Radioterapija sekundarnih tumorjev jeter Radiotherapy of secondary liver cancer

Povzetek

Sekundarni tumorji jeter, med njimi zasevki tumorjev gastrointestinalnega trakta, raka dojk in pljuč pogosto povzročajo simptome, ki niso obvladljivi s sistemskim zdravljenjem. V primeru difuznih jetrnih zasevkov lahko z obsevanjem celotnih jeter hitro, učinkovito in z majhnimi stroški dosežemo dobro paliacijo simptomov z blagimi neželenimi učinki. Ko je zasevkov manj in je tudi obseg bolezni v telesu manjši, lahko pri izbranih bolnikih z dodatnim lokalnim (ablativnim) zdravljenjem jetrnih zasevkov dosežemo izboljšanje časa do progresa bolezni in celokupnega preživetja. V nadaljevanju prispevka sta opisana radiacijska poškodba jeter in obsevanje jeter z različnimi radioterapevtskimi tehnikami, med katerimi izberemo najustreznejšo glede na obseg bolezni, velikost jetrnih zasevkov, simptome, laboratorijske izvide in stanje zmogljivosti bolnika.

Abstract (Eng)

Liver is commonly involved in a metastatic setting of gastrointestinal, lung and breast cancers. Symptoms of liver metastases are rarely mitigated by systemic (palliative) treatments only. Whole or partial liver radiotherapy is a cost-effective treatment option with minimal treatment toxicity to offer the mitigation of symptoms to patients with diffuse liver metastatic involvement. This treatment approach is different (and sometimes with curative intent) for selected patients with a lower tumour burden and an oligo-metastatic disease. Local ablative treatments of limited number and size of liver metastases show improvements in local control of the tumour, disease-free survival and overall survival. This article describes radiation induced liver disease and different radiation therapy approaches that can be chosen while taking into account the burden of the disease, size and number of liver metastases, symptoms, laboratory tests, possibilities of other local treatments and the clinical performance status of the patient.