Stereotactic body radiation therapy versus radiofrequency ablation in patients with small hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Background: This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT) and those treated with radiofrequency ablation (RFA).Methods: We searched databases for relevant clinical studies. The primary outcomes of interest were overall survival (OS) at 1 and 2 years, freedom from local progression (FFLP) rate at 2 years, and complications.Results: Five cohorts from 5 retrospective studies and 4814 patients with HCC were included. Pooled OS at 2 years was significantly lower for SBRT than for RFA [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.51-0.79; P<0.0001], but the pooled FFLP rate at 2 years was higher for SBRT than for RFA (OR:1.66; 95% CI: 1.05-2.61; P=0.03). In addition, there was no significant difference in the local and liver toxicities of the two treatments. The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location, but there were no uniform criteria to illustrate the radiological dose and location in the included studies.Conclusions: SBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC. The local toxicity was comparable in both treatments. Further trials should be designed with uniform standards for SBRT and RFA treatments.

Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease: Current Progresses and Challenges

“… 58 , 59 , 62 The Chinese guidelines, in contrast, recommend radiotherapy for stages IIIa and IIIb. 60 Although evidence seems to be growing that external radiation therapy can benefit patients with HCC, 99 , 100 data are lacking on NAFLD-related HCC. A retrospective study found no difference in overall survival or radiation injury between 87 patients with NAFLD-related HCC or 62 with HBV-related HCC after yttrium-90 radioembolization.…”

Stereotactic body radiation therapy and radiofrequency ablation in patients with hepatocellular carcinoma: not a rival but a partner for the cure

“…A recent meta-analysis by Hong et al included these previous studies and provided overall treatment outcomes of SBRT compared with RFA ( 3 ). After analyzing five retrospective studies (1 registry-based and 4 single-institution), the authors concluded that SBRT yielded superior local control but inferior overall survival (OS) outcome compared with RFA.…”

Comment on: “Stereotactic body radiation therapy versus radiofrequency ablation in patients with small hepatocellular carcinoma: a systematic review and meta-analysis”

“…We are grateful to Hepatobiliary Surg Nutr for publishing the study entitled “ Stereotactic body radiation therapy versus radiofrequency ablation in patients with small hepatocellular carcinoma : a systematic review and meta - analysis ”. In this well-designed study, the authors concluded that in patients with small hepatocellular carcinoma, stereotactic body radiation therapy has a higher local control rate but poorer prognosis than radiofrequency ablation; in addition, the local toxicity of the two treatments was comparable ( 1 ). While we read the article with pleasure, it must be noted that this study raises some thought-provoking issues.…”