Hepatobiliäre Tumoren und Lebermetastasen

  • D. Habermehl
  • T. W. Kraus
  • K. K. Herfarth


In westlichen Industrieländern liegt die Inzidenz des HCC zwischen 2,6 und 9,8 auf 100.000 Einwohner (Parkin 2001) und nimmt in den letzten Jahren zu (Bosch 2004). Männer sind hierbei insgesamt deutlich häufiger betroffen.


  1. Adson MA, van Heerden JA et al. (1984) “Resection of hepatic metastases from colorectal cancer.” Arch Surg 119(6): 647–651PubMedGoogle Scholar
  2. Andolino DL, Johnson CS et al. (2011) “Stereotactic body radiotherapy for primary hepatocellular carcinoma.” Int J Radiat Oncol Biol Phys 81(4): e447–453PubMedGoogle Scholar
  3. Bartlett DL, Fong Y et al. (1996) “Long–term results after resection for gallbladder cancer. Implications for staging and management.” Ann Surg 224(5): 639–646PubMedGoogle Scholar
  4. Ben-David MA, Griffith KA et al. (2006) “External-beam radiotherapy for localized extrahepatic cholangiocarcinoma.” Int J Radiat Oncol Biol Phys 66(3): 772–779PubMedGoogle Scholar
  5. Bismuth HR. Nakache, et al. (1992) “Management strategies in resection for hilar cholangiocarcinoma.” Ann Surg 215(1): 31–38PubMedGoogle Scholar
  6. Borgelt BB, Gelber R, et al. (1981) “The palliation of hepatic metastases: results of the Radiation Therapy Oncology Group pilot study.” In J Radiat Oncol Biol Phys 7(5): 587–591Google Scholar
  7. Bosch FX Ribes J et al. (2004) “Primary liver cancer: worldwide incidence and trends.” Gastroenterology 127(5 Suppl 1): S5–S16PubMedGoogle Scholar
  8. Bowling TE, Galbraith SM et al. (1996) “A retrospective comparison of endoscopic stenting alone with stenting and radiotherapy in non-resectable cholangiocarcinoma.” Gut 39(6): 852–855PubMedGoogle Scholar
  9. Brunner TB, Eccles CL (2010) “Radiotherapy and chemotherapy as therapeutic strategies in extrahepatic biliary duct carcinoma.” Strahlenther Onkol 186(12): 672–680PubMedGoogle Scholar
  10. Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RK, Dinniwell RE, Kassam Z, Ringash J, Cummings B et al. (2013) Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol, 31(13):1631–1639PubMedGoogle Scholar
  11. Bush DA, Hillebrand DJ et al. (2004) “High-dose proton beam radiotherapy of hepatocellular carcinoma: preliminary results of a phase II trial.” Gastroenterology 127(5 Suppl 1): S189–193PubMedGoogle Scholar
  12. Bush DA, Kayali Z et al. (2011) “The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial.” Cancer 117(13): 3053–3059PubMedGoogle Scholar
  13. Cheng JC, Wu JK, et al. (2002) “Radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma: dosimetric analysis and implication.” Int J Radiat Oncol Biol Phys 54(1): 156–162PubMedGoogle Scholar
  14. Child CG, Turcotte JG (1964) “Surgery and portal hypertension.” Major Probl Clin Surg 1: 1–85PubMedGoogle Scholar
  15. Combs SE, Habermehl D, Ganten T, Schmidt J, Edler L, Burkholder I, Jakel O, Haberer T, Debus J (2011) Phase i study evaluating the treatment of patients with hepatocellular carcinoma (HCC) with carbon ion radiotherapy: the PROMETHEUS-01 trial. BMC Cancer, 11:67PubMedGoogle Scholar
  16. Dawson LA, Ten Haken RK et al. (2001) “Partial irradiation of the liver.” Semin Radiat Oncol 11(3): 240–246PubMedGoogle Scholar
  17. Deodato F, Clemente G et al. (2006) “Chemoradiation and brachytherapy in biliary tract carcinoma: long-term results.” Int J Radiat Oncol Biol Phys 64(2): 483–488PubMedGoogle Scholar
  18. Eckel F, Brunner T et al. (2010) “Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.” Ann Oncol 21 Suppl 5: v65–69PubMedGoogle Scholar
  19. Ed,AT (2010).AJCC Cancer Staging Manual, Springer Science+Business MediaGoogle Scholar
  20. Elias DT, De Baere, et al. (1999) “During liver regeneration following right portal embolization the growth rate of liver metastases is more rapid than that of the liver parenchyma.” Br J Surg 86(6): 784–788PubMedGoogle Scholar
  21. Emami B, Lyman J et al. (1991) “Tolerance of normal tissue to therapeutic irradiation.” Int J Radiat Oncol Biol Phys 21(1): 109–122PubMedGoogle Scholar
  22. Farrell GC, Larter CZ (2006) “Nonalcoholic fatty liver disease: from steatosis to cirrhosis.” Hepatology 43(2 Suppl 1): S99–S112PubMedGoogle Scholar
  23. Fattovich, G., T. Stroffolini, et al. (2004). “Hepatocellular carcinoma in cirrhosis: incidence and risk factors.” Gastroenterology 127(5 Suppl 1): S35–50PubMedGoogle Scholar
  24. Fritz P, Brambs HJ et al. (1994) “Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinomas.” Int J Radiat Oncol Biol Phys 29(4): 855–861PubMedGoogle Scholar
  25. Gagner M, Rossi RL (1991) “Radical operations for carcinoma of the gallbladder: present status in North America.” World J Surg 15(3): 344–347PubMedGoogle Scholar
  26. Gerhards M. F, van Gulik TM et al. (2003) “Results of postoperative radiotherapy for resectable hilar cholangiocarcinoma.” World J Surg 27(2): 173–179PubMedGoogle Scholar
  27. Goodman K. A., Wiegner EA et al. (2010) “Dose-escalation study of single-fraction stereotactic body radiotherapy for liver malignancies.” Int J Radiat Oncol Biol Phys 78(2): 486–493PubMedGoogle Scholar
  28. Habermehl D, Haase K et al. (2011) “Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: an analysis of survival and treatment efficacy.” Tumori 97(5): 609–613PubMedGoogle Scholar
  29. Habermehl D, Debus J, Ganten T, Ganten MK, Bauer J, Brecht IC, Brons S, Haberer T, Haertig M, Jakel O et al. (2013) Hypofractionated carbon ion therapy delivered with scanned ion beams for patients with hepatocellular carcinoma - feasibility and clinical response. Radiat Oncol 8:59PubMedGoogle Scholar
  30. Helmberger TN, Holzknecht, et al. (2001) “[Radiofrequency ablation of liver metastases. Technique and initial results].” Radiologe 41(1): 69–76PubMedGoogle Scholar
  31. Herfarth C, Heusche UA, et al. (1995). “[Resections of recurrence in the liver of primary and secondary liver cancers].” Chirurg 66(10): 949–958PubMedGoogle Scholar
  32. Hoyer M, Swaminath A et al. (2012) “Radiotherapy for liver metastases: a review of evidence.” Int J Radiat Oncol Biol Phys 82(3): 1047–1057PubMedGoogle Scholar
  33. Huang GT, Lee PH, et al. (2005) “Percutaneous ethanol injection versus surgical resection for the treatment of small hepatocellular carcinoma: a prospective study.” Ann Surg 242(1): 36–42PubMedGoogle Scholar
  34. Hughes MA, Frassica DA et al. (2007) “Adjuvant concurrent chemoradiation for adenocarcinoma of the distal common bile duct.” Int J Radiat Oncol Biol Phys 68(1): 178–182PubMedGoogle Scholar
  35. Ingold JA, Reed GB et al. (1965). “Radiation Hepatitis.” Am J Roentgenol Radium Ther Nucl Med 93: 200–208PubMedGoogle Scholar
  36. Jaffe BM, Donegan WL et al. (1968). “Factors influencing survival in patients with untreated hepatic metastases.” Surg Gynecol Obstet 127(1): 1–11PubMedGoogle Scholar
  37. Japan LC. S. G. o. (1990) “Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Liver Cancer Study Group of Japan.” Ann Surg 211(3): 277–287Google Scholar
  38. Jenkins LT, Millikan KW et al. (1997) “Hepatic resection for metastatic colorectal cancer.” Am Surg 63(7): 605–610PubMedGoogle Scholar
  39. Jiang XM. D., C. M. D. Ke, et al. (2012) “Brain metastases from hepatocellular carcinoma: Clinical features and prognostic factors.” BMC Cancer 12(1): 49PubMedGoogle Scholar
  40. Jianshe Y, Wenjian L, et al. (2006) “Survival and initial chromatid breakage in normal and tumour cells exposed in vitro to gamma rays and carbon ions at the HIRFL.” Br J Radiol 79(942): 518–521PubMedGoogle Scholar
  41. Jianshe Y, Xigang J, et al. (2006) “Correlation between initial chromatid damage and survival of various cell lines exposed to heavy charged particles.” Radiat Environ Biophys 45(4): 261–266PubMedGoogle Scholar
  42. Kato H, Tsujii H et al. (2004) “Results of the first prospective study of carbon ion radiotherapy for hepatocellular carcinoma with liver cirrhosis.” Int J Radiat Oncol Biol Phys 59(5): 1468–1476PubMedGoogle Scholar
  43. Kawashima M, Furuse J et al. (2005) “Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma.” J Clin Oncol 23(9): 1839–1846PubMedGoogle Scholar
  44. Khan ZS, Livingston EH, et al. (2011) “Reassessing the need for prophylactic surgery in patients with porcelain gallbladder: case series and systematic review of the literature.” Arch Surg 146(10): 1143–1147PubMedGoogle Scholar
  45. Kimura W, Nagai H, et al. (1989) “Clinicopathologic study of asymptomatic gallbladder carcinoma found at autopsy.” Cancer 64(1): 98–103PubMedGoogle Scholar
  46. Komatsu S, Fukumoto T et al. (2011) “Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma.” Cancer 117(21): 4890–4904PubMedGoogle Scholar
  47. Kopek N, Holt MI et al. (2010) “Stereotactic body radiotherapy for unresectable cholangiocarcinoma.” Radiother Oncol 94(1): 47–52PubMedGoogle Scholar
  48. Kuper H, Ye W et al. (2001) “The risk of liver and bile duct cancer in patients with chronic viral hepatitis, alcoholism, or cirrhosis.” Hepatology 34(4 Pt 1): 714–718PubMedGoogle Scholar
  49. Lang H, Sotiropoulos GC, et al. (2005). “Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period.” Ann Surg 241(1): 134–143PubMedGoogle Scholar
  50. Law AL, Ng WT et al. (2012) “Treatment of primary liver cancer using highly-conformal radiotherapy with kV-image guidance and respiratory control.” Radiother Oncol 102(1): 56–61PubMedGoogle Scholar
  51. Lawrence SP, Lezotte DC, et al. (1995) “Course of thrombocytopenia of chronic liver disease after transjugular intrahepatic portosystemic shunts (TIPS). A retrospective analysis.” Dig Dis Sci 40(7): 1575–1580PubMedGoogle Scholar
  52. Lawrence TS, Robertson JM et al. (1995) “Hepatic toxicity resulting from cancer treatment.” Int J Radiat Oncol Biol Phys 31(5): 1237–1248PubMedGoogle Scholar
  53. Lehnert T, Golling M (2001) “[Indications and outcome of liver metastases resection].” Radiologe 41(1): 40–48PubMedGoogle Scholar
  54. Leibel SA., Pajak TF et al. (1987) “A comparison of misonidazole sensitized radiation therapy to radiation therapy alone for the palliation of hepatic metastases: results of a Radiation Therapy Oncology Group randomized prospective trial.” Int J Radiat Oncol Biol Phys 13(7): 1057–1064PubMedGoogle Scholar
  55. Lencioni R, Bartolozzi C et al. (1995) “Treatment of small hepatocellular carcinoma with percutaneous ethanol injection. Analysis of prognostic factors in 105 Western patients.” Cancer 76(10): 1737–1746PubMedGoogle Scholar
  56. Lewin K, Millis RR (1973) “Human radiation hepatitis. A morphologic study with emphasis on the late changes.” Arch Pathol 96(1): 21–26PubMedGoogle Scholar
  57. Limdi JK, Crampton JR (2004) “Hereditary haemochromatosis.” QJM 97(6): 315–324PubMedGoogle Scholar
  58. Llovet, JM, Burroughs A et al. (2003) “Hepatocellular carcinoma.” Lancet 362(9399): 1907–1917PubMedGoogle Scholar
  59. Llovet JM, Ricci S et al. (2008) “Sorafenib in advanced hepatocellular carcinoma.” N Engl J Med 359(4): 378–390PubMedGoogle Scholar
  60. Miwa S, Miyagawa S et al. (2006) “Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery.” J Gastroenterol 41(9): 893–900PubMedGoogle Scholar
  61. Mojica P, Smith D et al. (2007) “Adjuvant radiation therapy is associated with improved survival for gallbladder carcinoma with regional metastatic disease.” J Surg Oncol 96(1): 8–13PubMedGoogle Scholar
  62. Momm, F, Schubert E et al. (2010) “Stereotactic fractionated radiotherapy for Klatskin tumours.” Radiother Oncol 95(1): 99–102PubMedGoogle Scholar
  63. Mornex F, Girard N et al. (2006) “Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies-mature results of the French Phase II RTF-1 trial.” Int J Radiat Oncol Biol Phys 66(4): 1152–1158PubMedGoogle Scholar
  64. Nakeeb A, Pitt HA et al. (1996) “Cholangiocarcinoma. A spectrum of intrahepatic, perihilar, and distal tumors.” Ann Surg 224(4): 463–473; discussion 473–465PubMedGoogle Scholar
  65. Nelson JW, Ghafoori AP et al. (2009) “Concurrent chemoradiotherapy in resected extrahepatic cholangiocarcinoma.” Int J Radiat Oncol Biol Phys 73(1): 148–153PubMedGoogle Scholar
  66. Nzeako UC, Goodman ZD et al. (1996) “Hepatocellular carcinoma in cirrhotic and noncirrhotic livers. A clinico-histopathologic study of 804 North American patients.” Am J Clin Pathol 105(1): 65–75PubMedGoogle Scholar
  67. Ogura Y, Mizumoto R et al. (1991) “Radical operations for carcinoma of the gallbladder: present status in Japan.” World J Surg 15(3): 337–343PubMedGoogle Scholar
  68. Oh D, Lim do H et al. (2007) “The role of adjuvant radiotherapy in microscopic tumor control after extrahepatic bile duct cancer surgery.” Am J Clin Oncol 30(1): 21–25Google Scholar
  69. Park JY, Park SW et al. (2006) “Concurrent chemoradiotherapy with doxifluridine and paclitaxel for extrahepatic bile duct cancer.” Am J Clin Oncol 29(3): 240–245PubMedGoogle Scholar
  70. Parkin DM, Bray F, et al. (2001. “Estimating the world cancer burden: Globocan 2000.” Int J Cancer 94(2): 153–156PubMedGoogle Scholar
  71. Patel T (2001) “Increasing incidence and mortality of primary intrahepatic cholangiocarcinoma in the United States.” Hepatology 33(6): 1353–1357PubMedGoogle Scholar
  72. Perz JF, Armstrong GL et al. (2006) “The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide.” J Hepatol 45(4): 529–538PubMedGoogle Scholar
  73. Piehler JM, Crichlow RW (1978) “Primary carcinoma of the gallbladder.” Surg Gynecol Obstet 147(6): 929–942PubMedGoogle Scholar
  74. Pitt HA, Nakeeb A et al. (1995) “Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival.” Ann Surg 221(6): 788–797; discussion 797–788.PubMedGoogle Scholar
  75. van der Pool AE, Mendez Romero A et al. (2010) “Stereotactic body radiation therapy for colorectal liver metastases.” Br J Surg 97(3): 377–382PubMedGoogle Scholar
  76. Pugh RN, Murray-Lyon IM et al. (1973) “Transection of the oesophagus for bleeding oesophageal varices.” Br J Surg 60(8): 646–649.PubMedGoogle Scholar
  77. Rea DJ, Heimbach JK et al. (2005) “Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma.” Ann Surg 242(3): 451–458; discussion 458–461PubMedGoogle Scholar
  78. Reed GB Jr., Cox AJ Jr. (1966) “The human liver after radiation injury. A form of veno-occlusive disease.” Am J Pathol 48(4): 597–611Google Scholar
  79. Rees M, Tekkis PP et al. (2008) “Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer: a multifactorial model of 929 patients.” Ann Surg 247(1): 125–135PubMedGoogle Scholar
  80. Rule W, Timmerman R et al. (2011) “Phase I dose-escalation study of stereotactic body radiotherapy in patients with hepatic metastases.” Ann Surg Oncol 18(4): 1081–1087PubMedGoogle Scholar
  81. Russell AH, Clyde C et al. (1993) “Accelerated hyperfractionated hepatic irradiation in the management of patients with liver metastases: results of the RTOG dose escalating protocol.” Int J Radiat Oncol Biol Phys 27(1): 117–123PubMedGoogle Scholar
  82. Rusthoven KE, Kavanagh BD et al. (2009) “Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases.” J Clin Oncol 27(10): 1572–1578PubMedGoogle Scholar
  83. Sarkany, RP (2001) “The management of porphyria cutanea tarda.” Clin Exp Dermatol 26(3): 225–232PubMedGoogle Scholar
  84. Scheele J, Altendorf-Hofmann A, et al. (2001). “[Resection of colorectal liver metastases. What prognostic factors determine patient selection?].” Chirurg 72(5): 547–560PubMedGoogle Scholar
  85. Selby R, Kadry Z, et al. (1995). “Liver transplantation for hepatocellular carcinoma.” World J Surg 19(1): 53–58PubMedGoogle Scholar
  86. Serafini FM, Sachs D et al. (2001) “Location, not staging, of cholangiocarcinoma determines the role for adjuvant chemoradiation therapy.” Am Surg 67(9): 839–843; discussion 843–834PubMedGoogle Scholar
  87. Shaib YH, Davila JA, et al. (2004) “Rising incidence of intrahepatic cholangiocarcinoma in the United States: a true increase?” J Hepatol 40(3): 472–477PubMedGoogle Scholar
  88. Shimizu S, Shirato H, et al. (1999) “Three-dimensional movement of a liver tumor detected by high-speed magnetic resonance imaging.” Radiother Oncol 50(3): 367–370PubMedGoogle Scholar
  89. Skinner HD, Sharp HJ, et al (2011) “Radiation treatment outcomes for unresectable hepatocellular carcinoma.” Acta Oncol 50(8): 1191–1198PubMedGoogle Scholar
  90. Smela ME, Currier SS et al. (2001) “The chemistry and biology of aflatoxin B(1): from mutational spectrometry to carcinogenesis.” Carcinogenesis 22(4): 535–545PubMedGoogle Scholar
  91. Takenaka K, Shimada M, et al. (1994) “Liver resection for hepatocellular carcinoma in the elderly.” Arch Surg 129(8): 846–850PubMedGoogle Scholar
  92. Todoroki T, Ohara K, et al. (2000) “Benefits of adjuvant radiotherapy after radical resection of locally advanced main hepatic duct carcinoma.” Int J Radiat Oncol Biol Phys 46(3): 581–587PubMedGoogle Scholar
  93. Valle J, Wasan H et al. (2010) “Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer.” N Engl J Med 362(14): 1273–1281PubMedGoogle Scholar
  94. Vogl T, MackM et al. (2001) “[Thermal ablation of liver metastases. Current status and prospects].” Radiologe 41(1): 49–55PubMedGoogle Scholar
  95. Vogl TJ, Muller PK et al. (1999) “Liver metastases: interventional therapeutic techniques and results, state of the art.” Eur Radiol 9(4): 675–684PubMedGoogle Scholar
  96. Wagner JS, Adson MA et al. (1984) “The natural history of hepatic metastases from colorectal cancer. A comparison with resective treatment.” Ann Surg 199(5): 502–508PubMedGoogle Scholar
  97. Wang SJ, Fuller CD et al. (2008) “Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer.” J Clin Oncol 26(13): 2112–2117PubMedGoogle Scholar
  98. Watanapa P, Watanapa WB (2002) “Liver fluke-associated cholangiocarcinoma.” Br J Surg 89(8): 962–970PubMedGoogle Scholar
  99. Wharton JT, Delclos L, et al. (1973) “Radiation hepatitis induced by abdominal irradiation with the cobalt 60 moving strip technique.” Am J Roentgenol Radium Ther Nucl Med 117(1): 73–80PubMedGoogle Scholar
  100. Wiesner R, Edwards E et al. (2003) “Model for end-stage liver disease (MELD) and allocation of donor livers.” Gastroenterology 124(1): 91–96PubMedGoogle Scholar
  101. Wiesner R, Lake JR, et al. (2006) “Model for end-stage liver disease (MELD) exception guidelines.” Liver Transpl 12(12 Suppl 3): S85–87PubMedGoogle Scholar
  102. Wiesner RH. (2005) “Evidence-based evolution of the MELD/PELD liver allocation policy.” Liver Transpl 11(3): 261–263PubMedGoogle Scholar
  103. Wiesner RH, Freeman RB et al. (2004) “Liver transplantation for hepatocellular cancer: the impact of the MELD allocation policy.” Gastroenterology 127(5 Suppl 1): S261–267PubMedGoogle Scholar
  104. Wiesner RH, McDiarmid SV et al. (2001) “MELD and PELD: application of survival models to liver allocation.” Liver Transpl 7(7): 567–580PubMedGoogle Scholar
  105. Wilson SM, Adson MA (1976) “Surgical treatment of hepatic metastases from colorectal cancers.” Arch Surg 111(4): 330–334PubMedGoogle Scholar
  106. Yamada R, Kishi K et al. (1990) “Transcatheter arterial embolization in unresectable hepatocellular carcinoma.” Cardiovasc Intervent Radiol 13(3): 135–139PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • D. Habermehl
    • 1
  • T. W. Kraus
    • 2
  • K. K. Herfarth
    • 3
  1. 1.Klinik für RadioonkologieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  2. 2.Klinik für Allgemein- und Viszeralchirurgie Krankenhaus NordwestFrankfurt a.M.Deutschland
  3. 3.Abteilung für Radioonkologie und Strahlentherapie Radiologische KlinikHeidelbergDeutschland

Personalised recommendations