[Local and locoregional treatment of intrahepatic cholangiocarcinoma].
Lokale und lokoregionäre Therapie des intrahepatischen Cholangiokarzinoms.
Interventional oncology
Intraarterial therapy
Intrahepatic cholangiocarcinoma
Locoregional therapy
S3-guideline
Journal
Der Radiologe
ISSN: 1432-2102
Titre abrégé: Radiologe
Pays: Germany
ID NLM: 0401257
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
accepted:
29
11
2021
pubmed:
5
1
2022
medline:
8
3
2022
entrez:
4
1
2022
Statut:
ppublish
Résumé
In the new edition of the German S3-guideline published in June 2021, the diagnosis and treatment of cholangiocarcinoma (CCA) and gallbladder carcinoma are addressed for the first time. This article discusses the local and locoregional treatment options for intrahepatic CCA (iCCA). Mortality is high in iCCA and the incidence is rising. In unresectable patients, treatment options include local and locoregional approaches. Besides recommendations regarding surgery, biliary drainage, intraductal locoregional therapy and radiation therapy, two recommendations regarding interventional radiologic therapies are included in the updated S3-guideline. Percutaneous thermal ablation via radiofrequency or microwave ablation (RFA/MWA) is suggested for unresectable tumors with up to 3 cm in diameter as primary therapy and for recurrent tumors. In advanced, liver dominant iCCA, intra-arterial therapies such as transarterial radioembolization (TARE), transarterial chemoembolization (TACE) or hepatic arterial infusion (HAI) are recommended as single therapy or in combination with other therapies. Due to a lack of randomized controlled studies, the efficacy of locoregional therapies in iCCA is challenging to assess; however, various cohort studies, meta-analyses and review articles confirm their efficiency. Interventional radiological therapies alone or in combination with systemic therapies have the potential to improve the prognosis of patients with iCCA. Due to the various therapeutic options, patients with iCCA should be treated in centers which cover the entire therapeutic spectrum. KLINISCHES/METHODISCHES PROBLEM: In der Juni 2021 erschienenen Neuauflage der deutschen S3-Leitlinie wird erstmals auch auf die Diagnostik und Therapie des Cholangiokarzinoms (CCA) und Gallenblasenkarzinoms eingegangen. In diesem Artikel werden die lokalen und lokoregionären Therapien des intrahepatischen CCA (iCCA) diskutiert. Die Mortalität des iCCA ist hoch, die Inzidenz ist zunehmend. Bei inoperablen Patienten umfassen die Therapiemöglichkeiten auch lokale und lokoregionäre Verfahren. Neben Empfehlungen zur operativen Therapie, biliären Drainage, intraduktalen lokoregionären Therapie und zur Strahlentherapie sind auch 2 Empfehlungen zur interventionell radiologischen Therapie in der aktuellen S3-Leitlinie formuliert. Perkutane thermische Ablationen durch Radiofrequenz- oder Mikrowellenablation (RFA/MWA) werden bei irresektablen Tumoren bis 3 cm Durchmesser, primär und insbesondere bei Rezidiven empfohlen. Bei fortgeschrittenen, leberdominanten iCCA können intraarterielle Verfahren wie die transarterielle Radioembolisation (TARE), transarterielle Chemoembolisation (TACE) oder die hepatische arterielle Infusion (HAI), alleine oder in Kombination, angewandt werden. Aufgrund fehlender randomisiert-kontrollierter Studien ist die Beurteilung der Wirksamkeit lokoregionärer Therapieverfahren eingeschränkt. Zahlreiche Kohortenstudien, Metaanalysen und Review-Artikel bestätigen jedoch deren Effektivität. EMPFEHLUNG FüR DIE PRAXIS: Interventionell radiologische Verfahren alleine oder in Kombination mit systemischer Therapie haben das Potenzial, die Prognose von Patienten mit iCCA zu verbessern. Aufgrund der zahlreichen Therapieoptionen sollten die Patienten mit iCCA in einem Zentrum behandelt werden, in dem das gesamte Therapiespektrum abgedeckt wird.
Autres résumés
Type: Publisher
(ger)
KLINISCHES/METHODISCHES PROBLEM: In der Juni 2021 erschienenen Neuauflage der deutschen S3-Leitlinie wird erstmals auch auf die Diagnostik und Therapie des Cholangiokarzinoms (CCA) und Gallenblasenkarzinoms eingegangen. In diesem Artikel werden die lokalen und lokoregionären Therapien des intrahepatischen CCA (iCCA) diskutiert.
Identifiants
pubmed: 34981129
doi: 10.1007/s00117-021-00946-9
pii: 10.1007/s00117-021-00946-9
doi:
Types de publication
Journal Article
Review
Langues
ger
Sous-ensembles de citation
IM
Pagination
247-252Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.
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