The liver is a common site for metastatic spread for various primary tumor histologies. Stereotactic body radiation therapy (SBRT) is a non-invasive treatment technique with broad patient candidacy for the ablation of tumors in the liver and other organs. SBRT involves focused, high-dose radiation therapy delivered in one to several treatments, resulting in high rates of local control. Use of SBRT for ablation of oligometastatic disease has increased in recent years and emerging prospective data have demonstrated improvements in progression free and overall survival in some settings. When delivering SBRT to liver metastases, clinicians must balance the priorities of delivering ablative tumor dosing while respecting dose constraints to surrounding organs at risk (OARs). Motion management techniques are crucial for meeting dose constraints, ensuring low rates of toxicity, maintaining quality of life, and can allow for dose escalation. Advanced radiotherapy delivery approaches including proton therapy, robotic radiotherapy, and real-time MR-guided radiotherapy may further improve the accuracy of liver SBRT. In this article, we review the rationale for oligometastases ablation, the clinical outcomes with liver SBRT, tumor dose and OAR considerations, and evolving strategies to improve liver SBRT delivery.

肝脏是各种原发性肿瘤组织学转移扩散的常见部位。立体定向放射治疗 (SBRT) 是一种非侵入性治疗技术，具有广泛的患者候选资格，可用于消融肝脏和其他器官的肿瘤。SBRT 涉及在一次或多次治疗中进行集中的高剂量放射治疗，从而实现高局部控制率。近年来，SBRT 在寡转移性疾病消融中的使用有所增加，新出现的前瞻性数据表明，在某些情况下，无进展生存期和总生存期有所改善。在对肝转移进行 SBRT 治疗时，临床医生必须在考虑对周围危及器官 (OAR) 的剂量限制的同时，平衡提供消融性肿瘤剂量的优先级。运动管理技术对于满足剂量限制至关重要，确保低毒性，维持生活质量，并允许剂量增加。包括质子治疗、机器人放疗和实时 MR 引导放疗在内的先进放疗实施方法可能会进一步提高肝脏 SBRT 的准确性。在这篇文章中，我们回顾了寡转移酶消融的基本原理、肝脏 SBRT 的临床结果、肿瘤剂量和 OAR 考虑因素，以及改善肝脏 SBRT 递送的不断发展的策略。