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Erschienen in: Die Radiologie 3/2022

16.02.2022 | Supportivtherapie | Leitthema

Transarterielle Chemoembolisation des hepatozellulären Karzinoms

Erschienen in: Die Radiologie | Ausgabe 3/2022

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Zusammenfassung

Die transarterielle Chemoembolisation (TACE) wird bei Patienten mit hepatozellulärem Karzinom (HCC) als palliative und als neoadjuvante Therapie eingesetzt. Als Palliativtherapie soll sie Patienten im intermediären Stadium mit großem oder multinodulärem HCC angeboten werden, wenn keine kurativen Therapieoptionen durch Resektion oder Thermoablation vorliegen und extrahepatische Metastasen sowie Tumorinfiltration der Hauptstämme von V. portae und Lebervenen ausgeschlossen sind. Die TACE setzt eine erhaltene Leberfunktion (Child-Pugh A–B, optimal bis 7 Punkte) sowie einen guten Allgemeinzustand (ECOG 0) voraus. Die TACE kann als Bridging und auch zum Downstaging vor Lebertransplantation eingesetzt werden, um die hierfür erforderliche begrenzte intrahepatische Tumorausdehnung (Mailand-Kriterien) aufrecht zu erhalten bzw. zu erreichen. Die TACE soll dem Vaskularisationsmuster der Tumorherde angepasst so selektiv wie möglich und soweit notwendig auch mehrfach erfolgen mit dem Ziel der kompletten Devaskularisation des Tumorgewebes. Konventionelle TACE (Zytostatika, Lipiodol® und partikuläre Embolisate) sowie „drug-eluting“ TACE (Anthrazykline vorgeladen in kalibrierten Mikropartikeln) können als annähernd gleichwertige Verfahren eingesetzt werden. Durch konventionelle TACE konnte in der palliativen Situation gegenüber supportiver Therapie ein Überlebensvorteil für die Patienten von 8 bis 11 Monaten erzielt werden. Hierfür ist die Berücksichtigung aller Kontraindikationen sowie weiterer prognostisch ungünstiger Merkmale der Tumor- und Lebererkrankung erforderlich. Durch „drug-eluting“ TACE wird eine bessere lokale Response erzielt; ein Überlebensvorteil gegenüber mit konventioneller TACE behandelten Patienten konnte bislang nicht gezeigt werden. Das Ansprechen der HCC-Herde auf eine neoadjuvante Therapie verbessert die Prognose nach Lebertransplantation.
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Metadaten
Titel
Transarterielle Chemoembolisation des hepatozellulären Karzinoms
Publikationsdatum
16.02.2022
Erschienen in
Die Radiologie / Ausgabe 3/2022
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI
https://doi.org/10.1007/s00117-022-00972-1

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