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Manipal Journal of Medical Sciences

Abstract

Introduction: SBRT (Stereotactic Body Radiotherapy) for the liver is a precise, high-dose radiation treatment for primary liver tumors or liver metastases, delivering a lethal radiation dose to the tumor in a small number of fractions (e.g., one to several).It's a non-invasive alternative for patients unsuitable for surgery, offering high rates of local tumor control.Image-guided systems and motion management techniques are used to ensure the radiation is delivered accurately to the tumor while minimizing damage to surrounding healthy tissues and organs. Benefits of SBRT for Liver Tumors: • High Local Control: SBRT has demonstrated high success rates in controlling liver tumors, often comparable to other local therapies. • Non-Invasive: It's a less invasive option compared to surgery, making it suitable for patients who are not surgical candidates. • Treats Various Tumors: SBRT can effectively treat both primary liver cancer (like hepatocellular carcinoma) and metastatic disease from other cancer types. • Improved Survival: In some cases, SBRT has shown improvements in progression-free survival and overall survival for patients with liver tumors. Method. We treated small lesion of liver with the help of ABC machine ( Active Breathing Coordinator) because Liver is moving while breathing .We treated so many patients on this technique. Motion Management Technique As the liver is a mobile organ that moves with respiration, we need to use any of the motion management techniques such as active breath control (ABC) technique, abdominal compression, tumor tracking, or gating technique to account for liver movement during respiration.4 In the current situation, we used ABC Machine by Elekta as the motion management technique for the simulation. Patient Set-Up During the simulation, the patient was set up in the supine position with a neutral neck position and arms above the head. The immobilization was done using an individualized vac Lock cushion. Knee rest given to Patient for comfortable position. Breathing Practice given to patient in Mould room and set the Threshold Value where the patient can breath easily. Synchronizing Breath Hold with Triple Phase CT Scan It is the most important step in SBRT planning for liver metastasis.Before triple-phase computed tomography (CT) scan-based simulation, we need to note the phase (arterial phase, portal venous phase, or delayed phase) during which the tumor was well defined from the prior images done during diagnostic CT scan or magnetic resonance imaging (MRI) of the abdomen. The breath hold was then synchronized with this particular phase of the triple-phase CT scan. For example, suppose the lesion was better seen in the portal venous phase, then the patient was asked to hold his breath for 35 sec, starting to hold his breath 10 sec after the contrast was given in order to synchronize the breath hold with the portal venous phase of the scan. Then, a CT scan was taken from the nipple to the Breast to extend upto Iliac Crest to cover the abdomen with a CT slice thickness of 1mm. After simulation, the digital imaging and communications in medicine (DICOM) CT images (Figure 2a?c) were sent to our treatment planning system which was then imported for delineation of target and organ at risk.. given Radiotherapy as per prescribed dose. Advice and Follow up; After the completion of the treatment the patient was referred to the Department of Medical Oncology for further treatment by chemotherapy as per the multi-disciplinary tumor board decision and was advised to follow up with a PET-CT scan after three months for review.

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