CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases

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Strahlenther Onkol. 2004 May;180(5):274-80.

[CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases].

[Article in German]

Source

Klinik für Strahlenheilkunde, Charité Virchow-Klinikum, Humboldt-Universität zu Berlin, Berlin, Germany. jens.ricke@charite.de

Abstract

PURPOSE:

To assess safety and efficacy of CT-guided brachytherapy of liver malignancies.

PATIENTS AND METHODS:

21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a (192)Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size > or = 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters.

RESULTS:

The mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 Gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively.

CONCLUSION:

CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization.