关键词: 肝细胞癌, 放射治疗, 立体定向放射治疗, 调强放疗, 门静脉癌栓, 新辅助放疗, 微血管侵犯, 桥接治疗

Abstract: Radiotherapy is increasingly demonstrating its importance in the treatment of hepatocellular carcinoma (HCC), particularly across different stages of HCC. For patients with early and locally advanced HCC, techniques such as stereotactic body radiation therapy (SBRT) and intensity-modulated radiotherapy (IMRT) have matured, offering effective tumor control and improved survival outcomes. These techniques provide a promising treatment option for those who are not candidates for surgery or are unsuitable for radiofrequency ablation (RFA) and transarterial chemoembolization (TACE). In the treatment of intermediate to advanced HCC, radiotherapy can be integrated as part of local therapy and combined with systemic treatments to exert synergistic effects, further improving overall survival (OS) and progression-free survival (PFS). For instance, in patients with portal vein tumor thrombosis (PVTT), neoadjuvant radiotherapy can downstage tumors, rendering them resectable and reducing postoperative recurrence and complications. Radiotherapy also serves as an adjuvant therapy, particularly in patients with postoperative pathology indicating microvascular invasion (MVI) or narrow surgical margins, lowering the risk of local recurrence and prolonging disease-free survival (DFS). Additionally, for patients who do not meet liver transplantation criteria, radiotherapy can be utilized as a bridging therapy to downstage tumors, thereby making them eligible for transplantation and achieving favorable long-term survival rates post-transplantation. Overall, the application of radiotherapy in HCC treatment is expanding, especially when combined with targeted and immunotherapy, showing potential for enhanced efficacy. However, further high-quality randomized controlled trials are necessary to validate the effectiveness and safety of these strategies.

Key words: hepatocellular carcinoma, radiotherapy, stereotactic body radiotherapy, intensity-modulated radiotherapy, portal vein tumor thrombus, neoadjuvant radiotherapy, microvascular invasion, bridging therapy