Case 23-2005: A Man with a Mass in the Liver

To the Editor: Tanabe et al. (July 28 issue) 1 provide an excellent example of the multidisciplinary decision making required in the case of a typical patient with hepatocellular carcinoma. Although radioactive yttrium-90 microspheres delivered through the hepatic artery were discussed as a treatment option, external-beam radiation was not. Historically, radiation therapy has played a minor role in the treatment of hepatocellular carcinoma, primarily because of the low tolerance of the whole liver to radiation. However, technological advances in tumor imaging, conformal-radiation planning, and radiation delivery have facilitated the safe use of high-dose radiotherapy for focal hepatocellular carcinomas, including tumors unsuitable . . .