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Dutta et al. Hepatoma Res 2019;5:23 Hepatoma Research
DOI: 10.20517/2394-5079.2019.09

Case Report Open Access

Third time re-irradiation of liver metastasis with
robotic radiosurgery: a case series

Debnarayan Dutta , Sathiya Krishnamoorthy , Rupa Das , Ram Madhavan , Haridas Nair , Raghavendra
1
1
1
2
1
Holla 1
1 Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682041, India.
2 Department of Radiation Oncology, Global Hospital, Chennai 600035, India.
Correspondence to: Debnarayan Dutta, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala 682041, India.
E-mail: duttadeb07@gmail.com
How to cite this article: Dutta D, Krishnamoorthy S, Das R, Madhavan R, Nair H, Holla R. Third time re-irradiation of liver
metastasis with robotic radiosurgery: a case series. Hepatoma Res 2019;5:23x. http://dx.doi.org/10.20517/2394-5079.2019.09
Received: 5 Feb 2019 First Decision: 17 Apr 2019 Revised: 20 Jun 2019 Accepted: 20 Jun 2019 Published: 11 Jul 2019

Science Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Received: First Decision: Revised: Accepted: Published:
Re-irradiation (Re-RT) in liver tumours is rarely reported owing to poor tolerance of liver and high incidence of
Science Editor: Copy Editor: Production Editor: Jing Yu radiation induced liver disease incidence. Fiducial based robotic radiosurgery allows to deliver high dose radiation
to the liver tumour and restricts the dose to healthy uninvolved liver, thereby increasing the potential for Re-RT.
Tolerance to radiation is low for entire liver and hence re-radiation is a challenge. On the other hand, as regenerative
potential of hepatocytes is rapid, replacement of necrotic liver tissue occurs with regenerated hepatocytes. These
regenerated hepatocytes are radiation naïve, do not have “memory” of radation therapy treatment and hence have
potential of Re-RT. We are reporting a series of two breast cancer patients presented with liver oligometastasis
treated with fiducial based CyberKnife system (CK). Both the patients were treated multiple times with CK and had
long-term survival (> 2 years) without any clinical features of radiation induced liver injury. Appropriately selected
patients are suitable for multiple sessions of CK for liver lesions with long-term outcome.

Keywords: Liver lesions, re-radiation, robotic radiosurgery

INTRODUCTION
Liver tissue has poor tolerance to radiation therapy (RT), hence RT was rarely considered for liver tumours.
Mean liver dose as low as 15 Gy to the whole liver can cause injury to the liver [radiation induced
liver disease (RILD)], presenting with anicteric hepatitis, ascites and progressive deterioration of liver

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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