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the various modalities are needed to elucidate comparative long-term outcomes of RT specifically. Dose
selection is currently arbitrary, based on lesion size, location and liver function. However, we acknowledge
that the spectrum of primary tumours may have varying radio-sensitivity, and an attempt to tailor the
[36]
dose (biologically-guided treatment), according to the different primaries, should be investigated . In
addition, the patient and disease should be considered holistically. As such, multidisciplinary discussion
and collaboration between surgeons, interventional radiologists and oncologists is crucial. Treatment
options should be personalized, with the pros and cons of each therapy balanced against the risk of disease
progression. On the other end of the palliative spectrum, low-dose whole or partial liver radiotherapy may
be used for patients with high disease burden and severe symptoms.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the conception and design of the work: John RG, Vellayappan BA
Drafted the manuscript: John RG, Appalanaido GK, Vellayappan BA
Reviewed the manuscript and provided approval for publication of the content: John RG, Ho F,
Appalanaido GK, Chen D, Tey J, Soon YY, Vellayappan BA

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

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