现代治疗恶性肝肿瘤的方法

StephenW

Modern therapeutic approaches for the treatment of malignant liver tumours

    Henrik Petrowsky, Ralph Fritsch, Matthias Guckenberger, Michelle L. De Oliveira, Philipp Dutkowski & Pierre-Alain Clavien

Nature Reviews Gastroenterology & Hepatology (2020)Cite this article

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Abstract

Malignant liver tumours include a wide range of primary and secondary tumours. Although surgery remains the mainstay of curative treatment, modern therapies integrate a variety of neoadjuvant and adjuvant strategies and have achieved dramatic improvements in survival. Extensive tumour loads, which have traditionally been considered unresectable, are now amenable to curative treatment through systemic conversion chemotherapies followed by a variety of interventions such as augmentation of the healthy liver through portal vein occlusion, staged surgeries or ablation modalities. Liver transplantation is established in selected patients with hepatocellular carcinoma but is now emerging as a promising option in many other types of tumour such as perihilar cholangiocarcinomas, neuroendocrine or colorectal liver metastases. In this Review, we summarize the available therapies for the treatment of malignant liver tumours, with an emphasis on surgical and ablative approaches and how they align with other therapies such as modern anticancer drugs or radiotherapy. In addition, we describe three complex case studies of patients with malignant liver tumours. Finally, we discuss the outlook for future treatment, including personalized approaches based on molecular tumour subtyping, response to targeted drugs, novel biomarkers and precision surgery adapted to the specific tumour.
Key points

    Contraindications for two-stage hepatectomy owing to a small future liver remnant should always be evaluated at expert centres.

    The minimally invasive resection of selective liver tumours is oncologically efficient and offers faster postoperative recovery than invasive procedures.

    Ablation therapy is an essential component of the treatment of liver tumours as it enables parenchymal preservation and treatment of high-risk patients and can be applied in combination with liver resection or as a bridge to liver transplantation.

    Liver transplantation and transplant oncology are evolving as life-saving treatment options for patients with otherwise unresectable liver tumours.

    Stereotactic body radiotherapy is a non-invasive treatment that achieves local tumour control in challenging situations such as when tumour size is >3 cm and tumour location is close to central vessels and the biliary system.

    Systemic therapy is used to convert unresectable tumours into resectable tumours, target micrometastatic disease and provide disease control for staged procedures.

StephenW

现代治疗恶性肝肿瘤的方法

    Henrik Petrowsky，Ralph Fritsch，Matthias Guckenberger，Michelle L.De Oliveira，Philipp Dutkowski和Pierre-Alain Clavien

自然评论胃肠病和肝病（2020）引用本文

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抽象

恶性肝肿瘤包括广泛的原发性和继发性肿瘤。尽管手术仍然是治愈性疗法的主要手段，但现代疗法融合了多种新辅助疗法和辅助疗法，并在生存率方面取得了显着改善。传统上认为无法切除的大量肿瘤现在可以通过全身性转化化学疗法进行治疗，然后通过多种干预措施进行治疗，例如通过门静脉闭塞，分期手术或消融方式来增强健康肝脏。在选定的肝细胞癌患者中已经建立了肝移植，但现在在许多其他类型的肿瘤（如肝门周围胆管癌，神经内分泌或结直肠肝转移）中正在成为有希望的选择。在本综述中，我们总结了可用于治疗恶性肝肿瘤的疗法，重点是外科手术和消融方法以及它们如何与其他疗法（例如现代抗癌药或放射疗法）保持一致。此外，我们描述了恶性肝肿瘤患者的三个复杂案例研究。最后，我们讨论了未来治疗的前景，包括基于分子肿瘤亚型的个性化方法，对靶向药物的反应，新型生物标志物和适合于特定肿瘤的精密手术。
关键点

    由于将来残留的少量肝素，两阶段肝切除术的禁忌症应始终在专家中心进行评估。

    选择性肝肿瘤的微创切除术在肿瘤学上是有效的，并且比侵入性手术提供更快的术后恢复。

    消融疗法是肝肿瘤治疗的重要组成部分，因为它可以实现实质性保存和治疗高危患者，并且可以与肝切除术结合使用或作为肝移植的桥梁。

    对于无法手术切除的肝肿瘤患者，肝移植和移植肿瘤学正在发展为挽救生命的治疗选择。

    立体定向放射疗法是一种非侵入性治疗，可在具有挑战性的情况下实现局部肿瘤控制，例如当肿瘤尺寸大于3 cm且肿瘤位置靠近中央血管和胆道系统时。

    全身疗法用于将不可切除的肿瘤转化为可切除的肿瘤，靶向微转移性疾病，并为分期手术提供疾病控制。

挚友888888

THANKS
关于肝癌治疗最好方法就是开刀或移植，但是对于多复发人群来说，越到后面选择治疗方法非常难，目前有各式各样药物最流行PD1，但是很多人反应很大，而且大部分人不起作用，花了很多金钱而且还很痛苦反应，最后控制几个月或一、二年，game is over。
希望将来有更好方法能治愈癌症。