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Role of Radiation Therapy in Hepatocellular Carcinoma

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Abstract

The toxicities of radiation to the liver have previously limited the feasibility and utility of radiation therapy in the treatment of hepatocellular carcinoma. Traditional treatment techniques did not allow for high, curative doses of radiation to be delivered while sparing the surrounding functional liver, bowel, and other critical organs. However, due to advances in technology, long-term tumor control rates appear to be comparable to ablation and surgical resection when curative doses can be administered. Similarly, toxicity rates from modern series are acceptable, particularly given the common comorbidity profile of this patient population. This may due to advances in radiation delivery techniques which allow for higher doses to be given more precisely with a lower risk of toxicity to the uninvolved liver and other nearby critical structures. More conformal techniques using IMRT or proton therapy can help to achieve this goal. SBRT and hypofractionated regimens also appear promising and allow shorter courses without compromising safety or efficacy.

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References

  1. Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol Off J Am Soc Clin Oncol. 2009;27(9):1485–91.

    Article  Google Scholar 

  2. Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg. 2001;234(1):63–70.

    Article  CAS  Google Scholar 

  3. Bruix J, Llovet JM. Prognostic prediction and treatment strategy in hepatocellular carcinoma. Hepatology (Baltimore MD). 2002;35(3):519–24.

    Article  Google Scholar 

  4. National comprehensive cancer network guidelines- hepatobiliary cancers [Internet]. [cited 2017 Jan 2]. https://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf.

  5. Rim CH, Seong J. Application of radiotherapy for hepatocellular carcinoma in current clinical practice guidelines. Radiat Oncol J. 2016;34(3):160–7.

    Article  Google Scholar 

  6. Korean Liver Cancer Study Group (KLCSG), National Cancer Center, Korea (NCC). 2014 KLCSG-NCC Korea practice guideline for the management of hepatocellular carcinoma. Gut Liver. 2015;9(3):267–317.

    Google Scholar 

  7. Hyder O, Dodson RM, Nathan H, Herman JM, Cosgrove D, Kamel I, et al. Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study. J Am Coll Surg. 2013;217(5):896–906.

    Article  Google Scholar 

  8. Dionisi F, Guarneri A, Dell’Acqua V, Leonardi M, Niespolo R, Macchia G, et al. Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology. Radiol Med (Torino). 2016;121(9):735–43.

    Article  Google Scholar 

  9. Benson R, Madan R, Kilambi R, Chander S. Radiation induced liver disease: a clinical update. J Egypt Natl Cancer Inst. 2016;28(1):7–11.

    Article  CAS  Google Scholar 

  10. Seong J, Park HC, Han KH, Chon CY. Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys. 2003;55(2):329–36.

    Article  Google Scholar 

  11. Liang S-X, Zhu X-D, Lu H-J, Pan C-Y, Li F-X, Huang Q-F, et al. Hypofractionated three-dimensional conformal radiation therapy for primary liver carcinoma. Cancer. 2005;103(10):2181–8.

    Article  Google Scholar 

  12. Liu M-T, Li S-H, Chu T-C, Hsieh C-Y, Wang A-Y, Chang T-H, et al. Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolization. Jpn J Clin Oncol. 2004;34(9):532–9.

    Article  Google Scholar 

  13. Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, Ten Haken RK. Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys. 2002;53(4):810–21.

    Article  Google Scholar 

  14. Ben-Josef E, Normolle D, Ensminger WD, Walker S, Tatro D, Ten Haken RK, et al. Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(34):8739–47.

    Article  Google Scholar 

  15. Dawson LA, McGinn CJ, Normolle D, Ten Haken RK, Walker S, Ensminger W, et al. Escalated focal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies. J Clin Oncol Off J Am Soc Clin Oncol. 2000;18(11):2210–8.

    Article  CAS  Google Scholar 

  16. Mornex F, Girard N, Beziat C, Kubas A, Khodri M, Trepo C, et al. Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies--mature results of the French phase II RTF-1 trial. Int J Radiat Oncol Biol Phys. 2006;66(4):1152–8.

    Article  Google Scholar 

  17. Meng M-B, Cui Y-L, Lu Y, She B, Chen Y, Guan Y-S, et al. Transcatheter arterial chemoembolization in combination with radiotherapy for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2009;92(2):184–94.

    Article  Google Scholar 

  18. Zeng Z-C, Fan J, Tang Z-Y, Zhou J, Qin L-X, Wang J-H, et al. A comparison of treatment combinations with and without radiotherapy for hepatocellular carcinoma with portal vein and/or inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys. 2005;61(2):432–43.

    Article  Google Scholar 

  19. Song DY, Kavanagh BD, Benedict SH, Schefter T. Stereotactic body radiation therapy. Rationale, techniques, applications, and optimization. Oncology (Williston Park). 2004;18(11):1419–30, 1432, 1435–6.

    Google Scholar 

  20. Katz AW, Chawla S, Qu Z, Kashyap R, Milano MT, Hezel AF. Stereotactic hypofractionated radiation therapy as a bridge to transplantation for hepatocellular carcinoma: clinical outcome and pathologic correlation. Int J Radiat Oncol Biol Phys. 2012;83(3):895–900.

    Article  Google Scholar 

  21. O’Connor JK, Trotter J, Davis GL, Dempster J, Klintmalm GB, Goldstein RM. Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation. Liver Transpl. 2012;18(8):949–54.

    Article  Google Scholar 

  22. Blomgren H, Lax I, Näslund I, Svanström R. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol. 1995;34(6):861–70.

    Article  CAS  Google Scholar 

  23. Choi BO, Choi IB, Jang HS, Kang YN, Jang JS, Bae SH, et al. Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis. BMC Cancer. 2008;8:351.

    Article  Google Scholar 

  24. Goyal K, Einstein D, Yao M, Kunos C, Barton F, Singh D, et al. Cyberknife stereotactic body radiation therapy for nonresectable tumors of the liver: preliminary results. HPB Surg. 2010;2010:8.

    Article  Google Scholar 

  25. Seo YS, Kim M-S, Yoo SY, Cho CK, Choi CW, Kim JH, et al. Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma. J Surg Oncol. 2010;102(3):209–14.

    Article  Google Scholar 

  26. Kwon JH, Bae SH, Kim JY, Choi BO, Jang HS, Jang JW, et al. Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer. BMC Cancer. 2010;10:475.

    Article  Google Scholar 

  27. Andolino DL, Johnson CS, Maluccio M, Kwo P, Tector AJ, Zook J, et al. Stereotactic body radiotherapy for primary hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2011;81(4):e447–53.

    Article  Google Scholar 

  28. Jang WI, Kim M-S, Bae SH, Cho CK, Yoo HJ, Seo YS, et al. High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma. Radiat Oncol. 2013;8:250.

    Article  Google Scholar 

  29. Yoon SM, Lim Y-S, Park MJ, Kim SY, Cho B, Shim JH, et al. Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma. PLoS One. 2013;8(11):e79854.

    Article  CAS  Google Scholar 

  30. Culleton S, Jiang H, Haddad CR, Kim J, Brierley J, Brade A, et al. Outcomes following definitive stereotactic body radiotherapy for patients with child-Pugh B or C hepatocellular carcinoma. Radiother Oncol. 2014;111(3):412–7.

    Article  Google Scholar 

  31. Scorsetti M, Comito T, Cozzi L, Clerici E, Tozzi A, Franzese C, et al. The challenge of inoperable hepatocellular carcinoma (HCC): results of a single-institutional experience on stereotactic body radiation therapy (SBRT). J Cancer Res Clin Oncol. 2015;141(7):1301–9.

    Article  CAS  Google Scholar 

  32. Su T-S, Liang P, Lu H-Z, Liang J, Gao Y-C, Zhou Y, et al. Stereotactic body radiation therapy for small primary or recurrent hepatocellular carcinoma in 132 Chinese patients. J Surg Oncol. 2016;113(2):181–7.

    Article  Google Scholar 

  33. Su T-S, Lu H-Z, Cheng T, Zhou Y, Huang Y, Gao Y-C, et al. Long-term survival analysis in combined transarterial embolization and stereotactic body radiation therapy versus stereotactic body radiation monotherapy for unresectable hepatocellular carcinoma >5 cm. BMC Cancer. 2016;16(1):834.

    Article  Google Scholar 

  34. Jacob R, Turley F, Redden DT, Saddekni S, Aal AKA, Keene K, et al. Adjuvant stereotactic body radiotherapy following transarterial chemoembolization in patients with non-resectable hepatocellular carcinoma tumours of ≥ 3 cm. HPB. 2015;17(2):140–9.

    Article  Google Scholar 

  35. Méndez Romero A, Wunderink W, Hussain SM, De Pooter JA, Heijmen BJM, Nowak PCJM, et al. Stereotactic body radiation therapy for primary and metastatic liver tumors: a single institution phase i-ii study. Acta Oncol. 2006;45(7):831–7.

    Article  Google Scholar 

  36. Tse RV, Hawkins M, Lockwood G, Kim JJ, Cummings B, Knox J, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 2008;26(4):657–64.

    Article  Google Scholar 

  37. Cárdenes HR, Price TR, Perkins SM, Maluccio M, Kwo P, Breen TE, et al. Phase I feasibility trial of stereotactic body radiation therapy for primary hepatocellular carcinoma. Clin Transl Oncol. 2010;12(3):218–25.

    Article  Google Scholar 

  38. Price TR, Perkins SM, Sandrasegaran K, Henderson MA, Maluccio MA, Zook JE, et al. Evaluation of response after stereotactic body radiotherapy for hepatocellular carcinoma. Cancer. 2012;118(12):3191–8.

    Article  Google Scholar 

  39. Kang J-K, Kim M-S, Cho CK, Yang KM, Yoo HJ, Kim JH, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer. 2012;118(21):5424–31.

    Article  Google Scholar 

  40. Bujold A, Massey CA, Kim JJ, Brierley J, Cho C, Wong RKS, et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(13):1631–9.

    Article  Google Scholar 

  41. Brade AM, Ng S, Brierley J, Kim J, Dinniwell R, Ringash J, et al. Phase 1 trial of sorafenib and stereotactic body radiation therapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2016;94(3):580–7.

    Article  CAS  Google Scholar 

  42. Takeda A, Sanuki N, Tsurugai Y, Iwabuchi S, Matsunaga K, Ebinuma H, et al. Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation. Cancer. 2016;122(13):2041–9.

    Article  Google Scholar 

  43. Kim JW, Seong J, Lee IJ, Woo JY, Han K-H. Phase I dose escalation study of helical intensity-modulated radiotherapy-based stereotactic body radiotherapy for hepatocellular carcinoma. Oncotarget. 2016;7(26):40756–66.

    PubMed  PubMed Central  Google Scholar 

  44. Weiner AA, Olsen J, Ma D, Dyk P, DeWees T, Myerson RJ, et al. Stereotactic body radiotherapy for primary hepatic malignancies - report of a phase I/II institutional study. Radiother Oncol. 2016;121(1):79–85.

    Article  Google Scholar 

  45. Horgan AM, Dawson LA, Swaminath A, Knox JJ. Sorafenib and radiation therapy for the treatment of advanced hepatocellular carcinoma. J Gastrointest Cancer. 2012;43(2):344–8.

    Article  CAS  Google Scholar 

  46. Lawrence JH, Tobias CA, Born JL, Linfoot JA, Kling RP, Gottschalk A. Alpha and proton heavy particles and the bragg peak in therapy. Trans Am Clin Climatol Assoc. 1964;75:111–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Chiba T, Tokuuye K, Matsuzaki Y, Sugahara S, Chuganji Y, Kagei K, et al. Proton beam therapy for hepatocellular carcinoma: a retrospective review of 162 patients. Clin Cancer Res. 2005;11(10):3799–805.

    Article  Google Scholar 

  48. Nakayama H, Sugahara S, Tokita M, Fukuda K, Mizumoto M, Abei M, et al. Proton beam therapy for hepatocellular carcinoma: the University of Tsukuba experience. Cancer. 2009;115(23):5499–506.

    Article  Google Scholar 

  49. Kawashima M, Kohno R, Nakachi K, Nishio T, Mitsunaga S, Ikeda M, et al. Dose-volume histogram analysis of the safety of proton beam therapy for unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2011;79(5):1479–86.

    Article  Google Scholar 

  50. Komatsu S, Fukumoto T, Demizu Y, Miyawaki D, Terashima K, Sasaki R, et al. Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma. Cancer. 2011;117(21):4890–904.

    Article  CAS  Google Scholar 

  51. Lee SU, Park J-W, Kim TH, Kim Y-J, Woo SM, Koh Y-H, et al. Effectiveness and safety of proton beam therapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Strahlenther Onkol. 2014;190(9):806–14.

    Article  Google Scholar 

  52. Kim DY, Park J-W, Kim TH, Kim BH, Moon SH, Kim SS, et al. Risk-adapted simultaneous integrated boost-proton beam therapy (SIB-PBT) for advanced hepatocellular carcinoma with tumour vascular thrombosis. Radiother Oncol. 2017;122(1):122–9.

    Article  Google Scholar 

  53. Mizumoto M, Okumura T, Hashimoto T, Fukuda K, Oshiro Y, Fukumitsu N, et al. Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols. Int J Radiat Oncol Biol Phys. 2011;81(4):1039–45.

    Article  Google Scholar 

  54. Fukuda K, Okumura T, Abei M, Fukumitsu N, Ishige K, Mizumoto M, et al. Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma. Cancer Sci. 2017;108(3):497–503.

    Article  CAS  Google Scholar 

  55. Bush DA, Kayali Z, Grove R, Slater JD. The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial. Cancer. 2011;117(13):3053–9.

    Article  Google Scholar 

  56. Hong TS, Wo JY, Yeap BY, Ben-Josef E, McDonnell EI, Blaszkowsky LS, et al. Multi-institutional phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol Off J Am Soc Clin Oncol. 2016;34(5):460–8.

    Article  CAS  Google Scholar 

  57. Bush DA, Smith JC, Slater JD, Volk ML, Reeves ME, Cheng J, et al. Randomized clinical trial comparing proton beam radiation therapy with transarterial chemoembolization for hepatocellular carcinoma: results of an interim analysis. Int J Radiat Oncol Biol Phys. 2016;95(1):477–82.

    Article  Google Scholar 

  58. Reed GB, Cox AJ. The human liver after radiation injury. A form of veno-occlusive disease. Am J Pathol. 1966;48(4):597–611.

    PubMed  PubMed Central  Google Scholar 

  59. Mornex F, Gérard F, Ramuz O, Van Houtte P. Late effects of radiations on the liver. Cancer Radiother. 1997;1(6):753–9.

    Article  CAS  Google Scholar 

  60. Lawrence TS, Robertson JM, Anscher MS, Jirtle RL, Ensminger WD, Fajardo LF. Hepatic toxicity resulting from cancer treatment. Int J Radiat Oncol Biol Phys. 1995;31(5):1237–48.

    Article  CAS  Google Scholar 

  61. Guha C, Kavanagh BD. Hepatic radiation toxicity: avoidance and amelioration. Semin Radiat Oncol. 2011;21(4):256–63.

    Article  Google Scholar 

  62. Unger EC, Lee JK, Weyman PJ. CT and MR imaging of radiation hepatitis. J Comput Assist Tomogr. 1987;11(2):264–8.

    Article  CAS  Google Scholar 

  63. da Silveira EBV, Jeffers L, Schiff ER. Diagnostic laparoscopy in radiation-induced liver disease. Gastrointest Endosc. 2002;55(3):432–4.

    Article  Google Scholar 

  64. Lightdale CJ, Wasser J, Coleman M, Brower M, Tefft M, Pasmantier M. Anticoagulation and high dose liver radiation: a preliminary report. Cancer. 1979;43(1):174–81.

    Article  CAS  Google Scholar 

  65. Bearman SI, Lee JL, Barón AE, McDonald GB. Treatment of hepatic venocclusive disease with recombinant human tissue plasminogen activator and heparin in 42 marrow transplant patients. Blood. 1997;89(5):1501–6.

    CAS  PubMed  Google Scholar 

  66. Sanuki N, Takeda A, Oku Y, Eriguchi T, Nishimura S, Aoki Y, et al. Influence of liver toxicities on prognosis after stereotactic body radiation therapy for hepatocellular carcinoma. Hepatol Res. 2015;45(5):540–7.

    Article  Google Scholar 

  67. Ingold JA, Reed GB, Kaplan HS, Bagshaw MA. Radiation hepatitis. Am J Roentgenol Radium Therapy, Nucl Med. 1965;93:200–8.

    CAS  Google Scholar 

  68. Austin-Seymour MM, Chen GT, Castro JR, Saunders WM, Pitluck S, Woodruff KH, et al. Dose volume histogram analysis of liver radiation tolerance. Int J Radiat Oncol Biol Phys. 1986;12(1):31–5.

    Article  CAS  Google Scholar 

  69. Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys. 1991;21(1):109–22.

    Article  CAS  Google Scholar 

  70. Russell AH, Clyde C, Wasserman TH, Turner SS, Rotman M. Accelerated hyperfractionated hepatic irradiation in the management of patients with liver metastases: results of the RTOG dose escalating protocol. Int J Radiat Oncol Biol Phys. 1993;27(1):117–23.

    Article  CAS  Google Scholar 

  71. Lawrence TS, Ten Haken RK, Kessler ML, Robertson JM, Lyman JT, Lavigne ML, et al. The use of 3-D dose volume analysis to predict radiation hepatitis. Int J Radiat Oncol Biol Phys. 1992;23(4):781–8.

    Article  CAS  Google Scholar 

  72. Tai A, Erickson B, Li XA. Extrapolation of normal tissue complication probability for different fractionations in liver irradiation. Int J Radiat Oncol Biol Phys. 2009;74(1):283–9.

    Article  Google Scholar 

  73. Xu Z-Y, Liang S-X, Zhu J, Zhu X-D, Zhao J-D, Lu H-J, et al. Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma. Int J Radiat Oncol Biol Phys. 2006;65(1):189–95.

    Article  Google Scholar 

  74. Pan CC, Kavanagh BD, Dawson LA, Li XA, Das SK, Miften M, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S94–100.

    Article  Google Scholar 

  75. Kim TH, Kim DY, Park J-W, Kim SH, Choi J-I, Kim HB, et al. Dose-volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67(1):225–31.

    Article  Google Scholar 

  76. Liang S-X, Zhu X-D, Xu Z-Y, Zhu J, Zhao J-D, Lu H-J, et al. Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys. 2006;65(2):426–34.

    Article  Google Scholar 

  77. Yamada K, Izaki K, Sugimoto K, Mayahara H, Morita Y, Yoden E, et al. Prospective trial of combined transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2003;57(1):113–9.

    Article  Google Scholar 

  78. Schefter TE, Kavanagh BD, Timmerman RD, Cardenes HR, Baron A, Gaspar LE. A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys. 2005;62(5):1371–8.

    Article  Google Scholar 

  79. Kavanagh BD, Schefter TE, Cardenes HR, Stieber VW, Raben D, Timmerman RD, et al. Interim analysis of a prospective phase I/II trial of SBRT for liver metastases. Acta Oncol. 2006;45(7):848–55.

    Article  Google Scholar 

  80. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–51.

    Article  CAS  Google Scholar 

  81. Eccles C, Brock KK, Bissonnette J-P, Hawkins M, Dawson LA. Reproducibility of liver position using active breathing coordinator for liver cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2006;64(3):751–9.

    Article  Google Scholar 

  82. Dawson LA, Brock KK, Kazanjian S, Fitch D, McGinn CJ, Lawrence TS, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys. 2001;51(5):1410–21.

    Article  CAS  Google Scholar 

  83. Briere TM, Beddar S, Balter P, Murthy R, Gupta S, Nelson C, et al. Respiratory gating with EPID-based verification: the MDACC experience. Phys Med Biol. 2009;54(11):3379–91.

    Article  Google Scholar 

  84. Heinzerling JH, Anderson JF, Papiez L, Boike T, Chien S, Zhang G, et al. Four-dimensional computed tomography scan analysis of tumor and organ motion at varying levels of abdominal compression during stereotactic treatment of lung and liver. Int J Radiat Oncol Biol Phys. 2008;70(5):1571–8.

    Article  Google Scholar 

  85. Crane CH, Koay EJ. Solutions that enable ablative radiotherapy for large liver tumors: fractionated dose painting, simultaneous integrated protection, motion management, and computed tomography image guidance. Cancer. 2016;122(13):1974–86.

    Article  Google Scholar 

  86. Wurm RE, Gum F, Erbel S, Schlenger L, Scheffler D, Agaoglu D, et al. Image guided respiratory gated hypofractionated stereotactic body radiation therapy (H-SBRT) for liver and lung tumors: initial experience. Acta Oncol. 2006;45(7):881–9.

    Article  CAS  Google Scholar 

  87. Brock KK, Dawson LA. Adaptive management of liver cancer radiotherapy. Semin Radiat Oncol. 2010;20(2):107–15.

    Article  Google Scholar 

  88. van de Lindt TN, Schubert G, van der Heide UA, Sonke J-J. An MRI-based mid-ventilation approach for radiotherapy of the liver. Radiother Oncol. 2016;121(2):276–80.

    Article  Google Scholar 

  89. Fukumitsu N, Sugahara S, Nakayama H, Fukuda K, Mizumoto M, Abei M, Shoda J, Thono E, Tsuboi K, Tokuuye K. A prospective study of hypofractionated proton beam therapy for patients with hepatocellular carcinoma. Int J Radiat Oncol Biol Phys. 2009;74(3):831–6. https://doi.org/10.1016/j.ijrobp.2008.10.073.

    Article  Google Scholar 

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Holliday, E.B., Koay, E.J., Crane, C.H. (2018). Role of Radiation Therapy in Hepatocellular Carcinoma. In: Cardona, K., Maithel, S. (eds) Primary and Metastatic Liver Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-91977-5_6

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