TACE Plus SBRT Effective in Large Tumors Caused by HCC

New research suggests the combination of transarterial chemoembolization (TACE) and stereotactic body radiotherapy (SBRT) is effective in patients with large liver tumors due to hepatocellular carcinoma (HCC).1 The findings, which were reported in Cancer Reports, also offered insights on prognostic factors associated with superior survival outcomes.

HCC is difficult to detect at an early stage, even in countries with advanced health care systems, the authors explained. HCC is the most common type of liver cancer, and it typically occurs in patients with chronic liver conditions.2 This includes metabolic dysfunction–associated steatohepatitis, which is an emerging cause of HCC.3

Late diagnosis can result in larger tumors at the time of diagnosis.1 That is important for prognostic reasons, the authors noted, because liver tumors greater than 5 cm in diameter are associated with a poorer prognosis. Among patients with large tumors, TACE is a common therapeutic choice, though it has significant limitations.

HCC is the most common type of liver cancer, and it typically occurs in patients with chronic liver conditions. | Image Credit: Crystal light - stock.adobe.com

“While TACE remains the primary treatment for intermediate-stage HCC when curative options are not feasible, its effectiveness diminishes with repeated sessions, and the risk of liver function deterioration increases,” they wrote.

The limits of TACE have led some to look for additional therapeutic approaches to pair with TACE. SBRT has led to promising outcomes in HCC, though the authors said its use has been limited due to concerns about radiation-induced liver disease.

“However, technological advancements, including respiratory motion management and image-guided delivery, have improved the precision and safety of SBRT, making it a potential alternative or adjunct to TACE,” they said.

Early studies into the combination of SBRT and TACE have been promising, but the authors noted that direct evidence comparing SBRT plus TACE to other combination strategies remains limited.

The new study was designed to help scientists better understand long-term outcomes and prognostic indicators associated with survival in patients with large HCC-associated liver tumors treated with TACE and SBRT.

The investigators identified 42 patients with intermediate-stage HCC who were treated at their hospital between December 2018 and June 2024. Of those, 34 patients had tumors measuring 5 cm or greater in diameter. Each of the patients underwent one session of TACE, followed one month later by SBRT. SBRT dosage ranged from 27.5 to 48 Gy, delivered in 3-5 fractions, the authors said.

At a median follow-up of 32.2 months, the median overall survival was 32.6 months. The one-year overall survival (OS) rate was 73.8%, and the 5-year OS rate was 19.6%. In terms of progression-free survival (PFS), the median PFS was 16.6 months. The one-year PFS rate was 71.4%, and the 3-year PFS rate was 19.0%.

“The combination of TACE and SBRT is a potentially effective and safe treatment approach for patients with intermediate-stage HCC presenting with large tumors,” the authors wrote.

A multivariate analysis identified a number of factors as important predictors of survival. They included younger age (below 60 years), an equivalent dose in a 2 Gy fraction of less than 74 Gy, and a biologically effective dose of less than 100 Gy.

The authors noted some of their prognostic findings differed from previous studies; however, they said those differences could be due to differences in patient populations. They recommend conducting a larger study across multiple centers in order to validate their findings.

References

1. Duc HD, Thanh MB, Hong MB, et al. Long-term survival and prognostic factors of stereotactic body radiotherapy following transarterial chemoembolization for hepatocellular carcinoma. Cancer Rep (Hoboken). 2025;8(5):e70212. doi:10.1002/cnr2.70212

2. Hepatocellular carcinoma. Mayo Clinic. April 28, 2023. Accessed July 30, 2025. https://www.mayoclinic.org/diseases-conditions/hepatocellular-carcinoma/cdc-20354552

3. Karin M, Kim JY. MASH as an emerging cause of hepatocellular carcinoma: current knowledge and future perspectives. Mol Oncol. 2025;19(2):275-294. doi:10.1002/1878-0261.13685