Interventionelle verfahren zur therapie von lebertumoren

Colorectal liver metastases are the most prevalent reason of secondary liver malignancies in the western world whereas hepatocellular carcinoma is the most frequent liver own tumor. Only 20-30% of this collective can be admitted to potentially curative surgery. In cases of non-resectability, interventional treatment modalities such as RFA, SIRT, TACE and PAIT offer capable therapeutic options with a low rate of adverse effects but otherwise high tumor control rates and will therefore play an increasing role in the treatment of hepatic solid tumors. Recent studies show the therapeutic longterm success of TACE in non-resectable HCCs and the potential of a combined therapy with TACE and PAIT in large HCCs up to 7cm. In accordance with the international recommendation of the EASL (European Association for the Study of the Liver) PAIT should be used as second line treatment in up to three HCC less than 3cm in size. Radiofrequency ablation is applicable in both metastatic and primary liver malignancies. RFA seems to be superior to PAIT alone concerning invasivity, local response rates and survival. SIRT is an effective tool in multifocal metastastatic hepatic disease. In most cases where modern chemotherapeutic concepts including newer drugs such as irinotecan or oxaliplatin have failed SIRT has the potential to stop tumor progression. As most studies show a low level of evidence so far no clear and conclusive recommendation on the indication of interventional treatments can be drawn but actual studies raise hope that these minimal invasive therapies can increase life expectancy of patients with a poor prognosis.