Brachytherapy of Primary Liver Lesions

Abstract

Numerous pilot studies and randomized comparisons have shown that interstitial brachytherapy (iBT) is capable of achieving high to very high rates of tumor control, for various tumor entities. These rates vary up to >90% after 12 months, even for large or very large tumors. A dose-dependence was demonstrated, and hepatic metastases of most tumor entities, including primary liver tumors, could be brought excellently under control with a 15–20 Gy radiation dose. In a randomized study, superiority of iBT compared with transarterial chemoembolization was shown, with a significantly longer time to progression and time to untreatable progression.

For iBT in the treatment of patients with hepatocellular carcinoma and advanced liver cirrhosis, there are indications of a greater risk of hemorrhage as compared with patients who have secondary neoplasms, although the total number of severe bleedings is still low to moderate. A biliodigestive anastomosis or history of papillotomy may increase the risk of post-interventional cholangitis or liver abscesses.

All in all, iBT is a safe procedure with regard to sparing of liver function. Classical radiation-induced liver disorders have not been observed in our own studies or reported in the literature by other centers, although isolated, atypical cases of icteric increase in liver enzymes or ascites have been observed.