An international study evaluates the impact of external beam radiotherapy in liver cancer

A study published in Journal of Clinical Oncology shows that external beam radiotherapy can provide survival outcomes comparable to those of established local treatments in hepatocellular carcinoma, particularly in early stages. The study, based on data from nearly 5,000 patients, is considered the largest conducted to date in this field.

The study was coordinated by Dr. Maria Reig, head of the Liver Oncology Unit (BCLC) at Clínic-IDIBAPS and member of CIBERehd, together with Dr. Andrew M. Moon from the Division of Gastroenterology and Hepatology at the University of North Carolina. From the BCLC group, Dr. Meritxell Mollà, head of the Radiation Oncology Department at Clínic and researcher in the IDIBAPS Translational Genomics and Targeted Therapies in Solid Tumors group, also participated.

A need for stronger evidence to consolidate new treatment options

Hepatocellular carcinoma is the most common type of liver cancer and one of the leading causes of cancer-related death worldwide. Its management is complex and includes several local treatment options such as surgery, thermal ablation, and intrahepatic approaches like TACE or TARE, as well as systemic therapies.

Despite advances in these strategies, there is still a need to expand available options, particularly for patients in early stages or those who are not candidates for certain procedures.

In this context, external beam radiotherapy had shown promising results in previous studies, but the lack of robust, large-scale evidence had limited its positioning in international clinical guidelines.

“This study addresses this gap,” explains Dr. Meritxell Mollà, “as it is an individual patient data meta-analysis that rigorously evaluates overall survival in patients with hepatocellular carcinoma treated with this technique.”

The largest international study in liver radiotherapy

The study analyzes data from 4,913 patients treated with external beam radiotherapy across 30 centers in 11 countries, with a median follow-up of five years. This makes it the largest international study conducted to date in this field and provides a representative picture of real-world clinical outcomes.

The aim was to determine the role of external beam radiotherapy in patient survival across different disease stages, with particular focus on very early and early stages, where treatment can have curative intent.

Survival comparable to standard treatments in early stages

The results show that external beam radiotherapy can achieve survival outcomes comparable to other local ablative treatments, such as surgical resection or thermal ablation, in patients with early-stage hepatocellular carcinoma.

“Survival outcomes are particularly noteworthy in treatment-naïve patients and in those with preserved liver function, highlighting the potential of this technique as a therapeutic option in selected scenarios,” notes Dr. Maria Reig.

A step forward in therapeutic decision-making

“Overall, these findings support the inclusion of external beam radiotherapy in the CUSE-BCLC therapeutic decision-making process, developed at Clínic-IDIBAPS and widely used internationally in liver cancer management,” says Dr. Maria Reig. She adds that “the study reinforces its role as an alternative to established local treatments in selected patients and contributes to consolidating its place within clinical strategies.”

Study reference: Moon AM, Yanagihara TK, Dawson LA, Yu JI, Lawrence TS, Kim TH, Yan M, Iwata H, Nabavizadeh N, Apisarnthanarax S, Dunne EM, Lock MI, Chuong MD, Chiang CL, Scorsetti M, Katoh N, Sioshansi S, Numata K, Liu HY, Iwamoto H, Wakatsuki M, Chen Y, Pollom EL, Gkika E, Jabbour SK, Munoz-Schuffenegger P, Dutta D, Hajj C, Ueno M, Hallemeier CL, Feldman AM, Méndèz Romero A, Tan X, Molla M, Tepper JE, Torres F, Reig M; EBRT Collaboration Group. Overall Survival Among Patients With Hepatocellular Carcinoma Treated With External Beam Radiation Therapy: Individual Patient Data Outcomes From a Multinational Cohort. J Clin Oncol. 2026 May 15:JCO2502399. doi: 10.1200/JCO-25-02399.