Radiation is the use of high-energy electromagnetic rays to disrupt the DNA that causes cancer. Radiation can kill the cancer cells and/or stop new cells from being created. A radiation oncologist plans and directs radiation treatment in cancer patients, working with a team that may include a radiation oncology nurse, technicians, and therapists.

In this video from Cancer.net, Dr. Karen Winkfield gives an overview of the types of radiation therapy and potential side effects

In some cases, radiation is used in combination with other treatments, such as surgery and/or chemotherapy. For example, radiation may be used to shrink tumors before surgery, or may be used in conjunction with chemotherapy to treat recurring tumors. Radiation can also be used to shrink tumors, make the patient more comfortable, and prolong life when surgery is not possible. Radiation is also sometimes used to treat fibrolamellar metastases outside of the liver1.

Use of radiation therapy in FLC

For cancers like FLC, radiation therapy is typically given in two ways:

External beam radiation therapy (EBRT) can help control the growth of liver metastases. This approach is most often used when the cancer can’t be removed surgically, and the liver tumors are too large for treatment with ablation, a type of interventional radiology.

With EBRT, a machine delivers radiation following imaging scans taken of the tumors. As with any form of radiation, the goal is to deliver a targeted dose of radiation directly to a tumor, with as little radiation as possible hitting healthy organs. For that reason, a patient’s abdomen may be tattooed with tiny dots to help the technician pinpoint the exact location of the disease.

Before the start of radiation treatment, the patient is also usually fitted for a mold – a foam device that will hold the body in place during treatment and ensure that the patient will be in exactly the same position for all the radiation treatments.

Sometimes other drugs, like 5-FU, are used alongside radiation therapy as radiosensitizers, to make the tumor more susceptible to damage by the radiation treatment.

Types of EBRT

There are several ways of delivering the external radiation:

  • Stereotactic body radiation therapy (SBRT) is an intense radiation dose (delivered in one to several sessions). The major downside of SBRT is the possibility of damaging neighboring organs.
  • Intensity-modulated radiation therapy (IMRT) involves targeting the tumor with small beams of radiation of varying strengths, which has the advantage of limiting exposure to adjacent organs.
  • Three-dimensional conformal radiation therapy (3D-CRT) uses a three dimensional image of the tumor, then employs beams of radiation matched to the tumor’s size and shape. Because of its precision, it is often used when tumors are close to vital organs. This form of radiation usually requires multiple sessions over many weeks.
  • Proton beam therapy (PBT) aims proton beams (positively-charged particles that create energy to destroy cancer cells) at the tumor. PBT has the advantage of being highly targeted and can be done over just a few sessions. However, there are very few treatment centers that offer PBT, and it is much more expensive than other treatments.

In many clinics and hospitals, the radiation technology is sometimes called by the brand name of the company that made the machine. Brands of commonly-used machines that move around to target the tumor from many different angles include CyberKnife, X-Knife, Clinac, Novalis, and TrueBeam. Gamma Knife is another brand of machine that uses about 200 separate small beams of radiation at one time, creating a very large dose focused on the tumor.

Coping with Side Effects

A session of radiation typically takes about 15 minutes, and is painless. However, many people do experience side effects after several sessions. Some of the most common side effects with abdominal radiation include itchy, dry or blistering skin at the site of the radiation, fatigue, loss of appetite, nausea, diarrhea and cramping. 

A patient’s radiology team will suggest ways to cope with most of these side effects. For example, there are medications to prevent vomiting, lotions to soothe the skin, and dietary changes that can help with digestive issues. The good news is that many of these side effects are temporary and go away shortly after radiation treatments have ended.

With internal beam radiation, an interventional radiologist inserts radioactive material inside or near the tumor to kill cancer cells and shrink the tumor.  This form of treatment is often called brachytherapy. It has the advantage of delivering a high dose of radiation to a very targeted area. Radioembolization is the most common form of brachytherapy used in FLC and other liver cancers. (See radioembolization under interventional radiology.)

For more information about radiation therapy, please visit:

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3804803/

Please note: The Fibrolamellar Cancer Foundation does not provide medical advice or recommend any specific organizations or services. We provide website users with information to help them better understand their health conditions and current approaches to the diagnosis and treatment of FLC. Always seek the advice of your physician or other qualified healthcare providers.