Stereotactic body radiotherapy vs radiofrequency ablation for the treatment of hepatocellular carcinoma: a meta-analysis

ABSTRACT

Background: There are limited and discording results on the comparison between stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). The aim of this meta-analysis was to compare the two treatments in terms of efficacy and safety.

Research design and methods: A bibliographic search was performed on main databases through September 2020. Primary outcome was recurrence-free survival. Overall survival and adverse event rates were the secondary outcomes. Results were expressed as odds ratio (OR) or hazard ratio (HR) and 95% confidence interval (CI)

Results: Nine studies enrolling 6545 patients were included. Recurrence-free survival at 1-year was similar between the two treatments (OR 2.11, 0.67–6.63); recurrence-free survival at 2- and 3-year was significantly in favor of SBRT as compared to RFA (OR 2.06, 1.48–2.88 and 1.86, 1.07–3.26, respectively). In a meta-analysis of plotted HRs, SBRT significantly outperformed RFA (HR 0.50, 0.33–0.76, p = 0.001). Overall survival was similar between the two treatments (HR 1.03, 0.72–1.47). No significant difference in terms of severe adverse event rate was observed (OR 1.38, 0.28–6.71).

Conclusions: SBRT prolongs recurrence-free survival as compared to RFA in HCC patients, although no significant survival benefit was demonstrated.

KEYWORDS:

• Liver cancer
• HCC
• RFA
• recurrence
• SBRT
• survival

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Antonio Facciorusso, Andrea Chierici, Ivan Cincione, Christian Cotsoglou were involved in the conception and design

Antonio Facciorusso and Andrea Chierici were involved in the analysis and interpretation of the data

Antonio Facciorusso and Babu P Mohan were involved in the drafting of the paper

Rodolfo Sacco, Daryl Ramai, Babu P Mohan, Saurabh Chandan, and Andrew Ofosu revised the manuscript critically for intellectual content

All of the authors approved the final version to be published and agree to be accountable for all aspects of the work.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This paper received no funding.