CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique.
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.
Ricke
Jens
J
Klinik für Strahlenheilkunde, Charité Virchow-Klinikum Medical Faculty of the Humboldt-University Berlin, Berlin, Germany. jens.ricke@charite.de
Wust
Peter
P
Stohlmann
Anna
A
Beck
Alexander
A
Cho
Chie Hee
CH
Pech
Maciej
M
Wieners
Gero
G
Spors
Birgit
B
Werk
Michael
M
Rosner
Christian
C
Hänninen
Enrique Lopez
EL
Felix
Roland
R
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
D007496:Iridium Radioisotopes