Impact of Radiotherapy on ctDNA in Patients With Hepatocellular Carcinoma

Inclusion criteria

• Patients aged ≥ 18 years old
• Eastern Cooperative Oncology Group (ECOG) performance 0 to 1
• Confirmed diagnosis of Hepatocellular carcinoma (HCC)
• Tumour size ≥ 3cm
• Patients planning on undergoing Stereotactic Body Radiation Therapy (SBRT) for HCC
• Prior radiofrequency ablation at a different site, or prior surgery are eligible
• Child-Pugh A liver function
• Life expectancy longer than 12 weeks
• At least one measurable treatment lesion according to RECIST 1.1
• Written informed consent must be obtained prior to any study related procedures
• Adequate haematological function (Hemoglobin ≥ 8.5g/dL; Platelet Count ≥ 75x109/L; Antenatal Care ≥ 1.5x109/L; international normalised ratio ≤ 1.5)
• Adequate hepatic function (albumin ≥ 28g/l; Bilirubin ≤ 1.5xULN; Alanine transaminase < 5 times upper limit normal)
• Adequate renal function (serum creatinine ≤ 1.5 times the upper limit of normal range; Sodium ≥ 130mmol/L; Potassium ≥ 3.0mmol/L)
• Able to read, understand and provide written consent

Exclusion criteria

• Histology shows sarcomatoid HCC, fibrolamellar HCC, mixed cholangiocarcinoma-hepatocellular carcinoma
• Presence of other malignancy than HCC within 5 years from diagnosis of HCC
• Prior Transarterial chemoembolization (TACE) within 3 months
• Previous radiotherapy to the abdomen
• Previous yttrium-90 chemoembolization
• Repetitive history of non-healing wounds or ulcers within 2 months of inclusion
• Pregnant or lactating females at any time during the study
• Active autoimmune disease requiring systemic therapy in the past 2 years
• Diagnosis of immunodeficiency (including Human Immunodeficiency Viruses)
• Patients with coagulopathy or on anticoagulant will be excluded from liver biopsy