). Cardiovasc Intervent Radiol 2022; 45: 1430-1440
- 18 Brunskill N, Robinson J, Nocum D. et al. Exploring software navigation tools for liver tumour angiography: a scoping review. J Med Radiat Sci 2024; 71: 261-268
- 19 Miszczuk MA, Chapiro J, Geschwind J-FH. et al. Lipiodol as an Imaging Biomarker of Tumor Response After Conventional Transarterial Chemoembolization: Prospective Clinical Validation in Patients with Primary and Secondary Liver Cancer. Transl Oncol 2020; 13: 100742
- 20 Wu CH, Liang PC, Su TH. et al. Iodized oil computed tomography versus ultrasound-guided radiofrequency ablation for early hepatocellular carcinoma. Hepatol Int 2021; 15: 1247-1257
- 21 Vincenzi B, Di Maio M, Silletta M. et al. Prognostic Relevance of Objective Response According to EASL Criteria and mRECIST Criteria in Hepatocellular Carcinoma Patients Treated with Loco-Regional Therapies: A Literature-Based Meta-Analysis. PLoS One 2015; 10: e0133488
- 22 Bai J, Huang M, Zhou J. et al. Development of a predictive nomogram for postembolization syndrome after transcatheter arterial chemoembolization of hepatocellular carcinoma. Sci Rep 2024; 14: 3303
- 23 Kim J, Jung Y. Radiation-induced liver disease: current understanding and future perspectives. Exp Mol Med 2017; 49: e359