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Die konservative Therapie des hepatozellulären Karzinoms (HCC)

The conservative treatment of hepatocellular carcinoma (HCC)

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Zusammenfassung

Grundlagen

Die derzeit für das hepatozelluläre Karzinom (HCC) bekannten Therapieoptionen können in Abhängigkeit von Patienten- und Tumorparametern individuell auf jeden Patienten abgestimmt werden.

Methodik

Anhand einer Übersichtsarbeit sollen die Faktoren, die die Therapieauswahl bestimmen, sowie verschiedene Therapiemethoden analysiert und diskutiert werden.

Ergebnisse

Solange das HCC auf die Leber beschränkt ist, besteht die Indikation für eine Resektion oder Lebertransplantation. Besteht eine Kontraindikation zur Resektion oder Lebertransplantation oder ist der Tumor nicht resektabel, sind konservative Therapieversuche angezeigt. Cisplatin und Anthrazykline repräsentieren die wirksamsten Zytostatika in der Therapie des HCC. Interferon alpha 2 kann bei dieser Tumorentität als zumindest äquieffektiv zu Zytostatika eingestuft werden. Intraarteriell applizierte Zytostatikatherapie unter Verwendung von Lipiodol als Trägersubstanz mit anschließender Embolisierung kann erfolgversprechende Ergebnisse erzielen. Die Bestrahlung mit radioaktiv markiertem Lipiodol oder radioaktiv markierten Antikörpern gegen Ferritin oder Alpha-1-Fetoprotein ist als palliative Maßnahme derzeit ebenfalls in Erprobung. Bei kleinen Tumoren führt die perkutane Äthanolinjektion zu sehr guten Erfolgen. Ein großer Teil der Patienten weist primär ein weit 2fortgeschrittenes Tumorleiden auf und kann deshalb lediglich supportiven Maßnahmen zugeführt werden.

Schlußfolgerungen

Die zahlreichen, derzeit angewandten Therapiemethoden weisen vielversprechende Ansätze und Ergebnisse auf und lassen bei patientenadaptierter Behandlung auf weitere Lebensqualitäts verbesserung und-verlängerung hoffen.

Summary

Background

Individual treatment of hepatocellular carcinoma (HCC) has to be selected from multiple therapeutic options depending on patients' and tumor parameters.

Methods

This review analyzes and discusses those parameters and various methods of therapy.

Results

In patients with HCC confined to the liver a surgical curative treatment either by resection or by liver transplantation is indicated. Patients unfit for surgical treatment may benefit from conservative treatment. Cisplatin and anthracyclines are the most effective cytostatics in HCC. Interferon alpha 2 has been shown to be at least as effective as cytostatic drugs in this tumor entity. Intraarterial chemotherapy with lipiodol and/or embolization with gelfoam yield promising results. Radiotherapy with radiolabelled lipiodol or antibodies to ferritin or alpha 1-fetoprotein are new therapeutic approaches still under clinical investigation. In patients with small tumors, percutaneous instillation of ethanol shows excellent results. Many patients present with far advanced tumor stages at diagnosis and all measures are therefore restricted to supportive therapy.

Conclusions

The therapeutic considerations represent new approaches in therapy of HCC. In future, further improvement of quality of life and a prolongation of survival can be expected from patient-adapted therapies.

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Authors and Affiliations

  1. Universitätsklinik für Radiodiagnostik der Universität Wien, Wien, Österrich

    R. Walter

  2. Klinischen Abteilung für Onkologie, Universitätsklinik für Innere Medizin I der Universität Wien, Wien, Österrich

    Ch. Dittrich

  3. Klinischen Abteilung für Gastroenterologie und Hepatologie, der Universitätsklinik für Innere Medizin IV der Universität Wien, Wien, Österrich

    Martina Baur, M. Walgram & P. Ferenci

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Baur, M., Walgram, M., Walter, R. et al. Die konservative Therapie des hepatozellulären Karzinoms (HCC). Acta Chir Austriaca 25, 106–109 (1993). https://doi.org/10.1007/BF02602139

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