CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies

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.

Local Response and Impact on Survival After Local Ablation of Liver Metastases From Colorectal Carcinoma by Computed Tomography–Guided High-Dose-Rate Brachytherapy

“…This new technique, referred to as CTguided brachytherapy, merges image-guided intervention with high-dose-rate interstitial irradiation. It has been proven not to be affected by cooling effects, and it has demonstrated safety and efficacy in various locations of the body (16)(17)(18). The aim of the present study is to prove the effectiveness of CT-guided brachytherapy in providing local tumor control in surgically nonresectable colorectal liver metastases at various dose levels.…”

Computed Tomography–Guided High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma: Safety, Efficacy, and Effect on Survival

“…The therapeutic effect of this new technique is not influenced by cooling of surrounding large vessels and patient movement, and the method is not limited by tumor size or PVT. It requires facilities that are widely available, and it is comparatively inexpensive (17)(18)(19)(20)(21)(22).…”

Image-Guided Interstitial High-Dose-Rate Brachytherapy in Hepatocellular Carcinoma

“…intermittently during systemic chemotherapy, or to allow discontinuation of chemotherapy in light of side effects decreasing the patient's quality of life. Furthermore, primary or secondary lung malignancies as well as lymph node or other metastases at various locations have been assessed for safety and efficacy of this technique, with promising results [21,[26][27][28] .…”

“…The therapeutic effect of this new technique is not influenced by cooling of surrounding large vessels and patient movement, and the method is not limited by tumor size. It requires facilities that are widely available, and it is comparatively inexpensive [21][22][23][24][25][26] .…”