What is the role of liver SBRT in the setting of an excellent interventional radiology program?  

Our hospital has an aggressive and talented interventional radiology group. We have wanted to start a stereotactic liver radiotherapy program but are assured that there is no place for SBRT as they can do everything.  To their credit, they routinely perform selective embolization, Y 90, RF and microwave. 

Criticisms of SBRT are that they can easily treat dome lesions, and that explant series demonstrate a substantial and greater persistence of disease after SBRT than after RF or microwave. Additionally, stereotactic radiation may convert Childs A patients to Childs B and C patients.

From my understanding of the literature, stereotactic radiation is complementary and effective even for a talented interventional program, and especially worthwhile in tumors near the hilum, as well as dome lesions and lesions more than 3-4 cm, although it needs to be applied carefully.

I’d like to solicit opinions on this topic as well as recent current literature, if it exists, that demonstrates where we may provide benefit with stereotactic RT.