Stereotactic body radiotherapy versus radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Purpose: To compare the efficacy and safety of stereotactic body radiotherapy (SBRT) with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Materials and methods: PubMed, MedLine, EMBASE, the Cochrane Library and Web of Science were searched to identify potentially eligible studies comparing the efficacy and safety of SBRT with RFA for HCC from January 1990 to May 2020. Hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine the effect size for overall survival (OS), local control (LC) and complications. Results: Seven studies including 7928 patients were enrolled in this meta-analysis. The results showed that SBRT was not inferior to RFA based on the pooled HR for OS (HR ¼ 1.09, 95%CI ¼ 0.78-1.52, p ¼ .62); however, the pooled HR for the LC rate showed the superiority of SBRT (HR ¼ 0.54, 95%CI ¼ 0.35-0.84, p ¼ .006). Subgroup analysis showed that the pooled HR for the LC rate favored SBRT in patients with tumors sized >2 cm (HR ¼ 0.41, 95%CI ¼ 0.23-0.74, p ¼ .003), but no significant difference was observed in patients with tumors sized 2 cm (HR ¼ 0.56, 95%CI ¼ 0.25-1.28, p ¼ .17). In addition, no significant differences in the incidence of late severe complications were observed between the SBRT and RFA groups (OR ¼ 1.01, 95%CI ¼ 0.59-1.73, p ¼ .97). Conclusions: Based on the current data, we concluded that SBRT was well tolerated with an OS equivalent to that with RFA; SBRT was superior to RFA in terms of LC of HCC, especially in those with tumors sized >2 cm.

Current Understanding of Ablative Radiation Therapy in Hepatocellular Carcinoma

“… 48 On the contrary, Wang et al in a review and meta-analysis of 7928 patients, reported better local control of HCC with SBRT than with RFA especially for slightly larger tumors (> 2cm) with equivalent overall survival outcomes and comparable toxicity. 49 In addition, a large multi-institutional retrospective study by Kim et al including 2064 patients reported significantly lower local recurrence rates with SBRT than with RFA in both the unmatched and propensity score matched cohorts. 50 SBRT was also associated with superior local control in small tumors ≤ 3 cm irrespective of location, large tumors in subphrenic location and those that progressed after TACE.…”

Stereotactic body radiation therapy for hepatocellular carcinoma: From infancy to ongoing maturity

“…Three recent meta-analyses have aimed to provide objectivity to inform decision making. [68] , [69] , [70] The meta-analysis by Pan et al. included 10 studies comparing SBRT with RFA in patients with treatment-naïve HCC and showed superior 1- and 3-year local control with SBRT.…”

Treatments of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: Current Status and Controversy

“…At present, three-dimensional conformal radiotherapy is the most widely reported external radiotherapy technique with relatively clear curative efficacy. High-level evidence has recently suggested the value of proton beam radiotherapy 60 and stereotactic radiotherapy 61 in the treatment of small HCC, and positive results of these two methods in PVTT are expected.…”