Role of modern radiotherapy in managing patients with hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Several treatment options are available for managing HCC patients, classified roughly as local, local-regional, and systemic therapies. The high post-monotherapy recurrence rate of HCC urges the need for the use of combined modalities to increase tumor control and patient survival. Different international guidelines offer treatment recommendations based on different points of view and classification systems. Radiotherapy (RT) is a well-known local-regional treatment modality for managing many types of cancers, including HCC. However, only some of these treatment guidelines include RT, and the role of combined modalities is rarely mentioned. Hence, the present study reviewed clinical evidence for the use of different combined modalities in managing HCC, focusing on modern RT's role. Modern RT has an increased utility in managing HCC patients, mainly due to two driving forces. First, technological advancement ( e.g. , stereotactic body radiotherapy and advanced proton-beam therapy) enables precise delivery of radiation to increase tumor control and reduce side effects in the surrounding normal tissue. Second, the boom in developing target therapies and checkpoint-blockade immunotherapy prolongs overall survival in HCC patients, re-emphasizing the importance of local tumor control. Remarkably, RT combines with systemic therapies to generate the systemic therapy augmented by radiotherapy effect, a benefit now being actively investigated.

Hepatocellular carcinoma effective stereotactic body radiotherapy using Gold Anchor and the Synchrony system: Two case reports and review of literature

“…Regarding early-stage HCC, it is standard to undergo curative treatments, such as surgical resection (partial liver resection or liver transplantation) and percutaneous ablation, most commonly RFA. Regarding intermediate-stage HCC, many patients undergo TACE as their first local regional treatment[ 5 , 8 ]. However, such treatments have limitations in locally advanced cases.…”

“…Five-year tumor recurrence rates after surgical resection and RFA may be more than 50% and up to 80%, respectively. These high recurrence rates include patients who undergo TACE[ 8 , 12 ]. In our case, one patient had a recurrence after surgery and again after TACE.…”

“…SBRT sufficiently reduces the dose to adjacent organs due to its sharp dose fall-down outside of the target, while enhancing the biological effectiveness of a large single dose[ 7 ]. However, with SBRT it can be difficult to track tumors in the liver due to respiratory motion management (RMM)[ 8 ]. SBRT with RMM is becoming more common; however, RMM is often performed with breath-holding or fixation of the trunk.…”

Strategies to Improve the Antitumor Effect of Immunotherapy for Hepatocellular Carcinoma

“…Locoregional therapies, such as radiofrequency ablation (RFA) (80), transarterial chemoembolization (TACE) (81), stereotactic body radiotherapy (SBRT) (82), and selective internal radiation therapy (SIRT) (83), play a key role in the treatment of patients with HCC. These locoregional treatments not only can destroy primary tumors but also facilitate antitumor immunity by releasing the neoplasm antigens from killed tumor cells (84).…”

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy

“…Radiotherapy combined with immune checkpoint inhibitors augments the tumoricidal effect by upregulating the major histocompatibility complex and increasing susceptibility to T-cell-mediated cell death. 102 Radiotherapy combined with other treatment measures to control primary lesions and improve the survival time of patients is important. Although the efficacy of monotherapy with a multi-kinase inhibitor or immune checkpoint inhibitor is unsatisfactory for patients with advanced HCC, “T+A” treatment is brilliant.…”