Radiation therapy for liver tumors: ready for inclusion in guidelines

Disclosures of potential conflicts of interest may be found at the end of this article. Key Words. Hepatobiliary cancer x Stereotactic body radiation therapy x Radiation therapy x Cholangiocarcinoma x Hepatocellular carcinoma Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatment modality. Surgical resection and/or liver transplantation are traditionally regarded as the most effective forms of therapy, although the majority of patients with hepatocel-lular carcinoma and intrahepatic cholangiocarcinoma pres-ent with locally advanced or unresectable disease on the basis of local vascular invasion or inadequate baseline hepatobiliary function. In this context, many efforts have focused on nonoperative treatment approaches including novel systemic therapies, transarterial chemoembolization, ethanol ablation, radiofrequency ablation, and stereotac-tic body radiation therapy (SBRT). This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies. The Oncologist 2014;19:868–879 Implications for Practice: Radiation therapy has historically served a limited role in the management of primary hepatic malignancies.Modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatmentmodality. In particular, stereotactic body radiation therapy (SBRT) has emerged as a feasible andnoninvasive treatment for patientswith locally advancedormedically unresectableprimaryhepaticmalignancies includinghepatocellular carcinomaand intrahepatic cholangiocarcinoma. This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies and to illustrate future areas of investigation