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Abstract
Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

Author information

Chino F1, Stephens SJ1, Choi SS2, Marin D3, Kim CY4, Morse MA5, Godfrey DJ1, Czito BG1, Willett CG1, Palta M1.
1
Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina.
2
Department of Medicine, Gastroenterology, Duke University Medical Center, Durham, North Carolina.
3
Department of Radiology, Duke University Medical Center, Durham, North Carolina.
4
Department of Radiology, Interventional Radiology, Duke University Medical Center, Durham, North Carolina.
5
Department of Medicine, Medical Oncology, Duke University Medical Center, Durham, North Carolina.