Publication

Rethinking the Role of Radiation Therapy in the Treatment of Unresectable Hepatocellular Carcinoma: A Data Driven Treatment Algorithm for Optimizing Outcomes

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Last modified
  • 05/21/2025
Type of Material
Authors
    Mutlay Sayan, Rutgers State UniversityNikhil Yegya-Raman, Rutgers State UniversityStephanie H. Greco, Rutgers State UniversityBin Gui, Rutgers State UniversityAndrew Zhang, Rutgers State UniversityAnupama Chundury, Rutgers State UniversityMiral S. Grandhi, Rutgers State UniversityHoward S. Hochster, Rutgers State UniversityTimothy J. Kennedy, Rutgers State UniversityRussel C. Langan, Rutgers State UniversityUsha Malhotra, Rutgers State UniversityVinod K. Rustgi, Rutgers State UniversityMihir Shah, Emory UniversityKristen R. Spencer, Rutgers State UniversityDarren R. Carpizo, Rutgers State UniversityJohn L. Nosher, Rutgers State UniversitySalma K. Jabbour, Rutgers State University
Language
  • English
Date
  • 2019-06-18
Publisher
  • Frontiers Media
Publication Version
Copyright Statement
  • Copyright © 2019 Sayan, Yegya-Raman, Greco, Gui, Zhang, Chundury, Grandhi, Hochster, Kennedy, Langan, Malhotra, Rustgi, Shah, Spencer, Carpizo, Nosher and Jabbour.
License
Final Published Version (URL)
Title of Journal or Parent Work
ISSN
  • 2234-943X
Volume
  • 9
Issue
  • JUN
Start Page
  • 345
End Page
  • 345
Abstract
  • Hepatocellular carcinoma (HCC) is the second most common cause of cancer death worldwide, with a majority of HCC patients not suitable for curative therapies. Approximately 70% of initially diagnosed patients cannot undergo surgical resection or transplantation due to locally advanced disease, poor liver function/underlying cirrhosis, or additional comorbidities. Local therapeutic options for patients with unresectable HCC, who are not suitable for thermal ablation, include transarterial embolization (bland, chemoembolization, radioembolization) and/or external beam radiation therapy (EBRT). Regarding EBRT specifically, technological advancements provide a means for safe and effective radiotherapy delivery in a wide spectrum of HCC patients. In multiple prospective studies, EBRT delivery in a variety of different fractionation schemes or in combination with transcatheter arterial chemoembolization (TACE) demonstrate improved outcomes, particularly with combination therapy. The Barcelona Clinic Liver Cancer classification provides a framework for treatment selection; however, given the growing complexity of treatment strategies, this classification system tends to simplify decision-making. In this review, we discuss the current literature regarding unresectable HCC and propose a modified treatment algorithm that emphasizes the role of radiation therapy for Child-Pugh score A or B patients with ≤3 nodules measuring >3 cm, multinodular disease or portal venous thrombosis.
Author Notes
Keywords
Research Categories
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Oncology
  • Biology, Radiation

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