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Abstract

Hepatocellular carcinoma (HCC) is a leading cause of cancer death worldwide; its incidence is increasing in the United States. Depending on disease extent and underlying liver status, patients may be treated with local, locoregional, and/or systemic therapy. Recent data indicates that radiotherapy (RT) can play a meaningful role in the management of HCC. Here, we review published experiences using RT for HCC, including the use of radiosensitizers and stereotactic RT. We discuss methods for performing preclinical studies of RT for HCC and biomarkers of response. As a part of the HCC Working Group, an informal committee of the National Cancer Institute's Radiation Research Program, we suggest how RT should be implemented in the management of HCC and identify future directions for the study of RT in HCC.​ 

Figure 2.

Current Barcelona Clinic Liver Classification system and proposed roles for radiotherapy in the management of hepatocellular carcinoma. HCC = hepatocellular carcinoma; PS = performance status; RFA = radiofrequency ablation; RT = radiotherapy; SBRT = stereotactic body radiotherapy; TACE = transarterial chemoembolization.​ 

Table 2.

Targeted agents in clinical hepatocellular carcinoma studies, grouped by biologic compartment​​ 

*US Food and Drug Administration–approved. EGF = epidermal growth factor; ERK = extracellular signal-regulated kinase; HDAC = histone deacetylase; HGF = hepatocyte growth factor; IGF = insulin-like growth factor; JAK = Janus kinase; MEK = mitogen-activated protein kinase; mTOR = mammalian target of rapamycin; PDGF = platelet-derived growth factor; PI3K = phosphoinositide 3-kinase; STAT = signal transducer and activator of transcription; TGF = transforming growth factor; VEGF = vascular endothelial growth factor. 

Author information​

Ohri N1, Dawson LA1, Krishnan S1, Seong J1, Cheng JC1, Sarin SK1, Kinkhabwala M1, Ahmed MM1, Vikram B1, Coleman CN1, Guha C2.

1Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD.

2Department of Radiation Oncology (NO, CG) and Montefiore-Einstein Center for Transplantation (MK), Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY; Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Ontario, Canada (LAD); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (SK); Department of Radiation Oncology, Yonsei University Hospital, Seoul, North Korea (JS); Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan (JCC); Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India (SKS); Molecular Radiation Therapeutics Branch (MMA) and Clinical Radiation Oncology Branch (BV), Radiation Research Program (CNC), National Cancer Institute, National Institutes of Health, Bethesda, MD. cguhamd@gmail.com.