A non-invasive weapon: Image-guided radiotherapy for hepatocellular carcinoma

Abstract

The high prevalence of chronic hepatitis B virus infection in Hong Kong makes hepatocellular carcinoma one of the area's most important solid tumours. Late presentation and underlying cirrhosis mean that many hepatocellular carcinomas are inoperable at first presentation. For many years, radiotherapy was a poor option for inoperable hepatocellular carcinoma because of low hepatic tolerance of radiation and technical limitations in the delivery of radiotherapy. A variety of technological advances in the areas of diagnostic imaging, radiotherapy planning, motion management, and image guidance during radiotherapy delivery have overcome most of the barriers to effective application of radiotherapy in hepatocellular carcinoma. In the Department of Clinical Oncology at Pamela Youde Nethersole Eastern Hospital, image-guided radiotherapy has achieved excellent results in 59 patients with liver-confined hepatocellular carcinoma, and the treatment is well tolerated. The one-year local control rate and one-year overall survival rate were 91% and 71%, respectively. Our experience and other published data indicate that image-guided radiotherapy can be considered the treatment of choice for patients with hepatocellular carcinoma who prefer non-surgical intervention. © 2012 Hong Kong College of Radiologists.