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According to the 2003 clinical practice guideline reported by Korean Liver Cancer Study Group (KLCSG) and National Cancer Center (NCC), Radiation therapy (RT) has been considered as alternative or complementary modality in cases where surgical resection is not possible, local treatment or trans-hepatic arterial chemo-embolization (TACE) does not provide a cure. At that time, the guideline suggested that further studies are needed to confirm the beneficial role of RT in the management of HCC because RT lacked the high quality scientific evidences at that time. However, the 2003 guideline did the pivotal role in accentuating research efforts to enlighten the role of RT in HCC management. Recently, many scientific evidences are piled up strengthening the level of evidence. Also there was the quantitative expansion of reported studies dealing with RT role in HCC management. In the 2009 Practice guidelines for the management of HCC, radiation oncologists participated as member of revision committee put every efforts to make good of RT related guideline. And to place RT related guidelines as a special feature of Korean version of HCC management guidelines. Discussions were made among radiation oncologists in the revision committee. The participating radiation oncologists realized that still there are no randomized controlled trials exploring the role of RT in HCC management. The role of RT in the management of HCC is underestimated still. To prepare the next version of practice guideline, the every effort must go on to invigorate the role of RT in the management of HCC.
Understanding the mechanism of hepatocarcinogenesis has provided the opportunity to evaluate the efficacy of molecularly targeted agents in HCC. Sorafenib is a multikinase inhibitor with antiangiogenic, proapoptotic, and Raf kinase inhibitory effects, and it is the first new agent to consistently prolong overall survival in patients with advanced hepatocellular carcinoma (HCC). The success of sorafenib is a milestone for systemic therapy of HCC, shifting the paradigm of systemic treatment to molecular targeted agents. Many novel agents that inhibit angiogenesis, epidermal growth factor receptor, and mammalian target of rapamycin are under clinical development. This review attempts to summarize the current status and future perspectives of systemic therapy in HCC.