Stereotactic body radiotherapy in early-stage hepatocellular carcinoma: a systematic review and meta-analysis

<h3>Background</h3> First-line treatment strategies for (very) early-stage hepatocellular carcinoma (HCC) include liver transplantation, surgical resection and thermal ablation. Stereotactic body radiotherapy (SBRT) has recently been included in the European Association for the Study of the Liver Clinical Practice Guidelines on the management of hepatocellular carcinoma as an alternative ablative strategy. We aimed to carry out a systematic review and meta-analysis on oncological outcomes and toxicity of SBRT focused on early-stage HCC treatment. <h3>Materials and methods</h3> We carried out a systematic literature search in PubMed, Embase, and the Cochrane Library from inception throughout October 2022. Studies of SBRT targeting treatment-naive (very) early-stage HCC (BCLC 0/A) patients were included. <h3>Results</h3> One prospective and 15 retrospective studies were included in this review. In aggregate, SBRT in 1249 patients resulted in a 1-, 2-, and 3-year local control rate of 94% (95% CI 92%-97%), 89% (95% CI 85%-93%), and 79% (95% CI 68%-90%), respectively. The pooled results of the 1-, 2-, and 3-year overall survival rate were 90% (95% CI 85%-94%), 75% (95% CI 63%-87%), and 59% (95% CI 45%-73%), respectively. Grade ≥3 toxicity was observed in 2% of patients (95% CI 0%-4%). <h3>Conclusion</h3> This systematic review and meta-analysis showed that SBRT is an effective and safe treatment modality for treatment-naive patients with early-stage HCC. The data support incorporation of SBRT as a treatment option in the treatment algorithms for (very) early-stage HCC.