Stereotactic body radiation therapy following transarterial chemoembolization for unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second largest contributor to cancer mortality, especially in the developing world (1). While less common in the United States, there has been a consistent increase in prevalence and mortality over the past several decades (2). Among several staging systems, the Barcelona Clinic Liver Cancer (BCLC) is among the most widely accepted, which uses several factors, including tumor size, number of lesions, vascular invasion, and performance status to prognosticate and make treatment recommendations (3). For early stage disease, surgical resection, transplant, or radiofrequency ablation (RFA) are the preferred treatments and can be curative in select patients. For intermediate stage, the only treatment shown to improve survival in a randomized trial is transarterial chemoembolization (TACE) (4). TACE has also produced good outcomes in the BCLC A population via stage migration; however, TACE is generally not considered an ablative treatment