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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: Patients diagnosed with early-stage hepatocellular carcinoma had comparable survival with external beam radiation as other traditional therapies. More research is needed for later-stage disease. Patients with very early or early-stage hepatocellular carcinoma have similar survival with external beam radiation as they do with traditional therapies. A systemic review of approximately 5,000 patients with HCC showed those with Barcelona Clinic Liver Cancer (BCLC) stage 0 had a median OS of nearly 7 years and those with stage A disease had a median OS of almost 5 years.
Data derived from Moon AM, et al. J Clin Oncol. 2026;doi:10.1200\/JCO-25-02399.
The \u201cbenchmark\u201d for traditional therapies, such as ablation, resection and transplant, is 5 years or more, Andrew M. Moon, MD, MPH, assistant professor of medicine in the division of gastroenterology and hepatology at The University of North Carolina at Chapel Hill, told Healio. Andrew M. Moon \u201cExternal beam radiation therapy is an excellent treatment for patients with very early-stage and early-stage HCC,\u201d he said. The study, which included 4,913 patients (mean age, 67 years; standard deviation, 10; 76% men), prompted the BCLC group to recommend external beam radiation as a treatment option for this patient population after omitting it in its 2022 update. Healio spoke with Moon about how external beam radiation fits in the treatment landscape of HCC, its potential in later-stage disease and more. Healio: How has hepatocellular carcinoma historically been treated? Moon: In localized hepatocellular carcinoma, there are three groups of treatments. We have surgical treatments like resection and liver transplant. We have non-surgical therapies like [transarterial chemoembolization (TACE)], transarterial radioembolization and thermal ablation. And then there\u2019s the new kid to the block, external beam radiation, specifically stereotactic body radiation therapy. Traditionally, surgical resection and thermal ablation have been the first-line options for very early-stage, a single lesion less than 2 centimeters. For early-stage, a single lesion of any size or up to three lesions of 3 centimeters or less, ablation, transplant and radioembolization have been the first-line therapies. Healio: Why wasn\u2019t external beam radiation used? Moon: The main reason was, when you treat HCC with external beam radiation, the rest of the uninvolved liver got a high radiation dose, and patients would be at high risk for radiation-induced liver disease. But, techniques have improved in recent years, and now they can precisely target lesions with high doses of radiation with relative sparing of the uninvolved liver. The nice thing about SBRT is it\u2019s totally noninvasive. The patient sits there, the radiation beams come from outside the body, and the radiation can specifically target the HCC. Over the last couple years, we\u2019ve shown really good outcomes in terms of local control, but we don\u2019t have as much data on how external beam radiation influences overall survival. The lack of overall survival data, specifically prospective data, led to the BCLC update in 2022 not including external beam radiation. There was a lot of controversy about that omission, particularly among the radiation oncology field. In light of that, Maria Reig, MD, PhD, director of Barcelona Clinic Liver Cancer of Hospital Clinic Barcelona and senior study author, was really interested in looking at the data on the association between external beam radiation therapy and overall survival among patients with HCC. Healio: Why would some patients benefit from external beam radiation over other therapies? Moon: Sometimes, decisions are straightforward. For example, if a patient cannot receive sedation or anesthesia because of a non-liver comorbidity or if a needle cannot physically reach a lesion to perform a thermal ablation – these are scenarios where external beam radiation can still be used effectively. Because external beam radiation is noninvasive, the patient just shows up, gets their treatment and walks out that day. Other cases are more nuanced and will depend on many factors, including expectations around post-treatment symptoms. Radiation-based treatments can cause some fatigue. Sometimes we see nausea and abdominal pain. However, it can be better tolerated than some of the intra-arterial therapies, like radioembolization and TACE. Oftentimes, patients will say, \u201cI didn\u2019t really feel anything after the external beam radiation therapy.\u201d If patients have lots of gastrointestinal symptoms before treatment, this can be better tolerated. One of the downsides of external beam radiation is inconvenience. It often requires more treatment sessions, usually three to five, compared to ablation, TACE or radioembolization, which are one-and-done. Additionally, any radiation-based treatment can be associated with worsening liver function. We have to carefully select who\u2019s a good candidate for external beam radiation. If we\u2019re worried about their baseline liver function or if nearby sensitive organs will get too much radiation, like the stomach or small bowel, we often avoid it. Healio: What is OS for other treatment modalities? Moon: Patients with very early-stage or early-stage HCC who get first-line ablation, resection or transplant have an expected overall survival over 5 years. That was our benchmark. Healio: What were the key findings? Moon: The big findings are specifically for BCLC-0, a single lesion less than or equal to 2 centimeters. [Median] overall survival was 6.8 years for that group. The important thing is, if you look at a lot of studies of early-stage disease, they often report median overall survival, but they don\u2019t look at it specifically among patients who are treatment naive. Patients who have gotten another treatment are a totally separate population, and their overall survival is not expected to be as good because they\u2019re diagnosed a few years earlier when they got their first treatment. We wanted to look not only at BCLC-0, but also treatment naive and then<\/p>\n","protected":false},"author":1,"featured_media":3091,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3090","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3090","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3090"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3090\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3091"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3090"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3090"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3090"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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