Safety and Efficacy of Stereotactic Body Radiation Therapy in Very Elderly Patients (≥80 years) with Solitary Hepatocellular Carcinoma

Background: The number of elderly patients with hepatocellular carcinoma (HCC) has been increasing worldwide. This study aimed to evaluate the clinical outcomes of stereotactic body radiation therapy (SBRT) for patients aged ≥80 years with solitary HCC. Methods: This retrospective study included 117 patients with solitary HCC treated with SBRT between January 2019 and June 2025 at eight institutions in Japan. Patients were categorized into the very elderly group (≥80 years, n = 41) and the control group (<80 years, n = 76). Overall survival (OS), local tumor progression (LTP), and treatment-related toxicities were evaluated. Propensity score matching (PSM) was performed to minimize baseline imbalances between the two groups. Results: The median age was 84 years in the very elderly group and 74 years in the control group. The 3-year OS rates were 79.0% in the very elderly group and 62.8% in the control group, with no statistically significant difference observed (crude cohort, p = 0.072; PSM cohort, p = 0.114). The 3-year LTP rates were 18.9% in the very elderly group and 15.6% in the control group, without significant intergroup differences. Acute toxicities were numerically more frequent in the very elderly group; however, no grade ≥3 toxicities or treatment-related deaths were observed. Changes in ALBI score did not differ significantly between groups (p = 0.785). Conclusions: SBRT may represent a feasible treatment option with an acceptable safety profile in carefully selected very elderly patients with solitary HCC. It may be a reasonable option for this growing patient population.