Radiation Oncology

Liver Tumors

Questions discussed in this category

Does liver-directed therapy (SBRT, Y-90, TACE, RFA, microwave ablation, etc.) improve overall survival?

Does it improve the patient's quality of life?

In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?

The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, wha...

3 Answers available

In a patient with amyloidosis and abnormal liver function but child Pugh A, would you still proceed with SABR for a liver metastasis?

1 Answer available

Do you offer palliative whole liver radiation for patients with diffuse liver metastases?

What dose-fractionation scheme do you utilize? Are there particular groups of patients this would not be a good option for (i.e. histologies of diseas...

3 Answers available

How would you manage a solitary unresectable liver metastasis?

From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...

2 Answers available

What is your approach to cancer patients who inquire about alternative or complementary treatments?

8 Answers available

How do you employ focal therapies in localized hepatocellular carcinoma?

Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...

2 Answers available

In the Nebraska/Mayo transplant protocol for perihilar cholangiocarcinoma, do you ever offer prophylactic biliary drainage/stenting to prevent obstruction post-chemoradiation?

If the patient had PSC and baseline atrophy preventing brachytherapy boost (received SBRT boost instead), would this change your threshold for stentin...

1 Answer available

What treatment would you recommend for a patient with recurrent oligometastatic abdominal leiomyosarcoma, with two liver lesions?

No evidence of distant disease elsewhere. Surgical resection is not possible. Would you recommend metastasis direct therapy to the liver (i.e. SBRT or...

2 Answers available

Do you use liver SBRT to areas previously treated with Y90 and subsequently failed?

What contraindications or concerns do you have in this scenario beyond assessing the Child Pugh Score?

5 Answers available

What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?

If borderline resectable, can the TOPAZ regimen be considered for downstaging effects?

4 Answers available

How would you manage a patient with epithelioid hemangioendothelioma?

1 Answer available

For liver metastases, what criteria do you use to decide between SBRT vs Y90?

Is there a benefit of SBRT over Y90 or vice versa?

1 Answer available

What clinical parameters determine when you treat a large HCC lesion with ablative radiation vs Y-90?

2 Answers available

Do you offer SBRT Liver for patients with low platelets?

If so what is the crietria?

1 Answer available

How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?

In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?

2 Answers available

Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?

3 Answers available

What is your treatment algorithm for solitary hepatocellular carcinoma, 3-5 cm, non-operative candidate but Child-Turcotte Pugh A/B?

Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT? What if the size is >5 cm?

1 Answer available

How do you choose between SBRT and RFA for CRC metastases to the liver?

*What dose and fractionation do you recommend for metastases >4cm in favorable positions (ie. not abutting mucosal tissue)?

1 Answer available

How do you explain progression free survival to patients?

5 Answers available

How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?

Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...

1 Answer available

How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?

Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?

1 Answer available

What factors determine the choice of treatment in the management of intermediate (BCLC stage B) hepatocellular carcinoma?

What features would help you decide between TACE vs. TARE vs. external beam radiation therapy?

1 Answer available

Do you offer adjuvant radiation therapy for patients with hepatocellular carcinoma status post partial hepatectomy with positive parenchymal margins?

What dose and volumes would you use?

2 Answers available

What is the appropriate role for radiation therapy in patients with HCC or intrahepatic cholangiocarcinoma who are transplant candidates?

Should radiation be offered as a bridge to transplant? Should this depend on whether SBRT is feasible (i.e. is fractionated IMRT an appropriate option...

1 Answer available

Do you ever offer repeat radiation for hepatobiliary cancers in cases of local recurrence after definitive external beam or SBRT?

If so, what constraints would you use for central biliary and other normal structures and what dose/fractionation would you use?

1 Answer available

Is liver radiotherapy contraindicated in patients with Child-Pugh C liver function?

Would you avoid any RT in these patients, including palliation for a portal vein thrombus? Or would you consider a short course of RT (like 20Gy/5fx)?

4 Answers available

Papers discussed in this category

Practical radiation oncology, 2015

Treatment variables related to liver toxicity in patients with hepatocellular carcinoma, Child-Pugh class A and B enrolled in a phase 1-2 trial of stereotactic body radiation therapy.

International journal of radiation oncology, biology, physics, 2013-12-01

Mapping patterns of local recurrence after pancreaticoduodenectomy for pancreatic adenocarcinoma: a new approach to adjuvant radiation field design.

International journal of radiation oncology, biology, physics, 2015-04-01

Predictors of toxicity associated with stereotactic body radiation therapy to the central hepatobiliary tract.

Int. J. Radiat. Oncol. Biol. Phys., 2013-03-15

Acceptable toxicity after stereotactic body radiation therapy for liver tumors adjacent to the central biliary system.

Practical radiation oncology, 2017

Gallbladder toxicity and high-dose ablative-intent radiation for liver tumors: Should we constrain the dose?

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005-12-01

Phase II trial of high-dose conformal radiation therapy with concurrent hepatic artery floxuridine for unresectable intrahepatic malignancies.

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2014-01

Neoadjuvant stereotactic body radiation therapy, capecitabine, and liver transplantation for unresectable hilar cholangiocarcinoma.

Advances in radiation oncology, 2016

Stereotactic body radiotherapy (SBRT) for locally advanced extrahepatic and intrahepatic cholangiocarcinoma.

J. Hepatol., 2017-07-01

Stereotactic body radiotherapy vs. TACE or RFA as a bridge to transplant in patients with hepatocellular carcinoma. An intention-to-treat analysis.

Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 2012-08

Long-term outcomes of stereotactic body radiation therapy in the treatment of hepatocellular cancer as a bridge to transplantation.

Advances in radiation oncology, 2016

Comparison of outcomes between SBRT, yttrium-90 radioembolization, transarterial chemoembolization, and radiofrequency ablation as bridge to transplant for hepatocellular carcinoma.

Liver Transpl., 2013-10-01

Down-staging of hepatocellular carcinoma via external-beam radiotherapy with subsequent liver transplantation: a case report.

Future Oncol, 2016-07-01

Conformal radiotherapy as a bridge to liver transplantation for hepatocellular carcinoma: is it safe?

Practical radiation oncology, 2015

Effect of high-dose stereotactic body radiation therapy on liver function in the treatment of primary and metastatic liver malignancies using the Child-Pugh score classification system.

Radiother Oncol, 2014 Jun

Outcomes following definitive stereotactic body radiotherapy for patients with Child-Pugh B or C hepatocellular carcinoma.

J Clin Oncol, 2013 May 1