Is it feasible to treat central liver tumors +/- portal vein thrombus with SBRT while minding central hepatobiliary tract constraints?

The Stanford report (Osmundson, IJROBP 2015) on central hepatobiliary tract toxicity recommended dose constraints to the cHBT that would limit dose to sub therapeutic levels for HCC and intrahepatic cholangiocarcinma. Does this mean we shouldn't treat central tumors or a portal vein thrombus with definitive SBRT?

Answer from: Radiation Oncologist at Academic Institution

Remember that biliary strictures frequently cause death in these patients because stents don't always drain after these high doses of radiation. I have personally never caused a biliary stricture. The regimens that I am using with an SBRT technique are below the threshold for biliary stricture and r...

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Radiation Oncologist at Ascension Saint Agnes Cancer Institute
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Answer from: Radiation Oncologist at Academic Institution

The Stanford group has done some very nice work investigating the tolerance of central liver. Given the bile duct is not often easily seen on cross sectional imaging, these authors suggest using a fixed margin (1.5 -2 cm) around the PV (from the spleno-portal confluence to the PV bifurcation) analog...

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Is it feasible to treat central liver tumors +/- portal vein thrombus with SBRT while minding central hepatobiliary tract constraints?

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