Radiotherapy for hepatocellular carcinoma downstaging: From palliative care to radical treatment
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摘要:
肿瘤分期是为了指导按分期治疗,某一期别的治疗方案不是一成不变的,应根据病情变化适时调整,尽可能朝有利疾病控制的方向转化。肝癌治疗进程需要随访和再分期,目的是为患者创造更好的治疗方案,特别是根治机会。局限肝内的大肝癌不能手术切除,经过介入栓塞化疗结合放疗,肿瘤缩小降期,部分转化为可手术切除,从不可治愈转化为可治愈。伴有门静脉癌栓的肝癌患者,经过新辅助放疗,癌栓缩小后再予手术切除,生存期较未新辅助放疗者显著延长。大肝癌经过综合治疗后降期为小肝癌,转化为立体定向放疗或射频消融,也可从姑息走向根治。肝癌放疗降期的临床报道渐多,循证级别逐渐提高,值得在临床实践中借鉴。
Abstract:The purpose of tumor staging is to guide treatment,and the treatment for a certain stage should be adjusted based on the changes in disease condition,in order to facilitate better control of tumor. Therefore,the treatment of liver cancer requires follow-up and re-staging to develop better treatment regimens for patients,especially the opportunity for cure. Surgical resection is not suitable for large hepatocellular carcinoma confined to the liver,and after embolization chemotherapy combined with radiotherapy for tumor regression and downstaging,some patients may undergo surgical resection,and the incurable tumor can thus be cured. For liver cancer patients with portal vein tumor thrombus,surgical resection can be performed after tumor thrombus is reduced by neoadjuvant radiotherapy,and the patients undergoing neoadjuvant radiotherapy have a significant increase in survival time than those not undergoing neoadjuvant radiotherapy. Large hepatocellular carcinoma can be downstaged to small hepatocellular carcinoma after multimodality therapy,and then stereotactic radiotherapy or radiofrequency ablation can help to achieve radical treatment. There is an increasing number of clinical reports of radiotherapy for liver cancer downstaging,with a gradual increase in evidence-based level,and thus it holds promise for clinical application.
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Key words:
- carcinoma,hepatocellular /
- chemoradiotherapy
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