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Thermoablation

Freund und Feind der Immuntherapie

Thermoablation

Friend and foe of immunotherapy

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Zusammenfassung

Hintergrund

In den letzten Jahren häufen sich die wissenschaftlichen Hinweise, dass (thermo)ablative Verfahren das Potenzial haben, über eine Aktivierung des körpereigenen Immunsystems auch nicht direkt behandelte Metastasen im selben Organ – oder selbst andernorts im Körper – zu beeinflussen. Dieser Effekt wird in der Literatur als „abscopal effect“ beschrieben. Dieser „abscopal effect“ kommt jedoch nur in sehr unterschiedlicher Ausprägung vor – ein deutliches Ansprechen wird nur in Einzelfallbeschreibungen berichtet. Allerdings gibt es auch Berichte, die zeigen, dass nach Thermoablation Metastasierung und Tumorwachstum zunahmen – vermutlich ausgelöst durch einen gegenläufigen immunvermittelten Effekt. Parallel dazu haben immunmodulierende Therapien einen festen Platz in der systemischen Tumortherapie bekommen, da die Kombination aus klassischen Chemotherapien mit Immuntherapien erstaunliche Verbesserungen des Outcomes für die Patienten bewirken. Der logische Schritt war deshalb, Immuntherapien mit Ablationen zu verknüpfen, um die positiven Effekte zu verstärken.

Ziel der Arbeit

In diesem Beitrag werden die Wirkungen der Thermoablation auf das Immunsystem beschrieben, unterschiedliche ablative Verfahren vorgestellt und ein Ausblick auf die Kombination der beiden Therapieoptionen gegeben.

Abstract

Background

Evidence from multiple studies have shown the potential of thermal ablative therapies to induce regression of metastases and tumors which are distant from the treated metastases—within the same organ or even in other organs—the so-called abscopal effect. Unfortunately, this effect is most often weak and not always reproducible. Recent developments in systemic therapies showed that immunomodulating drugs are of major interest in patient-tailored tumor therapy due to the fact that they are able to enhance the treatment effect of conventional chemotherapy. Furthermore, several studies and reports showed that these immunomodulating therapies are also able to enhance the response of the immune system to the tumor—if combined with local ablative therapies—and trigger a systemic antitumor response. Unfortunately, there is also evidence that effects caused by thermal ablation can hamper the immune system and, therefore, increase tumor growth and tumor spread.

Objectives

In this article, the effects of thermal ablation in general are described, different (thermo-)ablative techniques are presented and a perspective of combination therapies is given.

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Authors and Affiliations

  1. Institut und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Carl-Gustav-Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    Christoph G. Radosa &  Ralf-Thorsten Hoffmann

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  1. Christoph G. Radosa
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Correspondence to Ralf-Thorsten Hoffmann.

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Interessenkonflikt

C.G. Radosa und R.-T. Hoffmann geben an, dass kein Interessenkonflikt besteht.

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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Radosa, C.G., Hoffmann, RT. Thermoablation. Radiologe 60, 704–710 (2020). https://doi.org/10.1007/s00117-020-00719-w

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  • DOI: https://doi.org/10.1007/s00117-020-00719-w

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