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

The jury is still out
  • Author Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Lei Duan
    Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Affiliations
    Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, Chengdu 610000, China
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  • Author Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Lu Yang
    Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Affiliations
    Nursing Department, The Sixth People's Hospital of Chengdu, Chengdu, China
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  • Author Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Bohan Zhang
    Correspondence
    Corresponding author: Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu 610000, China.
    Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
    Affiliations
    Department of Plastic and Burn Surgery, West China Hospital of Sichuan University, 37 Guoxue Lane, Wuhou District, Chengdu 610000, China
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  • Jiaxu Liao
    Correspondence
    Corresponding author: Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, Chengdu 610000, China.
    Affiliations
    Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, Chengdu 610000, China
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  • Xiaohua Zheng
    Correspondence
    Corresponding author: Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, Chengdu 610000, China.
    Affiliations
    Department of Radiology, The Sixth People's Hospital of Chengdu, 16 Jianshe South Street, Chenghua District, Chengdu 610000, China
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  • Author Footnotes
    1 Lei Duan, Lu Yang and Bohan Zhang contributed equally to this work.
Published:August 03, 2022DOI:https://doi.org/10.1016/j.ejca.2022.06.021
      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 [
      • 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.
      ]. 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) [
      • 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.
      ], 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.
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