基于临床证据的肝细胞癌 TACE 治疗更新:如何以及何时使用。
Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence.
机构信息
Digestive Oncology, Institut de Cancérologie de l'Ouest, Boulevard Professeur Jacques Monod, 44805 Nantes-Saint Herblain, France.
Barcelona Clinic Liver Cancer Group, Liver Unit, IDIBAPS, Hospital Clínic, University of Barcelona, Calle Villaroel 170, 08036 Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Avenida Monforte de Lemos, 28029 Madrid, Spain.
出版信息
Cancer Treat Rev. 2019 Jan;72:28-36. doi: 10.1016/j.ctrv.2018.11.002. Epub 2018 Nov 12.
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the sixth leading cause of cancer and the third leading cause of cancer-related mortality. Patient stratification and treatment allocation are based on tumor stage, liver function, and performance status. According to the Barcelona Clinic Liver Cancer (BCLC) staging system, transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate stage HCC, including those with large or multinodular HCC, well-preserved liver function, and no cancer-related symptoms or evidence of vascular invasion or extrahepatic spread. Two TACE techniques have been used since 2004, conventional TACE (cTACE) and TACE with drug-eluting beads (DEB-TACE). cTACE was evidenced first to treat intermediate stage HCC patients. It combines the transcatheter delivery of chemotherapy using Lipiodol-based emulsion plus an embolizing agent to achieve strong cytotoxic and ischemic effects. Drug-eluting beads (DEBs) were developed in order to slowly release chemotherapeutic agents, and to increase ischemia intensity and duration. Recent advances allow TACE treatment of both early stage patients (i.e. those with a solitary nodule or up to 3 nodules under 3 cm) and some advanced stage patients. Here we review recent clinical evidence related to TACE treatment of patients with early, intermediate, and advanced stage HCC. Based on the 2014 TACE algorithm of Raoul et al., this international expert panel proposes an updated TACE algorithm and provides insights into TACE use for patients at any HCC stage.
肝细胞癌 (HCC) 是最常见的原发性肝癌,占癌症的第六大常见病因,也是癌症相关死亡的第三大常见病因。患者分层和治疗分配基于肿瘤分期、肝功能和体能状态。根据巴塞罗那临床肝癌 (BCLC) 分期系统,经动脉化疗栓塞 (TACE) 是中期 HCC 患者的一线治疗方法,包括大或多结节 HCC、肝功能良好且无癌症相关症状或血管侵犯或肝外扩散证据的患者。自 2004 年以来,已经使用了两种 TACE 技术,即传统 TACE (cTACE) 和载药微球 TACE (DEB-TACE)。cTACE 是首先被证实用于治疗中期 HCC 患者的方法。它结合了使用载 Lipiodol 的乳剂加栓塞剂的经导管化疗输送,以实现强烈的细胞毒性和缺血作用。载药微球 (DEBs) 的开发是为了缓慢释放化疗药物,并增加缺血的强度和持续时间。最近的进展允许 TACE 治疗早期 (即单发结节或 3cm 以下的 3 个结节) 和一些晚期患者。在这里,我们回顾了与 TACE 治疗早期、中期和晚期 HCC 患者相关的最新临床证据。基于 Raoul 等人 2014 年的 TACE 算法,这个国际专家小组提出了一个更新的 TACE 算法,并就 TACE 在任何 HCC 阶段的应用提供了一些见解。