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Interventionelle Therapie von Lungen- und Lebermetastasen

Interventional therapy of lung and liver metastases

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Ziel der Arbeit

Der vorliegende Beitrag befasst sich mit interventionellen onkologischen Konzepten zur Therapie von Lungen- und Lebermetastasen.

Material und Methoden

Die verschiedenen Behandlungstechniken in der interventionellen Onkologie werden vorgestellt. Sie beinhalten den Einsatz von Ablationstechniken wie Radiofrequenz- (RFA), Mikrowellen- (MWA) und Laserablation (LITT), irreversible Elektroporation (IRE) sowie Kryotherapie. Weiterhin werden vaskuläre Therapieverfahren wie die transarterielle Chemoembolisation (TACE), die transarterielle Chemoperfusion (TACP), die Drug-Eluting Bead-TACE (DEB-TACE), die selektive interne Radiotherapie (SIRT), die transpulmonale Chemoembolisation (TPCE) und die Chemosaturation besprochen.

Ergebnisse

Die interventionellen Verfahren wie RFA, MWA und LITT bieten sich bei nichtresektablen Patienten mit Lebermetastasen des kolorektalen Karzinoms als effektive Alternativen an. Dies gilt für eine Anzahl von bis zu 5 Metastasen mit jeweils einem Größendurchmesser ≤ 3 cm. Die weiteren vaskulären Therapieverfahren bei Lebermetastasen werden in einen multimodalen Ansatz integriert. Dies betrifft insbesondere die Möglichkeiten der SIRT und TACE als palliatives Therapiekonzept bei chemotherapieresistenter intrahepatischer Metastasierung. Für Lungenmetastasen gelten derzeit Indikationskriterien für die thermische Ablation von 3 Metastasen pro Seite bis zu einer Größe von 3 cm im Durchmesser. Auch hier liegt onkologisch in der Regel eine nichtresektable Situation bei chemotherapeutisch ausbehandelte Patienten vor.

Diskussion

Derzeit muss der multimodale Ansatz bei Leber- und Lungenmetastasen des kolorektalen Karzinoms auch im Hinblick auf Verfahren der interventionellen Onkologie diskutiert werden. Diese sind entweder streng lokalisiert auf den Tumor ausgerichtete Verfahren, wie die thermischen Ablationsverfahren, oder vaskulär ausgerichtete Optionen, die größere Tumorbezirke oder -volumen zu behandeln erlauben.

Abstract

Objectives

To present interventional oncological therapy concepts for lung and liver metastases.

Material and methods

The different treatment techniques in interventional oncology are presented and include thermal ablation techniques, such as radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LITT), irreversible electroporation (IRE) and cryotherapy. Furthermore, vascular therapy methods are presented, such as transarterial chemoembolization (TACE), transarterial chemoperfusion (TACP), drug-eluting bead TACE (DEB-TACE), selective internal radiotherapy (SIRT), transpulmonary chemoembolization (TPCE) and chemosaturation.

Results

The interventional treatment techniques, such as RFA, MWA und LITT offer patients, especially those with nonresectable liver metastases from colorectal carcinoma, an effective therapy option if there are no more than 5 metastases ≤ 3 cm in size. Further vascular treatment techniques for liver metastases are integrated in a multimodal approach. This is especially true for SIRT and TACE as a palliative therapy concept in chemotherapy-resistant intrahepatic metastases. For lung metastases the indications for thermal ablation are 3 lung metastases up to 3 cm in diameter per lobe. Here as well the patient is normally in a nonresectable situation and there is no response to systemic chemotherapy.

Discussion

Currently the multimodal approach in liver and lung metastases from colorectal carcinoma needs to be discussed also regarding interventional treatment options. These are either treatment techniques which are strictly localized to the tumor, such as thermal ablation or they are vascular treatment techniques which allow treatment of larger tumor areas or larger tumor volumes.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Th. J. Vogl, B. Panahi, S. Fischer, N. Naguib, N.-E. A Nour-Eldin, T. Gruber, J. Trojan, W. Bechstein, S. Zangos und K. Eichler geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Diagnostische und interventionelle Radiologie, Johann Wolfgang Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    T.J. Vogl, B. Panahi, S. Fischer, N. Naguib, N.-E.A. Nour-Eldin, T. Gruber, S. Zangos & K. Eichler

  2. Medizinische Klinik I, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland

    J. Trojan

  3. Klinik für Allgemein- und Viszeralchirurgie, Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland

    W. Bechstein

Authors
  1. T.J. Vogl
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  2. B. Panahi
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  3. S. Fischer
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  4. N. Naguib
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  5. N.-E.A. Nour-Eldin
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  6. T. Gruber
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  7. J. Trojan
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  8. W. Bechstein
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  9. S. Zangos
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  10. K. Eichler
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Corresponding author

Correspondence to T.J. Vogl.

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Vogl, T., Panahi, B., Fischer, S. et al. Interventionelle Therapie von Lungen- und Lebermetastasen. Onkologe 20, 746–756 (2014). https://doi.org/10.1007/s00761-014-2669-3

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  • DOI: https://doi.org/10.1007/s00761-014-2669-3

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