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Liver Tumor Treatment Options

Discover your options for treating Liver tumors

Cyberknife is the first and only Robotic Radiotherapy system for detecting and treating tumors in real time, maintaining sub-millimeter accuracy. This is particularly important for the treatment of liver tumors. Treatments are completed in 5 days or less. Most patients experience minimal to no side effects with a quick recovery time.

*Cyberknife and TrueBeam Lung tumor treatments are covered by Medicare and most all insurances.

What Sets CyberKnife Apart? 

How Does the CyberKnife System
Treat Liver Cancer?

The CyberKnife® Robotic Radiosurgery System was cleared by the U.S. Food and Drug Administration in 2001 to treat tumors anywhere in the body, including the liver. Despite its name, the CyberKnife System is not a surgical procedure. Instead the Cyberknife combines a unique robotic design with advanced real-time image guidance and intelligent tumor tracking to offer patients the most advanced Radiation treatment platform available. This combination of technology and software provides sub-millimeter treatment accuracy, delivering extremely high dose radiation directly to the tumor itself, sparing healthy surrounding tissues in just 5 treatments or less. Many patients experience little to no side effects. CyberKnife® Robotic Radiosurgery must be considered as an option for the treatment of your liver tumors. Spokane Cyberknife also offers the latest and most advanced gantry designed radiation therapy system – Truebeam.


How Does Spokane CyberKnife
Treat Liver Cancer?

1. How Does The CyberKnife System Treat Liver Cancer open

Treating liver cancer with radiation therapy is a challenge because liver tumors move with respiration.  In addition the tissue surrounding the liver tumors is very sensitive and can be damaged easily. The CyberKnife robotic Radiosurgery System is able to deliver very high doses of radiation to both primary and metastatic liver tumors with sub-millimeter accuracy. Working in conjunction with the CyberKnife System is the Synchrony® Respiratory Tracking System, which enables the radiation beam to track tumor movement in real-time and allows patients to breathe normally during their treatment sessions. With the CyberKnife System, our physicians can zero in on a moving target – the liver tumor – and irradiate it without harming the healthy surrounding tissue. As a result, the CyberKnife treatment is more comfortable for patients, radiation is delivered more accurately and treatments can be completed in just one to five sessions.

Liver cancer treatment with the CyberKnife System involves a team approach, in which several specialists participate. A team may include:

Once the team is in place they will complete the four steps of Treatment:

1.       Fiducial placement - During the first step, the patient is scheduled for a short outpatient procedure in which three to six fiducials – tiny gold seeds each about the size of a grain of rice – are inserted into and around the liver tumor using CT guidance, ultrasound or via a camera that is passed through the mouth into the stomach and small intestine. The CyberKnife System uses those fiducial markers as reference points to identify the exact location of the tumor throughout treatment. Once fiducials are implanted, the patient must wait approximately one week before CyberKnife treatment planning can begin to ensure that fiducial movement has stabilized.

2.       Set-up and imaging - During set-up and imaging, the patient will be fitted for a custom body cradle, which is designed to help keep him or her more comfortable and ensures consistent positioning for both imaging and treatment. The patient also will be fitted with a special Synchrony vest, which is worn during CyberKnife treatment and enables the robot to correlate chest motion and breathing patterns with the tumor position. The data generated with the vest allows the CyberKnife robot to precisely follow the tumor’s motion as it delivers each beam of radiation, ensuring safe and accurate radiation delivery. While wearing the vest and positioned in the cradle, the patient then will undergo a series of CT imaging studies, which will enable the CyberKnife team to determine the exact size, shape and location of the tumor. An MRI or PET-CT scan also may be necessary to fully visualize the tumor, liver and nearby anatomy. Once the imaging is done, the Synchrony vest and body cradle will be stored for use during CyberKnife treatment.

3.       Treatment planning - Next a treatment plan will be specifically designed by our Medical Physicist in conjunction with the our Radiation Oncologists. The patient does not need to be present at this time. During treatment planning, the imaging data is downloaded into the CyberKnife System’s software. The medical team determines the size of the area being targeted by radiation and the radiation dosage, as well as identifying critical structures where radiation should be minimized. Each patient’s unique treatment plan will take full advantage of the CyberKnife System’s extreme maneuverability, allowing for a safe and accurate liver cancer treatment.

4.       CyberKnife treatment - After a treatment plan is developed, the patient returns to the CyberKnife center for treatment. Our Radiation Oncology doctors may choose to deliver the liver cancer treatment in one session, or stage it for up to 5. Liver cancer treatments are typically completed within one week. 

For most patients, the CyberKnife treatment is a completely pain-free experience. Patients dress comfortably in their own clothes and, depending on the treatment center, they may be allowed to bring music to listen to during the treatment. Patients also may want to bring something to read while they wait, and have a friend or family member with them to provide support before and after treatment. 

When it is time for treatment, the patient will be asked to put on their Synchrony vest and lie on their custom body cradle. The radiation therapist will ensure the vest is properly adjusted and that the patient is positioned correctly on the treatment couch. 

As treatment begins, the location of the liver tumor will be tracked and detected continually as the patient breathes normally. The medical team will be watching every step of the way as the CyberKnife System tracks the patient’s liver tumor as it moves, and safely and precisely delivers radiation to it. 

The CyberKnife System’s computer-controlled robot will move around the patient’s body to various locations from which it will deliver radiation. At each position, the robot will stop. Then, special software will determine precisely where the radiation should be delivered by correlating the location of the tumor using digital images of the fiducials and information from the Synchrony vest. The CyberKnife’s robotic arm will adjust the radiation source automatically, to follow the liver tumor as it moves. Nothing will be required of the patient during treatment, except to relax during treatment.

2. How Does TrueBeam Treat Liver Tumors? open

Spokane Cyberknife is pleased to announce the arrival of the new TrueBeam™ system to Spokane. TrueBeam™ is an advanced radiotherapy technology for treating cancers throughout the body, including liver tumors. Spokane Cyberknife is the only center in the United States with not one, but the two most advanced Radiation Treatment Technologies in one center – Cyberknife M6 and Truebeam. Your Cancer Experts at Spokane Cyberknife work with your unique condition to personalize the most effective treatment plan, that at times involves multiple technologies and methodologies, and only Spokane Cyberknife can offer this with the Cyberknife M6 and Truebeam from one center.

TrueBeam can be used for many forms of advanced radiation treatment techniques including:

Because of this, patients can receive the treatment that is best suited for their specific clinical circumstances. Opening up treatment options for patients with cancers of the spine, it targets tumors with accuracy measured in millimeters. With its power and flexibility, our cancer experts can develop treatments that are best suited for patients’ individual circumstances. 

Advanced Features of the leading edge Radiation Therapy Truebeam system:


3. What is Radiosurgery? open
What is Radiosurgery?

Radiosurgery = Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)

Many cancers cannot be completely eradicated with traditional radiation therapy (RT) techniques. The goal of radiation treatment has always been to maximize the delivery of radiation to tumors while minimizing the amount of radiation to normal tissue. The higher the radiation dose delivered to a tumor, the greater the chance of tumor destruction. Likewise, the lower the radiation dose delivered to surrounding normal tissue, the less destruction. Historically, the available technology, found at other centers, was unable to accurately deliver high dose radiation to a tumor without also affecting the surrounding tissue. To minimize collateral damage to the surrounding tissues, radiation oncologists traditionally deliver radiation over many sessions, giving low doses each day over usually several weeks, (25 to 45 days). Following each fraction of radiation the normal tissue cells can recover better than many cancerous cells. Over many sessions, the hope is that more tumor cells die than normal tissue cells. Unfortunately, this strategy is often unsuccessful.

With the development of SRS & SBRT, physicians are now able to deliver lethal (surgical) doses of radiation to a tumor with sub-millimeter (surgical) accuracy, in 1 to 5 treatments. This methodology maximizes the amount of radiation going directly to the target tissue (and thus maximizing tumor response rate) while minimizing the radiation exposure to surrounding tissue. This is evidenced in the studies that compare the clinical treatment volume (CTV) to the planning treatment volume (PTV). With SRS & SBRT, unlike RT, the CTV and PTV are more closely aligned, which means that SRS & SBRT is able to precisely deliver lethal doses of radiation to the target tissue. By minimizing the impact on healthy tissue, SRS & SBRT shortens patient recovery time and decreases complication rates.

As technology has continued to evolve advancements have enabled physicians to apply SRS & SBRT to lesions in the body, as well as to lesions in the cranium, head, and neck. Procedures were originally performed on cranial tumors because the technology at the time required a frame, which can easily be screwed into the skull, as with the Gamma Knife. Attempts to develop body frames were cumbersome and unsuccessful. As a result, initially, no technological solution was available to accurately deliver lethal doses of radiation to tumors below the head without also destroying normal tissue.

Then came CyberKnife, the first and only dedicated robotic, SRS & SBRT treatment technology. And for the first time we now have a technology that allows for real time tracking of a tumor regardless of where it is in the body. Physicians are now able to achieve sub-millimeter (.3MM) accuracy in the head, without the frame, by using the anatomical markings of the skull and taking advantage of the stable relationship between the skull and an intracranial tumor. In the same manner, we are now able to use the anatomical markings of the spine to treat spinal lesions. For other tumors in soft tissue throughout the body, we are able to track, in real time, small gold fiducials placed in the tumor to accurately deliver radiosurgical doses.

Over the last 17 years, SRS & SBRT has case study data proving the clinical effectiveness in treating intra-cranial, extra-cranial neck, and body tumors. In many cases SRS & SBRT provides a clinically superior alternative to either surgery or traditional RT for head and body lesions. In some cases, SRS & SBRT is the only effective option. The SRS & SBRT approach allows for dose escalation, hypo-fractionation, and

heterogeneity of dosage within the tumor volume, and improved conformality and accuracy. As a result, SRS & SBRT delivers unique benefits to the patient, including improved tumor response, higher cure rates, improved pain control, success against tumors that had been radio-resistant or had exceeded tolerance levels, reduction in organ damage, and improved tolerance. These unique benefits apply to tumors regardless of their location in the head/neck or body.


Liver Tumors And Information 

1. What Is Liver Cancer? open
Liver cancer is the abnormal growth of cells in the liver resulting in a liver tumor. If the abnormal cells originated as liver cells, the resulting collection of cells is called a primary liver tumor. Some liver tumors are benign, meaning they are not cancerous and do not spread to other parts of the body. Malignant liver tumors, however, can invade other organs, and spread throughout the body. Most primary malignant liver cancers are classified as hepatocellular carcinoma or called hepatomas.

A much more common cancer of the liver is a metastatic liver tumor. In this case, cancerous cells from another part of the body are carried to the liver by the blood or other bodily fluids. Metastatic liver tumors can spread to the liver from the colon, lung, breast, stomach and pancreas, as well as other sites in the body.

 More than 21,300 cases of primary liver cancer are expected to be diagnosed in the United States in 2008. Primary liver cancer is expected to result in approximately 18,410 deaths during that time.1 Five-year relative survival rates for metastatic cancer to the liver is 3.3 percent.

Liver Tumor Types: 


2. Symptoms and Detection of Liver Cancer open

Patients may experience a variety of symptoms including:

  • Pain in the upper right abdomen
  • Swelling
  • Fever
  • Nausea
  • Jaundice

A physical exam and blood tests may be used in initial diagnoses. Additionally, doctors may recommend:

• PET-CT : Positron Emission Tomography – Computed Tomography
• MRI - Magnetic Resonance Imaging
• Ultrasound
• Angiogram - which is an X-ray that shows the blood vessels in the liver, is used to identify the tumor as well.
• Liver Tumor Biopsy may be needed to confirm the diagnosis.

Doctors then determine the stage – or extent of the disease – by establishing how big the tumor is and how much it has spread.

3. How Are Liver Tumors Treated? open

Our Cancer Experts at Spokane Cyberknife suggest that patients have a clear understanding of all their treatment options before the final decision is made. After liver cancer has been detected and staged, your physician should discuss several different treatment options.

Treatments for liver cancer depend on the type of cancer and the stage.

Early-stage primary liver cancer, and some metastatic tumors, may be treated with:

o    Surgery - with the goal of removing the entire tumor.

o    Ablation/Irradiation Alternatively, the tumor may be treated by ablation – or destroying it in place –

Using one of several methods

·         CyberKnife Radiosurgery – just 5 or less, non-invasive high dose radiation treatments.

·         RFA – radiofrequency ablation which is a high-temper water probe (radiofrequency ablation),

·         Cryoblation - a low-temperature probe.

·         Focused Chemotherapy Treatment - (chemoembolization)

·         Conventional Radiation Therapy

·         Local Alcohol Injection

In some cases, the entire liver can be removed and replaced with a donor liver transplant. With more advanced cases of liver cancer, chemotherapy combined with some of the above mentioned treatments may be used. See below for more details on the treatment options.

Learn More About Treating Liver Tumors At Spokane CyberKnife


Spokane Cyberknife M6 Liver Tumor - Patient Education

Patsy's Metastactic Breast Cancer to the Liver

CyberKnife Case Studies

Cyberknife SBRT for Primary Hepatocellular Carcinoma
Indiana University School of Medicine – Case Study

Cyberknife Radiosurgery or Radiofrequency Ablation for treating Liver Mets
University Hospital – Munich, Germany – Case Study