| 1 | Bae et al. [25] | Systematic review/meta-analysis | Outcomes and hepatic toxicity after SBRT for liver-confined HCC | Seventeen observational studies between 2003 and 2019 | 1889 patients with HCC treated with ≤9 SBRT fractions | The 3- and 5-year OS rates after SBRT were 57% (95% 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. 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. SBRT is an effective treatment modality for patients with HCC with mature follow-up |
| 2. | Kim et al. [23] | Retrospective study | Efficacy of SBRT and RFA for HCC, FFLP | Patients treated for HCC between 2012 and 2016 | 668 patients who underwent RFA of 736 tumors and 105 patients who underwent SBRT of 114 tumors | SBRT-treated tumors were more advanced, larger (median: 2.4 vs. 1.6 cm), and more frequently located in the subphrenic region than RFA-treated tumors (P < 0.001). SBRT is an effective alternative treatment for HCC when RFA is not feasible due to tumor location or size |
| 3 | Wahl et al. [24] | Retrospective study | Outcomes between SBRT and RFA for HCC | HCC patients from 2004 to 2012 | 224 patients with inoperable, nonmetastatic HCC underwent RFA (n = 161) to 249 tumors or image-guided SBRT (n = 63) to 83 tumors | One- and 2-year FFLP for tumors treated with RFA were 83.6% and 80.2%, respectively, and for tumors treated with SBRT were 97.4% and 83.8%, respectively. Increasing tumor size predicted for FFLP in patients treated with RFA (HR: 1.54 per cm; P = 0.006), but not with SBRT (HR: 1.21 per cm; P = 0.617). Overall survival 1 and 2 years after treatment was 70% and 53% after RFA and 74% and 46% after SBRT, respectively |
| 4 | Rim et al. [31] | Hybrid meta-analysis | Comparison between RFA and ablative RT for HCC | Twenty-one studies | 4,638 patients | Pooled 1- and 2-year survival rates for HCC studies were 91.8% and 77.7% after RFA and 89.0% and 76.0% after ablative RT, respectively; ablative RT can yield oncologic outcomes similar to RFA, and suggests that it can be more effective for the treatment of tumors in locations where RFA is difficult to perform or for large-sized tumors |
| 5 | Dumago et al. [27] | Systematic review/meta-analysis | Utility of SBRT, with or without TACE, for early-stage HCC patients not amenable to standard curative treatment options | Literature, comparative studies | Five studies (one Phase II randomized controlled trial, one prospective cohort, and three retrospective studies) compared SBRT versus TACE | Clinical outcomes improved significantly in all groups having SBRT as a component of treatment versus TACE alone or further TACE |
| 6 | Wong et al. [28] | Retrospective study | Outcomes of nonresectable HCC patients who had TACE versus SBRT after TACE (TACE + SBRT) |
| 49 patients were in the TACE + SBRT group and 98 patients were in the TACE group | TACE + SBRT is safe and results in better survival in nonresectable HCC patients |
| 7 | Shen et al. [29] | Retrospective study | Comparison of efficacy between SBRT and Sorafenib, when given after TACE Efficacy in comparison to SBRT + sorafenib, when combined with TACE | 77 HCC patients with macroscopic vascular invasion receiving TACE–SBRT or TACE–sorafenib combination therapies | 26 patients (33.8%) received TACE–SBRT treatment and 51 (66.2%) received TACE–sorafenib treatment | HR of OS to PFS for the TACE–SBRT approach and the TACE–sorafenib approach was 0.36 (95% CI: 0.17–0.75; P = 0.007) and 0.35 (95% CI: 0.20–0.62; P < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE–sorafenib therapy |
| 8. | Yoon et al. [30] | Randomized clinical trial | Efficacy and safety compared with sorafenib for patients with HCC and macroscopic of TACE plus RT vascular invasion | Randomized, open-label clinical trial, 90 treatment-naive patients with liver-confined HCC showing macroscopic vascular invasion | Sorafenib (400 mg twice daily; 45 participants [the sorafenib group]) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE, maximum 45 Gy with a fraction size of 2.5–3 Gy; 45 participants [the TACE-RT group]) | At week 12, the PFS rate was significantly higher in the TACE-RT group than in the sorafenib group (86.7% vs 34.3%; P < 0.001). The TACE-RT group showed a significantly higher radiologic response rate than the sorafenib group at 24 weeks (15 [33.3%] vs. 1 [2.2%]; P < 0.001), a significantly longer median time to progression (31.0 vs. 11.7 weeks; P < 0.001), and significantly longer overall survival (55.0 vs. 43.0 weeks; P = 0.04). Curative surgical resection was conducted for five patients (11.1%) in the TACE-RT group owing to downstaging |
| 9 | Sapisochin et al. [26] | Observational study | Safety and efficacy of SBRT on an intention-to-treat basis compared with TACE and RFA as a bridge to liver transplantation in a large cohort of patients with HCC | 379 patients | SBRT (n = 36, SBRT group), TACE (n = 99, TACE group), or RFA (n = 244, RFA group) | SBRT can be safely utilized as a bridge to LT in patients with HCC, as an alternative to conventional bridging therapies |
