- NHS England evaluation programmes for stereotactic ablative radiotherapy (SABR) of the liver are showing promising results.
- Use of precision-guided radiotherapy for the treatment of liver tumours is likely to expand, driven by clinical trials.
Why this matters
- SABR is a new option for patients who are not eligible for standard interventional therapies for liver tumours.
SABR of the liver is gaining acceptance in UK multidisciplinary teams (MDTs), according to Dr Rebecca Goody (Leeds Teaching Hospitals NHS Trust).
- SABR is an effective treatment with low toxicity, offering high-dose, precisely targeted radiotherapy.
- It is non-invasive, and the small number of fractions required makes it convenient for both patients and services.
- SABR is a good option for patients who are not fit enough for interventional therapies.
NHS England is running Commissioning through Evaluation (CtE) programmes for SABR in primary hepatocellular carcinoma (HCC) and in patients with liver oligometastases, and these are being implemented at specialist centres.
- In primary HCC, candidates are patients who are refractory or ineligible for surgery, radiofrequency ablation, or transarterial chemoembolization (TACE), and have good liver function and a maximum of 5 lesions.
- There is a need for close MDT working and careful patient selection.
- Radiotherapy for oligometastases in the liver is an option for younger, fitter patients with slower-growing cancers and low disease burden.
- So far, both programmes have shown promising efficacy and reassuring safety outcomes in patients with well-preserved underlying liver function, Professor Maria Hawkins (University College London) told delegates.
The phase 2 COMET 2 study (Palma et al. 2019) found that SABR for liver oligometastases in patients with controlled primary tumours was associated with improved overall survival over palliative standard of care, although 3 patients (4.5%) had treatment-related death.