Radiation Therapy in HCC: What Data Exist and What Data Do We Need to Incorporate into Guidelines?

Hepatocellular carcinoma (HCC) is a complex and diverse disease, with choice of treatment dependent on a patient's disease burden, location of disease, underlying liver function, and performance status. While radiation therapy (RT) was historically omitted from treatment algorithms, immense technological advances over the past several decades have enabled introduction of RT as an effective and safe treatment option for patients with HCC. Growing prospective and retrospective evidence supports the use of RT, particularly stereotactic body radiotherapy (SBRT), for a wide range of indications in HCC from locally advanced unresectable disease to bridge therapy for liver transplant candidates. SBRT is associated with excellent local control, even for patients refractory to or ineligible for other forms of locoregional therapy. Treatment is well-tolerated and associated with low rates of severe toxicity. Randomized trials are needed to define the role of SBRT in HCC treatment relative to other established locoregional treatments.