Emerging evidence-based role for external-beam radiation therapy in hepatocellular carcinoma.

For patients requiring downstaging or who are unresectable at presentation, the landscape of local treatment options has vastly changed over the past decades.

对于需要降期治疗或初诊时无法切除的患者，过去几十年里局部治疗方案的格局已经发生了巨大变化。

This change is partly due to the paucity of high-level evidence to guide the selection of liver-directed therapies, where physician preference and treatment patterns have historically resulted in relegating external-beam radiation therapy (EBRT) to a secondary option in the treatment of hepatocellular carcinoma in cases where arterially directed therapies or thermal ablations were not possible.

这种变化部分是由于缺乏高级别证据来指导肝脏定向治疗的选择，历史上，医生的偏好和治疗模式导致在无法进行动脉导向治疗或热消融的情况下，将体外放射治疗（EBRT）作为治疗肝细胞癌的次要选择。

However, technology advancements have substantially improved the ability to treat liver malignancies with high doses of radiation therapy and to minimise doses to uninvolved hepatic parenchyma and other nearby organs.

然而，技术进步显著提高了使用高剂量放射治疗治疗肝脏恶性肿瘤的能力，并最小化了对未涉及肝实质和其他附近器官的剂量。

These advancements have enabled safe treatment of hepatocellular carcinoma with EBRT, with low risk of toxicity.

这些进步使得使用外照射放疗（EBRT）安全治疗肝细胞癌成为可能，且毒性风险低。

Recent randomised trials support the role of EBRT in the treatment of hepatocellular carcinoma from early to advanced stages.

最近的随机试验支持了外照射放疗（EBRT）在治疗早期至晚期肝细胞癌中的作用。

These trials identified that EBRT improved several key patient-centred outcomes, including overall survivalwhen using stereotactic body radiotherapy and sorafenib compared with sorafenib alone in unresectable hepatocellular carcinoma, recurrence-free survival with the use of adjuvant EBRT in select patients after hepatocellular carcinoma resection, and quality of life for patients with painful hepatocellular carcinoma masses treated with palliative EBRT.

这些试验确定，与单独使用索拉非尼相比，立体定向体放射治疗和索拉非尼联合使用在不可切除的肝细胞癌中提高了包括总生存在内的多个关键患者中心结果，使用辅助性外照射放疗在肝细胞癌切除后的选择性患者中提高了无复发生存率，以及使用姑息性外照射放疗治疗疼痛性肝细胞癌肿块的患者提高了生活质量。

With emerging high-quality evidence, hepatocellular carcinoma therapeutic guidelines should include the growing role of EBRT in improving the quality and quantity of life for patients with liver cancer.

随着高质量证据的出现，肝细胞癌治疗指南应包括外照射放疗在提高肝癌患者生活质量和数量方面日益增长的作用。