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Objectives The optimal locoregional treatment for non-resectable hepatocellular carcinoma ( HCC) of ≥3 cm in diameter is unclear. Transarterial chemoembolization ( TACE) is the initial intervention most commonly performed, but it rarely eradicates HCC. The purpose of this study was to measure survival in HCC patients treated with adjuvant stereotactic body radiotherapy ( SBRT) following TACE. Methods A retrospective study of patients with HCC of ≥3 cm was conducted. Outcomes in patients treated with TACE alone ( n = 124) were compared with outcomes in those treated with TACE + SBRT ( n = 37). Results There were no significant baseline differences between the two groups. The pre- TACE mean number of tumours ( P = 0.57), largest tumour size ( P = 0.09) and total tumour diameter ( P = 0.21) did not differ significantly between the groups. Necrosis of the HCC tumour, measured after the first TACE, did not differ between the groups ( P = 0.69). Local recurrence was significantly decreased in the TACE + SBRT group (10.8%) in comparison with the TACE-only group (25.8%) ( P = 0.04). After censoring for liver transplantation, overall survival was found to be significantly increased in the TACE + SBRT group compared with the TACE-only group (33 months and 20 months, respectively; P = 0.02). Conclusions This retrospective study suggests that in patients with HCC tumours of ≥3 cm, treatment with TACE + SBRT provides a survival advantage over treatment with only TACE. Confirmation of this observation requires that the concept be tested in a prospective, randomized clinical trial. [ABSTRACT FROM AUTHOR]

Objectives Repeat transarterial chemoembolization ( TACE) is a common intervention performed for hepatocellular carcinoma ( HCC). The aim of this study was to identify predictors of the need for repeat TACE. Methods Between 2008 and 2012, data on patient and tumour variables were collected for 262 patients treated with a first TACE procedure for HCC. The decision to perform repeat TACE procedures was made at the completion of the first TACE or after follow-up imaging demonstrated the subtotal treatment of HCC tumours. Results Repeat TACE was performed in 67 of 262 (25.6%) patients. Necrosis of HCC, measured after the first TACE, was lower in patients who subsequently received repeat TACE ( P = 0.042). On multivariable analysis, total tumour diameter of >5 cm [odds ratio ( OR) 2.76, 95% confidence interval ( CI) 1.45-5.25; P = 0.002] and increasing age ( OR 1.04/year, 95% CI 1.00-1.07; P = 0.030) were predictive of the need for repeat TACE. Measures of liver function and TACE approach (selective versus non-selective) were not predictive of repeat TACE. Median survival did not differ significantly between patients who did (median survival: 21.1 months) and did not (median survival: 26.1 months) receive a repeat TACE procedure ( P = 0.574). Conclusions The requirement for repeat TACE is associated with older age, increased HCC tumour burden and subtotal TACE-induced HCC necrosis. Importantly, repeat TACE was not associated with reduced survival. [ABSTRACT FROM AUTHOR]