Overview
Primary malignant neoplasms of the liver include hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). These cancers can be treated with various modalities, including radiation therapy, systemic therapy, and locoregional therapies.Diagnosis
Diagnosis of primary liver cancers (HCC and IHC) is based on imaging and biopsy 1.Management
External beam radiation therapy (EBRT) is a potential first-line treatment for patients with liver-confined HCC who are not candidates for curative therapy 1.
EBRT can be used as consolidative therapy after incomplete response to liver-directed therapies 1.
EBRT is an option for salvage therapy for local recurrences of HCC 1.
EBRT is conditionally recommended for patients with liver-confined multifocal or unresectable HCC or those with macrovascular invasion, sequenced with systemic or catheter-based therapies 1.
Palliative EBRT is conditionally recommended for symptomatic primary HCC and/or macrovascular tumor thrombi 1.
EBRT is conditionally recommended as a bridge to transplant or before surgery in carefully selected patients 1.Key Recommendations
EBRT is recommended as a potential first-line treatment in patients with liver-confined HCC who are not candidates for curative therapy 1. (Evidence: Strong)
EBRT is recommended as consolidative therapy after incomplete response to liver-directed therapies 1. (Evidence: Strong)
EBRT is recommended as a salvage option for local recurrences 1. (Evidence: Strong)References
1 Apisarnthanarax S, Barry A, Cao M, Czito B, DeMatteo R, Drinane M et al.. External Beam Radiation Therapy for Primary Liver Cancers: An ASTRO Clinical Practice Guideline. Practical radiation oncology 2022. link