Skip to main content
SpringerLink
Log in

Lokoregionäre Therapie von primären Lebertumoren

  • Chapter
Kompendium Internistische Onkologie

  • 110 Accesses

Zusammenfassung

Bei der lokoregionären Behandlung primärer Lebertumoren spielt das hepatozelluläre Karzinom (HCC) eine alles überragende Rolle. Das HCC ist gegenwärtig das fünfthäufigste Karzinom und — infolge der zunehmenden Verbreitung von Hepatitis C — in der Bedeutung tendenziell steigend. Die überwiegende Anzahl der HCC befindet sich bei Diagnosestellung bereits in einem inkurablen Stadium, abhängig von der Leberfunktion und dem Ausmaß der Tumorerkrankung. Die Resektabilität weist mit 5–37% (ca. 30% der Child-A-Fälle), die perioperative Mortalität mit 3–7% Bandbreiten auf, die u.a. mit der regionalen Verteilung (West vs. Ost), der Art und Schwere der Grunderkrankung (HBV/HCV vs. alkoholinduziert) sowie der Frequenz und Erfahrung bei Vorsorgeuntersuchungen zusammenhängen (Okuda, Colella).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

Literatur

  • American Joint Committee on Cancer (2002). Liver 14:131–138

    Google Scholar 

  • Arii S, Yamaoka Y, Futagawa S et al (2000) Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: a retrospective and nationwide survey in Japan. Hepatology 32:1224–1229

    Article  PubMed  CAS  Google Scholar 

  • Bismuth H, Chiche L, Adam R et al (1993) Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 218:145–151

    Article  PubMed  CAS  Google Scholar 

  • Bloomston M, Binitie O, Fraiji E et al (2002) Transcatheter arterial chemoembolization with or without radiofrequency ablation in the management of patients with advanced hepatic malignancy. Am Surg 69:827–831

    Google Scholar 

  • Bruix J, Sherman M, Llovet JM et al (2001) EASL Panel of Experts on HCC. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol 35:421–430

    Article  PubMed  CAS  Google Scholar 

  • Buscarini L, Buscarini E, Di Stasi M (2001) Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results. Eur Radiol 11:914–921

    Article  PubMed  CAS  Google Scholar 

  • Buscarini L, Buscarini E, Di Stasi M (1999) Percutaneous radiofrequency thermal ablation combined with transcatheter arterial embolization in the treatment of large hepatocellular carcinoma. Ultraschall Med 20:47–53

    Article  PubMed  CAS  Google Scholar 

  • Cha CH, Ruo L, Fong Y et al (2003) Resection of hepatocellular carcinoma in patients otherwise eligible for transplantation. Ann Surg 238:315–321

    PubMed  Google Scholar 

  • Choi D, Lim HK, Kim MJ et al (2004) Recurrent hepatocellular carcinoma: percutaneous radiofrequency ablation after hepatectomy. Radiology 230:135–141

    Article  PubMed  Google Scholar 

  • Clavien PA, Kang KJ, Selzner N et al (2002) Cryosurgery after chemoembolization for hepatocellular carcinoma in patients with cirrhosis. J Gastrointest Surg 6:95–101

    Article  PubMed  Google Scholar 

  • CLIP investigators (1998) A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 28:751–755

    Google Scholar 

  • CLIP investigators (2000) Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. The Cancer of the Liver Italian Program (CLIP) Investigators. Hepatology 31:840–845

    Article  Google Scholar 

  • Colella G, Bottelli R, De Carlis L et al (1998) Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection, and chemoembolization. Transpl Int 11 (Suppl 1):S 193–196

    Google Scholar 

  • Curley SA, Izzo F, Ellis LM et al (2000) Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 232:381–391

    Article  PubMed  CAS  Google Scholar 

  • Curley SA, Marra P, Beaty K et al (2004) Early and lage complications after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 239:450–458

    Article  PubMed  Google Scholar 

  • De Sio I, Castellano L, De Girolamo V et al (2001) Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 34:609–610

    Article  PubMed  Google Scholar 

  • Di Stasi M, Buscarini L, Livraghi T et al (1997) Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates. Scand J Gastroenterol 32:1168–1173

    Article  PubMed  Google Scholar 

  • Ebara M, Ohto M, Sugiura N et al (1990) Percutaneous ethanol injection for the treatment of small hepatocellular carcinoma: study of 95 patients. J Gastroenterol Hepatol 5:616

    Article  PubMed  CAS  Google Scholar 

  • Ebara M, Ohto M, Watanabe Y et al (1986) Diagnosis of small hepatocellular carcinoma: correlation of MR imaging and tumor histologic studies. Radiology 159:371–377

    PubMed  CAS  Google Scholar 

  • Galle PR (1997) Apoptosis in liver disease. J Hepatol 27:405–412

    Article  PubMed  CAS  Google Scholar 

  • Goldberg SN, Solbiati L (2001) Tumor dissemination after radiofrequency ablation of hepatocellular carcinoma. Hepatology 34:609

    Article  PubMed  CAS  Google Scholar 

  • Graziadei IW, Sandmueller H, Waldenberger P et al (2003) Chemoembolization followed by liver transplantation for hepatocellular carcinoma impedes tumor progression while on the waiting list and leads to excellent outcome. Liver Transpl 9:557–563

    Article  PubMed  Google Scholar 

  • Guglielmi A, Ruzzente A, Battoccchia A et al (2003) Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients. Hepatogastroenterology 50:480–484

    PubMed  Google Scholar 

  • Hasegawa, H (1989) Multidisciplinary therapy for liver cancer focussing on surgical treatment. Annual report of the co-operative research with a grain of aid of the Japanese ministery of health and welfare; 22

    Google Scholar 

  • Huang J, He X, Lin X, Zhang C et al (2000) Effect of preoperative transcatheter arterial chemoembolization on tumor cell activity in hepatocellular carcinoma. Chin Med J (Engl) 113(5):446–448

    CAS  Google Scholar 

  • Huo T, Huang YH, Wu JC et al (2003) Comparison of percutaneous acetic acid injection and percutaneous ethanol injection for hepatocellular carinoma in cirrhotic patients: a prospective study. Scand J Gastroenterol 38:770–778

    Article  PubMed  CAS  Google Scholar 

  • Isbert C, Boerner A, Ritz JP et al (2002) In situ ablation of experimental liver metastases delays and reduces residual intrahepatic tumour growth and peritoneal tumour spread compared with hepatic resection. Br J Surg 89:1252–1259

    Article  PubMed  CAS  Google Scholar 

  • Iwatsuki S, Starzl TE, Sheahan DG et al (1991) Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 9:221–229

    Google Scholar 

  • Jonas S, Bechstein WO, Steinmüller T et al (2001) Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology 33:1080–1086

    Article  PubMed  CAS  Google Scholar 

  • Jones DB, Koorey DJ (1987) Screening studies and markers. Gastroenterol Clin North Am 16:563–573

    PubMed  CAS  Google Scholar 

  • Kamada K, Kitamoto M, Aikata H et al (2002) Combination of transcatheter arterial chemoembolization using cisplatin-lipiodol suspension and percutaneous ethanol injection for treatment of advanced small hepatocellular carcinoma. Am J Surg 184:284–290

    Article  PubMed  CAS  Google Scholar 

  • Kurokochi K, Watanabe S, Masaki T et al (2002) Combination therapy of percutaneous ethanol injection and radiofrequency ablation against hepatocellular carcinomas difficult to treat. In J Oncol 21:611–615

    Google Scholar 

  • Kuvshinoff BW, Ota DM (2002). Radiofrequency ablation of liver tumors: influence of technique and tumor size. Surgery 132:605–611

    Article  PubMed  Google Scholar 

  • Lencioni RA, Allgaier HP, Cloni D et al (2003) Small hepatocellular carcinoma in cirrhosis: randomized comparison of radiofrequency thermal ablation versus percutaneous ethanol injection. Radiology 228:235–240

    Article  PubMed  Google Scholar 

  • Lencioni R, Pinto F, Armillotta N, et al (1997) Long-term results of percutaneous ethanol injection therapy for hepatocellular carcinoma in cirrhosis: a European experience. Eur Radiology 7:514–519

    Article  CAS  Google Scholar 

  • Livraghi T (2003) Radiofrequency ablation, PEIT, and TACE for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg 10:67–76

    PubMed  Google Scholar 

  • Livraghi T, Giogio A, Marin G et al (1995) Hepatocellular carcinoma and cirrhosis in 746 patients: long-term results of percutaneouas ethanol injection. Radiology 197:101–108

    PubMed  CAS  Google Scholar 

  • Livraghi T, Solbiati I, Meloni MF et al (2003) Treatment of focal liver tumors with percutaneous radiofrequency ablation: complications encountered in a multicenter study. Radiology 226:441–451

    Article  PubMed  Google Scholar 

  • Llovet et al (2001) Increased risk of tumor seeding after percutaneous radiofrequency ablation or single hepatocellular carcinoma. Hepatology 33:1124–1129

    Article  PubMed  CAS  Google Scholar 

  • Llovet JM, Bru C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19:62–67

    Article  Google Scholar 

  • Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 362:1907–1916

    Google Scholar 

  • Llovet JM, Fuster J, Bruix J (1999) Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: resection versus transplantation. Hepatology 39:639–699

    Google Scholar 

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

    Article  PubMed  Google Scholar 

  • Maki S, Konno T, Maeda H et al (1985) Image enhancement in computerized tomography for sensitive diagnosis of liver cancer and semiquantification of tumor selective drug targeting with oily contrast medium. Cancer 56:751–757

    Article  PubMed  CAS  Google Scholar 

  • Matsuda M, Fujii H, Kono H et al (2001) Surgical treatment of recurrent hepatocellular carcinoma based on the mode of recurrence: repeat hepatic resection or ablation are good choices for patients with recurrent multicentric cancer. J Hepatobiliary Pancreat Surg 8:353–359

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Miyagawa S, Kawasaki S, Makuuchi M (1996) Comparison of the characteristics of hepatocellular carcinoma between hepatitis B and C viral infection: tumor multicentricity in cirrhotic liver with hepatitis C. Hepatology 24:307–310

    Article  PubMed  CAS  Google Scholar 

  • Mullier S, Mulier P, Ni Y et al (2002) Complications of radiofrequency coagulation of liver tumors. Br J Surg 89:1206–1222

    Article  Google Scholar 

  • Nagashima T (1989) The study on radiotherapy for hepatocellular carcinoma. Nippon Igaku Hoshasen Gakkai Zasshi 49:1141–1151

    PubMed  CAS  Google Scholar 

  • Nicoli N, Casaril A, Marchiori L et al (2001) Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation. Hepatobiliary Pancreat Surg 8:417–421

    Article  CAS  Google Scholar 

  • Ohnishi K, Nomura F, Ito S, Fujiwara K (1996) Prognosis of small hepatocellular carcinoma (less than 3 cm) after percutaneous acetic acid injection: study of 91 cases. Hepatology 23:994–1002

    Article  PubMed  CAS  Google Scholar 

  • Ohto M, Yoshikawa M, Saisho H et al (1995) Nonsurgical treatment of hepatocellular carcinoma in cirrhotic patients. World J Surg 19:42–46

    Article  PubMed  CAS  Google Scholar 

  • Okuda K (2000) Hepatocellular carcinoma. J Hepatol 32 (1 Suppl):225–237

    Article  PubMed  CAS  Google Scholar 

  • Okuda K (2002) Where we go with hepatocellular carcinoma: past, present, and future perspectives. J Hepatobiliary Pancreat Surg 9:683–685

    Article  PubMed  Google Scholar 

  • Okuda K, Obata H, Nakajima Y et al (1984) Prognosis of primary hepatocellular carcinoma. Hepatology 4:3 S

    Article  CAS  Google Scholar 

  • Okuda K, Ohtsuki T, Obata H et al (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 56:918–928

    Article  PubMed  CAS  Google Scholar 

  • Otto G, Heuschen U, Hofmann WJ et al (1998) Survival and recurrence after liver transplantation versus liver resection for hepatocellular carcinoma. Ann Surg 227:424–432

    Article  PubMed  CAS  Google Scholar 

  • Pacella CM, Bizzarri G, Mangolfi F et al (2001) Laser thermal ablation in the treatment of small hepatocellular carcinoma: results in 74 patients. Radiology 221:712–720

    Article  PubMed  CAS  Google Scholar 

  • Pelletier G, Ducreux M, Gay F et al (1998) Treatment of unresectable hepatocellular carcinoma with lipiodol chemoembolization: a multicenter randomized trial. J Hepatol 29:129–134

    Article  PubMed  CAS  Google Scholar 

  • Poon RT, Fan ST (2004) Hepatectomy for hepatocellular carcinoma: patient selection and postoperative outcome. Liver Transpl 10 (2 Suppl 1):S 39–45

    Article  Google Scholar 

  • Qian J, Feng GS, Vogl T (2003) Combined interventional therapies of hepatocellular carcinoma. World J Gastroenterol 9:1885–1891

    PubMed  Google Scholar 

  • Raoul JI, Bretagne JF, Caucanas JP et al (1992) Internal radiation therapy for hepatocellular carcinoma — results of a Frenchmulticenter phase II trial of transarterial injection of iodine 131 — labeled lipiodol. Cancer 69:346–352

    Article  PubMed  CAS  Google Scholar 

  • Rossi S, Di Stasi M, Buscarini E et al (1996) Percutaneous radiofrequency thermal ablation in the treatment of hepatic cancer. AJR AM J Roentgenol 67:759–768

    Google Scholar 

  • Rossi S, Garbagnati F, Lencioni R et al (2000) Percutaneous radio-frequency thermal ablation of nonresectable hepatocellular carcinoma after occlusion of tumor blood supply. Radiology 217:119–126

    PubMed  CAS  Google Scholar 

  • Ruzzente A, Manzoni GD, Molfetta M et al (2004) A rapid progression of hepatocellular carcinoma after radiofrequency ablation. World J Gastroenterol 10:1137–1140

    Google Scholar 

  • Shibata T, Iimuro Y, Yamamoto Y et al (2002) Small hepatocellular carcinoma: comparison of radiofrequency ablation and percutaneous microwave coagulation therapy. Radiology 23:331–337

    Article  Google Scholar 

  • Shiina S, Imamura M, Obi S et al (1996) Percutaneous ethanol injection therapy for small hepatocellular carcinoma. Gan To Kagaku Ryoho 23:835–839

    PubMed  CAS  Google Scholar 

  • Shiina S, Tagawa K, Unuma T et al (1991) Percutaneous ethanol injection therapy for hepatocellular carcinoma. A histopathologic study. Cancer 68:1524–1530

    Article  PubMed  CAS  Google Scholar 

  • Shiina S, Tagawa K, Unuma T et al (1990) Percutaneous ethanol injection therapy of hepatocellular carcinoma: analysis of 77 patients. AJR Am J Roentgenol 155:1221

    PubMed  CAS  Google Scholar 

  • Siperstein A, Garland A, Engle K et al (2000) Local recurrence after laparoscopic radiofrequency thermal ablation of hepatic tumors. Ann Surg Oncol 7:106–113

    Article  PubMed  CAS  Google Scholar 

  • Sitzmann JV, Abrams R. (1993) Improved survival for hepatocellular cancer with combination surgery and multimodality treatment. Ann Surg 217:149–154

    Article  PubMed  CAS  Google Scholar 

  • Solbiati L, Ierace T, Tonolini M et al (2001) Radiofrequency thermal ablation of hepatic metastases. Eur J Ultrasound 13:149–158

    Article  PubMed  CAS  Google Scholar 

  • Tacke J, Adam G, Speetzen R et al (1990) MR-guided interstitial cryotherapy of the liver with a novel nitrogen-cooled cryoprobe. Magn Reson Med 39:354–360

    Article  Google Scholar 

  • Tait IS, Yong SM, Cuschieri SA (2002) Laparoscopic in situ ablation of liver cancer with cryotherapy and radiofrequency ablation. Br J Surg 89:1613–1619

    Article  PubMed  CAS  Google Scholar 

  • Takayama T, Makuuchi S, Hirohashi S, et al (1998) Early hepatocellular carcinoma as an entity with high rate of surgical cure. Hepatology 28:1241–1246

    Article  PubMed  CAS  Google Scholar 

  • Tanikawa K (1992) Multidisciplinary treatment of hepatocellular carcinoma. In: Tobe T, Kameda H (eds) Primary Liver Cancer in Japan. Tokyo, Springer, p 327–334

    Google Scholar 

  • Tanikawa K, Majima Y (1993) Percutaneous ethanol injection therapy for recurrent hepatocellular carcinoma. Hepatogastroenterology 40:324–327

    PubMed  CAS  Google Scholar 

  • The Liver Cancer Study group of Japan (1994) Predictive factors for long term prognosis after partial hepatectomy for patients with hepatocellular carcinoma. Cancer 74:2772

    Article  Google Scholar 

  • Veltri A, Grosso M, Martina MC et al (1998) Effect of preoperative radiological treatment of hepatocellular carcinoma before liver transplantation: a retrospective study. Cardiovasc Intervent Radiol 21:393–398

    Article  PubMed  CAS  Google Scholar 

  • Vogl TJ, Straub R, Eichler K et al (2002) Malignant liver tumors treated with MR imaging-guided laser induced thermotherapy: experience with complications in 899 patients (2520 lesions). Radiology 225:367–377

    Article  PubMed  Google Scholar 

  • Wood TF, Rose DM, Chung M et al (2000) Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 7:593–600

    PubMed  CAS  Google Scholar 

  • Wu CC, Ho YZ, Ho WL et al (1995) Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal. Br J Surg 82:122–126

    Article  PubMed  CAS  Google Scholar 

  • Yamada K, Izaki K, Sugimoto K et al (2003) Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 1 57:113–119

    Google Scholar 

  • Yamada R, Kishi K, Sato M et al (1995) Transcatheter arterial chemoembolization (TACE) in the treatment of unresectable liver cancer. World J Surg 19:795–800

    Article  PubMed  CAS  Google Scholar 

  • Yamamoto J, Okada S, Shimada K et al (2001) Treatment strategy for small hepatocellular carcinoma: Comparison of long-term results after percutaneous ethanol injection therapy and surgical resection. Hepatology 34:707–713

    Article  PubMed  CAS  Google Scholar 

  • Yamamoto K, Masuzawa M, Kato M et al (1997) Evaluation of combined therapy with chemoembolization and ethanol injection for advanced hepatocellular carcinoma. Semin Oncol 24 (2 Suppl 6):50–55

    Google Scholar 

  • Youki K, Hirohashi S, Sakamotot M et al (1990) Growth and spread of hepatocellular carcinoma: a review of 240 consecutive autopsy cases. Cancer 66:2174–2179

    Article  Google Scholar 

  • Zhou XD, Tang ZY (1998) Cryotherapy for primary liver cancer. Semin Surg Oncol 14:171–174

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. M. Golling
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Schaudt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. O. Bechstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Schwerpunkt Hämatologie/Onkologie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle/Saale

    Hans-Joachim Schmoll (Direktor der Klinik und Poliklinik für Innere Medizin IV) (Direktor der Klinik und Poliklinik für Innere Medizin IV)

  2. Onkologie-Hämatologie-Gastroenterologie-Hepatologie-Infektiologie, Klinikum der Friedrich-Schiller-Universität Jena, Erlanger Allee 101, 07740, Jena

    Klaus Höffken (Direktor der Klinik und Poliklinik für Innere Medizin II) (Direktor der Klinik und Poliklinik für Innere Medizin II)

  3. Schwerpunkt Onkologie und Hämatologie, Universitätsmedizin Berlin, Charité-Campus Mitte Schumannstraße 20/21, 10117, Berlin

    Kurt Possinger (Direktor der Medizinischen Klinik II) (Direktor der Medizinischen Klinik II)

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Springer Medizin Verlag Heidelberg

About this chapter

Cite this chapter

Golling, M., Schaudt, A., Bechstein, W.O. (2006). Lokoregionäre Therapie von primären Lebertumoren. In: Schmoll, HJ., Höffken, K., Possinger, K. (eds) Kompendium Internistische Onkologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/3-540-31303-6_60

Download citation

  • DOI: https://doi.org/10.1007/3-540-31303-6_60

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-20657-6

  • Online ISBN: 978-3-540-31303-8

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation