Gerum Sabine, Grambozov Brane, Roeder Falk
Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University (PMU), Salzburg, Austria.
J Gastrointest Oncol. 2024 Aug 31;15(4):1880-1892. doi: 10.21037/jgo-23-771. Epub 2024 Feb 2.
Stereotactic body radiation therapy (SBRT) is a highly conformal technique of external beam radiotherapy precisely delivering high total (ablative) doses in a small number of fractions to clearly defined target volumes. Its development enabled efficient and safe radiation treatments in patients with localized hepatocellular cancer (HCC) unsuitable for other local treatment options. Moreover, it can be easily combined with several other therapy approaches. Thus, the aim of this narrative review is to outline the current role of SBRT in the multifocal treatment of HCC patients.
We searched PubMed for articles dealing with SBRT alone, in combination with other local or systemic treatments or in comparison to other local treatments in patients with HCC. This included original articles, reviews and conceptional articles dealing with the technique of SBRT. All articles were analysed for suitability by two independent reviewers.
This review summarizes the currently available evidence for SBRT as a definitive treatment for HCC as well as its role within combination approaches including bridging to transplantation. SBRT is an effective and safe definitive treatment option in patients with localized HCC unsuitable for surgery and/or other local therapies based on retrospective and prospective series. Its combination with other local treatments yields superior results compared to single modality treatment based on non-randomized data. A growing number of prospective trials confirmed at least similar if not superior rates of local control with low toxicities compared to well established other local treatments even in non-selected patients.
SBRT is a promising tool in the treatment of HCC. It can be used either as definitive treatment, within combination approaches or as a bridging tool. Several phase III trials comparing SBRT with other local options are ongoing, which will further clarify its encouraging role.
立体定向体部放射治疗（SBRT）是一种高度适形的外照射放疗技术，能够精确地在少数分次内给予明确界定的靶体积高总量（消融性）剂量。它的发展使那些不适合其他局部治疗选择的局限性肝细胞癌（HCC）患者能够接受高效且安全的放射治疗。此外，它还能轻松地与其他几种治疗方法联合使用。因此，本叙述性综述的目的是概述SBRT在HCC患者多模式治疗中的当前作用。
我们在PubMed上搜索了单独涉及SBRT、与其他局部或全身治疗联合使用或与HCC患者的其他局部治疗进行比较的文章。这包括涉及SBRT技术的原始文章、综述和概念性文章。两名独立审稿人对所有文章进行适用性分析。
本综述总结了目前关于SBRT作为HCC确定性治疗方法的现有证据，以及它在包括过渡到移植的联合治疗方法中的作用。基于回顾性和前瞻性系列研究，SBRT对于不适合手术和/或其他局部治疗的局限性HCC患者是一种有效且安全的确定性治疗选择。根据非随机数据，与单一模式治疗相比，它与其他局部治疗联合使用能产生更好的效果。越来越多的前瞻性试验证实，即使在未经过选择的患者中，与已确立的其他局部治疗相比，SBRT至少具有相似甚至更低毒性的局部控制率。
SBRT是治疗HCC的一种有前景的工具。它既可以用作确定性治疗、联合治疗方法的一部分，也可以用作过渡工具。正在进行几项将SBRT与其他局部选择进行比较的III期试验，这将进一步阐明其令人鼓舞的作用。
