肝癌电子杂志 ›› 2022, Vol. 9 ›› Issue (4): 12-14.

• 专家述评 • 上一篇    下一篇

原发性肝癌立体定向放射治疗进展

曾昭冲*   

  1. 复旦大学附属中山医院放射治疗科,上海 200032
  • 收稿日期:2022-07-18 出版日期:2022-12-31 发布日期:2023-02-03
  • 通讯作者: * 曾昭冲,E-mail:zeng.zhaochong@zs-hospital.sh.cn
  • 作者简介:曾昭冲,复旦大学附属中山医院,放射治疗科

Progresses for stereotactic radiotherapy in primary liver cancer

Zeng Zhaochong   

  1. Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
  • Received:2022-07-18 Online:2022-12-31 Published:2023-02-03

摘要: 近十年,随着精准放射治疗的普及,原发性肝癌的立体定向放射治疗(stereotactic radiotherapy,SRT)也不断得到广泛的临床应用,并积累了很多临床经验。从以前的病例或单中心的临床回顾性研究,发展到目前的多个多中心回顾性临床研究,再到随机前瞻性临床研究,其临床循证级别不断提高。既往报道的采用SRT的原发性肝癌患者绝大部分是复发或转移性肝癌,或者是经多种方法治疗后转变为难治性肝癌再转而接受SRT,其治疗效果不如首诊首治的患者,因此,往往误认为SRT的疗效不如其他局部治疗手段。最近,已经有首诊首治的早期原发性肝癌患者接受SRT,并且与同时期外科手术切除的患者进行倾向性评分匹配研究,证实SRT疗效与外科手术切除疗效相当,而毒副作用轻微。复发性或转移性的原发性肝癌容易复发或转移,故采用SRT结合抗程序性死亡蛋白(programmed death-1,PD-1)抗体治疗,而初步研究结果显示,患者的无进展生存期延长,值得今后进一步探索。

关键词: 原发性肝癌, 立体定向放射治疗, 进展

Abstract: In the past decade with the popularization of image guide radiotherapy, stereotactic radiotherapy (SRT) of primary liver cancer has been widely used and gained a lot of clinical experience. A gratifying course of development includes the experience from case reports or unique center retrospective clinical study to multiple center prospective clinical studies. The evidence based medicine of SRT gradually upgraded. Previous reports about SRT for patients with primary liver cancer focused on those with recurrence or metastatic disease or refractoriness which are poor prognosis in comparison with those with initial therapy with SRT. Study on the patients with primary liver cancer treated with SRT or surgical resection for intrahepatic lesions in the same period, the results showed that similar overall survival and local control rates after propensity score matching in the 2 groups. However, the toxicity is milder in the patients treated with SRT in comparison with surgical resection. Relapse or metastatic primary liver cancer is easy to recur or metastasize, so it is necessary to treat those patients using combination with both SRT and anti-programmed death-1 (PD-1) antibody. The primary results showed that SRT combination with immunotherapy has much better overall survival and progress free survival. The results indicate that it is worthy of further exploration in the future.

Key words: Primary liver cancer, Stereotactic radiotherapy, Progress