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Transarterielle Chemoembolisation von Lebermetastasen kolorektaler Karzinome mit abbaubaren Stärkepartikeln (Spherex®)

Eigene Beobachtungen und Literaturübersicht

Transcatheter arterial chemoembolization of colorectal liver metastases using degradable starch microspheres (Spherex®)

Own investigations and review to the literature

  • Freies Thema
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Zusammenfassung

Seit Beginn der 80er Jahre ist die transarterielle Chemoembolisation (TACE) von Lebermetastasen Gegenstand zahlreicher Studien, ohne dass sich bisher ein einheitliches Therapiekonzept durchgesetzt hat.

Die vorgestellte Studie untersuchte bei 21 Patienten mit inoperablen Lebermetastasen kolorektaler Karzinome retrospektiv die Überlebenszeiten, Ansprechraten und Nebenwirkungen nach TACE, und die Ergebnisse werden den Daten der bisherigen Literatur gegenübergestellt. Insgesamt wurden 68 TACE durchgeführt. Eine Suspension aus abbaubaren Stärkepartikel (degradable starch microspheres, DSM; Spherex®) und Mitomycin C wurde über einen transfemoralen Zugang selektiv in die Leberarterien appliziert. DSM bewirkt eine temporäre arterielle Okklusion. Die Therapiekontrolle erfolgte mit kontrastmittelunterstützter Spiralcomputertomographie (CT).

Die mediane Überlebenszeit betrug 13,8 Monate. Ein Ansprechen (nach WHO-Kriterien) wurde lediglich bei 3 Patienten beobachtet, das progressfreie Intervall lag im Median bei 5,8 Monaten. Als Nebenwirkung traten ein Postembolisationssyndrom (abdominelle Schmerzen, Fieber, Übelkeit) sowie eine Erhöhung der Transaminasen bei 27–43% der Interventionen auf. Nach 4 TACE kam es zur Entstehung eines Magenulkus, nach 2 TACE zu einer Cholezystitis.

Wie in den meisten vorangegangenen Arbeiten, ungeachtet der eingesetzten Substanzen, ist auch in dieser Studie der therapeutische Effekt der TACE von Lebermetastasen kolorektaler Karzinome eher als mäßig einzustufen. Ein Überlebensvorteil gegenüber dem Spontanverlauf konnte bisher in der Literatur nicht eindeutig belegt werden, die Ansprechraten sind meistens sehr begrenzt. Komplikationen sind bei der TACE insgesamt selten, in ihrer Schwere aber nicht zu unterschätzen. Das Postembolisationssyndrom scheint beim Gebrauch abbaubarer Stärkepartikel im Vergleich zu Embolisaten mit lang anhaltender oder permanenter Okklusion seltener aufzutreten. Daher könnten unter palliativen Gesichtspunkten abbaubare Stärkepartikel von Vorteil sein. Sollten in Zukunft weitere Studien zur TACE von Lebermetastasen stattfinden, muss unter palliativen Gesichtspunkten mehr Augenmerk auf die Lebensqualität des Patienten gerichtet werden.

Abstract

Since two decades transarterial chemoembolization (TACE) of liver metastases has been investigated in numerous studies. However, no standardized therapeutic procedure exists so far.

The present study retrospectively investigated survival, response and side effects after TACE of liver metastases in 21 patients with colorectal cancer and results are compared with previous literature. A total of 68 TACE procedures were performed. A suspension of degradable starch microspheres (DSM, Spherex®) and Mitomycin C was applied selectively into hepatic arteries via a transfemoral approach. DSM effect a temporary arterial occlusion. Follow-up studies were performed by contrast enhanced spiral computed tomography (CT).

The median survival was 13.8 months. Therapeutic response (according to WHO) was observed only in three patients. The progression free interval was 5.8 months. Patients developed a postembolization-syndrome (abdominal pain, fever, nausea) and increased transaminases in 27–43% of all interventions. A gastric ulcer occurred after four, cholecystitis after two TACE.

As already shown in most previous studies, regardless of the used agents, also this investigation underlines the moderate therapeutic effect of TACE on colorectal liver metastases. So far, no significant survival benefit has been shown in the literature and the response rates are rather limited. In general, complications of TACE seem to be rare, but should not to be underestimated. Compared to TACE with long or permanent arterial occlusion, postembolization syndrome seems to be less pronounced using DSM. As TACE is rather a palliative therapeutic approach, DSM therefore might be more suited. Further studies on TACE of liver metastases should focus on to the patients’ quality of life.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Universitätsklinikum Mannheim

    K. Wasser

  2. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln

    F. Giebel

  3. Institut für Klinische Radiologie, Universitätsklinkum Münster

    R. Fischbach

  4. Medizinische Klinik I, Universitätsklinikum Köln

    H. Tesch

  5. Onkologische Gemeinschaftspraxis Frankfurt

    H. Tesch

  6. Klinik für Diagnostische und interventionelle Radiologie, Henriettenstiftung Hannover

    P. Landwehr

  7. Institut für Klinische Radiologie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim

    K. Wasser

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Wasser, K., Giebel, F., Fischbach, R. et al. Transarterielle Chemoembolisation von Lebermetastasen kolorektaler Karzinome mit abbaubaren Stärkepartikeln (Spherex®). Radiologe 45, 633–643 (2005). https://doi.org/10.1007/s00117-004-1061-5

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