Pesapane F, Nezami N, Patella F, Geschwind J F
Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
Med Oncol. 2017 Apr;34(4):58. doi: 10.1007/s12032-017-0917-2. Epub 2017 Mar 16.
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related deaths worldwide with rapidly growing incidence rates in the USA and Europe. Despite improving surveillance programs, most patients are diagnosed at intermediate to advanced stages and are no longer amenable to curative therapies, such as ablation, surgical resection and liver transplantation. For such patients, catheter-based image-guided embolotherapies such as transarterial chemoembolization (TACE) represent the standard of care and mainstay therapy, as recommended and endorsed by a variety of national guidelines and staging systems. The main benefit of these therapies is explained by the preferentially arterial blood supply of liver tumors, which allows to deliver the anticancer therapy directly to the tumor-feeding artery while sparing the healthy hepatic tissue mainly supplied by the portal vein. The tool box of an interventional oncologist contains several different variants of transarterial treatment modalities. Ever since the first TACE more than 30 years ago, these techniques have been progressively refined, both with respect to drug delivery materials and with respect to angiographic micro-catheter and image-guidance technology, thus substantially improving therapeutic outcomes of HCC. This review will summarize the fundamental principles, technical and clinical data on the application of different embolotherapies, such as bland transarterial embolization, Lipiodol-based conventional transarterial chemoembolization as well as TACE with drug-eluting beads (DEB-TACE). Clinical data on Yttrium radioembolization as an emerging alternative, mostly applied for niche indications such as HCC with portal vein invasion, will be discussed. Furthermore, we will summarize the principle of HCC staging, patient allocation and response assessment in the setting of HCC embolotherapy. In addition, we will evaluate the role of cone-beam computed tomography as a novel intra-procedural image-guidance technology. Finally, this review will touch on new technical developments such as radiopaque, imageable DEBs and the rationale and role of combined systemic and locoregional therapies, mostly in combination with Sorafenib.
肝细胞癌（HCC）是全球癌症相关死亡的第二大常见原因，在美国和欧洲发病率迅速上升。尽管监测计划有所改进，但大多数患者在中晚期才被诊断出来，不再适合进行消融、手术切除和肝移植等根治性治疗。对于这些患者，基于导管的影像引导栓塞治疗，如经动脉化疗栓塞（TACE），是各种国家指南和分期系统推荐和认可的标准治疗方法和主要治疗手段。这些治疗方法的主要益处在于肝肿瘤优先通过动脉供血，这使得抗癌治疗能够直接输送到肿瘤供血动脉，同时保留主要由门静脉供血的健康肝组织。介入肿瘤学家的工具包中包含几种不同的经动脉治疗方式变体。自30多年前首次进行TACE以来，这些技术在药物输送材料以及血管造影微导管和影像引导技术方面都得到了逐步改进，从而显著提高了HCC的治疗效果。本综述将总结不同栓塞治疗方法（如单纯经动脉栓塞、基于碘油的传统经动脉化疗栓塞以及载药微球经动脉化疗栓塞（DEB-TACE））应用的基本原理、技术和临床数据。还将讨论钇放射性栓塞作为一种新兴替代方法的临床数据，其主要用于门静脉侵犯等特定适应症的HCC。此外，我们将总结HCC分期、患者分配和HCC栓塞治疗反应评估的原则。此外，我们将评估锥形束计算机断层扫描作为一种新型术中影像引导技术的作用。最后，本综述将涉及不透射线、可成像微球等新技术发展以及全身和局部联合治疗的原理和作用，主要是与索拉非尼联合使用。
