Division of Hepatology, Seoul St Mary's Hospital, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Oncology. 2011;81 Suppl 1:141-7. doi: 10.1159/000333277. Epub 2011 Dec 22.
The practice guideline for hepatocellular carcinoma (HCC) in Korea was revised in 2009. It was based on clinical evidence. The treatment algorithm was divided into curative and noncurative treatments. According to Barcelona Clinic Liver Cancer (BCLC) staging, the curative treatment group included early stage HCC (BCLC-A), and the noncurative treatment group consisted of intermediate and advanced stages of HCC (BCLC-B, C). The intermediate stage of HCC stands for noncurative disease, and therefore surgical resection and radiofrequency ablation are not considered as primary treatment modalities. Transarterial chemoembolization (TACE) forms the backbone of the treatment for intermediate stage HCC with Child-Pugh A cirrhosis. Patients in whom complete necrosis is not achieved or early recurrence after TACE develops should receive individualized treatments such as systemic treatment or combined radiation therapy (RT). Liver transplantation (LT) can be carried out for intermediate stage HCCs. However, the long-term survival rate after LT for intermediate stage HCCs is inferior to that of early stage HCCs because intermediate stage HCCs exceed the Milan criteria. In patients with Child-Pugh C liver function, LT would be better than TACE in terms of survival gain if the tumor burden is acceptable by expert opinion standards. The treatment algorithm becomes very complicated when it comes to advanced stage HCC. Sorafenib, a multikinase inhibitor with antiangiogenic and antiproliferative properties, has been shown to prolong the median overall survival and the median time to radiological progression compared to placebo in randomized controlled trials (RCTs) and has become the current standard of care for patients with advanced-stage tumors not suitable for surgical or locoregional therapies. RT is in the process of becoming a modality with a high efficacy and minimum side effects for HCC treatment, with recent improvements in equipment as well as radiation methods. However, to discover whether RT is really beneficial in the treatment of large-sized intermediate and advanced stage HCC, prospective RCTs should be carried out.
韩国的肝细胞癌（HCC）实践指南于 2009 年进行了修订。它是基于临床证据制定的。治疗方案分为根治性和非根治性治疗。根据巴塞罗那临床肝癌（BCLC）分期，根治性治疗组包括早期 HCC（BCLC-A），非根治性治疗组包括中晚期 HCC（BCLC-B、C）。中期 HCC 表示无法治愈的疾病，因此不考虑手术切除和射频消融作为主要治疗方法。经动脉化疗栓塞（TACE）是伴有 Child-Pugh A 肝硬化的中期 HCC 治疗的基础。未达到完全坏死或 TACE 后早期复发的患者应接受个体化治疗，如系统治疗或联合放射治疗（RT）。肝移植（LT）可用于中期 HCC。然而，由于中期 HCC 超出米兰标准，中期 HCC 患者 LT 的长期生存率低于早期 HCC 患者。对于肝功能为 Child-Pugh C 的患者，如果肿瘤负荷符合专家意见标准，LT 比 TACE 在生存获益方面更具优势。对于晚期 HCC，治疗方案变得非常复杂。多激酶抑制剂索拉非尼具有抗血管生成和抗增殖作用，在随机对照试验（RCT）中与安慰剂相比，可延长中位总生存期和中位影像学进展时间，已成为不适合手术或局部区域治疗的晚期肿瘤患者的标准治疗方法。RT 正在成为一种治疗 HCC 疗效高、副作用小的方法，最近设备和放射方法的改进也提高了 RT 的疗效。然而，要确定 RT 在治疗大尺寸中晚期 HCC 中是否真的有益，应开展前瞻性 RCT。
