Department of Radiology, 3400 Spruce St, Philadelphia, PA, 19104, USA.
University of Toronto, 500 University Avenue, Suite 602, Toronto, Ontario, M5G1V7, Canada.
Curr Treat Options Oncol. 2020 Mar 19;21(4):31. doi: 10.1007/s11864-020-0725-3.
The high mortality rate for hepatocellular carcinoma (HCC) relative to its prevalence underscores the need for curative-intent therapies. Image-guided therapies such as ablation and embolization have an established role as primary or neoadjuvants preparing patients for curative treatment.
For HCC < 3 cm, percutaneous thermal ablation provides oncologic outcomes similar to surgical resection and is now a recommended first-line therapy in the EASL guidelines. Both ablation and embolization are recommended as bridging therapies for HCC patients awaiting liver transplantation. T3 HCC can be downstaged by embolization to T2, allowing liver transplantation with similar outcomes to patients transplanted within Milan criteria. New and evolving techniques such as SBRT, radiation segmentectomy and lobectomy, and combination therapies show promise but require further prospective data before they can be integrated into treatment algorithms. Combinations of embolic, ablative, and extirpative therapies can increase access to curative-intent treatment of HCC. Multidisciplinary treatment decisions are required to craft optimal treatment strategies considering tumor size, location, and underlying liver cirrhosis.
肝细胞癌（HCC）的高死亡率与其发病率相比，突显了需要进行根治性治疗的必要性。影像引导治疗，如消融和栓塞，已作为主要治疗或新辅助治疗手段，为患者接受根治性治疗做好准备，具有明确的作用。
对于<3cm 的 HCC，经皮热消融提供的肿瘤学结果与手术切除相似，目前在 EASL 指南中被推荐为一线治疗方法。消融和栓塞均被推荐作为 HCC 患者等待肝移植的桥接治疗。栓塞可将 T3 HCC 降期为 T2，允许进行肝移植，其结果与符合米兰标准的患者相似。新出现和正在发展的技术，如 SBRT、放射节段切除术和叶切除术，以及联合治疗方法显示出希望，但需要进一步的前瞻性数据，才能将其纳入治疗方案。栓塞、消融和切除术的联合治疗可以增加获得 HCC 根治性治疗的机会。需要多学科治疗决策，根据肿瘤大小、位置和潜在肝硬化情况制定最佳治疗策略。
