Stereotactic body radiation therapy for hepatocellular carcinoma larger than 5 cm: a systematic review and meta-analysis.

PURPOSE: The efficacy of stereotactic body radiation therapy (SBRT) for large (≥ 5 cm) hepatocellular carcinoma (HCC) remains unclear.

MATERIALS AND

METHODS

This systematic review and meta-analysis (PROSPERO: CRD420261295276) searched six databases (Embase, PubMed, Scopus, Web of Science, Cochrane Library, and Clinical Trial databases) and included eleven studies (424 patients) evaluating SBRT for large HCC up to May 31, 2026.

RESULTS

The pooled 1- and 2-year local control rates were 81% (95% confidence interval [CI], 66-90%) and 69% (95% CI 48-84%), respectively, and the corresponding overall survival rates were 60% (95% CI 55-66%) and 37% (95% CI 30-45%). Mean/median age < 65 years was a favorable factor for 2-year overall survival (P < 0.05). Severe liver toxicity (grade ≥ 3) is rare. SBRT provides effective local control and overall survival with acceptable toxicity for large HCC.

CONCLUSION

These findings support SBRT as a viable option for patients with HCC ≥ 5 cm, although further prospective studies are warranted.