Do you offer adjuvant radiation therapy for patients with hepatocellular carcinoma status post partial hepatectomy with positive parenchymal margins?

The answer to this question had changed in my mind with the advent of ablative doses and techniques. If the postop scan does not show bowel near the area that you estimate to be at risk, I would observe and offer an ablative dose if there was an isolated recurrence. The competing risks of DM and liver decompression argues against an aggressive approach if bowel is present post op at the margin. In addion these patients often have coagulopathy and can be at increased risk for mucosal bleeding wit...

The University of Michigan does offer adjuvant radiotherapy for positive margin resection on a case by case basis, often after discussion at our multidisciplinary liver tumor board. We have used 30 Gy/5 fractions as a potential adjuvant hypofractionated course. In settings where we are not able to meet constraints due to surrounding bowel, a conventional course such as 50.4 to 54 Gy in 1.8Gy/fraction has been used. It is important to delineate volumes with the surgeon as treatment of the entire ...