肝细胞癌外照射放疗的研究进展

林海敏; 孔玲玲; 于金明; 韩大力

doi:10.3969/j.issn.1000-8179.2018.05.282

肝细胞癌外照射放疗的研究进展

doi: 10.3969/j.issn.1000-8179.2018.05.282

山东大学附属山东省肿瘤医院放疗二病区，济南大学山东省医学科学院（济南市250117）

详细信息

作者简介:
林海敏专业方向为常见恶性肿瘤的放射治疗。E-mail：linhimin@outlook.com

通讯作者:
韩大力 dalihan_sdch@163.com

计量
- 文章访问数: 47
- HTML全文浏览量: 5
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2017-12-11
- 修回日期: 2018-02-08
- 刊出日期: 2018-03-15

Research advances in external beam radiotherapy for hepatocellular carcinoma

Shandong Academy of Medical Sciences, Jinan 250117, China

More Information

Corresponding author: Dali Han; E-mail: dalihan_sdch@163.com

摘要

摘要: 肝细胞癌（hepatocellular carcinoma，HCC）的根治性治疗方式主要为行手术切除、肝移植或消融术。然而，就诊时仅少数病例为可切除病变。随着放疗技术的发展，外照射放疗在HCC治疗中的应用越来越广泛。大量研究表明，放疗对肝功能良好的各期别肝癌均具有明显疗效。立体定向放射治疗（stereotactic body radiation therappy，SBRT）可替代射频消融治疗不可行手术切除的早期HCC，放疗联合其他局部或全身治疗, 如：经导管动脉化学栓塞（transcatheter arterial chemoembdization，TACE）、索拉非尼适用于局部晚期和远处转移晚期HCC的治疗。粒子束因Bragg峰而较X线具有更佳的剂量分布优势，临床应用前景广阔。本文重点阐述外照射放疗在各期别HCC治疗中的进展。
- 肝细胞癌 /
- 放射治疗 /
- 射频消融术 /
- 经导管动脉化疗栓塞术 /
- 索拉菲尼
Abstract: Surgical resection or liver transplantation are the primary curative treatments for hepatocellular carcinoma (HCC). However, a minority of patients are eligible for these treatment strategies upon initial diagnosis. With the development of radiotherapy technology, radiotherapy is being used increasingly in the treatment of HCC. A large number of studies have shown that external beam radiotherapy has obvious advantages for different stages of HCC. Stereotactic radiotherapy provides an alternative to radiofrequency ablation in the treatment of early unresectable HCC, and radiotherapy combined with other local or systemic treatments, including transcatheter arterial chemoembolization and sorafenib, has been applied for the treatment of locally advanced and distant metastatic lesions. The particle beam has the advantages of Bragg peak and better dose distribution compared to conventional radiography, showing promising prospect in clinical application. This review focuses on the developments in the field of external beam radiotherapy in the treatment of HCC.
- hepatocellular carcinoma /
- radiotherapy /
- radiofrequency ablation /
- transcatheter arterial chemoembolization /
- sorafenib

HTML全文

参考文献(50)

[1]	Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012[J]. CA: A Cancer J Clin, 2015, 65(2):87-108. doi: 10.3322/caac.21262
[2]	Chen W, Zheng R, Baade PD, et al. Cancer statistics in china, 2015 [J]. CA: A Cancer J Clin, 2016, 66(2):115-132. doi: 10.3322/caac.21338
[3]	Center MM, Jemal A. International trends in liver cancer incidence rates[J]. Cancer Epidemiol, 2011, 20(11):2362-2368. doi: 10.1158/1055-9965.EPI-11-0643
[4]	Takeda A, Sanuki N, Tsurugai Y, et al. Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation[J]. Cancer, 2016, 122(13):2041-2049. doi: 10.1002/cncr.v122.13
[5]	Kudo M, Matsui O, Izumi N, et al. Jsh consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the liver cancer study group of japan[J]. Liver cancer, 2014, 3(3-4):458-468. doi: 10.1159/000343875
[6]	Song P, Tobe RG, Inagaki Y, et al. The management of hepatocellular carcinoma around the world: A comparison of guidelines from 2001 to 2011[J]. Liver Int, 2012, 32(7):1053-1063. doi: 10.1111/liv.2012.32.issue-7
[7]	Poon RT, Fan ST, Lo CM, et al. Long-term survival and pattern of recurrence after resection of small hepatocellular carcinoma in patients with preserved liver function: Implications for a strategy of salvage transplantation[J]. Ann Surg Oncol, 2002, 235(3):373-382. doi: 10.1097/00000658-200203000-00009
[8]	Truty MJ, Vauthey JN. Surgical resection of high-risk hepatocellular carcinoma: Patient selection, preoperative considerations, and operative technique[J]. Ann Surg Oncol, 2010, 17(5):1219-1225. doi: 10.1245/s10434-010-0976-5
[9]	Seo YS, Kim MS, Yoo HJ, et al. Radiofrequency ablation versus stereotactic body radiotherapy for small hepatocellular carcinoma: A markov model-based analysis[J]. Cancer Med, 2016, 5(11):3094-3101. doi: 10.1002/cam4.2016.5.issue-11
[10]	Kondo Y, Kimura O, Shimosegawa T. Radiation therapy has been shown to be adaptable for various stages of hepatocellular carcinoma[J]. World J Gastroenter, 2015, 21(1):94-101. doi: 10.3748/wjg.v21.i1.94
[11]	Kang JK, Kim MS, Cho CK, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization[J]. Cancer, 2012, 118(21):5424-5431. doi: 10.1002/cncr.27533
[12]	Huertas A, Baumann AS, Saunier-Kubs F, et al. Stereotactic body radiation therapy as an ablative treatment for inoperable hepatocellular carcinoma[J]. Radiother Oncol, 2015, 115(2):211-216. doi: 10.1016/j.radonc.2015.04.006
[13]	Yoon SM, Lim YS, Park MJ, et al. Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma[J]. PloS One, 2013, 8(11):e79854. doi: 10.1371/journal.pone.0079854
[14]	Sanuki N, Takeda A, Oku Y, et al. Stereotactic body radiotherapy for small hepatocellular carcinoma: A retrospective outcome analysis in 185 patients[J]. Acta Oncol, 2014, 53(3):399-404. doi: 10.3109/0284186X.2013.820342
[15]	Su TS, Liang P, Lu HZ, et al. Stereotactic body radiation therapy for small primary or recurrent hepatocellular carcinoma in 132 chinese patients [J]. J Surg Oncol, 2016, 113(2):181-187. doi: 10.1002/jso.v113.2
[16]	Su TS, Liang P, Liang J, et al. Long-term survival analysis of stereotactic ablative radiotherapy versus liver resection for small hepatocellular carcinoma[J]. Int J Radi Oncol Biol Phys, 2017, 98(3):639-646. doi: 10.1016/j.ijrobp.2017.02.095
[17]	Louis C, Dewas S, Mirabel X, et al. Stereotactic radiotherapy of hepatocellular carcinoma: Preliminary results[J]. Technol Cancer Res Treat, 2010, 9(5):479-487. doi: 10.1177/153303461000900506
[18]	Bujold A, Dawson LA. Stereotactic radiation therapy and selective internal radiation therapy for hepatocellular carcinoma[J]. Cancer Radiother, 2011, 15(1):54-63. doi: 10.1016/j.canrad.2010.11.003
[19]	Mendez Romero A, Wunderink W, Hussain SM, et al. Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase Ⅰ-Ⅱ study[J]. Acta Oncol (Stockholm, Sweden), 2006, 45(7):831-837. doi: 10.1080/02841860600897934
[20]	Takeda A, Takahashi M, Kunieda E, et al. Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: Preliminary results for efficacy and toxicity[J]. Hepat Res, 2008, 38(1):60-69. doi: 10.1111/hep.2008.38.issue-1
[21]	Choi BO, Jang HS, Kang KM, et al. Fractionated stereotactic radiotherapy in patients with primary hepatocellular carcinoma[J]. Jap J Clin Oncol, 2006, 36(3):154-158. doi: 10.1093/jjco/hyi236
[22]	Kwon JH, Bae SH, Kim JY, et al. Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer[J]. BMC Cancer, 2010, 10(475. http://cn.bing.com/academic/profile?id=a63687398f48e40b01fe3530bdd7d2eb&encoded=0&v=paper_preview&mkt=zh-cn
[23]	Guarneri A, Franco P, Trino E, et al. Stereotactic ablative radiotherapy in the treatment of hepatocellular carcinoma >3 cm[J]. Med Oncol, 2016, 33(10):104. doi: 10.1007/s12032-016-0823-z
[24]	Gkika E, Schultheiss M, Bettinger D, et al. Excellent local control and tolerance profile after stereotactic body radiotherapy of advanced hepatocellular carcinoma[J]. Radia Oncol, 2017, 12(1):116. doi: 10.1186/s13014-017-0851-7
[25]	Que JY, Lin LC, Lin KL, et al. The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities[J]. Radia Oncol, 2014, 9(120):1-8. http://www.europepmc.org/abstract/MED/24885086
[26]	Chen MY, Wang YC, Wu TH, et al. Efficacy of external beam radiationbased treatment plus locoregional therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis[J]. Biomed Red Int, 2016, 2016(6017406):1-9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143704
[27]	Bruix J, Sherman M. Management of hepatocellular carcinoma: An update[J]. Hepatology, 2011, 53(3):1020-1022. doi: 10.1002/hep.24199
[28]	Cheng S, Chen M, Cai J. Chinese expert consensus on multidisciplinary diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombus: 2016 edition[J]. Oncotarget, 2017, 8 (5):8867-8876. http://cn.bing.com/academic/profile?id=f274ca5bdbf0050b2d763a232b5bc5fc&encoded=0&v=paper_preview&mkt=zh-cn
[29]	Nakazawa T, Hidaka H, Shibuya A, et al. Overall survival in response to sorafenib versus radiotherapy in unresectable hepatocellular carcinoma with major portal vein tumor thrombosis: Propensity score analysis[J]. BMC Gastroenterol, 2014, (14):84. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4014748/
[30]	Koo JE, Kim JH, Lim YS, et al. Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus [J]. Int J Radiat Oncol Biol Phys, 2010, 78(1):180-187. doi: 10.1016/j.ijrobp.2009.07.1730
[31]	Zhang XB, Wang JH, Yan ZP, et al. Hepatocellular carcinoma with main portal vein tumor thrombus: Treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization[J]. Cancer, 2009, 115(6):1245-1252. doi: 10.1002/cncr.v115:6
[32]	Yoon SM, Lim YS, Won HJ, et al. Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: Long-term patient outcomes[J]. Int J Radiat Oncol Biol Phys, 2012, 82(5):2004-2011. doi: 10.1016/j.ijrobp.2011.03.019
[33]	Kim JY, Yoo EJ, Jang JW, et al. Hypofractionated radiotheapy using helical tomotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis[J]. Radiat Oncol, 2013, (8):15. doi: 10.1186/1748-717X-8-15
[34]	Tang QH, Li AJ, Yang GM, et al. Surgical resection versus conformal radiotherapy combined with tace for resectable hepatocellular carcinoma with portal vein tumor thrombus: A comparative study[J]. World J Surg, 2013, 37(6):1362-1370. doi: 10.1007/s00268-013-1969-x
[35]	Yu JI, Park HC, Jung SH, et al. Combination treatment with transarterial chemoembolization, radiotherapy, and hyperthermia (cert) for hepatocellular carcinoma with portal vein tumor thrombosis: Final results of a prospective phase Ⅱ trial[J]. Oncotarget, 2017, 8(32): 52651-52664. https://www.researchgate.net/publication/316670852_Combination_treatment_with_transarterial_chemoembolization_radiotherapy_and_hyperthermia_CERT_for_hepatocellular_carcinoma_with_portal_vein_tumor_thrombosis_Final_results_of_a_prospective_phase_II_tri
[36]	Zhao Q, Zhu K, Yue J, et al. Comparison of intra-arterial chemoembolization with and without radiotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis: A meta-analysis[J]. Ther Clin Risk Manag, 2017, (13):21-31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189701
[37]	Shim SJ, Seong J, Han KH, et al. Local radiotherapy as a complement to incomplete transcatheter arterial chemoembolization in locally advanced hepatocellular carcinoma[J]. Liver Inter, 2005, 25(6): 1189-1196. doi: 10.1111/liv.2005.25.issue-6
[38]	Oh D, Lim DH, Park HC, et al. Early three-dimensional conformal radiotherapy for patients with unresectable hepatocellular carcinoma after incomplete transcatheter arterial chemoembolization: A prospective evaluation of efficacy and toxicity[J]. Am J Clini Oncol, 2010, 33(4):370-375. doi: 10.1097/COC.0b013e3181b0c298
[39]	Paik EK, Kim MS, Jang WI, et al. Benefits of stereotactic ablative radiotherapy combined with incomplete transcatheter arterial chemoembolization in hepatocellular carcinoma[J]. Radiat Oncol, 2016, 11(22. http://europepmc.org/articles/PMC4759954
[40]	Yu W, Gu K, Yu Z, et al. Sorafenib potentiates irradiation effect in hepatocellular carcinoma in vitro and in vivo[J]. Cancer Lett, 2013, 329 (1):109-117. doi: 10.1016/j.canlet.2012.10.024
[41]	Cha J, Seong J, Lee IJ, et al. Feasibility of sorafenib combined with local radiotherapy in advanced hepatocellular carcinoma[J]. Yonsei Medi J, 2013, 54(5):1178-1185. doi: 10.3349/ymj.2013.54.5.1178
[42]	Uchino K, Tateishi R, Shiina S, et al. Hepatocellular carcinoma with extrahepatic metastasis: Clinical features and prognostic factors[J]. Cancer, 2011, 117(19):4475-4483. doi: 10.1002/cncr.25960
[43]	Habermehl D, Haase K, Rieken S, et al. Defining the role of palliative radiotherapy in bone metastasis from primary liver cancer: An analysis of survival and treatment efficacy[J]. Tumori, 2011, 97(5):609-613. doi: 10.1177/030089161109700512
[44]	Jiang W, Zeng ZC, Zhang JY, et al. Palliative radiation therapy for pulmonary metastases from hepatocellular carcinoma[J]. Clinic Exp Metast, 2012, 29(3):197-205. doi: 10.1007/s10585-011-9442-4
[45]	Wee CW, Kim K, Chie EK, et al. Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis[J]. Brit J Radiol, 2016, 89(1065):20160383. doi: 10.1259/bjr.20160383
[46]	Yuan BY, Hu Y, Zhang L, et al. Radiotherapy for adrenal gland metastases from hepatocellular carcinoma[J]. Clin Transl Oncol, 2017, 19 (9):1154-1160. doi: 10.1007/s12094-017-1654-x
[47]	Kato H, Tsujii H, Miyamoto T, et al. Results of the first prospective study of carbon ion radiotherapy for hepatocellular carcinoma with liver cirrhosis[J]. Int J Radiat Oncol Biol Phys, 2004, 59(5): 1468-1476. doi: 10.1016/j.ijrobp.2004.01.032
[48]	Kimura K, Nakamura T, Ono T, et al. Clinical results of proton beam therapy for hepatocellular carcinoma over 5 cm[J]. Hepatol Res, 2017, 47(13):1368-1374. doi: 10.1111/hepr.v47.13
[49]	O'Connor JK, Trotter J, Davis GL, et al. Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation[J]. Liver Trans, 2012, 18(8): 949-954. doi: 10.1002/lt.v18.8
[50]	Sapisochin G, Barry A, Doherty M, et al. Stereotactic body radiotherapy vs. Tace or rfa as a bridge to transplant in patients with hepatocellular carcinoma. An intention-to-treat analysis[J]. J Hepat, 2017, 67(1):92-99. doi: 10.1016/j.jhep.2017.02.022