Liver cancer Radiotherapy

Radiotherapy (also known as radiotherapy) can be used for liver cancer in various situations and stages of the disease. In the case of localized cancer that is not amenable to surgery, in selected cases prior to resection or a possible future liver transplant with the aim of local tumour control or if the liver cancer has already spread. Radiotherapy can then prevent or alleviate symptoms caused by metastases or the liver cancer itself (palliative radiotherapy).

Procedure

Radiation therapy focuses high-energy X-rays on the tumor inside the body to specifically kill it. It is carried out as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can therefore be easily integrated into everyday private life. Depending on the extent of the tumor, radiotherapy for small tumor foci can be carried out in a few treatment sessions as body stereotactic radiotherapy (SBRT), or after surgery as fractionated treatment over several weeks. Close and personal support is a matter of course for us.

The Department of Radiation Oncology at the USZ uses only the most modern techniques to treat liver cancer as precisely as possible and with as few side effects as possible. You will be cared for by senior physicians experienced in the treatment of liver cancer.

We work closely with our colleagues in surgery and medical oncology to guarantee treatment from a single source.

For many patients, we are already offering tomorrow’s treatment today: in clinical trials, we are continuously working on improving the treatment of liver cancer to make it even more effective and tolerable. To the overview of currently open studies.

In the following, we will describe radiotherapy for the different types and stages of liver cancer.

Irradiation of liver cancer with the aim of local control

In the case of localized liver cancer, surgical resection or liver transplantation is the treatment of first choice. However, if the cancer cannot be operated on, or if surgery or liver transplantation is not (yet) possible at this stage, radiotherapy is a good option to slow down or stop the cancer growth. Radiotherapy (also known as irradiation) is used particularly frequently in this case if the cancer is located near large vessels, the main bile ducts or the diaphragm, or if the cancer is larger than 3 cm.

We use what is known as body stereotactic radiation therapy (SBRT). This kills the tumor in very few radiation sessions: typically in 5 outpatient radiation sessions. This is achieved by highly focused irradiation with an accuracy in the millimeter range. If possible, this therapy is carried out on our special device, the MR-LINAC, which combines MRI imaging and radiation. The integrated MRI allows a very detailed representation the actual anatomy. The position of the tumor and the surrounding healthy organs can thus be determined with millimeter precision every day and, if necessary, the radiation can be optimally adapted to the current situation immediately. In addition, we can also use MRI technology to determine the Monitor tumor and organ mobility “live” during radiation. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Body stereotactic radiotherapy (SBRT) is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

  • Vogel A, Cervantes A, Chau I, Daniele B, Llovet JM, Meyer T, Nault JC, Neumann U, Ricke J, Sangro B, Schirmacher P, Verslype C, Zech CJ, Arnold D, Martinelli E; ESMO Guidelines Committee. Hepatocellular carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29(Suppl 4):iv238-iv255.
  • Rim CH, Kim HJ, Seong J. Clinical feasibility and efficacy of stereotactic body radiotherapy for hepatocellular carcinoma: A systematic review and meta-analysis of observational studies. Radiother Oncol. 2019 Feb;131:135-144. doi: 10.1016/j.radonc.2018.12.005. Epub 2018 Dec 31. PMID: 30773180.
  • Petrowsky H, Fritsch R, Guckenberger M, De Oliveira ML, Dutkowski P, Clavien PA. Modern therapeutic approaches for the treatment of malignant liver tumours. Nat Rev Gastroenterol Hepatol. 2020 Dec;17(12):755-772.

Liver cancer before surgery

If the tumor has grown into specific liver vessels and has blocked them, radiotherapy can be used upstream with the aim of facilitating the subsequent operation. In these cases, radiotherapy is carried out in six sessions over a period of just over a week.

  • Wei X, Jiang Y, Zhang X, Feng S, Zhou B, Ye X, Xing H, Xu Y, Shi J, Guo W, Zhou D, Zhang H, Sun H, Huang C, Lu C, Zheng Y, Meng Y, Huang B, Cong W, Lau WY, Cheng S. Neoadjuvant Three-Dimensional Conformal Radiotherapy for Resectable Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Randomized, Open-Label, Multicenter Controlled Study. J Clin Oncol. 2019 Aug 20;37(24):2141-2151.

Metastases of liver cancer, e.g. in the brain or bones

Liver cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.

For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions. Metastatic liver cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.

State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.

In clinical trials, we are continuously trying to improve the treatment of liver cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

  • Lam TC, Tseng Y. Defining the radiation oncologist’s role in palliative care and radiotherapy. Ann Palliat Med. 2019 Jul;8(3):246-263.

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