CyberKnife Radiosurgery for Liver Lesions
Brief Overview:
Malignant tumors involving the liver take a variety of forms, including primary hepatocellular carcinoma, biliary neoplasms and liver metastases. The primary treatment for the majority of hepatobiliary neoplasms has been surgical resection, which represents potentially curative therapy, for primary or selected metastatic lesions (1, 2, 3, 4, 5, 6, 7, 8). There are many circumstances under which surgery is not the best answer though. Briefly, surgical contraindications include inoperability, patient inability to withstand the surgical procedure, or additional malignant activity elsewhere in the body that renders aggressive surgical therapy inappropriate.

Many nonsurgical approaches have also been applied to unresectable hepatobiliary lesions, including radiofrequency ablation, cryoablation, chemoembolization, direct hepatic chemotherapeutic infusion, and systemic chemotherapy (9, 10, 11, 12, 13, 14).  Radiotherapy has also been used to treat hepatobiliary lesions (15, 16, 17, 18, 19, 20). Traditional forms of radiotherapy have had a limited role in the management of hepatobiliary lesions, largely due to the fact that the liver parenchyma itself is very sensitive to radiation injury, particularly if a large volume of hepatic tissue is irradiated to a dose larger than 30Gy (20). Contemporary high dose conformal radiotherapy has yielded more meaningful and durable clinical responses in patients with hepatobiliary neoplasms, though cure remains uncommon (15, 16, 17, 18, 19).