Recent advancements in radiotherapy for hepatocellular carcinoma

Radiotherapy has traditionally been uncommonly used for hepatocellular carcinoma (HCC) due to concerns of radiation-induced liver damage. However, advancements including stereotactic body radiotherapy have improved target localization and reduced toxicity, leading to its inclusion as a locoregional therapy in recent international guidelines. Newer technologies, such as MR-Linac and particle radiotherapy, have further improved the therapeutic ratio of radiotherapy, showing early promising results. The increasing application of radiotherapy in HCC has led to broadening of its indication to bridging to transplant and palliation. Beyond being a standalone treatment, radiotherapy is increasingly being combined with systemic therapies to enhance treatment response and survival rates. This combination is particularly relevant for patients with portal vein tumour thrombosis, as other locoregional therapies are often unsuitable for them. Furthermore, with the evolving concepts of oligometastatic and oligoprogressive HCC, radiotherapy is being explored as a promising approach to manage these conditions, especially as HCC patients experience longer survival with the introduction of immunotherapy. In this review, we provide an overview of these recent advancements in radiotherapy for HCC.