Liver Cancer Radiotherapy: Which Cases Are Eligible, How Effective Is It, and Are the Side Effects Severe?

Q1: Why was radiotherapy for liver cancer rarely mentioned in the past?

1. Firstly, in the past, people had limited understanding of radiotherapy, and radiotherapy equipment lacked precision. Therefore, when liver cancer patients sought treatment, doctors often prioritized surgery, liver transplantation, interventional therapy, or targeted therapy, with radiotherapy rarely considered. However, with the development of precise tumor radiotherapy, radiotherapy has become an increasingly important treatment option for liver tumors. In the 2021 NCCN guidelines, radiotherapy for liver cancer is separated under local treatment, indicating its growing role in comprehensive liver cancer management.

2. Secondly, liver cancer treatment requires a systematic, multidisciplinary approach, and the optimal choice is difficult to determine by a single department alone. Currently, most oncology centers, including Jiahui International Cancer Center in Shanghai, advocate and implement multidisciplinary team (MDT) consultations, where doctors from multiple departments jointly discuss patient cases. This approach allows surgery, chemotherapy, radiotherapy, and other treatments to be integrated into a comprehensive plan from the start, helping patients achieve the maximum therapeutic benefit.


Q2: Which liver cancer patients are suitable for radiotherapy?

1. For early-stage liver cancer, if patients cannot tolerate surgery for medical reasons or prefer not to undergo surgery, curative radiotherapy is feasible. According to the “Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)”[1], SBRT (stereotactic body radiotherapy) can be used for patients with small liver cancers who are unsuitable for or unwilling to undergo surgery or ablation.

2. For patients eligible for liver transplantation but awaiting donor livers, limited organ availability may lead to tumor progression or metastasis during the waiting period, causing patients to miss the optimal treatment opportunity. Radiotherapy, especially SBRT, can serve as a bridging therapy before transplantation, shrinking or controlling tumors and providing more time and opportunities for liver transplantation.

3. More than half of liver cancer patients may develop portal vein tumor thrombosis (PVTT)[2]. Once PVTT occurs, it usually indicates advanced-stage disease and can cause vascular obstruction, serious complications, and metastasis. For liver cancer patients with PVTT, radiotherapy can shrink the thrombus, reducing portal vein pressure, effectively controlling tumor progression, and lowering the risk of gastrointestinal bleeding and ascites caused by high portal pressure[3].

4. For unresectable hepatocellular carcinoma (HCC) confined to the liver, especially in patients with large tumors (>5cm) or multiple lesions (more than 3), radiotherapy is often combined with interventional therapy or ablation based on patient tolerance, leveraging the strengths of each treatment to improve local tumor control.

5. For advanced liver cancer patients with extrahepatic metastases, such as lymph nodes, bones, brain, or lungs, radiotherapy can help shrink metastatic lesions and relieve symptoms, improving quality of life.

6. Additionally, for unresectable intrahepatic cholangiocarcinoma or patients with residual tumor after surgery, radiotherapy can be considered as part of a comprehensive treatment plan, providing local tumor control and potentially prolonging survival, based on evaluation by radiotherapy specialists.


Q3: How long does a course of liver cancer radiotherapy take?

The number of radiotherapy sessions depends on tumor size, number, location, pathology, treatment purpose (preventive, curative, palliative, consolidative, conversion, or adjuvant), radiotherapy technique, and dose. The radiotherapy department will determine the course based on standardized guidelines and clinical experience.

Thus, treatment duration varies by patient. A shorter course does not imply poorer efficacy, and a longer course does not necessarily lead to more severe side effects. For example, SBRT for small liver cancers unsuitable for or unwilling to undergo surgery at Jiahui International Cancer Center typically requires only 1 week or less, which can reduce hospitalization costs. SBRT delivers high-dose radiation to the tumor in one or a few sessions while minimizing exposure to surrounding healthy tissue.


Q4: Are the side effects of liver cancer radiotherapy severe? Will it cause nausea or vomiting?

Side effects vary among patients and may depend on radiotherapy technique, radiation dose, treatment site, and patient health status. Common side effects for liver cancer radiotherapy include:

1. Fatigue is one of the most common side effects during tumor radiotherapy. It usually lasts 3–4 weeks after treatment but may persist for 2–3 months in some cases.

2. Because the liver is close to the stomach and intestines, some patients may experience nausea, loss of appetite, stomach discomfort, diarrhea, liver function abnormalities, or reduced white blood cell count. Overall, these side effects are not highly prevalent and can be managed with medications for symptom relief.

Most side effects subside after radiotherapy. With continuous optimization of radiotherapy equipment and techniques, precision has improved, allowing radiation to “target” the tumor while minimizing exposure to normal liver tissue. Patients need not be overly worried.

It is important for patients to monitor side effects. Professional support from doctors and nurses is available as needed.

At Jiahui International Cancer Center, side effect management is a professional service throughout the patient’s treatment course, with dynamic monitoring before, during, and after therapy. Any abnormalities are promptly addressed with medications or interventions, helping patients manage symptoms and continue their treatment smoothly.


Q5: What should patients pay attention to during and after liver cancer radiotherapy?

1. Maintain a positive and optimistic mindset.

2. Ensure high-quality and sufficient rest.

3. Consume a reasonable, balanced, and nutritious diet.

4. Protect the skin at the treatment site: during radiotherapy, the skin may become red and sensitive. Follow doctors’ and nurses’ instructions, avoid applying heat or cold (including pads or ice packs), and prevent direct sun exposure on treated skin.

5. Strictly follow medical instructions and actively seek help from healthcare providers if needed.




References
[1] Guidelines for Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)[J/OL]. J Clin Hepatobiliary Dis, 2022:1-16[2022-03-09]. http://kns.cnki.net/kcms/detail/22.1108.R.20220130.1411.002.html
[2] Su CH, Lin Y, Cai L. Genetic factors, viral infection, other factors and liver cancer: an update on current progress[J]. APJCP, 2013, 14(9):4953-4560.
Daichi T, Satoru S, et al. Hepatocellular carcinoma with portal vein tumor thrombosis: clinical characteristics, prognosis, and patient survival analysis[J]. Digestive Diseases & Sciences, 2007.
[3] Cheng S, Sun J, Shi J, et al. Diagnosis and treatment of hepatocellular carcinoma with portal vein tumor thrombosis[J]. Chin Med J, 2016, 096(046):3697-3701.
Luo J, Guo RP, Lai EC, et al. Transarterial chemoembolization for unresectable hepatocellular carcinoma with portal vein tumor thrombosis: a prospective comparative study[J]. Ann Surg Oncol, 2011, 18(2):413-420.