Background: Stereotactic body radiation therapy (SBRT) has high efficacy for early-stage hepatocellular carcinoma (HCC) and is expected as an accepted alternative to radiofrequency ablation (RFA). However, SBRT for HCC may cause subacute liver injury leading to negative clinical outcomes. In this study, we compared changes of liver function and prognosis after SBRT or RFA in patients with single, small HCC by using a propensity-score matching analysis.Methods: We reviewed medical records of 140 patients with single ≤3 cm HCC treated with SBRT or RFA at Kurashiki Central Hospital between January 2014 and February 2019. Changes of albumin-bilirubin (ALBI) score, local recurrence, and overall survival were compared between the propensity-score matched groups (31 patients treated with SBRT and 62 treated with RFA).Results: The ALBI score increased modestly but significantly after SBRT, while it was unchanged in the RFA group; the intergroup difference was statistically significant (p = 0.004). No local recurrence of tumor was identified in the SBRT group, whereas the cumulative recurrence incidence was 9.7% in the RFA group (p = 0.023). Overall survival was not significantly different between the two groups (hazard ratio 1.32, 95% confidence interval 0.60–2.89, p = 0.401).Conclusions: SBRT had modestly negative impact on liver function but better local control of HCC than did RFA. Although long-term follow-up of liver function is necessary with SBRT treatment especially in patients with impaired liver function, SBRT is a satisfactory alternative to RFA for treatment of single, small HCC.

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