title: CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies.
abstract: The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49-77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a 192Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2-15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4-18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1-16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies.
authors.affiliation: Klinik für Strahlenheilkunde, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: Gero
authors.initials: G
authors.lastname: Wieners
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Rudzinska
authors.forename: Lukas
authors.initials: L
authors.lastname: Lehmkuhl
authors.forename: Waldemar
authors.initials: W
authors.lastname: Wlodarczyk
authors.forename: Alexandra
authors.initials: A
authors.lastname: Miersch
authors.forename: Susanne
authors.initials: S
authors.lastname: Hengst
authors.forename: Roland
authors.initials: R
authors.lastname: Felix
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D018572:Disease-Free Survival; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011446:Prospective Studies; D011880:Radiotherapy Planning, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden