External Radiation versus Internal Radiation for Patients with Advanced Unresectable HCC -A SEER Based Study

Hepatocellular carcinoma (HCC), 2nd most lethal cancer globally, is the major type of primary liver malignancies currently resulting in about 800,000 deaths globally per annum. Surgical resection remains the only curative treatment to HCC, which does not fit for many patients diagnosed with advanced HCC. Radiation therapy has been gradually concerned as an optional treatment for patients with advanced unresectable HCC. This study aimed to compare external radiation (beam radiation) and internal radiation as a single radiation therapy to advanced HCC patients (TNA stage III and IV according to the derived AJCC Stage, 6th edition) stratified by other risk factors, based on the data collected from the Surveillance, Epidemiology and End Results (SEER) national database. In this cohort study, we mainly clarified the following three points: 1. Choices of radiation therapy for advanced HCC patients vary in demographic and clinical factors. Among these, TNM classification is the key factor. 2. Internal radiation provides a better prognosis in both OS and CSS. 3. Patients in stage IV could benefit from internal radiation preferentially, while for patients in stage III, internal radiation therapy makes no difference compared with external radiation.