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CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

CT-gesteuerte Hochdosis-Brachytherapie beim inoperablen hepatozellulären Karzinom

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Abstract

Purpose

The purpose of the present study was to evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable hepatocellular carcinoma (HCC).

Patients and methods

Over a 6-year period, 98 patients with 212 unresectable HCC underwent CT-HDRBT applying a 192Ir source at our institution. Magnetic resonance imaging (MRI) follow-up was performed 6 weeks after the intervention and then every 3 months. The primary endpoint was local tumor control (LTC); secondary endpoints included progression-free survival (PFS) and overall survival (OS).

Results

Patients were available for MRI evaluation for a mean follow-up of 23.1 months (range 4–64 months; median 20 months). Mean tumor diameter was 5 cm (range 1.8–12 cm). Eighteen of 212 (8.5 %) tumors showed local progression after a mean LTC of 21.1 months. In all, 67 patients (68.4 %) experienced distant tumor progression. The mean PFS was 15.2 months. Forty-six patients died during the follow-up period. Median OS was 29.2 months. Actuarial 1-, 2-, and 3-year OS rates were 80, 62, and 46 %, respectively.

Conclusion

CT-HDRBT is an effective therapy to attain local tumor control in patients with unresectable HCC. Prospective randomized studies comparing CT-HDRBT with the standard treatments like Radiofrequency ablation (RFA) and chemoembolization (TACE) are mandatory.

Zusammenfassung

Ziel

Zweck der vorliegenden Arbeit war die Analyse der klinischen Effektivität der CT-gesteuerten Hochdosis-Brachytherapie (CT-HDRBT) bei Patienten mit inoperablem hepatozellulären Karzinom (HCC).

Patienten und Methoden

Über einen Zeitraum von 6 Jahren, wurden an unserer Klinik 98 Patienten mit 212 inoperablen HCC mittels CT-HDRBT mit 192Ir behandelt. MRT-Verlaufskontrollen erfolgten 6 Wochen nach der Intervention und dann alle 3 Monate. Primärer Endpunkt der Studie war die lokale Tumorkontrolle (LTC); sekundäre Endpunkte waren das progressionsfreie Überleben (PFS) und Gesamtüberleben (OS).

Ergebnisse

Die mittlere Nachbeobachtungszeit betrug 23,1 Monate (Spanne 4–64 Monate, Median 20 Monate). Der mittlere Tumordurchmesser betrug 5 cm (Spanne 1,8–12 cm). Nach einer mittleren LTC von 21,1 Monaten zeigten 18 von 212 Tumoren (8,5 %) eine lokale Progression. Im weiteren Verlauf schritt die Tumorerkrankung bei 67 Patienten (68,4 %)in Form eines nichtlokalen Tumorprogress voran. Das mittlere PFS betrug 15,2 Monate. Während der Nachbeobachtungszeit verstarben 46 Patienten. Das mediane OS betrug 29,2 Monate. Die 1-Jahres-, 2-Jahres- und 3-Jahres-OS-Raten waren 80, 62 und 46 %.

Schlussfolgerung

Die CT-HDRBT ist eine effektive Therapie zur lokalen Kontrolle des Tumors bei Patienten mit inoperablem HCC. Vergleichende prospektive, randomisierte Studien gegenüber den Standardtherapien, wie Radiofrequenzablation (RFA) und Chemoembolisation (TACE) werden benötigt.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, CharitéUniversitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Federico Collettini, Nadja Schreiber,  Dirk Schnapauff,  Timm Denecke,  Bernd Hamm &  Bernhard Gebauer

  2. Department of Radiation Oncology, CharitéUniversitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Peter Wust

  3. Department of Gastroenterology, Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Eckart Schott

Authors
  1. Federico Collettini
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  2. Nadja Schreiber
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  3. Dirk Schnapauff
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  4. Timm Denecke
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  5. Peter Wust
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  7. Bernd Hamm
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  8. Bernhard Gebauer
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Correspondence to Federico Collettini.

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Conflict of interest

F. Collettini, N. Schreiber, D. Schnapauff, T. Denecke, P. Wust, E. Schott, B. Hamm, and B. Gebauerstate that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Collettini, F., Schreiber, N., Schnapauff, D. et al. CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma. Strahlenther Onkol 191, 405–412 (2015). https://doi.org/10.1007/s00066-014-0781-3

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  • DOI: https://doi.org/10.1007/s00066-014-0781-3

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