External beam radiation therapy for hepatocellular carcinoma: potential of intensity-modulated and image-guided radiation therapy.

Department of Radiation Oncology, UTHSC at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA.
Gastroenterology (Impact Factor: 16.72). 12/2004; 127(5 Suppl 1):S206-17. DOI: 10.1053/j.gastro.2004.09.035
Source: PubMed


External beam radiotherapy has historically played a minor role in the primary treatment of hepatocellular carcinoma. Although there is evidence for tumor response to external beam radiotherapy and despite the fact that a radiation dose-response relationship has been established, the limited radiation tolerance of the adjacent normal liver has prohibited wider use of radiation therapy in this disease. Recent technological and conceptual developments in the field of radiation therapy-such as intensity-modulated radiation therapy, image-guided radiation therapy, and stereotactic body radiation therapy-have the potential to improve radiation treatments by conforming the delivered radiation dose distribution tightly to the tumor or target volume outline while sparing normal liver tissue from high-dose radiation. Image guidance allows for a reduction of added (normal tissue) safety margins designed to account for interfraction patient and target setup variability, and stereotactic targeting will further reduce residual target setup uncertainty. Combining improvements in tumor targeting with normal tissue sparing, radiation dose delivery will enable clinically effective and safe radiation delivery for liver tumors such as hepatocellular carcinoma. This article reviews the role of radiotherapy for hepatocellular carcinoma; presents modern radiation therapy modalities and concepts such as intensity-modulated, image-guided, and stereotactic body radiation therapy; and hypothesizes about their future effect on primary treatment alternatives.

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    • "p = 0.009) compared with 3DCRT [14]. Fuss et al. reported that IMRT allowed a dose escalation to 60 Gy, in which range 3DCRT had to reduce the total dose to decrease the probability of RILD to acceptable levels [15]. "
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    Radiation Oncology 06/2011; 6(1):76. DOI:10.1186/1748-717X-6-76 · 2.55 Impact Factor
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    • "Most malignancy cells are of moderate radiosensitivity, therefore to achieve better treatment effect, radiosensitizers are frequently used in in vivo or in vitro performances. Historically, radiotherapy for hepatocellular carcinoma has yielded poor long-term survival, and the limited radiation tolerance of the adjacent normal liver has prohibited wider use of radiation therapy in this disease [Fuss et al., 2004]. "
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    • "Clinical investigations suggested that one-third, twothirds , and the whole liver can be safely irradiated with 90, 47, and 31 Gy, respectively, and that a partial volume of the liver can be irradiated with a tumor-control dose [11]. Furthermore, advanced irradiation techniques such as 3D-conformal RT (CRT) and image-guided RT (IGRT) made it possible to deliver a higher dose to the tumor without damage to the normal liver [12]. Although clinical results of RT for HCC-PVTT have been reported [13] [14] [15] [16] [17] [18], the optimal RT dose remains to be established . "
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