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

Prior Y90 is a risk factor for liver decompensation that's hard to quantify. If there is relatively low volume disease and I am retreating with complete overlap of the prior TARE, I don't think there isn't any increased risk with retreatment. If the TARE went to more than 1-2 segments, I would be co...

These are difficult situations at times and the plan for external RT really does need to be individualized. The greatest priority is maximizing the volume of liver spared RT. I tend to use proton therapy in this setting for this reason due to improved parenchymal sparing, but there is data using SBR...

I would be cautious here. Review current liver function (CPA preferred), and discuss with IR to review relevant imaging and plan to get a reference on where Y90 was performed. Was it a segmentectomy or Y90 lobectomy? The size and location of this lesion matter greatly. From there could consider a li...

There is data of increased toxicity with adding SBRT to Y90, but as noted above, it is difficult to reconstruct the dosimetry post Y90 and determine 'new re-irradiation' constraints. However, local progression post-TARE is a poor prognostic factor that warrants consideration of options. The go/no go...

For selected patients with liver disease only, good KPS, good liver reserve, and single lesion at favorable locations. I always use post-treatment dosimetry with 3-D nuclear medicine imaging (SPECT or PET) and MIM software to get 3-D dosimetry and DVH. In cases where there is significant underdose f...