Downstaging of Hepatocellular Carcinoma with Macrovascular Invasion by Radiotherapy (SBRT or Y90) and Atezolizumab Plus Bevacizumab Followed by Liver Transplantation - a Prospective Trial
The goal of this clinical trial is to learn if locoregional therapy and immunotherapy can be used together to help patients with hepatocellular carcinoma (HCC) and macrovascular invasion achieve liver transplantation. The main questions it aims to answer are: * How many patients will achieve transplant with this treatment strategy? * What will the 5-year survival and recurrence-free survival rates be for these patients? Participants will: * Undergo a biopsy of the tumor. * Receive locoregional therapy (SBRT or Y90) followed by immunotherapy (atezolizumab and bevacizumab) 2 to 6 weeks later, for a maximum of 9 months. * Be referred for a liver transplant and undergo the procedure if deemed eligible and safe. * If applicable, be followed for five years post-transplant with regular data collection.
• Age 18-70
• Weight \> 30 kg
• Child Pugh Turcotte score A5 to B7
• Macrovascular invasion (Vp1-3)
• Total tumour volume \< 350 cm3
• Alpha Fetoprotein \< 5000 ng/mL
• No extrahepatic disease
• No other contraindications to undergo a LT
• Eastern Cooperative Oncology Group (ECOG) score 0-1
• Capable to provide inform consent
• Radiological and histological confirmation of hepatocellular carcinoma