Stereotactic body radiation therapy and central liver toxicity: A case report

Abstract

Stereotactic body radiation therapy (SBRT) has become an increasingly common component in the treatment of primary andmetastatic liver tumors. Liver SBRT allows for focused high-dose radiation to the target while minimizing dose to the remaining liver. In the majority of cases, this treatment is effective and well tolerated; however, some studies have reported up to 30% grade 3 or higher toxicity.1 One of the potential risks of liver SBRT is radiation-induced liver disease (RILD), which is characterized by nonicteric ascites, hepatomegaly, and elevated alkaline phosphatase and typically develops 4 weeks to 3 months after treatment. The risk of RILD can be reduced by minimizing the mean liver dose or by sparing a critical volume of liver from receiving more than the dose tolerance. However, for centrally located liver lesions, RILD does not account for damage specific to the central hepatobiliary tree and portal vein, and the traditional dose constraints do not account for the specific tolerance of these structures. Toxicity of the central hepatobiliary tree may be attributable to stenosis/stricture, which could lead to elevated alkaline phosphatase, jaundice, and cholangitis. To further characterize the potential toxicity of SBRT, we describe a case of a patient who underwent liver