Role of Radiation Therapy in Hepatocellular Carcinoma

The toxicities of radiation to the liver have previously limited the feasibility and utility of radiation therapy in the treatment of hepatocellular carcinoma. Traditional treatment techniques did not allow for high, curative doses of radiation to be delivered while sparing the surrounding functional liver, bowel, and other critical organs. However, due to advances in technology, long-term tumor control rates appear to be comparable to ablation and surgical resection when curative doses can be administered. Similarly, toxicity rates from modern series are acceptable, particularly given the common comorbidity profile of this patient population. This may due to advances in radiation delivery techniques which allow for higher doses to be given more precisely with a lower risk of toxicity to the uninvolved liver and other nearby critical structures. More conformal techniques using IMRT or proton therapy can help to achieve this goal. SBRT and hypofractionated regimens also appear promising and allow shorter courses without compromising safety or efficacy.