This meta-analysis included 22 original studies involving 1858 HCC patients who received PBT to a total dose ranged from 55 GyE to 76 GyE. The median proportion of Child-Pugh class A was 86% (range: 41-100%), and the median tumor size was 3.6 cm (range: 1.2-9 cm). The pooled rates of 3- and 5-year local progression-free survival after PBT were 88% and 86%. The pooled 3- and 5-year overall rates were 60% and 46% respectively. The pooled rates of grade 3 hepatic toxicity, classic radiation-induced liver disease (RILD), and non-classic RILD were 1%, 2%, and 1%, respectively. The authors concluded that this data demonstrates favorable long-term survival and low hepatic toxicities compared with data from other radiotherapy modalities.