Stereotactic body radiotherapy in the treatment of hepatocellular carcinoma

Czech version

Authors: P. Hříbek ¹; F. Třebický ²; P. Urbánek ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN – VFN Praha ¹; Ústav radiační terapie, ÚVN – VFN Praha ²
Published in: Gastroent Hepatol 2025; 79(5): 356-360
Category: Review Article
doi: https://doi.org/10.48095/ccgh2025356

Overview

Hepatocellular carcinoma (HCC) is one of the most serious complications of liver cirrhosis. Although early diagnosis allows for the use of curative approaches, many patients are not candidates for surgical treatment. In such cases, alternative methods of locoregional therapy gain importance. Stereotactic body radiotherapy (SBRT) is a specific form of external beam radiotherapy that enables highly precise irradiation of the target lesion with minimal impact on the surrounding tissue, achieving high rates of local disease control. Current EASL guidelines (2025) already include SBRT among recognized therapeutic options for selected patient groups, particularly when ablative techniques or TACE are not feasible. Clinical experience from our institution confirms good tolerability of SBRT and its suitability as a form of consolidative therapy. Although it remains a highly selective method with limited availability, SBRT represents a valuable complement to existing therapeutic modalities, and its role in HCC management is likely to grow in the future.

Keywords:

hepatocellular carcinoma – liver cirrhosis – radiosurgery – stereotactic body radiotherapy

Sources

1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. 2012 [online]. Dostupné z: https: //portal.med.muni.cz/clanek-583-epidemiologie-zhoubnych-nadoru-v-ceske-republice.html.

2. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999; 19 (3): 329–338. doi: 10.1055/s-2007-1007122.

3. Khalaf N, Ying J, Mittal S et al. Natural history of untreated hepatocellular carcinoma in a US cohort and the role of cancer surveillance. Clin Gastroenterol Hepatol 2017; 15 (2): 273.e1–281.e1. doi: 10.1016/j.cgh.2016.07.033.

4. Ivanics T, Claasen M, Samstein B et al. Living donor liver transplantation for hepatocellular carcinoma within and outside traditional selection criteria: a multicentric North American experience. Ann Surg 2024; 279 (1): 104–111. doi: 10.1097/SLA.0000000000006049.

5. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol 2025; 82 (2): 315–374. doi: 10.1016/j.jhep.2024.08.028.

6. Hribek P, Klasova J, Tuma T et al. Etiopathogenetic factors of hepatocellular carcinoma, overall survival, and their evolution over time –⁠ Czech tertiary center overview. Medicina (Kaunas) 2022; 58 (8): 1099. doi: 10.3390/medicina58081099.

7. Tůma T, Hříbek P, Koutný T et al. Mikrobalónová okluzivní chemoembolizace hepatocelulárního karcinomu –⁠ představení metody a první zkušenosti. Ces Radiol 2024; 78 (4): 208–213. doi: 10.55095/CesRadiol2024.028.

8. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 2018; 69 (1): 182–236. doi: 10.1016/ j.jhep.2018.03.019.

9. Reig M, Forner A, Rimola J et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022; 76 (3): 681–693. doi: 10.1016/j.jhep.2021.11.018.

10. Kibe Y, Takeda A, Tsurugai Y et al. Local control by salvage stereotactic body radiotherapy for recurrent/residual hepatocellular carcinoma after other local therapies. Acta Oncol 2020; 59 (8): 888–894. doi: 10.1080/0284186X.2020.1741679.

11. Buckstein M, Kim E, Fischman A et al. Stereotactic body radiation therapy following transarterial chemoembolization for unresectable hepatocellular carcinoma. J Gastrointest Oncol 2018; 9 (4): 734–740. doi: 10.21037/jgo.2018.05.01.

12. 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.

13. Guo L, Wei X, Feng S et al. Radiotherapy prior to or after transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with portal vein tumor thrombus: a randomized controlled trial. Hepatol Int 2022; 16 (6): 1368–1378. doi: 10.1007/s12072-022 -⁠ 10423-7.

14. Sapir E, Tao Y, Schipper MJ et al. Stereotactic body radiation therapy as an alternative to transarterial chemoembolization for hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2018; 100 (1): 122–130. doi: 10.1016/j.ijrobp.2017.09.001.

15. Mendez Romero A, van der Holt B, Willemssen F et al. Transarterial chemoembolization with drug-eluting beads versus stereotactic body radiation therapy for hepatocellular carcinoma: outcomes from a multicenter, randomized, phase 2 trial (the TRENDY trial). Int J Radiat Oncol Biol Phys 2023; 117 (1): 45–52. doi: 10.1016/j.ijrobp.2023.03.064.

ORCID autorů

P. Hříbek 0000-0002-8090-4389,

F. Třebický 0000-0003-0577-9845,

P. Urbánek 0000-0002-1506-1135.

Doručeno/Submitted: 26. 6. 2025

Přijato/Accepted: 5. 8. 2025

Korespondenční autor

MUDr. Petr Hříbek, Ph.D.

Interní klinika

1. LF UK a ÚVN –⁠ VFN

U Vojenské nemocnice 1200/1

169 02 Praha 6