Targeting HCC With SBRT: Practical Strategies and Immunologic Synergies

Area of Science:

• Oncology
• Radiation Oncology
• Hepatology

Background:

• Hepatocellular carcinoma (HCC) is a major cause of cancer mortality with high recurrence rates.
• Current treatments include surgery, ablation, transarterial therapies, and systemic agents.
• Stereotactic body radiotherapy (SBRT) is emerging as a significant treatment modality for HCC.

Purpose of the Study:

• To review the contemporary evidence supporting SBRT in various stages of HCC.
• To discuss the practical considerations and radiobiology of SBRT for HCC.
• To explore the synergistic potential of SBRT with immunotherapy in HCC treatment.

Main Methods:

• Review of contemporary evidence on SBRT for HCC.
• Analysis of SBRT's role in early, intermediate, and advanced HCC.
• Discussion of practical aspects like dose selection, liver sparing, and response assessment.
• Exploration of HCC radiobiology and SBRT's interaction with immune checkpoint inhibitors.

Main Results:

• Modern SBRT enables precise, ablative dose delivery with liver parenchyma sparing, achieving excellent local control and acceptable toxicity.
• SBRT demonstrates efficacy as definitive therapy, salvage treatment, cytoreduction, palliation, and bridge to transplantation.
• High-dose hypofractionation in SBRT may overcome radioresistance via direct cytotoxicity and microenvironmental modulation.
• Early data suggest immunologic synergy between SBRT and immune checkpoint inhibitors.

Conclusions:

• SBRT is a valuable and versatile tool for managing hepatocellular carcinoma across the disease spectrum.
• Understanding SBRT's radiobiology and practical application is crucial for optimal outcomes.
• Combining SBRT with immunotherapy holds promise for future personalized HCC treatment strategies.
• SBRT is positioned to be a cornerstone of personalized, liver-directed HCC therapy.