立体定向放射治疗肝细胞癌概述

StephenW

An overview of stereotactic body radiation therapy for hepatocellular carcinoma
Tomoki Kimura, Yoshiko Doi, Sigeo Takahashi, Katsumaro Kubo, Nobuki Imano, Yuki Takeuchi, show all
Pages 271-279 | Received 22 Dec 2019, Accepted 16 Mar 2020, Published online: 30 Mar 2020

    Download citation https://doi.org/10.1080/17474124.2020.1744434 CrossMark Logo CrossMark

ABSTRACT

Introduction: According to several guidelines, stereotactic body radiation therapy (SBRT) for early hepatocellular carcinoma (HCC) can be considered an alternative to other modalities, such as resection, radiofrequency ablation (RFA), and transarterial chemoembolization (TACE), or when these therapies have failed or are contraindicated. This article reviews the current status of SBRT for the treatment of HCC.

Areas covered: From the results of many retrospective reports, SBRT is a promising modality with an excellent local control of almost 90% at 2–3 years and acceptable toxicities. Currently there are no randomized trials to compare SBRT and other modalities, such as resection, RFA, and TACE, but many retrospective reports and propensity score matching have shown that SBRT is comparable to the different modalities. Repeated SBRT for intra-hepatic recurrent HCC also resulted in high local control with safety and satisfactory overall survival, which were comparable to those of other curative local treatments.

Expert opinion: Despite the good results of SBRT, the conclusions of the comparisons of SBRT and other modalities are still controversial. Further studies, including randomized phase III studies to define that patients are more suitable for each curative local treatment, are needed.
KEYWORDS: Stereotactic body radiotherapy (SBRT), hepatocellular carcinoma (HCC), resection, radiofrequency ablation (RFA), transarterial chemoembolization (TACE)
Additional information
Funding
This manuscript has not been funded.
Article highlights

    According to several guidelines, SBRT can be considered an alternative to ablation/embolization or when these therapies have failed or are contraindicated.

    Promising results of SBRT have been reported in early HCC, with high local control (LC) rates that generally range from 70-100% at 2-3 years and overall survival rates that range from 60-70%.

    The most frequent adverse effects were generally mild, and associated with liver injury, such as the elevation of total bilirubin and transaminase and the decrease of platelets and ascites. Gastrointestinal toxicities, central biliary tract stenosis, and portal vein thrombosis should be evaluated as low incident toxicities.

    For evaluation after SBRT, residual early arterial enhancement disappeared within 6 months in most cases. An early assessment within 3 months may result in a misleading response evaluation.

    Currently there are no randomized trials to compare SBRT and other modalities, such as resection, RFA, and TACE, but many retrospective reports and propensity score matching reports, for the comparison of the different modalities, have been published. Compared to TACE, SBRT could improve LC. Compared to RFA and resection, the results are still controversial.

    Combining SBRT and immune checkpoint inhibitor has shown promising data.

StephenW

立体定向放射治疗肝细胞癌概述
木村智树，土井芳子，高桥雄夫，久保桂太郎，今野信希，竹内结希
第271-279页| 2019年12月22日收到，2020年3月16日接受，在线发布：2020年3月30日

    下载引文https://doi.org/10.1080/17474124.2020.1744434 CrossMark徽标CrossMark

抽象

简介：根据一些指南，早期肝细胞癌（HCC）的立体定向放射治疗（SBRT）可被视为其他方法的替代方法，例如切除，射频消融（RFA）和经动脉化学栓塞（TACE），或在这些情况下治疗失败或禁忌。本文回顾了SBRT治疗肝癌的现状。

涉及的领域：从许多回顾性报告的结果来看，SBRT是一种很有前途的模式，在2-3年内可将近90％的局部有效控制，并具有可接受的毒性。当前，尚无用于比较SBRT和其他方式（例如切除，RFA和TACE）的随机试验，但是许多回顾性报告和倾向评分匹配表明SBRT与不同方式相当。重复SBRT治疗肝内复发性HCC也可实现高度局部控制，安全性和总体生存率令人满意，这与其他治疗性局部治疗相当。

专家意见：尽管SBRT取得了不错的成绩，但SBRT与其他方式的比较结论仍存在争议。需要进一步的研究，包括确定患者更适合每种治疗性局部治疗的随机III期研究。
关键词：立体定向放疗（SBRT），肝细胞癌（HCC），切除，射频消融（RFA），经动脉化学栓塞（TACE）
附加信息
资金
该手稿尚未获得资助。
文章重点

    根据几项准则，可以将SBRT视为消融/栓塞的替代方案，或者当这些疗法失败或禁忌使用时。

    在早期肝癌中，SBRT的结果令人鼓舞，局部控制（LC）的高发率通常在2-3年时为70-100％，总生存率在60-70％之间。

    最常见的不良反应通常是轻度的，并与肝损伤相关，例如总胆红素和转氨酶的升高以及血小板和腹水的减少。胃肠道毒性，中央胆道狭窄和门静脉血栓形成应评估为低事件毒性。

    为了进行SBRT后的评估，大多数情况下，残留的早期动脉增强在6个月内消失了。在3个月内进行早期评估可能会导致误导性评估。

    目前，尚无用于比较SBRT和其他方式（例如切除，RFA和TACE）的随机试验，但是已经发布了许多回顾性报告和倾向评分匹配报告，用于比较不同方式。与TACE相比，SBRT可以改善LC。与RFA和切除相比，结果仍然存在争议。

    SBRT和免疫检查点抑制剂的组合已显示出可喜的数据。