Radeleff B A, Stampfl U, Sommer C M, Bellemann N, Hoffmann K, Ganten T, Ehehalt R, Kauczor H U
Abt. Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Radiologe. 2012 Jan;52(1):44-55. doi: 10.1007/s00117-011-2211-1.
Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and represents the main cause of death among European patients with liver cirrhosis. Only 30-40% of patients diagnosed with HCC are candidates for curative treatment options (e.g. surgical resection, liver transplantation or ablation). The remaining majority of patients must undergo local regional and palliative therapies. Transvascular ablation of HCC takes advantage of the fact that the hypervascularized HCC receives most of its blood supply from the hepatic artery. In this context transvascular ablation describes different therapy regimens which can be assigned to four groups: cTACE (conventional transarterial chemoembolization), bland embolization (transarterial embolization TAE), DEB-TACE (TACE with drug-eluting beads, DEB) and SIRT (selective internal radiation therapy, radioembolization). Conventional TACE is the most common type of transvascular ablation and represents a combination of intra-arterial chemotherapy and embolization with occlusion of the arterial blood supply. However, there is no standardized regimen with respect to the chemotherapeutic drug, the embolic agent, the usage of lipiodol and the interval between the TACE procedures. Even the exact course of a cTACE procedure (order of chemotherapy or embolization) is not standardized. It remains unclear whether or not intra-arterial chemotherapy is definitely required as bland embolization using very small, tightly calibrated spherical particles (without intra-arterial administration of a chemotherapeutic drug) shows tumor necrosis comparable to cTACE. For DEB-TACE microparticles loaded with a chemotherapeutic drug combine the advantages of cTACE and bland embolization. Thereby, a continuing chemotherapeutic effect within the tumor might cause a further increase in intratumoral cytotoxicity and at the same time a decrease in systemic toxicity.
肝细胞癌（HCC）是全球第五大常见癌症，也是欧洲肝硬化患者的主要死因。在被诊断为HCC的患者中，只有30% - 40%适合进行根治性治疗（如手术切除、肝移植或消融）。其余大多数患者必须接受局部区域和姑息治疗。HCC的经血管消融利用了高度血管化的HCC大部分血液供应来自肝动脉这一事实。在此背景下，经血管消融描述了不同的治疗方案，可分为四类：cTACE（传统经动脉化疗栓塞）、单纯栓塞（经动脉栓塞TAE）、DEB - TACE（载药微球TACE，DEB）和SIRT（选择性内放射治疗，放射性栓塞）。传统TACE是最常见的经血管消融类型，它是动脉内化疗与栓塞相结合，同时阻断动脉血供。然而，在化疗药物、栓塞剂、碘油的使用以及TACE程序之间的间隔方面，没有标准化的方案。甚至cTACE程序的确切过程（化疗或栓塞的顺序）也未标准化。目前尚不清楚动脉内化疗是否绝对必要，因为使用非常小的、精确校准的球形颗粒进行单纯栓塞（不进行动脉内化疗药物给药）显示出与cTACE相当的肿瘤坏死。对于DEB - TACE，载有化疗药物的微球结合了cTACE和单纯栓塞的优点。因此，肿瘤内持续的化疗作用可能会进一步增加肿瘤内的细胞毒性，同时降低全身毒性。
