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Spieler et al. Hepatoma Res 2019;5:4 Hepatoma Research
DOI: 10.20517/2394-5079.2018.77

Review Open Access

Stereotactic ablative radiotherapy for hepatocellular
carcinoma

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1
Benjamin Spieler , Eric A. Mellon , Patricia D. Jones , Huan Giap , Lynn Feun , Shree Venkat , Lorraine
2
1
Portelance 1
1 Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.
2 Department of Medicine, Division of Hepatology, University of Miami, Miami, FL 33136, USA.
3 Department of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.
4 Department of Radiation, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL 33136, USA.
Correspondence to: Dr. Lorraine Portelance, Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of
Miami, 1475 NW 12th Ave, Room D1500, Miami, FL 33136, USA. E-mail: lportelance@med.miami.edu
How to cite this article: Spieler B, Mellon EA, Jones PD, Giap H, Feun L, Venkat S, Portelance L. Stereotactic ablative radiotherapy for
hepatocellular carcinoma. Hepatoma Res 2019;5:4. http://dx.doi.org/10.20517/2394-5079.2018.77
Received: 12 Jun 2018 First Decision: 23 Jul 2018 Revised: 15 Dec 2018 Accepted: 25 Dec 2018 Published: 27 Jan 2019

Science Editor: Guang-Wen Cao Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Patients with hepatocellular carcinoma (HCC) often present with underlying liver disease and significant
comorbidities, limiting treatment tolerance. With the development of improved toxicity models and highly
conformal radiation delivery systems, external beam radiotherapy has become a valuable treatment option for liver
cancer. Using cutting edge technology, stereotactic ablative radiotherapy (SABR) allows for the delivery of ablative
doses in few fractions while sparing uninvolved liver tissue. This approach permits dose escalation and precise
tumor targeting with minimal risk of radiation induced liver disease. This review clarifies SABR’s role alongside
liver-directed treatments such as radiofrequency ablation, transarterial radioembolization, and transarterial
chemoembolization in the management of HCC. It also examines the promising potential of SABR combined with
immunotherapy to treat advanced HCC.

Keywords: Hepatocellular carcinoma, stereotactic ablative body radiation therapy, image guided radiation therapy,
adaptive radiation therapy, radiation toxicity, multidisciplinary cancer treatment

INTRODUCTION
Hepatocellular carcinoma (HCC) is the fifth most prevalent cancer worldwide and the second leading cancer-
[1]
related cause of mortality . Incidence in the United States (US) has risen dramatically over the past two
decades and is now estimated at 25,000 new cases each year . In US, patients diagnosed with HCC have a
[2]
[3]
poor prognosis, with mortality nearly doubling in recent decades and a 5-year survival rate less than 30% .
© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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