Meta Analysis Of The Clinical Efficacy And Adverse Reaction Of Stereotactic Body Radiotherapy Versus Surgery Or Radiofrequency Ablation In The Treatment Of Hepatocellular Carcinoma

Objective:Stereotactic body radiotherapy(SBRT),surgery and radiofrequency ablation(RFA)are all effective local treatments for hepatocellular carcinoma(HCC).The purpose of this study was to compare the efficacy and adverse reaction of SBRT and surgery,SBRT and RFA in the treatment of HCC.Materials and Methods:Search China knowledge net,Wanfang,VIP,CBM,PubMed,Embase,Cochrane and Web of Science databases for related articles published before January 2022.Two researchers independently retrieve and extract data.Meta-analysis was made on local control rate(LC),progression-free survival rate(PFS),overall survival rate(OS)and the incidence of grade 3 and above adverse reactions of different treatment methods included in the literature by RevMan5.4 software.Results:A total of 4 articles were included in the Meta analysis of SBRT and surgical treatment of HCC,involving 763 patients with early stage HCC,most of whom were complicated with hepatitis and cirrhosis,including SBRT group(n=253)and operation group(n=510).The results of Meta analysis showed that there was no statistical significance in the difference of PFS between the SBRT group and the operation group(HR 0.99,95%CI 0.64～1.53,P=0.96).There was no statistical significance in the difference of OS between the SBRT group and the operation group(HR 1.66,95%CI 0.92～3.00,P=0.09).The incidence of grade 3 and above adverse reactions in the SBRT group was lower than that in the operation group(OR 0.13,95%CI 0.02～0.86,P=0.03).A total of 12 articles were included in the Meta analysis of SBRT and RFA in the treatment of HCC,involving 8577 patients,including 1410 in SBRT group and 7167 in RFA group.The results of Meta analysis showed that the LC of SBRT group was better than that of RFA group(HR 0.41,95%CI 0.32～0.53,P<0.00001).The OS of SBRT group was lower than that of RFA group(HR 1.19,95%CI 1.06～1.35,P=0.005).The incidence of grade 3 and above adverse reactions in the SBRT group was lower than that in the RFA group(OR 0.56,95%CI 0.36～0.88,P=0.01).Conclusion:SBRT and surgery in the treatment of HCC,for patients with early staging of HCC,especially those with hepatitis and cirrhosis,the local efficacy of SBRT is comparable to that of surgery,and SBRT has a lower incidence of serious adverse reactions than surgery.SBRT and RFA in the treatment of HCC,SBRT has better local efficacy than RFA,and SBRT has a lower incidence of serious adverse reactions than RFA,but SBRT does not bring long-term survival benefits.