Palliative Therapie von Gallengangs- und Gallenblasenkarzinomen

Abstract

Non-resectable cholangiocarcinoma and gallbladder carcinoma have a poor prognosis. In addition to the general aspects of "best supportive care", biliary drainage is an important part of the palliative treatment of patients with malignant biliary stenosis. Photodynamic therapy has led to an improved median survival in hilar cholangiocarcinoma in two controlled studies. The survival benefit of external radiation or intraluminal brachytherapy has not yet been convincingly demonstrated. Whether or not systemic chemotherapy should be applied is still under debate. A single study including advanced biliary and pancreatic cancer patients has demonstrated a survival benefit for the combined group. In recent years, new chemotherapy protocols have been applied, some with promising results. Intra-arterial chemotherapy and chemotherapeutically coated stents have not been evaluated well enough to be recommended outside clinical studies. Ablative therapies have been used in a limited number of patients only. Further studies are necessary to clarify whether these treatment modalities are effective.

Palliative hepatic intraarterial chemotherapy (HIC) using a novel combination of gemcitabine and mitomycin C: results in hepatic metastases

“…The results seen in our patients (PR 20%, PD 60%) are not convincing, maybe due to a too conservative dosage of gemcitabine (1,000 mg/m 2 ) [6,35,36,40]. We recently treated a group of pancreatic (n=7) and cholangiocarcinoma patients (n=17) in a dose-escalation study with hepatic intraarterial gemcitabine with or without subsequent administration of embolization particles [40].…”

“…CR, 19 PR, 19 SD and 16 PD [overall response rate (OR)36.4%] were achieved. Of all patients, responders survived significantly longer than patients with progressive disease (12.4 vs. 6.3 months; P=0.005).…”

Radiologische Diagnostik und Intervention von Cholangiokarzinomen (CC)

“…Die Indikation zur Drainage lässt sich in 3 Felder einteilen: zur symptomatischen Therapie der Cholestase, insbesondere des Pruritus und Ikterus durch biliäre Dekompression, zur Vermeidung einer vorzeitigen Leberfunktionseinschränkung sowie zur Verringerung der Infektionsgefahr insbesondere nach einer Kontrastmittelinjektion im Rahmen einer ERCP [17,67] [67]. Metallstents dislozieren allerdings häufiger [71].…”

Aktuelle Chemotherapiekonzepte bei Gallengangskarzinomen

“…Deshalb nimmt die palliative Therapie biliärer Tumoren schon rein [48,49,51,[53][54][55]. Auch der Stellenwert einer kombinierten Radiochemotherapie gegenüber der Chemotherapie, der Bestrahlung und lediglich der biliären Drainage ist derzeit ungeklärt [56].…”