title: CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique.
abstract: OBJECTIVE
  To assess the safety and efficacy of CT-guided brachytherapy alone or in combination with laser-induced thermotherapy (LITT) in patients with liver malignancies.
  
  
  METHODS
  Thirty-seven patients presented with 36 liver metastases and two primary liver carcinomas. Twenty-one patients were treated with CT-guided high-dose-rate brachytherapy alone using a 192Ir source. Sixteen patients received brachytherapy directly after MRI-guided LITT. The indications for brachytherapy alone were a tumor size >5 cm, adjacent central bile duct or adjacent major vessels causing unfavorable cooling effects for thermal ablation, and technical failures of LITT. The dosimetry for brachytherapy was performed using three-dimensional CT data acquired after percutaneous applicator positioning. On average, a minimal dose of 17 Gy inside the tumor margin was applied (range, 10-20 Gy).
  
  
  RESULTS
  The mean tumor size was 4.6 cm (range, 2.5-11 cm). The mean liver volume receiving > or =5 Gy was 16% (range, 2-40%) of the total liver. Severe complications were recorded in 2 patients (5%). One patient developed acute liver failure possibly related to accidental continuation of oral capecitabine treatment. Another patient demonstrated obstructive jaundice owing to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. A commonly encountered moderate increase of liver enzymes was greatest in patients with combined treatment. The local control rate after 6 months was 73% and 87% for combined treatment and brachytherapy alone, respectively.
  
  
  CONCLUSIONS
  CT-guided brachytherapy using three-dimensional CT data for dosimetry is safe and effective alone or in combination with LITT. Brachytherapy as a stand-alone treatment displayed genuine advantages over thermal tumor ablation.
authors.affiliation: Klinik für Strahlenheilkunde, Charité Virchow-Klinikum Medical Faculty of the Humboldt-University Berlin, Berlin, Germany. jens.ricke@charite.de
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
authors.forename: Anna
authors.initials: A
authors.lastname: Stohlmann
authors.forename: Alexander
authors.initials: A
authors.lastname: Beck
authors.forename: Chie Hee
authors.initials: CH
authors.lastname: Cho
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Gero
authors.initials: G
authors.lastname: Wieners
authors.forename: Birgit
authors.initials: B
authors.lastname: Spors
authors.forename: Michael
authors.initials: M
authors.lastname: Werk
authors.forename: Christian
authors.initials: C
authors.lastname: Rosner
authors.forename: Enrique Lopez
authors.initials: EL
authors.lastname: Hänninen
authors.forename: Roland
authors.initials: R
authors.lastname: Felix
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation / Q000379:methods*; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D053685:Laser Therapy; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D014057:Tomography, X-Ray Computed
chemical_list: D007496:Iridium Radioisotopes