聚焦肝癌高复发率的世界难题,怎么办?本文提出放疗有可能成为治疗肝癌复发的新思路,癌周亚临床病灶是导致肝癌复发的主要根源,肝癌合理治疗应包括主癌灶和癌周亚临床病灶在内的所有肿瘤组织施行全面治疗,最大程度地预防肿瘤复发,这应该是肝癌治疗的理想总目标。围绕肝癌癌周亚临床病灶分布范围的认识来讨论三维适形放疗、“改良全肝移动条野放疗”和外科切除的优缺点,利用三者各有所长,优势互补的综合治疗的新方案,有待多中心循证研究证实其治疗效果,具有一定的启发性和创新性。方案1. 小肝癌宜手术切除,术后放疗用“改良全肝移动条野放疗”30 Gy,治疗已成形的肝癌癌周亚临床病灶。方案2. 大肝癌宜术前放疗,用“改良全肝移动条野放疗”30 Gy,治疗已成形的肝癌癌周亚临床病灶,继续小野3D-CRT剂量递增至60 Gy根治主癌灶,待主癌灶缩小后,二期切除。When focusing on high rate of liver cancer recurrence in the world, what should we do? Radiotherapy presented in this paper may become a new idea to treat liver cancer recurrence. Peritumoral subclinical lesion is the leading cause of cancer recurrence. Implementation of a comprehensive treatment of all tumor tissue including primary liver cancer and peritumoral subclinical lesions to maximize the prevention of tumor recurrence is the ideal and overall goal of treatment for liver cancer. The new comprehensive treatment method consists of three-dimensional conformal radiotherapy, “improved radiotherapy with moving split fields radiation of the whole liver” and surgical resection, which has certain Instructiveness and innovativeness. Program 1: Surgical operation is preferred for small HCC followed by ra- diotherapy with “improved radiotherapy with moving split fields radiation of the whole liver” 30 Gy. Program 2: Preop- erative radiotherapy with “improved radiotherapy with moving split fields radiation of the whole liver” 30 Gy is preferred for large HCC. It is followed by 3D-CRT dose escalation to 60 Gy to treat primary neoplasms foci. Surgical resection is performed when the primary neoplasms foci diminishes.
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