Treatment of metastatic liver tumors using stereotactic ablative radiotherapy

Figure 1 Images demonstrating tumors close to the critical structures. In these cases stereotactic ablative radiotherapy could prove useful than radiofrequency ablation or other alternative non-surgical therapies. A more fractionated regimen would be useful to minimise toxicity when abutting luminal structures. A: tumor abutting vascular trunk; B: Tumor close to luminal gastrointestinal structures (stomach in this case).

Figure 2 Diagram showing ideal post implantation distribution of the fiducials around the tumor (Adapted from Seppenwoolde et al[23]). Ideally the fiducial arrangement should be centred around the tumor, bracketing the lesion (B) and not lateralized to one side (A). At least 3 fiducials should be implanted.

Figure 3 Demonstrating the tight prescription isodose (long broken arrow) around the planning target volume (solid arrow). The steep dose fall gradient is demonstrated by the 50% isodose curve (short broken arrow) around the prescription isodose. Platinum fiducials showed as arrow head as seen in both computed tomography and magnetic resonance imaging.