The Current Role of Stereotactic Body Radiation Therapy (SBRT) in Hepatocellular Carcinoma (HCC)

Abstract

The role of stereotactic body radiotherapy (SBRT), which can deliver high radiation doses to focal tumors, has greatly increased in not only early-stage hepatocellular carcinoma (HCC), but also in portal vein or inferior vena cava thrombi, thus expanding this therapy to pre-transplantation and the treatment of oligometastases from HCC in combination with immune checkpoint inhibitors (ICI). In early-stage HCC, many promising prospective results of SBRT have been reported, although SBRT is not usually indicated as a first treatment potion in localized HCC according to several guidelines. In the treatment of portal vein or inferior vena cava tumor thrombi, several reports using various dose-fraction schedules have shown relatively good response rates with low toxicities and improved survival due to the rapid advancements in systemic therapy. Although SBRT is regarded as a substitute therapy when conventional bridging therapies to transplantation, such as transarterial chemoembolization (TACE) and radiofrequency ablation (RFA), are not applicable or fail in controlling tumors, SBRT may offer advantages in patients with borderline liver function who may not tolerate TACE or RFA, according to several reports. For oligometastases, the combination of SBRT with ICI could potentially induce an abscopal effect in patients with HCC, which is expected to provide the rationale for SBRT in the treatment of oligometastatic disease in the near future.

Oligo-Metastatic Cancers: Putative Biomarkers, Emerging Challenges and New Perspectives

“…The incidence of OMD varies depending on the type of tumors. It was hypothesized in the past that some cancers such as pancreatic adenocarcinoma and small-cell lung cancer, never present with an oligo-metastatic behavior; to date, an oligo-metastatic status has been reported in all cancers [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. The incidence of OMD varies greatly among cancer types, ranging from extremely rape (such as SCLC where only a few case reports are described) [ 21 ] to 10–40% of HCC [ 25 , 26 ].…”

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Japanese perspective

“…Since April 2022, particle therapies using protons and carbon ions have been applied to large ( 4 cm) and difficult-to-resect HCCs and are covered by health insurance in Japan (39). Further studies are needed to establish solid evidence for both stereotactic body radiation therapy and particle therapy (39,40).…”

BMI1 Silencing Liposomes Suppress Postradiotherapy Cancer Stemness against Radioresistant Hepatocellular Carcinoma

“…HCC is a highly aggressive cancer with poor survival as it is often diagnosed at an advanced stage . In general, liver tumors, as well as tumors arising from the bone marrow and lymphatic tissue, are highly sensitive to radiation treatment. , Therefore, stereotactic body radiotherapy (SBRT) has been recommended as a primary treatment modality for early liver cancer. , Radiotherapy is often combined with transcatheter arterial chemoembolization (TACE) to treat more advanced HCC. , However, the local control achieved following radiotherapy is still inferior, with about 90% of the irradiated HCC recurring within the radiation field or at a distant site . Locoregional recurrence and intrahepatic or extrahepatic metastasis remain the main cause of cancer-related death in HCC patients treated with radiotherapy .…”