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

To compare the efficacy and safety of stereotactic body radiotherapy (SBRT) with radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). 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. 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 = 1.09, 95%CI = 0.78-1.52, p = .62); however, the pooled HR for the LC rate showed the superiority of SBRT (HR = 0.54, 95%CI = 0.35-0.84, p = .006). Subgroup analysis showed that the pooled HR for the LC rate favored SBRT in patients with tumors sized >2 cm (HR = 0.41, 95%CI = 0.23-0.74, p = .003), but no significant difference was observed in patients with tumors sized ≤2 cm (HR = 0.56, 95%CI = 0.25-1.28, p = .17). In addition, no significant differences in the incidence of late severe complications were observed between the SBRT and RFA groups (OR = 1.01, 95%CI = 0.59-1.73, p = .97). 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.