Conformal and stereotactic radiotherapy in hepatocellular carcinoma

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Marta Scorsetti, Mario Bignardi

Ann. Ital. Chir., 2008; 79: 107-110

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Historically, Radiation Therapy (RT) has played a minor role in the treatment of hepatocellular carcinoma, especially
because of toxicity related to conventional techniques. However, high radiation doses can now be given safely by means
of 3D-conformal techniques and other more specialized techniques. 3D-conformal RT, in which both target definition
and treatment planning are based on three-dimensional image data sets, provided good local control in several series. As
an evolution of cranial radiosurgery, stereotactic body radiation therapy (SBRT) is currently being employed as a new
tool for the treatment of HCC, as it offers the opportunity of achieving radioablation for tumors up to 6 cm in diameter
with a minimal risk of radiation induced liver disease. SBRT is distinguished by the fact that both planning and
treatment are guided by reference to a system of external stereotactic coordinates. As a consequence, SBRT may succeed
in minimizing geometric treatment uncertainties, thus allowing the delivery of high doses to the target, given in a small
number of fractions. In several published series of SBRT for HCC, actuarial 5-year local control rates higher than 80%
have been achieved. In short, radiation therapy should be considered as a useful addition to the treatment spectrum of
HCC.

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