Radiotherapy for liver cancer
Radiotherapy uses high energy waves similar to x-rays to kill cancer cells. There are different types of radiotherapy used for liver cancer:
- stereotactic ablative radiotherapy (SABR) is a type of
external radiotherapy 
- selective internal radiotherapy (SIRT) is a type of
internal radiotherapy
You might have radiotherapy if other treatments like surgery or heat treatment aren’t suitable for you and the cancer hasn’t spread outside the liver. You need to be generally healthy and your liver needs to be working well to have these treatments.
SABR and SIRT are treatments for liver cancer. Primary liver cancer is different to cancer that spreads to your liver from somewhere else in your body. This is called secondary liver cancer or liver metastases.
Stereotactic ablative radiotherapy (SABR)
SABR is also called stereotactic body radiotherapy (SBRT) or stereotactic radiotherapy. It is a type of external targeted radiotherapy that can treat small cancers.
The machine aims radiation beams from different positions around the body. This means the tumour gets a high dose of radiation to kill cancer cells. But the tissues near the tumour only get a low dose of radiation which lowers the risk of side effects.
Planning SABR treatment
Before you start treatment you have a planning appointment. This is to make sure that your treatment is as accurate as possible. You will have some scans and you may have some small markings made on your skin. You won’t be allowed to eat or drink for a couple of hours before your scan, and before each treatment.
Having SABR treatment
You usually have SABR as an outpatient. You may have between 3 and 5 treatments over 1 or 2 weeks. Each treatment usually takes up to an hour.
You won't feel anything while you have your treatment and the machine doesn't touch you. This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.
Side effects of SABR
Radiotherapy can make you feel tired. This usually increases towards the end of a course of treatment. You may feel more tired than usual for a few days or weeks after you finish treatment.
Because the liver is near the stomach and bowel, radiotherapy can cause sickness or diarrhoea. Your nurse will give you medicines to help.
Very rarely, SABR can cause damage to your liver or kidneys. You will have blood tests to check for this.
Selective internal radiotherapy (SIRT)
SIRT is a type of internal radiotherapy that is sometimes used for larger liver cancers. It uses radioactive beads called microspheres to treat the cancer. It is sometimes called radioembolisation or trans arterial radioembolisation (TARE).
Before SIRT treatment
You have a test called an to help plan SIRT. An angiogram looks at the blood supply to the cancer. This is to check that SIRT is a suitable treatment for you. It also helps your doctors plan where the microspheres need to go.
You might have a for your angiogram. Or you may have drugs to make you sleepy (sedation). You won’t be allowed to eat or drink for a few hours beforehand if you have sedation. Your appointment letter will give more detail about this.
Having SIRT treatment
You have treatment 1 or 2 weeks after your planning. It is very similar to your planning appointment.
Your doctor injects the microspheres into the blood vessel that takes blood to the cancer. The microspheres get stuck in the small blood vessels in and around the cancer. The radiation destroys the cancer cells.
At the end of the treatment you have a scan to check the amount of radiation to your liver. You might stay in hospital overnight.
The range of radiation from the beads is very small. But as a precaution, they may tell you to avoid close contact with young children and pregnant women. Your healthcare team will give you information about this..
Side effects of SIRT
The radiation only travels a few millimetres from where the beads are trapped. So there should be little damage to the surrounding healthy tissue. The side effects are usually mild and include:
- a small bruise where the catheter was put in
- damage to the blood vessel by the catheter
- a raised temperature and chills
- feeling sick
- diarrhoea
- stomach ache
- tiredness
Very rarely, SIRT can cause damage to your liver.
Radiotherapy treatment for advanced liver cancer
You might have external radiotherapy to control symptoms of liver cancer that has spread (advanced cancer). You might have a single treatment, or a few treatments over a few days. It may help relieve symptoms such as pain.
Travelling to radiotherapy appointments
You might have to travel a long way for your radiotherapy. This depends on where your nearest cancer centre is. SIRT only takes place in specialist centres, so there may not be one in your local area. Travelling can make you very tired, especially if you have side effects from the treatment.
You can ask the therapy radiographers for an appointment time to suit you. They will do their best, but some departments might be very busy. Some radiotherapy departments are open from 7am till 9pm.
Car parking can be difficult at hospitals. Ask the radiotherapy staff if you are able to get free parking or advice or discounted parking. They may be able to give you tips on free places to park nearby.
The radiotherapy staff may be able to arrange transport if you have no other way to get to the hospital. Your radiotherapy doctor would have to agree. This is because it is only for people that would struggle using public transport and have no access to a car.
Some people are able to claim back a refund for healthcare travel costs. This is based on the type of appointment and whether you claim certain benefits. Ask the radiotherapy staff for more information about this.
Some hospitals have their own drivers and local charities might offer hospital transport. So do ask if any help is available in your area.
