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Gastroenterologie up2date 2016; 12(03): 249-261
DOI: 10.1055/s-0042-114591
Darm/Anorektum
© Georg Thieme Verlag KG Stuttgart · New York

Interventionelle Verfahren bei metastasiertem kolorektalem Karzinom

Jazan Omari
,
Max Seidensticker
,
Jens Ricke
Further Information

Publication History

Publication Date:
19 September 2016 (online)

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Kernaussagen

Stellenwert

  • Lokale und lokoregionäre Verfahren zur additiven Therapie des metastasierten kolorektalen Karzinoms konnten sich in den letzten Dekaden zunehmend durch überzeugende Daten etablieren und finden vermehrt Akzeptanz in den einschlägigen Guidelines, so auch in den kürzlich neu aufgelegten ESMO-Guidelines. Dies gilt insbesondere für die oligometastasierte Situation.

  • Die Wahl des ablativen Verfahrens obliegt laut ESMO-Guidelines dem multidiziplinären Team vor Ort.

Verfahren

  • Als Verfahren mit einer Chance auf eine R0-Ablation gelten neben der Resektion insbesondere die thermobasierten Verfahren. Gerade bei Tumoren unter 3 cm scheint hier kein Nachteil gegenüber der Resektion zu bestehen.

  • Das lokal-ablative Therapiespektrum wird durch die CT-gesteuerte Hochdosis-Brachytherapie und die stereotaktische Bestrahlung komplettiert, wobei diese Verfahren insbesondere bei ungünstigen Bedingungen für thermobasierte Verfahren (nicht resektable Tumoren > 3 cm und Nähe zu hitzesensiblen Strukturen) zu erwägen sind.

  • Als additiv lokoregionäres Therapieverfahren weist die 90Y-Radioembolisation die solideste Datenlage auf mit resultierender Empfehlung in den ESMO-Guidelines in der Salvage-Situation. Bezüglich der Anwendungsempfehlung der 90Y-Radioembolisation in früheren Stadien (primär First-Line-Therapie) sind Überlebensdaten großer prospektiv randomisierter Studien abzuwarten.

 

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