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Aktuelle Therapiekonzepte für lokale Cholangiokarzinome

Current therapy concepts for local cholangiocarcinoma

  • Leitthema
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Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Cholangiokarzinome (CCA) stellen ein komplexes Krankheitsbild dar, bei dem eine enge interdisziplinäre Kooperation unerlässlich ist.

Material und Methoden

Es erfolgten eine selektive Literaturrecherche sowie eine Darstellung der eigenen Erfahrungen in der Therapie von lokalen CCA.

Ergebnisse

Sofern CCA auf die Gallenwege und/oder die Leber beschränkt sind, ist die chirurgische Resektion die Therapie der Wahl. Allerdings ist dies nur in 30–40 % der Fälle möglich. Neoadjuvante Therapien spielen bei resektablen Befunden bisher keine Rolle. Dagegen kann bei lokaler Inoperabilität eine Chemo- und/oder Radiotherapie in Einzelfällen zu einer sekundären Resektabilität führen. Nach R0-Resektion ist der Lymphknotenstatus einer der wichtigsten Prognosefaktoren. So liegen bei perihilären CCA die Fünfjahresüberlebensraten bei negativen Lymphknoten bei 40–60 %, bei intrahepatischen CCA zwischen 30 % und 40 %. Lymphknotenmetastasen verschlechtert die Prognose deutlich (Fünfjahresüberleben < 20 %). Für eine generelle oder risikoadjustierte adjuvante Therapie fehlen bisher randomisierte Studien. Bei inoperablen, lokal begrenzten perihilären CCA kann eine lokale Reduktion der Tumormasse durch photodynamische Therapie oder transpapilläre Radiofrequenzablation den Galleabfluss verbessern. Bei Progress intrahepatischer CCA unter Chemotherapie liegen erste positive Ergebnisse für eine Radioembolisation vor. Diese kann ansonsten aufgrund fehlender randomisierter Studien noch nicht in einen standardisierten Therapiealgorithmus eingeordnet werden.

Schlussfolgerung

Aufgrund der Komplexität der Erkrankung und der weitgehend fehlenden kontrollierten Studien sollten Therapieentscheidungen in einem interdisziplinären Tumorboard getroffen werden.

Abstract

Background

Cholangiocarcinomas (CCA) represent a complex disease, which requires close interdisciplinary cooperation.

Methods

A selective search of the literature was carried out and is combined with a description of own experiences with the treatment of locoregional CCA.

Results

Surgical resection is the treatment of choice for CCAs, which are limited to the liver and/or the biliary tract; however, resection is only possible in 30–40 % of cases. Neoadjuvant treatment of operable tumors does not play a role in the standard therapeutic algorithm; however, in cases of local inoperable CCAs a secondary resectability can be achieved in individual cases by using chemotherapy and/or radiotherapy. The lymph node status is one of the most important prognostic factors after R0 resection. The estimated 5-year survival in lymph node negative tumors lies between 40 % and 60 % after resection of hilar CCA and between 30 % and 40 % after resection of intrahepatic CCA. The presence of lymph node metastases markedly impairs the prognosis (5-year survival < 20 %). No randomized trials addressing the question of a general or risk-adjusted adjuvant therapy are currently available. In non-resectable and locally confined perihilar CCAs, reduction of tumor mass via photodynamic therapy or transpapillary radiofrequency ablation improves biliary drainage. In cases of tumor progression during palliative chemotherapy initial positive results for radioembolization have been presented; however, due to the lack of randomized trials, radioembolization as an alternative or addition to chemotherapy cannot be integrated into a standardized therapeutic algorithm.

Conclusion

Owing to the complexity of the disease and the lack of controlled trials, all therapeutic decisions should be discussed in a interdisciplinary tumor board.

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Abbreviations

BDA:

Biliodigestive Anastomose

CCA:

Cholangiokarzinom

ECOG:

Eastern Cooperative Oncology Group

ERC:

Endoskopisch retrograde Cholangiographie

iCCA:

Intrahepatische CCA

ILCA:

International Liver Cancer Association

LK:

Lymphknoten

MWA:

Mikrowellenablation

pCCA:

Perihiläres CCA (Klatskin-Tumor)

PDT:

Photodynamische Therapie

RFA:

Radiofrequenzablation

SIRT:

Selektive interne Radiotherapie

TACE:

Transarterielle Chemoembolisation

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Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Wege leitet die von der Deutschen Krebshilfe geförderte ACTICCA-1 Studie, für die Chemotherapeutika von der medac GmbH zur Verfügung gestellt werden. D. Seehofer gibt an, dass kein Interessenskonflikt besteht.

Der Beitrag enthält keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Pl. 1, 13353, Berlin, Deutschland

    D. Seehofer

  2. Klinik für Strahlenheilkunde, Department für Radiologische Diagnostik und Therapie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    T.B. Brunner

  3. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    H. Wege

Authors
  1. D. Seehofer
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  2. T.B. Brunner
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  3. H. Wege
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Correspondence to D. Seehofer.

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Seehofer, D., Brunner, T. & Wege, H. Aktuelle Therapiekonzepte für lokale Cholangiokarzinome. Onkologe 21, 1054–1063 (2015). https://doi.org/10.1007/s00761-015-2931-3

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  • DOI: https://doi.org/10.1007/s00761-015-2931-3

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