[External radiotherapy for hepatocellular carcinoma].
For a long time radiotherapy has been excluded from the therapeutic strategy for hepatocellular carcinoma, given its significant toxicity on the non-tumoral liver parenchyma. Conformal radiation is a recent advance in the field of radiotherapy, allowing dose escalation and combination with other therapeutic options for hepatocellular carcinoma, including trans-arterial chemo-embolization. Conformal radiotherapy is associated with interesting features, especially in cirrhotic patients: wide availability, non-invasiveness, possibility to target multiple localizations anywhere within the liver parenchyma, and favorable tolerance profile even in patients with cirrhosis and/or in a poor medical condition. Recently, radiation delivery has been optimized through several technical developments: respiratory gating and intensity-modulated radiotherapy, which allow a better focalization of the ballistics, stereotactic techniques and proton-beam radiotherapy, whose availability is currently limited in Europe. Given the high response rates of hepatocellular carcinoma to radiation, conformal radiotherapy may be regarded as a curative-intent treatment for hepatocellular carcinoma, similar to surgery and per-cutaneous techniques. Yet the impact of radiotherapy has to be evaluated in randomized trials to better integrate in the complex therapeutic algorithm of hepatocellular carcinoma.
Service de pneumologie, hôpital Louis-Pradel, hospices civils de Lyon, 28 avenue du Doyen-Jean-Lépine, Bron, France.
N
N
Girard
F
F
Mornex
D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D055425:Respiratory-Gated Imaging Techniques