To evaluate and compare the efficacy and safety of SBRT sequential TACE combined with sorafenib versus sorafenib alone in the treatment of unreactable HCC with PVTT.

HCC Patients classified as BCLC stage C present with PVTT, and the recommended first-line treatment is systemic therapy with sorafenib according to updated Barcelona Clinical Liver cancer (BCLC) treatment algorithms.However, recent data from observational studies suggest that the combination of TACE and SBRT would be as effective as sorafenib.

Inclusion Criteria:

• Age >18 years
• Child-Pugh score ≤ 7
• Performance status: ECOG score ≤ 2
• HCC diagnosed by biopsy or by the noninvasive criteria of the Chinese Liver Cancer Guideline 2017
• the primary HCC being unresectable (BCLC C stage/ CNLC Ⅲa-b) according to NCCN guideline
• No previous therapy for HCC
• at least one measurable target lesion according to RECIST 1.1
• Adequate hematopoietic function: Hemoglobin ≥ 8.5 g/dL; Absolute neutrophil count ≥ 750/mm3; Platelet count ≥ 50,000/mm3
• Serum total bilirubin ≤ 2 x ULN
• Aspartate aminotransferase (AST) and alanine aminotransferase ≤ 10 x ULN
• Creatinine ≤ 1.5 x ULN
• No plan for pregnancy or breast feeding. Active contraception.
• Willing to give informed consent

Exclusion Criteria:

• Prior history to or exposure of transarterial chemoembolization, external beam radiation to liver, or sorafenib
• Complete obstruction of hepatic outflow
• Uncontrolled ascites of hepatic encephalopathy
• Prior liver transplantation
• Positive for human immunodeficiency virus (HIV)
• Active gastric or duodenal ulcer
• Other uncontrolled comorbidities or malignancy
• Inability to give informed consent