Helmberger T
Institut für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Klinikum Bogenhausen, Englschalkinger Strasse 77, Munich, Germany.
Chirurg. 2010 Jun;81(6):542-50. doi: 10.1007/s00104-010-1888-4.
The therapeutic concept for hepatic metastases is mainly based on surgical resection and systemic chemotherapy. Considering technical respectability, oncological significance and limiting comorbidities, only 10-30% of patients with hepatic metastases can undergo surgery with a curative intention. Patients assessed as being non-resectable qualify in general for (palliative) chemotherapy. However, for many patients surgical therapy of the liver is no longer possible due to medical or technical reasons, nevertheless, the total tumor load is still limited, which makes an interventional, local ablative therapy approach promising, with and without chemotherapy. Thus, various interventional-radiological, minimally invasive techniques could be successfully established as oncological therapy components besides surgery and chemotherapy. These types of intervention encompass mainly chemotherapy (percutaneous alcohol instillation, transarterial chemoembolization and transarterial chemotherapy), thermotherapy (radiofrequency, laser and microwave ablations) and radio-ablative procedures (radio-embolization, selective internal radiation therapy SIRT, interstitial and catheter-guided brachytherapy). Incorporating these procedures into therapeutic multimodal concepts inaugurates a significantly broadened therapy spectrum with a clear additional improvement in patient prognosis.
肝转移瘤的治疗理念主要基于手术切除和全身化疗。考虑到技术可行性、肿瘤学意义和并存疾病的限制,只有10%-30%的肝转移瘤患者能够接受根治性手术。评估为不可切除的患者一般适合(姑息性)化疗。然而,由于医学或技术原因,许多患者已无法进行肝脏手术治疗,但肿瘤总负荷仍然有限,这使得无论是否联合化疗,介入性局部消融治疗方法都具有前景。因此,除手术和化疗外,各种介入放射学、微创技术已成功确立为肿瘤治疗的组成部分。这些介入类型主要包括化疗(经皮酒精注射、经动脉化疗栓塞和经动脉化疗)、热疗(射频、激光和微波消融)以及放射消融程序(放射性栓塞、选择性内照射治疗SIRT、组织间和导管引导近距离放射治疗)。将这些程序纳入治疗多模式理念开创了显著拓宽的治疗范围,并明显改善了患者预后。