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External Beam Radiation Therapy for Primary Liver Cancers

Publication Date: October 20, 2021

Last Updated: March 14, 2022

EBRT in the definitive/nontransplant and palliative settings in HCC

Recommendation	Strength of Recommendation	Quality of Evidence
For patients with liver-confined HCC who are not candidates for curative options (surgery or thermal ablation) and for whom catheter-based therapies are being considered, EBRT is recommended as a potential first-line single therapy option.	Strong	Moderate
For patients with liver-confined multifocal and/or unresectable HCC, EBRT alone or sequenced with other catheter-based therapies* is conditionally recommended.	Conditional	Moderate
For patients with liver-confined HCC who had an incomplete response to thermal ablation or catheter-based therapies,* EBRT is recommended as a consolidative treatment option.	Strong	Moderate
For patients with locally recurrent HCC after surgery, thermal ablation, or catheter-based therapies, EBRT is recommended as a salvage treatment option.	Strong	Low
For patients with liver-confined HCC with macrovascular invasion, EBRT is conditionally recommended, alone or sequenced with systemic therapy or catheter-based therapies.	Conditional	Moderate
For patients with symptomatic locally advanced HCC, palliative hypofractionated EBRT directed to the liver and/or macrovascular tumor thrombus is conditionally recommended, alone or sequenced with systemic therapy or catheter-based therapies.	Conditional	Low
For patients with symptomatic metastatic HCC, palliative hypofractionated EBRT directed to the liver and/or macrovascular tumor thrombus is conditionally recommended, alone or sequenced with systemic therapy or catheter-based therapies.	Conditional	Expert Opinion

Neoadjuvant EBRT before surgery or OLT for HCC

Recommendation	Strength of Recommendation	Quality of Evidence
For patients with HCC who are potential candidates for OLT, ultra- or moderately hypofractionated EBRT is conditionally recommended as a bridge to transplant or as a downstaging intervention.	Conditional	Low
For patients with HCC with portal vein tumor thrombus that are potentially resectable, neoadjuvant EBRT is conditionally recommended.	Conditional	Low

Overview

Title

External Beam Radiation Therapy for Primary Liver Cancers

Authoring Organization