Liver metastases and SBRT: A new paradigm?

Abstract

Background: The outstanding innovations made by early diagnosis, novel surgical techniques, effective chemotherapy regimens and conformal radiotherapy, have significantly improved patients overall survival and quality of life. Multidisciplinary approach to cancer has also led to an increased prevalence of patients with few, organ-confined metastases, who can experience long-term survival even if their disease is no longer localized. Liver is one of the most common site for metastatic disease from several cancers, and when metastatic disease is confined to liver, given the ability of this organ to regenerate almost to its optimal volume, surgical resection represents the standard of care because is associated with a better prognosis. Approximately 70-90% of liver metastases, however, are unresectable and a safe, effective alternative therapeutic option is necessary for these patients.

Materials and methods: A review of the current literature was performed to analyze the role of SBRT in treating liver metastases from different cancers. A literature search using the terms "SBRT" and "liver metastases" was carried out in PUBMED.

Results: Stereotactic body radiation therapy has shown to provide promising results in the treatment of liver metastases, thanks to the ability of this procedure to deliver a conformal high dose of radiation to the target lesion and a minimal dose to surrounding critical tissues.

Conclusion: Stereotactic body radiation therapy is a non-invasive, well-tolerated and effective treatment for patients with liver metastases not suitable for surgical resection.

Keywords: Liver; Oligometastatic patients; SBRT.

Fig. 1

Examples of target volumes delineation for liver SBRT.

Fig. 2

Example of liver metastases SBRT with VMAT technique.

Fig. 3

Example of complete metabolic response in a single hepatic.