立体定向放疗治疗肝细胞癌合并门静脉癌栓的研究进展

Research progress of stereotactic body radiation therapy for hepatocellular carcinoma with porta vein tumor thrombus

摘要:

肝细胞癌（HCC）合并门静脉癌栓（PVTT）是晚期肝癌的常见表现之一，预后较差，治疗难度大。尽管HCC合并PVTT的治疗方式包括手术、系统治疗和局部治疗（如介入治疗、放疗等），但单一治疗效果有限，联合治疗已成为趋势。随着放疗技术的发展，立体定向放疗（SBRT）因其高精度、高剂量、分次少等优势，在姑息治疗、转化治疗、新辅助治疗及术后辅助治疗中发挥了重要作用。研究表明，SBRT单独或联合其他治疗手段可显著延长患者总生存期并提高局部控制率。本文综述了SBRT在HCC合并PVTT中的研究进展，重点探讨了SBRT单独应用及与手术、介入、靶向、免疫治疗等多种治疗方式的联合策略，以期为临床治疗提供参考依据。

Abstract:

Portal vein tumor thrombus (PVTT) is a common manifestation of advanced hepatocellular carcinoma (HCC), associated with poor prognosis and significant treatment challenges. Although various therapeutic options-including surgery, systemic therapies, and local treatments such as interventional procedures and radiotherapy-are available for HCC with PVTT, monotherapies often yield limited efficacy, highlighting the need for combined treatment strategies. With the advancement of radiotherapy technologies, stereotactic body radiation therapy (SBRT) has gained increasing recognition due to its high precision, ablative doses, and fewer treatment fractions. SBRT plays a crucial role in palliative care, conversion therapy, neoadjuvant, and adjuvant settings. Recent studies have demonstrated that SBRT, either alone or in combination with other modalities, significantly improves overall survival and local control rates in patients with HCC and PVTT. This review summarizes the current research progress of SBRT in the management of HCC with PVTT, emphasizing both monotherapy and combined approaches with surgery, interventional therapy, targeted agents, and immunotherapy, aiming to provide insights for clinical decision-making.