Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2015; 7(1): 101-112
Published online Jan 27, 2015. doi: 10.4254/wjh.v7.i1.101
Role of radiotherapy in the management of hepatocellular carcinoma: A systematic review
Maria-Aggeliki Kalogeridi, Anna Zygogianni, George Kyrgias, John Kouvaris, Sofia Chatziioannou, Nikolaos Kelekis, Vassilis Kouloulias
Maria-Aggeliki Kalogeridi, Anna Zygogianni, George Kyrgias, Radiotherapy Department, Larissa University Hospital, 41110 Larisa, Greece
Anna Zygogianni, John Kouvaris, 1st Radiology Department, Radiotherapy Unit, Aretaieion University Hospital, 11528 Athens, Greece
Sofia Chatziioannou, Nikolaos Kelekis, Vassilis Kouloulias, 2nd Radiology Department, Radiotherapy Unit, Attikon University Hospital, 12642 Athens, Greece
Author contributions: All authors contributed to this work.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Vassilis Kouloulias, MS, MD, PhD, Assistant Professor Radiation Oncology, 2nd Radiology Department, Radiotherapy Unit, Attikon University Hospital, Rimini 1, 12642 Athens, Greece. vkouloul@ece.ntua.gr
Telephone: +30-21-05831880 Fax: +30-21-05326418
Received: July 6, 2014
Peer-review started: July 6, 2014
First decision: August 28, 2014
Revised: October 26, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: January 27, 2015
Processing time: 188 Days and 13.1 Hours
Abstract

Many patients with hepatocellular carcinoma (HCC) present with advanced disease, not amenable to curative therapies such as surgery, transplantation or radiofrequency ablation. Treatment options for this group of patients include transarterial chemoembolization (TACE) and radiation therapy. Especially TACE, delivering a highly concentrated dose of chemotherapy to tumor cells while minimizing systemic toxicity of chemotherapy, has given favorable results on local control and survival. Radiotherapy, as a therapeutic modality of internal radiation therapy with radioisotopes, has also achieved efficacious tumor control in advanced disease. On the contrary, the role of external beam radiotherapy for HCC has been limited in the past, due to the low tolerance of surrounding normal liver parenchyma. However, technological innovations in the field of radiotherapy treatment planning and delivery, have provided the means of delivering radical doses to the tumor, while sparing normal tissues. Advanced and highly conformal radiotherapy approaches such as stereotactic body radiotherapy and proton therapy, evaluated for efficacy and safety for HCC, report encouraging results. In this review, we present the role of radiotherapy in hepatocellular carcinoma patients not suitable for radical treatment.

Keywords: Hepatocellular carcinoma; Radiotherapy; Radio-embolization; Hyperthermia; Review

Core tip: Treatment of hepatocellular carcinoma is challenging since it is usually associate with underlying liver morbidity. The role of radiotherapy has evolved. The combination settings with radioisotopes, transarterial chemoembolization, hyperthermia, stereotactic radiotherapy and charged particles, support the efficacy and safety of the radiation therapy.