Piron Lauranne, Cassinotto Christophe, Guiu Boris
CHU Montpellier, University of Montpellier, Saint-Éloi Hospital, Department of Radiology, Montpellier, France.
CHU Montpellier, University of Montpellier, Saint-Éloi Hospital, Department of Radiology, Montpellier, France.
Presse Med. 2019 Oct;48(10):1156-1168. doi: 10.1016/j.lpm.2019.10.010. Epub 2019 Oct 28.
Interventional radiology (IR) has considerably grown since the 90s and has currently a central position in the management of patients suffering from cancer. The aim of this paper is to describe the principle, indications, technique and results of three common hepatic oncologic IR procedures: preoperative portal vein embolization, transarterial chemoembolization and radioembolization. Portal vein embolization is performed before a right hepatectomy in order to increase the left liver volume and functional capacity to ensure adequate liver function of the future remnant liver and to prevent the post-hepatectomy liver failure. It is a proven, well-tolerated and effective technique, allowing most of patients to undergo surgery. Transarterial chemoembolization consists of an injection of a chemotherapeutic agent and an embolic agent into the hepatic artery to locally act on liver tumors. It is the standard of care for BCLC stage B hepatocellular carcinoma and is also recommended for the liver metastases treatment, mainly from neuroendocrine tumors. Radioembolization is an IR procedure on the rise that consists of the injection into the hepatic artery of Yttrium 90 loaded microparticles, which will preferentially deliver high dose on the tumors, sparing the adjacent hepatic parenchyma. Radioembolization is recommended for the palliative treatment of HCC and for colorectal cancer liver metastases resistant to treatment. It is a very well tolerated intervention which place has yet to be defined in the management of neuroendocrine tumors liver metastases and unresectable cholangiocarcinoma. IR is a constantly evolving discipline with proven techniques playing a major role in the oncological management of liver tumor patients. In oncology, IR is now the 4th patient management linchpin alongside oncology, surgery and radiotherapy.
自20世纪90年代以来，介入放射学（IR）有了显著发展，目前在癌症患者的管理中占据核心地位。本文旨在描述三种常见的肝脏肿瘤介入放射学手术的原理、适应症、技术和结果：术前门静脉栓塞、经动脉化疗栓塞和放射性栓塞。门静脉栓塞在右半肝切除术前进行，以增加左肝体积和功能能力，确保未来剩余肝脏有足够的肝功能，并预防肝切除术后肝功能衰竭。这是一种经过验证、耐受性良好且有效的技术，能使大多数患者接受手术。经动脉化疗栓塞包括将化疗药物和栓塞剂注入肝动脉，以局部作用于肝脏肿瘤。它是巴塞罗那临床肝癌（BCLC）分期B期肝细胞癌的标准治疗方法，也推荐用于肝转移瘤的治疗，主要是神经内分泌肿瘤的肝转移。放射性栓塞是一种正在兴起的介入放射学手术，包括将载有钇90的微粒注入肝动脉，这些微粒将优先在肿瘤上输送高剂量，同时 sparing the adjacent hepatic parenchyma（原文此处可能有误，推测是“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the adjacent hepatic parenchyma”，意为“ sparing the 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