Clinical Research Directory

Inclusion Criteria: * HCC diagnosis according to the American Association for the Study of Liver Diseases (AASLD) 2010 criteria * Tumor Stage * liver only disease * tumor thrombus at segment is allowed * no extra hepatic metastases * tumor encompassing less than 50% of hepatic volume * previous treatment with Transarterial Chemo Embolization (TACE) - patient must have performed at least 2 sessions of TACE and have signs of viable tumor in CT or MRI performed 30-40 days after last TACE * presence of measurable lesion (at least one lesion that can be measured equal or more than 1 cm in CT or MRI). * Maximum lesion size of 10 cm. * Liver residual volume equal or more than 700cc or 40% of total liver volume * Child-Pugh A or absence of hepatic cirrhosis * absence of encephalopathy or ascitis on clinical exam * Eastern Cooperative Oncology Group (ECOG) performance status 0-1 * Lab exams: * hemoglobin \> or equal 8 mg/dl * neutrophils \> or equal 1.200/mm³ * platelets \> or equal 45.000/mm³ * alanine aminotransferase (ALT) and aspartate aminotransferase (AST) less than 6 times the upper normal limit * bilirubin equal or \< 2 mg/dl * international normalized ratio (INR) \< 1.7 * serum creatinine equal or \< 1.5 times the upper normal limit or creatinine clearance \> or equal 60 ml/min * Albumin \>2.8 mg/dl * not being pregnant - a negative pregnancy test is required (for women). Patients in fertile age should use a contraceptive method during treatment and 4 months after. Exclusion Criteria: * Patients with more than 5 discrete lesions in the liver * Main or common biliary duct invasion * Patients with main portal vein tumor thrombus or more than 2 portal branch thrombus * Patients in systemic treatment (sorafenib, chemotherapy). There should be an interval of at least 4 weeks between any medication for treatment of HCC and the current study treatment * Previous radiation to upper abdomen * Patients with other malignant neoplasms or previous malignant neoplasms will be accepted in the study if HCC prognosis is worse * Patients with ischemic myocardial infarction within the last 6 months * Patients with large esophageal varices with red color sign or bleeding within the last 3 months * Patients with symptoms of colitis, enteritis, esophagitis, fistula, ileus, necrosis, stenosis or ulcer * Patients with severe anorexy, constipation, dehydration, diarrhea or vomiting * Patients unable to understand and sign written informed consent