[External radiotherapy for hepatocellular carcinoma].

Area of Science:

• Hepatobiliary oncology
• Radiation oncology
• Medical physics

Context:

• Hepatocellular carcinoma (HCC) treatment historically excluded radiotherapy due to liver toxicity.
• Conformal radiotherapy represents a significant advancement, enabling dose escalation and combination therapies.
• HCC management is complex, requiring integration of diverse therapeutic modalities.

Purpose:

• To review the role and advancements of conformal radiotherapy in hepatocellular carcinoma treatment.
• To highlight the benefits of conformal radiotherapy, particularly in cirrhotic patients.
• To discuss technical developments enhancing radiation delivery for HCC.

Summary:

• Conformal radiotherapy is increasingly recognized for HCC, offering non-invasiveness, broad applicability, and a favorable safety profile, even in patients with cirrhosis.
• Technical innovations like respiratory gating, intensity-modulated radiotherapy, and stereotactic techniques improve radiation focalization and precision.
• High response rates suggest conformal radiotherapy could be a curative-intent option for HCC, comparable to surgery or percutaneous ablation.

Impact:

• Conformal radiotherapy offers a promising, well-tolerated treatment option for hepatocellular carcinoma, especially in challenging patient populations.
• Optimized radiation delivery techniques enhance treatment efficacy and safety for HCC.
• Further randomized trials are needed to establish the definitive role of radiotherapy within the HCC therapeutic algorithm.