Therapeutic Strategies in HCC: Radiation Modalities

Table 2

Therapeutic strategies for nonoperable HCC.

Treatment	Indications	Advantages	Disadvantages	Efficacy
TACE	(i) Large or multifocal HCC not eligible for radical therapy; (ii) Nonoperable locoregional disease without distant metastases	(i) Safety; (ii) Bridge modality in patients awaiting OLT	(i) Poor complete tumor response; (ii) Short time to progression; (iii) Short progression free survival; (iv) PES; (v) Ischemic damage to normal liver	(i) Tumor shrinking; (ii) Survival (moderate)
TAMR	(i) Curative therapy of small-size HCC; (ii) HCC with portal vein thrombosis; (iii) Adjuvant treatment near surgery; (iv) Neoadjuvant approach; (v) Palliation of nonoperable HCC; (vi) Antalgic treatment for hyperalgesic HCC	(i) Cell killing intent; (ii) Healthy liver preservation; (iii) Bridge modality in patients awaiting OLT	(i) Radiation pneumonitis/hepatitis/cholecystitis/pancreatitis; (ii) Asthenia, anorexia, transient hepatalgies, brief alterations of hepatic tests, and leucopoenia; (iii) Workplace safety	(i) Tumor shrinking; (ii) Survival benefit; (iii) Long term efficacy
RTx	(i) Nonoperable HCC; (ii) Unfeasible/failed percutaneous therapies; (iii) Longest tumor diameter ≤5.0 cm; (iv) Child-Turcotte-Pugh Class A or B; (v) Patients with 1–3 lesions and sufficient uninvolved liver	(i) Bridge modality in patients awaiting OLT; (ii) Dose escalation; (iii) Accurate definition of the target volume	(i) Surrounding healthy liver damage	(i) Significant tumor response in small-size HCC

TACE: transarterial chemoembolization. OLT: orthotopic liver transplantation. PES: postembolization syndrome. TAMR: transarterial metabolic radiotherapy. RTx: external radiotherapy. : including 3D conformal radiation techniques and stereotactic body radiotherapy.