Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Cancer. 2022 Mar 1;128(5):956-965. doi: 10.1002/cncr.34033. Epub 2021 Nov 30.
The use of radiation for primary liver cancers has historically been limited because of the risk of radiation-induced liver disease. Treatment fields have become more conformal because of several technical advances, and this has allowed for dose escalation. Stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy, is now able to safely treat liver tumors to ablative doses while sparing functional liver parenchyma by using highly conformal therapy. Several retrospective and small prospective studies have examined the use of SBRT for liver cancers; however, there is a lack of well-powered randomized studies to definitively guide management in these settings. Recent advances in systemic therapy for primary liver cancers have improved outcomes; however, the optimal selection criteria for SBRT as a local therapy remain unclear among other liver-directed options such as radiofrequency ablation, transarterial chemoembolization, and radioembolization.
由于存在放射性肝损伤的风险，辐射在原发性肝癌治疗中的应用历来受到限制。随着几项技术进步，治疗野变得更加适形，从而可以进行剂量递增。立体定向体部放射治疗（SBRT），也称为立体定向消融放疗，现在可以通过使用高度适形的治疗来安全地治疗肝脏肿瘤至消融剂量，同时保护功能性肝实质。一些回顾性和小型前瞻性研究已经研究了 SBRT 在肝癌中的应用；然而，缺乏足够有力的随机研究来明确指导这些情况下的治疗管理。原发性肝癌的系统治疗的最新进展改善了治疗结果；然而，SBRT 作为局部治疗的最佳选择标准在其他肝脏导向治疗方法（如射频消融、经动脉化疗栓塞和放射性栓塞）中仍不明确。
