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. 2025 May;8(5):e70212.
doi: 10.1002/cnr2.70212.

Long-Term Survival and Prognostic Factors of Stereotactic Body Radiotherapy Following Transarterial Chemoembolization for Hepatocellular Carcinoma

Hoang Dong Duc  1 , Mai Binh Thanh  2 , Mai Bang Hong  2 , Nguyen Thinh Tien  2 , Nguyen Thai Van  2 , Bui Bieu Quang  3 , Nguyen Chau Dinh  3 , Thai Ky Doan  2
Affiliations

Long-Term Survival and Prognostic Factors of Stereotactic Body Radiotherapy Following Transarterial Chemoembolization for Hepatocellular Carcinoma

Hoang Dong Duc et al. Cancer Rep (Hoboken). 2025 May.

Abstract

Background/aims: This study presents a detailed analysis of long-term survival and critical factors influencing the outcomes of hepatocellular carcinoma patients treated with stereotactic body radiotherapy (SBRT) and transarterial chemoembolization (TACE). Our findings provide reassurance about the potential of the combination of TACE and SBRT as an effective treatment strategy for patients with large liver tumors due to HCC.

Methods: A prospective study was conducted on 42 patients with intermediate-stage hepatocellular carcinoma (HCC) at 108 Military Central Hospital between December 2018 and June 2024. Following a single session of TACE, each patient underwent SBRT 1 month later. The SBRT dose ranged from 27.5 to 48 Gy, delivered in 3-5 fractions. The patient survival analysis was conducted using the Kaplan-Meier method while examining prognostic factors influencing survival, which involved log-rank tests and Cox proportional hazards regression analysis.

Results: Among the 42 patients (83.3% male), 34 patients (81.0%) had tumors measuring ≥ 5 cm. The median follow-up period was 32.2 months (4.5-65.1 months). The median overall survival (OS) was 32.6 months, with the respective 1-, 3-, and 5-year OS rates reported as 73.8%, 24.5%, and 19.6%. Furthermore, the median progression-free survival (PFS) was 16.6 months, with corresponding 1- and 3-year PFS rates of 71.4% and 19.0%. Factors linked to improved OS and PFS included AFP levels and treatment response based on Modified RECIST criteria. Additionally, multivariate analysis identified patient age, EQD2, and BED10 as significant predictors of better survival outcomes.

Conclusions: Our study provides evidence supporting the effectiveness and safety of combining TACE and SBRT as a treatment strategy for patients with large liver tumors due to HCC, instilling confidence in the future of HCC treatment. Positive prognostic factors included patient age, EQD2, and BED10.

Keywords: hepatocellular carcinoma; stereotactic body radiotherapy; transarterial chemoembolization.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival curves; median overall survival was 32.6 months.
FIGURE 2
FIGURE 2
AFP response and objective response were significant prognostic factors for OS.
FIGURE 3
FIGURE 3
AFP response and objective response were significant prognostic factors for PFS.
See this image and copyright information in PMC

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