Primary Hepatic Radiosurgery

Radiation therapy has traditionally occupied a palliative role in the management of patients with primary and metastatic liver tumors. This has resulted from concerns about the side effects caused by irradiating the entire liver using standard radiotherapy techniques. Still, these tumors have demonstrated varied but promising degrees of sensitivity to irradiation, thus stimulating additional interest and research.

Over the past decade, technical advances in radiation therapy techniques have made it possible to deliver increasingly effective radiation treatments to tumor-bearing portions of the liver while sparing normal tissues. Termed hepatic radiosurgery, this treatment is precision-delivered in short courses with relatively few side effects.

Once patients are deemed appropriate candidates for radiosurgery (following evaluations by radiation and surgical oncologists), they are scheduled for implantation of tiny treatment planning seeds (called fiducials), an outpatient procedure done with local anesthesia under CT guidance. These fiducial seeds allow the computer-guided radiation unit (the Cyberknife® at Saint Francis Cancer Program) to accurately monitor and direct the treatment as it progresses, making appropriate adjustments for patient movement and breathing.

The preliminary data evaluating the effectiveness of this exciting new modality suggest that its ability to completely destroy liver tumors rivals that of the more traditional approaches such as surgery or cryotherapy. Still, not all patients are candidates for hepatic radiosurgery, appealing to patients as it may seem. They may instead, be counseled to pursue treatments more appropriate for their individual situation.