肝细胞癌围手术期放射治疗的研究进展  

Development and evidence of perioperative radiotherapy for hepatocellular carcinoma

作　　者：李丽娟 董德左 王洪智 朱向高[1] 王维虎 Li Lijuan;Dong Dezuo;Wang Hongzhi;Zhu Xianggao;Wang Weihu(Department of Radiation Oncology,Peking University Cancer Hospital,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院放射治疗科,北京100142

出　　处：《肝癌电子杂志》2022年第4期20-25,共6页Electronic Journal of Liver Tumor

摘　　要：肝细胞癌(hepatocellular carcinoma,HCC)是原发性肝癌的主要病理类型,发病率高且预后差,通过合理有序的多学科综合治疗能大大提高HCC患者的疗效。手术切除是HCC主要的治疗手段之一,但面临着术后高复发的问题。随着放射治疗技术的发展、成熟,放射治疗在HCC治疗中得到广泛应用。手术与放射治疗的联合应用能有效减少疾病复发、延长患者生存期。HCC围手术期放射治疗研究数据表明,对于窄切缘(<1cm)手术和微血管侵犯患者,术后或术中放射治疗可弥补手术不足,取得与宽切缘根治手术相似的疗效;伴门静脉癌栓的可切除HCC患者,术前新辅助放射治疗联合手术切除或术后放射治疗可显著改善患者预后;等候肝移植期间,体部立体定向放射治疗作为桥接治疗手段可安全有效地控制肿瘤进展,维持患者的移植候选状态。需继续开展包括放射治疗在内的综合治疗模式的前瞻性研究,从而继续进一步提高HCC患者的生存率。Hepatocellular carcinoma(HCC)is the main type of primary liver cancer with high incidence and poor prognosis.The long-term benefit of patients can be maximized by orderly multidisciplinary comprehensive treatment.Surgery is one of the main treatment methods for HCC,but it faces high risk of postoperative recurrence.With the development of radiotherapy technology,radiotherapy has been widely used in the treatment of HCC.The combined application of surgery and radiotherapy can effectively reduce disease recurrence and prolong patient survival.Evidence from perioperative radiotherapy for HCC shows that:for narrow-margin surgery and microvascular invasion,postoperative or intraoperative radiotherapy can make up for the insufficiency of surgery and achieve similar efficacy as wide-margin surgery;for resectable HCC with portal vein tumor thrombus,neoadjuvant radiotherapy combined with surgical resection or postoperative radiotherapy can significantly improve the prognosis;while waiting for liver transplantation,stereotactic body radiotherapy as bridging therapy can safely and effectively delay tumor progression and prevent drop-out from the waitlist.Prospective research on multidisciplinary treatment modality including radiotherapy will continue to improve the survival rate for patients with HCC.

关 键 词：肝细胞癌 放射治疗 围手术期 

分 类 号：R735.7[医药卫生—肿瘤]