Experience at HSN David Want MDFRCPC Overview Multidisciplinary Hepatobiliary Tumor Board Treatment selection Outcomes Liver Metastases Hepatocellular carcinoma Intrahepatic cholangiocarcinoma ID: 927468
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Slide1
Stereotactic Radiation for Liver
Experience at H.S.N.
David Want MD,FRCP(C)
Slide2Overview
Multidisciplinary (Hepatobiliary) Tumor Board
Treatment selection
Outcomes
Slide3Liver
Metastases
Hepatocellular carcinoma
Intrahepatic cholangiocarcinoma
Slide4Multidisciplinary Approach
Hepatobiliary Surgeon
Interventional Radiologist
Radiation Oncologist
Medical Oncology
Radiology
Pathology
Slide5Alternatives
Transarterial
Chemoembolization (TACE)
Radiofrequency Ablation (RFA)
S.A.B.R.
Slide6TACE
Slide7TACE
Slide8TACE
Lesion proximity to vessels
Able to treat larger lesions in some cases
Adriamycin
Slide9RFA
Slide10RFA
Slide11RFA
Slide12RFA
Lesion location and diaphragmatic motion factors.
Cirrhosis
Slide13Radiation
Non invasive
Immobilization and reproducibility issues
Dose (volume, normal tissues)
Slide14Reproducibility
Gastric preparation
Abdominal compression
Margins
Liver deformity (as well as motion)
Slide15IGRT
Slide16IGRT
Slide17Dose Considerations
Size, number of lesions
Location (normal organs)
Previous treatment
Volume (normal liver)
Child Pugh score
Slide18Child Pugh Score
Slide19Child Pugh Score
Slide20First Case – Post TACE
Slide21Slide22Slide23Outcomes
Local control
Survival
Slide24Slide25Slide26