Author information

¹Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.

²Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.

³Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea.

⁴Department of Radiation Oncology, Inje University Sanggye Paik Hospital, Seoul, Korea.

⁵Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.

⁶Department of Biostatistics, Soonchunhyang University College of Medicine, Bucheon, Korea.

⁷Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France.

⁸Department of Radiation Oncology, Kochi Medical School, Kochi University, Kochi, Japan.

⁹Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan; Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

¹⁰Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.

¹¹Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, United Kingdom.

¹²Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland.

¹³Department of Radiation Oncology, University of Washington, Seattle, Washington.

¹⁴Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.

¹⁵Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.

¹⁶Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.

¹⁷Department of Radiation Oncology, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada.

¹⁸Department of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul, Korea. Electronic address: mskim@kirams.re.kr.

Abstract

This systematic review and meta-analysis reports on outcomes and hepatic toxicity rates after stereotactic body radiation therapy (SBRT) for liver-confined hepatocellular carcinoma (HCC) and presents consensus guidelines regarding appropriate patient management. Using the Preferred Reporting Items for Systemic Review and Meta-Analyses guidelines, a systematic review was performed from articles reporting outcomes at ≥5 years published before October 2022 from the Embase, MEDLINE, Cochrane, and Scopus databases with the following search terms: ("stereotactic body radiotherapy" OR "SBRT" OR "SABR" OR "stereotactic ablative radiotherapy") AND ("hepatocellular carcinoma" OR "HCC"). An aggregated data meta-analysis was conducted to assess overall survival (OS) and local control (LC) using weighted random effects models. In addition, individual patient data analyses incorporating data from 6 institutions were conducted as their own subgroup analyses. Seventeen observational studies, comprising 1889 patients with HCC treated with ≤9 SBRT fractions, between 2003 and 2019, were included in the aggregated data meta-analysis. The 3- and 5-year OS rates after SBRT were 57% (95% confidence interval [CI], 47%-66%) and 40% (95% CI, 29%-51%), respectively. The 3- and 5-year LC rates after SBRT were 84% (95% CI, 77%-90%) and 82% (95% CI, 74%-88%), respectively. Tumor size was the only prognostic factor for LC. Tumor size and region were significantly associated with OS. Five-year LC and OS rates of 79% (95% CI, 0.74-0.84) and 25% (95% CI, 0.20-0.30), respectively, were observed in the individual patient data analyses. Factors prognostic for improved OS were tumor size <3 cm, Eastern region, Child-Pugh score ≤B7, and the Barcelona Clinic Liver Cancer stage of 0 and A. The incidence of severe hepatic toxicity varied according to the criteria applied. SBRT is an effective treatment modality for patients with HCC with mature follow-up. Clinical practice guidelines were developed on behalf of the International Stereotactic Radiosurgery Society (ISRS).