Re: Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with micro-vascular invasion: A randomized controlled trial

We read with great interest the article entitled ‘Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trial’ recently published in the European Journal of Cancer (May 2022) by Shi and colleagues [ [1] Shi C. Li Y. Geng L. Shen W. Sui C. Dai B. et al. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: a randomised controlled trial. Eur J Cancer. 2022; 166: 176-184https://doi.org/10.1016/j.ejca.2022.02.012 Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar ]. This single-centre, open-labelled, randomised controlled trial (RCT) initially included 236 patients with hepatocellular carcinoma (HCC) who underwent marginal liver resection (distance from tumour to resection margin ≤ 1 mm) [ [2] Nara S. Shimada K. Sakamoto Y. Esaki M. Kishi Y. Kosuge T. et al. Prognostic impact of marginal resection for patients with solitary hepatocellular carcinoma: evidence from 570 hepatectomies. Surgery. 2012; 151: 526-536https://doi.org/10.1016/j.surg.2011.12.002 Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar ], and screened 76 HCC patients with microvascular invasion (MVI) using stringent criteria thereafter. The patients were randomly assigned to receive no other interventions or stereotactic body radiation therapy (SBRT). Overall, the surgery arm and surgery + SBRT arm shared equal overall survival (OS) but the latter exhibited superior disease-free survival (DFS) with tolerable adverse events. Shi et al. concluded that SBRT achieved effective local control and served as safe adjuvant therapy for MVI-positive HCC patients who received marginal resection (MR). However, we have considerable misgivings about the study design, clinical treatment logic, and endpoint definition. We remain on the sidelines as to whether postoperative SBRT is authentically beneficial in MVI-positive HCC patients who received MR. Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with microvascular invasion: A randomised controlled trialEuropean Journal of CancerVol. 166PreviewSBRT on the resection margin provides a safe therapeutic modality of adjuvant setting in MVI-positive HCC with suboptimal resection margin. It prevents local recurrence and improves DFS. Full-Text PDF Response to letter entitled: Re: ‘Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with micro-vascular invasion: A randomized controlled trial’European Journal of CancerVol. 174PreviewWe are writing to respond to Duan et al.’s comments concerning our article titled, ‘Adjuvant stereotactic body radiotherapy after marginal resection for hepatocellular carcinoma with micro-vascular invasion: A randomized controlled trial.’ We thank these authors for their constructive feedback. Full-Text PDF