For a long time, patients with intermediate-stage liver cancer, where the tumour is too large to be removed with surgery, had no clear data on which treatment worked best.
One type of treatment directs tiny radioactive spheres to the tumour, while the other is an oral medication - sorafenib - that must be taken as long as the body can bear the side effects.
But after seven years of research, a team from Singapore led by National Cancer Centre Singapore (NCCS) surgeon Pierce Chow has found that half the people on the oral medication experienced side effects, compared with just over a quarter for the radiation treatment.
And of the people who completed the radiation treatment, 23 per cent had their tumours shrink, compared with 2 per cent for oral medication.
When the tumours shrink, it means doctors can potentially treat the problem with surgery or a liver transplant.
The study, presented at a prestigious international conference last month, has given both patients and doctors more information on which to base their decisions.
Before the results of the study, Professor Chow said a liver cancer patient's treatment was determined largely by his doctor's experience.
"It depended on which doctor you asked or where you went," he said. "Without our trial, this data would not be known."
In between, there were so many times we almost gave up.
ASSOCIATE PROFESSOR TEOH YEE LEONG, on how the project nearly did not come to fruition because it was hard to get funding.
The study involved 360 people from 11 places in the region, including Myanmar, Malaysia and Hong Kong. It was partially funded by grants from the National Medical Research Council.
Liver cancer is most common in Asia and Africa, and is often caused by the hepatitis B and C viruses or fatty liver disease.
Around half of all patients in Singapore are diagnosed in the intermediate stage, where their tumours are too big to be removed by surgery.
The disease ranks among the top five causes of cancer deaths here, with around 2,500 people dying of it between 2010 and 2014.
Associate Professor Teoh Yee Leong, who is the chief executive of the Singapore Clinical Research Institute (SCRI), said the project nearly did not come to fruition because it was difficult to secure funding. The SCRI was involved in the study as NCCS' academic partner.
Percentage of people who completed the radiation treatment who had their tumours shrink, as compared with 2 per cent for oral medication.
Number of people involved in the study from 11 places in the region, including Myanmar, Malaysia and Hong Kong.
"In between, there were so many times we almost gave up," said Prof Teoh.
Next, the team is planning to study how cost-effective each treatment is, especially when the treatment of side effects is taken into consideration.
Correction note: This story has been updated for clarity.