Chemoembolization is a minimally invasive therapy option for palliative treatment of liver metastases in patients with colorectal cancer, with similar results among three chemoembolization protocols.

Transarterial hepatic chemotherapy using mitomycin C and gemcitabine can be an effective therapeutic protocol for controlling local metastases and improving survival time in patients with hepatic metastases from neuroendocrine tumors.

The purpose was to evaluate the effectiveness of transarterial chemoembolization (TACE) in local tumor control and survival in patients with hepatic metastases from renal cell carcinoma (RCC). Prospective evaluation of TACE treatment outcome in 22 patients recruited from 1999 and 2005 was performed. The chemotherapeutic agent used was mitomycin only in 45% of the patients and mitomycin together with gemcitabine in the other 55%. The embolizing materials used in all of the patients were iodized oil (lipiodol) and degradable starch microspheres. Local response was evaluated by MRI and judged according to Response Evaluation Criteria in Solid Tumors (RECIST). Mean and median survival and survival probability after diagnosis and treatment were both calculated by Kaplan-Meier method. Partial response was achieved in 13.7%, stable disease in 59% and progressive disease in 27.3% of patients. Survival time from the diagnosis of metastases ranged from 18 to 307 months and from 2.2 to 35 months from the start of TACE treatment. The median and mean survival times from the date of diagnosis were 68.6 and 102.9 months, respectively. The median and mean survival times from the start of TACE were 8.2 and 11.7 months, respectively. Survival probability from the start of treatment was 31% after 1 year and 6% after 2 years. TACE can result in a favorable local tumor response in patients with hepatic metastases from RCC, but survival results are still limited.

A high-pitch, dual-source mode is potentially advantageous for evaluating the lung parenchyma and vascular structures in patients who have difficulty complying with breath-holding instructions. Increasing from 16 to 128 slices can significantly reduce the number and severity of motion artifacts.

e15595 Background: To evaluate local tumor control and survival data in the palliative and symptomatic treatment of hepatic cholangiocarcinoma (CCC) using repeated transarterial chemoperfusion and -embolization (TACE) with two different chemotherapy protocols. Methods: 41 patients with primary cholangiocarcinoma (CCC) were repeatedly treated with transarterial chemoembolization (TACE) in 4-week intervals. In total, 291 TACE sessions were performed with a mean of 7.1 sessions per patient (mean age: 57.1 years; range, 37–80 years). 22 patients had multiple tumors, 6 showed 1 lesion, 5 had 2 lesions and 8 presented 3 to 4 lesions. The local chemotherapy protocol consisted of Mitomycin C alone (n=20), or in combination with gemcitabine (n=18). Embolization was performed with lipiodol and starch microspheres for vessel occlusion. Tumor response was evaluated by magnetic resonance imaging (MRI) in 3-month intervals. Results: Evaluation of local tumor control according to the RECIST criteria was as follows: partial response 9.8%, stable disease 43.6%, and progressive disease 46.6%. The 1-year survival rate after TACE was 58%, the 2-year survival rate was 21%. The mean survival time from the date of diagnosis of liver involvement was 34.1 months (according to Kaplan-Meier), after first TACE treatment 16.7 months. The median survival time of the palliative group was 14.5 months and of the symptomatic group 6 months. Conclusions: Our data indicated that repeated TACE using the protocols is well tolerated and yields respectable results in patients with unresectable liver lesions from CCC. No significant financial relationships to disclose.

4062 Background: To evaluate the efficacy of chemoembolization (TACE) in the treatment of liver metastases in colorectal cancer patients concerning local control and survival. Methods: 207 patients with liver metastases of colorectal cancer were treated with repeated TACE in 4-week intervals. In total, 1,307 chemoembolizations were performed with a mean of 6.3 sessions per patient. At the time of first chemoembolization the average age of the patients was 68.8 years (range, 39.4–83.5 years). 158 patients were treated palliatively, 35 symptomatically and 14 patients neoadjuvantly. The chemotherapy consisted of Mitomycin C with/without Gemcitabin; embolization was performed with Lipiodol and starch microspheres for vessel occlusion. Tumor response was evaluated by magnetic resonance imaging (MRI). The change in size was calculated and the response was evaluated according to the RECIST criteria. Survival rates from the first diagnosis and from the first TACE session were both calculated according to the Kaplan-Meier method to obtain the median survival. Results: While 70% of the patients showed multiple metastases, 6% had 1 metastasis, 5.8% had 2 metastases and 18.2% had 3 to 4 metastases. Lesion size and number before, during and after treatment were assessed to deduce the morphological response. Local control results according to the RECIST criteria were as follows: partial response 12% of patients, stable disease in 51% and progressive disease in 37%. The 1-year survival rate after TACE was 62%, but the 2-year survival rate had been reduced to 38%. The median survival time from the date of diagnosis of metastases was 3.4 years (according to Kaplan-Meier), the median survival time from the start of TACE treatment was 1.34 years. The median survival time of the palliative group was 1.4 years, of the symptomatic group 0.8 years and of the neoadjuvant group 1.5 years. Conclusions: TACE is an effective minimal-invasive therapy for neoadjuvant, symptomatic or palliative treatment of liver metastases in colorectal cancer patients. No significant financial relationships to disclose.

Einleitung Lebermetastasen des kolorektalen Karzinoms stellen immer noch eine kritische Situation für die Therapiestrategie dar. Die moderne onkologische Therapie des kolorektalen Karzinoms beruht dabei auf den Säulen der Chirurgie, der systemischen Chemotherapie und Immuntherapie sowie der Radiotherapie. Neuere Techniken in der interventionellen Onkologie ergänzen das Spektrum bei spezifischen Indikationsstellungen (Tab. 1). Die 5-Jahresüberle-bensraten bei kolorektalem Karzinom gehen über 30 und 45 % hinaus, das krankheitsfreie Überleben liegt bei 20 % [6, 10]. Während das mediane Überleben von unbehandelten Patienten bei weniger als 12 Monaten liegt, sind heute bei modernen Chemotherapien Überlebenszeiten von 24 bis 27 Monaten üblich [4, 18]. Im Falle von metachronen, singulären oder oligonodulären Metastasen erhöhen sich die Überlebenschancen beträchtlich [3]. Im Folgenden werden die verschiedenen minimal-invasiven Therapieverfahren bei der Behandlung von Lebermetastasen des kolorektalen Karzinoms vorgestellt. Transarterielle Chemoembolisation (TACE) Gesundes Lebergewebe wird zu 75 % über das Portalvenensystem und zu 25 % vom arteriellen Blutstrom versorgt. Demgegenüber werden Lebertumore bis zu 95 % über die A. hepatica versorgt. Die Embolisation der A. hepatica bewirkt ischämische Nekrosen im Tumorgewebe, während das normale Lebergewebe durch die ausreichende portalvenöse Perfusion geschont wird. Zusätzlich werden durch die arterielle Einbringung der Chemotherapeutika in die A. hepatica im Lebergewebe bis zu 100fach höhere Konzentrationen gegenüber einer systemischen Chemotherapie erreicht, bei weniger starken Nebenwirkungen. Durch die Unterbindung des arteriellen Blutstroms wird die Wirkungszeit der Chemotherapeutika um Stunden bis Wochen verlängert. Bei der TACE erfolgt zunächst die Punktion der A. femoralis in der Leistenregion nach Lokalanästhesie. Hierbei wird in der Regel ein sehr kleines Schleusensystem verwendet, über welches dann ohne größeren Blutverlust die verschiedenen Katheter oder Führungsdrähte in die Arterien eingebracht werden können. Nach der Darstellung der Aorta und der großen hiervon abgehenden Gefäße wird ein sehr kleiner Katheter über die A. hepatica möglichst nah an die den Tumor versorgenden Arterien vorgeschoben. Dann wird die Chemoembolisation mit Mitomycin C, Gemcitabine, Cisplatin, Irinotecan oder Doxorubicin durchgeführt, kombiniert mit Lipiodol oder EmboCept zur Okklusion der Gefäße. Um das Auftreten von Schmerzen während der Behandlung zu vermeiden, werden den Patienten zusätzlich Schmerzmedikamente verabreicht. Nach Abschluss der TACE und Entfernung der Katheter und des Schleusensystems erfolgt die Anlage eines Druckverbandes zur Vermeidung von Komplikationen in der Leistengegend. In der folgenden 6-stündigen Überwachungsphase können mögliche Komplikationen erkannt und behandelt werden.

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