Conclusion:
CyberKnife® radiosurgery represents a conformal ablative radiation technique that offers a potent new treatment alternative for patients with hepatocellular carcinoma, cholangiocarcinoma, or liver metastases. The unique geometry of the CyberKnife® treatment delivery system, and the target tracking capability of the CyberKnife® Synchrony® respiratory tracking feature, distinctive in its ability to precisely follow the hepatic target lesion as it moves with respiration, enables radiation conformality around the tumor volume approaching that of a surgeon’s scalpel.

CyberKnife® radiosurgical treatment is reasonable to administer as aggressive “bridge therapy” to  hepatocellular carcinoma (HCC) patients awaiting transplantation, or to HCC patients that are not candidates for definitive surgery. It is a radiobiologically ablative form of radiation against liver metastases, allowing extreme radiation dose escalation compared with standard radiation delivery systems, due to its extreme precision. Used with caution and in conjunction with judicious surgical duodenal displacement when indicated, it also appears appropriately directed against selected cholangiocarcinoma lesions