Does Radiation Therapy Improve Survival in Hepatocellular Carcinoma Compared with Sorafenib Alone?

Sorafenib was once standard first-line treatment for inoperable or metastatic hepatocellular cancer (HCC) but has since been replaced by combination immunotherapy or by immunotherapy combined with bevacizumab. Prior to that shift, investigators initiated an open-label, randomized, phase 3 trial to evaluate whether adding stereotactic body radiotherapy (SBRT) to first-line sorafenib improved overall survival (OS) in patients with Child-Pugh A liver function and HCC not amenable to resection, ablation, or transarterial chemoembolization.

Patients assigned to sorafenib alone received 400 mg twice daily. Those assigned to SBRT and sorafenib received SBRT dosed at 27.5 to 50 Gy in 5 fractions over 5 to 15 days, followed by sorafenib 200 mg twice …