Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2434-2457
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2434
Role of modern radiotherapy in managing patients with hepatocellular carcinoma
Liang-Cheng Chen, Hon-Yi Lin, Shih-Kai Hung, Wen-Yen Chiou, Moon-Sing Lee
Liang-Cheng Chen, Hon-Yi Lin, Shih-Kai Hung, Wen-Yen Chiou, Moon-Sing Lee, Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Dalin, Chia-Yi 62247, Taiwan
Hon-Yi Lin, Shih-Kai Hung, Wen-Yen Chiou, Moon-Sing Lee, School of Medicine, Buddhist Tzu Chi University, Hualien 970, Taiwan
Hon-Yi Lin, Institute of Molecular Biology, National Chung Cheng University, Min-Hsiung, Chia-Yi 62102, Taiwan
Author contributions: Chen LC, Lin HY, and Hung SK contributed to the present review's conception and design; Chiou WY and Lee MS collected relevant papers and contributed to initial data interpretation; Chen LC, Lin HY and Hung SK wrote the manuscript; all authors brainstormed and discussed bi-weekly in the context of department research meetings.
Supported by Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation.
Conflict-of-interest statement: The authors declare no conflict of interest.
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: Shih-Kai Hung, MD, PhD, Assistant Professor, Chief Doctor, Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2 Mingsheng Road, Dalin, Chia-Yi 62247, Taiwan. oncology158@yahoo.com.tw
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: March 29, 2021
Revised: April 16, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: May 28, 2021
Processing time: 113 Days and 17.7 Hours
Abstract

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Several treatment options are available for managing HCC patients, classified roughly as local, local-regional, and systemic therapies. The high post-monotherapy recurrence rate of HCC urges the need for the use of combined modalities to increase tumor control and patient survival. Different international guidelines offer treatment recommendations based on different points of view and classification systems. Radiotherapy (RT) is a well-known local-regional treatment modality for managing many types of cancers, including HCC. However, only some of these treatment guidelines include RT, and the role of combined modalities is rarely mentioned. Hence, the present study reviewed clinical evidence for the use of different combined modalities in managing HCC, focusing on modern RT's role. Modern RT has an increased utility in managing HCC patients, mainly due to two driving forces. First, technological advancement (e.g., stereotactic body radiotherapy and advanced proton-beam therapy) enables precise delivery of radiation to increase tumor control and reduce side effects in the surrounding normal tissue. Second, the boom in developing target therapies and checkpoint-blockade immunotherapy prolongs overall survival in HCC patients, re-emphasizing the importance of local tumor control. Remarkably, RT combines with systemic therapies to generate the systemic therapy augmented by radiotherapy effect, a benefit now being actively investigated.

Keywords: Hepatocellular carcinoma, Stereotactic body radiotherapies, Radiotherapy, Guideline, Combined treatment, Immunotherapy

Core Tip: Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and treatments outcome are often unsatisfactory. The high post-monotherapy recurrence rate points to the need to combine modalities, including radiotherapy (RT). The international guidelines from North America, Europe and Asia offer treatment recommendations based on different classification systems. However, not all of these treatment guidelines include RT and the role of combined modalities. Hence, the present study reviewed clinical evidence of different combined modalities in managing HCC, focusing on RT's role and especially modern advanced RT techniques and the interaction with game-changing immunotherapy.