Aim: To test the efficacy and safety of liver stereotactic body radiation therapy (SBRT) in patients who harbor adverse factors.

Methods: We retrospectively evaluated the outcomes of liver SBRT in a single cancer center. We invented criteria consisting of two physical factors and two tumor factors to measure the treatment difficulty in each case. The clinical outcomes and toxicity were evaluated by stratification of the harboring factors.

Results: A total of 24 (23 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma) patients were eligible for this study, with a median follow-up duration of 18 months. Of all eligible patients, 21 patients (88%) had one or more factors. The local control, progression-free survival, and overall survival rates for all patients at 2 years were 89%, 42%, and 76% respectively. In the patients with physical and tumor adverse factors, local control/progression-free survival/overall survival rates at 2 years were 100%/42%/69% and 80%/23%/78%, respectively. The subgroup of 11 patients with 2 or more factors showed comparable local control rate at 2 years to the subgroup of 13 patients with 0 to 1 factors (100% vs. 86%, P = 0.59). One patient (4.2%) experienced a decline in the Child-Pugh score by 2 points at 3 months after the treatment. Grade 2 to 3 gastrointestinal toxicity was observed in three patients.

Conclusion: SBRT showed a high local control rate with acceptable toxicity for the group of liver cancer patients harboring both physical and tumor adverse factors as long as conducted following patient selection and dose constraints that were used in this study.

Liver metastases can present synchronously or at different time points. While systemic therapy continues to be the mainstay of treatment for patients with liver metastases, it is unlikely to completely eradicate the disease. Surgical “metastectomy” for patients with limited metastatic burden, particularly from colorectal cancers, has been shown to improve survival. However, owing to medical co-morbidities or tumour location, not all patients are eligible for surgical resection. In recent years, there has been an increase in the use of non-surgical techniques, including high dose radiation using stereotactic body radiotherapy, or brachytherapy, to ablate liver metastases. The purpose of this narrative review is to describe the role of radiotherapy in the management of liver metastases, both for local ablation and symptom palliation. We will elaborate on the techniques used, patient selection process, expected outcomes and toxicities based on the current literature.

Liver transplant (LT) is the curative treatment for patients with hepatocellular carcinoma (HCC). Bridge therapies are local treatments given to patients on the LT waitlist, to prevent tumor progression and to reduce the dropout rate. Case presentation: We reported a 40-year-old man diagnosed with Barcenola-Clinic Liver Cancer BCLC intermediate stage HCC and Child-Pugh A5 hepatitis B virus cirrhosis who underwent combined bridge therapies to LT. Firstly, the patient received transarterial chemoembolization (TACE) for two times and showed a partial response. Then he underwent stereotactic body radiation therapy (SBRT) with a total dose of 45 Gy in 3 fractions. Three months later, the tumor size and serum protein induced by Vitamin K absence or antagonists-II, alpha fetoprotein levels decreased gradually. In June 2019 a suitable donor was found and his LT was successfully performed. Conclusion: We propose that a combination of TACE and SBRT was feasible as bridge therapy for HCC patients on the LT waitlist.

Surgical resection or radiofrequency ablation (RFA) is considered first-choice treatment for small hepatocellular carcinomas (HCCs). When a patient has a small HCC that is inoperable or unsuitable for RFA, what are alternative treatments? Some oncologists recommend transarterial chemoembolization (TACE), chemotherapy, molecular-targeted therapy, or immunotherapy. However, these treatments have minimally beneficial effects in small HCCs. Stereotactic body radiation therapy (SBRT) is a liver-directed radical therapy for small HCCs, with treatment outcomes similar to those for surgical resection or RFA, but many oncologists do not comprehend its efficacy or accept this therapy. We herein discuss 11 typical patients who received SBRT for various indications: refusal to undergo resection or RFA; surgical resection or RFA considered difficult or unfeasible; residual cancer after surgical resection or RFA or incomplete iodized oil retention after TACE; or tumor recurrence after resection or RFA. We describe each case, including the radiation field, tumor radiation dose, and response to SBRT in both the tumor and liver parenchyma. These clinical data should help readers understand this new therapeutic technique. We also conducted a literature review and found evidence to support survival benefit with SBRT, including good three- and five-year overall survival rates. The purpose of this article is to encourage readers to accept the concept that SBRT is a low-toxicity and effective therapeutic option for patients with small HCCs, which offers substantial local control and improved overall survival, especially for patients with a tumor that is unresectable or unsuitable for RFA, residual tumor after local therapy, or intrahepatic recurrent tumor.

The use of stereotactic body radiotherapy (SBRT) in hepatocellular carcinoma (HCC) has increased over the past few decades. Thus, accurate evaluation of post-SBRT treatment response is essential to avoid over-treatment of responders as well as missing the opportunity to salvage non-responders. There are some intricate imaging differences after liver SBRT compared to those observed after conventional fractionated radiotherapy and other locoregional treatment. We aim to review the imaging changes that occur following SBRT for HCC and their potential clinical implications.