title: Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials.
abstract: A consensus meeting to develop practice guidelines and to recommend future clinical trials for radiation therapy (RT), including external beam RT (EBRT), and selective internal RT (SIRT) in hepatocellular carcinoma (HCC) was held at the 5th annual meeting of the Asia-Pacific Primary Liver Cancer Expert consortium. Although there is no randomized phase III trial evidence, the efficacy and safety of RT in HCC has been shown by prospective and retrospective studies using modern RT techniques. Based on these results, the committee came to a consensus on the utility and efficacy of RT in the management of HCC according to each disease stage as follows: in early and intermediate stage HCC, if standard treatment is not compatible, RT, including EBRT and SIRT can be considered. In locally advanced stage HCC, combined EBRT with transarterial chemoembolization or hepatic arterial infusion chemotherapy, and SIRT can be considered. In terminal stage HCC, EBRT can be considered for palliation of symptoms and reduction of morbidity caused by the primary tumor or its metastases. Despite the currently reported benefits of RT in HCC, the committee agreed that there is a compelling need for large prospective studies, including randomized phase III trial evidence evaluating the role of RT. Specifically studies evaluating the efficacy and safety of sequential combination of EBRT and SIRT are strongly recommended.
authors: Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Medical Device Management and Research, SAIHST, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Hee Chul
authors: HC
authors: Park
authors: Departments of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors: Jeong Il
authors: JI
authors: Yu
authors: Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan (ROC).
authors: Jason Chia-Hsien
authors: JC
authors: Cheng
authors: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Zhao Chong
authors: ZC
authors: Zeng
authors: Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan (ROC).
authors: Ji Hong
authors: JH
authors: Hong
authors: Department of Radiation Oncology, National Cancer Centre Singapore, Singapore.
authors: Michael Lian Chek
authors: ML
authors: Wang
authors: Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Republic of Korea.
authors: Mi Sook
authors: MS
authors: Kim
authors: Department of Radiation Therapy and Oncology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan (ROC).
authors: Kwan Hwa
authors: KH
authors: Chi
authors: Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan (ROC).
authors: Po-Ching
authors: PC
authors: Liang
authors: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan (ROC).
authors: Rheun-Chuan
authors: RC
authors: Lee
authors: Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.
authors: Wan-Yee
authors: WY
authors: Lau
authors: Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Kwang Hyub
authors: KH
authors: Han
authors: Department of Surgical Oncology, National Cancer Center; Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital; Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors: Pierce Kah-Hoe
authors: PK
authors: Chow
authors: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors: Jinsil
authors: J
authors: Seong
keywords: Consensus; External beam radiotherapy; Hepatocellular carcinoma; Practice guidelines; Selective internal radiation therapy