Randomized Controlled Trial of Transarterial Chemoembolization Versus Proton Beam Radiotherapy for the Treatment of Hepatocellular Carcinoma

Inclusion Criteria:

1. Patients are candidates to receive both proton beam and TACE

2. Patients with no evidence of metastasis or macrovascular invasion

3. Patients with tumor burden that meets San Francisco criteria

Exclusion Criteria:

1. Patients who are candidates for surgical resection

2. Patients with lesion < 2 cm

3. Patients who have contraindication to receive either TACE or proton

4. Patients with serum alpha fetoprotein > 500

5. Patients with metastasis or macrovascular invasion

6. Patients treated previously for HCC by any locoregional treatment

7. Patients with prior liver transplant

8. Patients with Child class C

9. Patients with MELD score of > 25

10. Patients with other comorbid diseases that may impact survival

11. Patients with ongoing alcohol intake

12. Patients with active sepsis

13. Patients with gastrointestinal bleeding within a week

14. Patients unwilling to sign informed consent form

15. Patients with history of noncompliance