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Review
. 2022 May 14;4(8):100498.
doi: 10.1016/j.jhepr.2022.100498. eCollection 2022 Aug.

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

Shirley Lewis  1   2 , Laura Dawson  1   2 , Aisling Barry  1   2 , Teodor Stanescu  1   2 , Issa Mohamad  3 , Ali Hosni  1   2
Affiliations
Review

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

Shirley Lewis et al. JHEP Rep. .

Abstract

Hepatocellular carcinoma (HCC) accounts for 90% of liver tumours and is one of the leading causes of mortality. Cirrhosis due to viral hepatitis, alcohol or steatohepatitis is the major risk factor, while liver dysfunction due to cirrhosis is a deciding factor in its treatment. The treatment modalities for HCC include liver transplant, hepatectomy, radiofrequency ablation, transarterial chemoembolisation, transarterial radioembolisation, targeted therapy, immunotherapy, and radiation therapy. The role of radiation therapy has been refined with the increasing use of stereotactic body radiation therapy (SBRT). Trials over the past two decades have shown the efficacy and safety of SBRT in recurrent and definitive HCC, leading to its acceptance and adoption in some more recent guidelines. However, high quality level I evidence supporting its use is currently lacking. Smaller randomised trials of external beam radiation therapy suggest high efficacy of radiation therapy compared to other treatments for patients with unresectable HCC, and phase III trials comparing SBRT with other modalities are ongoing. In this review, we discuss the rationale for SBRT in HCC and present evidence on its efficacy, associated toxicity, and technological advances.

Keywords: AASLD, American Association for the study of the Liver Diseases; BCLC, Barcelona Clinic of Liver Cancer; DCE, dynamic contrast enhanced; DWI, diffusion weighted imaging; HCC; HCC, hepatocellular carcinoma; Hepatocellular carcinoma; IVIM, intravoxel incoherent motion; OS, overall survival; PBT, proton beam therapy; PVT, portal vein thrombosis; RFA, radiofrequency ablation; RILD, radiation-induced liver disease; SBRT; SBRT, stereotactic body radiation therapy; TACE, transarterial chemoembolisation; radiation therapy.

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Conflict of interest statement

Shirley Lewis, Laura Dawson, Aisling Barry, Issa Mohamad- None. Teodor Stanescu- Research funding from Elekta for the development and implementation of novel imaging and treatment techniques for liver and pancreas on the Unity MR-Linac system. Ali Hosni- Nonfinancial leadership of liver TSG at Elekta MRL consortium. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Fig. 1
Fig. 1
Planning CT in arterial phase (axial, coronal, and sagittal cuts) showing SBRT plan for HCC – 3 lesions treated with a dose of 27.5 Gy in 5 fractions. 60-year-old gentleman diagnosed with multifocal HCC, BCLC B with Child-Pugh B8 with 3 lesions treated with SBRT as a bridge to transplant. Red- Gross tumour volume, Cyan- Planning target volume, Blue: 100% isodose line, Pink: 95% isodose line and Orange:70% isodose line.
See this image and copyright information in PMC

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