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Dutta et al. Hepatoma Res 2019;5:23 I http://dx.doi.org/10.20517/2394-5079.2019.09 Page 3 of 8

Figure 1. CyberKnife treatment plans. A: First CyberKnife plan (45 Gy/3 fr); B: Second CyberKnife plan (45 Gy/3 fr); C: Third CyberKnife
plan (50 Gy/5 fr)

evidence of disease. Follow-up scan in March 2018 showed a new lesion in segment II (2.5 cm × 2.3 cm). She
was treated the third time with fiducial based SBRT 50 Gy/5 fr [(prescription 88% isodose) three Accuray
defined fiducials, distributed by Alphamed®]. Response evaluation scan (Sep 2018) showed significant
regression of SUV uptake and mass in liver. She had no sign of radiation induced liver injury [Figure 2].
Three fiducials were placed close to the tumour under USG guidance by radiologist. Same fiducials were
used for tracking during Re-RT. In situations where new lesion is in another lobe of liver, larger PTV
margin (5 mm) was given to the GTV.

A thirty-six year-old female was diagnosed with carcinoma right breast (cT1N1M0, IDC Gr III, ER/
PR +ve, Her2neu -ve) in Nov 2010, was treated with breast conservative surgery (BCS). She received
adjuvant systemic therapy (FEC × 4 and Docetaxel × 4 cycle), followed by adjuvant loco-regional RT (45
Gy/25 fr/5 wk) [Table 2]. She was on periodic follow-up and had controlled disease until Feb 2014 when
routine PET scan showed multiple liver lesions in both lobes, largest measuring 7 cm × 8 cm in Seg VI/