Radiotherapy for unresectable hepatic malignancies

The management of hepatic malignancies, primary or metastatic, is an increasingly common problem in clinical practice. Unfortunately, most patients present with unresectable disease for which there is no universally accepted standard therapy. Radiotherapy is gaining importance in the management of these tumors and in this article we will review the advancements made in this field recently. Increased understanding of the relationship between radiation dose and volume and the risk of radiation-induced liver disease (RILD) has allowed delivery of high-dose focal liver radiation with encouraging results. A recent US phase II trial suggests a radiation dose-dependent improvement in survival when compared to historical controls. Others have reported favorable experience with moderate-dose external-beam radiotherapy, stereotactic hypofractionated radiotherapy, and radiopharmaceuticals.