体部立体定向放射治疗在肝细胞癌综合治疗中临床研究进展  

Research progress of stereotactic body radiation therapy in comprehensive treatment of hepatocellular carcinoma

作　　者：蒲文吉 姜勇 李济时 陈文琦 徐志渊 金晶 PU Wenji;JIANG Yong;LI Jishi;CHEN Wenqi;XU Zhiyuan;JIN Jing(Medical Oncology Center,University of Hong Kong-Shenzhen Hospital,Shenzhen,Guangdong 518000,China;Medical Department of Shenzhen University/General Hospital of Shenzhen University/Academy of ClinicalMedicine of Shenzhen University,Shenzhen,Guangdong 518055,China;Department of Radiotherapy,National Cancer Center/National Cancer Clinical Medical Research Center/ShenzhenHospital,Cancer Hospital of Peking Union Medical College,Chinese Academy of Medical Sciences,Shenzhen,Guangdong 518116,China)

机构地区：[1]香港大学深圳医院肿瘤医学中心,广东深圳518000 [2]深圳大学医学部/深圳大学总医院/深圳大学临床医学科学院,广东深圳518055 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院放射治疗科,广东深圳518116

出　　处：《中华肿瘤防治杂志》2024年第20期1266-1275,共10页Chinese Journal of Cancer Prevention and Treatment

基　　金：深圳市医疗卫生三名工程项目资助(SZSM202211017);深圳市医学重点学科建设经费资助(SZXK014);深圳市肿瘤转移和个体化治疗重点实验室(ZDSYS20210623091811035)。

摘　　要：目的总结体部立体定向放射治疗在肝细胞癌综合治疗中的临床研究,为该放疗技术的临床实践提供循证医学证据,以期进一步提高患者总生存期。方法使用PubMed及中国知网数据库检索系统,以“肝细胞癌”和“体部立体定向放射治疗”为中文关键词,“hepatocellular carcinoma”和“stereotactic body radiation therapy”为英文关键词,检索从建库至2024-06-31发表的相关文献。纳入标准:(1)肝细胞癌的流行病学及放射治疗研究背景;(2)体部立体定向放射治疗的治疗机制、适应证及常见剂量分割模式;(3)在小肝癌中,体部立体定向放射治疗与手术切除、射频消融及经导管动脉栓塞化疗等治疗措施的疗效对比;(4)联合治疗模式在中晚期肝细胞癌患者及等待肝移植的晚期肝细胞癌患者中的研究进展;(5)体部立体定向放射治疗相关治疗毒性。排除标准:重复、存在争议及数据陈旧的相关文献。最终纳入中英文文献共96篇。结果随着现代放疗技术的飞速发展,体部立体定向放射治疗在肝细胞癌全程综合治疗中均发挥着重要作用。多项回顾和前瞻性研究比较了低分次(3~10 Fx)高剂量(3~15 Gy)短周期的体部立体定向放射治疗与射频消融、经导管动脉栓塞化疗及手术切除的临床疗效,但有些研究结论不完全一致,多数研究仍支持体部立体定向放射治疗可达到相似甚至是更优的局部控制和总生存期,尤其是患者合并有肝功能失代偿、>3个癌结节、肿瘤位置特殊或肿瘤负荷较大等情况。而对于中晚期伴有门静脉肿瘤血栓的肝细胞癌患者,体部立体定向放射治疗联合经导管动脉栓塞化疗可较单一治疗模式取得更长的无进展生存期、更高的客观缓解率及肝脏肿瘤局部控制。另外,对于初治不可切除的肝细胞癌患者,体部立体定向放射治疗与免疫检查点抑制剂的联合运用可获得临床完全缓解和总生存期的Objective To summarize the clinical study of stereotactic body radiation therapy(SBRT)in the comprehensive treatment of hepatocellular carcinoma(HCC)and to provide evidence-based support for the clinical application of the radiotherapy technique in order to further improve patients'overall survival.Methods PubMed and the China National Knowledge Infrastructure database retrieval system were used to search the related literature from the creation of the database until 2024-06-31,with"hepatocellular carcinoma"and"stereotactic body radiation therapy"as the English key words.The following were requirements for inclusion:(1)the background in radiotherapy and epidemiology of HCC;(2)the therapeutic mechanisms,indications,and common dose segmentation modes of SBRT;(3)the comparisons of SBRT with surgical resection,radiofrequency ablation(RFA),and transcatheter arterial chemoembolization(TACE)for small hepatocellular carcinoma(sHCC);(4)the advancement of studies on combined therapy modes in HCC patients with intermediate and advanced stages and advanced HCC patients awaiting liver transplantation;(5)therapeutic toxicity associated with SBRT.Considerations for exclusion included dated data,controversies,and similar literature that was repeated.Ultimately,96pieces of literature in both Chinese and English were incorporated for evaluation and discussion.Results With the rapid development of modern radiotherapy technology,stereotactic radiotherapy plays an important role in the comprehensive treatment of hepatocellular carcinoma throughout the entire process.Multiple retrospective and prospective studies have compared the clinical efficacy of low-fractionation(3-10Fx)high-dose(3-15Gy)short course body stereotactic radiotherapy with radiofrequency ablation,transcatheter arterial chemoembolization,and surgical resection.However,some studies have inconsistent conclusions,and most studies still support that body stereotactic radiotherapy can achieve similar or even better local control and overall survival,especially in patients

关 键 词：肝细胞癌 体部立体定向放射治疗 小肝癌 放射治疗剂量 免疫检查点抑制剂 临床研究 循证医学 综述文献 

分 类 号：R735.7[医药卫生—肿瘤]