Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus

Ted K. Yanagihara, Joel E. Tepper, Andrew M. Moon, Aisling Barry, Meritxell Molla, Jinsil Seong, Ferran Torres, Smith Apisarnthanarax, Michael Buckstein, Higinia Cardenes, Daniel T. Chang, Mary Feng, Chandan Guha, Christopher L. Hallemeier, Maria A. Hawkins, Morten Hoyer, Hiromitsu Iwata, Salma K. Jabbour, Lisa Kachnic, Jordan KharofaTae Hyun Kim, Alexander Kirichenko, Eugene J. Koay, Hirokazu Makishima, Joel Mases, Jeffrey J. Meyer, Pablo Munoz-Schuffenegger, Dawn Owen, Hee Chul Park, Jordi Saez, Nina N. Sanford, Marta Scorsetti, Grace L. Smith, Jennifer Y. Wo, Sang Min Yoon, Theodore S. Lawrence, Maria Reig, Laura A. Dawson

Research output: Contribution to journalArticlepeer-review


Purpose: External beam radiation therapy (EBRT) is a highly effective treatment in select patients with hepatocellular carcinoma (HCC). However, the Barcelona Clinic Liver Cancer system does not recommend the use of EBRT in HCC due to a lack of sufficient evidence and intends to perform an individual patient level meta-analysis of ablative EBRT in this population. However, there are many types of EBRT described in the literature with no formal definition of what constitutes “ablative.” Thus, we convened a group of international experts to provide consensus on the parameters that define ablative EBRT in HCC. Methods and Materials: Fundamental parameters related to dose, fractionation, radiobiology, target identification, and delivery technique were identified by a steering committee to generate 7 Key Criteria (KC) that would define ablative EBRT for HCC. Using a modified Delphi (mDelphi) method, experts in the use of EBRT in the treatment of HCC were surveyed. Respondents were given 30 days to respond in round 1 of the mDelphi and 14 days to respond in round 2. A threshold of ≥70% was used to define consensus for answers to each KC. Results: Of 40 invitations extended, 35 (88%) returned responses. In the first round, 3 of 7 KC reached consensus. In the second round, 100% returned responses and consensus was reached in 3 of the remaining 4 KC. The distribution of answers for one KC, which queried the a/b ratio of HCC, was such that consensus was not achieved. Based on this analysis, ablative EBRT for HCC was defined as a BED10 ≥80 Gy with daily imaging and multiphasic contrast used for target delineation. Treatment breaks (eg, for adaptive EBRT) are allowed, but the total treatment time should be ≤6 weeks. Equivalent dose when treating with protons should use a conversion factor of 1.1, but there is no single conversion factor for carbon ions. Conclusions: Using a mDelphi method assessing expert opinion, we provide the first consensus definition of ablative EBRT for HCC. Empirical data are required to define the a/b of HCC.

Original languageEnglish (US)
Pages (from-to)134-145
Number of pages12
JournalPractical Radiation Oncology
Issue number2
StatePublished - Mar 1 2024


  • Humans
  • Carcinoma, Hepatocellular/radiotherapy
  • Consensus
  • Liver Neoplasms/radiotherapy
  • Ambulatory Care Facilities
  • Carbon

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging


Dive into the research topics of 'Defining Minimum Treatment Parameters of Ablative Radiation Therapy in Patients With Hepatocellular Carcinoma: An Expert Consensus'. Together they form a unique fingerprint.

Cite this