Stereotactic body radiotherapy of primary liver tumours: Indications and new techniques

The incidence of primary hepatic tumours is increasing and the reference treatments by liver trans-plantation or surgical resection do not allow to compensate for this increase because of the lack of grafts, or the low proportion of initially resectable tumours. The challenges for radiotherapy of primary liver tumors are multiple: physical, biological, medical and technological. Liver stereotactic body radio-therapy is sometimes the only local treatment option and is progressively finding its place for these tumors, even if the recognition of the indications would deserve a better standardization of international recommendations. The heterogeneity of practices and techniques is a major obstacle to the develop-ment of randomized studies, despite the excellent oncological results published. The latest ASTRO 2022 guidelines, the recent publication of the guidelines from the French society for radiation oncology on external radiotherapy , brachytherapy procedures ( RecoRadTM 2.0 ) , the inclusion in prospective clinical trials will help to homogenize protocols and improve recognition of the technique. The first data from the new techniques of adaptive radiotherapy and MR-guided radiotherapy, whose objectives are to improve targeting and reduce liver or gastrointestinal toxicity, confirm the excellent results of liver SBRT and allow the potential indications to be extended to locations that were previously difficult to treat. (c) 2022 Societe franc , aise de radiotherapie oncologique (SFRO). Published by Elsevier Masson SAS. All rights reserved.

Automated summary

The incidence of primary hepatic tumours is increasing, and traditional treatments are insufficient. Liver stereotactic body radiotherapy has emerged as a potential local treatment option, but lacks international standardization. However, the latest guidelines and research contribute to the application and recognition of this technique, while new radiotherapy technologies offer hope for previously difficult-to-treat tumor locations.