Powerful radiotherapy for hepatocellular carcinoma

Non‐surgical treatment of hepatocellular carcinoma

“…Radiotherapy for HCC is of limited value because of the normal liver’s inability to tolerate a therapeutic dose, difficulty in tumour localization and failure in practice 115–117 . A radiation dose of 30–33 Gy causes radiation hepatitis in 5%, but at 40 Gy the risk is about 50% 118 .…”

“…reported a partial response in 58% of patients and a minimal response in another 25% 115 . Cirrhotic patients tolerate less amounts of radiation than non‐cirrhotic patients 117 . Combining radiotherapy with systemic chemotherapy gave no benefit, while the side‐effects and toxicity increased 123…”

“…There have been promising results reported using proton beam radiotherapy, which produces radiation in a unique, ‘Bragg peak’ distribution. Large doses of irradiation travel in a straight line in tissue and then lose their energy by ionization at the end of the beam range 117 , . 129 This can be used to focus radiation on the target with minimal irradiation of the surrounding tissues 130 .…”

“… 129 This can be used to focus radiation on the target with minimal irradiation of the surrounding tissues 130 . Matsuzaki reported cumulative local tumour control in 99.1% and 91.4% at 1 year and 3–4 years, respectively, 117 but the technique does not appear to have been widely adopted.…”

Proton therapy for hepatocellular carcinoma

“…The role of external beam radiotherapy has historically been considered ineffective for treating HCC because the doses of radiation necessary to cure HCC far exceeded liver tissue tolerance to radiation. There is accumulating evidence that dose escalation can improve both tumor response and survival in HCC patients (14,15). One particularly challenging aspect of HCC is the fact that radiotherapy is guided not only by the characteristics of the tumor but also by the function of the cirrhotic liver.…”