Abstract：
OBJECTIVE: Primary and metastatic liver cancer presents heterogeneously. New radiotherapy techniques have reduced toxicity concerns, leading to increased use of liver radiotherapy. This review synthesizes available evidence and offers recommendations for palliative radiotherapy for liver cancer.
METHODS: PubMed, Ovid Medline, Embase, Cochrane Central, and Web of Science were searched from inception to December 28th, 2022. Articles reporting local control (LC), survival, toxicity, symptom control, and response after stereotactic body radiotherapy (SBRT), partial-liver, or whole-liver radiotherapy (WLRT) techniques were reviewed. We also identified nomograms identifying patients who may benefit from radiotherapy.
UNASSIGNED: Nine randomized-controlled trials were found, in addition to many retrospective, feasibility, and phase I or II studies. Patients with favorable prognosis may receive SBRT using 30-50 Gray (Gy) in 3-5 fractions for primary cancer and up to 60 Gy for metastases, provided normal-tissue constraints are met. Select patients with multiple (>5) or large (>10 cm) lesions or macrovascular invasion (MVI) may be considered, but with potentially reduced LC and increased toxicity. Lower SBRT doses (i.e., 25 Gy in 5 fractions) can be considered on a cautionary basis for patients with poorer liver function or health. Patients with larger tumor burden, poor performance status (PS), or inability to tolerate SBRT positioning or motion-management can consider partial-liver three-dimensional conformal radiotherapy (3DCRT). For patients with extremely guarded prognosis and/or extremely poor performance, WLRT provides pain and symptom relief over several weeks. Combining radiotherapy and systemic therapy may allow radiotherapy de-escalation while maintaining good outcomes.
CONCLUSIONS: Radiotherapy has a definite role for palliation of liver cancer with practical research providing guidance in the use of techniques and different regimens in various patient subgroups. Future investigation, including randomized trials, is needed to optimize patient selection, radiotherapy techniques, and integration with other therapies.
METHODS: PubMed, Ovid Medline, Embase, Cochrane Central, and Web of Science were searched from inception to December 28th, 2022. Articles reporting local control (LC), survival, toxicity, symptom control, and response after stereotactic body radiotherapy (SBRT), partial-liver, or whole-liver radiotherapy (WLRT) techniques were reviewed. We also identified nomograms identifying patients who may benefit from radiotherapy.
UNASSIGNED: Nine randomized-controlled trials were found, in addition to many retrospective, feasibility, and phase I or II studies. Patients with favorable prognosis may receive SBRT using 30-50 Gray (Gy) in 3-5 fractions for primary cancer and up to 60 Gy for metastases, provided normal-tissue constraints are met. Select patients with multiple (>5) or large (>10 cm) lesions or macrovascular invasion (MVI) may be considered, but with potentially reduced LC and increased toxicity. Lower SBRT doses (i.e., 25 Gy in 5 fractions) can be considered on a cautionary basis for patients with poorer liver function or health. Patients with larger tumor burden, poor performance status (PS), or inability to tolerate SBRT positioning or motion-management can consider partial-liver three-dimensional conformal radiotherapy (3DCRT). For patients with extremely guarded prognosis and/or extremely poor performance, WLRT provides pain and symptom relief over several weeks. Combining radiotherapy and systemic therapy may allow radiotherapy de-escalation while maintaining good outcomes.
CONCLUSIONS: Radiotherapy has a definite role for palliation of liver cancer with practical research providing guidance in the use of techniques and different regimens in various patient subgroups. Future investigation, including randomized trials, is needed to optimize patient selection, radiotherapy techniques, and integration with other therapies.
摘要：
原发性和转移性肝癌呈现异质性。新的放射治疗技术减少了毒性问题，导致肝脏放疗的使用增加。这篇综述综合了现有的证据，并为肝癌姑息性放疗提供了建议。
PubMed,OvidMedline,Embase,CochraneCentral,从成立到12月28日，搜索了WebofScience，2022年。报告本地控制（LC）的文章，生存,毒性,症状控制,和立体定向放射治疗（SBRT）后的反应，部分肝，或全肝放疗（WLRT）技术进行了综述。我们还确定了可以从放疗中受益的患者的列线图。
发现了9项随机对照试验，除了许多回顾性的，可行性,和第一阶段或第二阶段的研究。预后良好的患者可以接受SBRT，使用30-50Gray（Gy）在3-5个部位的原发性癌症和高达60Gy的转移，前提是满足正常组织约束。选择具有多个（>5）或较大（>10cm）病变或大血管侵犯（MVI）的患者可以考虑，但可能降低LC和增加毒性。较低的SBRT剂量(即，对于肝功能或健康状况较差的患者，可以在警告的基础上考虑5个部分中的25Gy）。肿瘤负荷较大的患者，性能状态(PS)不佳，或不能耐受SBRT定位或运动管理可考虑部分肝脏三维适形放疗(3DCRT).对于预后极其谨慎和/或表现极差的患者，WLRT在几周内提供疼痛和症状缓解。联合放疗和全身治疗可以允许放疗降阶梯，同时保持良好的结果。
放射治疗对肝癌的缓解具有明确的作用，实际研究为在各种患者亚组中使用技术和不同方案提供了指导。未来的调查，包括随机试验,需要优化患者选择，放射治疗技术，并与其他疗法相结合。
PubMed,OvidMedline,Embase,CochraneCentral,从成立到12月28日，搜索了WebofScience，2022年。报告本地控制（LC）的文章，生存,毒性,症状控制,和立体定向放射治疗（SBRT）后的反应，部分肝，或全肝放疗（WLRT）技术进行了综述。我们还确定了可以从放疗中受益的患者的列线图。
发现了9项随机对照试验，除了许多回顾性的，可行性,和第一阶段或第二阶段的研究。预后良好的患者可以接受SBRT，使用30-50Gray（Gy）在3-5个部位的原发性癌症和高达60Gy的转移，前提是满足正常组织约束。选择具有多个（>5）或较大（>10cm）病变或大血管侵犯（MVI）的患者可以考虑，但可能降低LC和增加毒性。较低的SBRT剂量(即，对于肝功能或健康状况较差的患者，可以在警告的基础上考虑5个部分中的25Gy）。肿瘤负荷较大的患者，性能状态(PS)不佳，或不能耐受SBRT定位或运动管理可考虑部分肝脏三维适形放疗(3DCRT).对于预后极其谨慎和/或表现极差的患者，WLRT在几周内提供疼痛和症状缓解。联合放疗和全身治疗可以允许放疗降阶梯，同时保持良好的结果。
放射治疗对肝癌的缓解具有明确的作用，实际研究为在各种患者亚组中使用技术和不同方案提供了指导。未来的调查，包括随机试验,需要优化患者选择，放射治疗技术，并与其他疗法相结合。
