Stereotactic body radiation therapy (SBRT)

Stereotactic body radiation therapy (SBRT) involves careful delivery of high-powered radiation beams to the tumor. With HCC, SBRT uses radiation to destroy the tumor.

SBRT is usually performed at a cancer treatment centre by a doctor specializing in radiation and cancer treatment, called a Radiation Oncologist. It is usually performed as a day procedure, meaning you will come into the centre, have the procedure done, and go home the same day.

Before the Procedure

Before the SBRT procedure, you will be asked to go to the treatment centre for two sessions to prepare you for the procedure.

At the first session, you will have tiny metal objects called markers placed in the liver, on or near the tumor. The markers will be used later to help the doctor pinpoint exactly where the tumor is located. Before the marker placement begins, you will have an intravenous inserted to give you sedative medications. The doctor will go over the procedure and its potential risks and benefits.

Once your questions have been answered, you will receive a mild sedative medicine through your intravenous. The skin over your liver will be cleaned and the doctor will numb the area by injecting freezing under your skin using a small needle. Then the doctor will insert a needle through your skin to insert the markers. You may feel some pressure around the area when the markers are being inserted. After the markers are placed, a CT scan will be used to look inside the liver and make sure they are in the right place.

About one week later, you will come back to the treatment facility for your second session. You may hear your healthcare team call this the ‘mapping day’ because the purpose is to map out the procedure. During this session you will be taught how to breath during the procedure and your measurements will be taken so that a custom mold can be made for you. You may also be asked to try on a special belt that will help compress your belly. The mold and the belt are used to keep your body still and reduce movement of the liver. You will also have a scan done to map out the exact location of your tumor and help the team decide the best dose of radiation needed to treat your tumor.

The Procedure

About 2-3 weeks later, your SBRT procedure will begin. SBRT is usually done over a series of 5 short treatments… taking place every other day… It is recommended that you don’t have anything to eat or drink for 2-3 hours before the procedure.

When you arrive in the procedure room, you will be asked to lay down in your custom mold and might also be asked to wear a compression belt. The radiation machine will then be turned on and used to deliver radiation to the tumor from many different angles, using the markers that were placed in in the first session for guidance. The markers help reduce the chance of damaging the non-cancerous parts of the liver. The machine will rotate a full 360 degrees around the tumor so that radiation can be delivered to it from all sides.  You should not feel any pain during the procedure. SBRT usually takes about 45 minutes, but the machine may only be on for 5-15 minutes.

After the Procedure

Most people tolerate SBRT well and are able to carry out regular activities after the procedure. You may notice temporary nausea, tiredness, or skin irritation.  Please call your doctor or nurse if you have any questions about symptoms that develop after the procedure.

The markers will stay in your body and won’t have any harmful effects. Your healthcare team will arrange a follow-up scan which will involve taking pictures of the liver and using a special contrast dye to help make the tumor area more visible. This is usually done about 2-3 months after the final SBRT procedure. Based on the results of your scan, your healthcare team will decide if any more treatment for your HCC is recommended and when more scans are needed.

You should also continue to monitor yourself for the development of any new symptoms and have blood work checked as recommended so your healthcare team can monitor your liver function.

SBRT is not usually considered curative, meaning it does not cure liver cancer. Instead, it is used to slow the growth down. Depending on how well it works, how many tumors you have, and your liver function, more HCC procedures may be recommended for you in the future.