Zusammenfassung
Hintergrund
Cholangiozelluläre Karzinome (CCC) sind in der überwiegenden Mehrzahl bei Diagnosestellung nicht kurativ resezierbar.
Fragestellung
Der aktuelle Kenntnisstands zur endoskopisch-interventionellen Palliativtherapie bei extrahepatischen CCC sowie zur selektiven internen Radiotherapie bei intrahepatischen bzw. hepatisch metastasierten CCC wird zusammengefasst. Zudem werden die Standards der systemischen Chemotherapie und dargestellt und ein Ausblick auf die aktuelle klinische Forschung gegeben.
Material und Methode
Es wird eine Übersicht der wichtigsten publizierten Ergebnisse gegeben und die Diskussion differenzialtherapeutischer Überlegungen dargestellt.
Ergebnisse
Grundlage der Palliativtherapie extrahepatischer CCC ist die adäquate biliäre Dekompression per endoskopischer retrograder Cholangiopankreatikographie (ERCP) oder perkutaner transhepatischer Cholangiographie (PTC) und Stenteinlage zur Verhinderung von Leberversagen und Infektkomplikationen. Bei selektionierten Patienten (ohne wesentliche extrahepatische Tumormanifestation) kann per biliärer photodynamischer Therapie bzw. biliärer Radiofrequenztherapie eine wesentliche Verlängerung des Überlebens erzielt werden. Für ausgesuchte Patienten mit intrahepatischen CCC steht u. a. die selektive interne Radiotherapie zur Verfügung. Sie kann bei guter Verträglichkeit das progressionsfreie und das Gesamtüberleben verlängern und erreicht in Einzelfällen ein Downstaging zur sekundären Resektabilität. Die systemische Chemotherapie des nichtresektablen CCC basiert auf Gemcitabin und Cisplatin bzw. Oxaliplatin, zielgerichtete Therapien befinden sich derzeit in der klinischen Prüfung.
Schlussfolgerung
Die Palliativtherapie von CCC gliedert sich in die biliäre Drainage mit/ohne lokoregionäre Tumorreduktion und systemische Chemotherapie. Insbesondere multimodale Kombinationstherapien sind vielversprechend, aber noch unzureichend untersucht.
Abstract
Background
At diagnosis, the majority of patients with cholangiocarcinoma (CCC) cannot be offered curative resection.
Objectives
The current state of knowledge concerning palliative treatment options (endoscopic interventions, selective internal radiotherapy, systemic chemotherapy) for CCC are summarized.
Materials and methods
A summary of key publications is presented and differential treatment considerations are discussed.
Results
The basis of palliative treatment is biliary decompression to avoid liver failure and infectious complications. In selected patients—without extrahepatic tumor spread—photodynamic therapy (PDT) and biliary radiofrequency ablation (RFA) offer prolonged overall survival. In patients with intrahepatic CCC or with hepatic metastases, selective internal radiotherapy is well tolerated and can offer marked survival benefit. Infrequently, downstaging to resectable disease stages can be achieved. Standard systemic palliative therapy of CCC combines gemcitabine with cisplatin or oxaliplatin. A number of targeted therapy approaches are under investigation.
Conclusion
Palliative therapy of CCC consists of biliary drainage with/without locoregional therapy and systemic chemotherapy. Multimodal approaches are promising, but to date are still insufficiently evaluated.
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S. Kasper gibt an, dass kein Interessenkonflikt besteht. A. Dechêne weist auf folgende Beziehungen hin: Er erhielt Vortragshonorare der BTG und übte eine Beratungstätigkeit für BTG aus.
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M. Müller-Schilling, Regensburg
G. Gerken, Essen
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Dechêne, A., Kasper, S. Cholangiozelluläres Karzinom . Gastroenterologe 11, 400–409 (2016). https://doi.org/10.1007/s11377-016-0096-2
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DOI: https://doi.org/10.1007/s11377-016-0096-2