Qian Kun, Zhang Feng, Allison Stephen K, Zheng Chuansheng, Yang Xiaoming
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, China.
Department of Radiology, Image-Guided Biomolecular Intervention Research, University of Washington School of Medicine, Seattle, WA, 98109, USA.
J Interv Med. 2020 Oct 12;4(1):1-7. doi: 10.1016/j.jimed.2020.10.008. eCollection 2021 Feb.
Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages. Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve. Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.
肝细胞癌(HCC)是全球最致命且常见的癌症之一,尽管在过去几十年中这种恶性肿瘤的治疗取得了巨大进展。由于发病率不断上升和预后不佳,它仍然是一个主要的健康问题。在美国或中国,大多数患者的HCC在中晚期被诊断出来。在这些阶段,诸如手术切除或肝移植等根治性治疗不被视为治疗选择。经动脉化疗栓塞术(TACE)是最广泛使用的局部治疗方法,曾是不可切除癌症实体病例的主要治疗手段。然而,对于那些血管少的肿瘤或肝功能储备受损的患者,TACE是次优的治疗选择。例如,栓塞不能完全覆盖血管少的肿瘤,在这些对TACE耐药的患者中,反而可能促进术后肿瘤复发或留下残余肿瘤。此外,TACE在肝功能或储备差的患者中导致肝失代偿的风险更高。HCC的非血管介入局部治疗包括射频消融(RFA)、微波消融(MWA)、高强度聚焦超声(HIFU)、激光诱导热疗(LITT)、冷冻消融(CSA)、不可逆电穿孔(IRE)、经皮乙醇注射(PEI)和近距离放射治疗。这些技术的最新进展显著提高了HCC的治疗效果,并扩大了符合治疗条件的患者群体。本综述涵盖了HCC影像引导下局部非血管介入治疗的现状,主要关注这些介入技术联合治疗的临床评估和疗效评估。
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