External beam radiotherapy versus local ablation therapy for the treatment of hepatocellular carcinoma: a systematic review and meta-analysis
- Journal
- Clinical and molecular hepatology (Q1)
- Published
- 30 July 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Sun Hyun Bae, Seo Hee Choi, Sang Min Yoon, Jeong Il Yu, Hyun-Cheol Kang, Nalee Kim, et al.
- PMID
- 42532487
- DOI
- 10.3350/cmh.2026.0535
Why clinicians should know about it
- Picked for Hepatology (top studies of the week, 2 August 2026).
Abstract
BACKGROUND/AIMS: Local ablation therapies (LATs), including radiofrequency (RFA) and microwave ablation (MWA), are established for small hepatocellular carcinoma (HCC) as standard treatment. External beam radiotherapy (EBRT), including stereotactic body radiotherapy (SBRT) and proton beam therapy (PBT), has emerged as a non-invasive alternative; however, direct comparative evidence remains limited. We conducted a systematic review and meta-analysis comparing the efficacy and safety of EBRT versus LAT in patients with HCC. METHODS: PubMed/MEDLINE, Embase, Cochrane Library, and KoreaMed were searched through June 2025 per PRISMA guidelines. Eligible studies included retrospective or prospective comparisons of EBRT (SBRT/PBT) with LAT (RFA/MWA) reporting recurrence or survival. Hazard ratios (HRs) and odds ratios (ORs) were pooled using random-effects models. RESULTS: Twelve studies (2,768) patients were included. Compared with LAT, EBRT was associated with significantly lower local recurrence (OR 0.36, 95% confidence interval [CI] 0.25-0.50; P<0.001; I² = 0%) and improved local progression-free survival (HR 0.41, 95% CI 0.34-0.50; P <0.001), regardless of tumor size. Progression-free survival favored EBRT (HR 0.80, 95% CI 0.64-1.00; P = 0.049), whereas overall survival did not differ significantly between modalities (HR 1.24, 95% CI 0.83-1.84; P = 0.291). Severe toxicities (grade ≥3) were comparable between groups for acute (OR 0.78, 95% CI 0.27-2.24) and late events (OR 1.29, 95% CI 0.85-1.95). CONCLUSIONS: EBRT was associated with better local control without significant differences in survival or toxicity compared with LAT. These findings support the safety and efficacy of EBRT for local treatment of patients with liver-confined HCC.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.