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局限性肝细胞癌的非手术治疗：经动脉栓塞、放疗和放射性栓塞

Authors
Steven A Curley, MD, FACS
Keith E Stuart, MD
Jonathan M Schwartz, MD
Robert L Carithers, Jr, MD
Section Editor
Kenneth K Tanabe, MD
Deputy Editor
Diane MF Savarese, MD
Translators
杜锡林, 主任医师，教授

引言

肝细胞癌(hepatocellular carcinoma, HCC)是一种侵袭性肿瘤，常见于肝硬化患者。患者的肝功能储备通常会决定治疗方式的选择(表 1和表 2)。治疗方式分为手术治疗[即切除术和原位肝移植术(orthotopic liver transplantation, OLT)]与非手术治疗[即射频消融术(radiofrequency ablation, RFA)和其他肿瘤热消融术、经皮无水乙醇注射(percutaneous ethanol injection, PEI)、冷冻消融术、经动脉化疗栓塞(transarterial chemoembolization, TACE)、放疗(radiation therapy, RT)、放射性栓塞和全身治疗])[1]。

治疗流程 — HCC的一般治疗方法如图所示(诊断流程 1)。Barcelona临床肝癌组使用另一种治疗流程(诊断流程 2)[2]。然而，尝试制定HCC的治疗流程十分困难，因为新的治疗方式和各种疗法的适应证变化很快。而且，治疗方式往往依据现有专业技术而有所不同，肝切除术和原位肝移植术也存在多种不同标准。上述问题和HCC的一般治疗方法将在别处详细讨论。 (参见“肝细胞癌治疗方法的概述”)

全面多学科治疗的重要性 — 大部分HCC患者都有基础肝病，可能与感染乙型肝炎病毒(hepatitis B virus, HBV)和/或丙型肝炎病毒(hepatitis C virus, HCV)有关。而且，接受任何形式治疗的患者都存在疾病复发和进展至肝衰竭的高风险。对于有较晚期肝病的患者适当地进行监测评估和治疗基础肝病是很重要的，基础肝病对长期生存可能有重大影响。肝硬化患者的全面治疗包括，针对HBV和HCV的抗病毒治疗、接种甲肝和乙肝病毒疫苗(如果需要)以及内镜筛查和监测静脉曲张。 (参见“肝细胞癌的流行病学和病因学关联”和“成人肝硬化：并发症、一般治疗和预后的概述”和‘乙型肝炎相关问题’)

本专题将总结经动脉栓塞、放疗和放射性栓塞治疗。而其他非手术治疗(RFA、PEI、冷冻消融术、微波和激光凝固术)，以及切除术、肝移植术和全身治疗将在别处讨论。 (参见“局部肝细胞癌的非手术疗法：射频消融、经皮无水乙醇注射、热消融和冷冻消融”和“潜在可切除性肝细胞癌的手术治疗”和“肝细胞癌的肝脏移植治疗”和“晚期肝细胞癌的全身性治疗”)

评估局部区域治疗的效果

评估治疗效果的标准方法[例如：一维的RECIST标准(表 3)、使用世界卫生组织(World Health Organizatio, WHO)标准的二维垂直测量[3])]是在治疗前后测量肿瘤直径。这类方法不涉及坏死的范围，坏死是局部区域消融治疗的最终结果[4]。

                                

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