Skip to main content
SpringerLink
Log in

Bildgeführte Therapie des hepatozellulären Karzinoms

RFA, transarterielle Chemoembolisation, 90Y‑Radioembolisation

Image-guided treatment of hepatocellular carcinoma

RFA, transarterial chemoembolization, 90Y radioembolization

  • Schwerpunkt
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Alle wesentlichen internationalen Leitlinien sehen neben chirurgischen und systemischen auch interventionell-radiologische, bildgeführte Techniken für die Behandlung des hepatozellulären Karzinoms vor. Eine chirurgische Resektion ist zu erörtern, wenn eine Lebertransplantation in kurativer Intention infrage kommt. Ansonsten werden bei kleinen Tumoren bis 3 cm Größe lokal ablative Verfahren eingesetzt oder lokoregionäre Techniken wie die transarterielle Chemoembolisation (TACE) oder 90Y-Radioembolisation. Letztere kommen gewöhnlich in der Palliativsituation zur Anwendung. Im Folgenden findet sich eine Analyse der aktuellen Datenlage für Radiofrequenzablation (RFA), transarterielle Chemoembolisation (TACE) und 90Y-Radioembolisation mit Empfehlungen zum Einsatz in der klinischen Routine. Eine chirurgische minimalinvasive Alternative stellt in einigen Fällen mit kleinen Tumoren die laparoskopische Leberteil- bzw. Segmentresektion dar. Bei größeren Tumoren (ab etwa >5 cm) oder bei diffuser Tumoraussaat ist die Radioembolisation gegenüber der Chemoembolisation von Vorteil.

Abstract

In addition to surgical and systemic interventions, all important international guidelines recommend image-guided radiologic techniques for the treatment of hepatocellular carcinoma. Surgical resection is to be considered when liver transplant with curative intent is a possible therapeutic option. Otherwise, in cases of small tumors up to 3 cm, local ablative methods are employed, or locoregional techniques such as transarterial chemoembolization (TACE) or 90Y radioembolization may be applied. The latter are generally used in a palliative situation. This study analyses the current data on radiofrequency ablation (RFA), TACE, and 90Y radioembolization, and makes recommendations for their use in clinical routine. Laparoscopic partial liver or segmental resection is a minimally invasive surgical alternative that is sometimes an option for small tumors. For larger tumors (from about >5 cm) or in the case of diffuse tumor dissemination, radioembolization has advantages over chemoembolization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Greten TF, Malek NP, Schmidt S et al (2013) Diagnosis of and therapy for hepatocellular carcinoma. Z Gastroenterol 51(11):1269–1326

    Article  CAS  PubMed  Google Scholar 

  2. European Association for Study of Liver, European Organisation for Research and Treatment of Cancer (2012) EASL-EORTC clinical practice guidelines: Management of hepatocellular carcinoma. Eur J Cancer 48(5):599–641

    Article  Google Scholar 

  3. Orlando A, Leandro G, Olivo M, Andriulli A, Cottone M (2009) Radiofrequency thermal ablation vs. percutaneous ethanol injection for small hepatocellular carcinoma in cirrhosis: Meta-analysis of randomized controlled trials. Am J Gastroenterol 104(2):514–524

    Article  PubMed  Google Scholar 

  4. Xu Q, Kobayashi S, Ye X, Meng X (2014) Comparison of hepatic resection and radiofrequency ablation for small hepatocellular carcinoma: a meta-analysis of 16,103 patients. Sci Rep 4:7252. doi:10.1038/srep07252

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wang Y, Luo Q, Li Y, Deng S, Wei S, Li X (2014) Radiofrequency ablation versus hepatic resection for small hepatocellular carcinomas: A meta-analysis of randomized and nonrandomized controlled trials. PLoS ONE 9(1):e84484

    Article  PubMed  PubMed Central  Google Scholar 

  6. Chen MS, Li JQ, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243(3):321–328

    Article  PubMed  PubMed Central  Google Scholar 

  7. Feng Q, Chi Y, Liu Y, Zhang L, Liu Q (2015) Efficacy and safety of percutaneous radiofrequency ablation versus surgical resection for small hepatocellular carcinoma: A meta-analysis of 23 studies. J Cancer Res Clin Oncol 141(1):1–9

    Article  PubMed  Google Scholar 

  8. Huang J, Yan L, Cheng Z et al (2010) A randomized trial comparing radiofrequency ablation and surgical resection for HCC conforming to the Milan criteria. Ann Surg 252(6):903–912

    Article  PubMed  Google Scholar 

  9. Yamasaki T, Kurokawa F, Shirahashi H, Kusano N, Hironaka K, Okita K (2002) Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy. Cancer 95(11):2353–2360

    Article  PubMed  Google Scholar 

  10. Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 37(2):429–442

    Article  CAS  PubMed  Google Scholar 

  11. Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319):1734–1739

    Article  PubMed  Google Scholar 

  12. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35(5):1164–1171

    Article  CAS  PubMed  Google Scholar 

  13. Hu HT, Kim JH, Lee LS et al (2011) Chemoembolization for hepatocellular carcinoma: Multivariate analysis of predicting factors for tumor response and survival in a 362-patient cohort. J Vasc Interv Radiol 22(7):917–923

    Article  PubMed  Google Scholar 

  14. Golfieri R, Renzulli M, Mosconi C et al (2013) Hepatocellular carcinoma responding to superselective transarterial chemoembolization: An issue of nodule dimension? J Vasc Interv Radiol 24(4):509–517

    Article  PubMed  Google Scholar 

  15. Hucke F, Pinter M, Graziadei I et al (2014) How to STATE suitability and START transarterial chemoembolization in patients with intermediate stage hepatocellular carcinoma. J Hepatol 61(6):1287–1296

    Article  PubMed  Google Scholar 

  16. Kadalayil L, Benini R, Pallan L et al (2013) A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol 24(10):2565–2570

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Luo J, Guo RP, Lai EC et al (2011) Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: A prospective comparative study. Ann Surg Oncol 18(2):413–420

    Article  PubMed  Google Scholar 

  18. Llovet JM, Ricci S, Mazzaferro V et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390

    Article  CAS  PubMed  Google Scholar 

  19. Hucke F, Sieghart W, Pinter M et al (2014) The ART-strategy: Sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE. J Hepatol 60(1):118–126

    Article  PubMed  Google Scholar 

  20. Adhoute X, Penaranda G, Naude S et al (2015) Retreatment with TACE: The ABCR SCORE, an aid to the decision-making process. J Hepatol 62(4):855–862

    Article  PubMed  Google Scholar 

  21. Arizumi T, Ueshima K, Minami T et al (2015) Effectiveness of Sorafenib in patients with Transcatheter Arterial Chemoembolization (TACE) refractory and intermediate-stage hepatocellular carcinoma. Liver Cancer 4(4):253–262

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ogasawara S, Chiba T, Ooka Y et al (2014) Efficacy of sorafenib in intermediate-stage hepatocellular carcinoma patients refractory to transarterial chemoembolization. Oncology 87(6):330–341

    Article  CAS  PubMed  Google Scholar 

  23. Bolondi L, Burroughs A, Dufour JF et al (2012) Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: Proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 32(4):348–359

    CAS  PubMed  Google Scholar 

  24. Piscaglia F, Terzi E, Cucchetti A et al (2013) Treatment of hepatocellular carcinoma in Child-Pugh B patients. Dig Liver Dis 45(10):852–858

    Article  PubMed  Google Scholar 

  25. Ha Y, Shim JH, Kim SO, Kim KM, Lim YS, Lee HC (2014) Clinical appraisal of the recently proposed Barcelona Clinic Liver Cancer stage B subclassification by survival analysis. J Gastroenterol Hepatol 29(4):787–793

    Article  PubMed  Google Scholar 

  26. Hilgard P, Hamami M, Fouly AE et al (2010) Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 52(5):1741–1749

    Article  CAS  PubMed  Google Scholar 

  27. Salem R, Lewandowski RJ, Mulcahy MF et al (2010) Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: A comprehensive report of long-term outcomes. Gastroenterology 138(1):52–64

    Article  CAS  PubMed  Google Scholar 

  28. Sangro B, Carpanese L, Cianni R et al (2011) Survival after yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across Barcelona clinic liver cancer stages: a European evaluation. Hepatology 54(3):868–878

    Article  PubMed  Google Scholar 

  29. Salem R, Lewandowski RJ, Kulik L et al (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507

    Article  PubMed  Google Scholar 

  30. El Fouly A, Ertle J, El Dorry A et al (2015) In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver Int 35(2):627–635

    Article  PubMed  Google Scholar 

  31. Lewandowski RJ, Kulik LM, Riaz A et al (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: Chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Deutschland

    K. Fischbach &  J. Ricke

Authors
  1. K. Fischbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Ricke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Ricke.

Ethics declarations

Interessenkonflikt

K. Fischbach gibt an, dass kein Interessenkonflikt besteht. J. Ricke weist auf folgende Beziehungen hin: Forschungsförderung und Vortragshonorar der Firmen Bayer Healthcare und Sirtex Medical Inc.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Müller-Schilling, Regensburg

G. Gerken, Essen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fischbach, K., Ricke, J. Bildgeführte Therapie des hepatozellulären Karzinoms. Gastroenterologe 11, 391–399 (2016). https://doi.org/10.1007/s11377-016-0099-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11377-016-0099-z

Schlüsselwörter

Keywords

Search

Navigation