Langzeitergebnisse der interventionellen Therapie von großen, inoperablen hepatozellulären Karzinomen (HCC): signifikanter Überlebensvorteil von transarterieller Chemoembolisation (TACE) und perkutaner Ethanolinjektion (PEI) gegenüber der TACE-Monotherapie

Zusammenfassung

Einleitung: Die Effektivität der Kombinationstherapie aus transarterieller Chemoembolisation und perkutaner Ethanolinjektion und der Chemoembolisation-Monotherapie wurde bei Patienten mit großen, nichtresektablen hepatozellulären Karzinomen retrospektiv analysiert. Material und Methode: 50 Patienten mit großen, nicht resezierbaren HCC wurden mit selektiver TACE behandelt. 42 dieser Patienten hatten eine Leberzirrhose aufgrund nutritiv toxischer (n = 22) oder viraler (n = 17) Genese. Bei drei Patienten blieb die Ursache der Leberzirrhose unklar. Im Child-Stadium A befanden sich 22 Patienten, 20 im Stadium Child B. 22 Patienten wurden mit mehrfachen Kombinationstherapien aus TACE und PEI behandelt, 28 erhielten die wiederholte TACE als Monotherapie. Überlebensraten und Behandlungskomplikationen wurden bestimmt und verglichen. Ergebnisse: Die 6-, 12-, 24- und 36-Monats-Überlebensraten (Kaplan und Meier) betrugen für die TACE-Monotherapie 61, 21, 4 und 4 %, für die Kombination aus TACE und PEI 77, 55, 39 und 22 %. Der Einfluss der Therapieform auf die Überlebensrate war im Log-Rank-Test (p = 0,002) signifikant. Ernsthafte Nebenwirkungen traten bei zwei Patienten in der Monotherapiegruppe und bei drei Patienten in der Kombinationstherapiegruppe auf. Schlussfolgerungen: Die Kombination aus TACE und PEI ist eine sichere und effektive, palliative Behandlungsmethode für große hepatozelluläre Karzinome, die das Patientenüberleben im Vergleich zur TACE-Monotherapie verlängern kann.

Abstract

Purpose: A retrospective analysis of long-term efficacy of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) and TACE monotherapy was conducted in patients with large, non-resectable hepatocellular carcinoma (HCC). Methods and Materials: Fifty patients with large, unresectable HCC lesions underwent selective TACE. Liver cirrhosis was present in 42 patients, due to alcohol abuse (n = 22) and viral infection (n = 17). In three patients, the underlying cause for liver cirrhosis remained unclear. Child A cirrhosis was found in 22 and Child B cirrhosis in 20 patients. Repeated and combined TACE and PEI were performed in 22 patients and repeated TACE monotherapy was performed in 28 patients. Survival and complication rates were determined and compared. Results: The 6-,12-, 24- and 36-month survival rates were 61 %, 21 %, 4 %, and 4 % for TACE monotherapy and 77 %, 55 %, 39 % and 22 % for combined TACE and PEI (Kaplan-Meier method). The kind of treatment significantly affected the survival rate (p = 0.002 log-rank test). Severe side effects were present in two patients of the monotherapy group and in three patients of the combination therapy group. Conclusion: The combination of TACE and PEI is an effective and safe method in the palliative treatment of large HCC that has the potential of improving long term survival compared to TACE monotherapy.

Key words

Hepatocellular carcinoma (HCC) - combined treatment - transcatheter arterial chemoinfusion - transcatheter arterial chemoembolization (TACE) - percutaneous ethanol injection (PEI)

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