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Therapieresponse von Lebertumoren nach selektiver interner Radiotherapie

Therapy response of liver tumors after selective internal radiation therapy

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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.

Abstract

Selective internal radiation therapy (SIRT) is used for the treatment of patients with liver tumors, especially for those with hepatocellular carcinoma (HCC) or liver metastases from various primary tumors. Currently this innovative treatment concept is recommended when established state-of-the-art treatment regimes have failed and tumor progression is noted or if the treatment has to be abandoned because of intolerable toxic effects. For SIRT small biocompatible microspheres (SIR-Spheres®) are labelled with the radioactive isotope 90Yttrium, a pure beta emitter, and are superselectively infused into the hepatic arteries. The microspheres are collected in the precapillary vessels in and surrounding the tumor. The beta radiation of 90Yttrium has an average penetration in tissue of approximately 2.5 mm and results in very high doses of radiation being selectively targeted to metastases providing protection to the surrounding healthy liver tissue. In this paper we review the results of SIRT in patients with hepatic metastases from colorectal cancer, breast cancer, neuroendocrine tumors and primary liver cancer (HCC).

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: hält gelegentlich Honorar-Vorträge für die Firma SIRTeX Medical Europe GmbH.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum Großhadern der Ludwig-Maximilians-Universität München , Marchioninistr. 15, 81377, München, Deutschland

    T.F. Jakobs, R.T. Hoffmann, C. Trumm & M.F. Reiser

  2. Klinik und Poliklinik für Nuklearmedizin, Klinikum Großhadern der Ludwig-Maximilians-Universität München , München, Deutschland

    K. Tatsch

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  1. T.F. Jakobs
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  2. R.T. Hoffmann
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  5. M.F. Reiser
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Correspondence to T.F. Jakobs.

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Jakobs, T., Hoffmann, R., Tatsch, K. et al. Therapieresponse von Lebertumoren nach selektiver interner Radiotherapie. Radiologe 48, 839–849 (2008). https://doi.org/10.1007/s00117-008-1730-x

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