Transcatheter arterial chemoembolization combined with stereotactic body radiation therapy versus transcatheter arterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis.

Abstract

BackgroundThe optimal integration of locoregional therapies for unresectable hepatocellular carcinoma (HCC) remains an area of active investigation. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of combining transcatheter arterial chemoembolization (TACE) with stereotactic body radiotherapy (SBRT) compared to TACE.MethodsA comprehensive literature search was conducted across five databases up to March 1, 2026. Eligible studies compared TACE combined with SBRT versus TACE (with or without concurrent systemic therapy) for unresectable HCC. The primary outcomes were overall survival (OS) and progression-free survival (PFS), with treatment-related adverse events (CTCAE grade ≥3) as a key safety outcome. Pooled hazard ratios (HR) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models. Heterogeneity was assessed using Cochran's Q test and the I² statistic. Subgroup analyses (by study design, concurrent systemic therapy, and HR adjustment) and sensitivity analyses were performed.ResultsNine studies involving 828 patients were included. The TACE-SBRT combination significantly improved OS (HR = 0.48, 95% CI: 0.35-0.65, P P P = 0.21). Sensitivity analyses confirmed the robustness of the findings.ConclusionIn patients with unresectable HCC, the combination of TACE and SBRT appears to confer a survival advantage over TACE, without significantly increasing the risk of severe adverse events.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261350374, identifier CRD 420261350374.