TOPLINE:

MRI-guided stereotactic body radiation therapy (SBRT) was well tolerated and safe among patients with liver metastases, with 97% completing treatment and only one grade 3 radiotherapy-related toxicity being reported. Quality of life (QOL) remained satisfactory, although clinically significant worsening occurred in role functioning, loss of appetite, pain, fatigue, and constipation at 3-month follow-up.

METHODOLOGY:

• This prospective study included 135 patients (median age, 67 years; 66 women) who underwent MRI-guided SBRT for liver metastases across seven international centres between April 2019 and April 2023.
• Prescribed total SBRT doses ranged from 20.0 to 67.5 Gy, delivered in 1-12 fractions of 7-22.5 Gy per fraction, with a median biologically effective dose of 180 Gy.
• Of the patients (97%) with documented therapy regimen, 16% received systemic therapy prior to radiotherapy, whereas 84% did not.
• Study outcomes were treatment tolerability at therapy completion, physician-rated toxicity assessed at baseline and 3 months, and QOL measured at same timepoints using European Organization for Research and Treatment of Cancer QLQ-C30 and EuroQol EQ-5D-5L questionnaires.

TAKEAWAY:

• Treatment was well tolerated and completed by 97% of patients (131/135) without any interruption at baseline and 3-month follow-up.
• At baseline, toxicity was scored in 75% of patients who completed treatment (98/131); grade 3 toxicities were nausea, vomiting, fatigue, and anorexia, each reported in one patient. No toxicities of grade ≥ 4 were reported.
• At 3-month follow-up, toxicity was scored in 86% of patients (113 /131): 14 grade 3 toxicities were recorded in 12 patients, with only one case of gastritis being recorded as radiotherapy related; no toxicities of grade ≥ 4 were reported.
• QOL assessments were completed by more patients at baseline than at 3-month follow-up (QLQ-C30, 70.2% vs 54.2%; EQ-5D-5L, 74.8% vs 48.9%). QLQ-C30 revealed high mean function scores and low mean symptom scores at 3 months post-radiotherapy.
• However, six QOL domains worsened significantly at 3-month follow-up (P < .05), and five of those exceeded the 5-point minimal clinically important difference: role functioning, fatigue, pain, loss of appetite, and constipation; usual activities also worsened over time (P = .003).

IN PRACTICE:

"MRI-guided SBRT for the treatment of patients with liver metastases is safe and well tolerated. We observed low toxicity rates and satisfactory quality of life outcomes, with the ability to reach BED_10Gy [biologically effective dose using an alpha/beta ratio of 10 Gy] > 100 Gy in more than 75% of patients. These results can contribute in informing patients about short-term side effects and provide physicians with insights about technical aspects of MRIgRT [MRI-guided radiotherapy] for patients with liver metastases," the authors wrote.

SOURCE:

This study was led by Julia E. Peltenburg, MD, PhD, The Netherlands Cancer Institute, Amsterdam, the Netherlands. It was published online on August 21, 2025, in Practical Radiation Oncology.

LIMITATIONS:

This study was limited by missing data for physician-reported toxicity outcomes and patient-reported outcomes. Treatment techniques and dose prescriptions varied between institutions, potentially introducing bias. The researchers also noted difficulty in distinguishing between radiotherapy-related and unrelated toxicities. The potential underestimation of peak toxicity and reliance on general questionnaires that may miss treatment-specific symptoms were additional limitations.

DISCLOSURES:

This study received funding through a grant from the Dutch Cancer Society. Some authors reported receiving grants or speaker fees and having other ties with various sources. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.