Radiation vs. scalpel: landmark trial seeks best treatment for small liver tumors

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

Inclusion Criteria: 1. Age 18 to 75 years, with no restriction on sex; 2. Clinically or pathologically diagnosed hepatocellular carcinoma, according to the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2024 edition); 3. A solitary tumor with a maximum diameter of ≤5 cm, for which treatment is indicated; 4. No radiologic evidence of macrovascular invasion, distant metastasis, or lymph node metastasis; 5. Treatment-naïve or previously treated patients are eligible, provided that they are deemed suitable for both surgical resection and radiotherapy by a multidisciplinary team (MDT) and do not require concomitant systemic therapy at enrollment; 6. For patients with recurrent disease, recurrence must occur at least 1 year after prior curative treatments; 7. Previously treated patients must not have received systemic therapy within 6 months before enrollment; 8. In previously treated patients, tumor size must be assessed according to RECIST version 1.1 at enrollment; 9. A normal liver volume of ≥700 cc, with an estimated future liver remnant volume of \>40% after resection; 10. A Karnofsky performance-status score of ≥90; 11. Child-Pugh class A liver function; 12. An estimated life expectancy of more than 6 months; 13. Adequate organ function, defined as follows: white-cell count ≥3.5×10⁹/L, absolute neutrophil count ≥1.5×10⁹/L, platelet count ≥75.0×10⁹/L, hemoglobin ≥90 g/L; serum albumin ≥28 g/L; total bilirubin ≤1.5 times the upper limit of normal (ULN), alanine aminotransferase or aspartate aminotransferase ≤2.5 times the ULN; serum creatinine ≤1.5 times the ULN or creatinine clearance \>60 mL per minute; and no severe concomitant organic disease; 14. The ability to understand the study procedures and to provide written informed consent before the initiation of any study-specific procedures, with agreement to receive treatment and follow-up according to the study protocol. Exclusion Criteria: 1. Severe dysfunction of major organs, including the heart, lungs, or kidneys; active infection other than viral hepatitis; or other serious concomitant conditions that preclude tolerance of either surgery or radiotherapy; 2. Contraindications to surgical resection or radiotherapy; 3. A history of other malignant tumors, with the exception of nonmelanoma skin cancer, carcinoma in situ of the cervix, or previously cured prostate cancer, nasopharyngeal carcinoma, breast cancer, or early-stage laryngeal cancer; 4. A history of multiple abdominal surgeries or liver or other solid-organ transplantation; 5. Previous radiotherapy to the upper abdomen; 6. Pregnancy or breastfeeding; 7. Any other condition that may interfere with patient enrollment or the assessment of study outcomes; 8. Refusal to comply with the follow-up requirements of the study protocol or refusal to provide written informed consent.