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Interne und perkutane Radiotherapie des hepatozellulären Karzinoms

Internal and percutaneous radiotherapy of hepatocellular carcinoma

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Zusammenfassung

Alternativ zu oder nach ablativen Verfahren bzw. der Chemoembolisation kann sowohl die selektive interne Radiotherapie (SIRT) als auch die perkutane stereotaktische Radiotherapie bei nicht resektablen Läsionen, unabhängig von deren Lokalisation in der Leber, angewandt werden. Diese Therapieoptionen sind palliativ und verlängern dosisabhängig das progressionsfreie Überleben. Die SIRT ist eine vielversprechende, innovative Therapie mit einem niedrigen Toxizitätsprofil, welche hohe lokale Tumordosen erzielen kann. Mehrere prospektive Studien konnten eine Überlegenheit der SIRT beim inoperablen hepatozellulären Karzinom (HCC) gegenüber anderen lokalen Therapieverfahren, aber auch gegenüber der Targeted-Therapie mit einem Thyrosinkinaseinhibitor zeigen. Die mittels stereotaktischer Koordinaten geführte 3D-hoch-konformale Radiotherapie erlaubt die risikoadaptierte fokale Dosiseskalation bei Patienten mit HCC und Leberzirrhose im Stadium Child-Pugh A. Der in der Ära der Ganzleberbestrahlung häufig fatal verlaufende radiogen induzierte Leberschaden kann mittels strahlenbiologischer Prädiktionsmodelle in Kenntnis der individuellen Dosis-Volumen-Belastung des strahlensensiblen Leberparenchyms vermieden werden.

Abstract

As an alternative to ablative treatment or chemoembolization both selective internal radiotherapy (SIRT) and external beam stereotactical radiotherapy can be used for irresectable lesions irrespective of the location within the liver. Both treatment options are palliative and will prolong progression-free survival in a dose-dependent manner. The SIRT is a promising innovative technique with a low toxicity profile and potentially high local tumor dose administration. Several studies could demonstrate the high efficacy compared with other local treatments and compared with targeted treatment using a tyrosine kinase inhibitor. The use of stereotactical 3-D conformal radiotherapy provides the means of a risk-adapted focused dose escalation in patients with HCC and Child-Pugh stage A liver cirrhosis. The risk of radiation-induced liver disease, which had a fatal prognosis in the era of total liver irradiation, can be prevented by radiobiological predictive models on the basis of the individual dose-volume load to the sensitive liver parenchyma.

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Authors and Affiliations

  1. Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    M.I. Eble

  2. Klinik für Nuklearmedizin, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

    F.M. Mottaghy

  3. Department of Nuclear Medicine, Maastricht University Medical Center, HX Maastricht, Niederlande

    F.M. Mottaghy

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Correspondence to M.I. Eble.

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Eble, M., Mottaghy, F. Interne und perkutane Radiotherapie des hepatozellulären Karzinoms. Onkologe 18, 611–616 (2012). https://doi.org/10.1007/s00761-012-2276-0

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