Diagnostik und Therapie von Lebermetastasen bei kolorektalem Primärtumor

Contrast-enhanced multislice computer tomography (MSCT) has
established itself as the standard tomographic imaging method both
for diagnosis and for treatment monitoring of hepatic lesions. To
clarify local conditions before partial liver resection,
diffusion-weighted magnetic resonance tomography (DWI-MRT) can also
provide important additional information. In order to meet the
criteria for a R0 resection, a margin of 0.5 mm seems to be
sufficient. Neoadjuvant chemotherapy aiming to reduce tumour size
can be given in parallel with portal artery embolisation without
adversely affecting perioperative morbidity and mortality. As far
as the management of primary resectable liver metastases is
concerned, there is an urgent need for more studies. Despite the
relatively limited evidence, adjuvant chemotherapy is currently
more widely favoured in Germany than perioperative chemotherapy.
There is also considerable need for studies concerning preoperative
therapy in patients with liver metastases that are not (yet)
resectable. In KRAS wild-type tumours, high response rates (in
terms of a reduction in the size of metastases) are achieved with a
cetuximab/chemotherapy combination. Bevacizumab/chemotherapy
combinations lead to high rates of pathohistological complete and
partial remissions. What the best parameter for judging the success
of preoperative therapy is remains unknown, and so comparison
studies using survival as a `hard' endpoint must be carried out.