Imaging and image-guided radiation therapy in liver cancer

Imaging for radiation therapy treatment planning and delivery is a critical component of the radiation planning process for liver cancer. Because of the lack of inherent contrast between liver tumors and the surrounding liver, intravenous contrast is required for accurate target delineation on the planning computed tomography scan. The appropriate phase of contrast is tumor specific, with arterial phase imaging usually used to define hepatocellular carcinoma and venous phase imaging for vascular thrombosis related to hepatocellular carcinoma and most types of liver metastases. Breathing motion and changes in the liver position day to day may be substantial and need to be considered at the time of radiation planning and treatment. Many types of integrated imaging-radiation treatment systems and image-guidance strategies are available to produce volumetric and/or planar imaging at the time of treatment delivery to reduce the negative impact of geometric changes that may occur. Image-guided radiation therapy facilitates reduced PTV margins and dose escalation and improves the precision of radiation therapy, so the prescribed doses are more likely to represent those actually delivered.