Comprehending the therapeutic effects of stereotactic body radiation therapy for small hepatocellular carcinomas based on imagings

Abstract

Surgical resection or radiofrequency ablation (RFA) is considered first-choice treatment for small hepatocellular carcinomas (HCCs). When a patient has a small HCC that is inoperable or unsuitable for RFA, what are alternative treatments? Some oncologists recommend transarterial chemoembolization (TACE), chemotherapy, molecular-targeted therapy, or immunotherapy. However, these treatments have minimally beneficial effects in small HCCs. Stereotactic body radiation therapy (SBRT) is a liver-directed radical therapy for small HCCs, with treatment outcomes similar to those for surgical resection or RFA, but many oncologists do not comprehend its efficacy or accept this therapy. We herein discuss 11 typical patients who received SBRT for various indications: refusal to undergo resection or RFA; surgical resection or RFA considered difficult or unfeasible; residual cancer after surgical resection or RFA or incomplete iodized oil retention after TACE; or tumor recurrence after resection or RFA. We describe each case, including the radiation field, tumor radiation dose, and response to SBRT in both the tumor and liver parenchyma. These clinical data should help readers understand this new therapeutic technique. We also conducted a literature review and found evidence to support survival benefit with SBRT, including good three- and five-year overall survival rates. The purpose of this article is to encourage readers to accept the concept that SBRT is a low-toxicity and effective therapeutic option for patients with small HCCs, which offers substantial local control and improved overall survival, especially for patients with a tumor that is unresectable or unsuitable for RFA, residual tumor after local therapy, or intrahepatic recurrent tumor.

Keywords

Small hepatocellular carcinomas / stereotactic body radiation therapy / treatment outcomes / toxicity / imaging changes

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