Hepatocellular carcinoma (HCC) accounts for 90% of liver tumours and is one of the leading causes of mortality. Cirrhosis due to viral hepatitis, alcohol or steatohepatitis is the major risk factor, while liver dysfunction due to cirrhosis is a deciding factor in its treatment. The treatment modalities for HCC include liver transplant, hepatectomy, radiofrequency ablation, transarterial chemoembolisation, transarterial radioembolisation, targeted therapy, immunotherapy, and radiation therapy. The role of radiation therapy has been refined with the increasing use of stereotactic body radiation therapy (SBRT). Trials over the past two decades have shown the efficacy and safety of SBRT in recurrent and definitive HCC, leading to its acceptance and adoption in some more recent guidelines. However, high quality level I evidence supporting its use is currently lacking. Smaller randomised trials of external beam radiation therapy suggest high efficacy of radiation therapy compared to other treatments for patients with unresectable HCC, and phase III trials comparing SBRT with other modalities are ongoing. In this review, we discuss the rationale for SBRT in HCC and present evidence on its efficacy, associated toxicity, and technological advances.
Keywords: AASLD, American Association for the study of the Liver Diseases; BCLC, Barcelona Clinic of Liver Cancer; DCE, dynamic contrast enhanced; DWI, diffusion weighted imaging; HCC; HCC, hepatocellular carcinoma; Hepatocellular carcinoma; IVIM, intravoxel incoherent motion; OS, overall survival; PBT, proton beam therapy; PVT, portal vein thrombosis; RFA, radiofrequency ablation; RILD, radiation-induced liver disease; SBRT; SBRT, stereotactic body radiation therapy; TACE, transarterial chemoembolisation; radiation therapy.
© 2022 The Authors.