Current situation and prospect of interventional treatment of hepatocellular carcinoma
-
摘要: 肝细胞癌(HCC)是全球最难治疗的恶性肿瘤之一,全球每年约有65万患者死于HCC。虽然其治疗手段繁多,但疗效仍不令人满意。目前,以经导管肝动脉化疗栓塞术(TACE)为代表的介入治疗已成为中晚期肝癌患者的主要治疗手段。介绍了经皮无水酒精注射、射频消融术、局部氩氦冷冻治疗、放射性粒子植入术等局部介入治疗的发展,以及与生物、基因治疗的联合应用,使综合介入治疗成为HCC最主要的非手术治疗模式。指出随着个体化、规范化的综合介入治疗手段的应用和推广,HCC的整体疗效将得到进一步提高。Abstract: Hepatocellular carcinoma ( HCC) is one of the most refractory malignancies worldwide, and there are about 650 000 people who die of HCC each year around the world. Despite many treatment methods for HCC, the treatment outcome is still not satisfactory. At present, interventional treatment, represented by transcatheter arterial chemoembolization, has become the main treatment means for advanced HCC.It is mentioned that the development of local interventional therapies, such as percutaneous ethanol injection, radiofrequency ablation, local argon- helium cryoablation, and radioactive particle implantation, as well as the application of biotechnology and gene therapy, enables comprehensive interventional therapy to become the major non- surgical treatment mode for HCC. It is pointed out that with the wide application of individualized and standardized comprehensive interventional therapy, the overall treatment outcome of HCC will be further improved.
-
Key words:
- liver neoplasms /
- interventional treatment /
- comprehensive treatment
-
[1]PARKIN DM, BRAY F, FERLAY J, et al.Globalcancer statistics, 2002[J].CA Cancer J Clin, 2005, 55 (2) :74-108. [2]LLOVET JM, BRUIX J.Systematic review of randomized trials for unresectable hepatocellular carcinoma:chemoembolization improves survival[J].Hepatology, 2003, 37 (2) :429-442. [3]BRUIX J, SALA M, LLOVET JM, et al.Chemoembolization for hepatocellular carcinoma[J].Gastroenterology, 2004, 127 (5) :s179-s188. [4]WEN F, LIANG HY, LU ZM, et al.Interventional therapy for extrahepatic collateral arterial supply of primary hepatic carcinoma[J].J China Clin Med Imaging, 2012, 23 (5) :319-321. (in Chinese) 温锋, 梁宏元, 卢再鸣, 等.原发性肝癌肝外侧支血供的介入治疗[J].中国临床医学影像杂志, 2012, 23 (5) :319-321. [5]SERGIO A, CRISTOFORI C, CARDIN R, et al.Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) :the role of angiogenesis and invasiveness[J].Am J Gastroenterol, 2008, 103 (4) :914-921. [6]BAI W, HAN GH.Comprehensive intervention treatment for hepatocellular carcinoma[J].J Clin Hepatol, 2013, 29 (1) :36-41. (in Chinese) 白苇, 韩国宏.肝细胞癌的综合介入治疗[J].临床肝胆病杂志, 2013, 29 (1) :36-41. [7]LAMMER J, MALAGARI K, VOGL T, et al.Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma:results of the PRECISION V study[J].Cardiovasc Intervent Radiol, 2010, 33 (1) :41-52. [8]KULIK LM, CARR BI, MULCAHY MF, et al.Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis[J].Hepatology, 2008, 47 (1) :71-81. [9]SALEM R, LEWANDOWSKI RJ, KULIK L, et al.Radioembolization results in longer time-to-progression and reduced toxicity compared with chemoembolization in patients with hepatocellular carcinoma[J].Gastroenterology, 2011, 140 (2) :497-507. [10]SALEM R, LEWANDOWSKI RJ, MULCAHY MF, et al.Radioembolization for hepatocellular carcinoma using yttrium-90 microspheres:a comprehensive report of long-term outcomes[J].Gastroenterology, 2010, 138 (1) :52-64. [11]LU ZM, WEN F, LIU ZY, et al.Observation on the efficacy of treatment for middle or advanced stage hepatocellular carcinoma with hepatic artery infusion and embolization[J].Chin J Modern Med, 2010, 11 (6) :1681-1683. (in Chinese) 卢再鸣, 温锋, 刘兆玉, 等.肝动脉灌注栓塞术治疗中晚期肝癌185例疗效观察[J].中国现代医学杂志, 2010, 11 (6) :1681-1683. [12]LI CP, CHAO Y, CHEN LT, et al.Fever after transcatheter arterial chemoembolization for hepatocellular carcinoma:incidence and risk factor analysis[J].Scand J Gastroenterol, 2008, 43 (8) :992-999. [13]DENG XJ, ZHANG SY, ZHANG HW, et al.Superselective embolization using hot lipiodol ultrafluid-anticancer drug emulsion for treating primary liver cancer[J].Guangdong Med J, 2010, 31 (7) :877-879. (in Chinese) 邓小军, 张树友, 张宏文, 等.热超液化碘油抗癌药乳剂超选择栓塞术治疗原发性肝癌[J].广东医学, 2010, 31 (7) :877-879. [14]YAMAMOTO J, OKADA S, SHIMADA K, et al.Treatment strategy for small hepatocellular carcinoma:comparison of long-term results after percutaneous ethanol injection therapy and surgical resection[J].Hepatology, 2001, 34 (4 Pt 1) :707-713. [15]MINAMI Y, KUDO M.Radiofrequency ablation of hepatocellular carcinoma:a literature review[J].Int J Hepatol, 2011.[Epub ahead of print] [16]ALESSANDRO C, FABIO P, MATTEO C, et al.Systematic review of surgical resection vs radiofrequency ablation for hepatocellular carcinoma[J].World J Gastroenterol, 2013, 19 (26) :4106-4118. [17]NI JY, LIU SS, XU LF, et al.Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma[J].World J Gastroenterol, 2013, 19 (24) :3872-3882. [18]LU ZM, WEN F, GUO QY, et al.Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma:a meta-analysis of randomized-controlled trials[J].Eur J Gastroenterol Hepatol, 2013, 25 (2) :187-194. [19]WANG CP, LU YY, WANG XZ, et al.Percutaneous argon-helium cryoablation for primary hepatocellular carcinoma:report of 300cases[J].Med J Chin PLA, 2008, 33 (12) :1413-1417. (in Chinese) 王春平, 陆荫英, 王新真, 等.经皮氩氦刀冷冻消融治疗原发性肝癌的疗效观察 (附300例报告) [J].解放军医学杂志, 2008, 33 (12) :1413-1417. [20]HUANG B, ZHOU S.Transcatheter arterial chemoembolization combined with Argon-Helium cryoablation for the treatment of hepatocellular carcinoma of giant lump type:a clinical study[J].J Intervent Radiol, 2011, 20 (1) :28-31. (in Chinese) 黄斌, 周石.TACE联合氩氦刀冷冻术治疗巨块型肝细胞癌的临床研究[J].介入放射学杂志, 2011, 20 (1) :28-31. [21]JAKOBS TF, HOFFMANN RT, TATSCH K, et al.Therapy response of liver tumors after selective internal radiation therapy[J].Radiologe, 2008, 48 (9) :839-849. [22]YU M, LI JK, YIN H, et al.Therapeutic effect of transcatheter arterial chemoembolization combined with radiofrequency ablation or125I interstitial brachytherapy on primary hepatocellular carcinom:a comparative study[J].J Intervent Radiol, 2009, 18 (5) :328-330. (in Chinese) 于淼, 李家开, 尹浩, 等.肝动脉化疗栓塞联合射频消融或放射性粒子组织间放疗对原发性肝癌的疗效比较研究[J].介入放射学杂志, 2009, 18 (5) :328-330. [23]CHEN KY, XIANG GA, WANG HN, et al.Iodine-125 seed implantational radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma[J].Chin J Radiat Oncol, 2007, 16 (6) :447-450. (in Chinese) 陈开运, 向国安, 王汉宁, 等.粒子植入放疗联合肝动脉化疗栓塞治疗肝癌的临床研究[J].中华放射肿瘤学杂志, 2007, 16 (6) :447-450. [24] LUO JJ, YAN ZP, WANG JH, et al.Endovascular placement of iodine-125 seed strand and self-expandable stent combined with transcatheter arterial chemoembolization for hepatocellular carcinoma with tumor thrombus in the main portal vein[J].Chin J Oncol, 2011, 33 (7) :535-539. (in Chinese) 罗剑钧, 颜志平, 王建华, 等.腔内植入125I粒子条及支架联合经动脉化疗栓塞治疗原发性肝癌合并门脉主干癌栓的疗效[J].中华肿瘤杂志, 2011, 33 (7) :535-539. [25]WENG ZC, YANG WZ, JIANG N, et al.Evaluation of CTguided125I seed implantation combined with transcatheter arterial chemoembolization in treating portal vein tumor thrombus associated with hepatocellular carcinoma[J].J Intervent Radiol, 2010, 19 (7) :535-539. (in Chinese) 翁志成, 杨维竹, 江娜, 等.CT引导下125I放射性粒子植入治疗肝癌门静脉癌栓的疗效评价[J].介入放射学杂志, 2010, 19 (7) :535-539. [26]GUAN YS, HE Q.Essentials in clinical application of p53 for tumors intervention-example of liver cancer[J].J Intervent Radiol, 2008, 17 (11) :761-763. (in Chinese) 官永松, 贺庆.肝癌介入治疗中应用p53的几个要点[J].介入放射学杂志, 2008, 17 (11) :761-763. [27]GUAN YS, SUN L, ZHOU XP, et al.Local recombinant human Ad-p53 injection combined with hepatic arterial chemoembolization in treatment of primary liver cancer[J].World Chin J Dig, 2005, 13 (1) :125-127. (in Chinese) 官永松, 孙龙, 周翔平, 等.重组人p53腺病毒基因局部注射联合肝动脉化疗栓塞治疗原发性肝癌[J].世界华人消化杂志, 2005, 13 (1) :125-127. [28]OU SQ, MA YL, KANG P, et al.Recombinant adenovirus-p53gene therapy combined with transcatheter arterial chemoembolization for p53-positive and p53-negative hepatocellular carcinoma[J].Chin J Interv Imaging Ther, 2010, 7 (4) :354-357. (in Chinese) 欧盛秋, 马亦龙, 康平, 等.重组人p53腺病毒联合经肝动脉化疗栓塞治疗不同p53表达的中晚期肝细胞癌[J].中国介入影像与治疗学, 2010, 7 (4) :354-357. [29]CHUNG YH, HAN G, YOON JH, et al.Interim analysis of START:Study in Asia of the combination of TACE (transcatheter arterial chemoembolization) with sorafenib in patients with hepatocellular carcinoma trial[J].Int J Cancer, 2013, 132 (10) :2448-2458. [30]PAWLIK TM, REYES DK, COSGROVE D, et al.Phase II trial of sorafenib combined with concurrent transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma[J].J Clin Oncol, 2011, 29 (30) :3960-3967. [31]XU LT, CHEN Z, LIN JH, et al.Clinical observation of transarterial chemoembolization combined with sorafeuib for advanced hepatocellular carcinoma[J].Chin J Oncol, 2010, 32 (9) :703-705. (in Chinese) 徐立涛, 陈震, 林钧华, 等.经导管肝动脉化疗栓塞联合索拉非尼治疗中晚期肝细胞癌的临床观察[J].中华肿瘤杂志, 2010, 32 (9) :703-705.
本文二维码
计量
- 文章访问数: 2436
- HTML全文浏览量: 31
- PDF下载量: 648
- 被引次数: 0