Application and Research Progress of Radiotherapy in Unresectable Hepatocellular Carcinoma

Unresectable hepatocellular carcinoma (uHCC) accounts for 70%-80% of newly diagnosed hepatocellular carcinoma (HCC) cases, presenting significant clinical challenges in treatment. Conventional therapies such as transarterial chemoembolization (TACE) or systemic approaches (targeted/immunotherapy) have shown limited efficacy, with a 5-year survival rate below 15%. Recent advancements in precision radiotherapy technologies (stereotactic body radiation therapy [SBRT], proton/heavy ion therapy) combined with synergistic exploration of immunotherapy and targeted therapies have transformed radiotherapy from a palliative to a curative modality. This systematic review examines the technological progress, core clinical applications, challenges, and controversies in uHCC radiotherapy over the past five years, while outlining future research directions to inform clinical practice and scientific inquiry.