ARLINGTON, Va., January 12, 2022 (view online) — A new clinical guideline from the American Society for Radiation Oncology (ASTRO) provides guidance on the use of radiation therapy to treat adult patients with primary liver cancers using external beam radiation therapy (EBRT). Evidence-based recommendations outline indications and optimal EBRT dosing, techniques and treatment planning for patients with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC), with a strong emphasis on multidisciplinary care. The guideline, ASTRO’s first for primary liver cancers, is published in Practical Radiation Oncology.

Primary liver cancers are among the most commonly diagnosed types of cancer and the fourth leading cause of cancer death worldwide. Incidence rates in the United States have more than tripled since 1980, rising approximately 2% each year in the last two decades; an estimated 42,230 new cases were diagnosed last year. Mortality rates from HCC and IHC also continue to rise despite the growing availability of screening for HCC and improved prevention and treatment of diseases that lead to liver cancer (i.e., hepatitis B, hepatitis C, nonalcoholic fatty liver disease).

Multidisciplinary involvement is particularly important for primary liver cancer treatment, due to complexities in diagnosis and staging, the availability of a wide range of treatment options and a need to consider medical comorbidities such as underlying cirrhosis, which is present in roughly 90% of patients with HCC.

Common treatment options for primary HCC include liver transplantation, surgical removal of the tumor, thermal ablation and catheter-based therapies for patients whose disease is confined to the liver, and systemic therapy (targeted therapy and/or immunotherapy) for those whose disease is more advanced. For IHC, standard treatment includes a combination of surgery and chemotherapy, with or without radiation. EBRT, which aims high doses of targeted radiation at tumor sites from outside the body with non-invasive techniques, has historically been used less frequently than other approaches; for example, a recent study found that just 4% of eligible patients received EBRT as a bridging therapy before liver transplant.

“Historically, low utilization rates for external beam radiation were due to technological limitations that made it challenging to avoid healthy liver tissue. However, with significant advances in imaging and radiation treatment delivery over the past 15 years and improved understanding of how the liver responds to radiation, we now have an increasing amount of clinical data on the role that EBRT can play for patients with these diseases,” said Higinia Cardenes, MD, PhD, chair of the guideline task force and a professor of clinical radiation oncology at Weill Cornell Medicine in New York.

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