Radiation Therapy

What is radiation therapy?

Radiation therapy is used to treat many cancers and is increasingly being used to treat liver cancers with encouraging results. Advances in computing and engineering mean that high doses of radiation can now be delivered from many angles with extreme accuracy and minimal side effects. This helps destroy cancer cells while minimising damage to nearby healthy tissue. This type of new radiotherapy is called stereotactic radiotherapy but is also called Stereotactic Ablative Radiotherapy (SABR), or Stereotactic Body Radiotherapy (SBRT). The two terms mean the same thing and can be used interchangeably.  

 SABR/SBRT is often used when surgery isn’t an option—either because the tumour can’t be removed or because the patient isn’t well enough for surgery. It can also be used to shrink liver tumours in people waiting for a liver transplant.  

For small or medium-sized cancers, SABR/SBRT can sometimes replace surgery or ablation. It’s considered a minimally invasive option, especially helpful for older or more frail patients as its non-invasive and doesn’t require an anaesthetic.  

As research continues to show its benefits, SABR/SBRT is becoming more widely available and commonly used. Treatment usually involves just 3 to 5 sessions over one or two weeks, using X-rays from outside the body.  

SABR/SBRT is increasingly being used to treat liver cancer, including both primary liver cancers like hepatocellular carcinoma and secondary (metastatic) cancers. This technique can produce excellent outcomes and can sometimes lead to a cure. Your doctor will only recommend this treatment for you if they think it is the best option for you and will be able to be given safely.  

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Cyberknife

CyberKnife is a non-invasive, highly targeted form of stereotactic radiotherapy (also called SBRT or SABR) that uses a fully robotic system to deliver precise, high-dose radiation to tumours, including liver cancer, while avoiding nearby healthy tissue. The robot moves around the body and tracks breathing, allowing it to treat the tumour from many angles without the need for breath-holding or restraints. Available only in Western Australia (with a Melbourne clinic opening in 2025), CyberKnife may be used as a first treatment, after other therapies like ablation or SIRT, or for cancers that have spread to nearby areas such as lymph nodes.  

How do I prepare for SABR/SBRT treatment?

Before starting this treatment, you will usually have a CT scan, and possibly an MRI, to help create a personalised treatment plan. In some cases, a minor procedure is needed to place tiny metal markers—called fiducials—near the tumour.  

These fiducials, often made of gold and about the size of a grain of rice or even smaller, help the radiation oncologist track the tumour’s exact location during treatment. They are inserted using a needle, typically during the CT scan. Not everyone will need fiducials.  

What happens during SABR/SBRT treatment?

SABR/SBRT precisely targets beams of high-dose radiation from different angles onto the tumour. 

During treatment, you will be asked to lie on a treatment table while a machine delivers the targeted beams to the tumour. It is important to lie very still during SABR/SBRT treatment. Simple breathing techniques – like holding your breath for 10–15 seconds – can help reduce movement during the procedure. Your treatment team will talk to you about this.  

SABR/SBRT itself is painless, and you can usually go home after the treatment. You will not be radioactive after treatment.  

 Radiation therapy is typically given on weekdays (Monday to Friday) at the radiation oncology department. Your treatment team will tell you how many sessions you’ll need each week. Most people receive treatment as outpatients, meaning you won’t need to stay in hospital.  

The time needed for each treatment session can vary, depending on your individual plan. Your team will let you know how long to expect each visit to take.  

A course of radiation therapy for liver cancer will take approximately 2 to 3 weeks to complete.  

You and your team of doctors and healthcare professionals (known as a multidisciplinary team, or MDT) will consider things such as:   

• the type of treatments available  

• the number of treatments needed   

• your circumstances and preferences.   

This helps to develop a treatment plan that is right for you, your family and carers.  

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What are the side effects of SABR/SBRT treatment?  

Cancer treatments can cause damage to normal cells in your body, which can cause side effects. Everyone gets different side effects, and some people will have more problems than others. Common short-term effects may include:  

• Nausea  

• Vomiting  

• Pain or discomfort in your abdomen (belly)  

• Indigestion  

• Tiredness, lack of energy (fatigue)  

• Nausea and vomiting  

• Skin changes – your skin may become red and dry in the area of treatment. You should protect your skin from the sun and can use mild creams to help soothe the area.  

If you are experiencing any of these side effects talk to your treating team – there are medications that can help manage the symptoms.  

Longer term effects can occur weeks to months, or even years after treatment has finished.   

• Radiation induced liver injury – this happens when the radiation causes damage to healthy liver tissue. It is more likely to occur in someone who already has some reduction in liver function. It can cause symptoms like abdominal pain, jaundice (yellowing of your eyes), dark urine, itchy skin, nausea and vomiting and changes in blood tests. You may develop ascites (fluid in the belly). If you notice that your eyes are yellow or your urine is darker, or your belly is swollen, you must let your doctor know straight away.  
• Lung changes (pneumonitis) – this is uncommon but can be serious. Symptoms can include a cough that won’t go away, shortness of breath and fever.  

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How much does SABR/SBRT/ cost?

If you are having your treatment in a public hospital, you will not have to pay for it. If you are having treatment in a private centre your health cover and Medicare may cover some or all of the cost. You should speak to your doctor about the best option for you.    

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Resources

Liver Foundation Nurse Led Support Line: call 1800 841 118 or email support@liver.org.au to talk to a friendly, expert hepatology nurse. 

Reviewed Jan 2026