Radiotherapy for liver cancer

Radiotherapy uses radiation, such as x-rays, to kill cancer cells. You might have internal or
external radiotherapy for liver cancer:

• external radiotherapy targets radiation at cancer from a machine outside of the body
• internal radiotherapy means having radiotherapy from inside the body

There are different types of internal and external radiotherapy. When you have liver cancer you might have radiotherapy to:

• treat your liver cancer, or
• control liver cancer that has spread to other parts of your body

Radiotherapy is not used as much as other treatments for liver cancer.

Stereotactic body radiotherapy (SBRT)

Stereotactic body radiotherapy is a type of external targeted radiotherapy. 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.

This type of radiotherapy is also called stereotactic ablative radiotherapy (SABR) or stereotactic radiotherapy. This is a treatment option for hepatocellular carcinoma, the most common type of liver cancer. You would only have this treatment for small tumours and if you can’t have other treatments. For example, treatment such as thermal ablation.

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 usually have treatment as an outpatient. This type of radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

You may have between 1 and 8 treatments. Radiotherapy can make you feel tired. This usually increases towards the end of a course of treatment. You may continue to feel more tired than usual for a few days or weeks after you finish treatment.

The liver is very near the stomach and bowel. So radiotherapy to this part of the body can cause sickness or diarrhoea. Your nurse will give you medicines to help.

Other external radiotherapy treatment 

You might have external radiotherapy to help control cancer that has spread. For example, if your liver cancer has spread to the bones. It may also help relieve symptoms such as pain.

Selective internal radiotherapy (SIRT)

SIRT is a type of internal radiotherapy. It uses radioactive beads to treat cancer in the liver. It is sometimes called radioembolisation or trans arterial radioembolisation (TARE).

It is available on the NHS in England and Wales. You might have it as a treatment if you have advanced hepatocellular carcinoma and:

• your liver is working normally
• you can’t have surgery to remove your cancer
• you are unable to have other treatments such as trans arterial chemoembolization (TACE)

If you live in other countries of the UK, your doctor might be able to submit a funding request to see if you can have SIRT on the NHS.

You have a test called an angiogram to help plan your SIRT. An angiogram looks at the blood supply to the liver. You have treatment 1 or 2 weeks after your planning.

Your doctor puts tiny radioactive beads into a blood vessel that takes blood into your liver. The beads are called microspheres. These beads get stuck in the small blood vessels in and around the cancer. Then the radiation destroys the cancer cells.

You usually stay in hospital overnight after your treatment. The range of radiation from the beads is very small. But as a precaution, you may be told to avoid close contact with young children and pregnant women for the first week after treatment. The advice about this can vary slightly between hospitals. So do ask your doctor or specialist nurse if you are not sure.

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 raised temperature and chills
• feeling sick
• diarrhoea
• stomach ache

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.