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John et al. Hepatoma Res 2020;6:56 Hepatoma Research
DOI: 10.20517/2394-5079.2020.37

Review Open Access

Can radiotherapy finally “go live” in the
management of liver metastases?

Reggie G. John , Francis Ho , Gokula K. Appalanaido , Desiree Chen , Jeremy Tey , Yu Yang Soon ,
1
1
2
1
1
1
Balamurugan A. Vellayappan 1
1 Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore
119228, Singapore.
2 Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, Jln Tun Hamdan Sheikh Tahir, Pulau Pinang 13200,
Malaysia.
Correspondence to: Dr. Balamurugan A. Vellayappan, Department of Radiation Oncology, National University Cancer Institute
Singapore, National University Hospital, 1E Kent Ridge Road, Level 7 Tower Block, Singapore 119228, Singapore.
E-mail: bala_vellayappan@nuhs.edu.sg
How to cite this article: John RG, Ho F, Appalanaido GK, Chen D, Tey J, Soon YY, Vellayappan BA. Can radiotherapy finally “go
live” in the management of liver metastases? Hepatoma Res 2020;6:56. http://dx.doi.org/10.20517/2394-5079.2020.37
Received: 14 Apr 2020 First Decision: 6 Jul 2020 Revised: 20 Jul 2020 Accepted: 4 Aug 2020 Published: 1 Sep 2020

Academic Editors: Su Pin Choo, Guang-Wen Cao, David Tan Boon Harn Copy Editor: Cai-Hong Wang Production Editor: Jing Yu
Received: First Decision: Revised: Accepted: Published:

Science Editor: Copy Editor: Production Editor: Jing Yu Abstract
Liver metastases can present synchronously or at different time points. While systemic therapy continues to be
the mainstay of treatment for patients with liver metastases, it is unlikely to completely eradicate the disease.
Surgical “metastectomy” for patients with limited metastatic burden, particularly from colorectal cancers, has
been shown to improve survival. However, owing to medical co-morbidities or tumour location, not all patients are
eligible for surgical resection. In recent years, there has been an increase in the use of non-surgical techniques,
including high dose radiation using stereotactic body radiotherapy, or brachytherapy, to ablate liver metastases.
The purpose of this narrative review is to describe the role of radiotherapy in the management of liver metastases,
both for local ablation and symptom palliation. We will elaborate on the techniques used, patient selection
process, expected outcomes and toxicities based on the current literature.

Keywords: Radiotherapy, stereotactic body radiotherapy, liver metastases, brachytherapy, palliation

INTRODUCTION
The liver is one of the most common sites for metastases from primary cancers of the colon, pancreas,
breast, and lung. Liver metastases are associated with considerable morbidity and shortened survival.

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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