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Biliary duct stenosis after image-guided high-dose-rate interstitial brachytherapy of central and hilar liver tumors

A systematic analysis of 102 cases
  • Maciej PowerskiEmail author
  • Susanne Penzlin
  • Peter Hass
  • Ricarda Seidensticker
  • Konrad Mohnike
  • Robert Damm
  • Ingo Steffen
  • Maciej Pech
  • Günther Gademann
  • Jens Ricke
  • Max Seidensticker
Original Article

Abstract

Objective

Image-guided high-dose-rate interstitial brachytherapy (iBT) with iridium-192 is an effective treatment option for patients with liver malignancies. Little is known about long-term radiation effects on the bile duct system when central hepatic structures are exposed to iBT. This retrospective analysis investigates the occurrence of posthepatic cholestasis (PHC) and associated complications in patients undergoing iBT.

Materials and methods

We identified patients who underwent iBT of hepatic malignancies and had point doses of ≥1 Gy to central bile duct structures. Patients with known bile duct-related diseases or prior bile duct manipulation were excluded.

Results

102 patients were retrospectively included. Twenty-two patients (22%) developed morphologic PHC after a median of 17 (3–54) months; 18 of them were treated using percutaneous transhepatic cholangiopancreatography drainage or endoscopic retrograde cholangiopancreatography. The median point dose was 24.8 (4.4–80) Gy in patients with PHC versus 14.2 (1.8–61.7) Gy in those without PHC (p = 0.028). A dose of 20.8 Gy (biological effective dose, BED3/10 = 165/64.1 Gy) was identified to be the optimal cutoff dose (p = 0.028; 59% sensitivity, 24% specificity). Abscess/cholangitis was more common in patients with PHC compared to those without (4 of 22 vs. 2 of 80; p = 0.029). Median survival did not differ between patients with and without PHC (43 vs. 36 months; p = 0.571).

Conclusion

iBT of liver malignancies located near the hilum can cause PHC when the central bile ducts are exposed to high point doses. Given the long latency and absence of impact of iBT-induced PHC on median survival, the rate of cholestasis and complications seen in our patients appears to be acceptable.

Keywords

Local ablation Interstitial brachytherapy Bile duct stenosis Extrahepatic cholestasis Central and hilar liver tumors 

Gallengangstenosen nach bildgeführter interstitieller Hochdosis-Brachytherapie zentraler und hilusnaher Lebertumore

Eine systematische Analyse von 102 Fällen

Zusammenfassung

Zielsetzung

Die bildgestützte interstitielle Hochdosis-Brachytherapie (iBT) mit Iridium-192 ist eine effektive Methode zur Ablation hepatischer Malignome. Unklar ist die Langzeitauswirkung auf das Gallengangsystem bei Bestrahlung zentraler Leberstrukturen. Die vorgestellte retrospektive Studie eruiert den Einfluss der iBT auf die Entstehung posthepatischer Cholestasen (PHC) und vergesellschafteter Komplikationen.

Material und Methoden

Eingeschlossen wurden Patienten mit iBT hepatischer/hilusnaher Malignome mit Punktdosen ≥1 Gy an zentralen Gallengangstrukturen. Ausschlusskriterien waren gallengangassoziierte Erkrankungen oder vorherige Manipulationen an den Gallenwegen.

Ergebnisse

In die Studie konnten 102 Patienten eingeschlossen werden. Von diesen entwickelten 22 (22 %) nach im Median 17 Monaten (Spanne 3–54 Monate) eine morphologische PHC, die in 18 Fällen (18 %) mit perkutaner transhepatischer Cholangiodrainage oder endoskopischer retrograder Cholangiopankreatikographie abgeleitet werden musste. Die Punktdosis der Patienten mit PHC lag im Median bei 24,8 Gy (Spanne 4,4–80 Gy), derjenigen ohne PHC bei 14,2 Gy (Spanne 1,8–61,7 Gy; p = 0,028). Bei 20,8 Gy (biologische effektive Dosis, BED3/10 = 165/64,1 Gy) konnte ein optimaler Cut-off-Wert (Schwellendosis) ermittelt werden (p = 0,028; Sensitivität 59 %, Spezifität 24 %). Abszesse/Cholangitiden traten bei Patienten mit PHC signifikant häufiger auf als ohne (4 von 22 vs. 2 von 80; p = 0,029). Im medianen Überleben zwischen Patienten mit und ohne PHC zeigte sich kein Unterschied (43 vs. 36 Monate; p = 0,571).

Schlussfolgerung

Die iBT hilusnaher Lebertumore kann bei hohen Punktdosen an zentralen Gallengängen zu einer klinisch relevanten PHC führen. In Anbetracht der langen Latenzzeit und der fehlenden Auswirkung iBT-assoziierter PHC auf das mediane Überleben halten wir die ermittelte Rate an Strikturen und Komplikationen für akzeptabel.

Schlüsselwörter

Lokale Ablation Interstitielle Brachytherapie Gallangangsstenose Extrahepatische Cholestase Zentrale und hilusnahe Lebertumore 

Notes

Conflict of interest

M. Powerski, S. Penzlin, P. Hass, R. Seidensticker, K. Mohnike, R. Damm, I. Steffen, M. Pech, G. Gademann, J. Ricke, and M. Seidensticker declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Maciej Powerski
    • 1
    Email author
  • Susanne Penzlin
    • 1
  • Peter Hass
    • 2
  • Ricarda Seidensticker
    • 3
  • Konrad Mohnike
    • 4
  • Robert Damm
    • 1
  • Ingo Steffen
    • 5
  • Maciej Pech
    • 1
  • Günther Gademann
    • 2
  • Jens Ricke
    • 3
  • Max Seidensticker
    • 3
  1. 1.Klinik für Radiologie und NuklearmedizinOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.Klinik für StrahlentherapieOtto-von-Guericke UniversityMagdeburgGermany
  3. 3.Klinik und Poliklinik für RadiologieKlinikum der Universität MünchenMünchenGermany
  4. 4.Diagnostisch Therapeutisches Zentrum BerlinBerlinGermany
  5. 5.Klinik für NuklearmedizinCharité Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany

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