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Reyngold et al. Hepatoma Res 2018;4:49 Hepatoma Research
DOI: 10.20517/2394-5079.2018.84

Review Open Access

Hypofractionated ablative radiation therapy for
hepatocellular carcinoma: practical considerations
and review of the literature

2
1
Marsha Reyngold , Eugene J. Koay , Christopher H. Crane 1
1 Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
2 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Correspondence to: Dr. Christopher H. Crane, Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York
Ave., New York, NY 10065, USA. E-mail: cranec1@MSKCC.org
How to cite this article: Reyngold M, Koay EJ, Crane CH. Hypofractionated ablative radiation therapy for hepatocellular carcinoma:
practical considerations and review of the literature. Hepatoma Res 2018;4:49. http://dx.doi.org/10.20517/2394-5079.2018.84
Received: 2 Jul 2018 First Decision: 19 Jul 2018 Revised: 1 Aug 2018 Accepted: 3 Aug 2018 Published: 20 Aug 2018

Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy. The prognosis for patients who
present with inoperable primary liver tumors is poor with median survival times of 12 months or less. Tumor-
related liver failure is a common cause of mortality, underscoring the importance of local control. Recent
advancements in external beam radiation therapy delivery techniques have enabled dose escalation that in turn
has significantly improved local control and has allowed radiation therapy to emerge as an effective modality in
this setting. In this review, we outline the critical practical aspects of treating liver tumors with radiation including
choice of fractionation, motion management, image guidance and use of intensity-modulated radiation therapy
vs. proton beam therapy. We review our approach to ablative radiation therapy for HCC with consideration of
underlying cirrhosis and provide a brief overview of the current literature.

Keywords: Hypofractionated ablative radiation therapy, stereotactic ablative radiotherapy, radiation, large
hepatocellular carcinoma

INTRODUCTION
Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is the second lead-
ing cause of cancer-related death worldwide. While surgical resection and/or transplantation represent well
established curative options for early stage cancer in patients with compensated liver disease, other local
treatments play an important role in more advanced patients, including patients with large locally unresect-

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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