Abstract
Treatment recommendations for primary liver malignancies, including hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), are complex and require a multidisciplinary approach. Despite surgical options that are potentially curative, options for nonsurgical candidates include systemic therapy, radiotherapy (RT), transarterial chemoembolization (TACE), and radiofrequency ablation (RFA). Stereotactic Body Radiation Therapy (SBRT) is now in routine use for the treatment of lung cancer, and there is growing evidence supporting its use in liver tumors. SBRT has the advantage of delivering ablative radiation doses in a limited number of fractions while minimizing the risk of radiation-induced liver disease (RILD) through highly conformal treatment plans. It should be considered in a multidisciplinary setting for the management of patients with unresectable, locally advanced primary liver malignancies and limited treatment options. Recently, the combination of immunotherapy with SBRT has been proposed to improve antitumor effects through engaging the immune system. This review aims at shedding light on the novel concept of the combination strategy of immune-radiotherapy in liver tumors by exploring the evidence surrounding the use of SBRT and immunotherapy for the treatment of HCC and CCA.
Highlights
The two most common subtypes of primary liver tumors are hepatocellular carcinoma (HCC) that arise from hepatocytes and intrahepatic cholangiocarcinoma (IHCs) that arise from epithelial cells of the intrahepatic bile ducts [4]
While Stereotactic Body Radiation Therapy (SBRT) alone and immunotherapy alone have shown promise as effective therapies in patients with primary liver tumors, the combination of SBRT and programmeddeath ligand-1 (PD-L1), PD-1, or CTLA4 blockade has not been tested in these tumors [133]
It is expected that such an approach would result in improved therapeutic outcomes similar to those obtained in metastatic solid tumors, including melanomas and nonsmall-cell lung cancer (NSCLC)
Summary
Primary liver cancer is the seventh most common cancer world-wide, with around 841,080 newly diagnosed cases in 2018 [1]. The two most common subtypes of primary liver tumors are HCCs that arise from hepatocytes and intrahepatic cholangiocarcinoma (IHCs) that arise from epithelial cells of the intrahepatic bile ducts [4]. Does the dismal prognosis of HCC patients stem from the advanced stage at presentation, and it arises from high recurrence rates. IHC constitutes around 3% of gastrointestinal cancers [22] It is the second most common primary hepatic malignancy in the United States following HCC, with around 5000 newly diagnosed cases per year [1]. The dismal prognosis is due to advanced stages at time of diagnosis, limited treatment options, and very high rates of recurrence and metastases [24].
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