Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status.
Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status.
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图像引导局部非血管内介入治疗肝细胞癌：现状
DOI：
10.1016/j.jimed.2020.10.008
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发表时间：
2021-03
影响因子：
--
通讯作者：
Yang X
中科院分区：
文献类型：
--
作者：
Qian K;Zhang F;Allison SK;Zheng C;Yang X
肝细胞癌是世界上最致命和最常见的癌症之一，尽管在过去的几十年里，这种恶性肿瘤的治疗已经取得了很大的进步。由于发病率上升和预后不佳，它仍然是一个主要的健康问题。在美国或中国，大多数患者的肝细胞癌诊断为中晚期。在这些阶段，手术切除或肝移植等根治性治疗不被认为是一种治疗选择。肝动脉化疗栓塞术(TACE)是应用最广泛的局部治疗方法，过去一直是不能切除的肿瘤实体的主要治疗方法。然而，对于那些血管稀少的肿瘤或肝功能储备受损的患者，TACE是一种次佳的治疗选择。例如，在这些对TACE耐药的患者中，栓塞术并不能完全覆盖血管稀少的肿瘤，反而可能会促进术后肿瘤的复发或留下残留的肿瘤。此外，在肝功能或储备功能较差的患者中，TACE具有较高的肝脏失代偿风险。肝细胞癌的非血管介入局部治疗包括射频消融(RFA)、微波消融(MWA)、高强度聚焦超声(HIFU)、激光诱导热疗(LIT)、冷冻消融(CSA)、不可逆电穿孔(IRE)、经皮无水乙醇注射(PEI)和近距离放射治疗。这些技术的最新进展显著提高了肝细胞癌的治疗效果，扩大了有资格接受治疗的患者人数。本文综述了影像引导下局部非血管内介入治疗肝癌的研究现状，重点介绍了应用这些介入技术进行综合治疗的临床评价和疗效评估。
Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages. Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve. Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.