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World J Gastroenterol. Jan 28, 2020; 26(4): 393-403
Published online Jan 28, 2020. doi: 10.3748/wjg.v26.i4.393
Indications of external radiotherapy for hepatocellular carcinoma from updated clinical guidelines: Diverse global viewpoints
Sunmin Park, Won Sup Yoon, Chai Hong Rim
Sunmin Park, Won Sup Yoon, Chai Hong Rim, Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, Ansan 15355, Gyeonggi-do, South Korea
Author contributions: Park S and Rim CH drafted the manuscript; Yoon WS and Rim CH made the supervision; Rim CH made literature review.
Supported by the National Research Fund of Korea, No. NRF-2018R1D1A1B07046998.
Conflict-of-interest statement: All the authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Chai Hong Rim, MD, PhD, Clinical Assistant Professor, Department of Radiation Oncology, Ansan Hospital, Korea University Medical College, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Gyeonggi-do, South Korea. crusion3@naver.com
Received: November 5, 2019
Peer-review started: November 5, 2019
First decision: December 23, 2019
Revised: January 6, 2020
Accepted: January 11, 2020
Article in press: January 11, 2020
Published online: January 28, 2020
Abstract

The etiology and disease patterns of hepatocellular carcinoma (HCC) significantly vary among regions. Modern standard treatments commonly require multidisciplinary approaches, including applications of up-to date medicine and advanced procedures, and necessitate the support of socioeconomic systems. For these reasons, a number of clinical guidelines for HCC from different associations and regions have been presented. External beam radiation therapy was contraindicated for HCC until a few decades ago, but with the development of new technologies, its application has rapidly increased as selective irradiation for tumorous lesions became possible. Most of the guidelines had been opposed or indifferent to radiotherapy in the past, but several guidelines have introduced indications and recommendations for radiotherapy in their updated versions. This review will discuss the characteristics of important guidelines and their contents regarding radiotherapy and will also provide guidance to physicians who are considering applications of locoregional modalities that include radiotherapy.

Keywords: Hepatocellular carcinoma, Clinical guideline, Radiotherapy, Radiation therapy, Liver neoplasm, Stereotactic body radiotherapy

Core tip: Hepatocellular carcinoma vary in incidence and disease characteristics by region. This review systematically organizes a number of hepatocellular carcionma treatment guidelines from a radiation oncological perspective, providing helpful information for physicians considering local treatment, including radiotherapy.