肝癌转化治疗相关技术方法及评价

由于肝癌发病早期无明显症状,大部分肝癌病人确诊时已属中晚期,失去根治性手术切除的机会.转化治疗有望将部分初始不可切除肝癌转化为可切除或接受更为有效的局部治疗手段,为病人争取根治性治疗机会、进一步延长生存期.对于病灶局限肝内的中晚期病人,肝动脉栓塞化疗(TACE)及肝动脉灌注化疗(HAIC)治疗可以缩小肿瘤负荷,或通过门...

Advances in the techniques and evaluation of conversion therapy for hepatocellular carcinoma

With asymptom in it early stage,most of hepatocellular carcinoma(HCC)patients are classified as unresectable at the initial diagnosis. Conversion therapy may transform parts of unresectable HCC into resectable or more effective local treatment, thus prolong overall survival time for those patients. For intermediate or late stage HCC patients(BCLC stage B or C, or CNCL stage IIb IIIa), TACE/HAIC can reduce high intrahepatic tumor budren;applying with PVE/ALPPS can increase residual liver volume to achieve possibility of conversion surgery or local therapy. For patients with major vascular invasion, HAIC/TARE or combination with external radiotherapy/SBRT can shrink or even eradicate the tumor thrombus, and thus provide more chances for conversion surgery or more effective local therapy further. The advanced HCC patients(BCLC stage C, or CNCL stage IIIb)with extrahepatic oligometastasis can also achieve status of no evidence of disease(NED) after local therapy. With first-line systemic therapy progression, such as tyrosine kinase inhibitors(TKIs), immune checkpoint inhibitors(ICIs)combination with angiogenesis inhibitors or TKIs, more higher tumor response and longer overall survival was observed in clinic, then sequential combination with radiofrequency ablation/TACE/HAIC and other local therapies can reduce the tumor burden and inactive drug resistance lesions. With the rapid developments of conversion therapy technologies and novel drugs, the concept of HCC conversion therapy needs renew, which will promote more advanced HCC from palliative to radical treatment.