Elsevier

Radiotherapy and Oncology

Volume 145, April 2020, Pages 63-70
Radiotherapy and Oncology

Systematic Review
Comparisons between radiofrequency ablation and stereotactic body radiotherapy for liver malignancies: Meta-analyses and a systematic review

https://doi.org/10.1016/j.radonc.2019.12.004Get rights and content

Highlights

  • The application of RFA and SBRT for liver neoplasms have complementary and overlapping aspects.

  • Pooled 2-year LC was higher with SBRT, including HCC and metastases studies. (83.8% vs. 71.8%, p=0.024).

  • LC was equivalent between SBRT and RFA for HCC (p=0.431) and better for SBRT for metastases (p<0.001).

  • OS was not different significantly between two modalities regarding metastases studies.

  • Although RFA showed better OS for HCC, the discrepancy between LC and OS requires further investigation, as they are local modalities with comparable efficacy.

Abstract

Introduction

Radiofrequency ablation (RFA) is a standard ablative modality for small liver malignancies. Stereotactic body radiotherapy (SBRT) has emerged although yet suffers a lack of high-level evidence. We performed meta-analyses and a systematic review to integrate the literature and help in clinical decision-making.

Methods

Systemic searches were performed of the PubMed, Medline, and EMBASE databases to identify controlled studies comparing RFA and SBRT.

Results

Eleven studies involving 2238 patients were included. Among them, eight studies were for treating early hepatocellular carcinomas (HCCs) and three for liver metastases. Including HCCs and liver metastases studies, the pooled two-year local control (LC) rate was higher in the SBRT arm (83.8%, 95% confidence interval [CI]: 77.6–88.4) than that in the RFA arm (71.8%, 95% CI: 61.5–80.2) (p = 0.024). Among studies on liver metastases, the pooled two-year LC rate was higher in the SBRT arm (83.6% vs. 60.0%, p < 0.001). No significant difference was found between arms in HCC studies (SBRT vs. RFA: 84.5 vs. 79.5% p = 0.431). Pooled analysis of overall survival (OS) in HCC studies showed an odds ratio of 1.43 (95% CI: 1.05–1.95, p = 0.023), favoring RFA. Among the two liver metastases studies with comparative survival data, no significant difference was observed.

Conclusion

LC was equivalent between RFA and SBRT for HCC and better for SBRT for the treatment of liver metastases. RFA was associated with better OS for HCC, but discrepancy between LC and OS requires further investigation, as they are local modalities having comparable efficacy.

Section snippets

Materials and method

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was performed across databases including Medline and EMBASE. The search terms were designed to identify studies comparing treatment outcomes between RFA and SBRT for malignancies in the liver: (RFA OR radiofrequency) AND (SBRT OR stereotactic) AND (HCC OR hepatocellular OR liver). No language or publishing period restrictions were applied. In addition to published articles, we

Results

A total of 621 studies were initially obtained. After excluding reviews, letters, editorials, case reports and series, and laboratory studies, 208 studies were subjected to abstract review. In the abstract review, studies with irrelevant subjects were excluded and multiple published studies in a single institution were filtered according to the criteria described above. The remaining 27 studies were subjected to full-text review to exclude those with irrelevant subjects or that did not fully

Discussion

While comparisons of treatment modalities for HCC might seem to be a furious battle for some researchers [29], some clinicians find them more likely to be complementary [12]. Competition among modalities can cause disputes among clinicians but may also provide a driving force for the development of modalities. As there are overlapping and mutually complementary parts among competitive modalities, it is important to objectively understand the advantages and disadvantages of each modality to

Conflict of interest statement

All the authors have no conflicts of interests in terms of employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or any funding.

Acknowledgement

This work was supported by Inha University Hospital Research Grant.

References (35)

  • N. Sanuki et al.

    Role of stereotactic body radiation therapy for hepatocellular carcinoma

    World J Gastroenterol

    (2014)
  • C.H. Rim et al.

    Leaflet manual of external beam radiation therapy for hepatocellular carcinoma: a review of the indications, evidences, and clinical trials

    Onco Targets Ther

    (2018)
  • D.R. Wahl et al.

    Outcomes after stereotactic body radiotherapy or radiofrequency ablation for hepatocellular carcinoma

    J Clin Oncol

    (2016)
  • D.J. Rajyaguru et al.

    Radiofrequency ablation versus stereotactic body radiotherapy for localized hepatocellular carcinoma in nonsurgically managed patients: analysis of the national cancer database

    J Clin Oncol

    (2018)
  • N. Sanuki et al.

    Are head-to-head comparisons between radiofrequency ablation and stereotactic body radiotherapy really necessary for localized hepatocellular carcinoma?

    J Clin Oncol

    (2018)
  • Bae SH, Park HC. Local modalities for inoperable hepatocellular carcinoma: radiofrequency ablation versus stereotactic...
  • Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised...
  • Cited by (91)

    • Advances in Radiation Therapy for Primary Liver Cancer

      2023, Surgical Oncology Clinics of North America
    View all citing articles on Scopus
    View full text