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Computed tomography-guided interstitial high dose rate brachytherapy for centrally located liver tumours: a single institution study

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To evaluate the clinical outcome of computed tomography (CT)-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the treatment of unresectable primary and secondary liver malignancies. This report updates and expands our previously described experience with this treatment technique.

Methods

Forty-one patients with 50 tumours adjacent to the liver hilum and bile duct bifurcation were treated in 59 interventions of CT-guided IRT HDR BRT. The tumours were larger than 4 cm with a median volume of 84 cm3 (38–1,348 cm3). The IRT HDR BRT delivered a median total physical dose of 20.0 Gy (7.0–32.0 Gy) in twice daily fractions of median 7.0 Gy (4.0–10.0 Gy) in 19 patients and in once daily fractions of median 8.0 Gy (7.0–14.0 Gy) in 22 patients.

Results

With a median follow-up of 12.4 months, the local control for metastatic hepatic tumours was 89 %, 73 % and 63 % at 6, 12 and 18 months respectively. The local control for primary hepatic tumours was 90 %, 81 % and 50 % at 6, 12 and 18 months respectively. Severe side effects occurred in 5.0 % of interventions with no treatment-related deaths.

Conclusions

CT-guided IRT HDR BRT is a promising procedure for the radiation treatment of centrally located liver malignancies.

Key points

• Interstitial high-dose-rate brachytherapy (IRT HDR BRT) is a promising treatment for central liver tumours

• CT-guided IRT HDR BRT is safe for treating extensive tumours

• CT-guided IRT HDR BRT could play a role in managing unresectable hepatic malignancies

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Abbreviations

BRT:

Brachytherapy

D90 :

Dose delivered to 90 % of the PTV

EBRT:

External beam radiotherapy

EQD2 :

Total biologically equivalent dose in 2 Gy fractions

HCC:

Hepatocellular carcinoma

HDR:

High dose rate

IRT:

Interstitial

LC:

Local control

LDR:

Low dose rate

LITT:

Laser-induced thermotherapy

MPD:

Minimum peripheral dose

OS:

Overall survival

PD:

Progressive disease

PR:

Partial response

PTV:

Planning target volume

RFA:

Radiofrequency ablation

SD:

Stable disease

TACE:

Transarterial chemoembolisation

V100, V150 and V200 :

Percentage of the PTV receiving 100 %, 150 % and 200 % of the prescribed reference dose

WHO:

World Health Organisation

3D:

Three-dimensional

References

  1. Buscarini E, Savoia A, Brambilla G et al (2005) Radiofrequency thermal ablation of liver tumors. Eur Radiol 15:884–894

    Article  PubMed  Google Scholar 

  2. Nikfarjam M, Muralidharan V, Christophi C (2006) Altered growth patterns of colorectal liver metastases after thermal ablation. Surgery 139:73–81

    Article  PubMed  Google Scholar 

  3. Vogl TJ, Straub R, Eichler K, Söllner O, Mack MG (2004) Colorectal carcinoma metastases in liver: laser-induced interstitial thermotherapy-local tumor control rate and survival data. Radiology 230:450–458

    Article  PubMed  Google Scholar 

  4. Livraghi T, Solbiati L, Meloni F, Ierace T, Goldberg SN, Gazelle GS (2003) Percutaneous radiofrequency ablation of liver metastases in potential candidates for resection: the “test-of-time approach”. Cancer 97:3027–3035

    Article  PubMed  Google Scholar 

  5. Goldberg SN, Grassi CJ, Cardella JF et al (2009) Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20:377–390

    Article  Google Scholar 

  6. Mack MG, Straub R, Eichler K, Söllner O, Lehnert T, Vogl TJ (2004) Breast cancer metastases in liver: laser-induced interstitial thermotherapy—local tumor control rate and survival data. Radiology 233:400–409

    Article  PubMed  Google Scholar 

  7. Vogl TJ, Straub R, Zangos S, Mack MG, Eichler K (2004) MR-guided laser-induced thermotherapy (LITT) of liver tumours: experimental and clinical data. Int J Hyperth 20:713–724

    Article  Google Scholar 

  8. Chen M, Li J, Zheng Y et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–328

    Article  PubMed  Google Scholar 

  9. Crocetti L, de Baere T, Lencioni R (2010) Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 33:11–17

    Article  PubMed  Google Scholar 

  10. Yin X, Xie X, Lu M et al (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 115:1914–1923

    Article  PubMed  CAS  Google Scholar 

  11. Paulet E, Aubé C, Pessaux P et al (2008) Factors limiting complete tumor ablation by radiofrequency ablation. Cardiovasc Intervent Radiol 31:107–115

    Article  PubMed  Google Scholar 

  12. 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 15:1279–1286

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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 184:302–306

    Article  PubMed  Google Scholar 

  15. Schnapauff D, Denecke T, Grieser C et al (2012) Computed tomography-guided interstitial HDR brachytherapy (CT-HDRBT) of the liver in patients with irresectable intrahepatic cholangiocarcinoma. Cardiovasc Intervent Radiol 35:581–587

    Article  PubMed  Google Scholar 

  16. Mohnike K, Wieners G, Schwartz F et al (2010) Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy, and effect on survival. Int J Radiat Oncol Biol Phys 78:172–179

    Article  PubMed  Google Scholar 

  17. Collettini F, Schnapauff D, Poellinger A et al (2012) Hepatocellular carcinoma: computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of large (5–7 cm) and very large (7 cm) tumours. Eur Radiol 22:1101–1109

    Article  PubMed  Google Scholar 

  18. Ricke J, Mohnike K, Pech M et al (2010) Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography-guided high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys 78:479–485

    Article  PubMed  Google Scholar 

  19. Wieners G, Mohnike K, Peters N et al (2011) Treatment of hepatic metastases of breast cancer with CT-guided interstitial brachytherapy—a phase II-study. Radiother Oncol 100:314–319

    Article  PubMed  Google Scholar 

  20. Tselis N, Chatzikonstantinou G, Kolotas C et al (2012) Hypofractionated accelerated computed tomography-guided interstitial high-dose-rate brachytherapy for liver malignancies. Brachytherapy 11:507-514

    Google Scholar 

  21. Tsalpatouros A, Baltas D, Kolotas C et al (1997) CT-based software for 3-D localization and reconstruction in stepping source brachytherapy. IEEE Trans Inf Technol Biomed 1:229–242

    Article  PubMed  CAS  Google Scholar 

  22. Park JO, Lee SI, Song SY et al (2003) Measuring response in solid tumors: comparison of RECIST and WHO response criteria. Jpn J Clin Oncol 33:533–537

    Article  PubMed  Google Scholar 

  23. 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 62:776–784

    Article  PubMed  Google Scholar 

  24. Dawson LA, Normolle D, Balter JM, McGinn CJ, Lawrence TS, ten Haken RK (2002) Analysis of radiation-induced liver disease using the Lyman NTCP model. Int J Radiat Oncol Biol Phys 53:810–821

    Article  PubMed  Google Scholar 

  25. Martinez-Monge R, Nag S, Nieroda CA, Martin EW (1999) Iodine-125 brachytherapy in the treatment of colorectal adenocarcinoma metastatic to the liver. Cancer 85:1218–1225

    Article  PubMed  CAS  Google Scholar 

  26. Nag S, DeHaan M, Scruggs G, Mayr N, Martin EW (2006) Long-term follow-up of patients of intrahepatic malignancies treated with iodine-125 brachytherapy. Int J Radiat Oncol Biol Phys 64:736–744

    Article  PubMed  Google Scholar 

  27. Armstrong JG, Anderson LL, Harrison LB (1994) Treatment of liver metastases from colorectal cancer with radioactive implants. Cancer 73:1800–1804

    Article  PubMed  CAS  Google Scholar 

  28. Lin ZY, Lin J, Lin C et al (2012) 1.5T conventional MR-guided iodine-125 interstitial implants for hepatocellular carcinoma: feasibility and preliminary clinical experience. Eur J Radiol 81:1420–1425

    Article  PubMed  Google Scholar 

  29. Vogl TJ, Gruber T, Balzer JO, Eichler K, Hammerstingl R, Zangos S (2009) Repeated transarterial chemoembolization in the treatment of liver metastases of colorectal cancer: prospective study. Radiology 250:281–289

    Article  PubMed  Google Scholar 

  30. Vogl TJ, Naguib NNN, Nour-Eldin NA et al (2012) Transarterial chemoembolization in the treatment of patients with unresectable cholangiocarcinoma: results and prognostic factors governing treatment success. Int J Cancer 131:733–740

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Nicholas Galanopoulos for his help in editing the manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Germany

    Nikolaos Tselis, Georgios Chatzikonstantinou & Nikolaos Zamboglou

  2. Department of Medical Physics and Engineering, Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach am Main, Germany

    Natasa Milickovic & Dimos Baltas

  3. Institute for Radiotherapy, Hirslanden Medical Center, Rain 34, 5000, Aarau, Switzerland

    Christos Kolotas

Authors
  1. Nikolaos Tselis
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  2. Georgios Chatzikonstantinou
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  3. Christos Kolotas
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  4. Natasa Milickovic
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  5. Dimos Baltas
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  6. Nikolaos Zamboglou
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Correspondence to Nikolaos Tselis.

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Tselis, N., Chatzikonstantinou, G., Kolotas, C. et al. Computed tomography-guided interstitial high dose rate brachytherapy for centrally located liver tumours: a single institution study. Eur Radiol 23, 2264–2270 (2013). https://doi.org/10.1007/s00330-013-2816-z

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  • DOI: https://doi.org/10.1007/s00330-013-2816-z

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