PDF(Pubmed)
Abstract：
The combination of stereotactic body radiation therapy (SBRT) plus immune checkpoint inhibitors (ICI) must be explored to treat advanced primary liver tumors such as hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Limited retrospective reviews and case reports/series suggest this combination can be effective and safe in both cancer types. With ICIs moving into the first line (IMbrave 150, HIMALAYA, and TOPAZ-1) to manage these cancers, identifying a suitable population for this approach is challenging. Patients with macrovascular invasion (MVI)-positive HCC (especially if larger veins are involved) or recurrent HCCs post-locoregional therapies (such as transarterial radioembolization (TARE), transarterial chemoembolization (TACE), or ablation), as well as those ineligible for bevacizumab or tyrosine kinase inhibitors (TKIs), should be the focus of exploring this combination in HCC. Unresectable or oligometastatic CCA patients who cannot tolerate gemcitabine/cisplatin (GC) or those who progressed on GC without durvalumab and do not have targetable mutations could also be considered for this approach. In both HCC and CCA disease groups, SBRT plus ICI can be examined post-ICI as these two modalities act synergistically to enhance anti-tumor activity (based on pre-clinical studies). Large-scale randomized trials are needed to identify the subsets of primary liver cancers suitable for this approach and to clearly define its clinical benefit.
摘要：
必须探索立体定向放射治疗（SBRT）加免疫检查点抑制剂（ICI）的组合，以治疗晚期原发性肝肿瘤，如肝细胞癌（HCC）和胆管癌（CCA）。有限的回顾性回顾和病例报告/系列表明，这种组合在两种癌症类型中都是有效和安全的。随着ICIs进入第一线(IMbrand150，HIMALAYA，和TOPAZ-1）来管理这些癌症，为这种方法确定合适的人口是具有挑战性的。大血管侵犯（MVI）阳性HCC（特别是如果涉及大静脉）或局部治疗后复发性HCC（如经动脉放射栓塞（TARE），经动脉化疗栓塞术(TACE),或消融)，以及那些不符合贝伐单抗或酪氨酸激酶抑制剂（TKIs）的人，应该是在HCC中探索这种组合的重点。不能耐受吉西他滨/顺铂（GC）的不可切除或寡转移的CCA患者或那些在没有durvalumab的GC上进展且没有可靶向突变的患者也可以考虑用于这种方法。在HCC和CCA疾病组中，SBRT加ICI可以在ICI后检查，因为这两种方式协同作用以增强抗肿瘤活性（基于临床前研究）。需要大规模的随机试验来确定适合这种方法的原发性肝癌的亚群，并明确定义其临床益处。
