The evolving evidence for the efficacy and safety of charged particle therapy for hepatocellular carcinoma—a commentary

Qi and coauthors (1) present a systematic review and meta-analysis of outcomes and toxicity for hepatocellular carcinoma (HCC) patients treated with charged particle therapy (CPT) or photon-based radiation therapy [conventional radiotherapy (CRT) or stereotactic body radiation therapy (SBRT)]. Due to a lack of randomized data comparing these two modalities, the authors utilize data collected from 70 observational studies to draw the conclusion that CPT offers superior survival outcomes compared to CRT and decreased toxicity compared to both CRT and SBRT. The authors conclude that these data may provide evidence for an advantage of CPT in HCC radiation treatment, although definitive conclusions cannot yet be drawn. They acknowledge the lack of high-quality data and bias inherent in the comparison of observational studies and recommend additional prospective trials comparing these modalities.