S3012
Invited Speaker
ESTRO 2026
Reig M, Sanduzzi-Zamparelli M, Forner A, et al. BCLC strategy for prognosis prediction and treatment recommendations: The 2026 update. J Hepatol. 2026;84(3):631-654. Kawaguchi Y, Hasegawa K, Kashiwabara K, et al. Surgery versus ablation for hepatocellular carcinoma: a randomized controlled trial (SURF-RCT Trial) and a nonrandomized prospective observational trial (SURF- Cohort Trial). J Clin Oncol . 2025;43(23):2628-2638. Salem R, Padia SA, Toskich BB, et al. Radiation segmentectomy for early hepatocellular carcinoma is curative. J Hepatol . 2025;82(6):1125-1132. 5347 Testimonials and conclusions Jan-Jakob Sonke Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands Ben Mijnheer can be considered ‘the father of in vivo EPID dosimetry’. He started his career in radiation oncology in 1971 at the Netherlands cancer society on a project regarding neutron therapy. Following this project, he was appointed as a clinical physicist. He specialized in dosimetry, the development of new radiation techniques, and quality control. Ben realized that over the years, radiotherapy became increasingly complex and required rigorous quality assurance. The introduction of in-vivo dosimetry for each treatment would provide a robust QA system and help achieving safer treatments. With the development of EPIDs, Ben envisioned portal dosimetry as a key enabler of patient specific QA. Ben has led many research projects to advance the field of portal dosimetry and supervised more than 25 PhD students. He also contributed to different guidelines on dosimetry, QA and portal dosimetry through ICRU, BIR and AAPM. Ben realized that clinical physics needed improved representation within Estro. He chaired the first two ESTRO Biennial Meeting on Physics in Clinical Radiotherapy and was a member of the scientific committee for many other ESTRO meetings. Ben was also the first physics editor of "The Green Journal" and was a course director and teacher in multiple ESTRO courses. Ben was a strong advocate for multidisciplinary collaborations and encouraged physicists, technicians, and doctors to work together to improve the quality of radiotherapy. Ben never really retired and remained actively involved in education and research until the very end. Ben was an inspiration to the current generation of clinical physicists and, through his work, will continue to inspire future professionals in radiotherapy. Ben Mijnheer leaves behind a world where radiotherapy is significantly safer and more precise than when he began.
“ablation” is progressively expanding beyond conventional percutaneous thermal techniques. Rather than being defined only by the energy source used, ablation should be understood as the complete destruction of the tumor together with an adequate safety margin, with the goal of eradicating both the visible lesion and potential microscopic peritumoral spread while preserving functional liver parenchyma. Thermal ablation, including radiofrequency and microwave ablation, is a well-established treatment for small HCC, in very early and early stages. Its main advantages are minimal invasiveness, repeatability, low complication rates, short hospital stay, and excellent local control for tumors up to 3 cm. Randomized evidence comparing surgery and radiofrequency ablation in small HCC has shown no significant difference in overall survival or recurrence- free survival between the two strategies, supporting ablation as a valid curative-intent option in carefully selected patients. However, local recurrence may be more frequent after thermal ablation than after resection, especially when tumors are larger or difficultly located. Radiation segmentectomy further broadens the therapeutic meaning of ablation. By delivering a highly selective, ablative dose of yttrium-90 microspheres to one or two tumor-bearing hepatic segments, this technique can induce complete tumor necrosis while sparing the remaining liver. It is particularly relevant for patients with solitary or limited HCC who are unsuitable for resection, transplantation, or thermal ablation because of tumor location, comorbidities, or technical limitations. Modern dosimetry-based approaches aim to deliver sufficiently high absorbed doses to achieve durable local control and, in selected cases, complete pathological necrosis. Thermal ablation and radiation segmentectomy should therefore be viewed as complementary rather than competing strategies. Thermal ablation remains highly effective for small, accessible tumors, while radiation segmentectomy offers an alternative ablative approach for lesions that are larger or unfavorably located. Treatment selection should be individualized through multidisciplinary assessment, considering tumor size, number, location, liver function, portal hypertension, transplant eligibility, patient frailty, and local expertise. Within a modern HCC treatment algorithm, both modalities represent parenchyma- sparing, repeatable, curative-intent options that can improve outcomes while preserving future therapeutic opportunities. References: European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol. 2025 Feb;82(2):315-374.
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