Journal of liver cancer最新文献

{"title":"Pain, analgesic use and misconceptions in patients with hepatocellular carcinoma: a cross-sectional survey.","authors":"Jina Park, Jiwon Yang, Sung Won Chung, Won-Mook Choi, Ju Hyun Shim, Danbi Lee, Kang Mo Kim, Young-Suk Lim, Han Chu Lee, Jonggi Choi","doi":"10.17998/jlc.2026.03.19","DOIUrl":"10.17998/jlc.2026.03.19","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Cancer-related pain remains undertreated despite established guidelines. In hepatocellular carcinoma (HCC), underlying chronic liver disease may amplify concerns regarding analgesic safety. We aimed to evaluate pain prevalence, analgesic use, pain-related perceptions, and educational needs among patients with HCC.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of 200 adult patients with HCC receiving systemic therapy at a tertiary referral center. A 30-item questionnaire assessed pain presence and intensity using a numeric rating scale (NRS), analgesic use patterns, liver-related safety concerns, opioid-related stigma, and educational needs. Clinical characteristics, including tumor burden and liver function, were analyzed in relation to pain and perception domains.</p><p><strong>Results: </strong>Fifty-five patients (27.5%) reported current pain (mean NRS, 3.6±2.5; mean worst pain 5.2±2.8). Among them, 31 patients (56.3%) were using analgesics; however, 51.6% reported using them only when pain became unbearable. Misconceptions regarding analgesic safety were prevalent: 70.0% believed long-term analgesic use damages the liver, 56.0% believed analgesics are unsafe with impaired liver function, 46.5% associated opioids with addiction, and 30.0% hesitated due to the term \"narcotic.\" These beliefs were not associated with Child-Pugh class or serum albumin level. Extrahepatic metastasis was associated with higher liver-related concern scores and a trend toward increased pain prevalence. Patients with elementary school education or less had poorer pain scale knowledge and no prior counseling.</p><p><strong>Conclusions: </strong>Pain undertreatment and safety-related misconceptions are common in HCC and appear independent of objective liver function. Structured, proactive education, particularly for patients with untreated pain and low educational attainment, may improve pain control in this population.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"287-297"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic body radiation therapy for hepatocellular carcinoma: 2026 expert consensus-based practical recommendation of the Korean Liver Cancer Association.","authors":"Jinhong Jung, Han Ah Lee, Do Young Kim, Hyun-Cheol Kang, Sun Hyun Bae, Ji Hye Min, Gyu Sang Yoo, Jeong Il Yu, Seo Hee Choi, Hae Lim Lee, Subin Heo, Chai Hong Rim, Sang Min Yoon, June Sung Lee","doi":"10.17998/jlc.2026.08.22","DOIUrl":"10.17998/jlc.2026.08.22","url":null,"abstract":"<p><p>Stereotactic body radiation therapy (SBRT) is a noninvasive, high-precision radiation technique that delivers a high dose to the tumor in a limited number of fractions, typically five or fewer, and is increasingly used as a curative-intent option for hepatocellular carcinoma (HCC), particularly when surgical resection, liver transplantation, or local ablative therapies are not feasible. Although domestic and international guidelines have incorporated SBRT into the treatment algorithm for HCC, the lack of comprehensive evidence and expert opinion regarding patient selection, pretreatment evaluation, treatment planning and delivery, complication management, and post-treatment follow-up has resulted in substantial variation in clinical practice. Accordingly, expert consensus-based practical recommendations for SBRT were developed by a group of radiation oncologists, hepatologists, and radiologists from the Research Committee of the Korean Liver Cancer Association, based on expert surveys, a comprehensive review of evidence-based literature, and a modified Delphi process. Encompassing the entire clinical workflow of liver SBRT, these recommendations are intended to provide practical guidance for the safe and effective implementation of SBRT in patients with HCC.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"182-204"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of automated computed tomography body composition in hepatocellular carcinoma: a volumetric versus single-slice comparison.","authors":"Seok Jin Hong, Jeong Hee Yoon, Jae Hyun Kim, Jeongin Yoo, Jeong Min Lee","doi":"10.17998/jlc.2026.06.08","DOIUrl":"10.17998/jlc.2026.06.08","url":null,"abstract":"<p><strong>Background/aims: </strong>To compare the prognostic value of fully automated volumetric versus single-slice computed tomography (CT)-derived body composition analysis for predicting overall survival in patients with newly diagnosed hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>In this retrospective study of 448 patients with newly diagnosed HCC, deep-learning algorithm quantified volumetric (L1-L5) and single-slice (L3) skeletal muscle and adipose tissue metrics using CT images. Spearman correlation assessed the relationship between volumetric and single-slice body composition metrics. Cox proportional hazards models, adjusted for established clinical prognostic factors, were used to evaluate association between body composition parameters and overall survival. Harrell's C-index was used to compare prognostic performance of Cox models.</p><p><strong>Results: </strong>Strong correlations (correlation coefficient ≥0.82) were observed between volumetric and single-slice measurements for muscle attenuation, visceral fat index, and subcutaneous fat index, while muscle index demonstrated only moderate correlation (correlation coefficient= 0.50). Single-slice low muscle index (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.15-2.31; P=0.006), single-slice low muscle attenuation (HR, 1.38; 95% CI, 1.01-1.88; P=0.045) and volumetric low muscle attenuation (HR, 1.42; 95% CI, 1.03-1.95; P=0.034) were identified as independent predictors of overall survival. Median follow-up was 6.6 years. The single-slice and volumetric models showed comparable discrimination (C-index, 0.816 vs. 0.817; P=0.11).</p><p><strong>Conclusion: </strong>Automated single-slice muscle parameters at the L3 level provide significant prognostic stratification in patients with hepatocellular carcinoma, establishing it as a viable, time-efficient tool for routine oncologic practice. In contrast, automated volumetric body composition assessment did not provide superior discrimination compared with the single-slice approach.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"263-274"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic driving of the cancer-immunity cycle in HCC: roles of immune, molecular-targeted, and locoregional therapies.","authors":"Hideki Iwamoto, Hironori Koga, Takumi Kawaguchi","doi":"10.17998/jlc.2026.08.26","DOIUrl":"10.17998/jlc.2026.08.26","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) treatment has entered the immunotherapy era, characterized by multiple systemic and locoregional therapeutic options. Understanding how each modality modulates the tumor immune microenvironment (TIME) is essential to optimize treatment strategies. The cancer-immunity cycle provides a conceptual basis for antitumor immunity, consisting of a priming phase involving antigen release and T cell activation, and an effector phase characterized by cytotoxic T cell-mediated tumor elimination. Immune checkpoint inhibitor-based combinations play a central role in HCC treatment. Anti-programmed death ligand-1 plus anti-vascular endothelial growth factor (VEGF) therapy primarily activates the effector phase by reducing regulatory T cells and macrophages and enhancing cytotoxic T cell infiltration. In contrast, cytotoxic T lymphocyte-associated antigen 4 blockade-based regimens primarily promote the priming phase by activating CD4+ T cells and dendritic cells. Molecular-targeted agents also modulate the TIME. VEGF inhibition commonly reduces immunosuppressive cell populations, lenvatinib enhances cytotoxic T cell activation through fibroblast growth factor inhibition, and cabozantinib promotes dendritic cell-mediated immune activation via AXL inhibition. Locoregional therapies, including transarterial therapies, stereotactic body radiotherapy, and transarterial radioembolization with yttrium 90, induce tumor injury, release tumor-associated antigens, and activate inflammatory signaling. In this review, we propose the concept of \"strategic driving of the cancer-immunity cycle,\" in which treatment selection and sequencing are guided by their ability to activate distinct phases of the cycle. This concept may provide a rational strategy to maximize antitumor efficacy in HCC.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"220-230"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148883080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing non-LR-5 liver lesion diagnoses: the incremental value of serum alpha-fetoprotein and PIVKA-II for detecting hepatocellular carcinoma components.","authors":"Junghoan Park, Jeong Min Lee, Rae Rim Ryu, Seok Jin Hong","doi":"10.17998/jlc.2026.05.26","DOIUrl":"https://doi.org/10.17998/jlc.2026.05.26","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>To investigate whether incorporating serum alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) into gadoxetic acid-enhanced liver MRI improves the accuracy of differentiating hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined hepatocellular-cholangiocarcinoma (cHCC-CC) from non-LR-5 lesions.</p><p><strong>Methods: </strong>This retrospective study included 123 patients comprising 70 HCC, 30 ICC, and 23 cHCC-CC cases who underwent preoperative MRI and tumor marker analysis. Two abdominal radiologists independently interpreted the MRI without markers (Decision 1). Then, lesions were reclassified as HCC if either marker was elevated, regardless of the initial interpretation (Decision 2, biomarker-assisted override strategy). Outcomes included the diagnostic performance for identifying HCC versus non-HCC malignancies and distinguishing the presence of HCC components (HCC or cHCC-CC) from ICC. The McNemar's test and Cohen's κ compared diagnostic performance and evaluated interobserver agreement, respectively.</p><p><strong>Results: </strong>Adding AFP and PIVKA-II (Decision 2) improved the sensitivity and accuracy of detecting HCC components from 62.4-76.3% to 81.7-90.3% (P<0.001) and 66.7-76.4% to 81.3-87.0% (P<0.001), respectively. The overall accuracy for differentiating HCC from non-HCC malignancies did not improve. However, the accuracy for detecting HCC in small tumors (<3 cm) significantly improved from 68.8-72.5% to 81.3-82.5% (P= 0.002-0.008). Interobserver agreement also increased, from moderate (κ = 0.48) to substantial (κ = 0.68) after adding tumor marker values.</p><p><strong>Conclusions: </strong>In non-LR-5 hepatic lesions, adding AFP and PIVKA-II to MRI interpretations significantly improved the accuracy of identifying HCC components, as well as HCC detection in small tumors.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148335204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic drug sequencing in hepatocellular carcinoma in the era of chemo-diversity: maximizing the therapeutic benefit of lenvatinib.","authors":"Hideki Iwamoto, Shigeo Shimose, Hironori Koga, Takumi Kawaguchi","doi":"10.17998/jlc.2025.12.12","DOIUrl":"10.17998/jlc.2025.12.12","url":null,"abstract":"<p><p>The emergence of systemic therapies has ushered in an era of chemo-diversity for hepatocellular carcinoma, in which drug sequencing is pivotal for maximizing outcomes. Among available agents, lenvatinib is notable for its potent anti-angiogenic and immunomodulatory properties. This review proposes a structured building-block strategy for optimizing sequential drug therapy, conceptualizing each treatment line as a block that contributes cumulatively to survival, and grounding the discussion in clinical insights from lenvatinib administration. We comprehensively evaluated clinical trials, preclinical investigations, and real-world data to identify actionable approaches that enhance tolerability and prolong progression-free survival, with a particular focus on mitigating adverse events, optimizing dosing schedules, and integrating with transarterial therapies. Five refinements emerge as central to maximizing therapeutic benefit: early detection and classification of adverse events, use of supportive agents such as L-carnitine and branched-chain amino acids, structured telephone follow-up, optimization of dosing schedules, including weekend-off regimens, and strategic combination with transarterial therapy. In addition, rationale-based sequencing and clinically relevant switching criteria that extend beyond RECIST are summarized. Collectively, these measures increase the height of each therapeutic block, thereby contributing to cumulative survival within the building-block strategy. In the current era of chemo-diversity, lenvatinib remains a cornerstone agent when accompanied by these clinical refinements. The review provides a practical and conceptual framework for enhancing efficacy through structured sequencing, proactive adverse-event mitigation, and synergistic locoregional strategies, with broad applicability to real-world clinical practice.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"83-92"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of IgG4-related sclerosing cholangitis followed by rapid subsequent diagnosis of cholangiocarcinoma.","authors":"Gordon Hong, Amber Hussain, Eduardo Thadeu de Oliveira Correia, Akram Shalaby, Leonardo K Bittencourt, Amit Mahipal, Lee M Ocuin, Seth N Sclair","doi":"10.17998/jlc.2025.12.09","DOIUrl":"10.17998/jlc.2025.12.09","url":null,"abstract":"<p><p>Immunoglobulin G4 (IgG4)-related sclerosing cholangitis (IgG4-SC) is a rare condition with symptoms often mimicking malignancy, infection, or other autoimmune diseases. This case report describes the unique case of a 62-year-old male initially diagnosed with IgG4-SC, followed by subsequent diagnosis of cholangiocarcinoma. Biliary tract cancer in the setting of IgG4 related disease has been previously described; however, this patient course is novel as it encompasses the spectrum of challenges in IgG4-SC management, including diagnostic uncertainty, risk of infection with immunosuppressive agents, and development of malignancy diagnosed shortly following IgG4-SC diagnosis. We review the literature of management, outcomes, and malignancy risk and furthermore, highlight a promising recent therapy in treatment of IgG4 related disease, inebilizumab.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"169-175"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145770576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical management of intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma: a narrative review of principles, technical nuances, and emerging strategies.","authors":"Woohyung Lee, Kwang Pyo Hong, Jae Hoon Lee, Mirang Lee, Minkyu Sung, Seung Jae Lee, Ki Byung Song, Dae Wook Hwang, Song Cheol Kim","doi":"10.17998/jlc.2026.01.24","DOIUrl":"10.17998/jlc.2026.01.24","url":null,"abstract":"<p><p>Intrahepatic cholangiocarcinoma (CCA) is the second most common primary liver cancer after hepatocellular carcinoma (HCC). However, combined HCC-CCA is a rare malignancy exhibiting hepatocytic and cholangiocytic differentiation. For both tumors, R0 resection with regional lymph node dissection remains the only potentially curative treatment. Nevertheless, key aspects of surgical management remain controversial. In this narrative review, we synthesize contemporary evidence on the surgical management of intrahepatic CCA and combined HCC-CCA. We summarize current data on lymphadenectomy, safety, and oncologic comparability of minimally invasive vs. open surgery, and integration of liver hypertrophy techniques for major hepatectomy. We also review the emerging clinical experience with immune checkpoint inhibitor-based chemoimmunotherapy as a neoadjuvant treatment and conversion surgery for advanced disease. We highlight persisting knowledge gaps and propose practical perspectives to support individualized surgical planning for this heterogeneous disease.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"19-28"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146121270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic therapy for combined hepatocellular-cholangiocarcinoma: a comprehensive review of chemotherapy, immunotherapy, and targeted therapy.","authors":"Jung Yong Hong, Dong Hyun Sinn, Sang Yun Ha","doi":"10.17998/jlc.2026.03.02","DOIUrl":"10.17998/jlc.2026.03.02","url":null,"abstract":"<p><p>Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver malignancy exhibiting both hepatocytic and cholangiocytic differentiation. Since the 2019 World Health Organization (WHO) reclassification, growing molecular and clinical evidence has reshaped our understanding of this entity. However, patients with cHCC-CCA have been systematically excluded from landmark clinical trials in both hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA), leaving clinicians without prospective evidence to guide treatment selection. This review comprehensively evaluates the current evidence on systemic therapy for advanced cHCC-CCA, encompassing cytotoxic chemotherapy, immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors, and molecularly targeted agents. Retrospective data indicate that gemcitabine plus platinum-based chemotherapy achieves the most consistent efficacy among conventional regimens, with median overall survival of 10-16 months. ICIs demonstrate objective response rates of 20-33% with durable responses in a subset of patients, supported by the finding that approximately 57% of cHCC-CCA tumors harbor an immune-high phenotype. Nearly 25% of tumors carry potentially actionable genomic alterations, including fibroblast growth factor receptor 2 (FGFR2) fusions, isocitrate dehydrogenase 1 (IDH1) mutations, and human epidermal growth factor receptor 2 (HER2) amplification. The molecular heterogeneity of cHCC-CCA, with tumors classifiable as HCC-like or CCA-like in approximately 75% of cases, provides a rational framework for personalized treatment selection. We propose an emerging molecular classification-based treatment algorithm and identify critical gaps requiring dedicated prospective investigation. For clinical settings where comprehensive genomic profiling is not feasible, we discuss a pragmatic surrogate-based approach using imaging characteristics and serum tumor markers to guide initial treatment selection. We also address post-progression treatment considerations, including phenotype-based regimen switching and the role of re-biopsy.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"36-44"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of radiotherapy in the management of combined hepatocellular-cholangiocarcinoma: current evidence and future perspectives.","authors":"Seo Hee Choi, Woong Sub Koom, Ik Jae Lee","doi":"10.17998/jlc.2026.03.04","DOIUrl":"10.17998/jlc.2026.03.04","url":null,"abstract":"<p><p>Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare and highly aggressive hybrid malignancy characterized by a poor prognosis and high recurrence rates due to its dual histological nature. In the absence of established standard-of-care protocols, clinical management strategies are frequently extrapolated from the guidelines for its components, hepatocellular carcinoma and intrahepatic cholangiocarcinoma (iCCA). This review evaluates the evolving role of radiotherapy (RT) as an integral part of the multidisciplinary care for cHCC-CCA. Adjuvant RT may be considered for patients exhibiting high-risk pathological features, such as positive or close resection margins, lymphovascular invasion, and perineural invasion. For unresectable disease unfeasible for surgery or transarterial therapies, definitive RT using intensified doses, analogous to iCCA protocols, is employed to improve local control. High-precision modalities, particularly particle therapies such as proton or carbon ion RT, are emphasized as preferred options for delivering ablative doses while minimizing toxicity and preserving functional liver reserve. Furthermore, preliminary clinical evidence suggests a potential synergy between RT and immune checkpoint inhibitors, with reported cases demonstrating complete responses or successful conversion to curative-intent resection. While current evidence remains limited to retrospective cohorts and case series, the strategic integration of precision RT offers a rational pathway for optimizing outcomes in cHCC-CCA, necessitating further prospective validation.</p>","PeriodicalId":94087,"journal":{"name":"Journal of liver cancer","volume":" ","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13062623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}