The Ottawa Hospital Cancer Centre, Ottawa, Ontario.
Curr Oncol. 2010 Apr;17(2):6-12. doi: 10.3747/co.v17i2.555.
Hepatocellular carcinoma (HCC) is an uncommon tumour, but its incidence is increasing in Canada and elsewhere. Currently, there are no Canadian recommendations for diagnosis and treatment of hcc, and possible options may have regional limitations. A consensus symposium was held in the Ottawa region to consider current diagnostic and management options for hcc. These recommendations were developed: Diagnosis-with adequate imaging, a biopsy is not required pre-surgery, but is required before the start of systemic therapy; lesions smaller than 1 cm should be followed and not biopsied; repeat biopsies should be core tissue biopsies; magnetic resonance imaging is preferred, but triphasic computed tomography imaging can be useful. Resection-recommended for localized HCC. Radiofrequency ablation-recommended for unresectable or non-transplantable HCC; should not be performed in the presence of ascites. Trans-arterial chemoembolization (TACE)-doxorubicin with lipiodol is the agent of choice; trans-catheter embolization is an alternative for patients if TACE is not tolerated or is contraindicated. Medical management-first-line sorafenib should be considered the standard of care. Transplantation-suitable patients meeting Milan criteria should be assessed for a graft regardless of other treatments offered. The authors feel that the recommendations from this consensus symposium may be of interest to other regions in Canada.
肝细胞癌 (HCC) 是一种罕见的肿瘤，但在加拿大和其他地方其发病率正在上升。目前，加拿大没有关于 HCC 诊断和治疗的建议，并且可能的选择可能存在区域性限制。在渥太华地区举行了一次共识研讨会，以考虑 HCC 的当前诊断和管理选择。提出了以下建议：诊断-充分的影像学检查，手术前不需要活检，但在开始系统治疗前需要活检；小于 1cm 的病变应随访而不进行活检；重复活检应进行核心组织活检；首选磁共振成像，但三期 CT 成像也可以有用。切除术-推荐用于局限性 HCC。射频消融术-推荐用于不可切除或不可移植的 HCC；腹水存在时不应进行。经动脉化疗栓塞术 (TACE)-多柔比星联合碘化油是首选药物；如果 TACE 不耐受或禁忌，则经导管栓塞是患者的另一种选择。药物治疗-一线索拉非尼应被视为标准治疗。移植-符合米兰标准的合适患者应评估供体，无论提供其他何种治疗。作者认为，本次共识研讨会的建议可能对加拿大其他地区感兴趣。
