CASE REPORT article
Front. Oncol.
Sec. Radiation Oncology
Volume 15 - 2025 | doi: 10.3389/fonc.2025.1591424
This article is part of the Research TopicCase Reports in Radiation Oncology: 2025View all 17 articles
SFRT combined with immunotherapy for a growing hepatocellular carcinoma after the failure of anti-angiogenesis and anti-PD1 treatment: a case report
Provisionally accepted
- 1Sir Run Run Shaw Hospital, School of Medicine, Graduate School, Zhejiang University, Hangzhou, China
- 2Zhejiang University, Hangzhou, Zhejiang Province, China
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Background: Hepatocellular carcinoma (HCC) is one of the prevalent tumors worldwide, posing a global health-care threaten. The existing treatment options for large HCC have poor therapeutic effect and are prone to drug resistance. Spatially fractionated radiation therapy (SFRT) is a highly precise radiotherapy technique that delivers a concentrated, high-dose of radiation to a well-defined tumor target while minimizing radiation exposure to surrounding normal tissues. SFRT specially delivers a non-uniform radiation dose to the target area instead of a homogeneous dose throughout the tumor volume. This steep dose gradient within the targeted tumor could increase the immune-rich infiltrate within the tumor, thus enhancing the efficacy of immunotherapy. Case report: A 22-year-old male was diagnosed with large HCC, classified as Barcelona Clinic Liver Cancer (BCLC) stage C. The patient received first-line systemic treatment of evacizumab and atezolizumab, followed by locoregional therapy of hepatic arterial infusion chemotherapy (HAIC). The tumor rapidly grew over the next 2 months. Subsequently, the patient underwent SFRT combined with anti-PD1/CTLA4 (anti-programmed death 1/anti-cytotoxic T-lymphocyte antigen-4) immunotherapy and anti-angiogenesis treatment. SFRT was administered using volumetric modulated arc therapy, delivering 26.68Gy in 2 fractions every other day to the high dose spheres, and 8Gy in 2 fractions to the targeted tumor. The tumor regressed nearly 40% over 2 months after the treatment, without significant treatment-related side effects (grade 3 or 4 acute and subacute toxicities) observed during the subsequent follow-up exams. Conclusion: SFRT combined with immunotherapy is a promising strategy for large HCC.
Keywords: HCC, SFRT, Immunotherapy, case report, Combination (Combined) Therapy
Received: 11 Mar 2025; Accepted: 27 Aug 2025.
Copyright: © 2025 Hu, Jin, Wang, Pang, Wang, Xie, Wang and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xiaonan Sun, Sir Run Run Shaw Hospital, School of Medicine, Graduate School, Zhejiang University, Hangzhou, China
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