Lin Shi-Ming
Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, College of Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taiwan, ROC.
Liver Cancer. 2013 Apr;2(2):73-83. doi: 10.1159/000343843.
Hepatocellular carcinoma (HCC) is the second commonest cancer in Taiwan. The national surveillance program can detect HCC in its early stages, and various curative modalities (including surgical resection, orthotopic liver transplantation, and local ablation) are employed for the treatment of small HCC. Local ablation therapies are currently advocated for early-stage HCC that is unresectable because of co-morbidities, the need to preserve liver function, or refusal of resection. Among the various local ablation therapies, the most commonly used modalities include percutaneous ethanol injection and radiofrequency ablation (RFA); percutaneous acetic acid injection and microwave ablation are used less often. RFA is more commonly employed than other local ablative modalities in Taiwan because the technique is highly effective, minimally invasive, and requires fewer sessions. RFA is therefore advocated in Taiwan as the first-line curative therapy for unresectable HCC or even for resectable HCC. However, current RFA procedures are less effective against tumors that are in high-risk or difficult-to-ablate locations, are poorly visualized on ultrasonography (US), or are large. Recent advancements in RFA in Taiwan can resolve these issues by the creation of artificial ascites or pleural effusion, application of real-time virtual US assistance, use of combination therapy before RFA, or use of switching RF controllers with multiple electrodes. This review article provides updates on the clinical outcomes and advances in local ablative modalities (mostly RFA) for HCC in Taiwan.
肝细胞癌（HCC）是台湾地区第二常见的癌症。国家监测计划能够在早期阶段检测出HCC，并且多种治愈性治疗方式（包括手术切除、原位肝移植和局部消融）被用于治疗小肝癌。目前，局部消融治疗被推荐用于因合并症、需要保留肝功能或拒绝手术切除而无法切除的早期HCC。在各种局部消融治疗中，最常用的方式包括经皮乙醇注射和射频消融（RFA）；经皮乙酸注射和微波消融的使用较少。在台湾地区，RFA比其他局部消融方式应用更为普遍，因为该技术高效、微创且所需疗程较少。因此，在台湾地区，RFA被推荐作为无法切除的HCC甚至可切除HCC的一线治愈性治疗方法。然而，目前的RFA程序对于处于高风险或难以消融位置、在超声检查（US）中显示不佳或体积较大的肿瘤效果较差。台湾地区RFA的最新进展可以通过制造人工腹水或胸腔积液、应用实时虚拟超声辅助、在RFA前使用联合治疗或使用带有多个电极的切换射频控制器来解决这些问题。这篇综述文章提供了台湾地区针对HCC的局部消融方式（主要是RFA）的临床结果和进展的最新情况。
