影像引导经皮局部区域治疗肝癌。

Image-guided percutaneous locoregional therapies for hepatocellular carcinoma.

机构信息

Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, François-Mitterrand University Hospital, Dijon, France.

Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

出版信息

Chin Clin Oncol. 2023 Apr;12(2):17. doi: 10.21037/cco-22-119. Epub 2023 Apr 18.

Abstract

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the 3rd leading cause of cancer death worldwide. Treatment options include surgical resection, liver transplantation, image-guided percutaneous locoregional options, external beam radiation therapy (EBRT) and systemic therapies. Treatment choice depends on the stage of the disease and patient's characteristics including performance status and liver function. Barcelona Clinic Liver Cancer (BCLC) staging system, with its recent 2022 update, is one of the most widely endorsed staging system. Locoregional therapies (LRT) are recommended for very early stage (BCLC-0), early stage (BCLC-A), and the two first subgroups of intermediate stage (BCLC-B). Image-guided percutaneous locoregional therapies include ablation, mainly thermal ablation with radiofrequency (RFA), microwave ablations (MWA) and cryoablation, transarterial embolization (TAE, also known as bland embolization), transarterial chemoembolization (TACE), drug-eluding beads-transarterial chemoembolization (DEB-TACE), combination of ablation with embolization, transarterial radioembolization (TARE) also known as selective internal radioembolization therapy, and hepatic artery infusion (HAI). While ablation is recognized as a curative therapy, all intra-arterial therapies are considered non-curative options. There is growing evidence that TARE, through radiation segmentectomy, can be considered a curative intent treatment in appropriate selective patients. In this article, we will review indications, complications, and outcomes of locoregional therapies for HCC.

摘要

肝细胞癌 (HCC) 是最常见的原发性肝癌,也是全球癌症死亡的第 3 大主要原因。治疗选择包括手术切除、肝移植、影像引导下经皮局部区域治疗、外照射放疗 (EBRT) 和系统治疗。治疗选择取决于疾病的阶段和患者的特征,包括体能状态和肝功能。巴塞罗那临床肝癌 (BCLC) 分期系统及其最近的 2022 年更新是最广泛认可的分期系统之一。局部区域治疗 (LRT) 推荐用于极早期 (BCLC-0)、早期 (BCLC-A) 和两个中间期的前两个亚组 (BCLC-B)。影像引导下经皮局部区域治疗包括消融,主要是射频 (RFA)、微波消融 (MWA) 和冷冻消融的热消融,经动脉栓塞 (TAE,也称为单纯性栓塞)、经动脉化疗栓塞 (TACE)、载药微球经动脉化疗栓塞 (DEB-TACE)、消融与栓塞联合、经动脉放射栓塞 (TARE) 也称为选择性内放射栓塞治疗,以及肝动脉灌注 (HAI)。虽然消融被认为是一种治愈性治疗,但所有的动脉内治疗都被认为是非治愈性选择。越来越多的证据表明,TARE 通过放射段切除术,可以在适当的选择性患者中被视为一种有治愈意图的治疗方法。在本文中,我们将回顾 HCC 的局部区域治疗的适应证、并发症和结果。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索