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Die Radiologie
Erschienen in: Der Radiologe 2/2017

27.01.2017 | Nierenkarzinom | Leitthema

Was kann/soll bei Nierentumoren wann behandelt werden

verfasst von: PD Dr. C. M. Sommer, D. F. Vollherbst, G. M. Richter, H. U. Kauczor, P. L. Pereira

Erschienen in: Die Radiologie | Ausgabe 2/2017

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Zusammenfassung

Klinisches/methodisches Problem

Bei der Behandlung des lokalisierten Nierenzellkarzinoms stellt das fehlende Randomisieren in den kontrollierten Studien zur Thermoablation eine wesentliche Limitation dar. Letztgenanntes führt zu wesentlichen Studienverzerrungen und es bleibt letztendlich unklar, ob das verbesserte Gesamtüberleben zugunsten der partiellen Nephrektomie tatsächlich auf die Behandlungsmethode selbst zurückzuführen ist.

Radiologische Standardverfahren

Für T1a (≤4 cm)-Nierenzellkarzinome ohne Lymphknoten- und Fernmetastasen sind exzellente technische und klinische Ergebnisse nach bildgeführter Radiofrequenz- und Kryoablation beschrieben.

Methodische Innovationen

Niedrige Majorkomplikationsraten, die Erhaltung der Nierenfunktion sowie die dreidimensionale Bestätigung negativer Ablationsränder (A0-Ablation) sind die Vorteile der CT-gesteuerten Thermoablation.

Leistungsfähigkeit

Entsprechend kontrollierten (nichtrandomisierten) klinischer Studien zum T1a Nierenzellkarzinom sind die krebsspezifischen Überlebensraten zwischen ablativen und chirurgischen Techniken vergleichbar.

Bewertung

Es ist höchste Zeit für prospektive randomisierte kontrollierte Studien, um den tatsächlichen Stellenwert der perkutanen Thermoablation und der partiellen Nephrektomie bei der Behandlung des T1a-Nierenzellkarzinoms zu bestimmen.

Empfehlung für die Praxis

Neben dem lokalisierten Nierenzellkarzinom eignen sich Angiomyolipome und Onkozytome für die Thermoablation. Die transarterielle Embolisation erweitert das radiologische Spektrum bei der Behandlung von Nierentumoren, entweder als ergänzende Embolisation (z. B. vor Thermoablation von T1a- und T1b-Nierenzellkarzinomen), als prophylaktische Embolisation (z. B. Angiomyolipome >6 cm), als präoperative Embolisation (z. B. vor laparoskopischer partieller Nephrektomie) oder als palliative Embolisation (z. B. bei inoperablen Patienten mit symptomatischer Makrohämaturie bei Nierenzellkarzinom).
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Metadaten
Titel
Was kann/soll bei Nierentumoren wann behandelt werden
verfasst von
PD Dr. C. M. Sommer
D. F. Vollherbst
G. M. Richter
H. U. Kauczor
P. L. Pereira
Publikationsdatum
27.01.2017
Verlag
Springer Medizin
Erschienen in
Die Radiologie / Ausgabe 2/2017
Print ISSN: 2731-7048
Elektronische ISSN: 2731-7056
DOI
https://doi.org/10.1007/s00117-016-0202-y

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