Changcheng Tao,1,* Liguo Liu,2,* Nan Hu,1,* Hongwei Wang,1,* Kai Zhang,1 Yue Liu,1 Fan Wu,1 Liming Wang,1 Weiqi Rong,1 Jianxiong Wu1 

1Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China; 2Second Department of Hepatopancreatobiliary Surgery, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Weiqi Rong, Email dr_rongweiqi@163.com; Jianxiong Wu, Email dr_wujx@163.com

Background: Radiotherapy offers potential benefits for patients with hepatocellular carcinoma (HCC); however, the distinct role of intraoperative radiotherapy (IORT) during narrow-margin hepatectomy remains inadequately defined. This study aims at assessing the safety and effectiveness of IORT for centrally located HCCs during narrow-margin hepatectomy.
Methods: This single-center, retrospective research incorporated 659 patients with centrally located HCCs. After applying exclusion criteria, 607 patients remained and were divided into two groups: IORT integrated with liver resection (IORT+LR, 54 patients) and mere liver resection (LR, 553 patients). Propensity score matching (PSM) was performed to balance baseline characteristics. Post PSM, surgical outcomes, long-term recurrence, survival rates and adverse events were analyzed.
Results: A total of 54 patients were successfully matched, without significant differences upon baseline characteristics (standardized mean difference, SMD < 0.15). Post-matching analysis revealed that overall survival (OS) and disease-free survival (DFS) were notably improved in the IORT+LR group (P =0.027 and 0.015, respectively). Multivariate Cox regression identified IORT as an independent prognostic factor for better DFS and OS. Among the 108 patients included after matching, 57 experienced HCC recurrence, 23 in the IORT group and 34 in the LR group, showing a clear difference in recurrence rates (P =0.034). Also, there were no apparent differences in mild/severe complications between IORT and RT groups (96.3% vs 98.2%, P =0.558, respectively).
Conclusion: IORT is an effective and well-tolerated therapy for HCC patients. The combination of narrow-margin hepatectomy and IORT enhances patient prognosis, with IORT identified as an independent prognostic factor.

Keywords: centrally located hepatocellular carcinoma, intraoperative radiotherapy, hepatectomy, recurrence, prognosis