Liver cancer, one of the most common malignant tumors, is characterized by high malignancy, strong infiltration and metastasis, and poor prognosis. There are more than 300,000 new cases in China every year, accounting for more than half of the global cases. According to statistics, the annual mortality rate of liver cancer in China is 20.37/100,000, ranking 2nd among malignant tumor mortality rates, second only to lung cancer in urban areas and second only to stomach cancer in rural areas.
At present, the popular treatment means of liver cancer are mainly as follows
(1) Surgical resection: Patients who have indications for surgery should be preferred for surgical treatment. Early resection is the key to improve the survival rate and prolong the survival period, and the smaller the tumor, the higher the 5-year survival rate. However, due to various reasons, only more than 20% of patients can undergo surgical resection, and for most liver cancer patients, the opportunity of surgical resection has been lost. Moreover, the recurrence rate is high after surgical resection, and it is difficult to completely remove the potential cancer foci.
(2) Minimally invasive treatment: including physical ablation and chemical ablation, the former includes radiofrequency ablation, microwave ablation, argon helium knife cryoablation, high-focus ultrasound, etc., and the latter includes anhydrous ethanol injection, etc. According to literature, for small hepatocellular carcinoma with diameter less than 75px, the effect of radiofrequency ablation can be comparable to surgical resection. Ablation therapy is minimally invasive, safe and inexpensive, which is the current hot spot for non-surgical treatment of liver cancer, but for special sites, which can no longer be ablated, it needs to be combined with other treatment means.
(3) Embolization therapy: i.e. interventional therapy (TACE), which is based on the theory that hepatocellular carcinoma is mainly supplied by hepatic artery, and chemotherapeutic drugs and embolic agents are infused into hepatocellular carcinoma through hepatic artery to kill tumor cells.
(4) Radiation therapy: Radiotherapy is suitable for more limited unresectable tumors. External radiation therapy has undergone changes such as whole liver radiation, local radiation, whole liver mobile strip radiation, local hyper-segmentation radiation, stereotactic radiation, etc., and its efficacy has been continuously improved. It is especially suitable for hepatocellular carcinoma combined with portal vein carcinoma thrombosis situation. Intrahepatic arterial injection of 90-Y microspheres, 131-I iodized oil or radionuclide labeled monoclonal antibody can play the role of internal radiation therapy. Radiation therapy is also palliative treatment.
(5) Molecular targeted therapy: Molecular targeted drugs represented by sorafenib have made a breakthrough in the treatment of hepatocellular carcinoma and become the standard treatment drug for advanced or progressive hepatocellular carcinoma. Combining sorafenib with surgery, TACE or radiofrequency for the treatment of intermediate and advanced hepatocellular carcinoma can improve the efficacy and prolong the survival. It is worth mentioning that the side effects of sorafenib are also greater and need to be taken seriously.
(6) Systemic chemotherapy: the overall effect is not satisfactory and there is no recognized effective chemotherapy regimen. Although some studies have found that FOLFOX4 regimen and arsenious acid injection can benefit the survival of some patients with intermediate to advanced hepatocellular carcinoma, the actual clinical value is limited due to the toxicity and side effects of chemotherapy drugs themselves, which have adverse effects on liver and kidney functions.
(7) Bioimmunotherapy: This is the hot spot of research in recent years, such as CIK therapy, stem cell transplantation, etc. Bioimmunotherapy for liver cancer comes with the rapid development of molecular biology technology and genetic engineering technology, although experimental research has achieved promising results, it has a certain distance compared with the actual clinical effect, high cost, and involves ethics, whether there is a risk of carcinogenesis, so its application is relatively limited at present.
(8) Chinese medicine treatment: it is the characteristic content of liver cancer treatment in China. Using the holistic view of Chinese medicine and evidence-based treatment, it has certain value in relieving the symptoms of middle and late stage liver cancer and alleviating the complications or side effects caused by therapeutic means, and can be applied to the adjuvant treatment of liver cancer at different stages.
(9) Treatment of underlying diseases: most of the liver cancers in China have hepatitis B and C background, and should be treated with antiviral therapy according to the situation. According to different symptoms, liver protection, enzyme lowering, analgesia, diuretic, anti-infection, anemia correction and nutritional support should be given in time to improve the survival quality of patients as much as possible.
As we can see above, there are many different treatment methods for hepatocellular carcinoma, involving many clinical departments such as hepatobiliary surgery, hepatobiliary medicine, interventional medicine, radiotherapy, etc., which can be called “eight immortals crossing the sea with their own skills”.
Each method has its best indications, and although clinicians of various specialties recognize the importance of comprehensive treatment, most of them are still working individually and fighting alone, “railroad police, each in charge of its own section”. A poor choice of initial treatment will definitely affect the next step of treatment and will definitely affect the treatment effect of patients. Cancer is both a local lesion and a systemic disease. Theoretically, no single treatment can cure liver cancer.
Therefore, the best choice for liver cancer treatment is to organically combine various existing liver cancer treatment technologies and methods – integrated treatment of liver cancer.
Integrated treatment is a qualitative leap in treatment concept, which is a multidisciplinary and collaborative treatment model that shifts medical treatment from “technology” to “patient” oriented and aims to achieve the ultimate goal. The integrated multidisciplinary treatment model is implemented through integration, which is only a treatment point. The integrated multidisciplinary treatment is a dynamic treatment process, reflecting the scientific and discriminatory clinical decision-making process, which is characterized by systematization, individualization, standardization and dynamization.
1. Systematization.
That is, from the treatment goal, the overall treatment content as a system, follow the principle of local disease and the whole body together, in the design of the treatment plan, from the treatment method, stand on the high point of various treatment techniques, fully grasp the principle, advantages and disadvantages, indications and efficacy of various treatment techniques for each treatment goal, and the interaction with other treatments, in order to choose the best.
2.Individualization.
That is, from individual patient differences, from macroscopic factors to microscopic factors, according to the various types of characteristics of various diseases, the function of the affected organs and systemic conditions and other differences that exist, control the diversity of comprehensive treatment programs, avoiding the arbitrary design of treatment programs by doctors.
3. Standardization.
That is, starting from the treatment standards, the specific implementation should not only follow the latest progress, but also follow the relevant treatment guidelines and treatment norms for various diseases, emphasize the correct choice of each treatment technology, follow the operation standards of specific technologies, and effectively ensure the effect of treatment implementation.
4.Dynamicization.
That is, from the treatment time frame, in order to dynamically assess the multiple stages of the overall treatment, after the completion of each treatment course and treatment items to make timely stage evaluation of the disease and its efficacy, and adjust the overall treatment plan in a timely manner.
All-in-one is more importantly a concept through which to promote multidisciplinary integrated treatment.
At present, our Weifang Hospital of Traditional Chinese Medicine carries out integrated treatment of liver cancer with the Department of Hepatobiliary Medicine. The expert group takes the patient as the center, and based on the guidelines of liver cancer diagnosis and treatment, the group consults each liver cancer patient within 3 days of admission, comprehensively evaluates the patient’s condition, formulates the preferred, best and individualized treatment plan and subsequent scientific and reasonable treatment plan, and through implementation, avoids technical defects and one-sided exaggeration of each specialty, thus providing the patient with the best platform for liver cancer treatment.