肝细胞癌介入肿瘤学进展。
完整摘要 · 中文译文
局部区域治疗用于肝细胞癌（HCC）的整个治疗谱系，包括小肿瘤的治愈性治疗、肝移植前的桥接或降期治疗、中期疾病的治疗，以及在部分患者中作为与全身治疗联合治疗的一部分。本叙述性综述总结了经动脉放射性栓塞（TARE）、经动脉化疗栓塞（TACE）和经皮消融技术的最新进展，并将已确立的临床进展与早期研究性工作区分开。最强证据支持个体化TARE剂量学和放射性肝段切除术、重复治疗前重新评估的选择性TACE，以及采用客观切缘评估的影像引导热消融。TACE联合抗血管生成和免疫检查点治疗的3期试验显示，在部分不可切除、无转移的HCC患者中无进展生存期改善，尽管这些联合方案的生存获益迄今仅扩展至无进展生存期，最佳治疗顺序仍有待确定。组织碎化术、脉冲电场消融、电化学治疗、冷冻消融、高强度聚焦超声、可成像或替代性放射性栓塞微球、新型栓塞剂、机器人技术和人工智能仍处于不同的临床开发阶段。大多数支持数据来自单臂研究、回顾性队列研究、混合肝肿瘤人群的试验或临床前模型研究。治疗选择 应综合考虑肿瘤负荷及位置、肝功能、门静脉高压、血管侵犯、移植候选资格、现有替代治疗方案、本地专业经验及患者偏好。未来研究应重点关注持久的局部控制、肝功能保护、生活质量、移植资格、总生存期及成本。
完整摘要 · 英文原文
Locoregional therapies are used across the hepatocellular carcinoma (HCC) treatment spectrum, including for curative treatment of small tumors, as bridging or downstaging therapy before liver transplant, for treatment of intermediate-stage disease, and as part of combination treatment with systemic therapy in selected patients. This narrative review summarizes recent developments in transarterial radioembolization (TARE), transarterial chemoembolization (TACE), and percutaneous ablation techniques and separates established clinical advances from early investigational work. The strongest evidence supports personalized TARE dosimetry and radiation segmentectomy, selective TACE with reassessment before repeat treatment, and image-guided thermal ablation with objective margin assessment. Phase 3 trials of TACE combined with antiangiogenic and immune checkpoint therapy demonstrated improved progression-free survival in selected patients with unresectable, nonmetastatic HCC, although the survival benefit of these combinations so far extends only to progression-free survival, and the best treatment sequence remains to be defined. Histotripsy, pulsed electric-field ablation, electrochemotherapy, cryoablation, high-intensity focused ultrasound, imageable or alternative radioembolic microspheres, new embolic agents, robotics, and artificial intelligence remain at different stages of clinical development. Most supporting data are derived from single-arm studies, retrospective cohort studies, trials in mixed liver-tumor populations, or studies in preclinical models. Treatment selection should account for tumor burden and location, liver function, portal hypertension, vascular invasion, transplant candidacy, available alternatives, local expertise, and patient preferences. Future studies should focus on durable local control, preservation of liver function, quality of life, transplant eligibility, overall survival, and cost.