Abstract
The purpose was to evaluate the safety and efficacy of high-dose-rate (HDR) CT-guided interstitial brachytherapy in the treatment of extrahepatic, extrapulmonary, secondary malignancies. Nineteen patients were included in this prospective study. The median age was 66 years (49–77). Underlying primaries comprised colorectal carcinomas in six, renal cell carcinoma in three, pancreatic carcinoma in three, cervical cancer in two, endometrial cancer in two and NSCLC, breast cancer and sarcoma in one patient each. All patients had undergone extensive pretreatments. CT-guided HDR brachytherapy employed a 192Iridium source. Dose planning for brachytherapy was performed using 3D CT data acquired after CT-guided percutaneous applicator positioning. MRI follow-up was performed 6 weeks and every 3 months post intervention. Primary endpoints were complications, local tumor control and progression-free survival. The median tumor diameter was 6 cm (2–15 cm). Tumor locations included the hepatoduodenal ligament, mesentery, adrenal gland, mesogastrium and local recurrences after rectal or pancreatic cancer. The minimal median dose in the target volume was 11 Gy (4–18 Gy). Minor complications comprised pain and fever (n=6, 32%). Major complications included one hospital death of unknown causes (n=1; 5%). Median follow-up was 7 months (1–16). Four patients (21%) died during the follow-up period. Local tumor control was 76.5% after 6 months and progression-free survival 47% after 6 months. Minimally invasive CT-guided HDR brachytherapy is safe and effective in the palliative treatment of extrahepatic, extrapulmonary secondary malignancies.
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References
Scheele J, Stang R, Altendorf-Hofmann A, Paul M (1995) Resection of colorectal liver metastases. World J Surg 19:59–71
Watanabe I, Arai T, Ono M et al (2003) Prognostic factors in resection of pulmonary metastasis from colorectal cancer. Br J Surg 90:1436–1440
Mayo-Smith WW, Dupuy DE (2004) Adrenal neoplasms: CT-guided radiofrequency ablation-preliminary results. Radiology 231:225–230
Cioni R, Armillotta N, Bargellini I et al (2004) CT-guided radiofrequency ablation of osteoid osteoma: long-term results. Eur Radiol 14:1203–1208
Zagoria RJ (2003) Percutaneous image-guided radiofrequency ablation of renal malignancies. Radiol Clin North Am 41:1067–1075
Yasui K, Kanazawa S, Sano Y et al (2004) Thoracic tumors treated with CT-guided radiofrequency ablation: initial experience. Radiology 22(231):850–857
Thanos L, Mylona S, Pomoni M et al (2004) Primary lung cancer: treatment with radio-frequency thermal ablation. Eur Radiol 14:897–901
Herfarth KK, Debus J, Lohr F, Bahner ML, Rhein B, Fritz P, Hoss A, Schlegel W, Wannenmacher MF (2001) Stereotactic single-dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol 19:164–170
Mack MG, Straub R, Eichler K et al (2001) MR-guided laser-induced thermotherapy in recurrent extrahepatic abdominal tumors. Eur Radiol 11:2041
Griffin PC, Amin PA, Hughes P, Levine AM, Sewchand WW, Salazar OM (1994) Pelvic mass: CT-guided interstitial catheter implantation with high-dose-rate remote afterloader. Radiology 191:581–583
Kolotas C, Baltas D, Zamboglu N (1999) CT-based interstitial HDR brachytherapy. Strahlenther Onkol 175:419–427
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 127:2237–2242
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 58:1496–1505
Ricke J, Wust P, Wieners G, Beck A, Cho CH, Seidensticker M, Pech M, Werk M, Rosner C, Hanninen EL, Freund T, Felix R (2004) Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation. J Vasc Interv Radiol 15:1279–1286
Mahnken AH, Gunther RW, Tacke J (2004) Radiofrequency ablation of renal tumors. Eur Radiol 14:1449–1455
Veltri A, De Fazio G, Malfitana V, Isolato G, Fontana D, Tizzani A, Gandini G (2004) Percutaneous US-guided RF thermal ablation for malignant renal tumors: preliminary results in 13 patients. Eur Radiol 14:2303–2310
Iqbal S, Lenz HJ (2004) Integration of novel agents in the treatment of colorectal cancer. Cancer Chemother Pharmacol 54 [Suppl 1]:S32–S39
Rougier P, Lepille D, Bennouna J et al (2002) Antitumour activity of three second-line treatment combinations in patients with metastatic colorectal cancer after optimal 5-FU regimen failure: a randomised, multicentre phase II study. Ann Oncol 13:1558–1567
Kolotas C, Roddiger S, Strassmann G, Martin T, Tselis N, Aebersold DM, Baltas D, Zamboglou N (2003) Palliative interstitial HDR brachytherapy for recurrent rectal cancer. Implantation techniques and results. Strahlenther Onkol 179:458–463
Galandi D, Antes G (2002) Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev 3:CD003046
Curley SA, Izzo F (2002) Radiofrequency ablation of primary and metastatic hepatic malignancies. Int J Clin Oncol 7:72–81
Pech M, Werk M, Beck A et al (2002) System continuity and energy distribution in laser-induced thermo therapy (LITT). Fortschr Rontgenstr 174:754–760
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Wieners, G., Pech, M., Rudzinska, M. et al. CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies. Eur Radiol 16, 2586–2593 (2006). https://doi.org/10.1007/s00330-006-0241-2
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DOI: https://doi.org/10.1007/s00330-006-0241-2