Stereotactic Body Radiation Therapy With or Without Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone in Early-Stage Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Abstract Purpose This study aims to review the current evidence on the utility of stereotactic body radiation therapy (SBRT), with or without transarterial chemoembolization (TACE), for early-stage hepatocellular carcinoma (ESHCC) patients not amenable to standard curative treatment options. Methods Literature search was conducted using PubMed, ScienceDirect, and Google Scholar. Comparative studies reporting oncologic outcomes were included in the review. Results Four studies (one prospective cohort, three retrospective studies) compared SBRT versus TACE. Pooled analysis showed an overall survival (OS) benefit after three years (OR 1.67, 95% CI 1.17–2.39, p = 0.005) which persisted in the 5-year data (OR 1.53, 95% CI 1.06–2.39, p = 0.02) in favor of SBRT. Recurrence-free survival benefit with SBRT was also seen at three years (OR 2.06, 95% CI 1.03–4.11, p = 0.04) which continued after five years (OR 2.35, 95% CI 1.47–3.75, p = 0.0004). Two retrospective studies compared TACE followed by SBRT (TACE + SBRT) versus TACE alone. Pooled analysis showed significantly improved 3-year OS (OR 5.47; 95% CI 2.47–12.11, p < 0.0001) and local control (LC) (OR: 21.05; 95% CI 5.01–88.39, p = < 0.0001) in favor of the TACE + SBRT group. A phase III study showed significantly improved LC and progression-free survival with SBRT after failed TACE/TAE versus further TACE/TAE. Conclusions In ESHCC patients not amenable to established SOC, SBRT alone or the combination of TACE + SBRT appears to be more effective than TACE alone. SBRT after TACE/TAE failure also appears to be superior to further TACE/TAE based on a phase III trial. Larger prospective studies are warranted to further define the role of SBRT and TACE for ESHCC.