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.

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

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

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