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Neoadjuvant radiotherapy for resectable hepatocellular carcinoma with vascular invasion: A systematic review and meta‑analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Advances in conformal and image-guided external-beam radiotherapy have expanded its application in hepatocellular carcinoma (HCC); however, the benefit of neoadjuvant radiotherapy before resection for HCC with vascular invasion remains uncertain.A systematic review and meta-analysis were conducted comparing neoadjuvant radiotherapy plus hepatectomy vs. hepatectomy alone in resectable HCC with vascular invasion.Databases were searched through August 1, 2024.Primary outcomes were overall survival (OS) and disease-free survival (DFS).A total of four studies (n=362) were included.In the overall pooled analysis, neoadjuvant radiotherapy was not associated with a statistically significant improvement in 1-year OS [risk ratio (RR) 1.62; 95% confidence interval (CI) 0.71-3.69]or 2-year OS (RR 2.64; 95% CI 0.57-12.27),with considerable heterogeneity (I 2 97 and 94%, respectively).Similarly, 1-year DFS was not significantly different between groups (RR 2.68; 95% CI 0.50-14.43;I² 95%).In subgroup analyses by vascular invasion type, patients with portal vein tumor thrombus (PVTT) showed a higher 1-year and 2-year OS compared with surgery alone, and two studies reporting time-to-event outcomes suggested lower recurrence and mortality; however, these findings are based on a small number of studies and should be interpreted with caution.Reported radiotherapy-related toxicities were generally manageable.Overall, current evidence is limited and heterogeneous; neoadjuvant radiotherapy may benefit selected patients with resectable HCC and PVTT, but adequately powered multicenter randomized trials with standardized protocols are needed.

Source: Oncology Letters

DOI: 10.3892/ol.2026.15619

Authors: Yuhao Su, Yuxin Liang, Deyuan Zhong, Hongtao Yan, Qinyan Yang, Xiaolun Huang

Institutions: University of Electronic Science and Technology of China, Sichuan Cancer Hospital

Language: English

Topic: Hepatocellular Carcinoma Treatment and Prognosis

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funder: Sichuan Province Science and Technology Support Program