This study from Japan was set to compare the survival outcomes of PBT with those of radiofrequency ablation (RFA) in patients with treatment-naïve solitary HCC with a single nodule measuring ≤5 cm in diameter, and a Child-Pugh score of ≤8. Ninety-five patients treated with PBT at the University of Tsukuba Hospital were enrolled in the study. In addition, 836 patients with treatment-naïve HCC treated by RFA at the University of Tokyo Hospital during the same period were analyzed as controls. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 86.6%, 49.5%, and 35.5% in the PBT group and 59.5%, 34.0%, and 20.9% in the RFA group (p = 0.058); the respective OS rates were 97.6%, 77.8%, and 57.1% in the PBT group and 95.1%, 81.7%, and 67.7% in the RFA group (p = 0.16). No grade 3 or higher adverse events were noted in the PBT, but two grade 3 adverse events occurred within 30 days of RFA in the RFA group. The authors concluded that PBT showed no significant difference in RFS and OS compared to RFA, and PBT can be an alternative for patients with solitary treatment-naïve HCC.