| 赵倩倩,曾昭冲.不能手术切除早期肝细胞癌的放疗进展——2024年度循证更新[J].中华放射医学与防护杂志,2026,46(1):90-92.Zhao Qianqian,Zeng Zhaochong.Advances in radiotherapy for unresectable early-stage hepatocellular carcinoma: A 2024 evidence-based update[J].Chin J Radiol Med Prot,2026,46(1):90-92 |
| 不能手术切除早期肝细胞癌的放疗进展——2024年度循证更新 |
| Advances in radiotherapy for unresectable early-stage hepatocellular carcinoma: A 2024 evidence-based update |
| 投稿时间：2025-07-12 |
| DOI：10.3760/cma.j.cn112271-20250712-00247 |
| 中文关键词: 早期肝细胞癌 不可手术切除 放射治疗 |
| 英文关键词:Early-stage hepatocellular carcinoma Unresectable Radiotherapy |
| 基金项目:国家自然科学基金(82373519);国家重点研发计划项目(2022YFC2503704) |
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| 中文摘要: |
| 在晚期肝细胞癌(HCC)系统治疗格局飞速演进的当下,不可手术切除的早期HCC(NCLC 1A-2A期)的放射治疗因性价比优势日益凸显。在HCC放疗方面,2024年共发表3篇随机前瞻性多中心临床研究,直接改变国际肝癌诊治指南,尤其是欧洲指南,如巴塞罗那肝癌分期(BCLC)和欧洲肝病学会(EASL)指南,他们首次把早期HCC放疗列入诊疗路线图。本文依据国家卫生健康委《原发性肝癌诊疗指南》及《肝癌放疗共识》,系统梳理该亚群放疗的最新循证证据。通过整合前瞻性随机对照试验及多中心回顾性队列,对立体定向放疗(SBRT)、射频消融(RFA)及经动脉化疗栓塞联合放疗(TACE+RT)的疗效。结果提示,对于不可切除且直径≤5 cm的病灶,尤以邻近大血管、膈顶等高危解剖部位者,SBRT可作为首选策略;对>5 cm的病灶,TACE + RT较单纯TACE可显著提高3年局部控制率(56.6% vs. 17.8%, P=0.0015),且联合方案可将平均介入次数减少2.1次。因此,在晚期药物层出不穷的背景下,个体化选择SBRT或TACE+RT实现了与手术切除等效的肿瘤学结局,为不可切除早期HCC的精准放疗提供了循证依据。 |
| 英文摘要: |
| Amid the rapidly evolving landscape of systemic therapy for advanced hepatocellular carcinoma (HCC), radiotherapy for unresectable early-stage HCC (NCLC stage 1A-2A) has gained prominence owing to its favorable cost-effectiveness profile. This review, grounded in China's National Health Commission Guidelines for the Diagnosis and Treatment of Primary Liver Cancer and the Consensus Statements on Radiotherapy for HCC, systematically synthesizes the latest evidence on radiotherapy for this subpopulation. Through integrated analysis of prospective randomized controlled trials and multicenter retrospective cohorts, we conducted a comprehensive evaluation of the efficacy for stereotactic body radiotherapy (SBRT), radiofrequency ablation (RFA), and transarterial chemoembolization combined with radiotherapy (TACE+RT). Our analysis reveals that for unresectable lesions ≤5 cm, particularly those in high-risk anatomical locations (e.g., adjacent to major vessels or the diaphragm), SBRT represents the preferred therapeutic strategy. For lesions >5 cm, TACE+RT significantly improves 3-year local control rates compared to TACE alone (56.6% vs. 17.8%, P = 0.0015), while reducing the mean number of TACE sessions by 2.1. Thus, in the era of rapidly expanding advanced therapeutics, personalized selection of SBRT or TACE+RT achieves oncological outcomes comparable to surgical resection. These findings establish an evidence-based framework for precision radiotherapy in unresectable early-stage HCC. |
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