Liu David M, Leung Thomas Wt, Chow Pierce Kh, Ng David Ce, Lee Rheun-Chuan, Kim Yun Hwan, Mao Yilei, Cheng Yu-Fan, Teng Gao-Jun, Lau Wan Yee
Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
Comprehensive Oncology Centre, Hong Kong Sanatorium & Hospital, Hong Kong.
Int J Surg. 2022 Jun;102:106094. doi: 10.1016/j.ijsu.2021.106094. Epub 2022 Jun 1.
Hepatocellular carcinoma (HCC) is subject to different management approaches and guidelines according to Eastern and Western therapeutic algorithms. Use of selective internal radiation therapy (SIRT) with resin yttrium 90 microspheres for HCC has increased in Asia in recent years, without clearly defined indications for its optimal application. The objective of this systematic review and expert consensus statement is to provide guidance and perspectives on the use of SIRT among patients with HCC in Asia.
A systematic literature review identified current publications on HCC management and SIRT recommendations. A group of 10 experts, representing stakeholder specialties and countries, convened between August 2020 and March 2021 and implemented a modified Delphi consensus approach to develop guidelines and indications for use of SIRT for HCC in Asia. Final recommendations were organized and adjudicated based on the level of evidence and strength of recommendation, per approaches outlined by the American College of Cardiology/American Heart Association and Oxford Centre for Evidence-Based Medicine.
The experts acknowledged a general lack of evidence relating to use of SIRT in Asia and identified as an unmet need the lack of phase 3 randomized trials comparing clinical outcomes and survival following SIRT versus other therapies for HCC. Through an iterative process, the expert group explored areas of clinical relevance and generated 31 guidance statements and a patient management algorithm that achieved consensus.
These recommendations aim to support clinicians in their decision-making and to help them identify and treat patients with HCC using SIRT in Asia. The recommendations also highlight areas in which further clinical trials are needed to define the role of SIRT in management of HCC among Asian populations.
根据东西方的治疗算法，肝细胞癌（HCC）的管理方法和指南有所不同。近年来，亚洲使用树脂钇90微球进行选择性内放射治疗（SIRT）治疗HCC的情况有所增加，但其最佳应用的明确指征尚未确定。本系统评价和专家共识声明的目的是为亚洲HCC患者使用SIRT提供指导和观点。
系统的文献综述确定了关于HCC管理和SIRT建议的当前出版物。一组代表利益相关方专业和国家的10位专家于2020年8月至2021年3月召开会议，采用改良的德尔菲共识方法制定亚洲使用SIRT治疗HCC的指南和指征。根据美国心脏病学会/美国心脏协会和牛津循证医学中心概述的方法，基于证据水平和推荐强度对最终建议进行组织和判定。
专家们认识到亚洲在使用SIRT方面普遍缺乏证据，并指出缺乏比较SIRT与其他治疗HCC的临床结局和生存率的3期随机试验是一个未满足的需求。通过反复过程，专家组探讨了临床相关领域，并产生了31条指导声明和一个达成共识的患者管理算法。
这些建议旨在支持临床医生进行决策，并帮助他们在亚洲识别和治疗使用SIRT的HCC患者。这些建议还强调了需要进一步进行临床试验以确定SIRT在亚洲人群HCC管理中的作用的领域。
