SBRT Versus Surgical Resection for Small HCC

Inclusion Criteria

• •1. Age 18 to 75 years, with no restriction on sex;
• •2. Clinically or pathologically diagnosed hepatocellular carcinoma, according to the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2024 edition);
• •3. A solitary tumor with a maximum diameter of ≤5 cm, for which treatment is indicated;
• •4. No radiologic evidence of macrovascular invasion, distant metastasis, or lymph node metastasis;
• •5. Treatment-naïve or previously treated patients are eligible, provided that they are deemed suitable for both surgical resection and radiotherapy by a multidisciplinary team (MDT) and do not require concomitant systemic therapy at enrollment;
• •6. For patients with recurrent disease, recurrence must occur at least 1 year after prior curative treatments;
• •7. Previously treated patients must not have received systemic therapy within 6 months before enrollment;
• •8. In previously treated patients, tumor size must be assessed according to RECIST version 1.1 at enrollment;
• •9. A normal liver volume of ≥700 cc, with an estimated future liver remnant volume of \>40% after resection;
• •10. A Karnofsky performance-status score of ≥90;
• •11. Child-Pugh class A liver function;
• •12. An estimated life expectancy of more than 6 months;
• •13. Adequate organ function, defined as follows: white-cell count ≥3.5×10⁹/L, absolute neutrophil count ≥1.5×10⁹/L, platelet count ≥75.0×10⁹/L, hemoglobin ≥90 g/L; serum albumin ≥28 g/L; total bilirubin ≤1.5 times the upper limit of normal (ULN), alanine aminotransferase or aspartate aminotransferase ≤2.5 times the ULN; serum creatinine ≤1.5 times the ULN or creatinine clearance \>60 mL per minute; and no severe concomitant organic disease;
• •14. The ability to understand the study procedures and to provide written informed consent before the initiation of any study-specific procedures, with agreement to receive treatment and follow-up according to the study protocol.