South central.

Top Line: Centrally-located hepatocellular carcinoma (HCC) typically carries an even worse prognosis than peripheral HCC.

The Study: That’s because of its proximity to critical vascular and biliary structures making surgery difficult and wide margins nearly impossible. In this Chinese single arm phase 2 trial, 38 patients with resectable central HCC received neoadjuvant radiation via IMRT to 50-60 Gy in 25-30 fractions. The CT simulation was fused with multiphasic contrast MR imaging. The clinical target was gross tumor plus a 0.5 cm radial margin plus any tumor thrombus, and the planning target added another 1 cm margin sup-inf for respiratory motion and 0.5 cm in all other directions. Partial hepatectomy was performed 4-12 weeks following radiation completion. A major pathological response was achieved in 13 (34%), of whom 5 (13%) achieved a complete pathological response. Median overall survival has not been reached as 69% are still alive at 5 years. That is in stark contrast to 37% alive at 5 years among enrollees with similar inclusion criteria in another prospective trial.

TBL: With further investigation, radiation may be an effective neoadjuvant treatment option for centrally located HCC. | Wu, JAMA Surg 2022