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Feun. Hepatoma Res 2019;5:26 Hepatoma Research
DOI: 10.20517/2394-5079.2019.21

Editorial Open Access

Hepatocellular carcinoma: a new hope?

Lynn G. Feun

Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL USA.

Correspondence to: Prof. Lynn G. Feun, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL,
USA. E-mail: lfeun@med.miami.edu
How to cite this article: Feun LG. Hepatocellular carcinoma: a new hope? Hepatoma Res 2019;5:26.
http://dx.doi.org/10.20517/2394-5079.2019.21
Received: 15 Jun 2019 First Decision: 17 Jun 2019 Revised: 18 Jun 2019 Accepted: 18 Jun 2019 Published: 12 Jul 2019

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

In this special issue of Hepatoma Research, we highlight certain Novel Approaches to Hepatocellular
Carcinoma. In the article “Stereotactic ablative radiotherapy for hepatocellular carcinoma” Dr Spieler and
Dr Portelance discussed the development of improved toxicity models and highly conformal radiation
delivery systems which allows for stereotactic radiosurgery to ablate liver tumors in few fractions and spare
Received: First Decision: Revised: Accepted: Published:
[1]
noncancerous liver tissue . Stereotactic body radiation therapy or SABR is an advanced form of external
Science Editor: Copy Editor: Production Editor: Jing Yu body radiation therapy. SABR combines both tumor/organ motion managment with multiple beams of
high energy so that very high doses of radiation can be administered precisely in one to five fractions.
Advantages to SABR is that this treatment is minimally invasive, can treat large tumor volume, or tumors
close to liver capsule, major blood vessels or diaphragm and when disease is associated with portal vein
thrombosis. This enables treatment for patients whose liver function tests may preclude radioembolization
or chemoembolization, or when the portal vein is occluded which may preclude chemoembolization. In
addition, as mentioned in the article, there is a rationale for this treatment to be considered to combine
with immunotherapeutic agents to enhance response. Preclinical and clinical studies demonstrate that
radiation therapy can upregulate PD-L1 expression in tumors so checkpoint inhibitors may be more
effective. Currently there are multiple clinical trials combining radiation therapy with checkpoint
inhibitors such as anti-PD-1 or anti-PD-L1 inhibitors or with cytotoxic T-lymphocyte associate protein
[2]
inhibitor (anti-CTLA-4) to treat hepatocellular carcinoma .
In the case report of “Congenital absence of the portal vein complicated by hepatocellular carcinoma in
the liver of an adult”, Dr Mehta highlights the rarity of this condition . There are only 101 previously
[3]
reported cases of congenital absence of the portal vein and 40% of which were associated with hepatic
tumors, including hepatocellular carcinoma. They discussed different approaches to treatment for patients

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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