Division of Radiation Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada.
Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI.
Semin Radiat Oncol. 2023 Apr;33(2):181-192. doi: 10.1016/j.semradonc.2022.11.008.
The liver is a common site for metastatic spread for various primary tumor histologies. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment technique with broad patient candidacy for the ablation of tumors in the liver and other organs. SBRT involves focused, high-dose radiation therapy delivered in one to several treatments, resulting in high rates of local control. Use of SBRT for ablation of oligometastatic disease has increased in recent years and emerging prospective data have demonstrated improvements in progression free and overall survival in some settings. When delivering SBRT to liver metastases, clinicians must balance the priorities of delivering ablative tumor dosing while respecting dose constraints to surrounding organs at risk (OARs). Motion management techniques are crucial for meeting dose constraints, ensuring low rates of toxicity, maintaining quality of life, and can allow for dose escalation. Advanced radiotherapy delivery approaches including proton therapy, robotic radiotherapy, and real-time MR-guided radiotherapy may further improve the accuracy of liver SBRT. In this article, we review the rationale for oligometastases ablation, the clinical outcomes with liver SBRT, tumor dose and OAR considerations, and evolving strategies to improve liver SBRT delivery.
肝脏是各种原发性肿瘤转移的常见部位。立体定向体部放射治疗（SBRT）是一种非侵入性治疗技术，具有广泛的患者适用性，可用于消融肝脏和其他器官的肿瘤。SBRT 涉及集中、高剂量的放射治疗，分一次或多次进行，可实现高局部控制率。近年来，SBRT 用于寡转移疾病的消融治疗有所增加，新出现的前瞻性数据表明，在某些情况下，无进展生存期和总生存期有所改善。在对肝转移灶进行 SBRT 时，临床医生必须在满足消融肿瘤剂量的优先级的同时，兼顾对周围危及器官（OARs）的剂量限制。运动管理技术对于满足剂量限制、降低毒性发生率、保持生活质量以及提高剂量强度至关重要。先进的放射治疗技术，包括质子治疗、机器人放疗和实时 MR 引导放疗，可能进一步提高肝脏 SBRT 的准确性。本文综述了寡转移灶消融的基本原理、肝脏 SBRT 的临床结果、肿瘤剂量和 OAR 注意事项，以及不断发展的改善肝脏 SBRT 治疗的策略。
