Radiotherapy for hepatobiliary tumors: From cholangiocarcinoma to hepatocarcinoma, what are the indications, what are the results? [Radiothérapie des tumeurs hépatobiliaires : du cholangiocarcinome à l'hépatocarcinome, quelles indications, quels résultats attendre ?]

摘要

Classical external-beam radiation in the treatment of hepatocellular carcinoma produced unsatisfactory results. Research on the development of irradiation is in an evaluation stage to reach an optimal strategy or even a curative goal. Three-dimensional conformal radiation therapy has a possibility of increasing the radiation dose to eliminate tumors and to avoid toxicity in non-tumor tissues. New improvements are currently available with the advent of respiratory gating and stereotactic irradiation, to again increase the radiation dose while sparing the surrounding normal tissues. In addition, surgery, radiofrequency ablation, percutaneous injection of alcohol, and the advantages of the external-beam radiation have been clearly demonstrated such as its availability, accessibility to target multiple localizations anywhere within the liver parenchyma, non-invasive treatment for profound lesions, and potential association with anti-tumor approaches. Current clinical trials on these newtechniques contribute to the integration of external radiotherapy as one of the optimal therapeutic strategies for the treatment of hepatocellular carcinoma. On the other hand, due to the late and mediocre diagnosis of cholangiocarcinoma, radiotherapy plays its role mainly in palliative care, rather than curative one. Two types of irradiation, by associating with other therapeutic modalities, are disposables: external-beam radiation and brachytherapy. Results are encouraging, but definitive randomized trials for this setting are difficult to design. To cite this journal: Oncologie 14 (2012).