The following is a description of radiotherapeutic procedures depending on the primary tumor or stage of the disease:
- In the presence of extrahepatic (“outside the liver”) manifestations or elevated bilirubin levels, therapy may be given with:
- Selective internal radiotherapy (SIRT, TACE)-irradiating the tumor from withinIn one study, selective internal radiotherapy (SIRT) was compared with transarterial chemoembolization (TACE) for the treatment of nonresectable hepatocellular carcinoma (HCC). Results: a single SIRT session was as effective and safe as multiple TACE sessions.
- Drug therapy with sorafenib – active substance from the group of multi-kinase inhibitors (see below “Drug therapy”).
- In large, localized-limited liver carcinoma or primary and metastatic liver tumor(s), which can be destroyed neither surgically nor with local-ablative (local, tumor-destroying) procedures, therapy can be carried out with:
- External radiation therapy (radiotherapy; externally applied radiation treatment), possibly as sterotactic radiotherapy/body stereotaxy or “stereotactic body radiotherapy” (SBRT); the procedure has a steeper dose gradient between tumor and surrounding normal tissue
- Proton and brachytherapy – allows sparing of tumor-free liver volumes in advanced cirrhosis and in large tumors
