Improved radiotherapy for primary and secondary liver cancer: stereotactic body radiation therapy.

BACKGROUND Radiation therapy for primary and secondary liver cancer has been limited due to dose-limiting radiation-associated liver injury. Stereotactic body radiation therapy (SBRT) permits higher dose to tumors while minimizing radiation to uninvolved liver. The purpose of this study was to assess the efficacy and safety of SBRT for treating primary and secondary hepatic neoplasms. MATERIALS AND METHODS We performed a systematic review of prospective clinical trials published in English. RESULTS Fifteen studies involving 158 patients with primary tumors and 341 patients with metastases to the liver were included. Treatment was performed in 1-10 fractions to total doses of 18-60 Gy. One year local control and overall survival rates were 50-100% and 33-100% respectively. There were 13 cases of radiation-induced liver disease and 4 grade 5, 6 grade 4, and 69 grade 3 adverse events reported. CONCLUSION For patients who are unable or unwilling to undergo local therapy, SBRT is safe and efficacious for treating primary and secondary liver cancer.