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Zeng et al. Hepatoma Res2020;6:43 Hepatoma Research
DOI: 10.20517/2394-5079.2020.29

Review Open Access

Comprehending the therapeutic effects of

stereotactic body radiation therapy for small
hepatocellular carcinomas based on imagings

Zhao-Chong Zeng , Jia Fan , Jian Zhou , Meng-Su Zeng , Yi-Xing Chen , Zhi-Feng Wu , Jing Sun , Jian-Ying
2
1
1
2
3
1
1
Zhang , Yong Hu , Qian-Qian Zhao 1
1
1
1 Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
2 Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
3 Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Correspondence to: Dr. Zhao-Chong Zeng, Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai
200032, China. E-mail: zeng.zhaochong@zs-hospital.sh.cn
How to cite this article: Zeng ZC, Fan J, Zhou J, Zeng MS, Chen YX, Wu ZF, Sun J, Zhang JY, Hu Y, Zhao QQ. Comprehending the
therapeutic effects of stereotactic body radiation therapy for small hepatocellular carcinomas based on imagings. Hepatoma
Res2020;6:43. http://dx.doi.org/10.20517/2394-5079.2020.29
Received: 23 Mar 2020 First Decision: 29 Apr 2020 Revised: 6 May 2020 Accepted: 28 May 2020 Published: 10 Jul 2020
Academic Editors: Su Pin Choo, Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Surgical resection or radiofrequency ablation (RFA) is considered first-choice treatment for small hepatocellular
carcinomas (HCCs). When a patient has a small HCC that is inoperable or unsuitable for RFA, what are alternative
treatments? Some oncologists recommend transarterial chemoembolization (TACE), chemotherapy, molecular-
targeted therapy, or immunotherapy. However, these treatments have minimally beneficial effects in small HCCs.
Stereotactic body radiation therapy (SBRT) is a liver-directed radical therapy for small HCCs, with treatment
outcomes similar to those for surgical resection or RFA, but many oncologists do not comprehend its efficacy
or accept this therapy. We herein discuss 11 typical patients who received SBRT for various indications: refusal
to undergo resection or RFA; surgical resection or RFA considered difficult or unfeasible; residual cancer after
surgical resection or RFA or incomplete iodized oil retention after TACE; or tumor recurrence after resection or
RFA. We describe each case, including the radiation field, tumor radiation dose, and response to SBRT in both the
tumor and liver parenchyma. These clinical data should help readers understand this new therapeutic technique.
We also conducted a literature review and found evidence to support survival benefit with SBRT, including good
three- and five-year overall survival rates. The purpose of this article is to encourage readers to accept the concept
that SBRT is a low-toxicity and effective therapeutic option for patients with small HCCs, which offers substantial
local control and improved overall survival, especially for patients with a tumor that is unresectable or unsuitable
for RFA, residual tumor after local therapy, or intrahepatic recurrent tumor.

Keywords: Small hepatocellular carcinomas, stereotactic body radiation therapy, treatment outcomes, toxicity,
imaging changes

© The Author(s) 2020. 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,
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