The Role of Radiation in the Treatment of Hepatocellular Carcinoma

Abstract

In the past two decades, Radiation Therapy (RT) has become a cornerstone in the treatment of hepatocellular carcinoma (HCC), thanks to significant advancements in radiation delivery techniques. Previously, conventional RT played a limited role in treating HCC due to the high risk of toxicity to normal liver tissue. However, with the introduction of advanced techniques like stereotactic body radiation (SBRT), radiation has become more precise and targeted. SBRT, in particular, has emerged as a valuable locoregional therapy for HCC patients who are not candidates for surgery or other local treatments. This chapter aims to explore the evolving role of RT in multidisciplinary HCC care and highlight the technique, indications, and supporting literature for SBRT and proton therapy in early and intermediate HCC treatment. Additionally, we will delve into the palliative uses of RT for pain relief and tumor burden reduction in HCC patients. Finally, we will review recent advances in RT, such as adaptive radiotherapy and biological-guided radiotherapy, discussing their potential impact on HCC treatment.