The findings contribute to a growing body of evidence that durable local control of liver tumors can be achieved with radiation.2 Liver transplantation and partial hepatectomy clearly remain the gold standards for curative-intent treatment of HCC, Hong wrote; how-ever, in light of the new study, SBRT appears to be an additional alternative treatment for patients who are not candidates for curative-intent interventions, and results in outcomes com-parable to treatment with sorafenib in patients who are not candidates for sur-gery.2 SBRT might therefore become a common treatment for these patients. Phase 2 local control outcomes with SBRT in patients previously treated with incomplete transarterial chemoembolization are also promising.10 Importantly, tumor vascular thrombus appears to be treatable (recanalized) with radiotherapy, presumably restoring vascular function to some degree.1,2

The results of this trial add to the evidence base only for SBRT, and not other radiotherapy modalities such as intensity-modulated radiotherapy (IMRT). Radiotherapy planning and performance, modalities and equipment, and fractionation vary from facility to facility, cautions Hong, and these factors might affect patient outcomes.2 Hong emphasized that although the study by Bujold and colleagues clearly shows that radiation is an effective local modality for treating high-risk HCC, that radiation therapy will ultimately improve survival is not a foregone conclusion.2 “Even if radiation can

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ablate a tumor and tumor thrombus, the competing risks of distant disease progression and underlying liver disease remain significant,” reported Hong.2ONA 

Bryant Furlow is a medical journalist based in Albuquerque, New Mexico.


1. Bujold A, Massey CA , Kim JJ , et al. Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol. 2013;31(13):1631-1639. doi:10.1200/JCO .2012.44.1659.

2. Hong TS. Radiotherapy for hepatocellular carcinoma with tumor vascular thrombus: ready for prime time? J Clin Oncol. 2013;31(13):1619-1620. doi:10.1200/JCO .2012.48.2703.

3. H a NB, Ha NB, Ahmed A, et al. Risk factors for hepatocellular carcinoma in patients with chronic liver disease: a case-control study. Cancer Causes Control. 2012;23(3):455-462. doi:10.1007/s10552-012-09895-z.

4. What are the risk factors for liver cancer? American Cancer Society Web site. Accessed May 14, 2013.

5. Adult primary liver cancer treatment (PDQ). National Cancer Institute Web site. Accessed May 14, 2013.

6. Klein J, Dawson LA . Hepatocellular carcinoma radiation therapy: review of evidence and future opportunity. Int J Radiat Oncol Biol Phys. 2012;pii:SO360-3016(12)03510-9. doi:10.1016/j.ijrobp.2012.08.043.

7. How is liver cancer staged? American Cancer Society Web site. Accessed May 14, 2013.

8. Daniele B, Annunziata M, Barletta E, et al. Cancer of the Liver Italian Program (CLIP) score for staging hepatocellular carcinoma. Hepatol Res. 2007;37(suppl2):S206-S209. doi:10.1111/j.1872.034X.2007.00186.x.

9. Child-Turcotte-Pugh (CTP) calculator. United States Departments of Veterans Affairs Web site. Accessed May 14, 2013.

10. Kang JK, Kim MS, Cho CK, et al. Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete transarterial chemoembolization. Cancer. 2012;118(21):5424-5431. doi:10.1002/cncr.27533.