Radiation therapy

Several phase II studies have suggested a benefit of radiation therapy in local control and OS compared with historical controls for patients with locally advanced HCC unsuitable for standard locoregional therapies.[29,30][Level of evidence C2]

Curative-intent stereotactic body radiation therapy (SBRT) improved OS in a group of patients with HCC in the NRG/RTOG 1112 study (NCT01730937), which has been presented in abstract form. Most studies have included patients with Child-Pugh class A cirrhosis. Patients with Child-Pugh class B and C cirrhosis can also be treated with liver radiation, although with a higher risk of toxicity.[31][Level of evidence B1]

Many centers deliver photon-based SBRT, while others also offer proton-based (or other heavy-ion based) radiation therapy to the liver. Based on retrospective data, proton-based radiation therapy has the potential to offer a lower dose to the normal liver and dose-escalation to the liver tumor.[32,33] Clinical trials, including NRG-GI003 (NCT03186898), are evaluating whether photon or proton therapy is superior for patients with HCC.

Palliative radiation therapy improved pain response in a randomized trial presented in abstract form. Doses commonly used included 30 Gy in ten fractions and 8 Gy in one fraction. For more information, see the Radiation therapy section in Treatment of Localized Primary Liver Cancer.[34][Level of evidence B3]