More than 24,000 people are diagnosed with liver cancer each year, and at UAB, treatment options are contemporary, accurate, efficient, and effective. Patients diagnosed with liver cancer can rest assured that they have an expert team behind them. The Hepatobiliary team at the University of Alabama at Birmingham is comprised of surgeons, radiologists, pathologists, medical & radiation oncologists, scientists, GI physicians and physicists who work together incessantly toward a cure for liver cancer.
The most common form of primary (which means it originates there versus spreads from other organs) liver cancer is hepatocellular carcinoma (HCC). Its incidence in US is rising, secondary to cirrhosis and hepatitis. Surgery or transplantation are the best options to treat HCC, but only 15 percent of patients are candidates for these treatments. In many cases, tumors are too large or extensive by the time they are diagnosed to be successfully removed. Approximately 70 percent of HCC patients will be treated using non-surgical options, the most common being chemoembolization (TACE), where treatment is administered through the individual arteries that feed the tumors, and radiofrequency ablation (RFA), which uses radio waves to kill cancer cells. Tumor number, size and location determine which therapies may be recommended.
Better Accuracy, Better Results
The UAB Hepatobiliary team is committed to developing novel ways to treat liver tumors. Radiation Therapy is one such modality being refined to treat liver tumors. The main drawback to traditional radiation therapy is the time required for delivery. Thanks to the treatments available at UAB, however, doctors have been able to shorten radiation courses from several weeks in length to five or less treatments . Modern computer technology helps pin-point radiation treatment with a high degree of accuracy, resulting in greater tumor destruction and less damage to adjacent structures.
UAB radiation oncologists use several different techniques to deliver radiation to treat liver cancer, including:
- Stereotactic Body Radiation Therapy (SBRT), a highly accurate radiation treatment that uses multiple radiation beams at different angles to treat the tumor over a few treatments.
- Image Guided Radiation Therapy (IGRT), in which markers called fiducials are implanted to help direct radiation beams to the tumor even more accurately.
- Intensity Modulated Radiation Therapy (IMRT) helps spare normal tissues even further by adjusting the radiation beam to the shape of the tumor, allowing higher radiation doses to be delivered without over-exposing surrounding healthy tissue.
- Intra-Arterial Radiation Therapy uses catheters placed through arteries in the liver close to the tumor, through which radiation is administered. This therapy can halt tumor progression or even shrink it considerably in patients with tumors that affect the entire liver, or one of the liver’s lobes.
Two other techniques, namely Dynamic Arc and Respiratory Gating, also help UAB doctors increase accuracy and effectiveness in liver tumor treatments. With dynamic arc technique, it is possible to shorten the treatment time while delivering the dose with extremely high accuracy. Respiratory gating helps to synchronize radiation delivery with the breathing cycle. This is important because tumors can naturally move as the patient breathes, so this technique reduces radiation of noncancerous cells by only emitting radiation when the tumor is in the target area determined by the doctor.
Pioneering New Treatments
Encouraging treatement effects have been observed in tumors that are treated with radiation therapy in concert with other established treatement modalities. Several UAB studies are currently looking at novel combinations to treat HCC. One example evaluates the use of a combination of SBRT and a drug called Sorafenib. Radiation therapy induces hypoxic (low oxygen levels) damage to the tumor and Sorafenib kills tumor cells by direct action and also by preventing growth of new blood vessels. These treatments are complimentary in their mechanism of action. Another approach is the use of SBRT along with a procedure called Trans-Arterial Chemo-Embolization (TACE) for selected patients with inoperable tumors. TACE is very effective at treating the center of tumors but not so much at the periphery of the tumor where most recurrences occur. . In contrast, radiation therapy is active at the periphery of the tumor where there is an adequate supply of oxygen. Again, this combined approach maximizes the strengths of the individual treatments for a better oncologic result.
Cholangio-carcinoma, another type of liver cancer, arises from the bile ducts either within or outside the liver. Unfortunately, many of these tumors are asymptomatic until they become quite advanced. While surgery is the treatment of choice for these tumors, many are inoperable at the time of diagnosis due to their size or location. However, these tumors are radio-sensitive, and physicians at UAB are currently evaluating the role of chemotherapy and radiation combinations as a primary treatment or as an additional treatment following an operation. Because cholangiocarcinomas are typically large, conventional radiation therapy approaches are usually employed. Alternatively, intra-arterial radiotherapy using radioactive Yttrium (Y90) can also be utilized. The Y90 is coated on tiny beads which are delivered through the hepatic artery directly to the tumor. The beads become lodged in the tumor and release the radiation over several days.
Contributing to this post were:
Derek A. DuBay, M.D.
Assistant Professor of Surgery, Liver Transplant and Hepatobiliary Surgery
Rojymon Jacob, M.D.
Assistant Professor of Radiation Oncology