DOI: https://doi.org/10.36347/sasjm.2026.v12i05.023

Pages: 491-497

Background. Liver metastases are frequent during the course of solid malignancies, particularly colorectal, breast, lung, pancreatic cancers and melanoma. Surgical resection remains the reference local treatment when complete resection is feasible, and thermal ablation is an established option for selected small lesions. Nevertheless, many patients are not suitable candidates for surgery or percutaneous ablation because of tumor location, lesion size, comorbidities, limited hepatic reserve, proximity to vascular or biliary structures, or concomitant extrahepatic disease. In this setting, stereotactic body radiotherapy (SBRT), also referred to as stereotactic ablative radiotherapy (SABR), has emerged as a non-invasive ablative treatment capable of delivering high biological doses in a limited number of fractions while limiting irradiation of uninvolved liver parenchyma. Objective. This systematic review evaluated the role of SBRT in the treatment of liver metastases between 2015 and 2025, with emphasis on study validity, treatment characteristics, oncological outcomes and toxicity. Methods. A systematic review was conducted in accordance with PRISMA 2020 recommendations. PubMed/MEDLINE, Scopus, Web of Science and the Cochrane Library were searched for studies published from January 2015 to December 2025. Eligible studies included adult patients treated with SBRT or SABR for liver metastases and reported at least one oncological outcome. Randomized studies were assessed using RoB 2 and non-randomized studies using ROBINS-I. Extracted data included patient and tumor characteristics, treatment schedule, biological effective dose, local control, overall survival, progression-free survival and grade 3 or higher toxicity. Because of substantial clinical and methodological heterogeneity, the synthesis was primarily descriptive. Results. Thirty-three studies were included. The evidence base consisted mainly of phase I/II trials, retrospective cohorts and multicenter registri