[CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases].
OBJECTIVE
To assess safety and efficacy of CT-guided brachytherapy of liver malignancies.


METHODS
21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a (192)Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size > or = 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters.


RESULTS
The mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 Gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively.


CONCLUSIONS
CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization.
Ricke
Jens
J
Klinik für Strahlenheilkunde, Charité Virchow-Klinikum, Humboldt-Universität zu 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
Lopez Hänninen
Enrique
E
Felix
Roland
R
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007430:Intraoperative Care / Q000379:methods; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000000981:diagnostic imaging / Q000532:radiotherapy; D011874:Radiometry / Q000379:methods*; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D007496:Iridium Radioisotopes; D019275:Radiopharmaceuticals