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March C, Thormann M, Hass P, Georgiades M, Sensse M, Herrmann T, Omari J, Pech M, Damm R. Mortality and postinterventional complications after ablative treatment of liver malignancies: A cohort study of 4374 patients. Brachytherapy 2024:S1538-4721(24)00114-4. [PMID: 39179474 DOI: 10.1016/j.brachy.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/26/2024] [Accepted: 07/08/2024] [Indexed: 08/26/2024]
Abstract
PURPOSE Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings. Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort. MATERIALS AND METHODS Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death. RESULTS Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (p = 0.003; p = 0.0001). Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications. CONCLUSION Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures. They are a viable alternative or addition to a surgical approach in treating liver lesions.
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Affiliation(s)
- Christine March
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.
| | - Maximilian Thormann
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Department of Radiotherapy and Radiooncology, Helios Klinikum Erfurt, Erfurt, Germany
| | - Marilena Georgiades
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Maximilian Sensse
- Data Integration Center, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Tim Herrmann
- Data Integration Center, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Department of diagnostic and interventional Radiology, Klinikum Frankfurt (Oder), Frankfurt (Oder), Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Auer TA, Anhamm M, Böning G, Fehrenbach U, Schöning W, Lurje G, Gebauer B, Collettini F. Effectiveness and safety of computed tomography-guided high-dose-rate brachytherapy in treating recurrent hepatocellular carcinoma not amenable to repeated resection or radiofrequency ablation. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108429. [PMID: 38788357 DOI: 10.1016/j.ejso.2024.108429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 04/28/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To assess the efficacy and safety of computed tomography (CT)-guided high-dose-rate HDR) brachytherapy in treating recurrent hepatocellular carcinoma (HCC) not amenable to repeated resection or radiofrequency ablation. MATERIALS AND METHODS From January 2010 to January 2022, 38 patients (mean age, 70.1 years; SD ± 9.0 years) with 79 nodular and four diffuse intrahepatic HCC recurrences not amenable to repeated resection or radiofrequency ablation underwent CT-guided HDR brachytheapy in our department. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves (KPCs). Severity of procedure-related complications (PRCs) was classified as recommended by the Society of Interventional Radiology (SIR). RESULTS Patients were available for MRI evaluation for a mean follow-up of 33.1 months (SD, ±21.6 mm, range 4-86 months; median 29 months). Patients had a mean of 2.3 (SD, ±1.4) intrahepatic tumors. Mean tumor diameter was 43.2 mm (SD, ±19.6 mm). 13 of 38 (34.2%) patients showed local tumor progression after CT-guided HDR brachytherapy. Mean LTC was 29.3 months (SD, ±22.1). Distant tumor progression was seen in 12 patients (31.6%). The mean PFS was 20.8 months (SD, ±22.1). Estimated 1-, 3-, and 5-year PFS rates were 65.1%, 35.1% and 22.5%, respectively. 13 patients died during the follow-up period. Mean OS was 35.4 months (SD, ±21.7). Estimated 1-, 3-, and 5-year OS rates were 91.5%, 77.4% and 58.0%, respectively. SIR grade 1 complications were recorded in 8.6% (5/38) and SIR grade 2 complications in 3.4% (2/58) of interventions. CONCLUSION CT-guided HDR brachytherapy is a safe and efficient therapeutic option for managing large or critically located HCC recurrences in the remaining liver after prior hepatic resection.
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Affiliation(s)
- Timo Alexander Auer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany.
| | - Melina Anhamm
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany
| | - Georg Böning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany
| | - Uli Fehrenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany
| | - Wenzel Schöning
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Surgery, Germany
| | - Georg Lurje
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Surgery, Germany
| | - Bernhard Gebauer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany
| | - Federico Collettini
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Department of Radiology, Germany; Berlin Institute of Health (BIH), Anna-Louisa-Karsch 2, 10178, Berlin, Germany
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Auer TA, Müller L, Schulze D, Anhamm M, Bettinger D, Steinle V, Haubold J, Zopfs D, Pinto Dos Santos D, Eisenblätter M, Gebauer B, Kloeckner R, Collettini F. CT-guided High-Dose-Rate Brachytherapy versus Transarterial Chemoembolization in Patients with Unresectable Hepatocellular Carcinoma. Radiology 2024; 310:e232044. [PMID: 38319166 DOI: 10.1148/radiol.232044] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Background CT-guided high-dose-rate (HDR) brachytherapy (hereafter, HDR brachytherapy) has been shown to be safe and effective for patients with unresectable hepatocellular carcinoma (HCC), but studies comparing this therapy with other local-regional therapies are scarce. Purpose To compare patient outcomes of HDR brachytherapy and transarterial chemoembolization (TACE) in patients with unresectable HCC. Materials and Methods This multi-institutional retrospective study included consecutive treatment-naive adult patients with unresectable HCC who underwent either HDR brachytherapy or TACE between January 2010 and December 2022. Overall survival (OS) and progression-free survival (PFS) were compared between patients matched for clinical and tumor characteristics by propensity score matching. Not all patients who underwent TACE had PFS available; thus, a different set of patients was used for PFS and OS analysis for this treatment. Hazard ratios (HRs) were calculated from Kaplan-Meier survival curves. Results After propensity matching, 150 patients who underwent HDR brachytherapy (median age, 71 years [IQR, 63-77 years]; 117 males) and 150 patients who underwent TACE (OS analysis median age, 70 years [IQR, 63-77 years]; 119 male; PFS analysis median age, 68 years [IQR: 63-76 years]; 119 male) were analyzed. Hazard of death was higher in the TACE versus HDR brachytherapy group (HR, 4.04; P < .001). Median estimated PFS was 32.8 months (95% CI: 12.5, 58.7) in the HDR brachytherapy group and 11.6 months (95% CI: 4.9, 22.7) in the TACE group. Hazard of disease progression was higher in the TACE versus HDR brachytherapy group (HR, 2.23; P < .001). Conclusion In selected treatment-naive patients with unresectable HCC, treatment with CT-guided HDR brachytherapy led to improved OS and PFS compared with TACE. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Chapiro in this issue.
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Affiliation(s)
- Timo A Auer
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Lukas Müller
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Daniel Schulze
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Melina Anhamm
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Dominik Bettinger
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Verena Steinle
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Johannes Haubold
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - David Zopfs
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Daniel Pinto Dos Santos
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Michel Eisenblätter
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Bernhard Gebauer
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Roman Kloeckner
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
| | - Federico Collettini
- From the Department of Radiology, Charité-Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany (T.A.A., M.A., B.G., F.C.); Berlin Institute of Health, Berlin, Germany (T.A.A., F.C.); Department of Diagnostic and Interventional Radiology, University Medical Center, Mainz, Mainz, Germany (L.M.); Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Berlin, Germany (D.S.); Department of Medicine II, University of Freiburg Medical Center, Freiburg, Germany (D.B.); Department of Diagnostic and Interventional Radiology, University Medical Center Heidelberg, Heidelberg, Germany (V.S.); Institute of Diagnostic and Interventional Radiology and Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany (J.H.); Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany (D.Z., D.P.d.S.); Institute of Diagnostic and Interventional Radiology, University Hospital of Frankfurt, Frankfurt, Germany (D.P.d.S.); Department of Diagnostic and Interventional Radiology, Medical Faculty OWL, Bielefeld University, Bielefeld, Germany (M.E.); and Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck, Germany (R.K.)
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Heinze C, Damm R, Othmer M, Thormann M, Surov A, Hass P, Seidesticker R, Seidensticker M, Ricke J, Powerski M, Pech M, Omari J. Local tumor control of intermediate and advanced stage hepatocellular carcinoma after local ablative treatment with image-guided interstitial high-dose-rate brachytherapy: A subgroup analysis of 286 HCC nodules. Brachytherapy 2023; 22:231-241. [PMID: 36697267 DOI: 10.1016/j.brachy.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE Image-guided interstitial high-dose-rate brachytherapy (iBT) has been demonstrated to offer high local tumor control rates (LTC) of >90% after local ablation of intermediate and advanced hepatocellular carcinoma (HCC; BCLC B and C). The purpose of this study was to show the efficacy of iBT stratified by subgroups and to identify clinical characteristics associated with superior local tumor control (LTC) based on a highly heterogenous patient population METHODS AND MATERIALS: A cumulative number of 286 HCC nodules in 107 patients were retrospectively analyzed. Clinical and imaging follow-ups were conducted every 3 months after treatment. Analyzed clinical factors were: etiology, presence of liver cirrhosis, radiographic features, lesion size, pretreatment, administered dose, presence of portal hypertension, portal vein thrombosis, and level of alpha-fetoprotein (AFP). RESULTS LTC rate was 88.8% for a median follow-up of 14.3 months (range 3-81 months; 95% CI: 85-92%). Median minimal enclosing tumor dose (D100) was 16.1 Gy (range 7.1-30.3 Gy; reference dose 15 Gy). Subgroup analysis showed significant fewer local recurrences for alcoholic liver disease (ALD)-related HCCs compared to those related to other causes of liver cirrhosis (nonalcoholic fatty liver disease, virus-related liver cirrhosis and other causes) (p = 0.015). LTC was significantly lower after prior surgical resection (p = 0.046). No significant variance was observed for the applied D100 in each group or for all other clinical factors tested. CONCLUSIONS IBT achieves high LTC rates across treated subgroups. However, further studies should particularly address the possible impact of underlying etiology on local recurrence with emphasis on a possible higher radiosensitivity of ALD-related HCCs.
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Affiliation(s)
- Constanze Heinze
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Robert Damm
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Max Othmer
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maximilian Thormann
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Department of Radiotherapy, University Hospital Magdeburg, Magdeburg, Germany
| | | | - Max Seidensticker
- Department of Radiology, University Hospital Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital Munich, Munich, Germany
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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5
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Zhu W, Zhong Z, Yan H, Guo H, Xiao M, He X, Gao F, Zhang F. Clinical efficacy of CT-guided 125I brachytherapy in patients with local residual or recurrent hepatocellular carcinoma after thermal ablation. Insights Imaging 2022; 13:185. [PMID: 36471084 PMCID: PMC9723008 DOI: 10.1186/s13244-022-01327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of 125I brachytherapy for local residual or recurrent lesion after thermal ablation. METHODS A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent 125I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model. RESULTS After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable. CONCLUSIONS CT-guided 125I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.
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Affiliation(s)
- Wenliang Zhu
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Zhihui Zhong
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Huzheng Yan
- grid.12981.330000 0001 2360 039XDepartment of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630 People’s Republic of China
| | - Huanqing Guo
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Meigui Xiao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Xu He
- grid.452930.90000 0004 1757 8087ZhuHai Interventional Medical Center, ZhuHai People’s Hospital (ZhuHai Hospital Affiliated With Jinan University), Jinan University, ZhuHai, 519000 Guangdong People’s Republic of China
| | - Fei Gao
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
| | - Fujun Zhang
- grid.488530.20000 0004 1803 6191Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060 People’s Republic of China
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6
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Ott D, Gawish A, Lux A, Heinze C, Brunner TB, Hass P. Can alternative liver function scores facilitate the establishment of an indication for radioablative therapy in patients with hepatocellular carcinoma? J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04411-5. [DOI: 10.1007/s00432-022-04411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 10/08/2022] [Indexed: 01/27/2023]
Abstract
Abstract
Background and purpose
ALBI and IBI are new scores to evaluate the liver function in patients with hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the prognostic abilities of those scores in patients treated with interstitial brachytherapy (iBT).
Materials and methods
190 patients treated with iBT between 01.01.2006 and 01.01.2018 were included in this study. The clinical target dose was 15 Gy. The patients were all in Child–Pugh stadium A or B and across the Barcelona Clinic Liver Cancer (BCLC) Stages 0–C. Retrospectively ALBI and IBI were calculated pre- and post-therapeutic until 6 months after iBT. Hazards ratios were calculated, and p values corrected using the false discovery rate according to Benjamini and Hochberg.
Results
The median overall survival was 23.5 months (CI 19–28.5 months), and the median progression-free survival was 7.5 months (CI 6–9 months). Elevated ALBI showed a significantly higher risk to die with a hazard ratio (HR) of 2.010 (ALBI 2 vs. 1) and 4082 (ALBI 3 vs. 1), respectively. The IBI did also show a higher risk with an HR of 1.816 (IBI 1 vs. 0) and 4608 (IBI 2 vs. 0), respectively. Even 3 months after therapy elevated ALBI and IBI showed poor overall survival. Concerning progression-free survival, ALBI and IBI could not provide any relevant additional information.
Conclusion
ALBI and IBI are useful tools to predict the overall survival in patients treated with iBT and might be helpful to assign the patients to the appropriate therapy.
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7
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Appalanaido GK, Ahmad MZ, Shukor SA, Cheen Hoe AK, Subramaniam MK, Fan AS, Abdul Aziz MZ. Pathological complete response with immunotherapy and brachytherapy to 15 metastatic liver lesions in a single patient. Hepat Oncol 2022; 9:HEP44. [PMID: 36176484 PMCID: PMC9517960 DOI: 10.2217/hep-2021-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Materials & methods: High dose rate interstitial brachytherapy (HDR-IBT) treatment plan for 15 metastatic liver lesions in a patient with pancreatic cancer was retrieved and analyzed for liver dose parameters and diaphragm dose. Serial 18F-FDG PET-CT scans were reviewed for disease response assessment and left liver lobe volume. Serial laboratory records were analyzed for liver parameters. Results: Left liver lobe volume increased from 241 cm3 pre-HDR-IBT to estimated 600 cm3 after seven sessions of HDR-IBT. Metabolic complete response (CR) and subsequently pathological CR was confirmed in the right hepatotectomy specimen for all the 15 PET-CT avid lesions treated with HDR-IBT. Maximum diaphragm dose in a single fraction was 82 Gy. The liver parameters were stable and patient did not develop radiation induced liver disease. Discussion: This is the largest reported series of HDR-IBT to liver lesions in a single patient. This first ever reported combined treatment of immunotherapy (IT) and HDR-IBT had likely rendered this patient disease free both at local the liver and systemically. Metabolic CR by PET-CT can be seen as early as 46 days after HDR-IBT. Diaphragm can tolerate very high doses of radiation and repeated treatment. Conclusion: In this patient HDR-IBT for multiple liver lesions with IT is well tolerated. PET-CT can be used for response assessment of HDR-IBT liver. Synergistic effect of IT with HDR-IBT and it’s role as bridging for liver resection has clinical potential and should be further studied in prospective trials.
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Affiliation(s)
| | - Muhamad Zabidi Ahmad
- Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Syadwa Abdul Shukor
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | | | | | - Ang Soo Fan
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
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8
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Yu W, Xie Q, Li J, Tang J, Yang W, Tao Y. Salvage 125I brachytherapy for liver metastases of colorectal cancer in anatomically challenging locations after failure of systemic chemotherapy-A retrospective study. Brachytherapy 2022; 21:592-598. [PMID: 35750620 DOI: 10.1016/j.brachy.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 11/02/2022]
Abstract
PURPSOE Colorectal cancer liver metastasis (CCLM) in anatomically challenging locations is difficult to treat. This retrospective study aimed to evaluate the effectiveness and safety of permanent 125I seeds implantation (ISI) for treatment of CCLM in anatomically challenging locations after failure of systemic chemotherapy. METHODS AND MATERIALS A total of 31 liver metastases (in 25 patients) were treated by ISI under computerized tomography guidance from January 2011 to December 2017. Post-treatment follow-up was for 40 months. Adverse events were classified using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Tumor response was evaluated by the mRECIST criteria. Objective response rate, overall survival rate, and complications were retrospectively analyzed. RESULTS All ISI procedures were performed successfully. Most patients only complained of fatigue and mild pain after ISI. Only one patient had liver rupture during the procedure. Serum alanine aminotransferase and aspartate aminotransferase levels at 1 month after ISI were not significantly different from pre-procedure levels (p > 0.05). Computed tomography at 6 months after ISI treatment showed completed response in 11 (11/31, 35.5%) lesions, partial response in 14 (14/31, 45.2%) lesions, stable disease in 4 (4/31, 12.9%) lesions, and disease progression in 2 (2/31, 6.5%) lesions; thus, the objective response rate was 80.6%. Median survival was for 12 months. The 1 and 2 year overall survival rates were 52.0% and 20.0%, respectively. CONCLUSIONS 125I seeds implantation for CCLM in anatomically challenging locations is safe and effective. Survival benefit is limited in the salvage setting where patients have high intrahepatic tumor load after failed systemic chemotherapy.
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Affiliation(s)
- Wenhui Yu
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China.
| | - Qigen Xie
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Jie Li
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Jie Tang
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Wenge Yang
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
| | - Yun Tao
- Department of Interventional Radiology, Hospital of Jiangnan University, Jiangsu Province, Wuxi, China
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9
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Karagiannis E, Strouthos I, Leczynski A, Zamboglou N, Ferentinos K. Narrative Review of High-Dose-Rate Interstitial Brachytherapy in Primary or Secondary Liver Tumors. Front Oncol 2022; 12:800920. [PMID: 35299745 PMCID: PMC8920984 DOI: 10.3389/fonc.2022.800920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open
Abstract
The optimal management of intrahepatic malignancies involves a multidisciplinary approach. Although surgical resection has been considered the only curative approach, the use of several minimally invasive ablative techniques has dramatically increased the last two decades, mainly due to the fact that they provide similar oncological results with significantly decreased morbidity. Among these modalities, interstitial liver brachytherapy, probably the most flexible liver ablative method, with excellent clinical data on its safety and effectiveness, is frequently not even mentioned as an option in the current peer reviewed literature and guidelines. Brachytherapy is a type of radiotherapy utilizing radionuclides that are directly inserted into the tumor. Compared to external beam radiation therapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time, with the advantage of a rapid dose fall-off, that allows for sparing of adjacent healthy tissue. For numerous malignancies such as skin, gynecological, breast, prostate, head and neck, bladder, liver and soft-tissue tumors, brachytherapy as a monotherapy or combined with external beam radiation therapy, has become a standard treatment for many decades. This review article aims to describe the high-dose-rate liver brachytherapy technique, its selection criteria, present its advantages and disadvantages, as well as the available clinical data, in order to help physicians to explore and hopefully introduce liver brachytherapy into their clinical routine.
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Affiliation(s)
- Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus.,Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
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10
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Walter F, Rottler M, Nierer L, Landry G, Well J, Rogowski P, Mohnike K, Seidensticker M, Ricke J, Belka C, Corradini S. Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients. Cancers (Basel) 2021; 13:cancers13246250. [PMID: 34944869 PMCID: PMC8699459 DOI: 10.3390/cancers13246250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/10/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Interstitial brachytherapy (iBT) is one of the locally ablative treatment options for unresectable liver metastases in oligometastatic disease. We report the feasibility and oncologic outcome of 141 iBT treatments of 244 oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. iBT was feasible, safe and effective in the treatment of oligometastatic liver metastases with good local control rates and low toxicity. Histology and total tumor volume had an impact on local control rates. Abstract Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. Patients undergoing iBT between August 2017and March 2019 were included. A retrospective analysis of patient outcomes and treatment complications was performed. Patients treated for metastatic colorectal carcinoma (CRC) were compared to other histologies. A total of 141 iBT procedures were performed in 106 patients (male:52; female:54) and 244 liver metastases. Overall, 51% (54/106) of patients had a diagnosis of metastatic CRC. The median follow-up was 9 months, and overall survival (OS) was 92.3% at 6 months and 76.3% at 12 months. Local-relapse-free survival (LRFS) was 88.4% at 6 months and 71.5% at 12 months, with a significant difference between patients with CRC (84.1% and 50.6%) versus other histologies (92.4% and 92.4%, p < 0.001). A sub-group analysis showed a significant advantage in patients with CRC receiving a minimal dose (D100) of 20 Gy to the planning target volume. Treatments of smaller total liver-tumor volumes (<18 ccm) resulted in better LRFS rates. iBT is a safe and effective treatment approach for oligometastatic liver disease. A higher treatment dose is needed for patients with CRC. Moreover, lower metastatic burdens may be favorable for LRFS. Prospective studies are needed to assess the role of iBT in the oligometastatic setting as an alternative to other local ablative treatment approaches in patients with liver metastases.
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Affiliation(s)
- Franziska Walter
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Maya Rottler
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Justus Well
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Paul Rogowski
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Konrad Mohnike
- Diagnostisch Therapeutisches Zentrum (DTZ), 10243 Berlin, Germany;
| | - Max Seidensticker
- Department of Radiology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (M.S.); (J.R.)
| | - Jens Ricke
- Department of Radiology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (M.S.); (J.R.)
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, Ludwig Maximilian University, 81377 Munich, Germany; (F.W.); (M.R.); (L.N.); (G.L.); (J.W.); (P.R.); (C.B.)
- Correspondence:
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11
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Fabritius MP, Ben Khaled N, Kunz WG, Ricke J, Seidensticker M. Image-Guided Local Treatment for Unresectable Intrahepatic Cholangiocarcinoma-Role of Interventional Radiology. J Clin Med 2021; 10:jcm10235574. [PMID: 34884275 PMCID: PMC8658286 DOI: 10.3390/jcm10235574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 01/27/2023] Open
Abstract
Intrahepatic cholangiocarcinoma is a highly aggressive malignancy with an increasing incidence in recent years. Prognosis is poor and most patients are not eligible for resection at the time of initial diagnosis due to the anatomic location, inadequate hepatic reserve, limiting comorbidities or metastatic disease. Several locoregional therapies from the field of interventional radiology exist for patients who are not amenable for surgery, or in case of local recurrence as a single treatment modality or combined with systemic treatment. To date, evidence is limited, with most conclusions drawn from single-center studies with small patient cohorts, often treated in the salvage situation or for local recurrence after initial resection. Nevertheless, the results are promising and suggest a survival benefit in selected patients. This narrative review focuses on the use of different locoregional treatment options for intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Matthias P. Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (W.G.K.); (J.R.)
- Correspondence: (M.P.F); (M.S.)
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany;
- German Cancer Consortium (DKTK), Partner Site Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (W.G.K.); (J.R.)
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (W.G.K.); (J.R.)
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; (W.G.K.); (J.R.)
- Correspondence: (M.P.F); (M.S.)
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12
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Walter F, Fuchs F, Gerum S, Rottler MC, Erdelkamp R, Neumann J, Nierer L, Guba M, De Toni EN, Seidensticker M, Ricke J, Belka C, Corradini S. HDR Brachytherapy and SBRT as Bridging Therapy to Liver Transplantation in HCC Patients: A Single-Center Experience. Front Oncol 2021; 11:717792. [PMID: 34513694 PMCID: PMC8426600 DOI: 10.3389/fonc.2021.717792] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background In the treatment of patients with HCC awaiting liver transplantation (LT), local ablative treatments (LAT) are available either for downstaging or as bridging treatment. We present our clinical experience with both available radiation-based techniques, brachytherapy (BT), and stereotactic body radiotherapy (SBRT). Methods All patients diagnosed with HCC and who were treated with BT or SBRT at our institution between 2011 and 2018 were retrospectively reviewed. The current analysis included all patients who subsequently underwent LT. Results A total of 14 patients (male=9; female=5) were evaluated. Seven underwent BT for bridging before LT, and seven were treated with SBRT. BT was performed with a prescribed dose of 1 × 15 Gy, while SBRT was applied with 37 Gy (65%-iso) in three fractions in six patients, and one patient was treated with 54 Gy (100%-iso) in nine fractions. The treatment was generally well tolerated. One case of grade 3 bleeding was reported after BT, and one case of liver failure occurred following SBRT. All patients underwent LT after a median time interval of 152 days (range 47–311) after BT and 202 days (range 44–775) following SBRT. In eight cases, no viable tumor was found in the explanted liver, while four liver specimens showed vital tumor. The median follow-up after SBRT was 41 months and 17 months following BT. Overall, no hepatic HCC recurrence occurred following LT. Conclusion Both SBRT and BT are feasible and well tolerated as bridging to LT when applied with caution in patients with impaired liver function. Radiation-based treatments can close the gap for patients not suitable for other locally ablative treatment options.
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Affiliation(s)
- Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Frederik Fuchs
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Sabine Gerum
- Department of Radiation Oncology, Landeskrankenhaus Salzburg, Uniklinikum der Paracelsus Medizinischen Universität, Salzburg, Austria
| | - Maya C Rottler
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Robert Erdelkamp
- Department of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Neumann
- Department of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Markus Guba
- Department of Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Enrico N De Toni
- Department of Gastroenterology, University Hospital, LMU Munich, Munich, Germany
| | - Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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13
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Appalanaido GK, Bahajjaj SIBZA, Shukor SA, Ahmad MZ, Francis HCH. Case Report-Staged brachytherapy achieving complete metabolic response in unresectable oligometastatic colorectal cancer to the liver. Oxf Med Case Reports 2021; 2021:omab016. [PMID: 33948189 PMCID: PMC8081016 DOI: 10.1093/omcr/omab016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/03/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
Liver is the most common site for metastasis from colorectal cancer (CRC). Non-surgical treatment options for oligometastatic CRC confined to the liver which represents an intermediate state in the metastatic cascade are fast expanding. Currently, several liver-directed local therapeutic options are available, such as hepatic arterial infusion (HAI) therapy, radio-frequency ablation (RFA), transarterial chemoembolization (TACE), stereotactic body radiotherapy and high dose rate brachytherapy (HDRBT). Many factors such as patient's fitness, liver function (LF), tumour size, location of the tumour in the liver and scheduling of systemic therapy need to be considered when selecting patients for surgery or local liver-directed therapy. This case report illustrates a successful local treatment with staged HDRBT for a large and unresectable, liver only oligometastatic disease from CRC. This patient underwent 4 cycles of chemotherapy (FOLFOX 4) followed by primary tumour resection and first stage of HDRBT to liver for a residual 14 cm tumour after the chemotherapy. After completing a further 4 cycles of chemotherapy with the same regimen, the tumour remained stable at 8 cm. She underwent a second stage of HDRBT to the same lesion and a repeat PET-CT scan done 8 weeks after the second HDRBT showed complete metabolic response. To our knowledge, this is the largest CRC metastatic liver lesion that has been successfully treated with HDRB.
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Affiliation(s)
- Gokula Kumar Appalanaido
- Department of Radiotherapy & Oncology, Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | | | - Syadwa Abdul Shukor
- Department of Radiotherapy & Oncology, Sarawak General Hospital, Kuching, Malaysia
| | - Muhammad Zabidi Ahmad
- Department of Radiology, Advanced Medical & Dental Institute, Universiti Sains Malaysia, Penang, Malaysia
| | - Ho Cho Hao Francis
- Department of Radiation Oncology, National University Cancer Institute Singapore
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14
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Seidensticker M, Schütte K, Seidensticker R, Mühlmann M, Schulz C. Multi-modal and sequential treatment of liver cancer and its impact on the gastrointestinal tract. Best Pract Res Clin Gastroenterol 2020; 48-49:101709. [PMID: 33317790 DOI: 10.1016/j.bpg.2020.101709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 01/31/2023]
Abstract
Hepatic tumors include hepatocellular cancer (HCC) and cholangiocarcinoma (CC), a small subgroup of tumors (approx. 1%) are classified as combined hepatocellularcholangiocellular carcinomas. Different stage-dependent therapeutic approaches comprise resection, local ablative techniques, locoregional therapies, systemic treatment, liver transplantation in selected cases and possible combination of these treatment modalities. This review summarizes current knowledge on multi-modal treatment strategies for liver cancer focusing on gastrointestinal side effects.
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Affiliation(s)
- Max Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany.
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken, Marienhospital, Osnabrück, Germany
| | - Ricarda Seidensticker
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Marc Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany
| | - Christian Schulz
- Medical Department II, University Hospital, LMU, Munich, Germany
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Omari J, Drewes R, Orthmer M, Hass P, Pech M, Powerski M. Treatment of metastatic gastric adenocarcinoma with image-guided high-dose rate, interstitial brachytherapy as second-line or salvage therapy. ACTA ACUST UNITED AC 2020; 25:360-367. [PMID: 31348004 DOI: 10.5152/dir.2019.18390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to evaluate the safety and effectiveness of image-guided high-dose rate interstitial brachytherapy (iBT) for the treatment of patients with hepatic, lymphatic, and pancreatic metastases originating from gastric cancer, an entity rarely surgically treatable with curative intent. METHODS Twelve patients with a cumulative number of 36 metastases (29 liver, 2 pancreatic, 5 lymph node) from histologically proven gastric adenocarcinoma received iBT between 2010 and 2016 and were retrospectively analyzed. Every patient underwent palliative chemotherapy prior to iBT. The iBT procedure employs a temporarily, intratumorally placed iridium-192 source in a single fraction with the goal of tumor cell eradication. Effectiveness was assessed clinically and by radiologic imaging every three months. RESULTS Local tumor control was achieved in 32 of all treated metastases (89%). Four lesions showed a local recurrence after 7 months. Lesion sizes varied from 9 to 102 mm with a median of 20 mm. The median progression-free survival was 6.6 months (range, 1.8-46.8 months). The median overall survival was 11.4 months (range, 5-47 months). One patient suffered a major complication following iBT, hepatic hematoma and abscess (Common Terminology Criteria for Adverse Events grade 3), successfully dealt with by transcutaneous drainage. CONCLUSION iBT is an overall safe procedure, which facilitates high rates of local tumor control in treatment of metastatic gastric adenocarcinoma. Compared with surgical metastasectomy, similar overall survival rates could be achieved in our patient collective after iBT application.
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Affiliation(s)
- Jazan Omari
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Ralph Drewes
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Max Orthmer
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Peter Hass
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany;Department of Radiology, Gdansk University School of Medicine, Gdansk, Poland
| | - Maciej Powerski
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University School of Medicine, Magdeburg, Germany
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Complications of Computed Tomography-Guided High-Dose-Rate Brachytherapy (CT-HDRBT) and Risk Factors: Results from More than 10 Years of Experience. Cardiovasc Intervent Radiol 2019; 43:284-294. [DOI: 10.1007/s00270-019-02386-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
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Damm R, Streitparth T, Hass P, Seidensticker M, Heinze C, Powerski M, Wendler JJ, Liehr UB, Mohnike K, Pech M, Ricke J. Prospective evaluation of CT-guided HDR brachytherapy as a local ablative treatment for renal masses: a single-arm pilot trial. Strahlenther Onkol 2019; 195:982-990. [DOI: 10.1007/s00066-019-01501-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/11/2019] [Indexed: 01/20/2023]
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First report on extended distance between tumor lesion and adjacent organs at risk using interventionally applied balloon catheters: a simple procedure to optimize clinical target volume covering effective isodose in interstitial high-dose-rate brachytherapy of liver malignomas. J Contemp Brachytherapy 2019; 11:152-161. [PMID: 31139224 PMCID: PMC6536139 DOI: 10.5114/jcb.2019.84798] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/01/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Organs at risk (OARs), which are very close to a clinical target volume (CTV), can compromise effective tumor irradiation. The present study investigated the feasibility and safety of a novel approach, in particular, the extent of the dosimetric effect of distancing CTV from adjacent OARs by means of interventionally applied balloon catheters. Material and methods Patients with peripheral hepatic malignancies, in whom the critical proximity of an OAR to the CTV in the assessment by contrast-enhanced magnetic resonance imaging (MRI) scans and the preplanning process were included. Additionally, patients underwent placement of an interventional balloon catheter during computed tomography (CT)-guided application of interstitial brachytherapy (iBT) catheters inserted into the tissue between hepatic capsule and adjacent OAR. The virtual position of an OAR without balloon catheter was anticipated and contoured in addition to contouring of CTV and OAR. The calculated dose values for CTV as well as 1 cc of the relevant OAR (D1cc) with and without balloon were recorded. The D1cc of the realized irradiation plan was statistically compared to the D1cc of the virtually contoured OARs. Results In 31 cases, at least one balloon catheter was administered. The mean D1cc of the OAR in the group with balloon(s) was 12.6 Gy compared with 16 Gy in the virtual cohort without the device, therefore significantly lower (p < 0.001). Overall, there were no acute complications. Severe (> 2 CTCAEv4.03) late complications observed in 3/31 (9.6%) patients during follow-up period after brachytherapy were most certainly not due to the balloon application. Side effects were probably associated with pre-existing serious diseases and potentially additional local late effects of the irradiation in general rather than with the balloon catheters. Conclusions The distancing of the adjacent OARs allows a higher D100 value of CTV, therefore allowing for more efficient local control.
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Radioablation by Image-Guided (HDR) Brachytherapy and Transarterial Chemoembolization in Hepatocellular Carcinoma: A Randomized Phase II Trial. Cardiovasc Intervent Radiol 2018; 42:239-249. [DOI: 10.1007/s00270-018-2127-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
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Repeating of local therapy of distant metastases increases overall survival in patients with synchronous metastasized rectal cancer-a monocentric analysis. Int J Colorectal Dis 2018; 33:1533-1541. [PMID: 29968021 DOI: 10.1007/s00384-018-3113-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim was to evaluate the outcome of treatment-naive patients with synchronous metastatic rectal cancer after chemotherapy with FOLFOXIRI followed by local therapeutic procedures of all tumor lesions as complete as possible. METHODS We reviewed data of 30 patients with synchronous distant metastatic rectal cancer who underwent chemotherapy with FOLFOXIRI and subsequent local therapy in our institution. RESULTS Median follow-up was 28 months (range: 8; 74). Cumulative overall survival (OS) and progression-free survival (PFS) was 93.3, 76.9, 55.6% and 46.2, 29.7, 29.7% after 1, 2, 4 years. Non-response to chemotherapy with FOLFOXIRI was associated with a highly significant decreased OS (p < 0.0001). The consistent use of local ablative procedures led to a statistically significant increase in OS (p < 0.0001), but not in PFS (p = 0.635). Patients with ≤ 4 distant metastases showed a better OS (p = 0.033). CONCLUSIONS Response to intensified first-line chemotherapy with FOLFOXIRI, treatment of the primary rectal tumor, and repeated thorough local ablative procedures in patients with synchronous metastasized rectal cancer may lead to long-term survival, even in a subset of patients with unresectable disease at initial diagnosis.
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Herrmann E, Terribilini D, Manser P, Fix MK, Toporek G, Candinas D, Weber S, Aebersold DM, Loessl K. Accuracy assessment of a potential clinical use of navigation-guided intra-operative liver metastasis brachytherapy-a planning study. Strahlenther Onkol 2018; 194:1030-1038. [PMID: 30022277 PMCID: PMC6208950 DOI: 10.1007/s00066-018-1334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 06/28/2018] [Indexed: 11/29/2022]
Abstract
For patients with inoperable liver metastases, intra-operative liver high dose-rate brachytherapy (HDR-BT) is a promising technology enabling delivery of a high radiation dose to the tumor, while sparing healthy tissue. Liver brachytherapy has been described in the literature as safe and effective for the treatment of primary or secondary hepatic malignancies. It is preferred over other ablative techniques for lesions that are either larger than 4 cm or located in close proximity to large vessels or the common bile duct. In contrast to external beam radiation techniques, organ movements do not affect the size of the irradiated volume in intra-operative HDR-BT and new technical solutions exist to support image guidance for intra-operative HDR-BT. We have retrospectively analyzed anonymized CT datasets of 5 patients who underwent open liver surgery (resection and/or ablation) in order to test whether the accuracy of a new image-guidance method specifically adapted for intra-operative HDR-BT is high enough to use it in similar situations and whether patients could potentially benefit from navigation-guided intra-operative needle placement for liver HDR-BT.
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Affiliation(s)
- E Herrmann
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr., 3010, Bern, Switzerland.
| | - D Terribilini
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - P Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - G Toporek
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - D Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, University of Berne, Bern, Switzerland
| | - S Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - D M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr., 3010, Bern, Switzerland
| | - K Loessl
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Freiburgstr., 3010, Bern, Switzerland
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Schippers AC, Collettini F, Steffen IG, Wieners G, Denecke T, Pavel M, Wust P, Gebauer B. Initial Experience with CT–Guided High-Dose-Rate Brachytherapy in the Multimodality Treatment of Neuroendocrine Tumor Liver Metastases. J Vasc Interv Radiol 2017; 28:672-682. [DOI: 10.1016/j.jvir.2016.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/09/2016] [Accepted: 07/09/2016] [Indexed: 02/07/2023] Open
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Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy. Strahlenther Onkol 2017; 193:612-619. [DOI: 10.1007/s00066-017-1120-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023]
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Mohnike K, Sauerland H, Seidensticker M, Hass P, Kropf S, Seidensticker R, Friebe B, Fischbach F, Fischbach K, Powerski M, Pech M, Grosser OS, Kettner E, Ricke J. Haemorrhagic Complications and Symptomatic Venous Thromboembolism in Interventional Tumour Ablations: The Impact of Peri-interventional Thrombosis Prophylaxis. Cardiovasc Intervent Radiol 2016; 39:1716-1721. [DOI: 10.1007/s00270-016-1423-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
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