Artikel
Liver resection after selective internal radiotherapy (SIRT)
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Autoren
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Christoph Justinger
- Städtisches Klinikum Karlsruhe, Klinik für Allgemein- und Visceralchirurgie, Karlsruhe, Deutschland
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Konstantinos Kouladouros
- Städtisches Klinikum Karlsruhe, Klinik für Allgemein- und Visceralchirurgie, Karlsruhe, Deutschland
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Klaus Tatsch
- Städtisches Klinikum Karlsruhe, Klinik für Nuklearmedizin, Karlsruhe, Deutschland
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Peter Reimer
- Städtisches Klinikum Karlsruhe, Klinik für diagnostische und interventionelle Radiologie, Karlsruhe, Deutschland
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Martin Binnenhei
- Städtisches Klinikum Karlsruhe, Medizinische Klinik III: Onkologie, Karlsruhe, Deutschland
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Martin Bentz
- Städtisches Klinikum Karlsruhe, Medizinische Klinik III: Onkologie, Karlsruhe, Deutschland
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Thomas Rüdiger
- Städtisches Klinikum Karlsruhe, Institut für Pathologie, Karlsruhe, Deutschland
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Michael R. Schön
- Städtisches Klinikum Karlsruhe, Klinik für Allgemein- und Visceralchirurgie, Karlsruhe, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
Text
Background: Extend of liver resections is now restricted by the volume and functionality of the future liver remnant (FLR). Different strategies have been developed to increase the frequency of curative resections. Selective internal radiation therapy (SIRT) has emerged as an effective therapy for patients with primary non-resectable malignancies of the liver. Here we report a clinical series of patients with curative liver resection following SIRT.
Materials and methods: Starting 2010 all patients with liver malignancies were evaluated in an interdisciplinary tumor board. Patients with marginally resectable liver metastases treated by SIRT followed by liver resection were identified and prospectively documented in a database for subsequent retrospective analysis. The median follow-up was 26 months (range 1- 54 months).
Results: Fifteen patients with marginally resectable liver metastases were planned for liver resection after SIRT. Analyzing the effect of SIRT, we observed a decrease in tumor size and increased volumes of the FLR (relative volume: 34.6±3.9% to 44.0±6.0%). The internal radiation was well tolerated in all patients. After SIRT, twelve patients had potentially curative hepatic resection which was performed safely in all patients. In three patients the therapeutic strategy was changed because of new metastases in the FLR.
Conclusion: The combination of SIRT with modern liver surgery enables new therapeutic options in patients with liver metastases. SIRT as an oncologic intervention that accomplishes tumour control with good patient tolerability offers new options in multimodal therapy strategies.
