Radiation Therapy for Hepatocellular Carcinoma
Section snippets
Fractionated Conformal Radiotherapy
Historically, radiotherapy (RT) has been quite limited in the treatment of HCC. Without multiphase contrast computed tomography scans or magnetic resonance imaging, as described by Brock in this issue (see pages 247-255), tumor delineation was a challenge, and radiation volumes often included a significant portion of the liver. Because the whole liver has a low tolerance to radiation, patients were at risk for liver toxicity and also did not derive much benefit from low-dose radiation therapy.
Stereotactic Body Radiotherapy of HCC
Stereotactic body radiotherapy (SBRT) has also been applied to select patients with HCC. Figure 2 shows a typical SBRT HCC case. This technique was pioneered by Blomgren et al,25 who treated 20 liver tumors, including 8 HCCs, with an objective response in 70% and stable disease in 25%. Generally, dose per fraction and total dose range was between 4 and 15 and 24 and 54 Gy, respectively. In contrast to patients with metastatic disease to the liver who have relatively normal liver function and
Combined Therapies
Because of the risk for developing multifocal or regional disease outside the irradiated volume, elsewhere in the liver, and the risk of RILD with high doses of RT, it is intuitive to think about combining RT with other treatment modalities for both a local and regional effect. TACE has been combined with RT, usually at reduced doses because of concerns about increased toxicity, mostly by Asian investigators.38, 39, 40, 41, 42, 43 Two general approaches are used for this combination. First, RT
Conclusions
Over the past 20 years, a worldwide experience in treating HCC with RT has been developed. With today's highly conformal techniques, high doses can be delivered via conventional fractionation or SBRT with a low risk of toxicity in patients with intact liver function. Patients with compromised liver function should be treated more cautiously. Because of a high likelihood of progressive disease outside of the treated volumes, combination therapy with TACE or systemic agents should be further
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2019, Seminars in Nuclear MedicineCitation Excerpt :Stereotactic body radiation therapy (SBRT) is a newer, more focused radiation therapy where three-dimensional conformal, noncoplanar radiation can be delivered in higher fractionated radiation doses to a specific liver lesion while limiting dose to adjacent normal liver tissue. This means SBRT allows for a higher potential tumor dose with a lower theoretical risk of RILD.95 SBRT use for HCC is a relatively recent development, with promising early results for effectiveness in palliation of advanced disease and bridge to transplantation.96,97
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2019, Journal of Interventional MedicineCitation Excerpt :Grade 3 toxicity was reported in 9 patients, and Grade 1 and 2 toxicity was reported in 11 patients (Table 4). Although HCC is a radiosensitive tumor, the use of radiation in patients with HCC has been limited by the risks of nontargeted tissue exposure and radiation injury, as radiation affects both tumor cells and uninvolved normal cells.15 A typical safe dose (ie, one that does not cause substantial organ damage) of external beam radiation therapy is approximately 30 Gy for the whole liver.16