Radiation-Immuno combo targets tough liver cancer clot

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Patients aged ≥ 18 years old * ECOG performance 0 to 1 * Confirmed diagnosis of HCC (either histologic or cytologic analysis, or clinical features according to the American Association for the Study of Liver Diseases) * Presence of major portal vein thrombosis (Vp3 \[first-order tumour thrombosis in portal vein\] or Vp4 \[tumour thrombosis in the main portal vein, or portal vein branch in contralateral lobe\]), limited to the liver and should be amenable to SBRT * No disease progression after 2 cycles of atezolizumab plus bevacizumab * Presence of ≤5 lesions within the liver * Gastric or esophageal varices must be screened; if interventions were performed, repeated upper endoscopy is needed to confirm healing of treated varices * Child-Pugh A liver function * Life expectancy longer than 3 months * At least one measurable treatment lesion according to RECIST 1.1 * Extrahepatic metastases are allowed, limited to 3 sites, and not causing functional compromise * Written informed consent must be obtained prior to any study related procedures * Adequate haematological function (Hb ≥ 8.5g/dL; Plt ≥ 75x109/L; ANC ≥ 1.5x109/L; INR ≤ 1.5) * Adequate hepatic function (albumin ≥ 28g/L; Bilirubin ≤ 40 μmol/L; ALT \< 5 times upper limit normal) * Adequate renal function (serum creatinine ≤ 2 times the upper limit of normal range; Na ≥ 130mmol/L; K ≥ 3.0mmol/L) * Able to read, understand and provide written consent Exclusion Criteria: * History of another malignancy except appropriately-treated BCC of skin or CIN of cervix during the last 5 years * History of rupture HCC in the past 3 months * History of gastric or esophageal varices with interventions performed within 1 month * Tumour thrombosis that extends beyond the portal vein (e.g. inferior vena cava, superior vena cava) * Liver tumours occupy ≥ 50% of liver * 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 HIV) * Ongoing corticosteroid therapy \>10mg prednisone daily