摘要
精准外科理念下,肝癌的介入放射治疗尤其是钇90(90Y)选择性内放射治疗(SIRT)正在成为肝癌治疗的重要手段之一。肝癌作为恶性消化道肿瘤,其高发病率和高死亡率对公共健康构成了重大挑战。手术切除是肝癌有效的治愈方式,但大部分中晚期肝癌确诊时已无法切除。90Y选择性内放射治疗通过介入途径将90Y微球直接注入肿瘤供血动脉,实现“从内向外”的高剂量精准放射治疗。该技术的关键在于精确术前评估与精密手术规划、精致术中操作以及精良术后管理,以确保治疗的有效性和安全性。90Y选择性内放射治疗能够杀灭肿瘤,增加余肝体积,消除门静脉癌栓,在肝癌的降期转化治疗中可发挥重要作用,为部分本不可切除的肝癌病人创造手术切除的机会,进而提高病人的长期生存率。在精准外科理念的指导下,将进一步规范创新介入放射治疗技术在肝癌治疗中应用,提高其疗效和安全性。在多学科综合治疗协作组(MDT)的协作下,通过个体化的治疗方案与术中操作规范化,90Y选择性内放射治疗在肝癌治疗中的应用前景广阔。未来,随着临床经验的积累和技术的进步,90Y选择性内放射治疗将在提高肝癌治愈率、优化治疗流程、减少副反应以及提高病人生活质量等方面发挥更加重要的作用。
Under the paradigm of precision surgery,interventional radiotherapy for hepatocellular carcinoma(HCC),particularly Yttrium-90 selective internal radiation therapy(SIRT),is becoming a key treatment modality.HCC,a highly malignant gastrointestinal tumor,poses significant public health challenges due to its high incidence and mortality rates.Surgical resection is an effective curative treatment for HCC,but most advanced HCC patients are unresectable when diagnosed.Yttrium-90 SIRT achieves high-dose precision radiation“from the inside out”by directly injecting yttrium-90 microspheres into the tumor-feeding arteries.The success of this technique relies on precise preoperative assessment and planning,accurate intraoperative procedures,and meticulous postoperative management and monitoring to ensure treatment efficacy and safety.Yttrium-90 SIRT can reduce tumor size,increase residual liver volume and eliminate portal vein tumor thrombus,playing an important role in the downgrading treatment of HCC,creating surgical resection opportunities for unresectable tumors,thereby improving long-term survival rates.Under the guidance of precision surgery,the efficacy and safety of interventional radiation therapy for HCC will be better optimized via furtherly standardized and innovative applications.With the collaboration of a multidisciplinary team(MDT),individualized treatment plans,and standardized intraoperative procedures,yttrium-90 SIRT holds broad prospects in HCC management.In the future,as clinical experience accumulates and technology advances,yttrium-90 SIRT is expected to play an increasingly important role in improving HCC cure rates,optimizing treatment processes,reducing side effects,and improving quality of life.
作者
董家鸿
张琳
冯晓彬
DONG Jia-hong;ZHANG Lin;FENG Xiao-bin(Hepatopancreatobiliary Center,Bejing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,The Precision Hepatobiliary Surgery Paradigm Innoation Unit,Chinese Academy of Medical Sciences,Beijing 102218,China;不详)
出处
《中国实用外科杂志》
CAS
CSCD
北大核心
2024年第9期988-991,995,共5页
Chinese Journal of Practical Surgery
基金
国家自然科学基金重点项目(No.81930119)
中国医学科学院医学与健康科技创新工程创新单元项目(No.2019-I2M-5-056)。
关键词
精准外科
肝癌
选择性内放射治疗
钇90
precision surgery
hepatocellular carcinoma
selective internal radiation therapy
Yttrium-90
作者简介
通信作者:董家鸿,E-mail:dongjiahong@mail.tsinghua.edu.cn。
