Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation.

Abstract

PURPOSE:

To evaluate computed tomography (CT)-guided brachytherapy in patients with very large liver malignancies or with liver tumors located adjacent to the liver hilum.

MATERIALS AND METHODS:

In this prospective nonrandomized phase II trial, we treated 20 patients (19 liver metastases and one cholangiocarcinoma) with CT-guided high-dose-rate (HDR) brachytherapy using a (192) Iridium source. All patients demonstrated no functional liver degradation prior to irradiation. Entry criteria were liver tumors > 5 cm (group A, n = 11, no upper limit) or liver tumors < or = 5 cm adjacent to the liver hilum (group B, n = 9). Dose planning for brachytherapy was performed with three dimensional (3D) CT data acquired after percutaneous applicator positioning. Magnetic resonance (MR) imaging follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control (absence of tumor growth after treatment followed by shrinkage of the lesion starting at 6 months) and progression-free survival.

RESULTS:

The mean tumor diameter was 7.7 cm (range, 5.5-10.8 cm) in group A, 3.6 cm (range, 2.2-4.9 cm) in group B. On average, a minimal dose of 17 Gy in the target volume was applied (range, 12-25 Gy). Severe side effects were recorded in two patients (10%). One patient demonstrated an obstructive jaundice caused by tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. One patient developed intra-abdominal hemorrhage that was treated by a single blood transfusion and has ceased. We frequently encountered moderate increases of liver enzymes (70% of patients) and bilirubin (50% of patients) without clinical symptoms and thus considered to be insignificant. The median follow-up was 13 months. In group A (tumors > 5 cm), primary local tumor control after 6 and 12 months was 74% and 40%, respectively; in group B, it was 100% and 71%, respectively. All but one local recurrence (in a patient with diffuse tumor progression) were successfully treated during another CT-guided brachytherapy leading to a primary assisted local control of 93% after 12 months.

CONCLUSION:

CT-guided brachytherapy based on individual dose plans and 3D CT data sets generated encouraging results in large liver malignancies as well as in tumors located adjacent to the liver hilum.

• Authors: Jens Ricke, Peter Wust, Gero Wieners, Alexander Beck, Chie Hee Cho, Max Seidensticker, Maciej Pech, Michael Werk, Christian Rosner, Enrique Lopez Hänninen, Torsten Freund, Roland Felix
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 15 Issue 11 Pg. 1279-86 (Nov 2004) ISSN: 1051-0443 [Print] United States
• PMID: 15525748 (Publication Type: Clinical Trial, Clinical Trial, Phase II, Journal Article)

Chemical References

• Iridium Radioisotopes

Topics

• Adult
• Aged
• Aged, 80 and over
• Brachytherapy (adverse effects, methods)
• Carcinoma (radiotherapy)
• Contraindications
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Humans
• Hyperthermia, Induced
• Imaging, Three-Dimensional (methods)
• Iridium Radioisotopes (therapeutic use)
• Liver (diagnostic imaging, pathology)
• Liver Neoplasms (radiotherapy, secondary)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Neoplasm Metastasis (radiotherapy)
• Prospective Studies
• Survival Analysis
• Tomography, X-Ray Computed (methods)