Sharma Deepti, Khosla Divya, Meena Babu L, Yadav Hanuman P, Kapoor Rakesh
Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Radiation Oncology, PGIMER, Chandigarh, India.
J Clin Exp Hepatol. 2025 Jan-Feb;15(1):102386. doi: 10.1016/j.jceh.2024.102386. Epub 2024 Aug 3.
Hepatocellular carcinoma (HCC) carries significant morbidity and mortality. Management of the HCC requires a multidisciplinary approach. Surgical resection and liver transplantation are the gold standard options for the appropriate settings. Stereotactic body radiation therapy (SBRT) has emerged as a promising treatment modality in managing HCC; its use is more studied and well-established in advanced HCC (aHCC). Current clinical guidelines universally endorse SBRT as a viable alternative to radiofrequency ablation (RFA), transarterial chemoembolisation (TACE), and transarterial radioembolisation (TARE), a recommendation substantiated by literature demonstrating comparable efficacy among these modalities. In early-stage HCC, SBRT primarily manages unresectable tumours unsuitable for ablative procedures such as microwave ablation and RFA. SBRT has been incorporated as a modality to downstage tumours or as a bridge to transplant. In the case of intermediate or advanced HCC, SBRT offers excellent results either as a single modality or adjunct to other locoregional modalities such as TACE/TARE. Recent data from late-stage HCC patients illustrate the effectiveness of SBRT in achieving local tumour control while minimising damage to surrounding healthy liver tissue. It has promising local control of approximately 80-90% in managing HCC. Additional prospective data comparing the efficacy of SBRT with the first-line recommended therapies such as RFA, TACE, and surgery are essential. The standard of care for patients with advanced/metastatic disease is systemic therapy (immunotherapy/tyrosine kinase inhibitors). SBRT, in combination with immune-checkpoint inhibitors, has an immune-modulatory effect that results in a synergistic effect. Recent findings indicate that the combination of immunotherapy and SBRT in HCC is well-tolerated and exhibits synergistic effects. Further exploration of diverse immunotherapy and radiotherapy strategies is essential to identify the appropriate time for combination treatments and to optimise dose and fraction regimens. Prospective, randomised studies are imperative to establish SBRT as the primary treatment for HCC.
肝细胞癌（HCC）具有很高的发病率和死亡率。HCC的管理需要多学科方法。手术切除和肝移植是适用于特定情况的金标准选择。立体定向体部放射治疗（SBRT）已成为治疗HCC的一种有前景的治疗方式；其在晚期HCC（aHCC）中的应用得到了更多研究且已确立。当前临床指南普遍认可SBRT是射频消融（RFA）、经动脉化疗栓塞（TACE）和经动脉放射性栓塞（TARE）的可行替代方案，文献证明这些治疗方式疗效相当，支持了这一推荐。在早期HCC中，SBRT主要用于治疗不适用于微波消融和RFA等消融手术的不可切除肿瘤。SBRT已被纳入作为降低肿瘤分期的一种方式或作为移植桥梁。对于中期或晚期HCC，SBRT作为单一治疗方式或与TACE/TARE等其他局部区域治疗方式联合使用都能取得优异效果。晚期HCC患者的近期数据表明SBRT在实现局部肿瘤控制的同时能将对周围健康肝组织的损伤降至最低。它在治疗HCC方面有望实现约80 - 90%的局部控制率。比较SBRT与RFA、TACE和手术等一线推荐治疗方法疗效的更多前瞻性数据至关重要。晚期/转移性疾病患者的标准治疗是全身治疗（免疫治疗/酪氨酸激酶抑制剂）。SBRT与免疫检查点抑制剂联合使用具有免疫调节作用，可产生协同效应。近期研究结果表明，免疫治疗与SBRT联合用于HCC耐受性良好且具有协同效应。进一步探索多种免疫治疗和放疗策略对于确定联合治疗的合适时机以及优化剂量和分割方案至关重要。必须开展前瞻性随机研究以确立SBRT作为HCC的主要治疗方法。
