TY - JOUR
T1 - Stereotactic radiotherapy for hepatocellular carcinoma
T2 - Expanding the multidisciplinary armamentarium
AU - Shanker, Mihir D.
AU - Liu, Howard Y.
AU - Lee, Yoo Young
AU - Stuart, Katherine A.
AU - Powell, Elizabeth E.
AU - Wigg, Alan
AU - Pryor, David I.
PY - 2021/4
Y1 - 2021/4
N2 - Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third most common cause of cancer-related death. Long-term prognosis remains poor with treatment options frequently limited by advanced tumor stage, tumor location, or underlying liver dysfunction. Stereotactic ablative body radiotherapy (SABR) utilizes technological advances to deliver highly precise, tumoricidal doses of radiation. There is an emerging body of literature on SABR in HCC demonstrating high rates of local control in the order of 80–90% at 3 years. SABR is associated with a low risk of radiation-induced liver disease or decompensation in appropriately selected HCC patients with compensated liver function and is now being incorporated into guidelines as an additional treatment option. This review outlines the emerging role of SABR in the multidisciplinary management of HCC and summarizes the current evidence for its use as an alternative ablative option for early-stage disease, as a bridge to transplant, and as palliation for advanced-stage disease. We outline specific considerations regarding patient selection, toxicities, and response assessment. Finally, we compare current international guidelines and recommendations for the use of SABR and summarize ongoing studies.
AB - Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the third most common cause of cancer-related death. Long-term prognosis remains poor with treatment options frequently limited by advanced tumor stage, tumor location, or underlying liver dysfunction. Stereotactic ablative body radiotherapy (SABR) utilizes technological advances to deliver highly precise, tumoricidal doses of radiation. There is an emerging body of literature on SABR in HCC demonstrating high rates of local control in the order of 80–90% at 3 years. SABR is associated with a low risk of radiation-induced liver disease or decompensation in appropriately selected HCC patients with compensated liver function and is now being incorporated into guidelines as an additional treatment option. This review outlines the emerging role of SABR in the multidisciplinary management of HCC and summarizes the current evidence for its use as an alternative ablative option for early-stage disease, as a bridge to transplant, and as palliation for advanced-stage disease. We outline specific considerations regarding patient selection, toxicities, and response assessment. Finally, we compare current international guidelines and recommendations for the use of SABR and summarize ongoing studies.
KW - Cancer: biology, diagnosis, and therapy
KW - Hepatocellular carcinoma, clinical
KW - Hepatocellular carcinoma, treatment
KW - Neoplasia
UR - http://www.scopus.com/inward/record.url?scp=85087988063&partnerID=8YFLogxK
U2 - 10.1111/jgh.15175
DO - 10.1111/jgh.15175
M3 - Review article
C2 - 32632941
AN - SCOPUS:85087988063
VL - 36
SP - 873
EP - 884
JO - Journal of Gastroenterology and Hepatology
JF - Journal of Gastroenterology and Hepatology
SN - 0815-9319
IS - 4
ER -