RT for hepatocelluar carcinoma,Qifeng WangDepartment of Radiation Oncology, Sichuan Cancer Hospital& Institution, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China;,Epidemiology (worldwide),Liver cancer incidence trend for selected registries 1993-2002,Center MM, et al. Cancer Epidemiol Biomarkers Prev 2011; 20(11): 23622368.,Epidemiology (worldwide),Annual incidence rate by age group for selected registries 1998-2002,Center MM, et al. Cancer Epidemiol Biomarkers Prev 2011; 20(11): 23622368.,Epidemiology (China),Age-standardized rate of liver cancer,Chen JG, et al. Chin J Prev Med 2010; 44(5): 383-389.,Topics,Liver function tests Staging systems Treatment guidelines Radiotherapy Toxicities Quality Of Life,Topics,Liver function tests Staging systems Treatment guidelines Radiotherapy Toxicities Quality Of Life,Liver function tests,Liver Function,UptakeMetabolismConjugationExcretionimmunology,Liver function tests,Hoekstra LT, et al. Ann Surg 2013; 257: 27-36.,Conventional tests,Liver function tests (clinical grading systems),Child-Pugh scoring system,Liver function tests,Hoekstra LT, et al. Ann Surg 2013; 257: 27-36.,Molecular tests,Topics,Liver function tests Staging systems Treatment guidelines Radiotherapy Toxicities Quality Of Life,TNM stage,No liver function status, not perfect!,7th AJCC TNM stage, 2010.,Staging systems,Most common used staging systems,CLIP scoring system,Perrone F, et al. Hepatology 1998; 28: 751-755.,BCLC staging classification,Llovet JM, et al. Semin liver dis 1999; 19(3): 329-338.,Topics,Staging systems Liver function tests Treatment guidelines Radiotherapy Toxicities Quality Of Life,BCLC treatment options,EASL, AASLD, NCCN guidelines.,Evidence-based guidelines in Japan,Makuuchi M, et al. Hepatol Res 2008; 38(1): 37-51.,BCLC treatment outcomes,Outcome estimate for HCC (Child-Pugh A),Dawson LA. Semin radiat oncol 2011; 21: 242-246.,BCLC treatment options,unsuitable for resection, transplant or RFA (early stage) unsuitable/refractory to TACE (intermediate stage) portal invasion (advanced stage) symptomatic alleviation (end stage),Radiotherapy role?,Topics,Staging systems Liver function tests Treatment guidelines Radiotherapy Toxicities Quality Of Life,Radiotherapy,Palliative therapy Local therapy (3DCRT, SBRT and charged particle therapy) Tumor thrombosis therapy Combination with TACE and sorafenib Bridge to liver transplant Image and imaging guided RT Response assessment,Radiotherapy,Palliative therapy Local therapy (3DCRT, SBRT and charged particle therapy) Tumor thrombosis therapy Combination with TACE and sorafenib Bridge to liver transplant Image and imaging guided RT Response assessment,Palliative therapy,RT for metastases in HCC,Zeng ZC, et al. Int J Radiat Oncol Biol Phys 2005; 63(4): 1067-1076. Yamashita H, et al. J Gastroenterol Hepatol 2007; 22(4): 523-527. He J, et al. Cancer 2009; 115: 2710-2720. Jiang W, et al. Clin exp metastasis 2012; 29(3): 197-205. Zeng ZC, et al. Jpn JCO 2005; 35(2): 61-67.,Palliative therapy (summary),RR: 76.9- 99.5% OS: 7.4- 13m RT regimen: 50-60 Gy/2 Gy Optimal dose (short-course?) RCT (RT vs BSC),Radiotherapy,Palliative therapy Local therapy (3DCRT, SBRT and charged particle therapy) Tumor thrombosis therapy Combination with TACE and sorafenib Bridge to liver transplant Image and imaging guided RT Response assessment,Conformal RT,An IMRT plan to deliver 65 Gy in 20 fractions,Feng M, et al. Semin Radiat Oncol 2011; 21: 271-277.,Conformal RT,Reported studies of 3DCRT for local HCC,Dawson LA, et al. JCO 2000; 18: 2210-8. Seong J, et al. Int J Radiat Oncol Biol Phys 2000; 47(5): 1331-5. Liu MT, et al. Jpn JCO 2004; 34(9): 532-9. Ben-Josef E, et al. JCO 2005; 23: 8739-47. Liang SX, et al. Cancer 2005; 103: 2181-8. Mornex F, et al. Int J Radiat Oncol Biol Phys 2006; 66(4): 1152-8.,DIH: intrahepatic metastasis out of field. EH: extrahepatic metastasis. LR: local recurrence. IH: intrahepatic metastasis.,Conformal RT,Dose-response relationship in local RT for HCC,Park HC, et al. Int J Radiat Oncol Biol Phys 2002; 54(1): 150-4.,Conformal RT (summary),Early stage unsuitable for S, transplant or RFA Focal intermediate stage unsuitable or refractory to TACE RR: 45-66.7%, OS: 11-20m, LR: 22-44%, DIH: 37-64% Recommended dose: 40-50 Gy/1.8-2.0 Gy High risk of toxicity in Child-Pugh B or C RCT (RT vs BSC in Child-Pugh B) RCT (RT + TACE/ RT alone in Child-Pugh A),SBRT,An SBRT plan to deliver 50 Gy in 5 fractions,Feng M, et al. Semin Radiat Oncol 2011; 21: 271-277.,SBRT,Reported studies of SBRT for local HCC,DIH: intrahepatic metastasis out of field. EH: extrahepatic metastasis. LR: local recurrence. IH: intrahepatic metastasis.,Bujold A, et al. JCO 2013; 31: 1631-9. Kang JK, et al. Cancer 2012; 7: 166-174. Price TR, et al. Cancer 2012; 118:3191-8. Bae SH, et al. Int J Radiat Oncol Biol Phys 2012; 82: e603-7. Huang WY, et al. Int J Radiat Oncol Biol Phys 2012; 84: 355-361. Andolino DL, et al. Int J Radiat Oncol Biol Phys 2011; 81: e447-53.,