Radiation Therapy in Treating Patients With Hepatocellular Carcinoma, Cholangiocarcinoma, or Liver Metastasis Who Have Impaired Liver Function

Inclusion Criteria

• •Diagnosis of hepatocellular carcinoma, cholangiocarcinoma, or liver metastasis from any histology
• •Patients may have single or multinodular tumors
• •There is no specific tumor size cut-off for this protocol; however, the radiation treatment plan must meet the protocol's dose constraints
• •Compromised liver function as defined by any of the following:
• •* Cohort 1: Advanced cirrhosis group
• •* Borderline Child-Pugh class A6
• •* Child-Pugh class B
• •* The patients in this advanced cirrhosis group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (computed tomography \[CT\] or magnetic resonance imaging \[MRI\]) or single photon emission computed tomography (SPECT)/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
• •* Cohort 2: Low functional liver volume without underlying chronic liver disease
• •* Previous irinotecan or oxaliplatin chemotherapy
• •* Previous liver resection(s)
• •* These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging computed tomography or magnetic resonance imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients;
• •* Cohort 3: History of prior liver-directed radiation therapy with either fractionated external beam radiation therapy (EBRT), stereotactic body radiation therapy (SBRT) or yttrium-90 radioembolization (Y90 RE); the interval between prior EBRT and re-irradiation on protocol should be equal to or greater than 12 months; the interval between prior Y90 RE and re-irradiation on protocol should be equal to or greater than 6 months;
• •* Cirrhosis group:
• •* Child-Pugh class A5;
• •* Borderline Child-Pugh class A6;
• •* The patients in this group must have at least 400 ml of functional liver, as estimated on either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
• •* Low functional liver volume without underlying liver disease
• •* Previous irinotecan or oxaliplatin chemotherapy
• •* Previous liver resection(s)
• •* These patients must have at least 400 ml of functional liver, as estimated by either diagnostic imaging (CT or MRI) or SPECT/CT with Tc-99m sulfur colloid; there is no upper limit on the functional liver volume for these patients
• •Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2
• •Women of childbearing potential (those who have not undergone a hysterectomy or who have not been postmenopausal for at least 24 consecutive months) must agree to practice adequate contraception and to refrain from breast feeding
• •Prior history of surgical resection, chemotherapy, transarterial chemoembolization (TACE), and/or radiofrequency ablation are allowed
• •Expected survival must be greater than 3 months
• •Patients may receive concurrent capecitabine or sorafenib at the discretion of the treating physicians
• •Signed study-specific consent form