Therapeutic outcome and related predictors of stereotactic body radiotherapy for small liver-confined HCC: a systematic review and meta-analysis of observational studies

• Published in: Radiation oncology (London, England) England), 2021-04, Vol.16 (1), p.68-15, Article 68
• Main Authors: Long, Yanyan, Liang, Yan, Li, Shujie, Guo, Jing, Wang, Ying, Luo, Yan, Wu, Yongzhong
• Format: Article
• Language: English
• Subjects: Ablation; Adult; Age; Aged; Aged, 80 and over; Cancer therapies; Carcinoma, Hepatocellular - radiotherapy; Care and treatment; Clinical trials; Complications; Confidence intervals; Development and progression; Evaluation; Female; Hepatocellular carcinoma; Hepatocellular carcinoma (HCC); Hepatoma; Humans; Lesions; Liver; Liver - pathology; Liver cancer; Liver Neoplasms - radiotherapy; Lymphatic system; Male; Medical prognosis; Meta-analysis; Metastasis; Methods; Middle Aged; Observational studies; Observational Studies as Topic; Patient outcomes; Patients; Prognosis; Radiation; Radiation dosage; Radiation therapy; Radiosurgery - methods; Radiotherapy; Statistical analysis; Statistical methods; Stereotactic body radiotherapy (SBRT); Subgroups; Systematic review; Toxicity; Treatment Outcome; Tumors
• ISSN: 1748-717X; 1748-717X
• DOI: 10.1186/s13014-021-01761-1

Stereotactic body radiotherapy (SBRT) is a promising ablative modality for hepatocellular carcinoma (HCC) especially for those with small-sized or early-stage tumors. This study aimed to synthesize available data to evaluate efficacy and explore related predictors of SBRT for small liver-confined HCC (≤ 3 lesions with longest diameter ≤ 6 cm). A systematic search were performed of the PubMed and Cochrane Library databases. Primary endpoints were overall survival (OS) and local control (LC) of small HCC treated with SBRT, meanwhile, to evaluate clinical parameters associated with treatment outcome by two methods including subgroup comparisons and pooled HR meta-analysis. The secondary endpoint was treatment toxicity. After a comprehensive database review, 14 observational studies with 1238 HCC patients received SBRT were included. Pooled 1-year and 3-year OS rates were 93.0% (95% confidence interval [CI] 88.0-96.0%) and 72.0% (95% CI 62.0-79.0%), respectively. Pooled 1-year and 3-year LC rates were 96.0% (95% CI 91.0-98.0%) and 91.0% (95% CI 85.0-95.0%), respectively. Subgroup comparisons regarding Child-Pugh class (stratified by CP-A percentage 100%, 75-100%, 50-75%) showed there were statistically significant differences for both 1-year and 3-year OS rate (p