TACE With or Without SBRT as Bridging Therapy for Pre-transplant HCC Patients

The purpose of this study is to determine whether the combination of stereotatic body
radiotherapy (SBRT) tand transarterial chemoembolization (TACE) is an effective "bridging
therapy" for patients hepatocellular carcinoma (HCC) of the liver awaiting transplantation.

Inclusion Criteria:

- Patient capable of giving informed consent

- Patient diagnosed with hepatocellular carcinoma and listed or recommended to be listed
for orthotopic liver transplantation at the participating institution

- Age > 18 years old

- Meets clinical criteria for eligibility for TACE to the target lesion per
Interventional Radiology

- Childs' Class A or B7

- Eastern Clinical Oncology Group performance status 0 or 1

Exclusion Criteria:

- Prior radiotherapy to the upper abdomen or radioembolization of the liver

- Prior TACE to the target lesion, RFA, or liver transplant

- Active GI bleed within 2 weeks of study enrollment

- Active GI ulcer disease within 4 weeks of study enrollment

- Ascites refractory to medical therapy

- Contraindication to receiving radiotherapy or TACE

- Complete obstruction of portal venous flow to the segment of liver that includes the
target lesion

- Contraindication to both contrast enhanced MRI and contrast enhanced CT (i.e. unable
to undergo follow-up imaging or SBRT treatment planning)

- Women who are pregnant

- Participation in another concurrent treatment protocol