Skip to main content
SpringerLink
Log in

Selektive interne Radioembolisation beim nichtresektablen hepatozellulären Karzinom

Selective internal radioembolization in nonresectable hepatocellular carcinoma

  • Originalien
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Einleitung

Der Stellenwert der selektiven internen Radioembolisation (SIRT) in der Therapie des hepatozellulären Karzinoms (HCC) ist aktuell noch unklar.

Material und Methoden

In die Untersuchung gingen 52 Patienten mit einem nichtresektablen HCC in Zirrhose ein, die mittels SIRT von April 2011 bis Oktober 2015 in der Klinik für Allgemein-, Viszeral- und Gefäßchirurgie in Kooperation mit der Klinik für Nuklearmedizin und dem Institut für Diagnostische und Interventionelle Radiologie therapiert wurden.

Ergebnisse

Bei 5 Patienten diente die SIRT als Bridging zur Lebertransplantation. In der histologischen Untersuchung der explantierten Lebern fanden sich bei den mit SIRT vorbehandelten Patienten in den therapierten Arealen ausgedehnte Tumornekrosen mit nur geringen randständigen vitalen Restbefunden. 4 der mit SIRT als Bridgingtherapie lokal therapierten Patienten leben nach Transplantation tumorfrei.

Bei den 47 palliativ therapierten Patienten wurden insgesamt 76 Radioembolisationen durchgeführt. Die beobachteten 1‑ bzw. 2‑Jahres-Überlebensraten dieser Patienten nach der ersten SIRT betrugen 58 % bzw. 29 %. In der multivariaten Analyse des Gesamtüberlebens erwiesen sich ein Alpha-1-Fetoprotein (AFP) vor erster SIRT >30 ng/ml, ein Zeitintervall von <12 Monaten zwischen Erstdiagnose und erster SIRT, ein größter Tumordurchmesser von >5 cm und eine Pfortaderthrombose als unabhängige, negative Einflussfaktoren. Die Zeit bis zur Progression wurde in der multivariaten Analyse nur durch den AFP-Wert vor erster SIRT unabhängig beeinflusst wurde.

Zusammenfassung

Die SIRT ist ergänzend zur Standardtherapie der transarteriellen Chemoembolisation (TACE) bei nichtresektablen HCC, insbesondere mit Pfortaderthrombose, mit gleichem Erfolg und weniger Interventionen nebenwirkungsarm durchführbar.

Abstract

Introduction

The role of selective internal radioembolization (SIRT) in the treatment of hepatocellular carcinoma (HCC) is currently unclear.

Materials and Methods

We investigated 52 patients with nonresectable HCC in cirrhosis who underwent SIRT at the Department of General, Visceral and Vascular Surgery in co-operation with the Department of Nuclear Medicine and the Institute of Diagnostic and Interventional Radiology between April 2011 and October 2015.

Results

In five patients, SIRT was employed for bridging to liver transplantation. In patients who had undergone pre-treatment with SIRT, histological examination of the explanted livers showed extensive tumor necrosis in the targeted areas with only minor remnant vital tissue at the margins. Four of the patients who underwent SIRT as local bridging treatment are tumor-free after transplantation.

In the 47 palliatively treated patients, a total of 76 radioembolizations were performed. The observed 1‑ and 2‑year survival rates in these patients were 58 and 29 %, respectively, after the first SIRT. In the multivariate analysis of the observed survival, AFP before the first SIRT >30ng/ml, time interval of <12 months between the initial diagnosis and the first SIRT, largest tumor diameter >5 cm and portal vein thrombosis were independent negative prognostic factors. In the multi-variate analysis, the time to progression was independently influenced only by the AFP level before the first SIRT.

Summary

In addition to standard treatment with transarterial chemoembolization (TACE), SIRT is feasible in nonresectable HCC, in particular with portal vein thrombosis, with identical results, less interventions and few side effects.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Rossi L, Zoratto F, Papa A, Iodice F, Minozzi M, Frati L, Tomao S (2010) Current approach in the treatment of hepatocellular carcinoma. World J Gastrointest Oncol 2(9):348–359. doi:10.4251/wjgo.v2.i9.348

    Article  PubMed  PubMed Central  Google Scholar 

  2. Llovet JM, Lencioni R, Di Bisceglie AM, Gaile PR, Dufour JF, Greten TF, Raymond E, Roskams T, De Baere T, Ducreux M, Mazzaferro V, Bernardi M, Bruix J, Colombo M, Zhu A (2012) EASL-EORTC clinical practice guidelines: Management of hepatocellular carcinoma. J Hepatol 56(4):908–943

    Article  Google Scholar 

  3. Malek NP, Schmidt S, Huber P, Manns MP, Greten TF (2014) The diagnosis and treatment of hepatocellular carcinoma. Dtsch Arztebl Int 111(7):101–106. doi:10.3238/arztebl.2014.0101

    PubMed  PubMed Central  Google Scholar 

  4. Forner A, Reig ME, de Lope CR, Bruix J (2010) Current strategy for staging and treatment: The BCLC update and future prospects. Semin Liver Dis 30(1):61–74. doi:10.1055/s-0030-1247133

    Article  CAS  PubMed  Google Scholar 

  5. Memon K, Lewandowski RJ, Kulik L, Riaz A, Mulcahy MF, Salem R (2011) Radioembolization for primary and metastatic liver cancer. Semin Radiat Oncol 21(4):294–302. doi:10.1016/j.semradonc.2011.05.004

    Article  PubMed  PubMed Central  Google Scholar 

  6. Geschwind JF, Salem R, Carr BI, Soulen MC, Thurston KG, Goin KA, Van Buskirk M, Roberts CA, Goin JE (2004) Yttrium-90 microspheres for the treatment of hepatocellular carcinoma. Gastroenterology 127(5 Suppl 1):194–205

    Article  CAS  Google Scholar 

  7. Goin JE, Salem R, Carr BI, Dancey JE, Soulen MC, Geschwind JF, Goin K, Van Buskirk M, Thurston K (2005) Treatment of unresectable hepatocellular carcinoma with intrahepatic yttrium 90 microspheres: Factors associated with liver toxicities. J Vasc Interv Radiol 16(2 Pt 1):205–213. doi:10.1097/01.RVI.0000142592.89564.F9

    Article  PubMed  Google Scholar 

  8. Hamoui N, Ryu RK (2011) Hepatic radioembolization complicated by fulminant hepatic failure. Semin Intervent Radiol 28(2):246–251. doi:10.1055/s-0031-1280674

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kulik LM, Atassi B, van Holsbeeck L, Souman T, Lewandowski RJ, Mulcahy MF, Hunter RD, Nemcek AA Jr., Abecassis MM, Haines KG 3rd, Salem R (2006) Yttrium-90 microspheres (TheraSphere) treatment of unresectable hepatocellular carcinoma: Downstaging to resection, RFA and bridge to transplantation. J Surg Oncol 94(7):572–586. doi:10.1002/jso.20609

    Article  CAS  PubMed  Google Scholar 

  10. Kolligs FT, Bilbao JI, Jakobs T, Inarrairaegui M, Nagel JM, Rodriguez M, Haug A, D’Avola D, op den Winkel M, Martinez-Cuesta A, Trumm C, Benito A, Tatsch K, Zech CJ, Hoffmann RT, Sangro B (2015) Pilot randomized trial of selective internal radiation therapy vs. chemoembolization in unresectable hepatocellular carcinoma. Liver Int 35(6):1715–1721. doi:10.1111/liv.12750

    Article  PubMed  Google Scholar 

  11. Salem R, Lewandowski RJ, Kulik L, Wang E, Riaz A, Ryu RK, Sato KT, Gupta R, Nikolaidis P, Miller FH, Yaghmai V, Ibrahim SM, Senthilnathan S, Baker T, Gates VL, Atassi B, Newman S, Memon K, Chen R, Vogelzang RL, Nemcek AA, Resnick SA, Chrisman HB, Carr J, Omary RA, Abecassis M, Benson AB 3rd, Mulcahy MF (2011) Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma. Gastroenterology 140(2):497–507.e492. doi:10.1053/j.gastro.2010.10.049

    Article  PubMed  Google Scholar 

  12. Inarrairaegui M, Pardo F, Bilbao JI, Rotellar F, Benito A, D’Avola D, Herrero JI, Rodriguez M, Marti P, Zozaya G, Dominguez I, Quiroga J, Sangro B (2012) Response to radioembolization with yttrium-90 resin microspheres may allow surgical treatment with curative intent and prolonged survival in previously unresectable hepatocellular carcinoma. Eur J Surg Oncol 38(7):594–601. doi:10.1016/j.ejso.2012.02.189

    Article  CAS  PubMed  Google Scholar 

  13. Kulik LM, Carr BI, Mulcahy MF, Lewandowski RJ, Atassi B, Ryu RK, Sato KT, Benson A 3rd, Nemcek AA Jr., Gates VL, Abecassis M, Omary RA, Salem R (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47(1):71–81. doi:10.1002/hep.21980

    Article  PubMed  Google Scholar 

  14. Woodall CE, Scoggins CR, Ellis SF, Tatum CM, Hahl MJ, Ravindra KV, McMasters KM, Martin RC 2nd (2009) Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis? J Am Coll Surg 208(3):375–382. doi:10.1016/j.jamcollsurg.2008.12.009

    Article  PubMed  Google Scholar 

  15. She WH, Cheung TT, Yau TC, Chan AC, Chok KS, Chu FS, Liu RK, Poon RT, Chan SC, Fan ST, Lo CM (2014) Survival analysis of transarterial radioembolization with yttrium-90 for hepatocellular carcinoma patients with HBV infection. Hepatobiliary Surg Nutr 3(4):185–193. doi:10.3978/j.issn.2304-3881.2014.07.09

    PubMed  PubMed Central  Google Scholar 

  16. Inarrairaegui M, Thurston KG, Bilbao JI, D’Avola D, Rodriguez M, Arbizu J, Martinez-Cuesta A, Sangro B (2010) Radioembolization with use of yttrium-90 resin microspheres in patients with hepatocellular carcinoma and portal vein thrombosis. J Vasc Interv Radiol 21(8):1205–1212. doi:10.1016/j.jvir.2010.04.012

    Article  PubMed  Google Scholar 

  17. Hilgard P, Hamami M, Fouly AE, Scherag A, Muller S, Ertle J, Heusner T, Cicinnati VR, Paul A, Bockisch A, Gerken G, Antoch G (2010) Radioembolization with yttrium-90 glass microspheres in hepatocellular carcinoma: European experience on safety and long-term survival. Hepatology 52(5):1741–1749. doi:10.1002/hep.23944

    Article  CAS  PubMed  Google Scholar 

  18. Toso C, Kneteman NM, Shapiro JAM, Bigam DL (2009) The estimated number of patients with hepatocellular carcinoma selected for liver transplantation using expanded selection criteria. Transpl Int 22(9):869–875. doi:10.1111/j.1432-2277.2009.00882.x

    Article  PubMed  Google Scholar 

  19. Moreno-Luna LE, Yang JD, Sanchez W, Paz-Fumagalli R, Harnois DM, Mettler TA, Gansen DN, de Groen PC, Lazaridis KN, Narayanan Menon KV, Larusso NF, Alberts SR, Gores GJ, Fleming CJ, Slettedahl SW, Harmsen WS, Therneau TM, Wiseman GA, Andrews JC, Roberts LR (2013) Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma. Cardiovasc Intervent Radiol 36(3):714–723. doi:10.1007/s00270-012-0481-2

    Article  PubMed  Google Scholar 

  20. Saxena A, Meteling B, Kapoor J, Golani S, Danta M, Morris DL, Bester L (2014) Yttrium-90 radioembolization is a safe and effective treatment for unresectable hepatocellular carcinoma: A single centre experience of 45 consecutive patients. Int J Surg 12(12):1403–1408. doi:10.1016/j.ijsu.2014.07.269

    Article  PubMed  Google Scholar 

  21. Carr BI, Kondragunta V, Buch SC, Branch RA (2010) Therapeutic equivalence in survival for hepatic arterial chemoembolization and yttrium 90 microsphere treatments in unresectable hepatocellular carcinoma: a two-cohort study. Cancer 116(5):1305–1314. doi:10.1002/cncr.24884

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Memon K, Kulik L, Lewandowski RJ, Wang E, Ryu RK, Riaz A, Nikolaidis P, Miller FH, Yaghmai V, Baker T, Abecassis M, Benson AB 3rd, Mulcahy MF, Omary RA, Salem R (2012) Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis. J Hepatol 56(5):1112–1120. doi:10.1016/j.jhep.2011.11.020

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Riaz A, Kulik L, Lewandowski RJ, Ryu RK, Giakoumis Spear G, Mulcahy MF, Abecassis M, Baker T, Gates V, Nayar R, Miller FH, Sato KT, Omary RA, Salem R (2009) Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres. Hepatology 49(4):1185–1193. doi:10.1002/hep.22747

    Article  PubMed  Google Scholar 

  24. Lewandowski RJ, Kulik LM, Riaz A, Senthilnathan S, Mulcahy MF, Ryu RK, Ibrahim SM, Sato KT, Baker T, Miller FH, Omary R, Abecassis M, Salem R (2009) A comparative analysis of transarterial downstaging for hepatocellular carcinoma: Chemoembolization versus radioembolization. Am J Transplant 9(8):1920–1928. doi:10.1111/j.1600-6143.2009.02695.x

    Article  CAS  PubMed  Google Scholar 

  25. Carr BI (2004) Hepatic arterial 90Yttrium glass microspheres (Therasphere) for unresectable hepatocellular carcinoma: interim safety and survival data on 65 patients. Liver Transplant 10(2 Suppl 1):107–110. doi:10.1002/lt.20036

    Article  Google Scholar 

  26. Rivera L, Giap H, Miller W, Fisher J, Hillebrand DJ, Marsh C, Schaffer RL (2006) Hepatic intra-arterial infusion of yttrium-90 microspheres in the treatment of recurrent hepatocellular carcinoma after liver transplantation: A case report. World J Gastroenterol 12(35):5729–5732

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kudo M, Izumi N, Kokudo N, Matsui O, Sakamoto M, Nakashima O, Kojiro M, Makuuchi M (2011) Management of hepatocellular carcinoma in Japan: Consensus-Based clinical practice guidelines proposed by the Japan Society of Hepatology (JSH) 2010 updated version. Dig Dis 29(3):339–364. doi:10.1159/000327577

    Article  PubMed  Google Scholar 

  28. Yau T, Tang VY, Yao TJ, Fan ST, Lo CM, Poon RT (2014) Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology 146(7):1691–1700.e1693. doi:10.1053/j.gastro.2014.02.032

    Article  PubMed  Google Scholar 

  29. Poon RT, Cheung TT, Kwok PC, Lee AS, Li TW, Loke KL, Chan SL, Cheung MT, Lai TW, Cheung CC, Cheung FY, Loo CK, But YK, Hsu SJ, Yu SC, Yau T (2015) Hong Kong consensus recommendations on the management of hepatocellular carcinoma. Liver Cancer 4(1):51–69. doi:10.1159/000367728

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jelic S, Sotiropoulos GC (2010) Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v59–v64. doi:10.1093/annonc/mdq166

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Allgemein-,Visceral-und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    A. Bauschke, A. Altendorf-Hofmann, C. Malessa & U. Settmacher

  2. Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Deutschland

    M. Freesmeyer & T. Winkens

  3. Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Jena, Jena, Deutschland

    J.-H. Schierz & U. Teichgraeber

Authors
  1. A. Bauschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Altendorf-Hofmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Freesmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Winkens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Malessa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J.-H. Schierz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. U. Teichgraeber
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. U. Settmacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Bauschke.

Ethics declarations

Interessenkonflikt

A. Bauschke, A. Altendorf-Hofmann, M. Freesmeyer, T. Winkens, C. Malessa, J.-H. Schierz, U. Teichgraeber und U. Settmacher geben an, dass kein Interessenkonflikt besteht.

Die Verwendung von Daten der Patienten für diese Arbeit erfolgte mit Zustimmung der zuständigen Ethikkommission (Nr. 4337-02/15). Die Untersuchungen am Menschen wurden, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki durchgeführt. Keiner der Patienten wurde im Rahmen einer klinischen Studie therapiert.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bauschke, A., Altendorf-Hofmann, A., Freesmeyer, M. et al. Selektive interne Radioembolisation beim nichtresektablen hepatozellulären Karzinom. Chirurg 87, 956–963 (2016). https://doi.org/10.1007/s00104-016-0259-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-016-0259-1

Schlüsselwörter

Keywords

Search

Navigation