Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations.
Local and Regional Therapies for Hepatocellular Carcinoma and Future Combinations.
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DOI：
10.3390/cancers14102469
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发表时间：
2022-05-17
期刊：
影响因子：
5.2
通讯作者：
Kloeckner, Roman
中科院分区：
文献类型：
--
作者：
Hatzidakis, Adam;Mueller, Lukas;Krokidis, Miltiadis;Kloeckner, Roman
关键词：
经皮介入放射治疗技术为局部麻醉和镇静治疗肝细胞癌提供了多种选择。这些方法的目的是在不影响非恶性肝脏的情况下，局部摧毁恶性肿瘤。通过这种方式，并发症保持在较低水平，患者恢复得很快。适应症取决于肿瘤的大小、类型和分期，以及患者的病情、肝功能和合并症。近年来，将这种方法与免疫疗法相结合进行了大量的研究，但仍有许多工作要做。这篇手稿试图分析我们今天所处的位置，并使用一个全面的算法来解释每种不同临床情况的治疗选择。背景：肝细胞癌可通过经皮介入放射治疗的局部和区域性方法进行治疗。适应症取决于肿瘤的大小、类型和分期，以及患者的病情、肝功能和合并症。根据巴塞罗那临床肝癌的国际分类系统(BCLC)，根据肿瘤的特点，早期、早期或中期肿瘤可采用消融术或经动脉化疗栓塞术(TACE)治疗。两者的结合允许个体化的治疗形式，最终目标是改善反应和生存。近年来，将局部治疗与免疫治疗相结合进行了大量的研究。尽管系统治疗，特别是免疫治疗的最新进展似乎很有希望，并扩大了可能的联合治疗选择，但仍然没有足够的证据支持它们。本综述的目的是对所有这些技术进行全面的最新概述，解释适应症、禁忌症、技术问题、结果、结果和并发症。此外，还将讨论相互之间的经皮治疗或与免疫治疗的组合以及未来的选择。在考虑手术或移植之前，使用所有这些方法作为降级或桥接解决方案也将被审查。结论：局部和局部治疗仍然是肝细胞癌根治和姑息治疗的主要方法。目前，关于局部和区域治疗方案相互之间以及与其他治疗方式的潜在组合的证据正在增加，并有可能进一步使肝癌治疗个体化。为了从这些新的各种选择中找出最合适的治疗方案，肿瘤委员会对每个病例进行反复的跨学科讨论是至关重要的。
Percutaneous interventional radiological techniques offer many alternatives for treatment of Hepatocellular Carcinoma (HCC) using local anesthesia and sedation. These methods aim to destroy the malignant tumors locally without affecting the non-malignant liver. In this way, complications are kept low and patient recovery is quick. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. In recent years, a lot of research has been made in combining such approaches with immune therapy, but there is still much work to be done. This manuscript tries to analyze where we stand today and explain, using a comprehensive algorithm, the treatment options for each different clinical condition. Background: Hepatocellular carcinoma (HCC) can be treated by local and regional methods of percutaneous interventional radiological techniques. Indications depend on tumor size, type and stage, as well as patient’s condition, liver function and co-morbidities. According to international classification systems such as Barcelona Clinic Liver Cancer (BCLC) classification, very early, early or intermediate staged tumors can be treated either with ablative methods or with transarterial chemoembolization (TACE), depending on tumor characteristics. The combination of both allows for individualized forms of treatment with the ultimate goal of improving response and survival. In recent years, a lot of research has been carried out in combining locoregional approaches with immune therapy. Although recent developments in systemic treatment, especially immunotherapy, seem quite promising and have expanded possible combined treatment options, there is still not enough evidence in their favor. The aim of this review is to provide a comprehensive up-to-date overview of all these techniques, explaining indications, contraindications, technical problems, outcomes, results and complications. Moreover, combinations of percutaneous treatment with each other or with immunotherapy and future options will be discussed. Use of all those methods as down-staging or bridging solutions until surgery or transplantation are taken into consideration will also be reviewed. Conclusion: Local and regional therapies remain a mainstay of curative and palliative treatment of patients with HCC. Currently, evidence on potential combination of the local and regional treatment options with each other as well as with other treatment modalities is growing and has the potential to further individualize HCC therapy. To identify the most suitable treatment option out of these new various options, a repeated interdisciplinary discussion of each case by the tumor board is of utmost importance.
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影响因子：
6.1
作者：
Di Federico, Alessandro;Rizzo, Alessandro;Brandi, Giovanni
通讯作者：
Brandi, Giovanni
影响因子：
24.5
作者：
Benvegnù, L;Noventa, F;Alberti, A
通讯作者：
Alberti, A
影响因子：
25.7
作者：
Cucchetti, Alessandro;Piscaglia, Fabio;Pinna, Antonio D.
通讯作者：
Pinna, Antonio D.
影响因子：
5.2
作者：
Chu HH;Kim JH;Shim JH;Gwon DI;Ko HK;Shin JH;Ko GY;Yoon HK;Kim N
通讯作者：
Kim N
影响因子：
1.7
作者：
Chauhan N;Bukovcan J;Boucher E;Cosgrove D;Edeline J;Hamilton B;Kulik L;Master F;Salem R
通讯作者：
Salem R