Top Line: A recent pooled analysis suggests external beam radiation provides the best non-surgical disease control of hepatocellular carcinoma (HCC).
The Study: This large Korean single-institution retrospective cohort analyzed 1243 patients with treatment-naïve a single early-stage HCC who received either transarterial chemoembolization (TACE) alone (n=986) or TACE followed by radiation (n=257) between 2008–2018. Despite an expected higher rate of non-complete response after initial TACE in the radiation group, combined therapy delivered clear overall (63%→76%) and progression-free (42%→22%) survival advantages at 5 years. These advantages were exaggerated in propensity-score matching: overall survival was 54%→76% and progression free survival 12%→42%. Subgroup analyses identified who benefits most: tumors >4 cm, AFP >100, and non-complete response after TACE. Put together, these factors formed a simple stratification model—patients with 1–3 risk factors (Groups B & C) enjoyed major survival gains from RT, but those with none (Group A) saw no meaningful difference. Notably, as seen before, survival outcomes with early addition of radiation outperformed delayed radiation.
TBL: For select early-stage single HCC—especially larger tumors, high-producing AFP, or suboptimal TACE response—the addition of radiation to TACE achieves meaningfully better long-term survival. | Lee, Int J Radiat Oncol Biol Phys 2025
The Study: This large Korean single-institution retrospective cohort analyzed 1243 patients with treatment-naïve a single early-stage HCC who received either transarterial chemoembolization (TACE) alone (n=986) or TACE followed by radiation (n=257) between 2008–2018. Despite an expected higher rate of non-complete response after initial TACE in the radiation group, combined therapy delivered clear overall (63%→76%) and progression-free (42%→22%) survival advantages at 5 years. These advantages were exaggerated in propensity-score matching: overall survival was 54%→76% and progression free survival 12%→42%. Subgroup analyses identified who benefits most: tumors >4 cm, AFP >100, and non-complete response after TACE. Put together, these factors formed a simple stratification model—patients with 1–3 risk factors (Groups B & C) enjoyed major survival gains from RT, but those with none (Group A) saw no meaningful difference. Notably, as seen before, survival outcomes with early addition of radiation outperformed delayed radiation.
TBL: For select early-stage single HCC—especially larger tumors, high-producing AFP, or suboptimal TACE response—the addition of radiation to TACE achieves meaningfully better long-term survival. | Lee, Int J Radiat Oncol Biol Phys 2025