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The key to the success of the different EBRT fractionation schemes and the key to all EBRT is that the prescribed radiation dose reaches the underlying normal tissue with no density discontinuities. If density changes occur owing to a density-compensating solution, the radiation absorbed dose cannot be delivered uniformly across a solid tumor because tissue density changes as a function of distance from the target. To achieve uniform dose delivery across the target, it is necessary to balance beam intensity and beam position. These two characteristics are usually manifested in the dose distribution around the target and the dose distribution within the target itself [67].
Base on the biological characteristic of tumors, the dosage of conventional method exceeds the optimal dose for the kill of tumor cells. To reduce the radiation dose to organs at risk and lower the risk of radiation-induced injury of normal tissue, in the past decades, alternate methods for irradiation have been invented to improve the effect of irradiation. For example, intraoperative radiotherapy, brachytherapy, stereotactic radiotherapy, and so on. Among them, a radiotherapy technique of appropriate technique is adopted in the treatment process of RILD. This can to a certain extent help to alleviate the adverse reaction of normal liver tissues and reduce the damage of liver tissues induced by radiation [68].
For patients with liver metastasis, the safety of EBRT in terms of RILD has been increasingly reported. EBRT is the treatment of choice for the majority of these patients' GTVs. Improved reduction rates at 1 year and 2 years are found in patients who underwent consolidation ablation and the medium-sized GTV. More-advanced or larger GTVs may fail to induce RILD after EBRT, although it was the reason for withholding treatment.[67].
Intraoperative radiotherapy has the advantage of precise tumor control and is related to only one surgical procedure. By applying high dose radiation to the tumor margins and using low dose to the surrounding normal tissues, it ensures more radical resection and sufficient local control, while reducing the radiation dose received by normal tissues [69]. d2c66b5586