肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点:一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.     

超声引导肝细胞癌射频消融术后局部肿瘤进展的危险因素分析

目的研究超声引导肝细胞癌(HCC)射频消融术后影响局部肿瘤进展的危险因素。方法对99例患者107个病灶行超声引导经皮射频消融治疗,所有患者均进行超声造影血流灌注、肝组织硬度等检查,平均随访时间10.6个月。采用单因素分析和Cox多因素分析方法,研究HCC患者射频消融治疗后局部肿瘤进展的危险因素。结果肿瘤大小、是否邻近较大血管、血流灌注程度和肝组织硬度是HCC射频消融治疗后局部肿瘤进展独立危险因素,其风险比分别为1.12、1.38、1.59和1.77;HCC射频消融前行肝动脉化疗栓塞是局部肿瘤进展的保护因素,风险比为0.52。结论肿瘤大小、是否邻近较大血管、肿瘤血流灌注程度和肝组织硬度是HCC射频消融后局部肿瘤进展的独立影响因素,射频消融前行肝动脉化疗栓塞可有效降低局部肿瘤进展发生率。     

肝癌局部治疗——消融或切除?

肝癌是我国常见的恶性肿瘤之一,手术切除目前仍然是肝癌患者首选的根治性方法,但大部分患者由于受肿瘤大小及部位、肝功能和整体状况的影响,不能耐受手术切除。近年来,以射频和微波为代表的局部消融技术迅速发展,并在临床中广泛应用,更被誉为堪与外科切除相媲美的肝癌根治性治疗的新技术。就局部消融与外科切除在肝癌治疗中的应用和选择作一简介。     

经皮氩氦刀冷冻治疗肝细胞癌的安全性和疗效

肝细胞癌(hepatocellular carcinoma,HCC)居世界癌症死因第三位,在中国居第二位。手术切除率仅为20%～30%,因供体缺乏,肝移植术明显受限,因此多种局部消融术,如无水酒精、射频、激光、高强度聚集超声、微波和冷冻消融等在HCC治疗中发挥着重要作用。氩氦超导靶向手术系统(氩氦刀)冷冻治疗HCC是近年发展的一项局部消融术,尽管在中国经皮氩氦刀治疗HCC已有较多应用,但世界范围内对该技术尚存争议。与应用广泛的射频消融术及其他热消融技术相比,氩氦刀冷冻治疗有产生较大的毁损面积及更为清晰可辨的治疗区域等优势。本文对经皮氩氦刀冷冻治疗HCC的适应证、技术、患者管理、安全性及疗效进行评述。     

当前对原发性肝癌治疗的新认识

在全球常见的癌症中,原发性肝癌(HCC)发病率排名第五位,是第三大由癌症而致死的常见原因[1]。外科手术切除(HR)、局部消融治疗和肝移植(LT)被认为是有治愈可能的措施。但据估计,手术切除或射频消融(RFA)仅对10%的肝癌患者有明显疗效,且这部分患者的肿瘤直径≤3 cm[2];据报道,直到上世纪90年代中期,肝移植患者5年生存率仅为30%～40%。因此HCC的治疗措施并不是     

射频消融治疗肝细胞癌的预后因素及研究新进展

随着医学诊疗水平的提高,射频消融在治疗原发性肝癌的临床应用和基础研究方面都取得飞速进展,发挥着越来越重要的作用:(1)射频消融治疗原发性肝癌的10年总生存率为27.3%-46.1%,对于肿瘤单发且最大径≤3 cm的HCC患者, 10年总生存率可达74%,生存结果与手术切除相似;(2)射频消融联合其他治疗等可以扩大消融治疗的适应证,使患者生存获益;(3)建立预测射频消融治疗原发性肝癌的预后模型,可指导制定治疗和随访策略,为临床个体化诊疗提供重要依据.     

射频消融治疗肝细胞癌的机制

肝细胞癌(HCC)是一种世界范围内发病率和病死率均较高的恶性肿瘤,射频消融(RFA)是一种良好的治疗HCC的方法,尤其适用于肝癌术后复发患者、伴有肝功能不全且不能手术切除和某些多发肝癌患者姑息治疗等,可以明显提高患者的生存时间和生存质量,从直接损伤和间接损伤两个方面综述了RFA治疗HCC的机制,从而进一步理解RFA对肿瘤局部及全身的治疗作用,对今后HCC的多学科联合治疗有潜在价值。     

肝细胞癌的介入治疗

肝细胞癌(HCC)在全球范围内发病率逐年上升，已成为肿瘤相关致死原因第4位。影像引导介入治疗在HCC的治疗中发挥着主要作用。射频消融(RFA)是HCC早期的重要治疗手段，经动脉化疗栓塞(TACE)是中期HCC的标准治疗。其他局部消融技术如：微波消融(WMA)、冷冻消融(CRYO)和不可逆电穿孔(IRE)及经动脉治疗如：经动脉栓塞(TAE)、药物洗脱微球经动脉化疗栓塞(DTACE)、肝动脉灌注化疗(HAIC)和选择性内放射治疗(SIRT)也已得到广泛应用。我们总结了HCC介入治疗的研究成果，探讨患者选择和治疗决策的优化，分析联合全身治疗的方案及预期效果，并展望了未来探索方向，明确介入治疗在HCC治疗中的重要地位。     

射频消融在肝癌多学科综合治疗中的应用

以射频消融（RFA）为代表的局部消融治疗已成为肝癌的重要治疗手段,在肝癌治疗中得到广泛的应用。其主要适应证为肿瘤单发、直径≤5 cm;或者肿瘤2～3个、最大直径≤3 cm。数个临床研究表明射频治疗小肝癌的效果与手术切除相当,国内外多个肝癌临床治疗指南已经将射频与手术切除一样,并列为小肝癌的根治性治疗方法。临床上RFA常常与手术切除、血管介入、瘤内无水酒精注射术、放射治疗、化疗、靶向药物治疗、免疫生物治疗等方法联合应用,在肝癌多学科综合治疗领域中起着越来越重要的作用。     

超声引导射频消融治疗老年肝癌的效果及肿瘤残留的危险因素

目的探讨超声引导射频消融(RFA)治疗老年肝癌(HCC)的疗效及肿瘤残留的危险因素。方法接受超声引导RFA治疗的老年HCC患者315例。治疗后1个月评价疗效。采用单因素分析和多元Logistic回归分析法分析与RFA治疗后肿瘤残留有关的危险因素。结果患者的肿瘤完全消融率为90.16%;病灶的完全消融率为91.27%。单因素分析发现靠近肝内大血管和胆囊、肿瘤最大直径>5 cm及联合其他局部治疗影响患者RFA治疗后肿瘤残留(P<0.05)。靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。结论超声引导RFA治疗获得了良好的治疗效果,靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。     

Ablative strategies for recurrent hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is the fifth leading cause of cancer death worldwide and the third leading cause of all diseases worldwide. Liver transplantation, surgical resection and ablation are the three main curative treatments for HCC. Liver transplantation is the optimal treatment option for HCC, but its usage is limited by the shortage of liver sources. Surgical resection is considered the first choice for early-stage HCC, but it does not apply to patients with poor liver function. Therefore, more and more doctors choose ablation for HCC. However, intrahepatic recurrence occurs in up to 70% patients within 5 years after initial treatment. For patients with oligo recurrence after primary treatment, repeated resection and local ablation are both alternative. Only 20% patients with recurrent HCC (rHCC) indicate repeated surgical resection because of limitations in liver function, tumor location and intraperitoneal adhesions. Local ablation has become an option for the waiting period when liver transplantation is unavailable. For patients with intrahepatic recurrence after liver transplantation, local ablation can reduce the tumor burden and prepare them for liver transplantation. This review systematically describes the various ablation treatments for rHCC, including radiofrequency ablation, microwave ablation, laser ablation, high-intensity focused ultrasound ablation, cryablation, irreversible electroporation, percutaneous ethanol injection, and the combination of ablation and other treatment modalities.     

Lokalablative Therapien zur Behandlung des hepatozellul?ren Karzinoms

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide and only 5?C10% of patients can be successfully treated by resection or liver transplantation. All other patients should receive local ablative therapy when possible but an underlying liver cirrhosis is often a limiting factor. Transarterial chemoembolization, radiofrequency (thermal) ablation and selective intra-arterial radiotherapy are the most important local ablative therapies nowadays. The Barcelona clinic liver cancer (BCLC) staging system is the most important guideline for the treatment of HCC in Europe, considering it as a dynamic guideline as the stage of the disease in each patient might change several times.     

Role of stereotactic body radiation therapy for hepatocellular carcinoma

The integration of new technologies has raised an interest in liver tumor radiotherapy,with literature evolving to support its efficacy.These advances,particularly stereotactic body radiation therapy(SBRT),have been critical in improving local control or potential cure in liver lesions not amenable to first-line surgical resection or radiofrequency ablation.Active investigation of SBRT,particularly for hepatocellular carcinoma(HCC),has recently started,yielding promising local control rates.In addition,data suggest a possibility that SBRT can be an alternative option for HCC unfit for other local therapies.However,information on optimal treatment indications,doses,and methods remains limited.In HCC,significant differences in patient characteristics and treatment availability exist by country.In addition,the prognosis of HCC is greatly influenced by underlying liver dysfunction and treatment itself in addition to tumor stage.Since they are closely linked to treatment approach,it is important to understand these differences in interpreting outcomes from various reports.Further studies are required to validate and maximize the efficacy of SBRT by a large,multi-institutional setting.     

Radiological intervention of hepatocellular carcinoma]

In spite of the nice screening program using the state-of-the-art imaging modalities, most patients with hepatocellular carcinoma (HCC) are not eligible for curative resection due to poor hepatic functional reserve and multiplicity of the tumors. Therefore they greatly rely on percutaneous interventional procedures. Among these, transcatheter arterial chemoembolization and local ablation therapies including ethanol injection therapy or radiofrequency (RF) thermal ablation have gained wider acceptance for the local treatment of unresectable HCC with growing evidence of survival gain. Although we need more prospective randomized trials to determine the definite role of these interventional therapies, the current consensus is that they are safe and effective for the local control of small HCC and have a potential to replace definitive surgical options. In this review, the basic principles and published clinical results including long-term survival rates and complications are reviewed. The benefits and limitations of each therapy are also discussed.     

Advances in non-surgical management of primary liver cancer

Hepatocellular carcinoma(HCC) is the fifth most common cancer and the third most common cause of cancer-related death worldwide. There have been great improvements in the diagnosis and treatment of HCC in recent years, but the problems, including difficult diagnosis at early stage, quick progression, and poor prognosis remain unsolved. Surgical resection is the mainstay of the treatment for HCC. However, 70%-80% of HCC patients are diagnosed at an advanced stage when most are ineligible for potentially curative therapies such as surgical resection and liver transplantation. In recent years, non-surgical management for unrespectable HCC, such as percutaneous ethanol injection, percutaneous microwave coagulation therapy, percutaneous radiofrequency ablation, transcatheter arterial chemoembolization, radiotherapy, chemotherapy, biotherapy, and hormonal therapy have been developed. These therapeutic options, either alone or in combination, have been shown to control tumor growth, prolong survival time, and improve quality of life to some extent. This review covers the current status and progress of non-surgical management for HCC.     

Treatment for hepatocellular carcinoma in Japan over the last three decades: Our experience and published work review

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer‐related mortality worldwide. In the last few decades, there has been a marked increase in therapeutic options for HCC and epidemiological characteristics at HCC diagnosis have also significantly changed. With these changes and advances in medical technology and surveillance program for detecting earlier stage HCC, survival in patients with HCC has significantly improved. Especially, patients with liver cirrhosis are at high risk of HCC development, and regular surveillance could enable early detection of HCC and curative therapy, with potentially improved clinical outcome. However, unfortunately, only 20% of HCC patients are amenable to curative therapy (liver transplantation, surgical resection or ablative therapies). Locoregional therapies such as radiofrequency ablation, percutaneous ethanol injection, microwave coagulation therapy and transcatheter arterial chemoembolization play a key role in the management of unresectable HCC. Currently, molecular‐targeted agents such as sorafenib have emerged as a promising therapy for advanced HCC. The choice of the treatment modality depends on the size of the tumor, tumor location, anatomical considerations, number of tumors present and liver function. Furthermore, new promising therapies such as gene therapy and immunotherapy for HCC have emerged. Approaches to the HCC diagnosis and adequate management for patients with HCC are improving survival. Herein, we review changes of epidemiological characteristics, prognosis and therapies for HCC and refer to current knowledge for this malignancy based on our experience of approximately 4000 HCC cases over the last three decades.     

Current management of patients with hepatocellular carcinoma

The current management therapies for hepatocellular carcinoma(HCC) patients are discussed in this review. Despite the development of new therapies, HCC remains a "difficult to treat" cancer because HCC typically occurs in advanced liver disease or hepatic cirrhosis. The progression of multistep and multicentric HCC hampers the prevention of the recurrence of HCC. Many HCC patients are treated with surgical resection and radiofrequency ablation(RFA), although these modalities should be considered in only selected cases with a certain HCC number and size. Although there is a shortage of grafts, liver transplantation has the highest survival rates for HCC. Several modalities are salvage treatments; however, intensive care in combination with other modalities or in combination with surgical resection or RFA might offer a better prognosis. Sorafenib is useful for patients with advanced HCC. In the near future, HCC treatment will include stronger molecular targeted drugs, which will have greater potency and fewer adverse events. Further studies will be ongoing.     

Treatment of hepatocellular carcinoma

Opinion statement The incidence of hepatocellular carcinoma (HCC) is increasing in the United States. Several modalities are available for the treatment of HCC, and decisions regarding the optimal choice of therapy are based on tumor burden and severity of liver disease. Classification systems are helpful for prognostic purposes and to guide in the choice of therapy. Surgical resection is a mainstay of therapy for patients with solitary small tumors and preserved liver function (noncirrhotic or Child-Pugh class A cirrhotic patients without portal hypertension). Unfortunately, a minority of patients is eligible for resection, and postoperative recurrence or de novo HCC is common. Liver transplantation offers the best chance of curing HCC in cirrhotic patients. Patients with a solitary tumor less than 5 cm or no more than three tumors each 3 cm or less have a survival rate of 70% with less than 20% recurrence at 5 years. Access to liver transplantation is limited by organ availability, and tumor progression during the waiting period can lead to ineligibility. Ethanol injection and radiofrequency ablation are effective modalities to ablate small tumors (generally <5 cm) in patients who are not candidates for resection or liver transplantation. These modalities can also be used to treat HCC prior to liver transplantation. Transarterial chemoembolization is used to treat patients with multifocal or large HCC who are ineligible for other therapies. Chemotherapeutic agents are infused into the tumor via the hepatic artery along with embolic material in order to induce tumor necrosis. This technique should be used in selective patients with relatively preserved liver function, absence of portal vein thrombosis, or encephalopathy. Limited data exist to support the use of this modality as a primary treatment option for small HCC. Chemotherapeutic or hormonal therapies have a limited role in the management of patients with HCC. Despite mixed outcomes, we routinely use the somatostatin analog octreotide in advanced, multifocal HCC. Emerging therapies should focus on treatment of small tumors and targeted pharmacologic therapy for advanced disease.     

Presentación,clasificación y evolución de los pacientes con carcinoma hepatocelular en un centro de Veracruz,México

BackgroundHepatocellular carcinoma (HCC) staging provides a basis for calculating disease prognosis and therapeutic guidance. Liver resection and transplantation are curative options, and ablation therapies are applied to patients that are not candidates for curative treatment. Survival after liver resection or ablation therapies varies.AimsTo describe the presentation, staging, management, and outcome in patients with HCC in our center.Patients and methodsForty-two patients had a 7-year prospective follow-up. Survival was calculated with the Kaplan-Meier analysis and the log-rank test was used for its comparison between the staging systems (Okuda, BCLC, and CLIP) and types of treatment (liver resection, radiofrequency ablation, and no surgical treatment).ResultsThe mean age of the patients was 68.9 ± 9.5 years; 57% were women. A total of 54% of the patients presented with cirrhosis and 31% were infected with hepatitis C virus (HCV). The mean tumor size was 6.48 ± 2.52 cm. The CLIP 0, Okuda I, and BCLC A stages had better survival rates than the other stages (P<0.05). Survival with resection was superior (median of 32 months and survival at 1, 3, and 5 years of 83, 39, and 19.7%, respectively) to that of both radiofrequency ablation (median of 25 months and survival at 1 and 3 years of 90 and 17.2%, respectively) and no surgical treatment (1 year < 5%) (P<0.05).ConclusionThe patients at our center were diagnosed at late stages of HCC, as is the case in other Mexican populations. Outcome in relation to CLIP and BCLC was similar to the prognoses reported in the literature. The best results were observed in the patients with early stage disease and those that underwent HCC resection surgery.     

Hepatocellular carcinoma review:Current treatment,and evidence-based medicine

Hepatocellular carcinoma(HCC)is the fifth most common tumor worldwide.Multiple treatment options are available for HCC including curative resection,liver transplantation,radiofrequency ablation,trans-arterial chemoembolization,radioembolization and systemic targeted agent like sorafenib.The treatment of HCC depends on the tumor stage,patient performance status and liver function reserve and requires a multidisciplinary approach.In the past few years with significant advances in surgical treatments and locoregional therapies,the short-term survival of HCC has improved but the recurrent disease remains a big problem.The pathogenesis of HCC is a multistep and complex process,wherein angiogenesis plays an important role.For patients with advanced disease,sorafenib is the only approved therapy,but novel systemic molecular targeted agents and their combinations are emerging.This article provides an overview of treatment of early and advanced stage HCC based on our extensive review of relevant literature.