Chen L, Wang L, Wang H. Comparison of stereotactic body radiotherapy following transcatheter arterial chemoembolization vs transcatheter arterial chemoembolization alone in hepatocellular carcinoma. World J Gastrointest Surg 2025; 17(10): 105360 [DOI: 10.4240/wjgs.v17.i10.105360]
Corresponding Author of This Article
Hui Wang, MM, Medical Imaging Center, Central Hospital Affiliated to Shandong First Medical University (Jinan Central Hospital), No. 105 Jiefang Road, Lixia District, Jinan 250013, Shandong Province, China. wanghui85341@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Oct 24, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Chen L, Wang L, Wang H. Comparison of stereotactic body radiotherapy following transcatheter arterial chemoembolization vs transcatheter arterial chemoembolization alone in hepatocellular carcinoma. World J Gastrointest Surg 2025; 17(10): 105360 [DOI: 10.4240/wjgs.v17.i10.105360]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 105360 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.105360
Comparison of stereotactic body radiotherapy following transcatheter arterial chemoembolization vs transcatheter arterial chemoembolization alone in hepatocellular carcinoma
Lin Chen, Liang Wang, Hui Wang
Lin Chen, Liang Wang, Department of Radiology, The Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, Wuhan 430014, Hubei Province, China
Hui Wang, Medical Imaging Center, Central Hospital Affiliated to Shandong First Medical University (Jinan Central Hospital), Jinan 250013, Shandong Province, China
Co-first authors: Lin Chen and Liang Wang.
Author contributions: Chen L and Wang L contributed equally to this work and share first authorship; Chen L was responsible for data collection, statistical analysis, and manuscript drafting; Wang L contributed to study design, patient follow-up, and interpretation of results; Wang H supervised the entire study, including conceptualization, methodology development, critical revision of the manuscript, and final approval of the version to be submitted.
Institutional review board statement: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Jinan Central Hospital, Affiliated to Shandong First Medical University (Approval No. c2024-08-0026).
Informed consent statement: Written informed consent was obtained from all participants prior to enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to patient privacy and institutional regulations but are available from the corresponding author upon reasonable request at wanghui85341@163.com.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Wang, MM, Medical Imaging Center, Central Hospital Affiliated to Shandong First Medical University (Jinan Central Hospital), No. 105 Jiefang Road, Lixia District, Jinan 250013, Shandong Province, China. wanghui85341@163.com
Received: February 18, 2025 Revised: April 6, 2025 Accepted: August 8, 2025 Published online: October 27, 2025 Processing time: 247 Days and 17.3 Hours
Abstract
BACKGROUND
For patients with unresectable hepatocellular carcinoma (HCC), both stereotactic body radiation therapy (SBRT) and transcatheter arterial chemoembolization (TACE) have demonstrated effectiveness in controlling local tumor growth. We investigated whether combining these treatments could provide better outcomes than TACE monotherapy.
AIM
To evaluate whether combining SBRT with TACE provides superior clinical outcomes compared to TACE alone in patients with unresectable HCC.
METHODS
We conducted a randomized study involving eighty patients diagnosed with unresectable HCC, classified as Barcelona Clinic Liver Cancer stage B and Child-Pugh class A. Participants were divided into two treatment arms: A control group receiving TACE alone (Group A) and an experimental group receiving sequential TACE and SBRT (Group B). The SBRT regimen consisted of 40 Gy administered in five daily fractions over one week. Primary endpoints included local control, progression-free survival (PFS), and overall survival (OS), with secondary endpoints focusing on toxicity profiles. Additional analyses explored the impact of different SBRT dose levels.
RESULTS
The study enrolled 88 patients from April 2021 to January 2023, with 48 assigned to Group A and 40 to Group B. Over a median follow-up period of 20 months, the combination therapy group demonstrated superior outcomes in both tumor control and disease progression metrics. Complete response rates reached 75% in Group B compared to 54.5% in Group A. The combination therapy extended median PFS to 16 months, significantly longer than the 11 months observed with TACE alone (P = 0.003). Neither group had reached median OS by study conclusion. Importantly, both treatment approaches showed comparable safety profiles.
CONCLUSION
Our findings suggest that supplementing TACE with SBRT offers a well-tolerated and effective treatment strategy for advanced HCC patients. This combination approach achieved better tumor control and delayed disease progression compared to TACE monotherapy, while maintaining an acceptable safety profile.
Core Tip: Combining transcatheter arterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) significantly enhanced local tumor control and prolonged progression-free survival in unresectable hepatocellular carcinoma. Despite a mild increase in hepatic toxicity, it remained manageable and reversible, with most patients recovering by three months. The synergy of TACE’s localized chemotherapy and SBRT’s precise high-dose radiation is a promising approach for Barcelona Clinic Liver Cancer stage B, Child-Pugh A patients. Our findings emphasize careful dosing, robust imaging guidance, and close monitoring of liver function to optimize safety. Integration of immunotherapy and further refinements in treatment planning might yield even better outcomes in the future.
