Liver cancer treatment and radiotherapy
Hepatocellular carcinoma is treated with surgery, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), and others, but because it tends to arise repeatedly at different times within the liver, options often narrow over repeated treatment. Treatment becomes difficult if liver function is poor from the start or the lesion is near large vessels or bile ducts. Curative radiotherapy for liver cancer became possible with high-precision X-ray therapy and particle therapy such as protons and carbon ions.
When is it considered?
It is considered when surgery is difficult for various reasons and RFA is also difficult due to proximity to large vessels. Lesions over 5 cm, beyond the scope of high-precision X-ray therapy, can also be treated with particle therapy. QST Hospital determines indications for hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic liver tumors according to the unified treatment policy of the Japanese Society for Radiation Oncology.
Eligibility for hepatocellular carcinoma
The criteria are a Child-Pugh score (an index of liver function) of 9 or less and no more than 3 lesions requiring treatment.
Intrahepatic cholangiocarcinoma
It may be eligible when surgery is difficult. Safety is judged based on data from hepatocellular carcinoma treatment.
Liver metastases
The criteria are no lesions outside the liver or lesions that are controlled, and no more than 3 lesions in the liver. It is considered when surgery or RFA is difficult.
Preparation and schedule
First, metal markers for position verification are placed near the liver, and tests such as treatment-planning CT are performed. Preparation takes 3–4 days, and patients are often admitted because of many tests and dietary adjustments. The treatment plan is then created and verified over 1.5–2 weeks before treatment begins. Irradiation ranges from 1 fraction (1 day) to 12 fractions (3 weeks) depending on the condition and lesion location, and most finish within 1 week.
Insurance categories in Japan
Hepatocellular carcinoma of 4 cm or more and intrahepatic cholangiocarcinoma are covered by insurance; hepatocellular carcinoma under 4 cm and metastatic liver tumors are Advanced Medical Care. After treatment, follow-up is conducted jointly by the referring institution and QST Hospital.