Technological Advances in Radiotherapy

Radiation therapy, a highly effective treatment modality for hepatocellular carcinoma, is underutilized due to challenges posed by radiosensitivity of the non-tumor-bearing liver, movement of the liver with respiration, and the poor definition of the tumor edge on many occasions. Nonetheless, technological advances have improved our ability to safely target tumors in the liver while sparing adjacent normal liver and gastrointestinal mucosa, thereby making increasing numbers of patients with liver tumors amenable to radiation therapy with curative intent. This transition from the era of two- and three-dimensional radiation therapy to the modern era of radiotherapy was catalyzed by the advent of intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), image-guided radiation therapy (IGRT), and charged particle therapy resulting in a resurgence of interest in radiation therapy for liver tumors. We outline the technological advances that are at the vanguard of this renewed interest and the associated improved outcomes seen with radiation therapy for liver tumors.