Stereotactic body radiotherapy for hepatocellular carcinoma: Five-year prospective registry outcomes from an Australian tertiary transplant centre

doi:10.3748/wjg.118570

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Aug 28, 2026; 32(32): 118570
Published online Aug 28, 2026. doi: 10.3748/wjg.118570

Stereotactic body radiotherapy for hepatocellular carcinoma: Five-year prospective registry outcomes from an Australian tertiary transplant centre

Su Chen Fong, Sweet Ping Ng, Dominic Italiano, William Chung, Karl Vaz, Michael Fink, Mark Goodwin, Dinesh Ranatunga, Richard Khor

Su Chen Fong, Sweet Ping Ng, Richard Khor, Department of Radiation Oncology, Olivia Newton-John Cancer Centre at Austin Health, Melbourne 3084, Victoria, Australia

Su Chen Fong, Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne 3000, Victoria, Australia

Sweet Ping Ng, Richard Khor, Olivia Newton John Cancer Research Institute, Melbourne 3084, Victoria, Australia

Sweet Ping Ng, Dominic Italiano, Mark Goodwin, Melbourne Medical School, University of Melbourne, Melbourne 3010, Victoria, Australia

Dominic Italiano, Australian Stroke Alliance, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne 3050, Victoria, Australia

William Chung, Karl Vaz, Department of Gastroenterology, Austin Health, Melbourne 3084, Victoria, Australia

William Chung, Karl Vaz, Michael Fink, Victorian Liver Transplant Unit, Austin Health, Melbourne 3084, Victoria, Australia

Karl Vaz, Michael Fink, Department of Surgery, University of Melbourne, Melbourne 3084, Victoria, Australia

Mark Goodwin, Dinesh Ranatunga, Department of Radiology, Austin Health, Melbourne 3084, Victoria, Australia

Richard Khor, School of Molecular Sciences, La Trobe University, Melbourne 3086, Victoria, Australia

Author contributions: Fong SC, Khor R, and Ng SP designed the research study and methodology; Vaz K, Fong SC, Khor R, and Ng SP performed the investigation; Italiano D, Fong SC, and Khor R performed data curation and formal analysis; Fong SC, Ng SP, Italiano D, Chung W, Vaz K, Khor R, Fink M, Goodwin M, and Ranatunga D contributed to writing the draft manuscript and revisions; All authors have read and approved the final manuscript.

Institutional review board statement: This study was reviewed and approved by the Austin Health Human Research Ethics Committee.

Clinical trial registration statement: This study received ethical approval from the Austin Health Human Research Ethics Committee, No. HREC/17/QPAH/870 and No. HREC/CD 21/009.

Informed consent statement: The requirement for informed consent was waived by the committee due to the low-risk nature of the study and use of de-identified registry data.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.

Data sharing statement: Research data are stored in an institutional repository and are available upon justified request to the corresponding author.

Corresponding author: Su Chen Fong, Consultant, Research Fellow, Department of Radiation Oncology, Olivia Newton-John Cancer Centre at Austin Health, No. 145 Studley Road, Melbourne 3084, Victoria, Australia. fongsc.ro3@gmail.com

Received: January 7, 2026
Revised: March 12, 2026
Accepted: April 27, 2026
Published online: August 28, 2026
Processing time: 207 Days and 0.2 Hours

Abstract

BACKGROUND

Stereotactic body radiotherapy (SBRT) has emerged as a promising treatment modality for hepatocellular carcinoma (HCC), offering precise high-dose radiation delivery while preserving liver function. However, real-world prospective data from transplant centres, particularly regarding bridging and salvage applications, remain limited. We hypothesised that SBRT would achieve durable local control with acceptable toxicity across diverse clinical indications in a real-world tertiary transplant-centre cohort.

AIM

To evaluate efficacy and safety of SBRT for HCC in a prospective cohort at a tertiary transplant centre.

METHODS

We conducted a prospective, single-centre registry of consecutive HCC patients treated with SBRT between August 2016 and June 2022. The primary endpoint was local control. Secondary endpoints included progression-free survival (PFS), overall survival (OS), and treatment-related toxicity.

RESULTS

With a median follow-up of 23.6 months, 58 patients received 60 SBRT courses for 64 HCC lesions. Most were male (81%), cirrhotic (93.1%) and Child-Pugh A disease (74.1%). Barcelona Clinic Liver Cancer stages were 0/A in 43%, B in 40%, and C in 17%. Most patients (90%) had received prior locoregional treatment. The median prescribed biologically effective dose was 72 Gy, most commonly 40 Gy in 5 fractions. One- and two-year local control rates were 90% and 85%, OS 80% and 60%, and PFS 55% and 40%, respectively. Isolated local failure occurred in 13.3%, while intrahepatic and extrahepatic progression occurred in 35% and 13%. Treatment completion was 98%, with no grade ≥ 3 toxicities.

CONCLUSION

SBRT achieved durable local control with minimal toxicity for HCC, supporting its role as an effective liver-directed treatment option across curative, bridging and salvage clinical settings.

Keywords: Hepatocellular carcinoma; Stereotactic body radiotherapy; Liver-directed therapy; Local control; Treatment toxicity; Prospective registry; Bridging therapy; Salvage treatment

Core Tip: The role of stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma is evolving within contemporary treatment guidelines. In this prospective real-world registry, SBRT achieved durable local control with minimal toxicity across curative, bridging-to-transplant, and salvage indications, including patients with impaired liver function and advanced disease. Despite excellent in-field control, out-of-field intrahepatic progression was the dominant failure pattern, highlighting the importance of integrating SBRT within multidisciplinary, stage-adapted treatment pathways.