Recent Advances in the Treatment of Hepatocellular Carcinoma
RTP Poon
Hong Kong J Radiol 2012;15(Suppl):S13-22
Multiple factors may influence the selection of treatments for patients with hepatocellular carcinoma. Surgical resection continues to be the mainstay of treatment for patients with well-preserved liver function. Appropriately selected candidates can have a five-year postoperative survival rate of up to 70%, but hepatic resections are also associated with a high recurrence rate. Patients with small hepatocellular carcinoma tumours can be treated with radiofrequency ablation. However, this procedure is also associated with high recurrence rates. Microwave ablation can induce large ablation volumes and yield good local tumour control, especially for small tumours. High-intensity focused ultrasound can be safely used to ablate tumours adjacent to major vessels or hepatic ducts. Long-term survival after thermal ablation is comparable to that of surgery for tumours of 3 cm or smaller. Liver transplantation is considered to be curative of both the tumour and the underlying cirrhosis. Transplantation is associated with favourable long-term survival and low recurrence rates. However, graft availability, costs, and lack of local expertise may limit the availability of this procedure for many patients with hepatocellular carcinoma. For patients with well-preserved liver function and multinodular tumours without vascular invasion, transarterial chemoembolisation can be a suitable treatment. Transarterial chemoembolisation with doxorubicineluting beads is a newly developed locoregional treatment for unresectable hepatocellular carcinoma, and may be safer and more effective than conventional transarterial chemoembolisation. Yttrium-90 radioembolisation is a relatively new technique that implements transarterial administration of minimally embolic microspheres to deliver selective internal radiation to the tumour. So far, no prospective study has compared selective arterial radioembolisation with yttrium-90 microspheres with transarterial chemoembolisation, however, the latter has shown promise, particularly for hepatocellular carcinoma with portal vein invasion. Sorafenib has been approved for treatment of advanced hepatocellular carcinoma, with a gain in median survival of about three months. Other molecular targeted therapies for hepatocellular carcinoma are being evaluated in clinical trials. This paper provides an update on current and emerging treatment options for patients with hepatocellular carcinoma.
中文摘要
治療肝癌的最新發展
潘冬平
多項因素會影響肝癌患者選擇治療的方法。手術切除仍然是患者保存良好肝功能的主要療法，合適 的病人術後五年的存活率可達至70%，但肝切除的復發率屬於偏高。如肝癌患者的腫瘤屬小型，可 選擇射頻燒灼術，但此方法的復發率同樣偏高。微波燒灼術有較大燒灼量，尤其對於小型腫瘤，可產生較佳的局部療效。高強聚焦超音波對於位置較接近大型血管或肝動脈的腫瘤屬於較為安全的方 法。熱能燒灼術的遠期存活率可媲美腫瘤小於三厘米的切割手術。肝臟移植被認為是同一時間醫治 腫瘤及相關肝硬化的方法。肝臟移植有良好的遠期存活率及低復發率，可惜的是，對於眾多的肝癌 患者來說，活肝數量、治療成本、及本地醫療技術都限制肝臟移植的發展。對有良好肝功能而有多 結節但無血管侵犯腫瘤的患者，肝動脈栓塞化療可能較為適合。以doxorubicin緩釋微球作肝動脈栓 塞化療是治療不能手術切除肝癌的一種新研發的局部治療方法，比利用傳統肝動脈栓塞化療更安 全、更有效。釔90放射性栓塞治療是一種相對較新的技術，經肝動脈中的微創栓塞微球以傳送選擇 性的體內放射至腫瘤。直至目前為止，尚未有前瞻性研究比較釔90放射性栓塞治療與肝動脈栓塞化 療，可是，肝動脈栓塞化療尤其對已侵襲門靜脈的肝癌較有保證。Sorafenib已獲准治療晚期肝癌的 藥物，可延長病人的存活率中位數約三個月。目前正評估臨床試驗中其他分子標靶治療肝癌的成 效。本文為肝癌患者提供了一個現時和新興的治療方案。