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Radiation Therapy for Hepatocellular Carcinoma

  • Chapter
Hepatocellular Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

There are many factors that over time have contributed to the limited use of ionizing radiation in treating hepatocellular carcinoma (HCC). This is primarily because delivery of tumoricidal doses of radiation to a tumor will exceed tolerance of the normal surrounding liver. X-rays produce nondiscriminatory cell killing in the already diseased liver of patients with HCC. In the past, radiation beams could be delivered only in the simplest of geometric arrangements, which could not avoid enough normal liver tissue from X-rays to deliver doses of radiation to control solid tumors. Only in the past 15 years have technological advancements in radiation oncology and diagnostic radiology allowed for innovative approaches in both external beam therapy and brachytherapy for treatment of liver malignancies. Concurrent with hardware upgrades, such as megavoltage linear accelerators, have been powerful software programs that enable conversion of computed tomography (CT) or magnetic resonance imaging (MRI) data sets into three-dimensional (3D) virtual patients. With accurate 3D models of the patient to work from and estimates in real time of radiation dose deposition within the patient, radiation oncologists can attempt to deliver the higher doses of radiation that have a chance to control tumors while sparing the nonmalignant hepatocytes. Most solid malignancies are successfully treated with combination therapy, and for years, it has been the desire to apply these approaches to HCC. The technology described is now widely available in all cancer centers and explains, in part, why the interest, within multidisciplinary hepatic oncology groups and ongoing clinical trials, in treating HCC is increasing. Radiobiological protectants are now in clinical trials, which may allow in the future for selective sparing of the normal liver cells found within the radiation beam. This chapter summarizes the main techniques historically and currently available in delivering ionizing radiation to HCC and describes interesting new approaches. Clinical experience over the past century suggests radiation dose parameters, above which serious and possibly fatal liver dysfunction occurs. Moreover, this occurs when the entire liver (i.e., all functional units of the organ) receives external beam radiation in excess of 30 Gy. State-of-the art radiotherapy techniques can treat small portions of the liver to cumulative doses of 90 Gy or more, as will be discussed later, but the number of patients suitable for this approach is few. Placing radiation directly in the tumor (brachytherapy) holds the promise of success because it can deliver very large doses of radiation selectively to the tumor (80–300 Gy) but spares surrounding normal liver parenchyma, which is reviewed in the microsphere section.

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  1. Radiation Oncology, Wake Radiology Oncology, Cary, NC

    Andrew S. Kennedy MD

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  1. Andrew S. Kennedy MD
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  1. Liver Cancer Center, Thomas E. Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA

    Brian I. Carr MD, FRCP, PhD

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© 2005 Humana Press Inc., Totowa, NJ

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Kennedy, A.S. (2005). Radiation Therapy for Hepatocellular Carcinoma. In: Carr, B.I. (eds) Hepatocellular Cancer. Current Clinical Oncology. Humana Press. https://doi.org/10.1007/978-1-59259-844-1_13

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  • DOI: https://doi.org/10.1007/978-1-59259-844-1_13

  • Publisher Name: Humana Press

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