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Controversies in Radiotherapy for Hepatocellular Carcinoma

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Controversies in Radiation Oncology

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

Abstract

Radiation therapy for liver carcinomas has been used in some hospitals in North America and Europe, but widely in Asia. However, the role of radiation therapy in the management of liver carcinoma has not been recognized in liver cancer society, especially in North America and Europe. The modern radiation techniques, 3-dimensional radiation therapy, intensity-modulated radiation therapy, stereotactic body radiotherapy, and proton and carbon ion beam radiation therapy have yielded very encouraging outcome. Recently, the role of radiation therapy just started to be recognized by NCCN guideline.

In the radiation therapy society, there were controversies regarding the radiation techniques: (1) What was the optimal management to control target motion, especially for beam scanning delivery in proton and carbon ion therapy? (2) What were the optimal radiation fractionation and total dose for hypofractionated or stereotactic body radiation therapy? (3) What were the normal liver tolerances for the livers with different degrees of hepatic cirrhosis, when different irradiation fractionations and total doses were applied? (4) What were the appropriate indications for different radiation techniques?

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References

  • Andolino DL, Johnson CS, Maluccio M et al (2011) Stereotactic body radiotherapy for primary hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 81:e447–e453

    Article  PubMed  Google Scholar 

  • ASTRO, Model policies, proton beam therapy. May 2014. http://www.astro.org.

  • Bae SH, Kim MS, Cho CK, Kim KB, Lee DH, Han CJ, Park SC, Kim YH (2013) Feasibility and efficacy of stereotactic ablative radiotherapy for Barcelona Clinic Liver Cancer-C stage hepatocellular carcinoma. J Korean Med Sci 28:213–219

    Article  PubMed  PubMed Central  Google Scholar 

  • Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. https://doi.org/10.3322/caac.21492

  • Bujold A, Massey CA, Kim JJ et al (2013) Sequential phase I and II trials of stereotactic body radiotherapy for locally advanced hepatocellular carcinoma. J Clin Oncol 31(13):1631–1639

    Article  PubMed  Google Scholar 

  • Bush DA, Kayali Z, Grove R, Slater JD (2011) The safety and efficacy of high-dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial. Cancer 117:3053–3059

    Article  PubMed  Google Scholar 

  • Chen W, Zheng R, Baade PD et al (2016) CA Cancer J Clin. https://doi.org/10.3322/caac.21338

  • Cheng JC, Wu JK, Huang CM et al (2002) Radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma: dosimetric analysis and implication. Int J Radiat Oncol Biol Phys 54(1):156–162

    Article  PubMed  Google Scholar 

  • Chiba T, Tokuuye K, Matsuzaki Y et al (2005) Proton beam therapy for hepatocellular carcinoma: a retrospective review of 162 patients. Clin Cancer Res 11(10):3799–3805

    Article  PubMed  Google Scholar 

  • Chinese Ministry of Health (2011) Practice guideline of the diagnosis and treatment for liver cancer (Practice guideline for the diagnosis and treatment for primary liver cancers). J Clin Hepatol 27(11):1141–1159

    Google Scholar 

  • Chinese Society of Clinical Oncology (CSCO) guideline of diagnosis and treatment in liver cancers. 2018

    Google Scholar 

  • Cho YB, Lee KU, Suh KS et al (2007) Hepatic resection compared to percutaneous ethanol injection for small hepatocellular carcinoma using propensity score matching. J Gastroenterol Hepatol 22:1643–1649

    Article  PubMed  Google Scholar 

  • Choi BO, Choi IB, Jang HS et al (2008) Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis. BMC Cancer 8:351

    Article  PubMed  PubMed Central  Google Scholar 

  • Choi C, Koom WS, Kim TH et al (2014) A prospective phase 2 multicenter study for the efficacy of radiation therapy following incomplete transarterial chemoembolization in unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 90(5):1051–1060

    Article  PubMed  Google Scholar 

  • Dawson LA, Normolle D, Balter JM et al (2002) Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 53:810–821

    Article  PubMed  Google Scholar 

  • Dewas S, Bibault JE, Mirabel X et al (2012) Prognostic factors affecting local control of hepatic tumors treated by stereotactic body radiation therapy. Radiat Oncol 7:166

    Article  PubMed  PubMed Central  Google Scholar 

  • Dhir M, Melin AA, Douaiher J et al (2016) A review and update of treatment options and controversies in the management of hepatocellular carcinoma. Ann Surg 263:1112–1125

    Article  PubMed  Google Scholar 

  • Dyk P, Weiner A, Badiyan S et al (2015) Effect of high-dose stereotactic body radiation therapy on liver function in the treatment of primary and metastatic liver malignancies using the Child-Pugh score classification system. Pract Radiat Oncol 5(3):176–182

    Article  PubMed  Google Scholar 

  • Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122

    Article  CAS  PubMed  Google Scholar 

  • Gong GZ, Yin Y, Xing LG et al (2012) RapidArc combined with the active breathing coordinator provides an effective and accurate approach for the radiotherapy of hepatocellular carcinoma. Strahlenther Onkol 188(3):262–268

    Article  CAS  PubMed  Google Scholar 

  • Gu K, Lai ST, Ma NY et al (2011) Hepatic regeneration after sublethal partial liver irradiation in cirrhotic rats. J Radiat Res (Tokyo) 52(5):582–591

    Article  CAS  Google Scholar 

  • Guha C, Kavanagh BD (2011) Hepatic radiation toxicity: avoidance and amelioration. Semin Radiat Oncol 21:256–263

    Article  PubMed  PubMed Central  Google Scholar 

  • Guo WJ, Yu EX, Liu LM et al (2003) Comparison between chemoembolization combined with radiotherapy and chemoembolization alone for large hepatocellular carcinoma. World J Gastroenterol 9(8):1697–1701

    Article  PubMed  PubMed Central  Google Scholar 

  • Guo WX, Sun JX, Cheng YQ et al (2013) Percutaneous radiofrequency ablation versus partial hepatectomy for small centrally located hepatocellular carcinoma. World J Surg 37:602–607

    Article  PubMed  Google Scholar 

  • Hong TS, Wo JY, Yeap BY et al (2015) Multi-institutional Phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. https://doi.org/10.1200/JCO.2015.64.2710

  • Hou JZ, Zeng ZC, Zhang JY et al (2012) Influence of tumor thrombus location on the outcome of external-beam radiation therapy in advanced hepatocellular carcinoma with macrovascular invasion. Int J Radiat Oncol Biol Phys 84(2):362–368

    Article  PubMed  Google Scholar 

  • Hsieh CH, Liu CY, Shueng PW et al (2010) Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma. Radiat Oncol 5:40

    Article  PubMed  PubMed Central  Google Scholar 

  • Hsu WC, Chan SC, Ting LL et al (2006) Results of three-dimensional conformal radiotherapy and thalidomide for advanced hepatocellular carcinoma. Jpn J Clin Oncol 36(2):93–99

    Article  PubMed  Google Scholar 

  • Huang WY, Jen YM, Lee MS, Chang LP, Chen CM, Ko KH, Lin KT, Lin JC, Chao HL, Lin CS, Su YF, Fan CY, Chang YW (2012) Stereotactic body radiation therapy in recurrent hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 84:355–361

    Article  PubMed  Google Scholar 

  • Huo YR, Eslick GD (2015) Transcatheter arterial chemoembolization plus radiotherapy compared with chemoembolization alone for hepatocellular carcinoma: a systematic review and meta-analysis. JAMA Oncol 1(6):756

    Article  PubMed  Google Scholar 

  • Ibarra RA, Rojas D, Snyder L, Yao M, Fabien J, Milano M, Katz A, Goodman K, Stephans K, El-Gazzaz G, Aucejo F, Miller C, Fung J, Lo S, Machtay M, Sanabria JR (2012) Multicenter results of stereotactic body radiotherapy (SBRT) for nonresectable primary liver tumors. Acta Oncol 51:575–583

    Article  PubMed  Google Scholar 

  • Ingold JA et al (1965) Radiation hepatitis. Am J Roentgenol Radium Therapy Nucl Med 93:200–208

    CAS  Google Scholar 

  • Jackson A, Ten Haken RK, Robertson JM et al (1995) Analysis of clinical complication data for radiation hepatitis using a parallel architecture model. Int J Radiat Oncol Biol Phys 31:883–891

    Article  CAS  PubMed  Google Scholar 

  • Jiang W, Zeng ZC (2013) Is it time to adopt external beam radiotherapy in the NCCN guidelines as a therapeutic strategy for intermediate/advanced hepatocellular carcinoma? Oncology 84(Suppl 1):69–74

    Article  PubMed  Google Scholar 

  • Kagawa T, Koizumi J, Kojima S et al (2010) Transcatheter arterial chemoembolization plus radiofrequency ablation therapy for early stage hepatocellular carcinoma: comparison with surgical resection. Cancer 116:3638–3644

    Article  PubMed  Google Scholar 

  • Kang JK, Kim MS, Cho CK et al (2012) Stereotactic body radiation therapy for inoperable hepatocellular carcinoma as a local salvage treatment after incomplete trans-arterial chemoembolization. Cancer 118(21):5424–5431

    Article  PubMed  Google Scholar 

  • Kasuya G, Kato H, Yasuda S et al (2017) Progressive hypofractionated carbon-ion radiotherapy for hepatocellular carcinoma: combined analyses of 2 prospective trials. Cancer 123(20):3955–3965

    Article  CAS  PubMed  Google Scholar 

  • Kawashima M, Furuse J, Nishio T et al (2005) Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma. J Clin Oncol 23:1839–1846

    Article  PubMed  Google Scholar 

  • Kim TH, Kim DY, Park JW et al (2006) Three-dimensional conformal radiotherapy of unresectable hepatocellular carcinoma patients for whom transcatheter arterial chemoembolization was ineffective or unsuitable. Am J Clin Oncol 29(6):568–575

    Article  PubMed  Google Scholar 

  • Kim TH, Kim DY, Park J-W et al (2007) Dose-volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 67:225–231

    Article  PubMed  Google Scholar 

  • Kim SE, Lee HC, Kim KM et al (2011) Applicability of the BCLC staging system to patients with hepatocellular carcinoma in Korea: analysis at a single center with a liver transplant center. Korean J Hepatol 17(2):113–119

    Article  PubMed  PubMed Central  Google Scholar 

  • Kim TH, Park JW, Kim YJ et al (2014) Intensity modulated radiation therapy for inoperable hepatocellular carcinoma. Strahlenther Onkol 190(10):882–890

    Article  PubMed  Google Scholar 

  • Kim TH, Park JW, Kim YJ et al (2015a) Phase I dose-escalation study of proton beam therapy for inoperable hepatocellular carcinoma. Cancer Res Treat 47(1):34–45

    Article  CAS  PubMed  Google Scholar 

  • Kim GA, Shim JH, Yoon SM et al (2015b) Comparison of chemoembolization with and without radiation therapy and Sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis. J Vasc Interv Radiol 26(3):320–329. e6

    Article  PubMed  Google Scholar 

  • Klein J, Dawson LA (2013) Hepatocellular carcinoma radiation therapy: review of evidence and future opportunities. Int J Radiation Oncol Biol Phys 87(1):22–32

    Article  Google Scholar 

  • Komatsu S, Fukumoto T, Demizu Y et al (2011) Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma. Cancer 117:4890–4904

    Article  CAS  PubMed  Google Scholar 

  • Kwon JY, Yoon SK, Chung KW (2010) Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer. BMC Cancer 10:475

    Article  PubMed  PubMed Central  Google Scholar 

  • Lasley FD, Mannina EM, Johnson CS et al (2015) Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy. Pract Radiat Oncol 5(5):e443–e449

    Article  PubMed  Google Scholar 

  • Lazarev S, Hardy-Abeloos C, Factor O et al (2018) Stereotactic body radiation therapy for centrally located hepatocellular carcinoma: outcomes and toxicities. J Cancer Res Clin Oncol 144(10):2077–2083

    Article  PubMed  Google Scholar 

  • Liang SX, Zhu XD, Lu HJ et al (2005) Hypofractionated three-dimensional conformal radiation therapy for primary liver carcinoma. Cancer 103(10):2181–2188

    Article  PubMed  Google Scholar 

  • Liang SX, Zhu XD, Xu ZY et al (2006) Radiation-induced liver disease in three-dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Biol Phys 65:426–434

    Article  PubMed  Google Scholar 

  • Liu MT, Li SH, Chu TC et al (2004) Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolization. Jpn J Clin Oncol 34(9):532–539

    Article  PubMed  Google Scholar 

  • Livraghi T, Brambilla G, Carnaghi C et al (2010) Is it time to reconsider the BCLC/AASLD therapeutic flow-chart? J Surg Oncol 102(7):868–876

    Article  PubMed  Google Scholar 

  • Management of hepatocellular carcinoma, European Association for the Study of the Liver (2012) European Organization for Research and Treatment of Cancer (EORTC). Eur J Cancer 48:599–641

    Article  Google Scholar 

  • Ministry of Health of the People’s Republic of China (2011) Practice guideline for the diagnosis and treatment for primary liver cancers. J Clin Hepatol 27(11):1141–1159

    Google Scholar 

  • Mizumoto M, Okumura T, Hashimoto T et al (2011) Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols. Int J Radiat Oncol Biol Phys 81(4):1039–1045

    Article  PubMed  Google Scholar 

  • Mornex F, Girard N, Beziat C et al (2006) Feasibility and efficacy of high-dose three-dimensional-conformal radiotherapy in cirrhotic patients with small-size hepatocellular carcinoma non-eligible for curative therapies-mature results of the French phase II RTF-1 trial. Int J Radiat Oncol Biol Phys 66(4):1152–1158

    Article  PubMed  Google Scholar 

  • Mulier S, Ni Y, Jamart J et al (2005) Local recurrence after hepatic radiofrequency coagulation: multivariate meta-analysis and review of contributing factors. Ann Surg 242:158–171

    Article  PubMed  PubMed Central  Google Scholar 

  • Nakayama H, Sugahara S, Tokita M et al (2009) Proton beam therapy for hepatocellular carcinoma: the University of Tsukuba experience. Cancer 115:5499–5506

    Article  PubMed  Google Scholar 

  • Nishikawa H, Inuzuka T, Takeda H et al (2011) Comparison of percutaneous radiofrequency thermal ablation and surgical resection for small hepatocellular carcinoma. BMC Gastroenterol 11:143

    Article  PubMed  PubMed Central  Google Scholar 

  • Ohri N, Tome WA, Mendez Romero A et al (2018) Local control after stereotactic body radiation therapy for liver tumors. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2017.12.288. pii: S0360-3016(17)34525-X

  • Pan C, Kavanagh B, Dawson L, Li XA, Das S, Miften M, Ten Haken R (2010) Radiation-associated liver injury. Int J Radiat Oncol Biol Phys 76:S94–S100

    Article  PubMed  PubMed Central  Google Scholar 

  • Park HC, Seong J, Han KH et al (2002) Dose-response relationship in local radiotherapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 54(1):150–155

    Article  PubMed  Google Scholar 

  • Park W, Lim do H, Paik SW et al (2005) Local radiotherapy for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 61(4):1143–1150

    Article  PubMed  Google Scholar 

  • Qi WQ, Fu S, Zhang Q et al (2015) Charged particle therapy versus photon therapy for patients with hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 114:289–295

    Article  PubMed  Google Scholar 

  • Ren ZG, Zhao JD, Gu K et al (2011) Three-dimensional conformal radiation therapy and intensity-modulated radiation therapy combined with transcatheter arterial chemoembolization for locally advanced hepatocellular carcinoma: an irradiation dose escalation study. Int J Radiat Oncol Biol Phys 79(2):496–502

    Article  PubMed  Google Scholar 

  • Ren ZG, Zhao JD, Gu K et al (2012) Hepatic proliferation after partial liver irradiation in rat. Mol Biol Rep 39(4):3829–3836

    Article  CAS  PubMed  Google Scholar 

  • Santambrogio R, Salceda J, Costa M et al (2013) External validation of a simplified BCLC staging system for early hepatocellular carcinoma. Eur J Surg Oncol 39(8):850–857

    Article  CAS  PubMed  Google Scholar 

  • Sanuki N, Takeda A, Oku Y et al (2014) Stereotactic body radiotherapy for small hepatocellular carcinoma: a retrospective outcome analysis in 185 patients. Acta Oncol 53(3):399–404

    Article  PubMed  Google Scholar 

  • Seo YS, Kim MS, Yoo SY et al (2010) Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma. J Surg Oncol 102:209–214

    Article  PubMed  Google Scholar 

  • Seong J, Keum KC, Han KH et al (1999) Combined transcatheter arterial chemoembolization and local radiotherapy of unresectable hepatocellular carcinoma. Int J Radat Oncol Biol Phys 43(2):393–397

    Article  CAS  Google Scholar 

  • Seong J, Park HC, Han KH et al (2000) Local radiotherapy for unresectable hepatocellular carcinoma patients who failed with transcatheter arterial chemoembolization. Int J Radiat Oncol Biol Phys 47(5):1331–1335

    Article  CAS  PubMed  Google Scholar 

  • Seong J, Park HC, Han KH, Chon CY (2003) Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: a retrospective study of 158 patients. Int J Radiat Oncol Biol Phys 55(2):329–336

    Article  PubMed  Google Scholar 

  • Son SH, Kay CS, Song JH et al (2013) Dosimetric parameter predicting the deterioration of hepatic function after helical tomotherapy in patients with unresectable locally advanced hepatocellular carcinoma. Radiat Oncol 8:11

    Article  PubMed  PubMed Central  Google Scholar 

  • Song JH, Son SH, Kay CS et al (2015) Reducing the probability of radiation-induced hepatic toxicity by changing the treatment modality from helical tomotherapy to fixed-beam intensity-modulated radiotherapy. Oncotarget 6(32):33952–33960

    PubMed  PubMed Central  Google Scholar 

  • Su TS, Luo R, Liang P et al (2018. pii: S0360-3016(17)34525-X) A prospective cohort study of hepatic toxicity after stereotactic body radiation therapy for hepatocellular carcinoma [published online January 6, 2018]. Radiother Oncol. https://doi.org/10.1016/j.ijrobp.2017.12.288

  • Takeda A, Sanuki N, Eriguchi T et al (2014) Stereotactic ablative body radiotherapy for previously untreated solitary hepatocellular carcinoma. Gastroenterol Hepatol 29(2):372–379

    Article  CAS  Google Scholar 

  • Tang QH, Li AJ, Yang GM et al (2013) Surgical resection versus conformal radiotherapy combined with TACE for resectable hepatocellular carcinoma with portal vein tumor thrombus: a comparative study. World J Surg 37(6):1362–1370

    Article  PubMed  Google Scholar 

  • Tsujii H, Kamada T, Shirai T, Noda K, Tsuji H, Karasawa K (eds) (2014) Carbon ion radiotherapy, hepatocellular carcinoma. Springer, Japan, pp 213–220

    Google Scholar 

  • Velec M, Haddad CR, Craig T et al (2017) Predictors of liver toxicity following stereotactic body radiation therapy for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 97(5):939–946

    Article  PubMed  Google Scholar 

  • Verslype C, Rosmorduc O, Rougier P et al (2012) Hepatocellular carcinoma: ESMO–ESDO Clinical Practice. Ann Oncol 23(Suppl 7):vii41–vii48

    Article  PubMed  Google Scholar 

  • Wahl DR, Stenmark MH, Tao Y et al (2016) Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma. J Clin Oncol 34(5):452

    Article  CAS  PubMed  Google Scholar 

  • Wang WW (n.d.), Dosimetric comparison among irradiation plans of photon, proton and carbon ion beams for 8 patients with hepatocellular carcinoma. Chinese J

    Google Scholar 

  • Wang Z, Wang WW, Shahnazi K et al (2018) Carton ion radiation therapy for liver tumors. In: Target volume delineation an treatment planning for particle therapy. A practical guide. Springer International Publishing, Switzerland, pp 221–233

    Chapter  Google Scholar 

  • Wu DH, Liu L, Chen LH (2004) Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 10(15):2184–2189

    Article  PubMed  PubMed Central  Google Scholar 

  • Xu ZY, Liang SX, Zhu J et al (2006) Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma. Int J Radiat Oncol Biol Phys 65:189–195

    Article  PubMed  Google Scholar 

  • Yoon SM (2018) JAMA Oncol. online

    Google Scholar 

  • Yoon SM, Lim YS, Won HJ et al (2012) Radiotherapy plus transarterial chemoembolization for hepatocellular carcinoma invading the portal vein: long-term patient outcomes. Int J Radiat Oncol Biol Phys 82(5):2004–2011

    Article  PubMed  Google Scholar 

  • Yoon HI, Lee IJ, Han KH et al (2014) Improved oncologic outcomes with image-guided intensity-modulated radiation therapy using helical tomotherapy in locally advanced hepatocellular carcinoma. J Cancer Res Clin Oncol 140(9):1595–1605

    Article  CAS  PubMed  Google Scholar 

  • Zeng ZC, Tang ZY, Fan J et al (2004) A comparison of chemoembolization combination with and without radiotherapy for unresectable hepatocellular carcinoma. Cancer J 10(5):307–316

    Article  PubMed  Google Scholar 

  • Zhao JD, Xu ZY, Zhu J et al (2008) Application of active breathing control in 3-dimensional conformal radiation therapy for hepatocellular carcinoma: the feasibility and benefit. Radiother Oncol 87(3):439–444

    Article  PubMed  Google Scholar 

  • Zhao JD, Jiang GL, Hu WG et al (2009) Hepatocyte regeneration after partial liver irradiation in rats. Exp Toxicol Pathol 61(5):511–518

    Article  CAS  PubMed  Google Scholar 

  • Zhao Q, Wang R, Zhu J et al (2016) Superiority of helical tomotherapy on liver sparing and dose escalation in hepatocellular carcinoma: a comparison study of three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. Oncol Targets Ther 9:3807–3813

    Article  Google Scholar 

  • Zhou ZH, Liu LM, Chen WW et al (2007) Combined therapy of transcatheter arterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma. Br J Radiol 80(951):194–201

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center, Shanghai, China

    Guo-Liang Jiang & Zheng Wang

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  2. Zheng Wang
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Correspondence to Guo-Liang Jiang .

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Editors and Affiliations

  1. Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, USA

    Simon S. Lo

  2. Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA

    Bin S. Teh

  3. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

    Guo-Liang Jiang

  4. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Nina A. Mayr

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Jiang, GL., Wang, Z. (2019). Controversies in Radiotherapy for Hepatocellular Carcinoma. In: Lo, S., Teh, B., Jiang, GL., Mayr, N. (eds) Controversies in Radiation Oncology. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2019_216

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