Stereotactic body radiation therapy for hepatocellular carcinoma: 2026 expert consensus-based practical recommendation of the Korean Liver Cancer Association

Abstract

Stereotactic body radiation therapy (SBRT) is a noninvasive, high-precision radiation technique that delivers a high dose to the tumor in a limited number of fractions, typically five or fewer, and is increasingly used as a curative-intent option for hepatocellular carcinoma (HCC), particularly when surgical resection, liver transplantation, or local ablative therapies are not feasible. Although domestic and international guidelines have incorporated SBRT into the treatment algorithm for HCC, the lack of comprehensive evidence and expert opinion regarding patient selection, pretreatment evaluation, treatment planning and delivery, complication management, and post-treatment follow-up has resulted in substantial variation in clinical practice. Accordingly, an expert consensus-based practical recommendations for SBRT were developed by a group of radiation oncologists, hepatologists, and radiologists from the Research Committee of the Korean Liver Cancer Association, based on expert surveys, a comprehensive review of evidence-based literature, and a modified Delphi process. Encompassing the entire clinical workflow of liver SBRT, these recommendations are intended to provide practical guidance for the safe and effective implementation of SBRT in patients with HCC.