Department of Radiology.
Department of Oncology, Jules Bordet Institute, Brussels, Belgium.
Curr Opin Oncol. 2019 Jul;31(4):339-345. doi: 10.1097/CCO.0000000000000539.
This review explores current knowledge and recent data about vascular-centered locoregional treatments and proposes alternate algorithms.
Hepatocellular carcinoma represents the sixth most common neoplasm worldwide. Currently, the Barcelona Clinic Liver Cancer (BCLC) staging is the most commonly used in Europe for treatment allocation. According to this classification, European Society for Medical Oncology (ESMO) guidelines currently recommend transarterial chemoembolization for intermediate stage HCC and systemic treatments, such as, sorafenib in more advanced stages. However, strong evidences are still lacking to conclude to the superiority of one technique over another, as the optimal treatment choice remains challenging and should take into consideration more clinical, biological and imaging findings than reported in the BCLC staging system, such as patient age or clinical status, tumor characteristics (including distribution and heterogeneity), tumor vascularization and concomitant portal hypertension or biliary anomalies.
Many controversies remain, in particular, the relative place of bland embolization versus chemoembolization, the clinical benefit of drug-eluting bead chemoembolization (DEB-TACE) over conventional chemoembolization (cTACE), as well as the real place of radioembolization in general setting as well as innovative applications, such as radiation segmentectomy and radiation lobectomy.
本文探讨了以血管为中心的局部区域治疗的现有知识和最新数据，并提出了替代方案。
肝细胞癌是全球第六大常见肿瘤。目前，巴塞罗那临床肝癌（BCLC）分期在欧洲最常用于治疗分配。根据这一分级，欧洲肿瘤内科学会（ESMO）指南目前建议对中危 HCC 进行经动脉化疗栓塞治疗，对更晚期的 HCC 采用索拉非尼等全身治疗。然而，仍然缺乏强有力的证据来得出一种技术优于另一种技术的结论，因为最佳治疗选择仍然具有挑战性，应该考虑更多的临床、生物学和影像学发现，而不仅仅是 BCLC 分期系统中报告的那些，例如患者年龄或临床状况、肿瘤特征（包括分布和异质性）、肿瘤血管生成以及伴随的门静脉高压或胆管异常。
仍然存在许多争议，特别是单纯栓塞与化疗栓塞的相对地位、载药微球化疗栓塞（DEB-TACE）相对于传统化疗栓塞（cTACE）的临床获益，以及放射性栓塞在一般情况下以及创新应用（如放射段切除术和放射叶切除术）中的实际地位。
