High-Dose Focal Radiotherapy to Treat Hepatocellular Carcinoma and Liver Metastases

Anne Burke

October 30, 2007

October 30, 2007 (Los Angeles) — High-dose focal radiotherapy (RT) is safe for treating hepatocellular carcinoma and liver metastases, Laura A. Dawson, MD, FRCPC, from Princess Margaret Hospital at the University of Toronto, in Ontario, told attendees at the American Society for Therapeutic Radiology and Oncology (ASTRO) 49th Annual Meeting.

Speaking at a presidential symposium, Dr. Dawson, an associate professor in the department of radiation oncology, told her audience that high-dose radiation therapy results in tumor control and preservation of liver function in a majority of patients, many of whom are not eligible for other therapies.

Dr. Dawson cited a number of studies. One was conducted in Korea in 2005 and showed that radiation therapy can improve patient outcomes when combined with transarterial chemoembolization (TACE). This study involved 73 patients who had responded incompletely to TACE; 38 went on to receive RT and 35 received more TACE. The RT patients fared better, Dr. Dawson reported. Of RT patients, 37% survived 2 years out, compared with 14% of TACE-only patients, she said.

Dr. Dawson pointed to a strong need for therapies that not only treat and control liver cancer but also preserve liver function. Preservation of liver function is especially difficult because the majority of liver cancer patients have an underlying disease, such as cirrhosis, hepatitis B, or hepatitis C, she added.

Dawson told attendees that there are a number of methods to reduce toxicity. Among the most important is multidisciplinary care. For example, hepatitis B patients can be treated with antiviral therapy before radiation therapy. Toxicity can also be reduced with improved patient selection and a better understanding of normal toxicity. Dr. Dawson added that irradiation of normal tissue can be reduced through conformal RT planning, motion management, image-guided RT, and radiation protectors.

RT techniques for sparing liver function include external-beam radiotherapy, brachytherapy, radioembolization, and intraoperative RT, Dr. Dawson noted. Among innovative strategies, she mentioned RT plus surgery and RT in cases of hepatocyte transplantation to salvage liver failure.

Dr. Dawson began her presentation by explaining that hepatocellular carcinoma is the third leading cause of global cancer death. Cases are on the rise in the Western world because of increases in the incidence of hepatitis C, she said. Curative therapies, such as resection, transplantation, and radiofrequency ablation, do exist, but less than 20% of patients are eligible to receive them, Dr. Dawson noted.

Because standard therapies carry a risk for mortality, morbidity, and liver toxicity, there is a need for therapies that preserve liver function while treating the cancer, she said.

Dr. Dawson disclosed research grants related to liver cancer radiation therapy from the National Cancer Institute of Canada, the Canadian Cancer Society, and Elekta Oncology.

American Society for Therapeutic Radiology and Oncology 49th Annual Meeting. October 28, 2007.


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