In recent years, with the development of medical technology, the treatment outcome of hepatocellular carcinoma ( HCC) has improved substantially. However, the treatment of large HCC is still a difficult clinical problem. The biological characteristics of large HCC, as well as the surgical treatments ( hepatectomy and liver transplantation) and radiotherapy for large HCC, are reviewed. Under the guidance of surgical principle, radiotherapy can be considered as an alternative treatment for the inoperable patients. However, how to quantify the indices of hepatic functional reserve, how to limit the volume of normal liver and its radiation dose, and how to combine radiotherapy with other local treatments to increase tumor control rate are the urgent problems to be addressed.
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