Use of Radiotherapy Alone and in Combination with Other Therapies for Hepatocellular Carcinoma: Rationale and Future Directions

The continuous rise in incidence of hepatocellular carcinoma (HCC) worldwide has led to renewed efforts to improve therapeutic strategies. The gold standard of curative therapy for patients with HCC is surgery. However, in HCC patients with tumors with specific anatomical locations, such as near gastrointestinal structures or vessels, or with vascular occlusions, surgery may be particularly challenging. Poor baseline liver function is often an additional limiting factor for many established treatment modalities, especially for liver resection. Therefore, available treatment options have been very limited in efficacy, which led to dismal survival rates. In recent years, radiotherapy has emerged as a new and promising local treatment option for certain patients with HCC. Advances in technology and delivery techniques have aided in establishing radiotherapy as a safe and effective treatment modality. As a painless, non-invasive, outpatient treatment procedure, radiotherapy may have many advantages over other treatment modalities. This chapter will discuss recent developments and advances in establishing radiotherapy as a new pillar of treatment for patients with HCC, review available data from retrospective and prospective trials, and give an overview of potential future combinational treatment approaches with systemic therapies to further expand the benefits.