Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Current Trends and Controversies

Abstract

Hepatocellular carcinoma is the fourth leading cause of cancer-related death worldwide. Depending on the extent of disease and competing comorbidities for mortality, multiple liver-directed therapy options exist for the treatment of hepatocellular carcinoma. Advancements in radiation oncology have led to the emergence of stereotactic body radiation therapy as a promising liver-directed therapy, which delivers high doses of radiation with a steep dose gradient to maximize local tumor control and minimize radiation-induced treatment toxicity. In this study, we review the current clinical data as well as the unresolved issues and controversies regarding stereotactic body radiation therapy for hepatocellular carcinoma: (1) Is there a radiation dose–response relationship with hepatocellular carcinoma? (2) What are the optimal dosimetric predictors of radiation-induced liver disease, and do they differ for patients with varying liver function? (3) How do we assess treatment response on imaging? (4) How does stereotactic body radiation therapy compare to other liver-directed therapy modalities, including proton beam therapy? Based on the current literature discussed, this review highlights future possible research and clinical directions.

Geometrical tracking accuracy and appropriate PTV margins for robotic radiosurgery of liver lesions by SBRT

“…The radiosensitivity of hepatocellular carcinoma, a primary malignancy of the liver, makes it a suitable candidate for hypofractionated radiation treatments [7]. Many multi-center studies have evaluated the outcomes of liver SBRT using a variety of treatment techniques [8][9][10][11][12][13][14]. Stereotactic body radiation therapy (SBRT) by the CyberKnife V R (Accuray Inc., USA) using Synchrony V R respiratory motion compensation is a promising technique to treat liver cancer, especially for patients who are not eligible for radio-frequency ablation or surgical resection [15].…”

Cost-effectiveness analysis of transarterial chemoembolization combined with stereotactic body radiation therapy versus transarterial chemoembolization for inoperable hepatocellular carcinoma: A markov modelling study

“…Some studies show TACE combined with sorafenib or apatinib get a longer TTP, OS and tumour-response rate [28,34]. Recently, SBRT has emerged as a safe and effective solution for properly selected patients with HCC having excellent rates of local control rate [12], one review study demonstrated that SBRT is an adjunct to TACE and sorafenib, a substitute for RFA [35]. One meta-analysis showed TACE combined with SBRT was more effective than TACE alone [17].…”

“…Stereotactic body radiation therapy (SBRT) has been increasingly accepted as a treatment option for patients that unable surgery. By giving larger doses to tumour, SBRT provides excellent control rate while minimizing damage to adjacent liver and other normal tissue [12,13].…”

Gross and microscopic changes of liver neoplasms and background hepatic structures following neoadjuvant therapy

“…However, advancements in radiation oncology over the past decade have enabled the development of stereotactic body radiotherapy (SBRT) as a potential therapeutic option. SBRT functions to deliver highly conformal dose distributions with a rapid dose drop-off that offers the ability to spare large portions of the liver while simultaneously allowing for dose escalation with ablative potential within the tumour 57. In 2000, the Barcelona Conference (BCLC) outlined the optimal treatment algorithms for primary liver cancer without inclusion of radiotherapy because it was only until afterward that radiotherapy emerged as a promising treatment for HCC 58.…”