Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Gastroenterol Hepatol. 2021 Apr;36(4):873-884. doi: 10.1111/jgh.15175. Epub 2020 Jul 16.
Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third most common cause of cancer-related death. Long-term prognosis remains poor with treatment options frequently limited by advanced tumor stage, tumor location, or underlying liver dysfunction. Stereotactic ablative body radiotherapy (SABR) utilizes technological advances to deliver highly precise, tumoricidal doses of radiation. There is an emerging body of literature on SABR in HCC demonstrating high rates of local control in the order of 80-90% at 3 years. SABR is associated with a low risk of radiation-induced liver disease or decompensation in appropriately selected HCC patients with compensated liver function and is now being incorporated into guidelines as an additional treatment option. This review outlines the emerging role of SABR in the multidisciplinary management of HCC and summarizes the current evidence for its use as an alternative ablative option for early-stage disease, as a bridge to transplant, and as palliation for advanced-stage disease. We outline specific considerations regarding patient selection, toxicities, and response assessment. Finally, we compare current international guidelines and recommendations for the use of SABR and summarize ongoing studies.
肝细胞癌 (HCC) 是全球第五大常见恶性肿瘤，也是癌症相关死亡的第三大主要原因。由于肿瘤分期较晚、肿瘤位置或潜在肝功能障碍等原因，治疗方案往往受到限制，长期预后仍然较差。立体定向消融体放射治疗 (SABR) 利用技术进步来提供高度精确、杀伤肿瘤的放射剂量。目前，关于 HCC 的 SABR 有大量文献，显示出 3 年时局部控制率高达 80-90%。SABR 与适当选择的肝功能代偿 HCC 患者的放射性肝病或失代偿风险低相关，并且现在已被纳入指南作为额外的治疗选择。本文概述了 SABR 在 HCC 多学科管理中的新作用，并总结了其作为早期疾病的消融替代选择、移植桥接和晚期疾病姑息治疗的现有证据。我们概述了关于患者选择、毒性和反应评估的具体注意事项。最后，我们比较了 SABR 使用的当前国际指南和建议，并总结了正在进行的研究。
