Application of Radiotherapeutic Strategies in the BCLC-defined Stages of Hepatocellular Carcinoma

Abstract

The Barcelona Clinic Liver Cancer (BCLC) staging system is the method currently used to stage hepatocellular carcinoma (HCC) and therefore plays an important role in deciding on an appropriate course of treatment. BCLC takes into consideration the extent of the disease as well as patient factors such as hepatic function and performance status. However, it does not propose solutions for all clinical situations. Although radiotherapy (RT) is not included in the BCLC guidelines, the potent local antitumor effect of RT should be considered seriously as a part of the treatment strategy. Novel RT technologies introduced during the last decade have made it possible to deliver higher doses of radiation to the tumor while avoiding damage to critical normal tissues adjacent to the tumor. Because of the growing interest in using RT for HCC patients unfit for or progressed beyond standard treatments, the role of RT for HCC patients needs to be specified within the BCLC staging system. Curative RT can be used for patients with either very early or early stage BCLC; focal high dose RTs, such as stereotactic body RT, are especially useful. Intermediate or advanced stage disease confined to the liver can be managed safely and effectively by localized RT in conjunction with other treatment modalities such as transarterial chemoembolization or concurrent or adjuvant chemotherapy. In this review, the efficacy of RT in each BCLC stage of HCC will be discussed.

Decreased Blood Flow after Sorafenib Administration Is an Imaging Biomarker to Predict Overall Survival in Patients with Advanced Hepatocellular Carcinoma

“…Because most patients are diagnosed at advanced stages, only about 30% of patients presenting with early-stage tumors undergo potentially curative therapies, such as surgical resection [3,4], transplantation [5,6] or percutaneous ablation [7,8,9]. In contrast, patients with unresectable HCC usually receive palliative treatments, such as transarterial chemoembolization (TACE) [10], radiotherapy [11,12] or conventional chemotherapy [13], and some patients participate in clinical trials [10,14,15,16,17]. Among these options, only TACE has been shown to lead to survival benefits [18,19].…”

Hepatocellular carcinoma: Surgeon's view on latest findings and future perspectives

“…But despite the proven efficacy and safety, radiotherapy has not found its way into the EASL-EORTC guidelines, yet. However, Jihye et al [84] proposed a possible way of integration of radiotherapy in the BCLC guidelines. Another advantage of radiotherapy is the possibility of combination therapy with established treatment options, such as TACE [85,86] or systemic chemotherapy [87] although side effects and hepatic toxicity are critical limitations for this treatment approach.…”

Emerging Strategies for the Management of Hepatocellular Carcinoma

“…On the morning of the second day, four topics were discussed at the ‘Early Morning Breakfast Workshop': (1) ‘Surgical Treatment', (2) ‘Liver Transplantation' [13,17,18,19,20], (3) ‘Carcinogenesis, Genomics, Pathways, and Targets', and (4) ‘Radiation Therapy' [21,22]. An intensive and extremely valuable discussion was conducted by specialists in the respective fields.…”