[Efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma]

Objective: To investigate the efficacy and safety of neoadjuvant radiotherapy in patients with resectable hepatocellular carcinoma (HCC). Methods: A retrospective analysis was conducted on the clinical data of 34 patients with HCC who received neoadjuvant radiotherapy from February 2016 to August 2022 at the Chinese Academy of Medical Sciences and Peking Union Medical College in Beijing, China. Radiographic and pathological tumor response were evaluated. Follow-up period ended on September 30, 2025. The Kaplan-Meier method was used to calculate disease-free survival (DFS) and overall survival (OS), and the log-rank test was applied to compare DFS and OS between groups. Radiotherapy-and surgery-related adverse events were also evaluated. Results: Among the 34 patients [median age, 55 years (range:20-77 years); 31 male (91.2%) individuals], five patients (14.7%) had distal tumor thrombus. Thirty patients (88.2%) had tumor located within 1 cm of major blood vessels or their branches. Twenty-four patients (70.6%) had lesions with a maximum diameter>5 cm, two patients (5.9%) had serum alpha-fetoprotein levels>1 000 ng/ml. All patients completed the planned conventional fractionated radiotherapy (RT). According to Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1), 14 patients (41.2%) had partial response (PR); according to modified RECIST, 9 patients (26.5%) had complete response and 17 patients (50%) had PR. No patient had progressive disease before surgery. The median (range) interval between surgery and last RT was 9.9 (4.6-44.3) weeks. Severe treatment response was found in 16 patients (47.1%), while pathologic complete response in 4 patients (11.8%) and major pathological response in 15 patients (44.1%). With a median (range) follow-up of 83.7 (6.2-110.3) months, the median OS was not reached, and OS rates were 97.0% at 1 year, 84.8% at 3 years, and 84.8% at 5 years. The median DFS was 42.7 months, and DFS rates were 76.9% at 1 year, 63.0% at 3 years, and 37.8% at 5 years. Radiotherapy-related grade 3 adverse events were observed in 3 patients (7.7%). The remaining adverse events were all grade 1-2. Eleven patients (32.4%) developed operative complications, including grade Ⅰ complications in 2 patients (5.9%), grade Ⅱ in 4 patients (11.8%) and grade Ⅲa in 5 patients (14.7%). No grade Ⅲb or higher operative complications were observed. Conclusion: Neoadjuvant radiotherapy combined with surgery demonstrates promising local efficacy for patients with resectable HCC, achieving a 5-year OS of exceeding 80% with good tolerance of surgery.