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Therapie kolorektaler und nichtkolorektaler Lebermetastasen: Sinnhaftigkeit neoadjuvanter Therapiekonzepte

Treatment of colorectal and non-colorectal liver metastases: rationale for neoadjuvant therapeutic concepts

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Zusammenfassung

Hintergrund

Lebermetastasen stellen die häufigste sekundär maligne Erkrankung der Leber dar. Zahlen zur Inzidenz kolorektaler und nichtkolorektaler Lebermetastasen lassen sich aufgrund mangelnder Erfassung in Registern nur unzureichend untersuchen. Daten zur neoadjuvanten Therapie sind begrenzt und meist retrospektiv analysiert.

Fragestellung

Zusammenfassung und Bewertung der Sinnhaftigkeit neoadjuvanter Therapiekonzepte für kolorektale und nichtkolorektale Lebermetastasen.

Material und Methoden

Die Analyse erfolgte auf Grundlage der europäischen und US-amerikanischen Leitlinien und umfasste deutsche und englischsprachige Publikationen. Ergebnisse und Empfehlungen werden zusammengefasst und es wird ein Überblick über die Literatur gegeben.

Ergebnisse

Die neoadjuvante Therapie von Lebermetastasen erfolgt in heterogener Intention, sowohl die Selektion biologisch günstiger Tumoren als auch die Konversion eines inoperablen Befundes in einen resektablen Befund sind klassische Beweggründe für eine neoadjuvante Therapie. Die Sinnhaftigkeit neoadjuvanter Therapiekonzepte für kolorektale und insbesondere nichtkolorektale Lebermetastasen ist dem aktuellen Stand der Literatur und Leitlinien folgend nicht durchgehend schlüssig zu beantworten. Die Erstellung der Therapiestrategie in der klinischen Praxis folgt in der Regel folgenden Kriterien: Metastasierungsmuster, Komplexität der Resektion und biologische Faktoren (metachrone/synchrone Metastasen, Prognosefaktoren).

Schussfolgerungen

Beim metastasierten kolorektalen Karzinom ist die Neoadjuvans im Kontext einer Konversionstherapie Standard. Biologische Selektion günstiger Tumoren als Basis der Neoadjuvans bei resektablen Läsionen ist beim kolorektalen Karzinom kein durchgehender Standard. Nichtkolorektale Lebermetastasen werden nur im Rahmen individueller Konzepte reseziert.

Abstract

Background

Liver metastases represent the most common secondary malignant liver disease. Data regarding the incidence of colorectal and non-colorectal liver metastases are rare due to insufficient documentation in a register. Results regarding neoadjuvant therapy are limited and mostly from retrospective analyses.

Objective

A summary and rating of the rationale for neoadjuvant therapeutic concepts for colorectal and non-colorectal liver metastases were performed.

Material und methods

The analysis was based on European and American guidelines and included publications in both German and English languages. The results and recommendations were summarized and a review based on the literature is given.

Results

Neoadjuvant treatment of liver metastases is performed with heterogeneous intentions. The selection of biologically favorable tumors as well as the conversion of primarily non-operable into resectable metastases of the liver are classical reasons for neoadjuvant treatment. The rationale for neoadjuvant treatment of colorectal and especially for non-colorectal liver metastases cannot be answered in a consistently coherent way with respect to the current status quo of the literature and guidelines. The creation of treatment strategies in clinical settings follows criteria, such as patterns of metastases, complexity of the resection and biological factors (metachronous/synchronous metastases, prognostic factors).

Conclusion

Neoadjuvant treatment in the context of conversion therapy is the standard procedure for metastasized colorectal cancer. The biological selection of favorable tumors as the basis for neoadjuvant treatment of resectable lesions is not a consistently used standard for colorectal cancer. Non-colorectal liver metastases are resected only as part of individual concepts.

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Authors and Affiliations

  1. Chirurgische Klinik, Charité – Universitätsmedizin Berlin, Campus Charité Mitte | Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    S. Gül-Klein, R. Schmuck & J. Pratschke

  2. Abteilung für Hämatologie, Onkologie und Tumorimmunologie, Charité – Universitätsmedizin Berlin, Corporate Member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Campus Virchow Klinikum, Berlin, Deutschland

    D. P. Modest

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Correspondence to S. Gül-Klein.

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Interessenkonflikt

S. Gül-Klein R. Schmuck und J. Pratschke geben an, dass kein Interessenkonflikt besteht. D. P. Modest: Honorare/Beratung: Merck, Roche, Amgen, Servier, BMS, MSD, Taiho, Lilly, Sanofi; Studienförderung (institutionell): Amgen, Merck, Roche; Servier.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Die Autoren S. Gül-Klein und R. Schmuck haben zu gleichen Teilen zum Manuskript beigetragen.

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Gül-Klein, S., Schmuck, R., Modest, D.P. et al. Therapie kolorektaler und nichtkolorektaler Lebermetastasen: Sinnhaftigkeit neoadjuvanter Therapiekonzepte. Chirurg 91, 396–404 (2020). https://doi.org/10.1007/s00104-020-01133-7

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