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Die Radiologie

Erschienen in:

01.09.2008 | Leitthema

Therapieresponse von Lebertumoren nach selektiver interner Radiotherapie

verfasst von: Dr. T.F. Jakobs, R.T. Hoffmann, K. Tatsch, C. Trumm, M.F. Reiser

Erschienen in: Die Radiologie | Ausgabe 9/2008

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Zusammenfassung

Die selektive interne Radiotherapie (SIRT) wird zur Behandlung primärer Lebertumoren, insbesondere dem hepatozellulären Karzinom (HCC) und von Lebermetastasen verschiedener Primärtumoren eingesetzt. Derzeit wird diese innovative Therapieform empfohlen, wenn unter klassischen und etablierten Therapiekonzepten eine Progression der Lebererkrankung zu verzeichnen ist oder diese Therapien auf Grund intolerabler Toxizität abgebrochen werden müssen. Bei der SIRT werden kleine biokompatible Harzmikrosphären (SIR-Spheres®), die Betastrahlen emittierendes Yttrium-90 enthalten, über einen transarteriellen Zugangsweg superselektiv in die Leberarterien injiziert. Die Mikrosphären sammeln sich in präkapillaren Gefäßen in und um das Tumorgewebe an. Hier entfalten die Betastrahlen aufgrund ihrer geringen Penetrationstiefe von durchschnittlich 2,5 mm ihre lokale, strahlentherapeutische Wirkung unter Schonung des umgebenden, gesunden Leberparenchyms. In diesem Beitrag werden die Ergebnisse der SIRT bei hepatischen Metastasen des kolorektalen Karzinoms, des Mammakarzinoms und neuroendkriner Tumoren sowie beim primären Leberzellkrebs (HCC) dargestellt.

Bangash AK, Atassi B, Kaklamani V et al. (2007) 90Y radioembolization of metastatic breast cancer to the liver: toxicity, imaging response, survival. J Vasc Interv Radiol 18(5): 621–628PubMedCrossRef

Bruix J, Llovet JM, Castells A et al. (1998) Transarterial embolization versus symptomatic treatment in patients with advanced hepatocellular carcinoma: results of a randomized, controlled trial in a single institution. Hepatology 27(6): 1578–1583PubMedCrossRef

Chan JH, Tsui EY, Luk SH et al. (2001) Diffusion-weighted MR imaging of the liver: distinguishing hepatic abscess from cystic or necrotic tumor. Abdom Imaging 26(2): 161–165PubMedCrossRef

Coldwell D, Nutting C, Kennedy AK (2005) Use of yttrium-90 SirSpheres to treat metastatic unresectable neuroendocrine tumors to the liver. World Congress of Gastrointestinal Cancer, June 27–30, Barcelona, Spain

Coldwell DM, Kennedy AS, Nutting CW (2007) Use of Yttrium-90 microspheres in the treatment of unresectable hepatic metastases from breast cancer. Int J Radiat Oncol Biol Phys

De Gramont A, Figer A, Seymour M et al. (2000) Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol 18(16): 2938–2947

Deng J, Rhee TK, Sato KT et al. (2006) In vivo diffusion-weighted imaging of liver tumor necrosis in the VX2 rabbit model at 1.5 Tesla. Invest Radiol 41(4): 410–414PubMedCrossRef

Deng J, Miller FH, Rhee TK et al. (2006) Diffusion-weighted MR imaging for determination of hepatocellular carcinoma response to yttrium-90 radioembolization. J Vasc Interv Radiol 17(7): 1195–1200PubMedCrossRef

Douillard JY, Cunningham D, Roth AD et al. (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209): 1041–1047PubMedCrossRef

10.

Emmanouilides C, Sfakiotaki G, Androulakis N et al. (2007) Front-line bevacizumab in combination with oxaliplatin, leucovorin and 5-fluorouracil (FOLFOX) in patients with metastatic colorectal cancer: a multicenter phase II study. BMC Cancer 7: 91.91PubMedCrossRef

11.

Giantonio BJ, Catalano PJ, Meropol NJ et al. (2007) Bevacizumab in combination with oxaliplatin, fluorouracil, and leucovorin (FOLFOX4) for previously treated metastatic colorectal cancer: results from the Eastern Cooperative Oncology Group Study E3200. J Clin Oncol 25(12): 1539–1544PubMedCrossRef

12.

Goldstein D, van Hazel G, Pavlakis N (2005) Selective internal radiation therapy (SIRT) plus systemic chemotherapy with irinotecan: a phase I dose escalation study. American Society of Clinical Oncology Annual Meeting, May 13–17, Orlando, Fl

13.

Gray B, van Hazel G, Hope M et al. (2001) Randomised trial of SIR-spheres plus chemotherapy vs. chemotherapy alone for treating patients with liver metastases from primary large bowel cancer. Ann Oncol 12(12): 1711–1720PubMedCrossRef

14.

Gregory WM, Smith P, Richards MA et al. (1993) Chemotherapy of advanced breast cancer: outcome and prognostic factors. Br J Cancer 68(5): 988–995PubMed

15.

Gupta S, Johnson MM, Murthy R et al. (2005) Hepatic arterial embolization and chemoembolization for the treatment of patients with metastatic neuroendocrine tumors. Cancer 104(8): 1590–1602PubMedCrossRef

16.

Jakobs TF, Hoffman RT, Dehm K et al. (2007) Regional 90-Yttrium microsphere treatment of chemorefractory colorectal cancer liver metastases. JVIR, in press

17.

Jakobs TF, Hoffmann RT, Fischer T et al. (2008) Radioembolization in patients with hepatic metastases from breast cancer. J Vasc Interv Radiol 19(5): 683–690PubMedCrossRef

18.

Jakobs TF, Hoffmann RT, Poepperl G et al. (2007) Mid-term results in otherwise treatment refractory primary or secondary liver confined tumours treated with selective internal radiation therapy (SIRT) using (90)Yttrium resin-microspheres. Eur Radiol 17(5): 1320–1330PubMedCrossRef

19.

Jardines L, Callans LS, Torosian MH (1993) Recurrent breast cancer: presentation, diagnosis, and treatment. Semin Oncol 20(5): 538–547PubMed

20.

Kamel IR, Bluemke DA, Ramsey D et al. (2003) Role of diffusion-weighted imaging in estimating tumor necrosis after chemoembolization of hepatocellular carcinoma. AJR Am J Roentgenol 181(3): 708–710PubMed

21.

Kamel IR, Reyes DK, Liapi E et al. (2007) Functional MR imaging assessment of tumor response after 90Y microsphere treatment in patients with unresectable hepatocellular carcinoma. J Vasc Interv Radiol 18(1 Pt 1): 49–56PubMedCrossRef

22.

Kennedy AS, Coldwell D, Nutting C et al. (2005) Hepatic brachytherapy for GI neuroendocrine tumors with Y90 microspheres: long-term USA results. International Congress on Anti-Cancer Treatment, February 1–4, Paris, France

23.

Kennedy AS, Coldwell D, Nutting C et al. (2006) Resin 90Y-microsphere brachytherapy for unresectable colorectal liver metastases: modern USA experience. Int J Radiat Oncol Biol Phys 65(2): 412–425PubMed

24.

Kennedy AS, McNeillie P et al. (2006) Fractionation, dose selection, and response of hepatic metastases of neuroendocrine tumors after Y90 microsphere brachytherapy. Annual Meeting of the American Brachytherapy Society, May 10–12, Philadelphia

25.

King J, Morris DL, Glenn D et al. (2006) Pilot study of SIR-spheres in liver metastases from neuroendocrine cancer (NETLM). Third European Neuroendocrine Tumor Society (ENTS) Conference, Prague, Czech Republic

26.

Kulke M (2005) Advances in the treatment of neuroendocrine tumors. Curr Treat Options Oncol 6(5): 397–409PubMedCrossRef

27.

Lau WY, Ho S, Leung TW et al. (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of 90yttrium microspheres. Int J Radiat Oncol Biol Phys 40(3): 583–592PubMed

28.

Lau WY, Ho S, Leung WT et al. (2001) What determines survival duration in hepatocellular carcinoma treated with intraarterial yttrium-90 microspheres? Hepatogastroenterology 48(38): 338–340PubMed

29.

Llovet JM, Burroughs A, Bruix J (2003) Hepatocellular carcinoma. Lancet 362(9399): 1907–1917PubMedCrossRef

30.

Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 30(6): 1434–1440PubMedCrossRef

31.

Llovet JM, Real MI, Montana X et al. (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319): 1734–1739PubMedCrossRef

32.

Mazzaferro V, Regalia E, Doci R et al. (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334(11): 693–699PubMedCrossRef

33.

Miller AB, Hoogstraten B, Staquet M et al. (1981) Reporting results of cancer treatment. Cancer 47(1): 207–214PubMedCrossRef

34.

Miller FH, Keppke AL, Reddy D et al. (2007) Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol 188(3): 776–783PubMedCrossRef

35.

Namimoto T, Yamashita Y, Sumi S et al. (1997) Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging. Radiology 204(3): 739–744PubMed

36.

Rhee TK, Naik NK, Deng J et al. (2008) Tumor response after yttrium-90 radioembolization for hepatocellular carcinoma: comparison of diffusion-weighted functional MR imaging with anatomic MR imaging. J Vasc Interv Radiol 19(8): 1180–1186PubMedCrossRef

37.

Rubin D, Nutting C, Jones B (2004) Metastatic breast cancer in a 54-year-old woman: integrative treatment with yttrium-90 radioembolization. Integr Cancer Ther 3(3): 262–267PubMedCrossRef

38.

Sangro B, Bilbao JI, Boan J et al. (2006) Radioembolization using 90Y-resin microspheres for patients with advanced hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 66(3): 792–800PubMed

39.

Shankar LK, Hoffman JM, Bacharach S et al. (2006) Consensus recommendations for the use of 18F-FDG PET as an indicator of therapeutic response in patients in National Cancer Institute Trials. J Nucl Med 47(6): 1059–1066PubMed

40.

Sharma RA, van Hazel GA, Morgan B et al. (2007) Radioembolization of liver metastases from colorectal cancer using yttrium-90 microspheres with concomitant systemic oxaliplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol 25(9): 1099–1106PubMedCrossRef

41.

Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective internal radiation therapy (SIRT) with 90Yttrium microspheres for extensive colorectal liver metastases. Hepatogastroenterology 48(38): 333–337PubMed

42.

Stubbs RS, Cannan RJ, Mitchell AW (2001) Selective internal radiation therapy with 90yttrium microspheres for extensive colorectal liver metastases. J Gastrointest Surg 5(3): 294–302PubMedCrossRef

43.

Therasse P, Arbuck SG, Eisenhauer EA et al. (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92(3): 205–216PubMedCrossRef

44.

Tournigand C, Andre T, Achille E et al. (2004) FOLFIRI followed by FOLFOX6 or the reverse sequence in advanced colorectal cancer: a randomized GERCOR study. J Clin Oncol 22(2): 229–237PubMedCrossRef

45.

Van Hazel G, Blackwell A, Anderson J et al. (2004) Randomised phase 2 trial of SIR-spheres plus fluorouracil/leucovorin chemotherapy versus fluorouracil/leucovorin chemotherapy alone in advanced colorectal cancer. J Surg Oncol 88(2): 78–85CrossRef

46.

Van Hazel G, Price D, Bower G (2005) Selective internal radiation therapy (SIRT) plus systemic chemotherapy with FOLFOX4: a phase I dose escalation study. American Society of Clinical Oncology Gastrointestinal Malignancies Symposium, 27–29 February, Hollywood, Fl

47.

Wong CY, Salem R, Qing F et al. (2004) Metabolic response after intraarterial 90Y-glass microsphere treatment for colorectal liver metastases: comparison of quantitative and visual analyses by 18F-FDG PET. J Nucl Med 45(11): 1892–1897PubMed

48.

Wong CY, Qing F, Savin M et al. (2005) Reduction of metastatic load to liver after intraarterial hepatic yttrium-90 radioembolization as evaluated by [18F]fluorodeoxyglucose positron emission tomographic imaging. J Vasc Interv Radiol 16(8): 1101–1106PubMed

49.

Wyld L, Gutteridge E, Pinder SE et al. (2003) Prognostic factors for patients with hepatic metastases from breast cancer. Br J Cancer 89(2): 284–290PubMedCrossRef

Titel: Therapieresponse von Lebertumoren nach selektiver interner Radiotherapie
verfasst von: Dr. T.F. Jakobs
R.T. Hoffmann
K. Tatsch
C. Trumm
M.F. Reiser
Publikationsdatum: 01.09.2008
Verlag: Springer-Verlag
Erschienen in: Die Radiologie / Ausgabe 9/2008
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI: https://doi.org/10.1007/s00117-008-1730-x

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