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

Abstract

New interventional options especially for patients with HCC and BCLC scores B and C give rise to disputes about the optimal therapeutic management. CT-guided brachytherapy complements established interventional techniques like RFA and TACE since it may also be used successfully in tumors much greater than 5 cm in diameter. In addition, unlike thermal ablation, the brachytherapy technique may be applied in tumors located nearby risk structures such as liver hilum or gallbladder and it is independent of cooling effects such as through large blood vessels or strong tumor perfusion. Depending on tumor size, geometry and visibility, MRI or CT guidance may be used. 15 Gy minimal target dose can be applied safely in a single or – in case of very large tumors – a sequential approach targeting different tumor portions. Local recurrence rates will be very low, and the rate of complications is moderate despite the fact that most patients present with underlying cirrhosis and related comorbidities. Preliminary data suggest a positive impact on overall survival. Randomized controlled trials are on their way to assess combination schemes with systemic treatments such as sorafenib.

Hepatocellular carcinoma: computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of large (5–7 cm) and very large (>7 cm) tumours

“…Ricke and colleagues, who first studied this technique, have reported equally satisfactory results in preceding studies [10]. In a pilot study, Mohnike et al reported local tumour control (93% after 12 months) and progression-free survival (6 months in 79% of patients and 12 months in 54%) comparable to those in the present study [39,40]. In a follow-up trial including 83 patients with 140 lesions treated with CT-HDRBT and a matched-pair analysis with a historical control group, Mohnike et al demonstrated a high positive impact of CT-HDRBT on overall survival as compared with standard treatments including TACE and RFA [10].…”

Treatment of hepatic metastases with computed tomography‑guided interstitial brachytherapy

“…Brachytherapy under CT control has been described as a safe and effective method for the treatment of primary and secondary liver lesions (13,(16)(17). In the present study, brachytherapy under CT as a palliative method of treating liver metastases was demonstrated to be an effective and safe method for the patient and a technically feasible procedure.…”

Value of Brachytherapy as Part of Interdisciplinary Therapeutic Concepts for Solid Tumor Lesions – Brachytherapeutic Options and Spectrum of Treatment Results at the Center of Radiology (Department of Radiotherapy - University Hospital of Magdeburg)

“…In addition, Mohnikeet al [32] was able to demonstrate a significant improvement of survival in patients with versus cases without BT of locally advanced HCC manifestation.…”

“…In particular, for pulmonary and hepatic metastases of colorectal carcinomas and for hepatocellular carcinoma (HCC), effectiveness by radiotherapy modes has been detected with regard to local tumor control and overall tumor prognosis [31][32][33][34].…”