Radiotherapy for hepatocellular carcinoma downstaging: From palliative care to radical treatment

The purpose of tumor staging is to guide treatment,and the treatment for a certain stage should be adjusted based on the changes in disease condition,in order to facilitate better control of tumor. Therefore,the treatment of liver cancer requires follow-up and re-staging to develop better treatment regimens for patients,especially the opportunity for cure. Surgical resection is not suitable for large hepatocellular carcinoma confined to the liver,and after embolization chemotherapy combined with radiotherapy for tumor regression and downstaging,some patients may undergo surgical resection,and the incurable tumor can thus be cured. For liver cancer patients with portal vein tumor thrombus,surgical resection can be performed after tumor thrombus is reduced by neoadjuvant radiotherapy,and the patients undergoing neoadjuvant radiotherapy have a significant increase in survival time than those not undergoing neoadjuvant radiotherapy. Large hepatocellular carcinoma can be downstaged to small hepatocellular carcinoma after multimodality therapy,and then stereotactic radiotherapy or radiofrequency ablation can help to achieve radical treatment. There is an increasing number of clinical reports of radiotherapy for liver cancer downstaging,with a gradual increase in evidence-based level,and thus it holds promise for clinical application.