SBRT is external-beam treatment, not catheter therapy or ablation
Unlike TACE or SIRT, SBRT does not require arterial catheterization. Unlike RFA or microwave ablation, it does not require a needle or antenna to be placed into the tumor. The target is treated from outside the body using image-guided high-precision radiation planning.
A small number of well-defined targets is a common stereotactic scenario
Charité, Heidelberg, Freiburg and UKE describe stereotactic treatment for selected extracranial tumors, including liver metastases. Selection depends on whether the target can be defined accurately and whether the planned dose can protect enough healthy liver and nearby organs.
- Exact diagnosis and primary cancer
- Number and size of liver lesions
- Location relative to stomach, bowel, bile ducts and other organs at risk
- Remaining healthy liver volume and liver function
- Previous liver surgery, ablation, TACE, SIRT or radiotherapy
- Presence and control of disease outside the liver
- Ability to account for respiratory motion
Respiratory motion is part of liver SBRT planning
Liver tumors can move with breathing. Modern centers use image guidance and motion-management strategies such as breath-hold, respiratory gating, tracking or treatment margins based on motion assessment. UKE explicitly describes accounting for breathing motion in extracranial stereotactic treatment, while Heidelberg and Freiburg publish high-precision stereotactic workflows for extracranial targets.
Treatment is usually delivered in a limited number of fractions
The exact number of sessions is individualized. Freiburg describes stereotactic radiotherapy/radiosurgery in one to ten fractions, and Heidelberg notes that extracranial stereotaxy can be completed in only a few treatment sessions. Fractionation depends on target size, location, nearby organs, prior radiation and the safe dose to healthy liver.
SBRT can be considered when surgery or percutaneous ablation is unsuitable
A non-invasive stereotactic approach can be relevant when a lesion cannot be resected or safely punctured, but this does not make SBRT automatically preferable. The liver tumor board should compare surgery, ablation, transarterial treatments, systemic therapy and radiation in the context of the exact cancer and treatment goal.
Risks depend on dose, treated liver volume and nearby organs
Possible effects include fatigue, nausea and transient liver-test changes. More serious toxicity can involve radiation injury to healthy liver or nearby stomach, bowel, chest wall or other organs, depending on tumor location and cumulative prior treatment. The radiation oncologist should explain the individual dose constraints before treatment.
Follow-up imaging must distinguish treatment effect from viable tumor
CT, MRI or PET/CT may be used according to the primary cancer and local protocol. Response after high-dose radiation can evolve over time, so international patients should agree which team will review follow-up imaging and how a suspected residual or new liver lesion will be handled.
Official sources
Sources last checked 2026-09-07.
- Organ metastases – stereotaxy and CyberKnife for liver metastases — Charité – Universitätsmedizin Berlin ↗
- Extracranial stereotaxy — Heidelberg University Hospital ↗
- Stereotactic radiotherapy / radiosurgery — University Medical Center Freiburg ↗
- Extracranial stereotaxy / SBRT — University Medical Center Hamburg-Eppendorf (UKE) ↗