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External-beam radiation therapy underused for people with liver cancer awaiting transplant

Press releases may be edited for formatting or style | October 25, 2021 Rad Oncology
People with liver cancer awaiting transplantation could benefit from non-invasive radiation treatments but are rarely given this therapy, according to a new analysis of U.S. national data. Findings will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

“External-beam radiation therapy is a proven, established, safe and effective treatment option for patients with unresectable liver cancer, yet its under-utilization within this population—fewer than 4% of patients—highlights a real-world gap in treatment options available for patients with hepatocellular carcinoma,” said study author Nima Nabavizadeh, MD, associate professor of radiation oncology and residency program director at Oregon Health & Science University in Portland.

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the fourth leading cause of cancer death. Roughly 90% of patients with HCC also have cirrhosis, which occurs when an underlying liver disease leads to scarring and permanent liver damage and is the strongest risk factor for liver cancer. People with unresectable HCC have tumors in their liver that cannot be safely removed with surgery, either due to severity of underlying cirrhosis or other clinical factors.

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For patients with localized liver cancer and advanced cirrhosis, “liver transplantation is the best and only chance for long-term survival,” said Dr. Nabavizadeh. However, the supply of organs available for transplant is limited, and candidates often wait months or more than a year to get a new liver. In addition, if a patient's cancer spreads outside of transplantable size criteria or to another part of the body while they are waiting for a new liver, they are no longer eligible for transplant. Many patients, therefore, receive liver-directed bridging therapy, which is treatment to prevent the growth or spread of tumors during the waiting period.

Liver-directed treatment options for patients awaiting transplant include: (1) thermal ablation procedures, which use advanced imaging technology to guide probes through the skin and into the liver, to burn or freeze tumors at the site; catheter-based treatments including (2) transarterial chemoembolization (TACE) and (3) Y-90 radioembolization, where small particles are injected selectively into an artery directly supplying the tumor that cut off a tumor’s blood supply and trap chemotherapy drugs or radioactive substances within the tumor; and (4) external-beam radiation therapy (EBRT), which aims high doses of targeted radiation at tumor sites from outside the body using non-invasive techniques.

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