演題抄録

臓器別シンポジウム

開催概要
開催回
第55回・2017年・横浜
 

肝細胞癌の非外科的治療

演題番号 : OSY16-3

[筆頭演者]
椎名 秀一朗:1 

1:順天堂大学・消化器画像診断・治療学

 

Various nonsurgical therapies have been introduced for HCC. Among these, RFA is considered best for early-stage HCC. RCTs have demonstrated that RFA is superior to ethanol injection (Shiina S, et al. Gastroenterology 2005). In our 10-year experience of RFA, final CT showed complete tumor ablation in 2,964 (99.4%) of 2,982 treatments performed for the 1,170 primary HCC patients. With a median follow-up of 38.2 months, 5- and 10-year survival rates were 60.2% and 27.3%, respectively. Age, anti-HCV, Child-Pugh class, tumor size, tumor number, DCP, and AFP-L3 were significantly related to survival. (Shiina S, et al. Am J Gastro 2012). Sophisticated RFA would be curative and achieve long-term survival. Various innovations, such as contrast-enhanced US and multimodality fusion imaging would further improve outcomes in RFA. Furthermore, innovated RFA systems and new-generation MWAs will be introduced into clinical practice in the near future. RFA is, however, highly operator-dependent. Its skills and outcomes are different from operator to operator. Juntendo, the highest volume center of RFA in Japan, have held RFA training programs to disseminate skills and know-hows for RFA. In eight domestic programs, 130 Japanese doctors participated while in three international ones, 31 foreign doctors attended. The programs were composed of lectures, live demonstrations and case studies. Questionnaire surveys revealed overwhelmingly positive feedback. Our programs may be useful to provide opportunities to understand basic concepts and learn essential technical tips in RFA. DEB-TACE has been introduced in vascular interventions. Hepatic arterial infusion chemotherapy is a therapeutic option for advanced HCC with intrahepatic metastases or PVTT, which is not eligible for resection, ablation, or TACE. New molecular targeting agents and immune checkpoint inhibitors are around the corner in clinical practice. In the aging society, nonsurgical therapies would play a more important role.

前へ戻る