Comparison of stereotactic body radiotherapy and radiofrequency ablation for hepatocellular carcinoma: systematic review and meta-analysis of propensity score studies.

AIM Stereotactic body radiotherapy (SBRT) is emerging treatment for hepatocellular carcinoma (HCC) and has shown excellent local control (LC) as with radiofrequency ablation (RFA). Since no randomized controlled trial compared SBRT and RFA for HCC, data from propensity score matched study (PSMS) is valuable. However, the results greatly varied and depend on composing factors of Barcelona Clinic Liver Cancer staging (BCLC-factors) adjusted. Therefore, we performed a systematic review and meta-analyses of the studies focusing on BCLC-factors matching. METHODS We systematically searched PubMed, the Cochrane database, EMBASE, and Web of Science to identify studies comparing RFA and SBRT using propensity score. The hazard ratios (HRs) of overall survival (OS) and LC from BCLC-factor-matched and unmatched PSMS were pooled. Heterogeneity between the data from these studies was assessed. RESULTS Three BCLC-factor-matched studies were identified. SBRT led to comparable OS (HR, 0.89; 95% CI, 0.74-1.08; p = 0.24; I2 = 0%; p for heterogeneity, 0.56) and significantly better LC (HR, 0.39; 95% CI, 0.30-0.51; p < 0.001; I2 = 0%; p for heterogeneity, 0.67). We also identified three additional BCLC-factor-unmatched studies (HR of OS, 1.41; 95% CI, 1.21-1.65; p < 0.0001; I2 = 0%; p for heterogeneity, 0.63). However, considerable heterogeneity was observed for HR of OS between BCLC-factor-matched and unmatched studies (I2 = 92.6%; p for heterogeneity, 0.0002). CONCLUSIONS When BCLC-factors were properly adjusted, the results of the meta-analysis revealed equivalent OS and better LC for SBRT compared with RFA. SBRT could be an alternative treatment option for HCC. This article is protected by copyright. All rights reserved.