title: Radioablation of liver malignancies with interstitial high-dose-rate brachytherapy : Complications and risk factors.
abstract: BACKGROUND
  To evaluate complications and identify risk factors for adverse events in patients undergoing high-dose-rate interstitial brachytherapy (iBT).
  
  
  METHODS
  Data from 192 patients treated in 343 CT- or MRI-guided interventions from 2006-2009 at our institution were analyzed. In 41 %, the largest tumor treated was ≥ 5 cm, 6 % of the patients had tumors ≥ 10 cm. Prior to iBT, 60 % of the patients had chemotherapy, 22 % liver resection, 19 % thermoablation or transarterial chemoembolization (TACE). Safety was the primary endpoint; survival data were obtained as the secondary endpoints. During follow-up, MRI or CT imaging was performed and clinical and laboratory parameters were obtained.
  
  
  RESULTS
  The rate of major complications was below 5 %. Five major bleedings (1.5 %) occurred. The frequency of severe bleeding was significantly higher in patients with advanced liver cirrhosis. One patient developed signs of a nonclassic radiation-induced liver disease. In 3 patients, symptomatic gastrointestinal (GI) ulcers were detected. A dose exposure to the GI wall above 14 Gy/ml was a reliable threshold to predict ulcer formation. A combination of C-reactive protein ≥ 165 mg/l and/or leukocyte count ≥ 12.7 Gpt/l on the second day after the intervention predicted infection (sensitivity 90.0 %; specificity 92.8 %.) Two patients (0.6 %) died within 30 days. Median overall survival after the first liver treatment was 20.1 months for all patients and the local recurrence-free surviving proportion was 89 % after 12 months.
  
  
  CONCLUSIONS
  Image-guided iBT yields a low rate of major complications and is effective.
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany. konrad.mohnike@med.ovgu.de.
authors.forename: Konrad
authors.initials: K
authors.lastname: Mohnike
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Wolf
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Damm
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Seidensticker
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Fischbach
authors.affiliation: Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Peters
authors.affiliation: Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hass
authors.affiliation: Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Gademann
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Maciej
authors.initials: M
authors.lastname: Pech
authors.affiliation: Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Ricke
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D005260:Female; D005858:Germany; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D008100:Liver Abscess / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D008297:Male; D015995:Prevalence; D011832:Radiation Injuries / Q000401:mortality*; D011879:Radiotherapy Dosage; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014456:Ulcer / Q000401:mortality
keywords: Adverse events; Hepatocellular carcinoma; Liver neoplasms; Local ablation; Treatment efficacy