Which Liver Patients are Best Treated with External Beam Radiation?

Michael Chuong, MD, radiation oncologist at Miami Cancer Institute, delivered a presentation focusing on the role of external beam radiation therapy (EBRT) in the treatment of liver cancer during a session at the 2023 Symposium on Clinical Interventional 

Dr. Michael Chuong, a radiation oncologist from Miami Cancer Institute, delivered a presentation focusing on the role of external beam radiation therapy (EBRT) in the treatment of liver cancer during a session at the 2023 Symposium on Clinical Interventional Oncology.

Dr. Chuong began by addressing the limited consideration of EBRT in tumor board discussions for primary or metastatic liver cancer. He acknowledged the historical lack of perspective and randomized data supporting the use of EBRT in this context. However, he expressed optimism about changing perspectives due to recent advancements and trials, including the RTG1112 trial, the results of which were discussed in the preceding sessions.

The NRG/RTOG 1112 trial compared sorafenib alone to stereotactic body radiation therapy (SBRT) followed by sorafenib for locally advanced hepatocellular carcinoma (HCC). Dr. Chuong highlighted that the SBRT doses varied considerably and emphasized the misconception that SBRT always implies ablative doses. Despite the variability, the trial demonstrated noteworthy outcomes, with a clear separation in Kaplan-Meier plots for progression-free survival and time to progression. Dr. Chuong suggested that even non-ablative SBRT showed efficacy, especially considering the advanced nature of the disease.

Dr. Michael Chuong also touched upon proton therapy, emphasizing its tendency to be ablative due to dose sparing in the liver. He mentioned an ongoing trial comparing proton therapy to transarterial chemoembolization (TACE) and shared preliminary results indicating differences in local control.

In addition, Dr. Chuong discussed a Canadian trial involving a single fraction of whole-liver EBRT for patients with advanced and symptomatic HCC. The study focused on palliating pain, and while the radiation plans were simple, the results indicated significant pain relief and a potential improvement in three-month overall survival.

Concluding his presentation, Dr. Michael Chuong urged for a broader consideration of EBRT in tumor board discussions, especially for advanced liver cancer cases. He emphasized the need for higher-level evidence to establish EBRT as a viable and effective treatment option in conjunction with other local therapies.