肝癌放疗获益人群筛选及方案选择  

Selection of beneficiary populations and regimen choice in radiotherapy for hepatocellular carcinoma

作　　者：郑晓宾 陈一兴 曾昭冲 杜世锁 ZHENG Xiao-bin;CHEN Yi-xing;ZENG Zhao-chong(Department of Radiation Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院放疗科,上海200032

出　　处：《中国实用外科杂志》2024年第9期1027-1031,共5页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82373517,No.82073479)。

摘　　要：在肝癌治疗中,放疗逐渐显示出其重要性,尤其在不同分期的肝细胞癌(HCC)中具有明显的应用价值。对于早期及局部晚期的肝癌病人,立体定向放射治疗(SBRT)和调强放疗(IMRT)等技术已经成熟,能够有效控制肿瘤,改善病人的生存期。这些技术对于那些无法手术或不适合射频消融(RFA)及经动脉化疗栓塞(TACE)的病人,提供了一种有前景的治疗选择。在中晚期肝癌的治疗中,放疗不仅能作为局部治疗的一部分,还可以与系统治疗联合,发挥协同作用,进一步提高病人的总生存期和无病生存期。例如,对于伴有门静脉癌栓的病人,新辅助放疗可以帮助部分病人将肿瘤降期,从而使其具备手术切除的条件,同时减少术后复发率和并发症的发生。放疗也可作为辅助治疗手段,尤其适用于术后病理提示有微血管侵犯(MVI)或切缘窄的病人,能够降低局部复发风险,延长无瘤生存期。此外,对于不符合肝移植标准的病人,放疗可以作为桥接治疗,通过降期手段使其达到移植标准,并在移植后实现良好的长期生存率。整体而言,放疗在肝癌治疗中的应用逐渐增加,特别是在与靶向治疗和免疫治疗联合使用时,显示出增强疗效的潜力。然而,仍需更多高质量的随机对照试验来进一步验证这些策略的有效性和安全性。Radiotherapy is increasingly demonstrating its importance in the treatment of hepatocellular carcinoma(HCC),particularly across different stages of HCC.For patients with early and locally advanced HCC,techniques such as stereotactic body radiation therapy(SBRT)and intensity-modulated radiotherapy(IMRT)have matured,offering effective tumor control and improved survival outcomes.These techniques provide a promising treatment option for those who are not candidates for surgery or are unsuitable for radiofrequency ablation(RFA)and transarterial chemoembolization(TACE).In the treatment of intermediate to advanced HCC,radiotherapy can be integrated as part of local therapy and combined with systemic treatments to exert synergistic effects,further improving overall survival(OS)and progression-free survival(PFS).For instance,in patients with portal vein tumor thrombosis(PVTT),neoadjuvant radiotherapy can downstage tumors,rendering them resectable and reducing postoperative recurrence and complications.Radiotherapy also serves as an adjuvant therapy,particularly in patients with postoperative pathology indicating microvascular invasion(MVI)or narrow surgical margins,lowering the risk of local recurrence and prolonging disease-free survival(DFS).Additionally,for patients who do not meet liver transplantation criteria,radiotherapy can be utilized as a bridging therapy to downstage tumors,thereby making them eligible for transplantation and achieving favorable long-term survival rates post-transplantation.Overall,the application of radiotherapy in HCC treatment is expanding,especially when combined with targeted and immunotherapy,showing potential for enhanced efficacy.However,further high-quality randomized controlled trials are necessary to validate the effectiveness and safety of these strategies.

关 键 词：肝细胞癌 放射治疗 立体定向放射治疗 调强放疗 门静脉癌栓 新辅助放疗 微血管侵犯 桥接治疗 

分 类 号：R735.7[医药卫生—肿瘤]