Department of Radiation Oncology, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima City, Japan.
Department of Radiation Oncology, Hiroshima High-precision Radiotherapy Cancer Center (HIPRAC), Higashi-ku, Hiroshima City, Japan.
Expert Rev Gastroenterol Hepatol. 2020 Apr;14(4):271-279. doi: 10.1080/17474124.2020.1744434.
: According to several guidelines, stereotactic body radiation therapy (SBRT) for early hepatocellular carcinoma (HCC) can be considered an alternative to other modalities, such as resection, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE), or when these therapies have failed or are contraindicated. This article reviews the current status of SBRT for the treatment of HCC.: From the results of many retrospective reports, SBRT is a promising modality with an excellent local control of almost 90% at 2-3 years and acceptable toxicities. Currently there are no randomized trials to compare SBRT and other modalities, such as resection, RFA, and TACE, but many retrospective reports and propensity score matching have shown that SBRT is comparable to the different modalities. Repeated SBRT for intra-hepatic recurrent HCC also resulted in high local control with safety and satisfactory overall survival, which were comparable to those of other curative local treatments.: Despite the good results of SBRT, the conclusions of the comparisons of SBRT and other modalities are still controversial. Further studies, including randomized phase III studies to define that patients are more suitable for each curative local treatment, are needed.
根据多项指南，立体定向体部放射治疗（SBRT）可作为早期肝细胞癌（HCC）的一种替代疗法，适用于其他疗法（如切除术、射频消融术（RFA）和经动脉化疗栓塞术（TACE））失败或禁忌的情况。本文回顾了 SBRT 治疗 HCC 的现状。
多项回顾性报告的结果表明，SBRT 是一种很有前途的治疗方法，2-3 年时的局部控制率接近 90%，且毒性可接受。目前尚无比较 SBRT 与其他疗法（如切除术、RFA 和 TACE）的随机试验，但许多回顾性报告和倾向评分匹配研究表明，SBRT 与不同疗法的效果相当。对肝内复发性 HCC 进行重复 SBRT 也可获得较高的局部控制率，且安全性良好，总生存率令人满意，与其他根治性局部治疗相当。
尽管 SBRT 取得了良好的效果，但 SBRT 与其他疗法比较的结论仍存在争议。需要进一步开展研究，包括随机 III 期研究，以确定哪些患者更适合每种根治性局部治疗。
