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Radiation therapy uses high-energy rays (or particles) to kill cancer cells.

When is radiation therapy used for liver cancer?

Radiation might be part of the treatment if:

• The liver tumor(s) cannot be removed by surgery 
• The liver tumor(s) cannot be treated with ablation or embolization or did not respond well to those treatments
• The cancer has spread to other parts of the body, such as the brain or bones
• Large liver tumors are causing pain
• A tumor thrombus (a collection of liver cancer cells) is blocking the portal vein

Radiation might not be a good option for some people whose liver has been extensively damaged by diseases such as hepatitis or cirrhosis.

How is radiation therapy given?

When used to treat liver cancer, radiation therapy is most often given using a machine that creates and focuses beams of radiation on the cancer. This is known as external radiation therapy.

Getting this type of radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, although the setup time (getting you into place for treatment) usually takes longer. The number of treatments you need, and the length of treatment will depend on why it’s being given.

Although liver cancer cells are sensitive to radiation,  the treatment is planned carefully to avoid damaging normal liver tissue as much as possible.

For example, treatment is often given using image-guided radiation therapy (IGRT), where an imaging scan (like a CT or MRI) is done just before each treatment. Because the tumor’s position in the body can change slightly from day to day, IGRT can help ensure the radiation is aimed more precisely, which might result in fewer side effects.

Newer radiation techniques, such as stereotactic body radiation therapy (SBRT), can help doctors target liver tumors while reducing the radiation to nearby healthy tissues. SBRT uses very focused beams of high-dose radiation that are aimed at the tumor from many different angles. To focus the radiation precisely, the person is put in a specially designed body frame for each treatment. Because of the higher doses of radiation, SBRT can be given over a shorter time compared to standard radiation therapy, often in 3 to 6 treatments.

Radioembolization

Some tumors in the liver can be treated by injecting small radioactive beads into the hepatic artery. The beads then lodge in the liver near the tumor and give off small amounts of radiation that travel only a short distance.

Possible side effects of radiation therapy for liver cancer

Some of the more common side effects of radiation therapy include:

• Skin changes in areas getting radiation, ranging from redness to blistering and peeling
• Nausea and vomiting
• Fatigue
• Diarrhea
• Loss of appetite

These effects typically go away within a few weeks after treatment ends.

A more serious side effect of radiation therapy to the liver is radiation-induced liver disease (RILD), in which other parts of the liver are damaged. This is less common than in the past, now that radiation beams can be aimed more precisely at the cancer. If RILD does develop, it is most often 3 to 4 months after treatment and usually only lasts for a set time, but sometimes it can be life-threatening. Signs and symptoms of RILD can include abnormal blood liver test results, an enlarged liver and spleen, ascites (fluid buildup in the abdomen), and jaundice.

Ask your doctor what side effects to expect and if there are things you can do to help prevent or relieve them.