This is the report of a randomized, open-label clinical trial comparing the survival outcomes of neoadjuvant radiotherapy (RT) plus hepatectomy with hepatectomy alone in patients with resectable hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). This trial was conducted at 3 hospitals in China, and 164 patients with HCC and PVTT were randomized 1:1 to receive RT followed by surgery or surgery alone. On multivariable analyses, neoadjuvant RT significantly reduced HCC-related mortality (HR 0.35; 95%CI 0.23-0.54; p<0.001) and HCC recurrence rates (HR 0.45; 95%CI 0.31-0.64; p<0.001) compared with surgery alone. Two patients had grade 3 liver toxicity and were considered unsuitable for surgery. Increased expressions of IL-6 in pre-RT serum and tumor tissues were significantly associated with resistance to RT.
(Wei X et al. – Journal of Clinical Oncology, 8 July 2019)