Multidisciplinary management of hepatocellular carcinoma: a model for therapy.
Multidisciplinary management of hepatocellular carcinoma: a model for therapy.
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DOI：
10.2147/jmdh.s41206
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发表时间：
2013
影响因子：
3.3
通讯作者：
Black M
中科院分区：
文献类型：
--
作者：
Cohen GS;Black M
在肝细胞癌的管理中，多学科模型是协调、个体化和优化护理的有用方法。天普大学医院的肝细胞癌多学科小组(MDT)成立于2008年，成员包括肝病学家、介入放射科医生、移植外科医生、肿瘤学家、住院医生、中层提供者和支持人员。患者可以通过以下方式进行登记：(1)坦普尔的肿瘤学家，(2)坦普尔最近成立的肝炎筛查诊所，由肝病住院医生组成，或(3)社区诊所。每周举行MDT会议，期间讨论病例(基于病史、图像解释和实验室分析)并制定治疗计划。坦普尔治疗算法遵循当前的护理标准，以肿瘤体积和形态为指导，但新颖的多学科互动挑战成员量身定制治疗，以实现可能的最佳结果。单个病变≤为2厘米的患者可能不会接受治疗，直到有资格接受移植或局部治疗或切除，每3至6个月进行一次成像以监测肿瘤的进展。对于肿瘤和≤分别为2厘米和5厘米的患者，如果病变是离散的和可接近的，则使用微波消融治疗。传统的肝动脉化疗栓塞术(TACE)或药物洗脱微球TACE(DEB-TACE)或Y-90微球用于多灶性疾病。病变<5厘米的患者是TACE的候选对象，以降低肿瘤的分期。索拉非尼通常用于2厘米至5厘米之间不能切除的病变。我们经常持续使用索拉非尼，并与DEB-TACE联合使用。在我们的经验中，索拉非尼不会对肿瘤血管或血流产生影响，从而影响DEB-TACE的疗效。文献记载了多学科护理的引入改善了肝细胞癌和其他癌症的预后。MDT的角色和组织受到团队文化、专业知识和流程以及机构和更大环境背景的影响。
A multidisciplinary model is a useful approach in the management of hepatocellular carcinoma (HCC) to coordinate, individualize, and optimize care. The HCC Multidisciplinary Team (MDT) at Temple University Hospital was established in 2008 and comprises hepatologists, interventional radiologists, transplant surgeons, oncologists, residents, midlevel providers, and support staff. Patients may be enrolled by referral from (1) oncologists at Temple, (2) the hepatitis screening clinic recently established at Temple and staffed by hepatology residents, or (3) community practices. MDT conferences are held weekly, during which cases are discussed (based on medical history, interpretation of images, and laboratory analyses) and treatment plans are formulated. The Temple treatment algorithm follows current standards of care, guided by tumor volume and morphology, but the novel multidisciplinary interaction challenges members to tailor therapy to achieve the best possible outcomes. Patients with a solitary lesion ≤ 2 cm may receive no treatment until eligible for transplantation or locoregional therapy or resection, with imaging every 3 to 6 months to monitor tumor progression. In patients with tumors > 2 cm and ≤ 5 cm, microwave ablation therapy is used if lesions are discrete and accessible. Conventional transarterial chemoembolization (TACE) or drug-eluting bead TACE (DEB-TACE) or yttrium-90 microspheres are utilized in multifocal disease. Patients with lesions > 5 cm are candidates for TACE for downstaging the tumor. Sorafenib is typically reserved for unresectable lesions between 2 cm and 5 cm. Frequently, we administer sorafenib continuously and in combination with DEB-TACE. In our experience, sorafenib does not produce effects on the tumor vasculature or blood flow that would impair the efficacy of DEB-TACE. The literature documents improved outcomes in HCC and other cancers associated with the introduction of multidisciplinary care. The role and organization of the MDT is influenced by team culture, expertise, and process, as well as institutional and larger environmental contexts.