Research progress of stereotactic body radiation therapy in comprehensive treatment of hepatocellular carcinoma
Objective To summarize the clinical study of stereotactic body radiation therapy(SBRT)in the comprehensive treatment of hepatocellular carcinoma(HCC)and to provide evidence-based support for the clinical application of the ra-diotherapy technique in order to further improve patients'overall survival.Methods PubMed and the China National Knowledge Infrastructure database retrieval system were used to search the related literature from the creation of the data-base until 2024-06-31,with"hepatocellular carcinoma"and"stereotactic body radiation therapy"as the English key words.The following were requirements for inclusion:(1)the background in radiotherapy and epidemiology of HCC;(2)the therapeutic mechanisms,indications,and common dose segmentation modes of SBRT;(3)the comparisons of SBRT with surgical resection,radiofrequency ablation(RFA),and transcatheter arterial chemoembolization(TACE)for small hepatocellular carcinoma(sHCC);(4)the advancement of studies on combined therapy modes in HCC patients with intermediate and advanced stages and advanced HCC patients awaiting liver transplantation;(5)therapeutic toxicity asso-ciated with SBRT.Considerations for exclusion included dated data,controversies,and similar literature that was repeat-ed.Ultimately,96 pieces of literature in both Chinese and English were incorporated for evaluation and discussion.Results With the rapid development of modern radiotherapy technology,stereotactic radiotherapy plays an important role in the comprehensive treatment of hepatocellular carcinoma throughout the entire process.Multiple retrospective and prospective studies have compared the clinical efficacy of low-fractionation(3-10 Fx)high-dose(3-15 Gy)short course body ster-eotactic radiotherapy with radiofrequency ablation,transcatheter arterial chemoembolization,and surgical resection.However,some studies have inconsistent conclusions,and most studies still support that body stereotactic radiotherapy can achieve similar or even better local control and overall survival,especially in patients with liver dysfunction,＞3 cancer nodules,special tumor location,or high tumor burden.For liver cancer patients with portal vein thrombosis in the middle and late stages,the combination of body stereotactic radiotherapy and transcatheter arterial chemoembolization can achieve longer progression free survival,higher objective response rates,and local control of liver tumors compared to a single treatment mode.In addition,for patients with unresectable hepatocellular carcinoma undergoing initial treatment,the combination of systemic stereotactic radiotherapy and immune checkpoint inhibitors can achieve clinical complete remission and overall survival benefits.Stereotactic radiotherapy for the body has the potential to become an effective bridge for late stage hepatocellular carcinoma patients waiting for liver transplantation,especially for patients with liver function Child Pugh scores≥8.Conclusions Under the premise of improving clinical efficacy and strict dose-volume restrictions in pa-tients with HCC,precise hyperfractionated radiotherapy technology has a low incidence of severe toxicities of teatment-re-lated≥grade 3.Therefore,radiotherapy plays a more and more important role in the multidisciplinary treatment of HCC,but it still needs to be further confirmed by follow-up high-quality,prospective,large-scale,randomized controlled trials.
hepatocellular carcinoma,stereotactic body radiation therapysmall hepatocellular carcinomaradiotherapy doseimmune checkpoint inhibitorsclinical studyevidence-based medicinereview literature
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