Conformal radiotherapy for hepatocellular carcinoma

Abstract Technical advancements in radiation therapy (RT) have facilitated the safe delivery of conformal, dose-escalated radiation to a wide spectrum of hepatocellular carcinoma (HCC) patients. A variety of doses and RT fractionation schemes have been used, and RT has been used in combination with...

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Bibliographic Details
Published in:Critical reviews in oncology/hematology 2008-08, Vol.67 (2), p.113-123
Main Authors: Tse, R.V, Guha, Chandan, Dawson, L.A
Format: Article
Language:English
Subjects:
Biological and medical sciences
Carcinoma, Hepatocellular - radiotherapy
Chemoembolization, Therapeutic
Conformal radiotherapy
Gastroenterology. Liver. Pancreas. Abdomen
Heavy Ions - therapeutic use
Hematologic and hematopoietic diseases
Hematology, Oncology and Palliative Medicine
Hepatocellular carcinoma
Humans
Liver - radiation effects
Liver Neoplasms - radiotherapy
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Proton therapy
Protons - therapeutic use
Radiation-induced liver disease (RILD)
Radiosurgery
Radiotherapy
Radiotherapy, Conformal - methods
Stereotactic radiotherapy
Tumors
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Summary:Abstract Technical advancements in radiation therapy (RT) have facilitated the safe delivery of conformal, dose-escalated radiation to a wide spectrum of hepatocellular carcinoma (HCC) patients. A variety of doses and RT fractionation schemes have been used, and RT has been used in combination with transarterial chemoembolization (TACE). Compared to untreated historical controls or those treated with TACE alone, outcomes following RT alone or TACE and RT are better. Despite advances in RT delivery, liver toxicity following RT remains a dose-limiting factor, and investigations to better understand the pathophysiology of RT-induced liver toxicity are warranted. For most tumors, RT can provide sustained local control. However, HCC tends to recur within the liver away from the irradiated volume, providing rationale for combining RT with systemic or regional therapies. There is a particular interest in combining RT with anti-VEGF-targeted agents for their independent activity in HCC as well as their radiation sensitization properties. Randomized trials of RT are warranted.
ISSN:1040-8428
1879-0461
DOI:10.1016/j.critrevonc.2008.01.005