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Phase II Feasibility Study on the Combination of Two Different Regional Treatment Approaches in Patients with Colorectal “Liver-Only” Metastases: Hepatic Interstitial Brachytherapy Plus Regional Chemotherapy

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Abstract

The aim of this study was to evaluate the feasibility, safety, and efficacy of combined treatment with hepatic interstitial brachytherapy (HIB) and hepatic arterial infusion (HAI) of chemotherapy after interventional implantation of port catheter systems. Thirty-three patients with unresectable “liver-only” metastases of colorectal cancer were treated with both HIB and HAI during the course of their disease. All 33 patients had recurrent disease and 27 had received previous chemotherapy. Of these, 15 received HAI first and were then consolidated with HIB, 9 started with HIB and were continued with HAI, and 9 received first HIB and subsequently HAI after hepatic disease progression. Patients were evaluated for treatment characteristics, side effects, and efficacy. Comparisons between treatment groups were also performed. The median tumor diameter of metastases treated with brachytherapy was 4.6 cm (range: 1–12 cm). The median minimal irradiation dose inside the tumor margin was 18 Gy administered to a mean of two metastases in 69 interventions. Minor (n = 4) and major (n = 3) complications occurred in 10% of interventions. WHO grade III adverse events of the regional chemotherapy were observed in seven patients; grade IV, in one patient. At a median follow-up of 28 months (range: 7–74 months), the median time to disease progression after first treatment was 10.5 months (range: 1–35 months). Of 138 metastases treated by brachytherapy, 16 local recurrences were seen (mean, 12.3 months; range, 3–45 months). No signs of hepatic failure were observed in any of our patients. In conclusion, combinations of two minimally invasive therapeutic methods are feasible, with acceptable complication rates, and provide promising results in colorectal cancer patients with unresectable hepatic metastases.

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References

  1. Griffin PC, Amin PA, Hughes P et al (1994) Pelvic mass: CT-guided interstitial catheter implantation with high-dose-rate remote afterloader. Radiology 191(2):581–583

    PubMed  CAS  Google Scholar 

  2. Kolotas C, Baltas D, Zamboglu N (1999) CT-based interstitial HDR brachytherapy. Strahlenther Onkol 175(9):419–427

    Article  PubMed  CAS  Google Scholar 

  3. Ricke J, Wust P, Wieners G et al (2005) CT-guided interstitial single fraction HDR brachytherapy of lung tumors: phase I results of a novel technique. Chest 127(6):2237–2242

    Article  PubMed  Google Scholar 

  4. Ricke J, Wust P, Stohlmann A et al (2004) CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique. Int J Radiat Oncol Biol Phys 58(5):1496–1505

    Article  PubMed  Google Scholar 

  5. Ricke J, Wust P, Wieners G et al (2004) Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation. J Vasc Interv Radiol 15(11):1279–1286

    PubMed  Google Scholar 

  6. Ohara K, Tsuji H, Tatsuzaki H et al (1994) Radiation tolerance of the liver in relation to the preserved functional capacity. Acta Oncol 33(7):819–823

    Article  PubMed  CAS  Google Scholar 

  7. Pech M, Wieners G, Kryza R et al (2008) CT-guided brachytherapy (CTGB) versus interstitial laser ablation (ILT) of colorectal liver metastases: an intraindividual matched-pair analysis. Strahlenther Onkol 184(6):302–306

    Article  PubMed  Google Scholar 

  8. Ricke J (2004) Interventional therapy for liver metastases. Z Gastroenterol 42(11):1321–1328

    Article  PubMed  CAS  Google Scholar 

  9. Herrmann KA, Waggershauser T, Sittek H, Reiser MF (2000) Liver intraarterial chemotherapy: use of the femoral artery for percutaneous implantation of catheter-port systems. Radiology 215:294–299

    PubMed  CAS  Google Scholar 

  10. Tanaka T, Arai Y, Inaba Y et al (2003) Radiologic placement of side-hole catheter with tip fixation for hepatic arterial infusion chemotherapy. J Vasc Interv Radiol 14:63–68

    PubMed  Google Scholar 

  11. Nath R, Anderson LL, Luxton G et al (1995) Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys 22(2):209–234

    Article  PubMed  CAS  Google Scholar 

  12. Ricke J, Hildebrandt B, Miersch A et al (2004) Hepatic arterial port systems for treatment of liver metastases: factors affecting patency and adverse events. J Vasc Interv Radiol 15(8):825–833

    PubMed  Google Scholar 

  13. Hildebrandt B, Pech M, Nicolaou A et al (2007) Interventionally implanted port catheter systems for hepatic arterial infusion of chemotherapy in patients with colorectal liver metastases: a phase II study and historical comparison with the surgical approach. BMC Cancer 24(7):69

    Article  Google Scholar 

  14. Hildebrandt B, Bechstein WO, Neuhaus P, Riess H (2000) Regional chemotherapy of the liver after resection of liver metastases in colorectal carcinoma. Z Gastroenterol 38(4):333–339

    PubMed  CAS  Google Scholar 

  15. Meyer L, Hildebrandt B, Riess H (2003) 5-Fluorouracil, folinic acid and oxaliplatin administered via hepatic arterial infusion as regional second-line therapy for advanced colorectal cancer. Oncology 64(4):473–474

    Article  PubMed  Google Scholar 

  16. Kerr DJ, McArdle CS, Ledermann J et al (2003) Medical Research Council’s colorectal cancer study group; European Organisation for Research and Treatment of Cancer colorectal cancer study group. Intrahepatic arterial versus intravenous fluorouracil and folinic acid for colorectal cancer liver metastases: a multicentre randomised trial. Lancet 361(9355):368–373

    Article  PubMed  CAS  Google Scholar 

  17. Cohen A, Kemeny N (2003) An update on hepatic arterial infusion chemotherapy for colorectal cancer. Oncologist 8(6):553–566

    Article  PubMed  Google Scholar 

  18. Nelson R, Freels S (2004) A systematic review of hepatic artery chemotherapy after hepatic resection of colorectal cancer metastatic to the liver. Dis Colon Rectum 47(5):739–745

    Article  PubMed  Google Scholar 

  19. Kemeny N, Huang Y, Cohen AM et al (1999) Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 341(27):2039–2048

    Article  PubMed  CAS  Google Scholar 

  20. Kemeny N, Niedzwiecki D, Hollis D et al (2006) Hepatic arterial infusion versus systemic therapy for hepatic metastases from colorectal cancer: a randomized trial of efficacy, quality of life and molecular markers (CALGB 9481). J Clin Oncol 24(9):1395–1403

    Article  PubMed  CAS  Google Scholar 

  21. Lorenz M, Muller HH (2000) Randomized, multicenter trial of fluorouracil plus leucovorin administered either via hepatic arterial or intravenous infusion versus fluorodeoxyuridine administered via hepatic arterial infusion in patients with nonresectable liver metastases from colorectal carcinoma. J Clin Oncol 18:243–254

    PubMed  CAS  Google Scholar 

  22. Wieners G, Pech M, Rudzinska M et al (2006) CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies. Eur Radiol 16(11):2586–2593

    Article  PubMed  Google Scholar 

  23. de Meijer VE, Verhoef C, Kuiper JW et al (2006) Radiofrequency ablation in patients with primary and secondary hepatic malignancies. J Gastrointest Surg 10(7):960–973

    Article  PubMed  Google Scholar 

  24. van der Pool AE, Lalmahomed ZS, de Wilt JH et al (2009) Local treatment for recurrent colorectal hepatic metastases after partial hepatectomy. J Gastrointest Surg 13:890–895

    Article  PubMed  Google Scholar 

  25. Rhim H (2003) Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow: comparison with standard percutaneous radiofrequency ablation therapy. Cancer 98:433–434

    Article  PubMed  Google Scholar 

  26. Pech M, Werk M, Beck A et al (2004) Comparison of different MRI sequences with and without application of gadolinium-bopta as follow up after LITT. Fortschr Röntgenstr 176:550–555

    Article  CAS  Google Scholar 

  27. Ruhl R, Ricke J (2006) Image-guided micro-therapy for tumor ablation: from thermal coagulation to advanced irradiation techniques. Onkologie 29(5):219–224

    Article  PubMed  Google Scholar 

  28. Dawson LA, Normolle D, Balter JM et al (2002) Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 53(4):810–821

    PubMed  Google Scholar 

  29. Emami B, Lyman J, Brown A et al (1991) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21(1):109–122

    PubMed  CAS  Google Scholar 

  30. Seong J, Han KH, Park YN et al (2003) Lethal hepatic injury by combined treatment of radiation plus chemotherapy in rats with thioacetamide-induced liver cirrhosis. Int J Radiat Oncol Biol Phys 57(1):282–288

    PubMed  Google Scholar 

  31. Ricke J, Seidensticker M, Lüdemann L et al (2005) In vivo assessment of the tolerance dose of small liver volumes after single-fraction HDR irradiation. Int J Radiat Oncol Biol Phys 62(3):776–784

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology and Nuclear Medicine, Otto-von-Guericke-University Magdeburg, Leipzigerstr. 44, 39120, Magdeburg, Germany

    Gero Wieners, Maciej Pech, Nils Peters, Konrad Mohnike, Max Seidensticker, Marcin Sawicki & Jens Ricke

  2. Charité Zentrum für Tumormedizin, Medizinische Klinik m. S. Hämatologie und Onkologie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Bert Hildebrandt & Annett Nicolaou

  3. Charité Zentrum für Tumormedizin, Klinik für Strahlentherapie, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany

    Peter Wust

Authors
  1. Gero Wieners
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  2. Maciej Pech
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  3. Bert Hildebrandt
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  4. Nils Peters
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  5. Annett Nicolaou
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  6. Konrad Mohnike
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  7. Max Seidensticker
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  8. Marcin Sawicki
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  9. Peter Wust
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  10. Jens Ricke
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Correspondence to Gero Wieners.

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Wieners, G., Pech, M., Hildebrandt, B. et al. Phase II Feasibility Study on the Combination of Two Different Regional Treatment Approaches in Patients with Colorectal “Liver-Only” Metastases: Hepatic Interstitial Brachytherapy Plus Regional Chemotherapy. Cardiovasc Intervent Radiol 32, 937–945 (2009). https://doi.org/10.1007/s00270-009-9597-4

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  • DOI: https://doi.org/10.1007/s00270-009-9597-4

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