title: Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy, and effect on survival.
abstract: OBJECTIVE
  To determine the safety and efficacy of computed tomography (CT)-guided brachytherapy in hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 83 patients were recruited, presenting with 140 HCC- lesions. Treatment was performed by CT-guided high-dose-rate (HDR) brachytherapy with an iridium-192 source. The primary endpoint was time to progression; secondary endpoints included local tumor control and overall survival (OS). A matched-pair analysis with patients not receiving brachytherapy was performed. Match criteria included the Cancer of the Liver Italian Program (CLIP) score, alpha-fetoprotein, presence, and extent of multifocal disease. For statistical analysis, Kaplan-Meier and Cox regression were performed.
  
  
  RESULTS
  Mean and median cumulative TTP for all patients (n = 75) were 17.7 and 10.4 months. Five local recurrences were observed. The OS after inclusion reached median times of 19.4 months (all patients), 46.3 months (CLIP score, 0), 20.6 months (CLIP score, 1) 12.7 months, (CLIP score, 2), and 8.3 months (CLIP score, >or=3). The 1- and 3-year OS were 94% and 65% (CLIP score, 0), 69% and 12% (CLIP score, 1), and 48% and 19% (CLIP score, 2), respectively. Nine complications requiring intervention were encountered in 124 interventions. Matched-pair analysis revealed a significantly longer OS for patients undergoing CT-guided brachytherapy.
  
  
  CONCLUSIONS
  Based on our results the study treatment could be safely performed. The study treatment had a beneficial effect on OS in patients with advanced HCC, with respect to (and depending on) the CLIP score and compared with OS in a historical control group. A high rate of local control was also observed, regardless of applied dose in a range of 15 to 25 Gy.
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Otto von Guericke University, Magdeburg, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Mohnike
authors.forename: Gero
authors.initials: G
authors.lastname: Wieners
authors.forename: Franziska
authors.initials: F
authors.lastname: Schwartz
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.forename: Ricarda
authors.initials: R
authors.lastname: Ruehl
authors.forename: Peter
authors.initials: P
authors.lastname: Wust
authors.forename: Enrique
authors.initials: E
authors.lastname: Lopez-Hänninen
authors.forename: Günther
authors.initials: G
authors.lastname: Gademann
authors.forename: Nils
authors.initials: N
authors.lastname: Peters
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D011832:Radiation Injuries / Q000628:therapy; D011879:Radiotherapy Dosage; D011881:Radiotherapy, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D007496:Iridium Radioisotopes; D000509:alpha-Fetoproteins