Stereotactic ablative radiotherapy for hepatocellular carcinoma: A systematic review and meta‐analysis of local control, survival and toxicity outcomes

Abstract

There is a growing body of literature supporting the use of stereotactic ablative body radiotherapy (SABR) in the management of primary hepatocellular carcinoma (HCC). This systematic review and meta-analysis of the current published evidence for SABR for HCC assessed the impact of treatment dose, fractionation and tumour size on the outcomes of local control (LC), overall survival (OS) and toxicity. A systematic search was independently performed by two authors for articles published in peer-reviewed journals between January 2005 and December 2019. A DerSimonian and Laird random effects model was used to assess pooled results. A multivariate meta-regression analysis incorporated the effect of explanatory variables (radiation dose in EQD2 [10], fractionation and tumour size) on outcomes of OS, LC and toxicity. Forty-nine cohorts involving 2846 HCC patients with 3088 lesions treated with SABR were included. Pooled 1-, 2-and 3-year LC rates were 91.1% (95% confidence interval [CI] 88.3-93.2), 86.7% (95% CI 82.7-89.8) and 84.2% (95% CI 77.9-88.9) respectively. Pooled 1-, 2-and 3-year OS rates were 78.4% (95% CI 73.4-82.6), 61.3% (55.2-66.9) and 48.3% (95% CI 39.0-57). Population-weighted median grade 3 toxicity rates were 6.5% (IQR 3.2-16) and mean grade 4/5 rates were 1.4% (IQR 0-2.1). Within EQD2 [10] ranges of 40 to 83.33 Gy corresponding to common dose-fractionation regimens of 30-50 Gy in 5 fractions, there was a multivariate association between superior LC and OS with increasing EQD2 [10] , with a proportionately smaller increase in grade 3 toxicity and no association with grade 4/5 toxicity. Stereotactic ablative body radiotherapy is a viable treatment option for HCC with high LC rates and low rates of reported grade 3/4 toxicity. Increasing EQD2 [10] was associated with improvements in LC and OS with a comparatively smaller increase in toxicity. Prospective randomised trials are warranted to define optimal patient selection and dose-fractionation regimens.

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

“…[91] Transarterial radioembolization (TARE) is equally effective [92]. Stereotactic body radiation bears antitumoral activity but further prospective studies are needed to define it role [93,94]. However, while safety and efficacy data are well established for RF and MW, TARE could be considered in patients with single nodules < 8 cm.…”

Bibliometric Analysis of the Top-Cited Publications and Research Trends for Stereotactic Body Radiotherapy

“…Daniel et al reported that SBRT was superior to radiofrequency ablation for hepatocellular carcinomas ≥2 cm (34), while Zhang et al found that SBRT yielded better clinical outcomes than fractionated radiotherapy in primary liver cancer with portal vein tumor thrombus (35). A recent meta-analysis confirmed the efficacy and safety of SBRT for hepatocellular carcinoma with a regimen of 30-50 Gy in five fractions (36).…”

Thermal ablation compared to stereotactic body radiation therapy for hepatocellular carcinoma: A multicenter retrospective comparative study

“…SBRT involves the delivery of highly targeted, fractionated radiation doses delivered with image guidance to liver tumors. SBRT is a promising alternative to RFA or MWA, with emerging data supporting its efficacy 9 . However, SBRT is not yet included as a primary treatment modality in all HCC treatment guidelines or in the updated BCLC system as there is less data using this modality at present 4 , 5 , 10 .…”