Towards Liver SBRT – A clinical experience

Abstract

Historically external beam radiation therapy has not been used to treat metastatic liver and hepatocellular carcinoma (HCC), due to the increased risk of radiation induced liver disease (RILD). Remarkable advances in imaging and delivery technology can now be harnessed to enhance target localisation and local control for patients suffering with HCC and oligometastatic liver disease. Image-Guided Radiation Therapy (IGRT) and Stereotactic Body Radiation Therapy (SBRT) are rapidly revolutionising the planning and delivery of radiation therapy in the treatment of cancer. Being able to see and track the changes that take place over a radical course of radiation therapy present numerous exciting opportunities. The treatment of liver carcinoma with radiotherapy is a highly complex non-invasive treatment option that can deliver significant benefits to non-operable patients when administered successfully. Safe administration of the world’s most advanced radiotherapy treatment techniques such as 4D-IGRT or end expiration breath-hold (EEBH), flattening filter free (FFF), SBRT volumetric arc therapy (VMAT) is a highly challenging commitment and endeavour to undertake, especially so for the clinical physicist. This presentation will highlight some of the main challenges encountered when developing and implementing a liver SBRT program across a multi-disciplinary team, which includes education and training, patient selection, physics QA and establishing process-specific documentation.