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Radioablation of liver malignancies with interstitial high-dose-rate brachytherapy

Complications and risk factors

Radioablation von Lebermalignomen mit interstitieller High-dose-rate-Brachytherapie

Komplikationen und Risikofaktoren

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Abstract

Background

To evaluate complications and identify risk factors for adverse events in patients undergoing high-dose-rate interstitial brachytherapy (iBT).

Material and 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.

Zusammenfassung

Hintergrund

Evaluierung der Komplikationsrate und Identifizierung von Risikofaktoren für Komplikationen und Nebenwirkungen bei Patienten mit Lebermalignomen, die mit der hochdosierten interstitiellen Brachytherapie (iBT) behandelt wurden.

Material und Methoden

Von 2006 bis 2009 wurden 192 Patienten in 343 CT- oder MRT-geführten Interventionen behandelt und deren Daten ausgewertet. Der größte behandelte Tumor war in 41% der Fälle ≥ 5 cm, 6% der Patienten hatten Tumoren ≥ 10 cm. Vor Behandlungsbeginn hatten 60% der Patienten eine Chemotherapie, 22% eine Leberesektion und 19% eine Thermoablation oder transarterielle Chemoembolisation (TACE). Primärer Endpunkt war die Behandlungssicherheit, als sekundäre Endpunkte wurden Überlebensdaten ausgewertet. Die Nachsorge umfasste neben klinischen und paraklinischen Parametern MRT- und CT-Untersuchungen.

Ergebnisse

Die Rate an Major-Komplikationen lag unter 5%. Es traten 5 behandlungsbedürftige Blutungen auf (1,5%). Die Häufigkeit schwerer Blutungen war bei Patienten mit Leberzirrhose im fortgeschrittenen Stadium signifikant höher. Ein Patient entwickelte Zeichen einer nichtklassischen Strahlenhepatitis. Bei 3 Patienten zeigten sich symptomatische Magen-Darm-Ulzera. Eine Dosisexposition der Magen- bzw. Duodenalschleimhaut von mehr als 14 Gy/ml Einzeitdosis war mit dem Risiko von radiogen bedingten Ulzera verbunden. Eine CRP-Erhöhung auf mehr als ≥ 165 mg/l und/oder ein Anstieg der Leukozytenzahl auf mehr als ≥12,7 Gpt/l am 2. postinterventionellen Tag wies auf eine Infektion hin (Sensitivität 90,0%; Spezifität 92,8%). Die 30-Tage-Mortalität betrug 0,6%. Das mediane Gesamtüberleben nach der ersten Leberbehandlung betrug 20,1 Monate, die Lokalrezidivfreiheit nach 12 Monaten lag bei 89%.

Schlussfolgerung

Die bildgeführte iBT hat eine niedrige Komplikationsrate und ist effektiv.

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Authors and Affiliations

  1. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    Konrad Mohnike,  Steffen Wolf,  Robert Damm,  Max Seidensticker,  Ricarda Seidensticker,  Frank Fischbach,  Maciej Pech &  Jens Ricke

  2. Klinik für Strahlentherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität, Leipziger Straße 44, 39120, Magdeburg, Germany

    Nils Peters,  Peter Hass &  Günther Gademann

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  1. Konrad Mohnike
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  2. Steffen Wolf
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  3. Robert Damm
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Corresponding author

Correspondence to Konrad Mohnike.

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Conflict of interest

K. Mohnike, S. Wolf, R. Damm, M. Seidensticker, R. Seidensticker, F. Fischbach, N. Peters, P. Hass, G. Gademann, M. Pech, and J. Ricke state that there are no conflicts of interest.

The study was conducted in accordance with the protocol, the ethical principles that have their origin in the Declaration of Helsinki and ICH-GCP. The study protocol and all study-related documentation were approved by all relevant authorities.

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Mohnike, K., Wolf, S., Damm, R. et al. Radioablation of liver malignancies with interstitial high-dose-rate brachytherapy. Strahlenther Onkol 192, 288–296 (2016). https://doi.org/10.1007/s00066-016-0957-0

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