Published online Aug 28, 2016. doi: 10.3748/wjg.v22.i32.7311
Peer-review started: April 2, 2016
First decision: May 30, 2016
Revised: June 21, 2016
Accepted: July 21, 2016
Article in press: July 21, 2016
Published online: August 28, 2016
Radiotherapy techniques have substantially improved in the last two decades. After the introduction of 3-dimensional conformal radiotherapy, radiotherapy has been increasingly used for the treatment of hepatocellular carcinoma (HCC). Currently, more advanced techniques, including intensity-modulated radiotherapy (IMRT), stereotactic ablative body radiotherapy (SABR), and charged particle therapy, are used for the treatment of HCC. IMRT can escalate the tumor dose while sparing the normal tissue even though the tumor is large or located near critical organs. SABR can deliver a very high radiation dose to small HCCs in a few fractions, leading to high local control rates of 84%-100%. Various advanced imaging modalities are used for radiotherapy planning and delivery to improve the precision of radiotherapy. These advanced techniques enable the delivery of high dose radiotherapy for early to advanced HCCs without increasing the radiation-induced toxicities. However, as there have been no effective tools for the prediction of the response to radiotherapy or recurrences within or outside the radiation field, future studies should focus on selecting the patients who will benefit from radiotherapy.
Core tip: Radiotherapy techniques have greatly improved in the last two decades. After the introduction of 3-dimensional conformal radiotherapy, the use of radiotherapy for hepatocellular carcinoma (HCC) has increased substantially. Currently, more advanced techniques including intensity-modulated radiotherapy, stereotactic ablative body radiotherapy, charged particle therapy, and image-guided radiotherapy are increasingly used for the treatment of HCCs. These techniques facilitate the delivery of higher dose radiotherapy for early to advanced HCCs, while minimizing radiation-induced toxicities. This review will cover the technical aspects of modern radiotherapy techniques along with their clinical applications.