[1]梁礼聪,朱康顺,祖茂衡.实现肝癌根治性治疗——钇-90微球选择性内放射治疗作用和价值[J].介入放射学杂志,2026,(04):365-369.[doi:10.3969/j.issn.1008-794X.2026.04.004 ]
　LIANG Licong,ZHU Kangshun,ZU Maoheng..Achieving radical treatment for hepatocellular carcinoma:the role and value of yttrium-90 microspheres selective internal radiation therapy[J].J Intervent Med,2026,(04):365-369.[doi:10.3969/j.issn.1008-794X.2026.04.004 ]
点击复制

实现肝癌根治性治疗——钇-90微球选择性内放射治疗作用和价值()

PDF下载中关闭

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
期数:
2026年04
页码:
365-369
栏目:
专论
出版日期:
2026-04-25

文章信息/Info

Title:
Achieving radical treatment for hepatocellular carcinoma:the role and value of yttrium-90 microspheres selective internal radiation therapy
文章编号:
1008-794X(2026)-004-0365-05
作者:
梁礼聪;  朱康顺;  祖茂衡
510800 广东广州 广州医科大学附属第二医院微创介入科(梁礼聪、朱康顺); 徐州医学院附属医院介入科(祖茂衡)
Author(s):
LIANG Licong1; ZHU Kangshun1; ZU Maoheng2.
1Department of Minimally Invasive Interventional Radiology,Affiliated Second Hospital of Guangzhou Medical University,Guangzhou,Guangdong Province 510800,China; 2Department of Interventional Radiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu Province 221006,China
关键词:
肝癌;  钇-90;  内放射治疗;  根治性治疗;  降期治疗
分类号:
R735.7
DOI:
10.3969/j.issn.1008-794X.2026.04.004
文献标志码:
A
摘要:
肝癌是国内发病率和死亡率均较高的恶性肿瘤,外科手术切除、消融、肝移植是实现根治性治疗的主要手段。但达到这些治疗条件患者不足30%,相当多患者需要接受经动脉化疗栓塞术(TACE)、肝动脉灌注化疗(HAIC)等肝动脉内介入治疗和/或靶向免疫等综合治疗。近年来钇-90微球选择性内放射治疗(selective internal radiation therapy,SIRT)因其强效缩瘤作用和残余肝增生能力,已成为肝癌根治性治疗重要手段之一。对于局限在1～2个肝段肿瘤,通过SIRT使整个目标肝段肿瘤和正常肝接受高钇-90辐射剂量,实现放射性肝段切除; 当肿瘤数量多但局限于单侧肝叶时,使用SIRT治疗患侧肝叶可有效控制肿瘤病变并使患侧肝叶萎缩,部分患者因正常肝叶代偿性增大后续接受根治性治疗,可有效降低术后复发率,延长生存时间。该文就SIRT在肝癌根治性治疗中的作用和价值作一阐述。

参考文献/References:

[1] Han B,Zheng R,Zeng H,et al.Cancer incidence and mortality in China,2022[J].J Natl Cancer Cent,2024,4:47-53.
[2]Reveron-Thornton RF,Teng MLP,Lee EY,et al.Global and regional long-term survival following resection for HCC in the recent decade:A meta-analysis of 110 studies[J].Hepatol Commun,2022,6:1813-1826.
[3]周 俭,肖永胜,李 辉.初始不可切除肝癌转化治疗主要模式及评价[J].中国实用外科杂志,2021,41:280-284.
Zhou J,Xiao YS,LI H.Advances and evaluation of main patterns of conversion therapy for initially unresectable primary liver cancer[J].Chin J Pract Surg,2021,41:280-284.
[4]Vogel A,Meyer T,Sapisochin G,et al.Hepatocellular carcinoma[J].Lancet,2022,400:1345-1362.
[5]Peng Z,Fan W,Zhu B,et al.Lenvatinib combined with transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma:a phase Ⅲ,randomized clinical trial(LAUNCH)[J].J Clin Oncol,2023,41:117-127.
[6]He M,Li Q,Zou R,et al.Sorafenib plus hepatic arterial infusion of oxaliplatin,fluorouracil,and leucovorin vs sorafenib alone for hepatocellular carcinoma with portal vein invasion[J].JAMA Oncol,2019,5:953-960.
[7]陈晓明,张 靖,祖茂衡.加强肝癌根治性介入治疗的理念与临床研究[J].介入放射学杂志,2025,34:805-807.
Chen XM,Zhang J,Zu MH.Strengthening the concept and clinical research of radical interventional therapy for liver cance[J].J Interv Radi,2025,34:805-807.
[8]Zhu H,Li H,Huang M,et al.Transarterial chemoembolization with PD-(L)1 inhibitors plus molecular targeted therapies for hepatocellular carcinoma(CHANCE001)[J].Signal Transduct Target Ther,2023,8:58.
[9]Jin Z,Chen J,Zhu X,et al.Immune checkpoint inhibitors and anti-vascular endothelial growth factor antibody/tyrosine kinase inhibitors with or without transarterial chemoembolization as first-line treatment for advanced hepatocellular carcinoma(CHANCE2201):a target trial emulation study[J].e Clinical Medicine,2024,72:102622.
[10]Cai M,Liang L,Zhang J,et al.Lenvatinib plus drug-eluting bead transarterial chemoembolization with/without hepatic arterial infusion chemotherapy for hepatocellular carcinoma larger than 7 cm with major portal vein tumor thrombosis:a multicenter retrospective cohort study[J].Int J Surg,2024,110:7860-7870.
[11]Kim E,Sher A,Abboud G,et al.Radiation segmentectomy for curative intent of unresectable very early to early stage hepatocellular carcinoma(RASER):a single-centre,single-arm study[J].Lancet Gastroenterol Hepatol,2022,7:843-850.
[12]Salem R,Padia SA,Toskich BB,et al.Radiation segmentectomy for early hepatocellular carcinoma is curative[J].J Hepatol,2025,82:1125-1132.
[13]Salem R,Johnson GE,Kim E,et al.Yttrium-90 radioembolization for the treatment of solitary,unresectable HCC:the LEGACY study[J].Hepatology,2021,74:2342-2352.
[14]Kokabi N,Arndt-Webster L,Chen B,et al.Voxel-based dosimetry predicting treatment response and related toxicity in HCC patients treated with resin-based Y90 radioembolization:a prospective,single-arm study[J].Eur J Nucl Med Mol Imaging,2023,50:1743-1752.
[15]Miller FH,Lopes Vendrami C,Gabr A,et al.Evolution of radioembolization in treatment of hepatocellular carcinoma:a pictorial review[J].Radiographics,2021,41:1802-1818.
[16]Malhotra A,Liu DM,Talenfeld AD.Radiation segmentectomy and radiation lobectomy:a practical review of techniques[J].Tech Vasc Interv Radiol,2019,22:49-57.
[17]Villalobos A,Pisanie JLd,Gandhi RT,et al.Yttrium-90 radioembolization dosimetry:dose considerations,optimization,and tips[J].Semin Intervent Radiol,2024,41:63-78.
[18]Padia SA,Johnson GE,Horton KJ,et al.Segmental Yttrium-90 radioembolization versus segmental chemoembolization for localized hepatocellular carcinoma:results of a single-center,retrospective,propensity score-matched study[J].J Vasc Interv Radiol,2017,28:777-785.e771.
[19]Reig M,Sanduzzi-Zamparelli M,Forner A,et al.BCLC strategy for prognosis prediction and treatment recommend-ations:The 2025 update[J].J Hepatol,2025,Epub ahead of print.
[20]Sarwar A,Malik MS,Vo NH,et al.Efficacy and safety of radiation segmentectomy with 90Y resin microspheres for hepatocellular carcinoma[J].Radiology,2024,311:e231386.
[21]Jia Z,Wang C,Paz-Fumagalli R,et al.Radiation segmentectomy for hepatic malignancies:Indications,devices,dosimetry,procedure,clinical outcomes,and toxicity of yttrium-90 microspheres[J].J Interv Med,2019,2:1-4.
[22]Aliseda D,Martí-Cruchaga P,Zozaya G,et al.Liver resection and transplantation following Yttrium-90 radioembolization for primary malignant liver tumors:a 15-Year single-center experience[J].Cancers(Basel),2023,15:733.
[23]Tzedakis S,Sebai A,Jeddou H,et al.Resection postradioembolization in patients with single large hepatocellular carcinoma[J].Ann Surg,2023,278:756-762.
[24]Mahvash A,Chartier S,Turco M,et al.A prospective,multicenter,open-label,single-arm clinical trial design to evaluate the safety and efficacy of 90Y resin microspheres for the treatment of unresectable HCC:the DOORwaY90(Duration Of Objective Response with arterial Ytrrium-90)study[J].BMC Gastroenterol,2022,22:151.
[25]Kokabi N,Webster LA,Dabbous H,et al.Resin-based 90Y tumor dose as a predictor of duration of response and survival in patients with surgically unresectable hepatocellular carcinoma[J].Clin Nucl Med,2024,49:799-805.
[26]Kwong AJ,Ghaziani TT,Yao F,et al.National trends and waitlist outcomes of locoregional therapy among liver transplant candidates with hepatocellular carcinoma in the United States[J].Clin Gastroenterol Hepatol,2022,20:1142-1150.e1144.
[27]Baker T,Tabrizian P,Zendejas I,et al.Conversion to resection post radioembolization in patients with HCC:recommend-ations from a multidisciplinary working group[J].HPB(Oxford),2022,24:1007-1018.
[28]Birgin E,Rasbach E,Seyfried S,et al.Contralateral liver hypertrophy and oncological outcome following radioembo-lization with 90Y-microspheres:a systematic review[J].Cancers(Basel),2020,12:294.
[29]Yu Q,Wang Y,Ungchusri E,et al.Modified radiation lobectomy strategy of radioembolization for right-sided unresectable primary liver tumors[J].J Vasc Interv Radiol,2024,35:989-997.e982.
[30]Dalzell CG,Taylor AC,White SB.New insights on liver-directed therapies in hepatocellular carcinoma[J].Cancers(Basel),2023,15:5749.
[31]Woloschak GE,Somma F,Stoia V,et al.Yttrium-90 trans-arterial radioembolization in advanced-stage HCC:The impact of portal vein thrombosis on survival[J].PLoS One,2019,14:e0216935.
[32]中国医师协会介入医师分会临床诊疗指南专委会,中国研究型医院学会肝胆胰外科专业委员会.钇-90微球选择性内放射治疗肝脏恶性肿瘤规范化操作专家共识(2024版)[J].中华医学杂志,2024,104:486-498.
Chinese Medical Doctor Association Clinical Guidelines Committee of Chinese College of Interventionalists,Chinese Research Hospital Association Society for Hepato-pancreato-biliary Surgery.Expert consensus on the standardized procedure of selective internal radiation therapy with Yttrium-90 microspheres for liver malignancies(2024 edition)[J].Chin J Med 2024,104:486-498.
[33]Camacho JC,Moncayo V,Kokabi N,et al.90Y radioembolization:multimodality imaging pattern approach with angiographic correlation for optimized target therapy delivery[J].Radiographics,2015,35:1602-1618.
[34]Inchingolo R,Cortese F,Pisani AR,et al.Selective internal radiation therapy segmentectomy:A new minimally invasive curative option for primary liver malignancies?[J].World J Gastroenterol,2024,30:2379-2386.
[35]Vouche M,Habib A,Ward TJ,et al.Unresectable solitary hepatocellular carcinoma not amenable to radiofrequency ablation:multicenter radiology-pathology correlation and survival of radiation segmentectomy[J].Hepatology,2014,60:192-201.
[36]Rudnick SR,Russo MW.Liver transplantation beyond or downstaging within the Milan criteria for hepatocellular carcinoma[J].Expert Rev Gastroenterol Hepatol,2017,12:265-275.
[37]Choi JW,Kim GM,Hyun D,et al.Radioembolization as a spearhead treatment of hepatocellular carcinoma with localized portal vein tumor thrombosis(RESOLVE):protocol for an open-label,multi-center,single-arm trial[J].Cardiovasc Intervent Radiol,2025,48:398-404.
(收稿日期:2025-12-09)
(本文编辑:谷 珂)

相似文献/References:

[1]曹海利,孟巍,白彬.肝癌基因治疗研究新进展[J].介入放射学杂志,2008,(05):375.
　CAO Haili,MENG Wei,BAI Bin.New progress in research of gene therapy for hepatocellular carcinoma[J].J Intervent Med,2008,(04):375.
[2]陆骊工,胡宝山,李勇,等.中晚期原发性肝癌合并症的介入治疗研究[J].介入放射学杂志,2008,(07):514.
　LU Ligong,HU Baoshan,LI Yong,et al.Study of interventional therapy for complications in advanced primary hepatocellular carcinoma[J].J Intervent Med,2008,(04):514.
[3]杨伟洪,刘鹏程,梁珊瑚,等.多层螺旋CT血管造影在判断肝癌寄生供血中的价值[J].介入放射学杂志,2008,(09):654.
　YANG Weihong,LIU Pengchen g,LIANG Shanhu,et al.Evaluation of MSCTA for parasitic blood supply in hepatic carcinoma[J].J Intervent Med,2008,(04):654.
[4]张茵,周兵,许秀芳,等.肝动脉化疗栓塞治疗原发性肝癌存活２０年一例[J].介入放射学杂志,2008,(09):684.
　ZHANG Yin,ZHOU Bing,XU Xiufang,et al.Survival more than２０years after transarterial chemical embolization for hepatocellular carcinoma：A case report[J].J Intervent Med,2008,(04):684.
[5]官泳松,贺庆.肝癌介入治疗中应用p５３的几个要点[J].介入放射学杂志,2008,(11):761.
　GUAN Yongsong,HE Qing.Essentials in clinical application of p５３for tumors intervention－example of liver cancer[J].J Intervent Med,2008,(04):761.
[6]肖运平,肖恩华.介入治疗在防治肝癌术后复发中的作用及进展[J].介入放射学杂志,2008,(11):831.
　XIAO Yunping,XIAO Enhua.The role and progress of interventional therapy in the prevention and treatment of postoperative hepatocellular carcinoma recurrence[J].J Intervent Med,2008,(04):831.
[7]史震山,陈自谦,杨熙章,等.原发性大肝癌患者TACE后S－腺苷蛋氨酸的护肝作用[J].介入放射学杂志,2008,(11):790.
　SHI Zhenshan,CHEN Ziqian,YANG Xizhang,et al.The clinical study on the liver－protection of S－adenosy－methionine in large hepatocellular carcinoma patients after TACE[J].J Intervent Med,2008,(04):790.
[8]王耀普,杨康健,赵思源,等.兔肝癌模型的改良接种及其DSA影像分析[J].介入放射学杂志,2010,(03):214.
　WANG Yaopu,YANG Kangjian,ZHAO Siyuan,et al.The modified inoculation method for the preparation of rabbit VX２hepatic carcinoma model and DSA imagining observation[J].J Intervent Med,2010,(04):214.
[9]贺洪德,贺晶,罗中华,等.肝动脉化疗栓塞联合门静脉栓塞治疗中晚期肝癌的疗效评价[J].介入放射学杂志,2010,(03):191.
　HE Hongde,HE Jing,LUO Zhonghua,et al.Evaluation of the therapeutic effect of hepatic arterial chemoembolization combined with portal chemoembolization for advanced hepatic carcinomas[J].J Intervent Med,2010,(04):191.
[10]李广琪,曹玮,李超,等.肝动脉热灌注对兔肝VX２肿瘤及正常肝组织血管渗透性功能的作用[J].介入放射学杂志,2010,(03):217.
　LI Guangqi,CAO Wei,LI Chao,et al.Influence of hepatic artery thermotherapy on the vascular permeability of hepatic tumor tissue and normal liver tissue in VX２tumor－bearing rabbits[J].J Intervent Med,2010,(04):217.

备注/Memo

备注/Memo:
基金项目: 国家自然科学基金面上项目(82572343); 广东省广州地区临床高新技术项目(2024C-GX08)
通信作者: 朱康顺 E-mail:zhksh010@163.com
更新日期/Last Update: 2026-04-25