Neoadjuvant radiotherapy for resectable hepatocellular carcinoma with vascular invasion: A systematic review and meta‑analysis

95%). In subgroup analyses by vascular invasion type, patients with portal vein tumor thrombus (PVTT) showed a higher 1-year and 2-year OS compared with surgery alone, and two studies reporting time-to-event outcomes suggested lower recurrence and mortality; however, these findings are based on a small number of studies and should be interpreted with caution. Reported radiotherapy-related toxicities were generally manageable. Overall, current evidence is limited and heterogeneous; neoadjuvant radiotherapy may benefit selected patients with resectable HCC and PVTT, but adequately powered multicenter randomized trials with standardized protocols are needed.