Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
Department of Medicine, Gastroenterology, Duke University Medical Center, Durham, North Carolina.
Cancer. 2018 Sep 1;124(17):3476-3489. doi: 10.1002/cncr.31334. Epub 2018 Apr 12.
Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.
肝细胞癌 (HCC) 的发病率和死亡率正在上升。尽管预后仍然不佳，但长期生存率已从 1970 年的 3%提高到今天的 18% 5 年生存率。这可能是因为引入了耐受良好的口服抗病毒疗法治疗丙型肝炎。 HCC 患者的治愈选择通常受到潜在的肝功能障碍/肝硬化和合并症的限制。不到三分之一的患者适合手术，这是目前治愈的金标准。非手术治疗包括栓塞疗法、经皮消融和消融放射治疗。过去几十年中，放射治疗技术的进步现在可以安全有效地对肝脏进行消融剂量。适形技术既能提高靶区剂量，又能保护正常组织。多项回顾性和前瞻性研究表明，作为单一疗法或与其他肝脏定向疗法联合使用的分割成像引导放射治疗可以提供出色的局部控制效果，具有成本效益。因此，随着 HCC 治疗模式的不断发展，消融放射治疗已从姑息性治疗转变为“桥接移植”和确定性治疗。
